The Effects of Cognitive Behavioral Therapy and Bibliotherapy on Self-Esteem

Abstract

The purpose of this research paper is to examine the effects of cognitive behavioral therapy (CBT) and Bibliotherapy on low self-esteem. As a result, three articles on CBT were examined: Yeo and Choi (2011), Taylor and Montgomery (2007), and Pack and Condren (2014). All three articles showed that cognitive behavioral therapy CBT was effective when it comes to treating low self-esteem in children of all ages (i.e., children, adolescents, young adults). In regard to Bibliotherapy, the following 3 articles were reviewed: Lenkowsky et al., (1987), Karacan and Güneri (2010), and Tofaha (2012). In addition, all three articles also found that Bibliotherapy increased self-esteem in children. Therefore, the research question that will be asked, is Bibliotherapy a more effective treatment than cognitive behavioral therapy (CBT) on low self-esteem (i.e., children, adolescents, young adults)?

Keywords: self-esteem, cognitive behavioral therapy, bibliotherapy

Introduction

The purpose of the paper is to examine low self-esteem in adolescents. In addition, the research paper will determine two treatments for low self-esteem. Past studies have shown that low self-esteem can be treated by cognitive behavioral therapy, Bibliotherapy, pharmacology, art therapy, and play therapy. However, the focus of this paper will be on cognitive behavior therapy (CBT) and Bibliotherapy as the treatments for low self-esteem in adolescents. The following articles will be reviewed for CBT: Yeo and Choi (2011), Taylor and Montgomery (2007), and Pack and Condren (2014). In regards to Bibliotherapy, the following articles will be reviewed: Lenkowsky et al., (1987); Karacan and Güneri (2010), and Wagener (1976).

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During adolescence, girls are at risk for no intimacy, no support, and self-disclosure to other people because of the negative effects of self-esteem (Agam, Tamir, and Golan, 2015). Moreover, the Hispanic PR Wire (2008) examined girls between the ages of 8 and 17. It found that seventy-five percent of girls when feeling insecure, engaged in destructive behaviors. An example of girls’ destructive behaviors would include smoking, drinking, and bullying. Although boys have a higher self-esteem, they are more likely to engage in competition that encourages, conflict and power (Agam, Tamir, and Golan, 2015). Among boys in grades 6-12, the New York Times (2012) found that forty percent of them reported using protein supplements while almost six percent acknowledged to experimenting with steroids. Therefore, it is evident that gender differences exist in girls and boys since self-esteem is a result of others’ opinions and their environment. Why do adolescents experience low self-esteem?

Adolescents have low self-esteem because of interpersonal problems (Kahle Klingel, & Kulka, 1980). According to Bronfenbrenner (2017), his theory on Ecological Systems suggests the complexity of interactions of the individual in social and cultural systems. The Ecological systems theory explores how development goes through a process of progressively more complex interactions between the child and its environments (Bluteau, Clouder, & Cureton, 2017). In addition, the Ecological Systems theory includes the microsystem, mesosystem, and chronosystem; however, the microsystem will be examined. Moreover, the micro system is defined as a pattern of social interactions and interpersonal relations that a child experiences in their environment whether the child is in setting with family, friends, or an environment that promotes a healthy engagement in a progressively more complex system with their immediate environment. Therefore, the purpose of this research paper is to examine the effects of cognitive behavioral therapy (CBT) and Bibliotherapy on low self-esteem in all ages. Thus, the research question for this paper will be is (CBT) a more effective treatment than Bibliotherapy on low self-esteem (i.e., children, adolescents, young adults)? Moreover, the hypotheses are:

• Cognitive Behavioral Therapy (CBT) increases self-esteem in all ages (i.e., children, adolescents, young adults).
• Bibliotherapy increases self-esteem in all ages (i.e., children, adolescents, young adults).

