Patient Expectations in Internet-Based Self-Help for Social Anxiety

A number of controlled trials have demonstrated the efficacy of Internet-based cognitive-behaviour therapy for treating social anxiety disorder (SAD). However, little is known about what makes those interventions work. The current trial focuses on patient expectations as one common mechanism of change. The study examines whether patients' expectancy predicts outcome, adherence, and dropout in an unguided Internet-based self-help programme for SAD. Data of 109 participants in a 10-week self-help programme for SAD were analysed. Social anxiety measures were administered prior to the intervention, at week 2, and after the intervention. Expectancy was assessed at week 2. Patient expectations were a significant predictor of change in social anxiety (β = - .35 to - .40, all p < .003). Patient expectations also predicted treatment adherence (β = .27, p = .02). Patients with higher expectations showed more adherence and better outcome. Dropout was not predicted by expectations. The effect of positive expectations on outcome was mediated by early symptom change (from week 0 to week 2). Results suggest that positive outcome expectations have a beneficial effect on outcome in Internet-based self-help for SAD. Furthermore, patient expectations as early process predictors could be used to inform therapeutic decisions such as stepping up patients to guided or face-to-face treatment options

Is low self-esteem a risk factor for depression? Findings from a longitudinal study of Mexican-origin youth

We examined the relation between low self-esteem and depression using longitudinal data from a sample of 674 Mexican-origin early adolescents who were assessed at age 10 and 12 years. Results supported the vulnerability model, which states that low self-esteem is a prospective risk factor for depression. Moreover, results suggested that the vulnerability effect of low self-esteem is driven, for the most part, by general evaluations of worth (i.e., global self-esteem), rather than by domain-specific evaluations of academic competence, physical appearance, and competence in peer relationships. The only domain-specific self-evaluation that showed a prospective effect on depression was honesty-trustworthiness. The vulnerability effect of low self-esteem held for male and female adolescents, for adolescents born in the United States versus Mexico, and across different levels of pubertal status. Finally, the vulnerability effect held when we controlled for several theoretically relevant 3rd variables (i.e., social support, maternal depression, stressful events, and relational victimization) and for interactive effects between self-esteem and the 3rd variables. The present study contributes to an emerging understanding of the link between self-esteem and depression and provides much needed data on the antecedents of depression in ethnic minority populations

High self-esteem prospectively predicts better work conditions and outcomes

We examined the reciprocal prospective relations between self-esteem and work conditions and outcomes, including justice at work, support at work, work stressors, job satisfaction, job success, and counterproductive work behavior. Data came from two independent longitudinal studies, including five assessments over an 8-month period (N = 663, age 16–62 years) and three assessments over a 2-year period (N = 600, age 22–51 years), respectively. Across both studies, high self-esteem prospectively predicted better work conditions and outcomes, whereas nearly all of the reverse effects (i.e., work conditions and outcomes predicting self-esteem) were nonsignificant. The results held for both male and female participants. If future research supports the causality of the self-esteem effects, interventions aimed at improving self-esteem might be useful in increasing an individual’s well-being and success at work, which consequently might be beneficial for employers.

Understanding the link between low self-esteem and depression

Although it is well documented that low self-esteem and depression are related, the precise nature of the relation has been a topic of ongoing debate. We describe several theoretical models concerning the link between self-esteem and depression, and review recent research evaluating the validity of these competing models. Overall, the available evidence provides strong support for the vulnerability model (low self-esteem contributes to depression), weaker support for the scar model (depression erodes self-esteem), and little support for alternative accounts such as the diathesis-stress model. Moreover, the vulnerability model is robust and holds across gender, age, affective-cognitive versus somatic symptoms of depression, European background versus Mexican-origin participants, and clinical versus nonclinical samples. Research on further specifications of the vulnerability model suggests that the effect is (a) partially mediated by rumination, (b) not influenced by other characteristics of self-esteem (i.e., stability and contingency), and (c) driven predominantly by global rather than domain-specific self-esteem. The research has important theoretical implications because it counters the commonly repeated claim that self-esteem has no long-term impact. Moreover, the research has important practical implications, suggesting that depression can be prevented, or reduced, by interventions that improve self-esteem.

