Weak Emotional Immune Systems

Everyone desires high self-esteem and if we were to judge by the vast assortment of magazines, books, programs, products, and self-proclaimed gurus that promise to deliver it, everyone can have it as well. That this billion-dollar industry exists at all is remarkable given that decades of research and thousands of scientific studies have demonstrated repeatedly that the overwhelming majority of self-esteem programs simply don’t work. It is a shame they don’t, because having low self-esteem is akin to having a weak emotional immune system: it renders us more vulnerable to many of the psychological injuries we sustain in daily life, such as failure and rejection. Further, people with low self-esteem are often less happy, more pessimistic, and less motivated than their higher-self-esteem counterparts. They also have much worse moods; they face a greater risk of depression, anxiety, and eating disorders; and they experience their relationships as less fulfilling than people with higher self-esteem do.

The good news is that despite the many failed promises of the self-esteem industry, researchers have found ways to boost our self-esteem and to strengthen our emotional immune systems by doing so. While such approaches cannot catapult someone’s low self-esteem into the extremely high self-esteem range, that is probably for the best. Having very high self-esteem has its own set of pitfalls. For example, people with very high self-esteem tend to blame others for their own mistakes, they reject negative feedback as unreliable, and they often struggle to accept the consequences of their own actions. These tendencies render them likely to repeat the same mistakes and have significant problems in the workplace and their relationships and personal lives as a result.

At the very high end of self-esteem, narcissists possess an overly high and grandiose opinion of themselves but are also quick to feel extremely hurt and angry when criticized or devalued even if the criticism is minor (i.e., there are no small insults to a narcissist). Because they feel so crushed by even insignificant slights, they often have the nasty habit of seeking to retaliate against the people who “punctured” their inflated sense of self. Perhaps scientists should be seeking remedies for narcissism instead of for low self-esteem, but then again, life often finds ways to serve humble pie to those who need it most.

While few of us are true narcissists, there has been a general “grade inflation” in our collective self-esteem over the past few decades, spurred in part by the lavish attentions of the self-esteem industry. Consequently, studies indicate that today most of us are of two minds when it comes to our self-esteem: we feel inadequate as individuals on one hand, yet believe we’re better than “average” on the other.

Indeed, the word “average” itself has developed strangely negative connotations. I say “strangely” because by definition, two-thirds of the population is “average” at any given thing (with one-sixth of people being above average and one-sixth below). Yet, these days, telling a student, an employee, or a lover that his or her skills and abilities are “average” would constitute an insult and a blow to the individual’s self-esteem. Most of us believe we’re better drivers than average, that we’re funnier, more logical, more popular, better looking, nicer, more trustworthy, wiser, and more intelligent than average as well.

Ironically, while we’ve been developing an aversion to being average, self-esteem scientists have been amassing one piece of evidence after another indicating that where our self-esteem is concerned, being average (not too high, not too low) is the best thing for us. Ideally, our self-esteem should lie in a range where our feelings of self-worth are both strong (not too low) and stable (not too high and fragile). Indeed, people with strong and stable self-esteem have more realistic evaluations of their real-world strengths and weaknesses and relatively more accurate assessments of how they’re perceived by others, and they are usually the “healthiest,” psychologically speaking.

Of course, this raises another question. How realistic are our self-assessments to begin with? In other words, does our self-esteem reflect the real-world value of our skills and attributes compared to others or does it reflect our subjective and often inaccurate assessments of these qualities based on our own psychological biases?

Let’s use physical attractiveness as an example. Studies clearly demonstrate that people with higher self-esteem believe they are more attractive than people with lower self-esteem profess themselves to be. But when scientists compared stripped-down photographs of higher-and lower-self-esteem people (no jewelry or makeup, just faces) it quickly became clear that such is not the case. People with lower self-esteem were found to be just as attractive as people with higher self-esteem were. But because low self-esteem can cause us to underestimate our attractiveness we often downplay our strengths and we get less positive feedback about our appearance as a result. On the other hand, people with higher self-esteem might dress more attractively than their low self-esteem counterparts, which brings them more positive feedback and fuels their self-esteem even more.

Is Our Self-Esteem Low if We Don’t Think Much of Anyone Else Either?

An athletic young man I once worked with came to therapy to deal with his “terribly low self-esteem.” He went on to describe his own body in extremely critical terms and then quickly proceeded to discuss celebrities known for having beautiful bodies while pointing out their “obvious and disgusting flaws” (which were “obvious and disgusting” only to him). “I don’t think you have low self-esteem,” I said to him as soon as he finished savaging Brad Pitt for having “skinny arms and chicken legs.” “True, you hate your body, but you hate everyone else’s body as well,” I pointed out while sucking in my stomach. “You might have low self-esteem, but the larger problem is your general negativity and unhappiness. Let’s discuss whether you might be depressed.” Depression can cause us to feel generally negative about everyone and everything (as well as a host of other symptoms) and it can masquerade as low self-esteem.

Of course, not everyone with a negative outlook on life is necessarily depressed, nor does such negativity necessarily indicate low self-esteem. For example, years ago scientists thought people with low self-esteem were also more prejudiced because they rated people of groups different from their own negatively (e.g., people of different race or gender). However, the scientists forgot to account for the fact that people with low self-esteem also rated their own groups negatively, which means their assessments of other groups weren’t prejudiced but rather part of their larger negativity. Once they accounted for people’s ratings of their own group the researchers found that people with low self-esteem were in fact less prejudiced than people with high self-esteem were.

One last point of clarification is that our self-esteem includes both a general sense of self-worth and how we feel about ourselves in specific domains of our lives (as a spouse, parent, friend, lawyer, nurse, golfer, video game player, etc.). When we think of ourselves as having low or high self-esteem we are usually referring to our global sense of self-worth. That being said, how we feel about ourselves in the specific domains we consider personally meaningful or important has a big impact on our general self-worth. For example, an aspiring chef might be much more bothered at the thought that she was a terrible cook than a professional athlete would be. Therefore, failures and success in meaningful domains of specific self-esteem can lead to changes in our global sense of self-worth as well.

Now that we’ve covered some of the basic foibles of our self-esteem, let’s turn our attention to the psychological injuries we sustain when our self-esteem is low.

The Psychological Wounds Low Self-Esteem Inflicts

Low self-esteem can inflict three types of psychological wounds: It makes us more vulnerable to many of the emotional and psychological injuries we sustain in daily life, it makes us less able to absorb positive feedback and other “emotional nutrients” when they come our way, and it makes us feel insecure, ineffective, unconfident, and disempowered.

Boosting our self-esteem would strengthen our weakened emotional immune system and buffer us against many of these threats to our psychological well-being. Most of us know this from our own experience. When we feel good about ourselves we are often able to shrug off the kinds of setbacks, disappointments, or criticisms that on a “low self-esteem day” would have a much greater impact. In order to apply emotional first aid treatments successfully and boost our self-esteem we need to have a better understanding of how each of these wounds operates. Let’s examine them in greater detail.

1. Egos Under Siege: Greater Psychological Vulnerability

Low self-esteem makes us more vulnerable to the psychological slings and arrows of daily life as even minor failures, rejections, or disappointments can sail over our emotional walls, get through our psychological defenses, and smash into our gut. When our self-esteem is low, normal “insults” like our boss frowning at us disapprovingly in a meeting, losing the office football pool, or a friend canceling plans to hang out with us impact our mood and disposition far more than they should. We blame ourselves for such events, we take them too personally, and we bounce back from them more slowly than we might were our self-esteem higher. Indeed, when our self-esteem is low, the barrage of hurts and slights we sustain on a regular basis can make us feel as though our egos are under siege from every angle.

