This report describes a novel cognitive-behavioral intervention aimed to increase self-esteem, in a lady with a diagnosis of bipolar illness. It is argued that self-esteem is important to the development, maintenance, and relapse of the illness symptoms, being both a vulnerability factor to, and a consequence of, illness episodes. The intervention involves modification of the strength of positive beliefs about the self through the focus of attention on specific behavioral examples of the patient’s positive attributes. The intervention is described in detail and results over the longer term are reported. There were significant improvements on measures of self-esteem, which was in the normal range at posttreatment and follow-up. General psychotic psychopathology improved by 20% and there was an improvement in social functioning over one standard deviation. Results at 3- and 12-month follow-ups indicate that improvements were largely maintained although there was some reduction in the magnitude of improvement.
American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.
2.
Beck, A. T., Rush, A. J., Shaw, B. F., & Emery, G. (1979). Cognitive therapy of depression. New York: Guilford.
3.
Birchwood, M., Smith, J., Cochrane, R., Wetton, S., & Copestake, S. (1990). The Social Functioning Scale: The development and validation of a new scale of social adjustment for use in family intervention programmes with schizophrenic patients. British Journal of Psychiatry, 157, 853-859.
4.
Bradshaw, W., & Brekke, J. S. (1999). Subjective experience in schizophrenia: Factors influencing self-esteem, satisfaction with life and subjective distress. American Journal of Orthopsychiatry, 69(2), 254-260.
5.
Brown, G. W., Andrews, R., Harris, T. O., Adler, Z., & Bridge, L. (1986). Social support self-esteem and depression. Psychological Medicine, 16, 813-831.
6.
Cochran, S. D. (1984). Preventing medical noncompliance in the outpatient treatment of bipolar affective disorders. Journal of Consulting and Clinical Psychology, 52, 873-878.
7.
Coryell, W., Endicott, J., Maser, J. D., Mueller, T., Lavori, P., & Keller, M. (1995). The likelihood of recurrence in bipolar affective disorder: The importance of episode recency. Journal of Affective Discord, 33, 201-206.
8.
Coryell, W., Scheftner, W., Keller, M., Endicott, J., & Klerman, G. L. (1993). The enduring psychosocial consequences of pain and depression. American Journal of Psychiatry, 150, 720-727.
9.
Fennel, M. J. V. (1997). Low self-esteem: A cognitive perspective. Behavioral and Cognitive Psychotherapy, 25, 1-25.
10.
Fennel, M. J. V. (1998). Low self-esteem. In N. Tarrier, A. Wells, & G. Haddock (Eds.), Treating complex cases: The cognitive therapy approach (pp. 217-240). Chichester, UK: Wiley.
11.
Fennel, M. J. V. (2000). Overcoming low self-esteem: A self help guide using cognitive behavioral techniques. London: Constable and Robinson Ltd.
12.
Freeman, D., Garety, P., Fowler, D., Kuipers, E., Dunn, G., Bebbington, P., et al. (1998). The London-East Anglia randomised controlled trial of cognitive behavior therapy for psychosis IV: Self-esteem and persecutory delusions. British Journal of Clinical Psychology, 37(4), 415-430.
13.
Gitlin, M. J., Swendsen, J., Heller, T. L., & Hammen, C. (1995). Relapse and impairment in bipolar disorder. American Journal of Psychiatry, 152, 1636-1640.
14.
Goodwin, F. K., & Jamison, K. R. (1990). Manic depressive illness. New York: Oxford University Press.
15.
Hall, P. L., & Tarrier, N. (2003). The cognitive-behavioral treatment to improve low self-esteem in psychotic patients: A pilot study. Behavior Research and Therapy, 41, 317-332.
16.
Harrow, M., Goldberg, J. F., Grossman, L. F., & Meltzer, H. Y. (1990). Outcome in manic disorders: A naturalistic follow-up study. Archives of General Psychiatry, 47, 665-671.
17.
Jamison, K. R., & Akishal, H. S. (1983). Medication compliance in patients with bipolar disorder. Psychiatric Clinics of North America, 6, 175-192.