Does low self-esteem predict depression and anxiety? A meta-analysis of longitudinal studies

Low self-esteem and depression are strongly related, but there is not yet consistent evidence on the nature of the relation. Whereas the vulnerability model states that low self-esteem contributes to depression, the scar model states that depression erodes self-esteem. Furthermore, it is unknown whether the models are specific for depression or whether they are also valid for anxiety. We evaluated the vulnerability and scar models of low self-esteem and depression, and low self-esteem and anxiety, by meta-analyzing the available longitudinal data (covering 77 studies on depression and 18 studies on anxiety). The mean age of the samples ranged from childhood to old age. In the analyses, we used a random-effects model and examined prospective effects between the variables, controlling for prior levels of the predicted variables. For depression, the findings supported the vulnerability model: The effect of self-esteem on depression (β = -.16) was significantly stronger than the effect of depression on self-esteem (β = -.08). In contrast, the effects between low self-esteem and anxiety were relatively balanced: Self-esteem predicted anxiety with β = -.10, and anxiety predicted self-esteem with β = -.08. Moderator analyses were conducted for the effect of low self-esteem on depression; these suggested that the effect is not significantly influenced by gender, age, measures of self-esteem and depression, or time lag between assessments. If future research supports the hypothesized causality of the vulnerability effect of low self-esteem on depression, interventions aimed at increasing self-esteem might be useful in reducing the risk of depression.

Gender differences in the association of a high quality job and self-esteem over time: A multiwave study

High self-esteem often predicts job-related outcomes, such as high job satisfaction or high status. Theoretically, high quality jobs (HQJs) should be important for self-esteem, as they enable people to use a variety of skills and attribute accomplishments to themselves, but research findings are mixed. We expected reciprocal relationships between self-esteem and HQJ. However, as work often is more important for the status of men, we expected HQJ to have a stronger influence on self-esteem for men as compared to women. Conversely, task-related achievements violate gender stereotypes for women, who may need high self-esteem to obtain HQJs. In a 4-year cross-lagged panel analysis with 325 young workers, self-esteem predicted HQJ; the lagged effect from HQJ on self-esteem was marginally significant. In line with the hypotheses, the multigroup model showed a significant path only from self-esteem to HQJ for women, and from HQJ to self-esteem for men. The reverse effect was not found for women, and only marginally significant for men. Overall, although there were some indications for reciprocal effects, our findings suggest that women need high self-esteem to obtain HQJs to a greater degree than men, and that men base their self-esteem on HQJs to a greater extent than women.

Does a Pre-Treatment Diagnostic Interview Affect the Outcome of Internet-Based Self-Help for Social Anxiety Disorder? A Randomized Controlled Trial

BACKGROUND: Numerous studies suggest that Internet-based self-help treatments are effective in treating anxiety disorders. Trials evaluating such interventions differ in their screening procedures and in the amount of clinician contact in the diagnostic assessment phase. The present study evaluates the impact of a pre-treatment diagnostic interview on the outcome of an Internet-based treatment for Social Anxiety Disorder (SAD). METHOD: One hundred and nine participants seeking treatment for SAD were randomized to either an interview-group (IG, N = 53) or to a non-interview group (NIG, N = 56). All participants took part in the same 10-week cognitive-behavioural unguided self-help programme. Before receiving access to the programme, participants of the IG underwent a structured diagnostic interview. Participants of the NIG started directly with the programme. RESULTS: Participants in both groups showed significant and substantial improvement on social anxiety measures from pre- to post-assessment (d IG = 1.30-1.63; d NIG = 1.00-1.28) and from pre- to 4-month follow-up assessment (d IG = 1.38-1.87; d NIG = 1.10-1.21). Significant between-groups effects in favour of the IG were found on secondary outcome measures of depression and general distress (d = 0.18-0.42). CONCLUSIONS: These findings suggest that Internet-based self-help is effective in treating SAD, whether or not a diagnostic interview is involved. However, the pre-treatment interview seems to facilitate change on secondary outcomes such as depression and general distress.

Self-esteem, coping styles, and quality of life in polish adolescents and young adults with unilateral cleft lip and palate.