Although there is an ongoing discussion about the extent to which high self-esteem functions as a general buffer (studies have only recently begun distinguishing high self-esteem from too-high and fragile self-esteem), a substantial body of research demonstrates that having high er self-esteem (i.e., not too low) can make us more psychologically resilient and boost our emotional immune systems on at least several different fronts.

For example, rejection hurts at all levels of self-esteem but brain scans have demonstrated that people with low self-esteem experience rejection as more painful than people with higher self-esteem do. Also, our psychological responses to rejection are far less adaptive when our self-esteem is low, as we typically withdraw and create more distance between ourselves and others to minimize the risk of further rejection and pain. In some cases, our psychological vulnerability and our efforts at self-protection can lead us to push others away so consistently that we become socially or emotionally isolated and place ourselves at risk for acute loneliness. Having low self-esteem also makes us more vulnerable to discrimination and the further loss in self-esteem such experiences cause.

We are also more vulnerable to failure when our self-esteem is low. Failing causes larger emotional blows and sharper declines in motivation in people who have low self-esteem than it does in those with higher self-esteem. In addition, we are likely to be less persistent after failing and to overgeneralize the meaning of the failure such that we perceive it as indicative of a wider and more serious set of shortcomings than it actually is. Failing also sets in motion a vicious cycle of pushing low self-esteem even lower and therefore making it even more vulnerable to future failures.

Having low self-esteem can also make us more vulnerable to anxiety. One study examined reactions to emotionally arousing situations. Participants were told they would be receiving “unpleasant electric shocks” (not that an electric shock is ever “pleasant,” but these days it always falls short of being outright painful; and most studies never actually shock participants at all, as researchers are more interested in the anxiety generated by the anticipation of a shock than people’s actual responses to being “zapped”). One group of waiting participants was given an intervention to raise their self-esteem (they were told they’d scored exceptionally well on a measure of verbal intelligence) and the other group was not. The group that received the self-esteem boost demonstrated significantly less anxiety when waiting to be “shocked” compared to the group that did not.

We also respond to stress much less effectively when our self-esteem is low than we do when our self-esteem is higher, making us more vulnerable to depression and anxiety as well as to a host of stress-related physical ailments and conditions. Straightforward observations of stress hormones such as cortisol have demonstrated that people with low self-esteem generally respond to stress more poorly and maintain higher levels of cortisol in their blood than people with high self-esteem do. High cortisol levels are associated with high blood pressure, poor immune system functioning, suppressed thyroid gland function, reduced muscle and bone density, and poor cognitive performance.

One of the reasons higher self-esteem buffers the effects of stress on both our psychological and physiological systems is that when our self-esteem is low we tend to make negative feedback even more stressful by exaggerating its implications and potential consequences. Further complicating matters, the more stressed we are, the less able we are to exert self-control. We are then likely to encounter slips and failures, judge ourselves too harshly for them, and damage our self-esteem even further.

Self-Esteem, Stress, and Self-Control

Rudy, a commodities broker who had an extremely stressful job, came to therapy to deal with a long-standing gambling problem. As stress built at work, Rudy would have a powerful urge to spend the night gambling in Atlantic City. He was able to resist this urge as long as the pressure at work remained high, but as soon as the stress level subsided, Rudy’s willpower gave out and off to gamble he would go. Rudy’s gambling binges often cost him thousands and even tens of thousands of dollars, which he could not afford. What made his self-loathing even greater after such episodes was that he was well aware of the role stress played in this cycle and he knew the triggers that preceded it (a reduction in stress after an intense period). Yet despite recognizing the pattern that led to his destructive behavior, Rudy was still powerless to stop it.

By the time Rudy showed up in my office he had gambled away his home, his entire savings, and most of his retirement, and he’d moved in with a friend. Needless to say, his self-esteem was at an all-time low. Determined as Rudy was to change his ways, his company was a breeding ground for cycles of heavy stress. But what made his situation even more urgent was that some years earlier Rudy’s aging parents had signed a power of attorney that granted Rudy access to their finances and Rudy worried that his parents’ home might be in jeopardy as well. Given his parents’ fragile health and their complete lack of awareness about how bad their son’s problem had become, Rudy worried that coming clean and nullifying the power of attorney would cause them such significant emotional distress it might even endanger their health.

Rudy’s reactions to stress were extreme in their self-destructiveness but not unusual. Stress can substantially weaken our willpower and self-control and make us revert to automatic and old habits without even realizing it. For example, a stressful day might make a dieter leave the supermarket and drive all the way home before snapping out of his daze and realizing that instead of a salad he’d just purchased a large bucket of fried chicken.

When our self-esteem is low, we are far less likely to attribute slips in willpower to mental and emotional fatigue (which are the more likely culprits) and far more likely to assume they reflect fundamental character deficits. Our self-esteem then drops yet another notch and we are even more likely to blame ourselves unnecessarily when our willpower fails us in the future.

The good news is that manipulations to boost self-esteem have been found to help people better manage failure, rejection, anxiety, and (especially) stress. Encouraging as such findings are, they illuminate only the benefits of boosting our self-esteem, not how we might actually go about doing so. Scientists tend to boost research subjects’ self-esteem by methods such as giving them bogus feedback about their score on a test of verbal intelligence. Obviously, we can’t go around lying to ourselves about how smart we are, or, at least, most of us cannot. But the results of these experiments represent a “proof of concept” that boosting self-esteem can strengthen our emotional immune systems and make us more emotionally resilient.

2. No Dessert for Me! Why We Resist Positive Feedback and Emotional Nourishment

It’s bad enough that having low self-esteem makes us more vulnerable to negative psychological experiences but researchers have also demonstrated that low self-esteem limits our ability to benefit from positive ones. In one study, people were exposed to sad music to put them in a bad mood and were then given the option to watch a comedy video to cheer up. Although people with high self-esteem jumped on the chance to have a laugh, people with low self-esteem agreed that watching the video would improve their mood, but they declined to do so nonetheless.

When our self-esteem is low, the resistance we have to positive experiences and information is quite sweeping. Unfortunately it includes exactly the kind of feedback that could play a vital role in rebuilding our self-worth and confidence and strengthening our emotional immune systems. Yet, thirsty as we are for such information, when our self-esteem is low, we are likely to reject it, avoid it, and at times even recoil from it.

Bo was a single man in his late twenties, a Southern gentleman who seemed to have everything going for him. He was tall and handsome with a stable job and in good health. But when it came to his personal life, Bo was miserable. He had no “social circle” to speak of and the few separate friends he did have seemed to walk all over him. His friends often stood him up, leaving Bo waiting on the street or in the movie theater or restaurant. They threw parties they told him about only after the fact. They criticized him relentlessly and they borrowed hundreds and at times thousands of dollars without paying him back. Bo was desperate to meet a woman he could settle down with, but here too his friends were more of a hindrance than a support. On the few occasions Bo tried talking to women at social events, his friends would join the conversation and “jokingly” put him down. At times, they even resorted to flirting with women in whom Bo had already expressed an interest. Although on the surface Bo had everything going for him, he rarely dated, and when he did, the relationships never lasted for more than a few weeks.

