A Cognitive-Behavioral Approach to the Enhancement of Self-Esteem in a Patient Suffering Chronic Bipolar Disorder

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.