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The effectiveness of a domain specific self-esteem group intervention: a pilot study Ciping Goh D. thesis (Volume 1), 2018 University College London 1 UCL Doctorate in Clinical Psychology Thesis declaration form I confirm that the work presented in this thesis is my own. Where information has been derived from other sources, I confirm that this has been indicated in the thesis. Signature: Name: Ciping Goh Date: 22 June 2018 2 Overview Volume one of this thesis is presented in three parts.

Part one presents a systematic review of domain specific self-esteem measures for adults. A total of 13 papers evaluating 10 domain specific self-esteem measures were reviewed. Results indicated a general lack of psychometric robustness of measures in literature. Future research should focus on the continued validation of these measures.

Part two is an empirical study which investigated the effectiveness of a domain specific self-esteem group intervention developed by Hollingdale (2015). The empirical study was conducted jointly with Emily Dixon. Results indicated an improvement in domain specific self-esteem (i. perceived competence) in valued domains.

The discrepancy between perceived competence and importance placed in valued domains decreased after the intervention. Attributional styles towards negative events showed a shift towards more external, unstable and specific styles post-intervention and continued moving towards this direction at the one-month follow up. A significant relationship was found between domain specific self-esteem and attributional styles towards negative events. Overall, the domain specific self- esteem group is a promising intervention for self-esteem that requires further study.

Part three provides a critical appraisal of the systematic review and empirical study. It begins with a discussion about definitional and measurement issues faced when conducting the systematic review. The commentary about the empirical study includes reflections on the theoretical issues, measurement issues, group experience and challenges faced. It concludes with a reflection on implementing the domain specific self-esteem group within the National Health Service (NHS).

3 Impact Statement Low self-esteem has been found to be an aetiological factor in a variety of mental health diagnoses, such as depression, anxiety, psychosis, eating disorders and obsessive compulsive disorder (Waite, McManus & Shafran, 2012). Difficulties with self-esteem and the impact it has on individuals’ mental health and wellbeing are commonly seen in clinical practice (Fennell, 1997). It is therefore critical to develop and evaluate effective treatments for improving self-esteem. There is extensive evidence in research supporting the domain-specific nature of self-esteem (Byrne, 1996).

Domain specific self-esteem refers to an individual’s self-appraisals within circumscribed domains, for example, intellect and athleticism (Harter, 2012). Individuals therefore may hold different levels of self-esteem in various domains. Hollingdale (2015) developed the unsatisfactory self-esteem model that considers domain specific self-esteem to be on a spectrum that at times can become “unsatisfactory” for an individual’s needs. This depends on their preferred level of functioning, within a specific domain, situation or period in their life.

The present research consisted of two aims. The first was to conduct a systematic review of existing domain specific self-esteem measures for adults in literature. Although some identified measures showed promise in terms of their psychometric properties, notable weaknesses in study methodology and psychometric properties were also found. Future research should therefore focus on the continued validation of these measures.

In mental health services, the use of domain specific self-esteem measures would allow clients and therapists to identify domains of focus for therapeutic interventions that are clinically meaningful to work on. Moreover, the developmental stages (e. adolescent, adult, older adult) that 4 some domain specific self-esteem measures account for might be relevant for specific populations in clinical settings. The further development of domain specific self-esteem measures would have real practical implications for how self-esteem is treated in the clinical setting.

The second aim of the present research was to develop and pilot the first known domain specific self-esteem group intervention. The research was conducted as an uncontrolled trial. The four-session Cognitive Behavioural Therapy (CBT) group intervention was based on the unsatisfactory self-esteem model developed by Hollingdale (2015) with the aim of improving domain specific self-esteem. The intervention consisted of the following components: charting individual domain specific self-esteem profiles; identifying valued domains; and employing various CBT techniques such as thought diaries and behavioural experiments.

The brief intervention provided preliminary evidence of clinical benefits such as improvements in domain specific self-esteem and attributional styles towards negative events. Moreover, the treatment gains appeared to be durable, at least for a month after the intervention ended. Clinically, the current group intervention allows clinicians to identify idiosyncratic life domains in which it would be meaningful to intervene in. This is likely to improve clients’ engagement in the intervention and increase motivation for change.

Moreover, a transdiagnostic intervention, such as the present group intervention might be beneficial for use across multiple mental health diagnoses. Future research should focus on evaluating the present group intervention in a controlled trial and also investigate how the intervention might complement evidenced based therapies that are utilised in local mental health services. 5 Table of Contents Acknowledgements. 9 Part 1: Literature Review.

68 Part 2: Empirical Paper. 132 Part 3: Critical Appraisal. 144 Reflections on the Literature Review. 144 6 Reflections on the Research Paper.

162 7 Tables and Figures Part 1: Literature Review Figure 1. 57 Part 2: Empirical Paper Figure 1. 112 8 Acknowledgements It gives me great pleasure to acknowledge the guidance and support given to me by my supervisors Henry Clements and Sue Watson, who continually supported and encouraged me throughout the research process. They were a great help to hurdle the obstacles in the completion of this thesis.

I would also like to thank to Emily Dixon for helping to make this joint project such a positive experience. It was a pleasure working with her throughout the entire research process. I would like to acknowledge Jack Hollingdale, who conceptualised the self- esteem model and group intervention used in the empirical paper. It was a privilege to work with him and take his ideas forward.