Bo knew his biggest problem was his extremely low self-esteem. In fact, one of the first things he told me when he came to therapy was that he was an admitted “self-help junkie” with a penchant for positive affirmation programs. Affirmations are positive statements about our self-worth, goals, and futures, which one reads, listens to, or states aloud. They are widely believed to contribute to healthy self-esteem, greater personal empowerment, and increased motivation and well-being, and Bo had tried all of them. He read The Secret and practiced the “law of attraction,” he sipped Chicken Soup for the Soul, he spent weeks sleeping with expensive headgear via which personalized messages realigned his “neuroprocessing” and “corrected his brainwaves” (alas, the only thing they ended up “correcting” was his bank account), and he listened to countless subliminal messages, such as “I am worthy and able,” which he assured me maintained their “subliminal” powers despite the messages being listed in bold print on the packaging in which they arrived.

But after investing many years and thousands of dollars in positive affirmation programs, Bo, like many other positive affirmation devotees, felt as worthless and disempowered as ever. This raises two questions: First, why did Bo keep investing time and money into positive affirmation programs when none of them worked? And second, why did these programs weaken Bo’s emotional immune system rather than strengthen it?

One reason Bo stuck with it is that because our self-esteem is so subjective, our ability to assess whether it has changed for the better is rather limited (unless we use more objective measures such as scientifically established self-esteem questionnaires or other tangible criteria). In fact, numerous studies have demonstrated that we are very likely to unconsciously distort our memories of how we felt before starting a self-esteem program such that we believe the program helped us improve when it actually did not.

For example, one study investigated a popular self-esteem product that used audiotaped positive affirmations. Researchers measured participants’ self-esteem before and after they completed the program and found that their self-esteem had not improved at all and had even declined in some cases. But despite this stark reality, the participants happily reported feeling significant improvements in their self-esteem because they unconsciously distorted their memory and believed they had felt worse previously. This is why so many bogus self-esteem programs have such glowing testimonials and commercial success despite being entirely ineffective.

This brings us to the second question: why do positive affirmations leave so many of their users feeling worse about themselves rather than better?

The answer requires a brief detour into the science of persuasion. Persuasion studies have long established that messages that fall within the boundaries of our established beliefs are persuasive to us, while those that differ too substantially from our beliefs are usually rejected altogether. If we believe we’re unattractive, we’re much more likely to accept a compliment like “You look very nice today” than “Why, your beauty is breathtaking!” Since positive affirmations are supposed to change how we feel about ourselves, whether they fall inside or outside the boundaries of our own self-concept is crucial to their effectiveness. When people with low self-esteem, like Bo, are exposed to positive affirmations that differ too widely from their existing self-beliefs, the affirmation is perceived as untrue and rejected in its entirety and it actually strengthens their belief that the opposite is true.

Recent research into the usefulness of positive affirmations has investigated these ideas and verified their potential to cause more harm than good. In one experiment, subjects were asked to complete a variety of questionnaires and then identify a trait they would like to possess but believed they lacked. Researchers then told subjects the good (albeit fictitious) news that they actually did possess the trait they desired. But hearing the “good” news made subjects feel worse and register drops in self-esteem. In other words, the very people who most need positive affirmations (like Bo) are those least likely to benefit from them (and most likely to be harmed by them) because they are likely to find such messages too discrepant from their current self-concepts. Rather than strengthening our emotional immune systems, positive affirmation programs are likely to weaken them even further.

When our self-esteem is chronically low, feeling unworthy becomes part of our identity, something with which we feel comfortable, a way of being to which we become accustomed. People with low self-esteem often feel more comfortable with negative feedback, because it verifies their existing feelings about themselves. One study found that poorly performing college students who were given messages to bolster their self-esteem actually declined academically as a result. Another found that when college students with low self-esteem had roommates who thought better of them than they did of themselves, they tended to look for new roommates. Indeed, one of the areas in which low self-esteem and our resistance to positive messages is especially problematic is in our relationships.

Low Self-Esteem and Relationships

People with low self-esteem have greater doubts about their partners’ affections for them than people with higher self-esteem do, and they report less satisfaction in their marital and dating relationships as well. When our self-esteem is low, we are quick to perceive any signs of rejection and disapproval from our partners. We not only interpret many such messages too negatively, we also tend to overgeneralize them and read far greater disapproval into them than is intended.

Although our relationships could and should be sources of support, praise, and, hence, increased self-esteem, people with low self-esteem have tremendous difficulty taking in positive messages from their partners and they often bristle against such emotional nutrients. In one study, praising people with low self-esteem for being considerate boyfriends or girlfriends (which is pretty mild as far as compliments go) was enough to make them feel more insecure about their partners and view their entire relationship more negatively.

Regardless of how parched we might be for positive feedback and affirmation, when our self-esteem is low, compliments, reassurances, and praise from our partners makes us feel pressured to live up to their heightened expectations. We worry we will not be able to sustain such efforts, that we will disappoint them (even when their expectations are well within our capabilities), and that their love is conditional on our being able to keep it up. As a result, rather than enjoy the closeness and intimacy that compliments should evoke, people with low self-esteem often respond to praise by shutting down, withdrawing, and becoming more distant. Unfortunately, pulling away and acting defensively often “succeeds,” as it lowers our partners’ expectations, tarnishes their perceptions of us, and undermines the integrity and longevity of the entire relationship.

Indeed, many of Bo’s dating experiences took a turn for the worse when a woman he considered attractive and successful made the mistake of complimenting him for being sweet, kind, or considerate. “Boy, she doesn’t know me at all!” Bo would joke self-disparagingly. “She has no idea of how screwed up I am!” Bo would then make all kinds of unconscious efforts to demonstrate exactly how “screwed up” he was, which, unsurprisingly, ended in the woman breaking off their brief courtship. Bo would then take her rejection as further proof that he could only “hide” his true (and unacceptable) self for so long. The fact that the only unacceptable thing about Bo was his terribly low self-esteem was a reality he was tragically unable to acknowledge.

3. Chronic Backbone Pain: How Low Self-Esteem Makes Us Feel Disempowered

Bo’s emotional immune system was extremely weak, affording him poor resiliency against the many rejections and betrayals he sustained from his “buddies.” Although he did his best to hide it, each backstabbing incident upset him tremendously and left him feeling more defective, more undeserving, and more inadequate than he had previously. Bo recognized he was being taken for granted, taken advantage of, and generally mistreated by his friends, but he felt completely disempowered to do anything about it. Not only was he unable to limit his exposure in such situations (for example, by refusing to lend people money), but he also felt incapable of avoiding the company of people that were bound to hurt his feelings. “I’d rather have bad friends than no friends” was how Bo justified his reluctance to make any changes in his social life.

Studies have repeatedly demonstrated that people with low self-esteem tend to speak up less in groups and social settings and take less initiative to extricate themselves from unhappy relationships and friendships when they find themselves embroiled in them. Having low self-esteem makes us feel fundamentally insecure, unconfident, and undesirable in social situations and our “beggars can’t be choosers” mentality leaves us feeling tremendously disempowered and unassertive as a result. We become convinced that setting limits, making demands, or stating expectations, however reasonable, will cause the other person to reject us immediately and drop us like a hot potato. Of course, others quickly recognize our reluctance to speak up, object, or cry foul, which encourages them to take us for granted and be even less considerate of our needs and feelings going forward.