According to Kahle, Kulka, and Klingel (1980) interpersonal problems is the result of low self-esteem. As a result, this can affect a child’s self-awareness and self-regulation. In addition, Leary, Schreindorfer, and Haupt (1995) as cited in Henriksen, Ranyoen, Indredavik, and Stenseng (2017) suggest people who have low self-esteem can experience eating disorders, substance abuse, and emotional problems. Moreover, having low self-esteem can be linked to psychiatric illness, depression, and anxiety (Freeman et al., 1998 as cited in Hall & Tarrier, 2003). Furthermore, Zimmerman, Copeland, Shope, and Dielman (1997) as cited in Taylor and Montgomery (2007), low self-esteem was negatively associated with causing peer pressure, low academic achievement, and alcoholic use in adolescents. Furthermore, the purpose of this research paper is to examine Therefore, this research papers will determine if CBT or Bibliotherapy is a more effective treatment for low self-esteem.

Self-Esteem

Leary and Downs (1995) define self-esteem as how a person perceives the outside world to be internally. These internal representations can affect a person physiologically, or psychologically. An example of this affecting a person physiologically and psychologically would be how a person is accepted and rejected by others. In addition, Coopersmith (1981) describes self-esteem to be driven by outside opinions. Thus, self-esteem is the valuing of others’ opinions.

Cognitive Behavioral Therapy

According to Fennell (1997), CBT aims to eliminate negative beliefs and to create a more positive outcome, which is done by changing behavior, and shifting perceptual bias through cognitive restructuring and behavioral experiments. CBT is essential for individuals with depression, anxiety, and low self-esteem (Kolubinski, Frings, Nikcevic, Lawrence, & Spada, 2018). An intervention was conducted at 3, 6, and 12 months over a 12-month period, with a series of assessments at week 12, week 26, week 52. CBT is comprised of reasoning reorganization, positive self-talk, and problem-solving skills. Furthermore, role play is an activity that supports cognitive behavioral therapy because it can improve the perspective taking (Yeo & Choi, 2011).

Bibliotherapy

In the opinion of Jacob and De Guzman (2016), Bibliotherapy is a treatment that makes use of materials, such as books, poems, and pamphlets, to assist people with mental health issues. The aim of Bibliotherapy is to train the reader how to influence negative emotions (Gualano et al., 2017). In addition, it is intended to take the place of negative thinking with deep thinking through strategies such as:

1. Connecting emotions with their actions
2. Realizing they are not alone in facing their problems
3. Realizing there are others who experience similar emotions

Bibliotherapy is of use for individuals that do not have access to other mental health services or are on waitlists (Cobham, 2012). It is a form of intervention that can consist of 12-15 sessions and address four components necessary for treatment (Zipora, 2017). The four components are:

1. Patient explores pain, sorrow, or helplessness of literary character
2. Patient compares their own emotions to a literary character
3. Patient analyzes their own behavior and discusses alternative behavior
4. Therapist and patient work on gaining control of feelings and behavior

Individuals who are dealing with anger management, anxiety, family, fear transitions, mental illness, and self-esteem, Bibliotherapy is effective in helping individuals (Heath, Sheen, Leavy, Young, & Money, 2005). The intervention included participants that were divided into four equal groups with regards to their reading level, sex, and age. Each group attended three “book report and literature” classes where they read books of interest. Furthermore, discussion was provided by some of the groups to express their feelings (Lenkowsky, Barowsky, Dayboch, Puccio, & Lenkowsky, 1987). During Bibliotherapy, individuals participate in reading books (Newton, 1969).

Results and Discussion

In this section, the author will review and discuss 3 peer reviewed journal articles for CBT and 3 peer reviewed journal articles for Bibliotherapy. The following articles on CBT will be reviewed: Yeo and Choi (2011), Taylor and Montgomery (2007), and Pack and Condren (2014). In regards to Bibliotherapy, the following articles will be reviewed: Lenkowsky et al., (1987); Karacan and Güneri (2010), and Wagener (1976).