Objectives : To evaluate self-esteem, coping styles, and health-related quality of life and their relationships in Polish adolescents and young adults with unilateral complete cleft lip and palate and related sex differences. Design and Participants : Self-report questionnaires measuring self-esteem (Multidimensional Self-Esteem Inventory), coping styles (Coping Inventory for Stressful Situations), and health-related quality of life (WHOQOL-BREF) were completed by 48 participants with cleft lip and palate (age, 16 to 23 years; 31 males, 17 females) and 48 controls without cleft lip and palate (age, 16 to 23 years; 28 males, 20 females) matched for age, place of residence, and socioeconomic status. Results : Regarding self-esteem, individuals with cleft lip and palate scored higher on body functioning (P < .01) and defensive self-enhancement (P < .05). Self-control showed an interaction effect: Females with cleft lip and palate scored higher than controls, but males did not differ between groups (P < .05). Males with cleft lip and palate scored lower than controls in personal power but higher in body functioning (P < .05); females showed no differences between groups. The groups did not differ with regard to coping styles or quality of life, but several correlations were found between self-esteem and coping styles, and quality of life (P < .01). Conclusions : Late adolescents and young adults with and without cleft lip and palate differed little in terms of psychological adjustment measures. The higher scores in defensive self-enhancement of individuals with cleft lip and palate suggest the need for instruments measuring social approval in psychosocial adjustment research involving this group.

Development of self-esteem and relationship satisfaction in couples: Two longitudinal studies

We examined the effects of self-esteem development on the development of relationship satisfaction in 2 samples of couples. Study 1 used data from both partners of 885 couples assessed 5 times over 12 years, and Study 2 used data from both partners of 6,116 couples assessed 3 times over 15 years. The pattern of results was similar across the 2 studies. First, development of relationship satisfaction could be modeled as a couple-level process. Second, initial level of self-esteem of each partner predicted the initial level of the partners’ common relationship satisfaction, and change in self-esteem of each partner predicted change in the partners’ common relationship satisfaction. Third, these effects did not differ by gender and held when controlling for participants’ age, length of relationship, health, and employment status. Fourth, self-esteem similarity among partners did not influence the development of their relationship satisfaction. The findings suggest that the development of self-esteem in both partners of a couple contributes in a meaningful way to the development of the partners’ common satisfaction with their relationship.

The development of self-esteem

In this article, we review new insights gained from recent longitudinal studies examining the development of self-esteem and its influence on important life outcomes. The evidence supports the following three conclusions. First, self-esteem increases from adolescence to middle adulthood, peaks at about age 50 to 60 years, and then decreases at an accelerating pace into old age; moreover, there are no cohort differences in the self-esteem trajectory from adolescence to old age. Second, self-esteem is a relatively stable, but by no means immutable, trait; individuals with relatively high (or low) self-esteem at one stage of life are likely to have relatively high (or low) self-esteem decades later. Third, high self-esteem prospectively predicts success and well-being in life domains such as relationships, work, and health. Given the increasing evidence that self-esteem has important real-world consequences, the topic of self-esteem development is of considerable societal significance.

Self-esteem development across the life span: A longitudinal study with a large sample from Germany

The authors examined the development of self-esteem across the life span. Data came from a German longitudinal study with 3 assessments across 4 years of a sample of 2,509 individuals ages 14 to 89 years. The self-esteem measure used showed strong measurement invariance across assessments and birth cohorts. Latent growth curve analyses indicated that self-esteem follows a quadratic trajectory across the life span, increasing during adolescence, young adulthood, and middle adulthood, reaching a peak at age 60 years, and then declining in old age. No cohort effects on average levels of self-esteem or on the shape of the trajectory were found. Moreover, the trajectory did not differ across gender, level of education, or for individuals who had lived continuously in West versus East Germany (i.e., the 2 parts of Germany that had been separate states from 1949 to 1990). However, the results suggested that employment status, household income, and satisfaction in the domains of work, relationships, and health contribute to a more positive life span trajectory of self-esteem. The findings have significant implications, because they call attention to developmental stages in which individuals may be vulnerable because of low self-esteem (such as adolescence and old age) and to factors that predict successful versus problematic developmental trajectories.

Rumination mediates the prospective effect of low self-esteem on depression: A five-wave longitudinal study

Previous research supports the vulnerability model of low self-esteem and depression, which states that low self-esteem operates as a prospective risk factor for depression. However, it is unclear which processes mediate the effect of low self-esteem. To test for the mediating effect of rumination, the authors used longitudinal mediation models, which included exclusively prospective effects and controlled for autoregressive effects of the constructs. Data came from 663 individuals (aged 16 to 62 years), who were assessed 5 times over an 8-month period. The results indicated that low self-esteem predicted subsequent rumination, which in turn predicted subsequent depression, and that rumination partially mediated the prospective effect of low self-esteem on depression. These findings held for both men and women, and for both affective-cognitive and somatic symptoms of depression. Future studies should test for the mediating effects of additional intrapersonal and interpersonal processes.