The reality of Bo’s predicament was that some of his friends might indeed reject him if he stood up to them or spoke up about their mistreatment of him. However, others would not. I tried to impress upon him that speaking up would constitute an important litmus test as to the quality and potential of the friendship each person offered him. Those who did indeed care about him, even somewhat, would respond to his objections by demonstrating some kind of accommodation or consideration that Bo could build upon. Those who did not were not worthy of his friendship to begin with.

To be clear, Bo’s friends were not necessarily terrible people, although they were unlikely to win any humanitarian awards. Most of us only put in as much effort as a situation requires from us. If we can “get away” with being less considerate or less reciprocal, and various other forms of “getting without giving,” many of us will, not because we’re evil, but simply because we can. If people demanded or expected more of us we would do more, but when they don’t, we don’t make the effort. This dynamic is true in practically every relationship we have. When our self-esteem is low and we expect very little of others, we are likely to get very little from them as well.

Changing this dynamic once a relationship is already established is difficult because we’re in essence “changing the terms of the deal” after the other person has already been operating under a specific set of assumptions and expectations. That is why it is crucial to pay great attention to the expectations we set up when our friendships and romantic relationships first begin. Bo’s challenge was to identify which of his friends were worth keeping and to find ways in which he could change the terms of “the deal” so he could enjoy more reciprocity and mutual support from those who did care about him and eliminate the ongoing damage his self-esteem was sustaining from those who did not.

Gladys, a forty-year-old breast cancer survivor, is another example of someone who had low self-esteem, although, unlike in Bo’s case, hers was not a lifelong struggle but rather the result of horrific emotional blows she had sustained over recent years. Without any prior warning, Gladys’s husband had left her midway through her chemotherapy treatments some years earlier. Demonstrating truly despicable cruelty, he chose to serve her divorce papers by having someone wait for her outside the hospital the day she was released after having a double mastectomy.

Although Gladys’s body recovered from the cancer, the chemotherapy, the double mastectomy, and the several reconstructive surgeries that followed, her self-esteem was not as fortunate. She never got over the blow of her husband abandoning her while she was fighting for her life nor the manner in which he did so. When I met Gladys, there was little evidence of the fighter who’d survived a terrible disease, the high school track athlete who had a closet full of medals and trophies, or the successful Web designer who’d built her own business from scratch after her divorce. Instead, Gladys came across as timid, insecure, and extremely unassertive.

Gladys did have a close circle of friends (many of whom were also breast cancer survivors) but she had not gone on a single date since her divorce, especially since she worked from home and had few opportunities to meet eligible men. However, what finally convinced her to start psychotherapy was that her low self-esteem began to have an impact on her business and her income as well.

“I’ve never been terribly assertive but I became much worse after my husband left. My business suffers because I often don’t get paid what I deserve and I get talked into doing too many unpaid extras. I’m just not very good at standing up to demanding people. I try but they bully and pressure and I always end up giving in.” Gladys went on to describe how her biggest client was also the worst offender. Despite already extracting huge concessions and discounts for the services she provided, the client kept demanding more. Gladys feared that refusing the requests would incite the company to take its business elsewhere, a loss that would have significant financial implications for her.

Much as Bob felt he had no room to make demands or set limits in his friendships, Gladys felt too insecure, unconfident, and disempowered to do so in her business. They were both convinced that their impoverished self-worth was an accurate reflection of their character and attributes, such that they basically “got what they deserved.” Their lack of assertiveness and backbone was a direct result of a weak emotional immune system that led them to believe that any acts of assertion on their part would only bring intolerable hurt, rejection, and disaster.

How to Treat the Psychological Wounds Low Self-Esteem Inflicts

Our self-esteem fluctuates regularly and even people with generally high self-esteem can have days in which they feel poorly about themselves. Such temporary dips in self-worth rarely require emotional first aid as we usually recover from them fairly swiftly. However, when our self-esteem is regularly low, or when we feel unable to stand up for ourselves and to set limits with friends or family members who treat us poorly or with disrespect, we need to treat our psychological wounds and boost our self-esteem.

The treatments in this chapter should help “stop the bleeding” and set us on the path to bolstering our sense of self-worth. However, improving our self-esteem in deep and fundamental ways requires both time and substantial effort. Higher self-esteem is essentially an outcome of doing well in our lives and relationships. Internalizing the lessons of this chapter and applying them cannot change our self-esteem overnight but it can give us the tools to establish a track record of success that, over time, will strengthen our self-esteem and make it more stable. Therefore, in addition to providing initial emotional relief, the treatments that follow should be adopted as daily strategies and life habits. Let’s open our psychological medicine cabinet and examine the treatment options available to us.

General Treatment Guidelines

Having low self-esteem weakens our emotional immune systems and inflicts three kinds of psychological wounds: it makes us more vulnerable to psychological injuries, it makes us dismissive of positive feedback and resistant to emotional nutrients, and it makes us feel unassertive and disempowered. The five treatments suggested in this chapter should be administered to correct self-critical habits and negative self-perceptions, especially following blows to self-esteem or if entering periods of increased stress.

Administer the treatments in the order in which they are presented. Treatment A (adopting self-compassion) helps prevent the self-critical mind-sets that damage our already weakened emotional immune systems. Treatments B (identifying and affirming strengths) and C (increasing tolerance for compliments) are focused on recognizing, acknowledging, and reconnecting to neglected or marginalized strengths, qualities, and abilities. Treatments D (increasing personal empowerment) and E (strengthening self-control) focus on rebuilding self-esteem and feelings of empowerment. At the end of the chapter, I provide guidelines for assessing when one should consult a mental health professional.

Treatment A: Adopt Self-Compassion and Silence the Critical Voices in Your Head

Imagine witnessing an emotionally abusive parent berating her child for getting a poor report card. The parent verbally attacks the child, mocks him, and mercilessly belittles him without displaying a whit of empathy, support, or compassion. Meanwhile, the child’s face registers utter devastation as he absorbs one emotional blow after another. Most of us would find such a scene extremely distressing to witness (especially those of us who grew up with such parents) and we would immediately vow never to treat our own children in such an abusive, cruel, and destructive manner.

And yet when our self-esteem is low, that is exactly how we treat ourselves. We blame ourselves for our mistakes, failures, rejections, and frustrations in the most harsh and self-punitive terms. We call ourselves “losers” and “idiots,” we give ourselves stern “lectures,” and we replay the scenes in our mind while ruminating on our inadequacies and deficiencies. In other words, we treat ourselves even worse than an emotionally abusive parent would. When I catch my patients running such damaging internal sound tracks in their minds and point it out to them, they are usually quick to respond, “I know I shouldn’t beat myself up about it but—” and then they go on to justify why they should beat themselves up about it. When I ask if they would ever treat their own children, their spouse, or their friends in a similar manner they look at me horrified, as if doing so would be unthinkable.

When our self-esteem is low, this double standard is a trap we easily fall into. Our reason abandons us and we struggle to implement the premise that if we consider it abusive to speak to others a certain way we should never direct such thoughts toward ourselves either. The first step we need to take on the path toward self-compassion is to embrace the most simple and basic fact that when our emotional immune systems are weak we should do everything in our power to strengthen them, not devastate them even further. Purging the emotionally abusive voices in our heads and adopting kinder, more supportive ones instead is an absolute imperative.