Article 1 (Yeo and Choi, 2011)

The purpose of Yeo & Choi’s (2011) study is to improve self-esteem and determine the success of CBT introduced to children in Singapore that have behavioral difficulties. The study included 95 participants, of which 82 were boys and 13 were girls, between the ages of 8-12 years from one elementary school who have behavioral difficulties, as well as self-esteem, lack of social skills, school and home behavior. The participants were randomly selected and 49 of the 95 participants were designated to the CBT group, while the other 46 participants were assigned to a control group. There were 10 one-hour sessions, twice a week done for both groups, and were on for a period of 3 months. The study found that there was an improvement in all behavioral domains from pupils including self-esteem. Also, the participants in the CBT group exceeded at increasing self-esteem than those of the control group. Moreover, the 46 participants in the control group that did not receive CBT, did not show any improvements in their behaviors. However, self-esteem increased only because the CBT program taught classroom rules. Therefore, what CBT does is show that children with behavioral difficulties are capable of changing their behavior through self-managing techniques which affects their feelings, behavior, and thinking. Thus, allowing the participants to achieve positive self-esteem.

Article 2 (Taylor and Montgomery, 2007)

The purpose of Taylor and Montgomery’s (2007) study was to examine CBT and its effect on improving self-esteem among adolescents. The study included 82 participants from two trials, aged ranging from 13-18 years because developmentally the age range in this group develop similarly. To measure self-esteem and depression, the Rosenberg Self-Esteem Scale was used. In addition, the outcomes were divided into an immediate post-treatment, a short-term follow up, a medium-term follow up, and a long-term follow up. Moreover, the study found that CBT can be suitable for adolescents as it appears to be effective in raising self-esteem. Furthermore, adolescents suffering from low self-esteem indicates that the use of CBT is suitable, although it was not seen during the short-term and medium-term follow up after the treatment. However, the goal of the treatment is to aid the client with skills to logically challenge negative thoughts over time. Although Taylor and Montgomery (2007) noticed that the treatment was not an immediate cure in the months, it was found over time to decrease depressive symptoms and affect self-esteem in the long term. Thus, the overall findings suggest that CBT as an effective intervention in decreasing depressive symptoms while increasing self-esteem. 

Article 3 (Pack and Condren, 2014)

The purpose of Pack and Condren’s (2014) study was to examine how effective group CBT was at treating low self-esteem. The study focused on participants who were less than 18 years, of which the 50 participants, 18 were men and 32 were women. The participants attended 10 sessions each at 1.5 hours, which included a 1.5-hour follow up session that was conducted after 3 months. Depression, anxiety and self-esteem were measured before and after using Mann-Whitney U tests. Moreover, to help increase participants’ awareness and understanding of their low self-esteem they participated in group discussion and doing homework outside of group sessions. However, Pack and Condren (2014) found that increasing self-acceptance, unhelpful thoughts, and behaviors is important for CBT to be effective at improving self-esteem. The study found group CBT to be effective at improving self-esteem while lowering levels of depression and anxiety due to the maintenance cycles being disrupted and the change in their beliefs.

Article 4 (Lenkowsky, Barowsky, Dayboch, Puccio, and Lenkowsky, 1987)

The purpose of Lenkowsky, et al., (1987) study was to examine the effects of Bibliotherapy on adolescents who were disabled. These individuals were disabled emotionally because of their inability to interpret and express their emotions effectively in a classroom setting. The study included 96 disabled, emotionally handicapped participants, of which were 79 boys and 16 girls, and were between the ages of 12-14 years. In addition, the participants were divided into four equal groups with regards to their reading level, sex, and age. Each group attended three “book report and literature” classes where they read books of interest. Moreover, to express their feelings some of the groups talked it over. Students were then tested with the Piers-Harris Child self-concept scale prior to the treatment and after the treatment. As a result, the Bibliotherapy groups significantly improved their self-concept. Furthermore, Lenkowsky et al., (1987) found Bibliotherapy to be successful in a classroom setting for adolescents who were emotionally disabled. Bibliotherapy involved students reading a story and gaining a new understanding of their problem, as well as improve their self-concept. By participating in three sessions weekly that included literature similar to the needs of the students, Bibliotherapy was able to produce a change in their point of view, their behavior and how they coping skills. Thus, Bibliotherapy helped improve their self-concept.

