Cognitive behaviour therapy for low self-esteem in a person with a learning disability: a case study

Date05 March 2018
Published date05 March 2018
AuthorLauren Evans,Kate Allez
subjectMatterHealth & social care,Learning & intellectual disabilities
Cognitive behaviour therapy for low
self-esteem in a person with a learning
disability: a case study
Lauren Evans and Kate Allez
Purpose Low self-esteemis common in people with learning disabilities. There is limitedresearch examining
the effectivenessof cognitive behaviouraltherapy (CBT) focusedon low self-esteem withinthis client group. The
purpose of this paper is to add to the limited evidence by describing the use of CBT focused on low
self-esteem for a personwith a learning disability in the context of emotion regulation difficulties.
Design/methodology/approach An individual case study design was used, with repeated quantitative
measures to monitor progress during weekly individual psychology sessions.
Findings There was a reduction in the clients feelings of anger and an increase in their self-esteem.
Research limitations/implications Further studies and follow-up would determine longevity of benefits.
The inclusion of distress tolerance techniques may have impacted on the findings and limits the conclusions
that can be drawn about the impact of CBT focused on low self-esteem.
Originality/value This case study could make a small contribution to the evidence base for the
effectiveness of CBT-based treatments for low self-esteem in people with learning disabilities, which is an
under-researched area.
Keywords Intellectual disabilities, Emotion regulation, Learning disabilities, Cognitive behavioural therapy,
Psychological therapy, Low self-esteem
Paper type Case study
Low self-esteem
Low self-esteem has been described as a negative image of the self, which tends to be global,
persistent and enduring (Fennell, 1997). Low self-esteem has been associated with many mental
health difficulties, although the nature of the relationship is unclear. Some suggest mental health
problems lower self-esteem (Ingham et al., 1987), whilst others suggest low self-esteem
predisposes to mental health difficulties (Wilhelm et al., 1999). Fennell (1997) proposed a
cognitive-behavioural (CBT) model of low self-esteem, which suggests negative life experiences
lead to the development of the bottom line, a negative self-belief reflecting a sense of worth.
Research has shown attachment to parents is directly related to self-esteem (Laible et al., 2004).
This is consistent with the assumptions of the attachment theory which suggests secure
attachments with parents are important for the development of healthy models of the self
(e.g. Allen and Land, 1999). Research has also demonstrated a link between childhood adversity
and the later development of emotionally unstable personality disorder (EUPD) (Ball and Links,
2009), where low self-esteem and negatives view of the self are core features (Lynum et al.,
2008). Such research highlights the importance of considering an individuals attachment style
and early life experiences when understanding an individuals presentation of low self-esteem.
According to the CBT model of self-esteem, specific situations can trigger this bottom line which
leads to negative automatic thoughts (NATs) about the self, behaviours and emotions, which, in
turn, confirm the bottom line. This model suggests people with low self-esteem will process
incoming information in line with their negative view of themselves, underestimating their
strengths and overemphasising their weaknesses (Fennell, 1997).
Received 12 June 2017
Revised 3 December 2017
30 January 2018
Accepted 2 February 2018
Lauren Evans is a Trainee
Clinical Psychologist at the
Department of Clinical
Psychology, University of Bath,
Bath, UK.
Kate Allez is a Clinical
Psychologist at the Learning
Disabilities Service, 2gether
NHS Foundation Trust,
Gloucester, UK.
DOI 10.1108/AMHID-06-2017-0023 VOL. 12 NO. 2 2018, pp.67-76, © Emerald Publishing Limited, ISSN 2044-1282

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