People with low self-esteem often bristle at the notion of adopting self-compassion when I first suggest it. They worry that switching off self-punitive thoughts and replacing them with soothing and compassionate ones will cause them to “slack off” and function more poorly, making their self-esteem even weaker and more vulnerable as a result. But such worries are entirely unfounded, as studies demonstrate that exactly the opposite is true. Practicing self-compassion actually strengthens our emotional immune systems. In one study, self-compassion was found to buffer incoming college students against homesickness, depression, and general dissatisfaction with their choice of school. In others, individuals who practiced self-compassion had quicker emotional recoveries from separation and divorce, and they recovered more quickly from failure and rejection experiences.

Despite the obvious benefits of adopting self-compassion, it remains challenging to do so when our self-esteem is low because the practice is so foreign to our ordinary way of thinking, it can cause discomfort and even an initial uptick in anxiety. Therefore, we must be determined to put an end to the destructive sound tracks that make up the current playlists in our minds. Once we truly accept that we require soothing and compassion far more than we do emotional abuse, we can turn to the following exercise.


Complete the following writing exercise three times, each time describing an event from your past (if possible, include at least one from your recent past). Try to write about one event each day so that you complete the exercise over three consecutive days.

  1. We’ve all experienced failures, embarrassments, humiliations, or rejections that made us feel self-critical and badly about ourselves. Choose one such event and detail what actually happened and how you felt about it.
  2. Imagine that the event happened to a dear friend or close family member who then felt terrible about herself (or himself) because of it. Describe that person’s experience of the event, how she would react and feel in the very same situation.
  3. You hate seeing this person in emotional pain and you decide to write her a letter with the explicit purpose of making her feel better about herself. Make sure to express kindness, understanding, and concern about the experience she went through and how she felt as a result, and remind her of why she is worthy of compassion and support.
  4. Now describe your own experience and your feelings about the event again, but this time, try to be as objective and understanding as you can about what happened and about how you felt. Make sure not to sound judgmental or negative. For example, you might note that your date never called you back, as that is factual, but not that your date thought you were a loser, because that is judgmental and nonfactual. Or that you made mistakes during a presentation, but not that your colleagues disrespect you as a result, because, regardless of how you perceived their reactions, when our self-esteem is low we tend to misinterpret people’s facial expressions too negatively.
Dosage: Apply the treatment over three days and repeat regularly until the principles of self-compassion become engrained and automatic.

Effective for: Increasing emotional resilience and decreasing emotional vulnerability and self-criticism.

Secondary benefits: Decreases resistance to positive feedback.

Treatment B: Identify Your Strengths and Affirm Them

Positive affirmation die-hards like Bo, the Southern gentleman with low self-esteem, need not forsake them entirely. Although positive affirmations can be damaging to people with low self-esteem, many positive affirmation routines can be tweaked to make the affirmations easier for us to digest (e.g., by affirming our need to take action when we’ve been wronged). Bo was hesitant to dispense with positive affirmations altogether but he agreed to adapt them to include action-oriented items such as “When I lend someone money, asking him to pay me back is far less rude than his failing to repay me in a timely manner,” and “When a friend upsets me I am entitled to speak up.”

That being said, a much more effective way to use affirmations is to use self-affirmations that identify and affirm valuable and important aspects of ourselves we already know to be true, such as our trustworthiness, loyalty, or work ethic (in contrast to positive affirmations, which affirm qualities we would like to possess but don’t believe we do). Reminding ourselves that we have significant worth regardless of any shortcomings we perceive in ourselves provides an immediate boost to our self-esteem and renders us less vulnerable to experiences of rejection or failure.

Another advantage of self-affirmations is they benefit us even when the quality we’re affirming has nothing to do with the situation of the moment. For example, if we’re hurting because we’ve been turned down for a promotion we do not have to affirm our value as an employee in order to feel better (which would be a hard sell in that moment anyway). Instead, affirming that we are a good parent or a great wife, a thoughtful friend or a champion quilter, a supportive brother or a great listener is sufficient to make us feel better about ourselves as we walk out of our boss’s office without the new title we had hoped to secure.

Ideally, we should employ self-affirmation exercises before we go into situations that might provide a blow to our self-esteem (i.e., before our big date, before the exam, before the job interview). This is also why it is best to use such exercises on a regular basis, as we cannot always predict when blows to our self-esteem might occur. Nonetheless, completing such exercises after the fact still has significant value.


Complete the following writing exercise as regularly as possible (weekly is good; daily is better). It is especially important to do the exercise when facing situations of heightened stress (e.g., for tax accountants, during tax season; for college students, during finals) or situations that pose potential threats to self-esteem (e.g., when applying to schools or jobs), as that is when our self-esteem might be most vulnerable. You will need two sheets of blank paper.

  1. On the first sheet of paper, make a list of your important attributes and qualities, including any achievements you have that are significant or meaningful to you. Aim for at least ten items and preferably many more.
  2. If while brainstorming items for your list you think of responses that are negative (e.g., “My boss thinks I’m a terrible employee”), critical (e.g., “I’m a loser”), or sarcastic (e.g., “What am I good at? Let’s see, there’s napping ... and I’m a champ at breathing too!”), write them down on the second sheet of paper.
  3. Choose one item from the first sheet of paper that is especially meaningful to you and write a brief essay (at least one paragraph) about why this specific attribute, achievement, or experience is meaningful to you and what role you hope it will play in your life.
  4. Once you’ve completed the essay, take the second sheet of paper, crumple it into a ball, and throw it in the garbage where it belongs.
  5. On subsequent days, choose other items from your positive attribute list and write about them, preferably each day, until you’ve completed the list. Feel free to add to your list at any time or to write about specific items several times.
Dosage: Apply the treatment until you complete your initial list and repeat it whenever you anticipate stress or experience a blow to your self-esteem.

Effective for: Increasing emotional resilience, decreasing emotional vulnerability, and minimizing feelings of disempowerment.

Secondary benefits: Decreases resistance to positive feedback and reduces self-criticism.

Treatment C: Increase Your Tolerance for Compliments

Having low self-esteem makes it difficult for us to absorb compliments and positive feedback from others, especially our loved ones, and to use such communications to rebuild our self-esteem. Instead, we are more comfortable scanning the environment for any hints of negative feedback that might confirm our (mis)perceptions of ourselves as being fundamentally unworthy or inadequate.

Because this resistance to compliments operates on both conscious and unconscious levels, some of us are aware we feel uncomfortable receiving positive feedback from others but many of us are not. Our lack of awareness is especially problematic when it comes to our romantic partners, because when our self-esteem is low, we not only rebuff positive communications from them but we also respond by withdrawing and devaluing the relationship. I should note that the subject pool used in much of this research was composed of college students and young adults. In my experience, long-term couples tend to be more aware when one or both members of the couple are resistant to compliments and they refrain from voicing positive feedback to the resistant person. Of course, that only exacerbates the problem for the person with low self-esteem, as hearing fewer compliments and receiving little positive affirmation from the person who knows us best is itself not conducive to building feelings of self-worth.

On a positive note, several studies that used subjects of all ages have demonstrated that by affirming aspects of our selves that are related to our worth as relationship partners, we can bolster our “relationship self-esteem.” Doing so renders any compliments we receive from our partners less discrepant from our current self-views and makes us less likely to reject or rebuff them. Affirming our value as relationship partners not only makes us feel better about ourselves (by boosting our self-esteem), it also makes us feel better about our partners and even about the relationship itself.


The following is a writing exercise that can and should be completed on a regular basis (weekly or more when possible).

