Low self-esteem is one of the most common areas of psychological difficulty. It permeates many psychological problems – from depression and anxiety disorders to eating disorders to relationship difficulties and chronic burnout. While we have had effective cognitive-behavioral models for years, modern research has significantly deepened our understanding of what low self-esteem really is and why does it persist?
In this article, I present a modern, research-based take on CBT that combines Melanie Fennell’s classic model with an enhanced version proposed by Katharine A. Rimes, Patrick Smith and Livia Bridge.
Symptoms of low self-esteem
Symptoms of low self-esteem are rarely limited to one area of functioning. According to the cognitive-behavioral view, they include interrelated cognitive, emotional and behavioral reactions that activate especially in situations involving judgment, comparison or risk of impairment in the eyes of others.
It is worth noting that many of these symptoms do not look like “lack of self-confidence.” They are often strategies that mask the problem well, socially rewarded or interpreted as personality traits.
Cognitive symptoms
At the cognitive level, low self-esteem is associated with entrenched negative beliefs about the self and a specific style of interpreting experiences.
The most common symptoms include:
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a tendency toward excessive self-criticism and harsh judgments of one’s own actions,
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interpreting mistakes and stumbles as evidence of personal inadequacy,
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selective focus on failures while overlooking successes,
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the belief that self-worth is conditional and easy to lose,
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constantly comparing oneself with others to the detriment of oneself.
According to Fennell’s model, these beliefs can remain relatively inactive until they are triggered by situations that violate conditional assumptions about self-worth.
Emotional symptoms
On an emotional level, low self-esteem is not limited to lowered mood. Often secondary emotions dominate, which themselves become a source of suffering.
Most commonly observed:
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shame and a sense of being “inferior” or “out of place.”
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fear of being judged, criticized or rejected,
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the tension of having to “maintain standards.”
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frustration and powerlessness in the face of one’s own reactions,
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feelings of guilt that arise even in neutral situations.
Behavioral symptoms (often confused with “character traits”)
The most prominent, yet most often unnoticed, are behavioral symptoms. Many of them function as compensatory or protective behaviors to protect against declining self-esteem.
Typical ones include:
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perfectionism and over-preparation,
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assuming over-responsibility,
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difficulty resting and delegating tasks,
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people-pleasing and conflict avoidance,
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withdrawing from situations that require exposure,
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excessive monitoring of others’ reactions,
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seeking reassurance or, conversely, avoiding feedback.
Symptoms in relationships and daily functioning
From the perspective of both CBT models, symptoms occurring in interpersonal relationships are particularly relevant:
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difficulty expressing needs and boundaries,
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hypersensitivity to signals of distance or criticism,
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fear of being “exposed.”
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giving up one’s own goals to maintain acceptance,
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feeling that relationships require constant “deserving.”
As a result, low self-esteem begins to organize the way we function, affecting career decisions, relationships, health and quality of life.
Melanie Fennell’s classic CBT model of low self-esteem
The cognitive-behavioral model of low self-esteem was first systematically described by Melanie Fennell in 1997. This model, which is firmly rooted in the cognitive tradition of Aaron T. Beck, has formed the basis of clinical work with people experiencing chronically lowered self-esteem for more than two decades.
In Fennell’s model, low self-esteem is relatively persistent and is activated particularly in situations that violate conditional assumptions about one’s self-worth, such as failure, criticism or failure to meet high standards. Repeated activation of negative core beliefs leads to increased self-criticism and lowered mood, which promotes the perpetuation of the vicious cycle of low self-esteem.
In Fennell’s view, key beliefs play a key role:
- negative core beliefs about the self,
- conditional assumptions and rules of life,
- activating situations,
- self-critical thoughts and lowered mood,
- avoidance and compensatory behaviors that create a vicious cycle of the problem, related to self-esteem.
This model has demonstrated clinical efficacy, but as research has developed, it has begun to be noticed that it does not fully capture the social and relational context of self-esteem.
A new CBT model of low self-esteem – Rimes, Smith and Bridge (2023)
In response to these limitations, Katharine A. Rimes, Patrick Smith and Livia Bridge proposed an improved cognitive-behavioral model of low self-esteem, published in 2023 in Behavioural and Cognitive Psychotherapy.