I would also like to express my gratitude to Joshua Stott for his guidance with my systematic review and research data analysis. I am thankful for his willingness to help despite his tight schedule. I appreciate the time and expertise offered by Rob Saunders, Ravi Das, and John King for the data analysis portion of the empirical study. I also appreciate Sunjeev Kamboj for his help with the study design.

My gratitude goes out to the people who volunteered their time to participate in this research, for which this study would not have been possible. Finally, my appreciation goes out to my fiancée and family who have journeyed with me over this period and showered me with numerous encouragements along the way. Above all, this thesis would not have been possible without my Lord and Saviour Jesus Christ, who has given me grace and strength to accomplish this. All glory goes to Him.

9 Part 1: Literature Review A Systematic Review of Domain Specific Self-Esteem Measures for Adults 10 Abstract Aim. Self-esteem is one of the most studied topics in research and clinical literature. Therefore, the adequate measurement of the construct is crucial. The objective of the present literature review was to summarise and critically appraise the quality of the measurement properties of instruments that measure domain specific self-esteem in adults.

A range of databases were searched, and articles were selected if their primary purpose was the development or assessment of measurement properties of instruments measuring domain specific self-esteem in adults. Methodological quality was assessed using the COnsensus based Standards for the selection of health Measurement INstruments checklist (COSMIN). A total of 13 papers evaluating 10 domain specific self-esteem measures met the inclusion criteria. Overall, the Self-Image Profile for Adults (SIP-AD) had more evidence for its psychometric properties compared to other instruments.

However, all the measures examined were found to have notable weaknesses. The analysis found a general lack of psychometric robustness in the measures used in current literature. Future research should focus on the continued validation of these measures, while bearing in mind the complexities around measuring the construct of domain specific self-esteem. 11 Introduction Self-esteem is one of the most studied topics in the social sciences and psychology (Mruk, 2006).

Despite the amount of research in this area, there is still considerable debate on the definition of self-esteem. Researchers have defined self- esteem as a need (Maslow, 1954), an attitude (Coopersmith, 1967), a belief in one’s competence (James, 1980) and being good enough as a person (Rosenberg, 1989). Irrespective of the definitional debate, the construct of self-esteem has been extensively examined in the literature, with many studies indicating links between the construct and various outcomes. High self-esteem is linked to coping with life stresses and achieving more in life (Coopersmith, 1967; Harter, 1990).

It is also associated with greater autonomy, sense of mastery, positive relations with others and self-acceptance (Paradise & Kernis, 2002). In contrast, low self-esteem has been identified as an aetiological factor in a variety of mental health conditions such as depression (Brown, Bifulco, & Andrews, 1990), anxiety (O’Brien, Bartoletti, & Leitzel, 2006; Watson, Suls, & Haig, 2002), psychosis (Hall & Tarrier, 2003) and eating disorders (Gual, Perez-Gaspar, Martinez-Gonzallaz, Lahortiga, & Cervera- Enguix, 2002). Taking into account the continued interest in self-esteem in research and clinical literature, the adequate measurement of the construct is critical. A Note on Terminology: Self-Esteem and Self-Concept One complexity in defining self-esteem is its conflation with self-concept.

Most researchers seem to agree that while self-concept implies a broader definition of the construct that includes cognitive, affective, and behavioural aspects, self- esteem is thought to be a more evaluative component of the broader self-concept term (Blascovich & Tomaka, 1991; Wells & Marwell, 1976). However, Shavelson, 12 Hubner and Stanton (1976) argued that self-concept is both descriptive and evaluative. Therefore, self-concept measures that include statements such as “I am good at mathematics” and “I can run a long way without stopping” have both evaluative and descriptive components (Marsh & Mara, 2008). Typical self-esteem and self-concept instruments consist of items that elicit both descriptive and evaluative components of the self, therefore making it almost impossible to separate these two constructs (Byrne, 1996).

Accordingly, it is common for most researchers to use the two terms interchangeably (Hughes, 1984; Shavelson et al. The complexity of teasing these two constructs apart arguably warrants a separate discussion. Therefore, consistent with other reviews of self-esteem measures (e. Byrne, 1996), this review will use both ‘self-esteem’ and ‘self-concept’ terms in the search and evaluation of instruments.

Conceptualising Self-Esteem: Global or Domain Specific? Harter (1990, p. 292) wisely reflected on the importance of not putting the “methodological cart before the conceptual horse”. Already, past reviews of self- esteem research have found the lack of theoretical basis and the poor quality of measurement instruments in many studies (e. Burns, 1979; Shavelson et al., 1976; Wells & Marwell, 1976; Wylie, 1974, 1979).

Byrne (1996) noted that variations in definitions of self-esteem at the conceptual level have led to methodological differences at the measurement level. One important issue in self-esteem research is whether self-esteem is conceptualised as a global or a multidimensional concept (Hertherton & Wyland, 2003). Most self-esteem research has traditionally considered the construct as a global concept, that is, an individual’s global evaluation of oneself 13 that is stable across time and situations (Rosenberg, 1989). Most research examining self-esteem has utilised self-report scales that measure global evaluations of the self.

However, since the 1980s, there is now a wealth of evidence supporting the multidimensional nature of self-esteem (Byrne, 1996). 427) conducted an extensive review of construct validation research of self-esteem and concluded that self-esteem is indeed “a multidimensional construct, having one general construct and several specific facets”. Furthermore, Marsh and Craven (2006, p.