  1. Think back to a time your partner, family member, or friend conveyed that he or she appreciated, liked, or enjoyed something about you, such as a personal quality you have or something you did that the person felt strongly about. Describe the incident and explain what made the person feel positively about you when it occurred.
  2. What does displaying this attribute or behavior mean to you?
  3. What benefits does having the attribute or behavior bring to your relationships and friendships?
  4. What other significant or meaningful functions or roles can the attribute or behavior contribute to your life?
Dosage: Apply the treatment regularly until you become more comfortable with receiving compliments. Make sure to repeat whenever you experience a blow to your self-esteem.

Effective for: Decreasing resistance to positive feedback and increasing relational self-esteem.

Secondary benefits: Increases emotional resilience, decreases emotional vulnerability, and minimizes feelings of disempowerment.

Treatment D: Increase Your Personal Empowerment

The vast majority of articles, books, and programs that promise to help us feel more personally empowered fail to recognize a critical flaw in their thinking—personal empowerment is not something one feels but rather something one has. Sure, we might feel empowered after reading a book about improving marital relationships, but unless we’re able to initiate a productive dialogue with our partner and create actual changes, we are no more empowered than we were when we started. To have an impact on our self-esteem, feelings of personal empowerment must be supported by evidence of having actual influence in the various spheres of our lives, whether in our relationships, in our social or professional contexts, as citizens, or even as consumers.

Converting our low self-esteem into assertive feelings of empowerment might sound like a tall order but there is one aspect of personal empowerment we can use to our advantage. Acting assertively and getting results in one area of our lives tends to empower us in other areas of our lives as well. Choosing our battles wisely and starting with smaller and simpler acts of assertiveness can quickly get the ball of empowerment rolling, as even small triumphs provide a significant boost to our self-esteem and make us feel generally more powerful, effective, and assertive.

For example, many of us have had the experience of feeling so “pumped up” by resolving, say, a consumer or customer service complaint (successfully removing charges from our bank statement, perhaps) that we walked straight over to our teenager’s bedroom and told her to do something about the mess with such conviction that, for the first time in months, she actually did as we asked without arguing.

Because one successful act of assertion and personal empowerment encourages another, we need to identify areas for potential assertive action that have both a high likelihood of success and manageable consequences in the event of failure. The best way to do so is first to gather as much information as we can about how to attain our goal and to formulate well-thought-out strategies and plans for proceeding. We can then begin a process of practicing assertive actions in lower-stakes situations so we can refine our technique, our approach, and our skills as we go.

  1. Think about aspects of your life that tend to make you feel frustrated. Try to include situations in your community life, work life, family and personal life, social life, and life as a consumer. Describe at least three examples for each of these domains. For example, when thinking about your married life you might feel frustrated about a spouse’s personal habits, the division of labor between you, your partner’s style of communication, or his or her approach to parenting.
  2. Rank your items according to which of them have both a high likelihood of success and manageable consequences in case of failure. For example, Bo decided to speak up about the two thousand dollars he had lent his friend Timothy; Timothy had promised to return it within three months, and a year had passed. Timothy was Bo’s “least-close friend” and Bo felt justified enough in the situation to be willing to risk the friendship and discuss the matter with him. And Gladys decided to speak up about a couple of “website tweaks” her client had asked her to “throw in” free of charge; Gladys felt the “tweaks” in question were not crucial enough to prompt her client to fire her if she refused to do them without compensation.

The final list represents your master plan for practicing assertive actions and attaining personal empowerment. Now that you’ve identified and prioritized your goals, it’s time to consider any additional information or specific skill sets that can help you execute them successfully and to plan your strategy accordingly.

Gathering Information and Strategic Planning

To maximize our chances of attaining each goal, we need to consider how the systems or people we plan to challenge operate. In other words, we need to gain a grasp of the priorities and mind-sets of any relevant people; the complaint management systems of any relevant businesses, companies, or local municipalities; or the politics, hierarchy, and human resource practices in our workplace.

For example, I asked Bo and Gladys to describe the situation from the other people’s perspectives in order to gain some insight about their mind-sets. Bo explained that Timothy had always been slightly resentful and jealous of his income because he earned substantially less than Bo did. Bo assumed he felt entitled to borrow money from him because Bo could afford it, and therefore, Timothy saw no urgency to pay him back. Bo indicated that Timothy spent hundreds of dollars a week going out so that he certainly could afford to pay him back, even if it were at the rate of a few hundred dollars a month. And Gladys told me that her clients were hoping to launch a minor redesign of their website in the near future and that they were unlikely to shop around for an entirely new Web designer unless they absolutely had to.

Examples of other kinds of information gathering we might do include finding out what human resource channels are available if we have a complaint about a work colleague, looking up relevant departments in our municipality so we know who to call about a missing stop sign on our street, finding out who in our cell phone company is authorized to deal with the dollar amount we’re disputing (most customer service representatives are only authorized to deal with small amounts), or inquiring whether our teenager has an exam the next day before we demand he spend the rest of the evening completing his chores.

Once we’ve gathered the necessary information, we need to formulate and think through our plan of action and anticipate any reactions. For example, we might want to figure out how we can ask a friend why she hasn’t returned our phone calls without sounding too accusatory or hostile (because even though we might feel hurt by her disappearing, being accusatory simply wouldn’t be productive) or how to phrase a complaint to our spouse so he doesn’t get too defensive (because even though we might have the right to be annoyed, we also know he doesn’t respond well when we approach him in anger). We might think through the best time and place to talk to a colleague about why he never gave us credit for our part in the team presentation and give careful consideration to what we want to achieve by doing so (e.g., rather than just venting frustration we can suggest that we should take the lead on the next presentation as compensation for his omission).

Practice, Patience, and Persistence

Personal empowerment is a process and not something we attain in a single step. We have to be prepared for the reality that not all our efforts will yield immediate results and that we’ll need to persist, practice our skill sets, and sharpen our tools before we’re able to wield them both effectively and consistently. Bo’s first plan to talk to Timothy at a social gathering failed because Timothy promised to chat later in the evening and then claimed he was too tired to do so. Bo learned that he needed to create the space to talk with Timothy without distractions and that he would have to be on the alert for any attempts Timothy made to prevent the conversation from happening.

When Gladys finally called her clients about the extra work they expected her to do, they steamrolled her, barely let her get a word in, and reassured her it wouldn’t take her long to make the tweaks they required. Gladys was extremely demoralized at first but once she reflected on the exchange, she realized the best way for her to convey her message was via e-mail, as her clients would not be able to cut her off and she would be able to express her thoughts fully and assertively.

Practice, patience, and persistence are key ingredients in developing personal empowerment. Once we begin speaking up, we will be able to assess our strengths and weaknesses and learn which of our skills and tools still need work. Each setback will also teach us how to devise more effective plans. Bo decided to propose a manageable payment schedule and send it to Timothy in the mail along with self-addressed stamped envelopes. The factual and nonaccusatory tone Bo used in his letter led Timothy to respond with an apology and a check for the first payment. Gladys continued communicating with her clients by e-mail until she extracted additional payment for the work they wanted her to do.

While both Bo and Gladys were elated by their successes and felt quite empowered as a result, their triumphs were only the first step on their respective paths to stronger self-esteem. Over the next year, Bo continued to “clean house” with his old friends, and he made new ones who were more supportive and loyal. Gladys formulated tighter guidelines for compensation that she distributed to all her clients before she agreed to start work. In time, her self-esteem improved to the point where she felt able to start dating. Although she had made no efforts to improve her self-esteem in the dating domain, feeling more empowered as a businesswoman had created a greater sense of self-worth that boosted her feelings of confidence in her personal life as well.

