Building psychological resilience 1: How to enhance self-esteem

What is resilience?

As discussed in an earlier post, there are a number of definitions of resilience, but it’s generally used to describe an ability that some people demonstrate to withstand the negative impact of stress. These are the people who keep their cool and keep going in the face of problems. They don’t show undue distress, act out, or give up.

Is it possible to build or increase your levels of resilience?

There’s a common misperception that resilience is a rare quality, held by the special few. This is simply inaccurate. Life is full of decisions, choices and challenges, and we all need some level of resilience to get us through. However, it’s clear that some people have a higher threshold for managing stress than others. In the past it was often believed that these kinds of abilities were part of our genetic make up: either you had them or you didn’t. This view is now rapidly changing. An ever-growing body of psychological research shows that we can change the way we think and see the world, and we can build those factors that make us more resilient.

So… which factors in particular make us more resilient?

Together with my colleagues, I have undertaken a number of studies into the factors that confer resilience. This has included two large review papers. In the past, resilience research has often confused the concept of resilience with wellbeing, suggesting that people with high wellbeing must be resilient. However, it’s possible that people who are high on wellbeing are simply low on stress. To properly understand resilience, we need to go beyond this. We need to group people depending on whether they are i) under high or low stress and ii) maintaining or not maintaining their wellbeing (see Figure 1). When we do this, we can identify those people who are coping well with stress, and find out what it is about them that helps them to do this. It is this approach that my work has taken.  

building self esteem1

Our work has suggested that higher self-esteem, more flexible thinking and higher self-confidence confer resilience. These factors are often targeted by psychological therapy. In particular, techniques included as part of cognitive-behaviour therapy (CBT) aim to enhance or increase these beliefs and abilities. Interventions to enhance these abilities hasn’t just been limited to people with diagnosed mental health problems though: studies in groups of young people and workers in high-stress environments have also focused on enhancing these factors (Morton and Montgomery, 2013, Lin et al., 2004).

In this post, we’re going to look at two ways to enhance self-esteem using psychological techniques. These interventions are brief, so they can be used in workshop and training sessions, and research suggests they work. We’ll outline the background and process to these techniques before providing some evidence for their effectiveness.

  1. Self-affirmation techniques

Background

Self-affirmation theory is a social psychological theory. It views people as story tellers who have a powerful need to tell a coherent and continuous story about themselves as people who are able to control important and moral outcomes in their lives (Cohen and Sherman, 2014). In other words, self-affirmation theory suggests we have a strong need to see ourselves as being a ‘good person’. Events which threaten this story are perceived as threats which cause upset and distress. According to self-affirmation theory, these events need not be big, like a job loss or marriage breakdown. Our need to maintain a sense of ourselves as essentially ‘good’ is so strong that it means that even mundane events can be experienced as threatening.

The technique

The good news is that, according to the theory, we don’t need to see ourselves as ‘wonderful’ or ‘excellent’ to be happier: we just need to see ourselves as being adequate. However, if we are experiencing more challenging threats than usual, we can sometimes need help to restore and strengthen our story of ourselves as a being a ‘good person’. The most commonly used self-affirmation technique to achieve this is to write a list of core personal values. Once written, people choose one value that is particularly important to them (Cohen and Sherman, 2014). They then write about why the value is important to them, and describe a time when the value was important. People often write about relationships with family or friends, religion, kindness or humour. The idea behind this is that it reminds people of the fundamentals of their story and enables them to strengthen their personal narrative around this. An excerpt from Cohen and Sherman (2014) provides an example of what one college student wrote during the exercise:

“My relationship with my family is very important to me because it is my parents and brother who helped push me to be who I am today. Without them, I probably wouldn’t have the patience and motivation to have applied for this university and be successful here. Whenever I have a problem, it is my family I can go to to help me through it.”