The new approach does not replace Fennell’s model, but develops it by integrating knowledge from social psychology, stigma and exclusion research and clinical observations.
Low self-esteem as a perceived value in the eyes of others
Contemporary cognitive-behavioral approaches are increasingly moving away from understanding self-esteem solely as what we think about ourselves. Instead, it is paying attention to what value we think we have in the eyes of other people.
According to this perspective, self-esteem acts like an internal monitoring system: it continuously “checks” whether we are accepted, liked and valued enough in relationships. When there are danger signals – criticism, distance, lack of response or ambiguous behavior from others – this system responds with a drop in self-esteem. In people with low self-esteem, this mechanism is overly sensitive. Even neutral or casual signals can be interpreted as a sign of rejection, disrespect or loss of meaning. The result is constant tension and vigilance: analyzing the behavior of others, comparing oneself, looking for confirmations of one’s own inadequacy.
From this perspective, the problem is not just a negative self-image, but a constant life in a mode of checking whether I still “deserve” a place in the relationship. It is this process that leads to behaviors that are meant to protect an individual’s self-worth – such as perfectionism, over-adjustment, conflict avoidance or withdrawal – and that sustain low self-esteem in the long term.
The model also takes into account biopsychosocial factors, that is, biological, psychological and social processes are interrelated through feedback loops, resulting in mutual influences.
Two domains of self-esteem
The Rimes, Smith and Bridge cognitive-behavioral model of low self-esteem assumes that self-esteem is not homogeneous. In most people, it revolves mainly around the two primary areas in which we monitor our self-worth: competence and connectedness with other people.
Although both areas are present in everyone’s life, in people with low self-esteem, one of the domains usually becomes dominant and it is around it that thoughts, emotions and behaviors are organized.
Personal competence and status
This domain deals with the question:
“How good, effective and respectable am I enough?”
Self-esteem here is mainly based on:
- achievements,
- results,
- comparisons with others,
- being perceived as competent, responsible or “valuable.”
Typical beliefs in this domain are:
- “If I make a mistake, I will lose value”
- “I have to be better than others to deserve respect”
- “My value depends on what I do and how I am judged”
People in whom this domain is particularly sensitive often:
- strive for perfectionism,
- overburden themselves,
- have difficulty relaxing,
- strongly experience failure and criticism.
Social bonding and belonging
This domain answers the question:
“Am I good enough to be accepted and loved?”
Self-worth here is based primarily on:
- relationships,
- a sense of being liked,
- belonging,
- emotional closeness to others.
Typical beliefs in this domain are:
- “If I show how I really am, I will be rejected”
- “I have to conform so they won’t abandon me”
- “Something is wrong with me if others don’t choose me”
People focused on this domain often:
- care excessively about the needs of others at the expense of their own,
- avoid conflicts,
- have difficulty setting boundaries,
- react strongly to signals of distance or emotional coldness.
Compensation between domains
In clinical practice, it is often observed that a threat in one domain leads to over-investment in another. For example:
- a person who fears rejection may try to “earn” relationships through achievements,
- a person who doubts his or her competence may seek confirmation of value only in the proximity and approval of others.
While these strategies may temporarily reduce anxiety, long-term they reinforce the belief that self-worth is conditional, fragile and easily lost.
Beliefs about self and beliefs about others
The newer CBT model makes a clear distinction:
- beliefs about ourselves,
- beliefs about how others perceive us.
This distinction is clinically crucial, since many safety behaviors are driven by fear of being judged, rather than negative self-esteem alone.
How does low self-esteem persist?
The problem is sustained by:
- cognitive distortions,
- secondary emotions (shame, guilt),
- compensatory behavior, e.g., taking action in another area where success is more likely,
- avoidance and seeking reassurance to increase a sense of security,
- ruminations, e.g., why am I not achieving as much as others or why is one not accepted enough?
- maladaptive mood regulation strategies.
What they have in common is short-term relief and a long-term cost that confirms negative beliefs about oneself. Read also: low self esteem-how to counteract it
A mini case study – low self-esteem
The patient (age 30) came to therapy because of chronic tension, depressed mood and a sense of “constantly being inadequate.” She functioned professionally at a high level and was perceived by those around her as competent and committed. Subjectively, however, she experienced a strong fear of making mistakes and a belief that her value depended solely on her performance.