Once we’ve tackled the first item on our lists and met with success, we should use the boost we get to our self-esteem and turn to the next item as soon as possible so we find success there as well. Although it will take time for our emotional immune systems to strengthen and to function more effectively, our small successes will soon begin to add up. Receiving a raise or promotion at work, resolving conflicts with friends, working out problems with our partners and family members, and getting satisfaction as consumers will each contribute to significantly strengthening our self-esteem and improving our general quality of life.

Dosage: Apply the treatment in each of the different spheres of your life when possible (i.e., your home and work life, your friendships, and as a consumer and community member) and repeat until you complete your list. Add new items to your action list when they arise.

Effective for: Increasing feelings of assertiveness and competence, strengthening weak feelings of entitlement, and demonstrating personal empowerment.

Secondary benefits: Increases emotional resilience and general self-esteem and decreases emotional vulnerability.

Treatment E: Improve Your Self-Control

Demonstrating self-control and willpower increases personal empowerment and helps us make progress toward our goals, both of which are extremely beneficial to our self-esteem. Although many of us assume willpower is a stable character trait or ability (i.e., we either have strong willpower or we do not), self-control actually functions more like a muscle. As such, learning how this muscle functions will allow us to use it wisely, strengthen it, and build our self-esteem as a result.

The most important thing to keep in mind about our self-control muscles is that they are subject to fatigue. Some of us might have bigger willpower muscles than others but even the most bulging willpower muscle will tire and become ineffective if we overwork it. Further, using this muscle in one context will tire it and make it weaker when we try to use it in another. For example, if we spend our day squelching the urge to rip off our tyrannical boss’s hairpiece and throw it across the conference room like a Frisbee, our willpower will be depleted by the time we get home and we are likely to find it difficult to stick to our diet and eat a healthy dinner.

Complicating matters further, the limited reservoir of emotional energy that fuels our willpower muscles is shared by other complex mental functions such as those responsible for making choices and decisions. Strange as it might sound, using these seemingly unrelated intellectual abilities saps our willpower and weakens our self-control. For example, when we spend the day making decisions about clothing and accessories for an upcoming photo shoot we’re styling, we might find it challenging to marshal the willpower to go to the gym when we get home. Indeed, our self-control often fails us at night after the energy reservoir fueling our willpower runs low and causes it to function less effectively.

In order to maximize the effectiveness of our willpower and use it to build our self-esteem we need to do three things: strengthen our basic willpower muscles, manage the energy reservoirs that fuel our self-control so they don’t get depleted, and minimize the impact of the many temptations that exist around us.

Pump Up Your Willpower Muscles

The downside of our willpower being a general muscle is that exerting willpower in one area will cause fatigue and make it harder to exert willpower in another. But this “limitation” has an upside. Exercising our willpower by practicing acts of self-control in insignificant areas will increase the strength and endurance of our willpower muscles in more meaningful and important areas as well. Scientists have investigated several such “willpower workouts,” including focusing on our posture (great for slouchers); avoiding cursing (more effective for potty mouths than it is for the “gosh darn it!” set); avoiding sweets, cookies, or cakes (great if you have a sweet tooth); squeezing a handgrip twice a day for as long as we can (handgrips are cheap and can be found in sporting goods stores); and the one I think works best—using our nondominant hand.

Practicing any task that requires us to regularly inhibit an automatic impulse (e.g., to slouch, use our dominant hand, curse, eat sweets, or let go of the handgrip when it becomes difficult) can be effective if we “train” for a sufficient period of time (at least four to eight weeks). In a variety of studies, such exercises provided significant benefits for smokers who were trying to quit, people with aggressive impulses who struggled to manage their anger, and compulsive shoppers who were trying to reform.

Exercise for Building Willpower

Use your nondominant hand for as many tasks as possible every day between the hours of 8:00a.m. and 6:00p.m. for four to eight weeks (the longer the better). Adjust these hours accordingly if your schedule requires (e.g., if you work the night shift or if you only wake up around noon). Include tasks such as brushing your teeth, opening doors, using a computer mouse or trackball, drinking (other than hot drinks, which can spill and cause burns), carrying things (other than babies and other breakables), stirring, combing your hair, using a fork (when you’re not using a knife), moving objects (other than breakable ones), and any other action for which you typically use your dominant hand.

If you are ambidextrous: Use the posture improvement exercise instead. Monitor your posture so that you are sitting as erect as possible at all times. Avoid slouching, lying down, reclining, or leaning on a desk during the hours of 8:00a.m. to 6:00p.m. (adjust the hours accordingly if necessary).

Make Sure You Have Fuel in the Tank

One of the most essential fuels our willpower muscles require (as do many of our other muscles, both cognitive and physical) is glucose (sugars). Scientists have known for a while that when our glucose levels are low, effortful mental processes such as asserting willpower and self-control are impaired (automatic and noneffortful processes such as washing the dishes are not). In one study, people were put through effortful mental exercises to deplete their brain of glucose levels and then given a glass of lemonade. Half of them received lemonade sweetened with sugar and half got lemonade with an artificial sweetener (which tastes similar but has no glucose). After fifteen minutes (the time necessary for the drink to get absorbed into their systems) subjects who were given lemonade with real sugar recovered from their mental fatigue and were able to display significantly greater willpower than those who drank lemonade with artificial sweetener.

In short, for our willpower to operate best we require optimal levels of glucose. Previous exertions of self-control or lack of caloric intake will make our blood glucose levels drop below optimal levels and our willpower will be weak as a result. Sleep and rest also have a big impact on our willpower’s ability to function at its capacity and being tired or sleep deprived will cause serious impairments in our ability to exhibit self-control.

Avoid Temptations and Manage Them When You Cannot

The average person spends three to four hours a day exerting some form of willpower. Dieters are surrounded by fattening foods, smokers trying to quit walk by people smoking outside most buildings, problem drinkers are never far from a bar or liquor store, students studying for finals face innumerable distractions from friends and electronic devices, and individuals with anger management issues encounter frustrating and provocative situations daily. The best way to manage temptations is not to overestimate our ability to manage them but to avoid them when possible. But there are also techniques we can use when it is impossible to do so.

1. Play One Side of Your Brain Against the Other

Our brain uses different systems to process rewards and risks. When faced with temptations, the reward system (go for it!) can drown out the system that evaluates risk (don’t!). While we can’t lower the volume on our cravings and urgings in such situations, we can turn up the volume on our risk assessment. For example, if we’re trying to quit drinking and we find ourselves at a dinner where alcohol is served we can remind ourselves that the last time we had a drink we made a royal mess of things because we never stop at just one. We can consider how demoralized we’ll feel if we allow alcohol back into our lives and how empowered and thankful we’ll feel the next day if we resist. We can replay snapshots of our spouse’s face the last time we fell off the wagon and see the disappointment in the eyes of our friends, or we can remind ourselves of our commitment, of why we started our journey in the first place, and the reasons we’ve been able to resist our urges so far. Beefing up our risk assessments by preparing a list of them in advance, which we can then refer to in the moment, can buy us just enough time to get through the situation.

2. Minimize the Damage

Many of us become extremely demoralized when we slip and succumb to temptation. “I’ve fallen off the wagon” or “I’ve blown my diet” is a thought that serves no useful purpose other than to give ourselves permission to indulge. After all, if we’ve blown our diet, we might as well eat whatever we want because we’ll have to start all over again anyway.