The evidence

A large body of research suggests that self-affirmation interventions help people to deal more effectively with stressful events. People who use them demonstrate less of a physical reaction to stress (Creswell et al., 2005), are more likely to take positive action when told they have a health problem (Epton et al., 2015), and even gain higher academic grades (Cohen and Sherman, 2014). Why? Well, the theory states that performing self-affirmations helps to build a person’s self-esteem. Strengthened in their personal story, and in their sense of who they are as a good and valuable person, they are less vulnerable to events or information that could threaten this. This explanation has been supported by evidence that people high in trait self-esteem who perform self-affirmations are those who cope best with stress (Creswell et al., 2005).

  1. Tarrier’s (2001) Cognitive-behavioural technique

Background

Cognitive-behaviour therapy (CBT) suggests that poor mental wellbeing can result from negative underlying beliefs. We can have these beliefs for sometime without being fully aware of them, but when we come across a ‘trigger’ event, they can lead to vicious cycles of negative thoughts, emotions and behavours (Figure 2). For example, we may have an underlying belief that we are worthless, but for as long as we are employed, this belief is kept at bay. However, when we find ourselves made redundant from our job, this belief is activated, leading to negative thoughts such as “I knew this would happen, I could never hold onto a job” and “I’ll never get another job, no other firm would employ me”. These thoughts can lead to sad emotions and a lack of motivation, which can then contribute to decisions to become less active, to disengage from friends and to stop applying for jobs.

build self-esteem

The technique

The good news is that if negative beliefs can bring us down emotionally, then CBT suggests that more positive beliefs can boost us, and this is the principle underlying Tarrier’s (2001) self-esteem building technique. In this technique, people are asked to generate a list of positive self-qualities or statements that they think describe them. The idea is that these will be generated over 5 sessions at a rate of 2 per session (10 in total) but this number can be adapted to suit the setting and format of the intervention. For each positive quality that has been suggested, people are then asked to list as many examples of themselves demonstrating this quality as they can think of. As far as is possible, these examples should be based in their own personal memories, and should be described in a good level of detail. Next, participants are asked to mentally rehearse the examples they have described in order to strengthen their access to these memories. Before and after this exercise participants are asked to rate their level of belief in the self-qualities that they have described (on a scale from 0-100). The idea of this is to demonstrate the importance of where our attention lies. In other words, this is done to show that when we think about good things about ourselves, we will believe it more strongly and feel better (Hall and Tarrier, 2003).

The evidence

This technique has now been explored in i) a case study with an older adult suffering from low mood and depression (Chatterton et al., 2007), ii)  a randomised-controlled trial with working age adults with mental health problems, (Hall and Tarrier, 2003) and iii) a group of working age adults with substance misuse problems (Oestrich et al., 2007). In each case, it has been found to be an effective intervention for boosting self-esteem.

Summary

Self-esteem is an important resilience factor, which can help us to maintain positive wellbeing when we are under pressure or stress. Two ways to boost our self-esteem are to remind ourselves of the values that we hold important, and the things about ourselves that are good. There are specific ways of doing this, and research suggests that when undertaken, doing this can help us to maintain a strong sense of self and to build our self-esteem.

Find out more about building resilience in my blog on how to reduce perfectionism.

 

CHATTERTON, L., HALL, P. L. & TARRIER, N. 2007. Cognitive Therapy for Low Self-Esteem in the Treatment of Depression in an Older Adult. Behavioural and Cognitive Psychotherapy, 35, 365-369.

COHEN, G. L. & SHERMAN, D. K. 2014. The psychology of change: Self-affirmation and social psychological intervention. Annual Review of Psychology, 65, 333-371.

CRESWELL, J. D., WELCH, W. T., TAYLOR, S. E., SHERMAN, D. K., GRUENEWALD, T. L. & MANN, T. 2005. Affirmation of personal values buffers neuroendocrine and psychological stress responses. Psychological Science, 16, 846-851.

EPTON, T., HARRIS, P. R., KANE, R., VAN KONINGSBRUGGEN, G. M. & SHEERAN, P. 2015. The impact of self-affirmation on health-behavior change: A meta-analysis. Health Psychology, 34, 187.