Article 5 (Karacan and Güneri, 2010)

The purpose of Karacan and Güneri (2010) study was to examine if bibliocounseling enhanced the self-esteem of sixth-grade students. The study included 24 students, of which 13 were female and 11 were male. They were randomly selected and designated to the group in an treatment or non-treatment group. Also, the group in treatment was measured by Coopersmith Self-Esteem Inventory (CSEI), and took part in an eight-week enhancing self-esteem bibliocounseling program. The CSEI consisted of 58 items, 50 of which measured self-esteem while 8 were made for social desirability. Furthermore, Karacan and Güneri (2010) found the study to be successful at significantly increasing self-esteem for the group of treatment, while there were no changes seen with the non-treatment group due to the topics that were determined according to the esteem needs of students. The students answered questions about a problem others’ faced with similar problems. Therefore, the authors suggest the treatment to be effective since the students’ self-esteem increased due to involved issues that related with the needs of students.

Article 6 (Tofaha, 2012)

The purpose of Tofaha’s (2012) study was to examine intelligent grade school children and the effects of bibliotherapy as an intervention program. There were 67 children, of which 41 were male and 26 were female. They were then split into 2 groups with one as the group in an experiment and the other being the comparison group. Also, the 2 groups were divided by age, IQ, and self-esteem. There was a total of 8 sessions given to the group in an experiment that totaled 40 minutes, once a week on Thursday. At each session, the participants were read a story orally while they followed along with their books. After, the participants discussed the characters such as what problems arose, and the characters feelings. The researcher then asked the participants to identify their feelings and how it related to the story. Furthermore, the participants followed up with an activity that reinforced the skills from the story. Tofaha (2012) found bibliotherapy to be effective at improving self-esteem of the participants in the group in an experiment over the comparison group that did not undergo treatment. Subsequently, by promoting self-esteem throughout the literature, the participants self-esteem increased due to their issues that related with the characters. Therefore, the participants self-esteem improved, raised their awareness about themselves and their environment.

Conclusion

To reiterate, the purpose of the research paper was to examine the effects of CBT and Bibliotherapy on low self-esteem in various age groups. Each covariate analyzed 3 peer reviewed journal articles for a total of 6 peer reviewed journal articles. The research question is:

Is bibliotherapy a more effective treatment than cognitive behavioral therapy (CBT) on low self-esteem (i.e., children, adolescents, young adults)?

The following are the hypotheses statements:

Cognitive behavioral therapy (CBT) increases self-esteem in all ages (i.e., children, adolescents, young adults).

Bibliotherapy increases self-esteem in all agess (i.e., children, adolescents, young adults).

In Yeo and Choi (2011), Taylor and Montgomery (2007), and Pack and Condren (2014), the three articles found that CBT worked when it came to having sessions. Therefore, the results of the studies support the hypothesis that self-esteem increased in children. When analyzing Bibliotherapy, Lenkowsky et al., (1987), Karacan and Güneri (2010), Tofaha (2012), the results indicated that Bibliotherapy has shown to increase self-esteem, dysfunctional attitudes while reducing symptoms of anxiety (Moldovan, 2013). Consequently, the results of the studies support the hypothesis that self-esteem increased in children. However, Moldovan (2013) states when there is limited access to other psychological treatments, Bibliotherapy is the intervention of choice since it is cheap and effective. Furthermore, Bibliotherapy is considered acceptable in society and encourages people to seek help (Leong et al., 2009). Therefore, the author would recommend Bibliotherapy as the first treatment and cognitive behavioral therapy (CBT) as the second treatment.

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APPENDICES

APPENDIX A: ROSENBERG SELF-ESTEEM SCALE

APPENDIX B: SELF-ESTEEM STABILITY SCALE