Viewing slips as simple alerts that our willpower is fatigued and needs to recover (instead of as indications of failure) will allow us to acknowledge the lapse without getting further off track.

3. Avoid the Triggers

Many of our bad habits are prompted by triggers. For example, researchers in one study gave moviegoers stale popcorn and sat them down to watch a movie. They ate just as much of the stale popcorn as they typically ate fresh popcorn—but only because they were watching a movie! When the researchers gave the same participants stale popcorn while watching a music video in a conference room, they barely touched it. Our habits always have triggers, such as lighting up a cigarette when we have a beer, doing recreational drugs when we hang out with certain friends, or biting our fingernails when we sit on the couch to watch television. If we wish to change the habits, we have to avoid the triggers, at least until the new habit becomes well engrained. Sad as it may be, we might have to skip the beers, avoid the drug-using friends (which is not a bad idea in general), or watch TV on a laptop in the kitchen.

4. Practice Mindfulness to Tolerate Urges, Impulses, and Cravings

Mindfulness involves a form of mediation in which we observe our feelings without judging them, in essence becoming anthropologists in our own minds. We act like outside observers, noting the strength of our emotions and the sensations they create in our bodies but without dwelling on them or their implications. Rudy, the stressed-out gambler who was in danger of gambling away his aging parents’ home, had an extremely stressful job that sapped his willpower and made it difficult for him to resist the urge to gamble. I suggested Rudy use a mindfulness technique, not just because it is effective for general stress management but because certain mindfulness exercises can be extremely useful for managing cravings, impulses, and urges (including the urge to gamble).

When learning to manage our cravings and urges we must first accept that such impulses, strong as they are, always pass with time. I suggested Rudy use one of our sessions to practice and instructed him to do the following: “Relax and focus on your breathing. Feel free to close your eyes. Study the urge to gamble as its waves wash over you, as if you were an alien who was interested in the human experience.” (Rudy was a sci-fi fan.) “Visualize the amplitude of the urge’s intensity like a seismograph readout that measures earthquake activity. As the waves come, follow the rise and fall of the dial on the readout; note when one wave intensifies and weakens and where another begins. Observe how different parts of your body feel when the urge intensifies and how the same parts of your body feel when it subsides. Continue to monitor your physiological responses this way, tracking one wave of urges after another as they rush toward you and over you, until the intensity of the waves eventually subsides as every earthquake does.”

Focusing on our breathing, visualizing the seismographic readout, and noting the sensations in our bodies can help us ride out the “quake” and resist acting on our cravings, urges, and impulses until they pass. Practicing this technique when we are not in the grips of our impulses will help us apply it more successfully when we are. Fortunately, Rudy was able to get in several weeks of daily mindfulness practice before the work stress subsided again and the urge to gamble swept in. When it did, Rudy was ready for it and he was able to ride it out. He described the situation as “touch-and-go for a while,” but the confidence he gained by resisting the urge to gamble when he had succumbed to it many times in the past provided a huge boost to his self-esteem.

Dosage: Apply this treatment daily toward goals that require willpower and self-control.

Effective for: Increasing willpower and feelings of empowerment, facilitating progress toward self-improvement goals, and boosting self-esteem.

When to Consult a Mental Health Professional

Self-esteem is a deeply rooted psychological construct and applying the treatments in this chapter such that they yield significant results requires time, effort, and dedication. If you feel unable to apply these techniques or if you’ve invested the time and effort to do so but have not been able to boost your self-esteem as a result, you should consider seeking the advice of a mental health professional.

If there are ongoing circumstances in your life that are contributing to your low self-esteem (e.g., if you have an emotionally abusive boss or partner or if you’re struggling to find work despite making consistent efforts to do so), a mental health professional could help you assess whether you should take steps to change your circumstances (as it is hard to rebuild your self-esteem if it is still actively “bleeding”). Finally, if your self-esteem feels so damaged that you have thoughts of harming yourself or others in any way, seek immediate help from a mental health professional or go to the nearest emergency room.


Create Your Personal Psychological Medicine Cabinet

We sustain frequent psychological wounds as we go through life. Unfortunately, until now, few of us have had the awareness and the know-how to treat them effectively. Instead we tend either to ignore them entirely or to unwittingly react in ways that deepen them and allow them to cause damage to our mental health over time. The treatments in this book (all of which are based on current research by experts in the field) represent a psychological medicine cabinet starter kit, a set of emotional balms, ointments, bandages, and painkillers that we can apply to emotional and psychological injuries when we first sustain them.

However, being a good self-practitioner means developing our own individualized set of mental-health-hygiene guidelines and you should endeavor to personalize your medicine cabinet whenever possible. Although we all sustain psychological injuries when faced with events such as loss, failure, or rejection, the extent of our wounds and the emotional first aid treatments to which they respond best can vary from person to person. The same is true when it comes to the pills and treatments we use to treat our phyical ills. For example, there are numerous over-the-counter pain relievers from which we can choose to treat headaches, backaches, relievers from which we can choose to treat headaches, backaches, and general pain, but we rarely stock all of them in our homes. Trial and error teaches us that one specific brand of pain reliever works better for us than others do and that is the one we are likely to have on hand.

Similarly, you might find that some of the emotional first aid treatments in this book are more effective for your individual psychological makeup than others. Or you might find that a specific treatment works best for you in some situations but that in a different set of circumstances it is more effective to apply another. Taking note of such things will help you refine your choices when applying emotional first aid techniques and make your future efforts more effective.

Psychology is a young science and one in which new approaches and treatments are continually being discovered and updated. That being said, the suggestions in this book are based on sound and fundamental assumptions about psychology and mental health that are unlikely to be radically revised in their entirety. Even if we find a cure for the common cold, neglecting to treat a cold when we first experience symptoms of one will always put us at risk for developing a more severe respiratory illness such as pneumonia. Similarly, even if we discover more effective strategies for dealing with a psychological injury such as failure, neglecting the psychological wounds failure inflicts will always risk damage to our mental health, self-esteem, and emotional well-being. Therefore, although the contents of our psychological medicine cabinet might need to be updated at some point in the future, having one and using it regularly will always be necessary and beneficial.

It is my sincere hope that prioritizing our mental health and taking the steps necessary to enhance and maintain it will become a daily practice, a habit we all integrate into our lives from an early age. Teaching our children to practice mental health hygiene and instructing them on how to apply the principles of emotional first aid can have an extraordinary impact on their lives and on society at large. All it would take is for the practice of mental health hygiene to become as ubiquitous as the practice of dental hygiene is today, and we could witness, in our lifetimes, a new generation of emotionally resilient and psychologically sophisticated people who confront life’s hardships with both strength and resolve, who recover from them rapidly and more completely, and who enjoy far greater happiness and life satisfaction than the average person does today.

If such notions seem foolish or romantic, consider that the goal of leading happy and satisfying lives was one few people even considered several generations ago. Most people were too busy struggling to fulfill basic needs such as food, shelter, and survival to worry about whether they were happy. Perhaps several generations from now, our descendants too will look back at us and marvel at how we took better care of our teeth than we did our minds, of how few of us thought to apply emotional first aid techniques when we sustained common psychological injuries.

Of course, until now, we’ve lacked the resources and the know-how to adopt such general practices and we’ve been unable to create a revolution in how we think about and care for our mental health and emotional well-being on a large scale. But we are limited no longer. Anyone who wishes to lead an emotionally healthier and happier life need only open his or her psychological medicine cabinet and reach for the treatments within.





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