HALL, P. L. & TARRIER, N. 2003. The cognitive-behavioural treatment of low self-esteem in psychotic patients: a pilot study. Behaviour research and therapy, 41, 317-332.

LIN, Y.-R., SHIAH, I.-S., CHANG, Y.-C., LAI, T.-J., WANG, K.-Y. & CHOU, K.-R. 2004. Evaluation of an assertiveness training program on nursing and medical students’ assertiveness, self-esteem, and interpersonal communication satisfaction. Nurse education today, 24, 656-665.

MORTON, M. H. & MONTGOMERY, P. 2013. Youth empowerment programs for improving adolescents’ self-efficacy and self-esteem a systematic review. Research on Social Work Practice, 23, 22-33.

OESTRICH, I. H., AUSTIN, S. F., LYKKE, J. & TARRIER, N. 2007. The Feasibility of a Cognitive Behavioural Intervention for Low Self-Esteem within a Dual Diagnosis Inpatient Population. Behavioural and Cognitive Psychotherapy, 35, 403-408.

TARRIER, N. 2001. The use of coping strategies and self-regulation in the treatment of psychosis. In: MORRISON, A. P. (ed.) Casebook of cognitive therapy for psychosis. London: Routledge.

What is psychological resilience?

What do we mean when we use the word ‘resilience’?

It’s widely accepted that when we talk about ‘resilience’ or ‘psychological resilience’, we are referring to an ability that some people show to withstand or quickly ‘bounce back’ from stress.

What can research tell us about resilience?

Researchers have been investigating psychological resilience for around 50 years. However, there have been a number of limitations with this research. For example, although we usually talk about psychological resilience as an ability to withstand stress, most researchers have not actually investigated their proposed resilience factors in relation to stress. Instead, they have simply measured their factor directly in relation to an outcome they’re interested in. For example, they have measured perceptions of social support in relation to wellbeing. They have found that high social support is linked with higher wellbeing, like this:

drawing[2]

However, if you think about it, the opposite of perceived social support is loneliness. And in fact, a number of researchers have previously shown us that feelings of loneliness are linked with indicators of poorer wellbeing, like this:

what is resilience 2

As you can see, this kind of ‘resilience’ research is not really telling us anything more than we used to learn from studies of risk factors!

So can resilience research tell us anything new?

Yes. However, we have to research it in the same way that we talk about: we need to study which variables reduce the likelihood that exposure to stressors will lead to negative outcomes. If we draw this out, it would look like this:

what is psychological resilience 3

If we research psychological resilience in this way, it becomes less important whether we use the term ‘high social support’ or ‘loneliness’: what is important is that our social relationships can influence how we will deal with stress. We can say that better social relationships can buffer or attenuate the likelihood that stress will lead to poor wellbeing, or that poorer social relationships harm our capacity for psychological resilience and will make us more vulnerable to poor wellbeing in response to stress.

To provide researchers with a guide for doing this kind of research, and to clarify the criteria that a variable should meet in order to be considered as conferring resilience, I have gathered these ideas together in a framework called ‘The Bi-Dimensional Framework’ (BDF) for resilience research (Johnson, 2016, Johnson et al., 2010a, Johnson et al., 2010b).

What advantages does the BDF offer resilience researchers?

  1. It overcomes the confusion caused by the range of terms that have been used to describe ‘resilience’

There have been a lot of words used in the research literature to describe psychological resilience, these include ‘mental toughness’, and ‘hardiness’, amongst others. This can be confusing. However, the BDF defines psychological resilience according to methodological criteria (i.e., what a variables does, or how it behaves), rather than terminology. It suggests that resilience factors are psychological variables which buffer the association between stress exposure (or exposure to risk factors) and the likelihood of negative outcomes. In particular, the BDF states that for low resilience individuals, there should be a clear increase in negative outcomes in relation to the amount of stress they experience. However, for high resilience individuals, there should be minimal increase in negative outcomes, no matter how much stress they experience. If we were to draw this relationship out, it would look like this:

psychological resilience

  1. It means we can use research to develop increasingly accurate concepts of resilience

In the past it has been common practice to propose a concept of psychological resilience, create a questionnaire to measure this, and then test it in relation to negative outcomes. If it is linked with lower levels of negative outcomes, the researchers conclude that the variable confers resilience. If it doesn’t, the researchers conclude that resilience doesn’t confer resilience in this instance. As outlined above, this doesn’t tell us whether the variable does indeed buffer the impact of stress. However, even more confusingly, how can a ‘resilience’ factor not confer resilience?! If this concept doesn’t confer resilience, then by the very definition of psychological resilience we must conclude that it is not in fact resilience at all. Instead, we could surmise that there are other factors which confer psychological resilience, which are not related to this concept.

This points to a need for concepts of psychological resilience which can be developed and adapted in response to research. As a framework for resilience research, the BDF allows for this kind of growth and development. In particular, it enables the systematic review of individual studies which have investigated factors which buffer the relationship between stress exposure and negative outcomes.

What do these reviews tell us?

Together with my collaborators, I have conducted two systematic reviews of resilience factors using the BDF approach, both of which have been published in a leading psychology journal (Johnson et al., 2016, Johnson et al., 2011). The first of these investigated psychological variables which buffer the relationship between exposure to any risk factor and suicidal thoughts. This suggested that hope, flexible thinking, self-confidence and a good way of looking at events conferred psychological resilience (Johnson et al., 2011). The second investigated psychological variables which buffer the relationship between exposure to failure experiences and psychological distress. This found that mental flexibility, higher self-esteem and a positive way of explaining events confer resilience to distress in response to failure (Johnson et al., 2016).

Together, these reviews suggest that even if you look at different kinds of negative outcomes, similar variables seem to confer psychological resilience. These variables relate to mental flexibility, self confidence and self-esteem, and a positive way of explaining events.

Can we train people to be more resilient?

Yes. The factors identified by these reviews (mental flexibility, self-esteem and self confidence and explanatory style) are those which are commonly targeted in cognitive-behaviour therapy, which is an evidence-based form of psychological therapy. CBT was initially developed as an intervention for people with mental health problems, but has since been found to be effective for improving mental wellbeing in a range of populations. With a collaborator in Australia, Dr Reema Harrison, I have been developing an intervention plan for training medical students in resilience which draws on CBT. This intervention is designed to train participants in resilience through three 60-minute workshops based on the principles of cognitive-behaviour therapy. These workshops will involve psychoeducation, experiential exercises and group work. We will be piloting this in Sydney in January 2017, and plan to then test this in subsequent research studies in different populations.

For more information on how to build psychological resilience, please see my blogs on enhancing self-esteem and reducing perfectionism.

References

JOHNSON, J. 2016. Resilience: The Bi-dimensional Framework. . In: WOOD, A. M. & JOHNSON, J. (eds.) Positive Clinical Psychology. Chichester: Wiley.

JOHNSON, J., GOODING, P. A., WOOD, A. M. & TARRIER, N. 2010a. Resilience as positive coping appraisals: Testing the schematic appraisals model of suicide (SAMS). Behaviour Research and Therapy, 48, 179-186.

JOHNSON, J., GOODING, P. A., WOOD, A. M., TAYLOR, P. J., PRATT, D. & TARRIER, N. 2010b. Resilience to suicidal ideation in psychosis: Positive self-appraisals buffer the impact of hopelessness. Behaviour Research and Therapy, 48, 883-889.

JOHNSON, J., PANAGIOTI, M., RAMSEY, L., BASS, J. & HARRISON, R. 2016. Resilience to emotional dysfunction in response to failure or error: A systematic review. Clinical Psychology Review, In press.

JOHNSON, J., WOOD, A. M., GOODING, P., TAYLOR, P. J. & TARRIER, N. 2011. Resilience to suicidality: The buffering hypothesis. Clinical Psychology Review, 31, 563-591.

Originally published 23rd Nov 2016 at https://www.psychreg.org/building-psychological-resilience/