Raising self-esteem

Question:
I have felt down with low self-esteem during the years I have been sick. Also, my disease and the medication(s) I take for it have caused physical changes that I am self-conscious about. I am getting healthier on AP but want to know what I can do to begin the process of feeling good about myself again.

Response:
Unfortunately, but understandably, many people who are diagnosed with a chronic or serious illness find that their self-esteem suffers along with their health. Initially, it is very common for people to blame themselves for their illness. Because human beings have an innate need to make sense of their lives and the world they live in, it is natural to look for cause and effect explanations of significant events. For example, you might decide that if you had more successfully managed the stress of moving or the new job or the divorce or any number of difficult situations, you would not have developed a rheumatic disease. Of course, this isn't true, and although this explanation might comfort some people who see it as an answer to the common question: "why now, why me?" it's ultimate effect is to strike a blow at your feelings of confidence, competence, and worth. Being ill is not your fault! Your attitudes can affect how you cope with a disease, and live well in spite of it, but they cannot give you arthritis or lupus or scleroderma.

After diagnosis, the prescription drugs you take, and your illness itself, may affect your appearance, and lower your self-esteem. Many of you have taken medications before you started on antibiotics, and some of you may be taking them concurrently with your antibiotics. It's not uncommon for them to have side effects that cause unwanted changes in how you look. For example, steroids can cause weight gain, changes in the shape of your face, and hair loss and thinning. Or your illness can prevent you from exercising, so a formerly active person who prided themselves on their physical fitness may experience unfamiliar changes in their body as well. Finally, rheumatic diseases themselves can cause changes in your joints, skin, and posture. These are factors that are often beyond your control, but your beliefs and behaviors are something you can do something about! And learning to feel good about yourself can greatly enhance the quality of your life, and isn't that what it's all about?

So let's look at improving your self-esteem. Here's what not to do. Don't use "All-or-Nothing thinking". For example, you might say to yourself, "I don't feel great; I've gained a lot of weight, my joints are all crooked, so why bother buying new clothes or getting my hair cut? I still won't look good." I call this "all or nothing thinking" because your belief is that you don't want to do anything about your appearance if it can't be all you want it to be. Another example: "I can't run 5 miles anymore, so I won't be able to get any exercise now that I have arthritis." Avoid this type of self-defeating thinking! Treat yourself as well as you would a beloved friend or family member. Use positive self-talk, and start adding positive actions to positive attitudes for a proven way to start liking yourself and your life again.

It's important to learn to take charge of and change the things you can, instead of focusing on what's out of your control. Doing small things for your self is a good place to start when your self-esteem has been shattered. Try this technique that can help you decrease feelings of helplessness and hopelessness, and replace them with positive feelings about yourself and your life:

ACTIVITY PLANNING FOR SELF-RESPECT AND PLEASURE

• Every day, think of one small action for self-respect and one small action for pleasure.
• An activity for self-respect is one that would usually make you feel "proud" of yourself for doing it. It is not necessarily one you enjoy. For example, it could be cleaning off the top of your desk. But don't pick a big project, like cleaning the house!
• An activity for pleasure is one that you typically enjoy. Popular choices are reading a chapter in a good book, watching a favorite TV program, or talking a short walk.
• Write it down in a notebook along with the day of the week and the date.
• Rate each activity on this scale, with zero representing getting no pleasure or self-respect after engaging in the selected activity, and 10 representing the most pleasure of self-respect you can imagine. Record the number next to the activity.
  
  0__________________________________10
  No Pleasure or Self-Respect                    The Most Pleasure or Self Respect
  
  
• You may not feel pleasure or self-respect at first, but keep selecting activities that would have provided these feelings in the past. Keep at it! Change needs time.

Use this notebook as a reminder of what you've done for yourself and what activities make you feel better about yourself. To increase self-esteem, it is very important to experience joy and a sense of accomplishment. And it is also important to have a realistic understanding of how small pleasures and achievements can give your life and attitude a needed boost! The journey toward healthy self-esteem can start with these small steps. And to learn even more about how your thoughts and actions can affect your self-esteem, I recommend: The Feeling Good Handbook by David Burns, Ph.D.

Dr. Susan E. Grober, psychologist