The domain of competence and status appeared to be dominant in conceptualization. Activation of core beliefs occurred especially in situations of evaluation – both formal (work) and socially ambiguous (team meetings). A key belief was: “If I’m not good enough, others will see that I don’t deserve respect.”
The patient used elaborate compensatory strategies:
- perfectionism,
- excessive preparation,
- taking responsibility for the tasks of others,
- avoiding situations in which she could be judged spontaneously.
These strategies reduced anxiety in the short term, but in the long term led to overload, exhaustion and increased self-criticism. Any fatigue or minor stumble was interpreted as evidence of personal inadequacy, reinforcing the original beliefs.
The turning point in therapy was not so much the “undermining” of negative self-esteem, but the realization of the costs of maintaining compensatory strategies and the gradual behavioral experimentation of giving up highly controlling behaviors. Psychotherapy is based on working on tolerating discomfort and fear of impairment.
If you are struggling and experiencing low self-esteem – cognitive-behavioral therapy
A clinical perspective for CBT therapists
1.Conceptualization based on value domains
The improved model encourages precise identification of the dominant value domain at risk. This helps understand the function of compensatory behavior and select appropriate therapeutic interventions.
2. Working with beliefs about self and others
Separate formulation of these beliefs enables more effective work with safety behaviors and fear of revealing the “truth” about oneself.
3. Sustaining behaviors as goals of therapy
Systematic mapping of corrective, compensatory and avoidant behaviors allows the client to see the full cost of maintaining low self-esteem.
4. Interpersonal and cultural context
The modern conceptualization of CBT (read also: how to create conceptualizations in cognitive-behavioral therapy) takes into account real-life experiences of rejection, criticism or devaluation, which promotes validation and development of self-compassion.
5. From raising self-esteem to value-based living
The goal of therapy is not “high self-esteem,” but to reduce the centrality of self-esteem monitoring and increase psychological flexibility.
Specialist are you working with patients experiencing low self-esteem and need support? Feel free to contact me – CBT supervision
Clinical checklist: working with low self-esteem in CBT
The following list can be used as a tool to help conceptualize and monitor the therapy process with people experiencing low self-esteem:
- ☐ Has the dominant domain of value at risk (competence vs. connectedness) been identified?
- ☐ What are the key core beliefs about the self?
- ☐ What beliefs about how the client is perceived by others play a significant role?
- ☐ What compensatory and safety behaviors are most commonly used?
- ☐ What short-term function do these behaviors serve?
- ☐ What long-term costs do they generate (emotional, relational, health)?
- ☐ Do interventions include both cognitive and behavioral levels?
- ☐ Does therapeutic work reduce the centrality of self-esteem monitoring?
- ☐ Is the client supported in taking actions in the therapy process consistent with values, despite discomfort?
Summary
Change is not about proving one’s worth, but about gradually coming out of a life subordinated to the fear of losing it. It’s a process that requires courage, but leads to greater authenticity and satisfaction. Underestimated self-esteem is a learned pattern of reaction, not an objective truth about a person. Modern CBT shows that change based on understanding, compassion towards oneself and acting in accordance with values is possible.
Bibliography
Fennell, M. (1997). Low self-esteem: a cognitive perspective. Behavioural and Cognitive Psychotherapy, 25, 1-26.
Rimes, K. A., Smith, P., & Bridge, L. (2023). Low self-esteem: a refined cognitive behavioral model. Behavioural and Cognitive Psychotherapy, 51, 579-594. https://www.cambridge.org/core/journals/behavioural-and-cognitive-psychotherapy/article/low-selfesteem-a-refined-cognitive-behavioural-model/A170A4A8E6A428A2F1CF139590452AC5
Beck, A. T. (1976). Cognitive Therapy and the Emotional Disorders. International Universities Press.
Leary, M. R., Tambor, E. S., Terdal, S. K., & Downs, D. L. (1995). Self-esteem as an interpersonal monitor: The sociometer hypothesis. Journal of Personality and Social Psychology, 68, 518-530.
Mahadevan, N., Gregg, A. P., & Sedikides, C. (2016). Is self-esteem a sociometer or a hierometer? Journal of Personality and Social Psychology, 110, 735-752.