18.
Kay, S., Fiszbein, A., & Opler, L. (1987). The Positive and Negative Syndrome Scale (PANSS) for schizophrenia. Schizophrenia Bulletin, 13, 261-275.
19.
Kuipers, E., Garety, P., Fowler, D., Dunn, G., Bebbington, P., Freeman, D., et al. (1997). The London-East Anglia randomised controlled trial of cognitive behavior therapy for psychosis: 1. Effects of the treatment phase. British Journal of Psychiatry, 171, 319-327.
20.
Lecomte, T., Cyr, M., Lesage, A. D., Wilde, J., Leclerc, C., & Richard, N. (1999). Efficacy of a self-esteem module in the empowerment of individuals with schizophrenia. Journal of Nervous and Mental Disease, 187(7), 406-413.
21.
McCarthy, E., Tarrier, N., & Gregg, L. (2002). The nature and timing of seasonal affective symptoms and the influence of self-esteem and social support: A longitudinal prospective study. Psychological Medicine, 32, 1425-1434.
22.
McKay, M., & Fanning, P. (1992). Self-esteem (2nd ed.). Oakland, Canada: New Harbinger.
23.
Miklowitz, D. J., & Goldstein, M. J. (1997). A family focused treatment approach. New York: Guilford.
24.
Mruk, C. (1995). Self-esteem: Research theory and practice. New York: Springer.
25.
Parikh, S. V., Kusumakar, V., Haslam, D. R. S., Matte, R., Sharma, V., & Yatham, L. N. (1997). Psychosocial interventions as an adjunct to pharmacotherapy in bipolar disorder. Canadian Journal of Psychiatry, 42(Suppl. 2), 74S-78S.
26.
Reasoner, R. W. (1992). Building self-esteem. Cited from Lecomte et al. (1999).
27.
Reinares, M., Colom, F., Martinez-Aran, A., & Vieta, E. (2002). Therapeutic interventions focused on the family of bipolar patients. Psychotherapy and Psychosomatics, 7, 2-10.
28.
Robson, P. (1989). Development of a new self report questionnaire to measure self-esteem. Psychological Medicine, 19, 513-518.
29.
Rosenberg, M. (1965). Society and the adolescent self image. Princeton, NJ: Princeton University Press.
30.
Silverstone, P. H. (1991). Low self-esteem in different psychiatric conditions. British Journal of Clinical Psychology, 30, 185-188.
31.
Silverstone, T., & Romans-Clarkson, S. (1989). Bipolar affective disorder: Causes and prevention of relapses. British Journal of Psychiatry, 154, 321-325.
32.
Tarrier, N. (2001). The use of coping strategies and self-regulation in the treatment of psychosis. In A. Morrison (Ed.), A casebook of cognitive therapy for psychosis (pp. 79-107). Cambridge, UK: Cambridge University Press.
33.
Tarrier, N., & Calam, R. (2002). New developments in cognitive-behavioral case formulation. Epidemiological, systemic and social context: An integrative approach. Cognitive and Behavioral Psychotherapy, 30, 335-352.
34.
Tarrier, N., & Haddock, G. (2002). Cognitive behavioral therapy of schizophrenia. In S. G. Hofmann & M. C. Thompson (Eds.), Handbook of psychological treatment for severe mental disorders (pp. 69-95). New York: Guilford.
35.
Tarrier, N., Wells, A., & Haddock, G. (Eds.). (1998). Cognitive behavior therapy for complex cases: An advanced guidebook for the practitioner. Chichester, UK: Wiley.
36.
Tarrier, N., & Wykes, T. (2004). Cognitive-behavioral treatments of psychosis: Clinical trials and methodological issues in clinical psychology. In S. Day, S. Green, & D. Machin (Eds.), Textbook of clinical trials (pp. 273-296). Chichester, UK: Wiley.
37.
Zigmond, S., & Snaith, R. P. (1983). The Hospital Anxiety and Depression Scale. Acta Psychiatrica Scandinavia, 67, 361-370.
