The influence of individual, group, and relative self-esteem on outcome for patients undergoing group cognitive-behavioural therapy treatment

Objectives Despite a strong association between individual self‐esteem and treatment outcome in group cognitive‐behavioural therapy (GCBT), no study has investigated how patient outcomes might be influenced by an individual's self‐esteem relative to other group members. Design The study comprised a retrospective examination of patients' data and used a multiple regression analysis to identify predictors of treatment outcome. Patients' pre‐treatment self‐esteem scores were assessed on a continuum and assigned to be low, medium, or high. Therapy groups were assigned to be either low, balanced or high self‐esteem groups based on averaged self‐esteem scores of participants. Methods In this study, 3,878 patients who had completed a 10‐day intensive cognitive behavioural group therapy programme at a private psychiatric facility were included in the study. The Rosenberg Self‐Esteem measure was chosen to assess self‐esteem. The three subscales of the Depression Anxiety Stress Scales were used as the outcome measures. Results Patient outcomes were influenced by pre‐treatment self‐esteem scores, such that higher initial self‐esteem was associated with better treatment outcomes. Low group self‐esteem was predictive of significantly better outcomes for depression, relative to higher self‐esteem groups. Additionally, the combined influence of high individual self‐esteem and low group self‐esteem was associated with significantly enhanced depression improvement. Conclusions High self‐esteem patients perform better on outcome measures following completion of GCBT. Low self‐esteem groups show greater improvement in depression symptoms. Similar results for depression are achieved when patients with high self‐esteem complete treatment in low self‐esteem groups. Practitioner points Patients with higher pre‐treatment self‐esteem perform better on outcome measures compared to individuals with lower self‐esteem. Low self‐esteem groups perform better with respect to depression improvement. Similar results are found when high self‐esteem patients complete treatment in low self‐esteem groups. The study was a retrospective examination of patients' data and not a manipulation study; therefore, cause and effect relationships were not able to be determined. The generalizability of the finding to patients in other health settings remains to be determined.