Abstract
Self-esteem is recognised as being an important contributing factor to individual wellbeing.
This systematic review sought to assess the impact of school-based interventions aimed at enhancing global self-esteem in adolescents. Findings demonstrated varied approaches to self-esteem interventions with mixed results. However, a slight majority of study outcomes indicated that self-esteem could be enhanced through intervention. Analysis of study themes identified some common approaches used in the most effective interventions: psychoeducational strategies, attitudinal change and social connection. The results from these were promising, however further research is needed to strengthen the conclusions drawn. Self-esteem measurement tools are discussed and the use of the popular Rosenberg Scale is questioned.
1 Introduction
1.1 Defining Self-Esteem
Self-esteem is a highly used term, though one which appears to have several definitions with varying distinctions. The term self-esteem dates to more than a century ago when William James referred to the term in what is regarded as the first American text-book on psychology (1890/1983, p. 296). He defined self-esteem in the following way:
“Our self-feeling in this world depends entirely on what we back ourselves to be
and do. It is determined by the ratio of our actualities to our supposed potentialities;
a fraction of which our pretensions are the denominator and the numerator our
success: thus, Self-esteem = Success/Pretensions”
This definition of self-esteem focuses on individual success which could also be seen as competence. The term “pretensions” would now be more accurately understood as aspirations. This suggests that the type of competence needed for self-esteem is one that is related to an individual’s identity and is of personal importance (Mruk, 2013).
Interest in self-esteem developed substantially in the 1960s and it was during this period that psychologists such as Carl Rogers and Abraham Maslow explored self concept and self-esteem from a humanistic perspective. They related the significance of self-esteem to self-actualization (Mruk, 2013). Another influential psychologist of this period was Rosenberg who created the most frequently used measure of self-esteem “The Rosenberg Scale”. He defined self-esteem as an indicator of self-acceptance, self-respect, and satisfaction with oneself (Niveau et al., 2021). In this sense, the focus is less one’s competence, instead it could be defined as a sense of self-worth. The Rosenberg scale: a 10-item questionnaire (Appendix A) highlights this focus with statements such as “I feel I am a person of worth, or at least on an equal plane to others” and “On the whole, I am satisfied with myself”.
The terms self-esteem and self concept are sometimes used interchangeably, but although they are closely linked, there are subtle differences. According to Carl Rogers, self-esteem forms part of our self concept. From this perspective, self concept consists of three parts: ideal image, self image and self-esteem. He noted that self-concept is not always aligned with individual aspirations. If there is a mismatch between self-image and the ideal self, self-concept is said to be incongruent and this incongruence can negatively affect self-esteem (Koch, 1959).
However, some more recent definitions appear to contradict the view of self-esteem being one aspect of a greater self concept. O’Mara (2006) and Marsh and Craven (2006) refer to a multi-modal definition of self-concept with self-esteem being the overarching view people hold of themselves. Thus, self-esteem refers to a more global self-concept, distinguishing it from specific domains such as physical, social or academic (O’Mara, 2006). In this study, the use of the term self-esteem will align with these more recent definitions and will thus refer to a global self-perspective.
1.2 Theories of Self-Esteem
Before considering the reasons behind the interest in self-esteem, it is worth exploring some concepts behind it. Self-esteem is usually understood in terms of three main theories: Terror Management Theory, the Sociometer Theory and the Self-Determination Theory (Ryan & Deci, 2004). Each of these rest on the assumption that self-esteem is not pursued for its own sake but instead serves a more significant purpose.
Terror Management Theory of self-esteem relates to the fear and anxiety it is assumed individuals have about their certain, eventual death. Through this theory, self-esteem functions as a buffer against this anxiety, helping individuals to feel significant and that their life has purpose (Harmon-Jones et al., 1997). The Sociometer theory is based on the idea that social inclusion has a survival value for humans. In evolutionary terms, exclusion from the protection of a group would bring a much higher chance of death. Thus self-esteem may have developed as a system which monitors and responds to cues of interpersonal acceptance or rejection (Perinelli et al., 2021).
However, Ryan and Deci (2004) argue that both the Terror Management Theory and the Sociometer Theory of self-esteem are incomplete. Both theories suggest that self-esteem is driven by anxiety and is therefore defensive in nature. Their alternative perspective, Self-Determination Theory, emphasises other intrinsic motives that people have which motivate the pursuit of competence, connection, meaning, and significance. Self-Determination Theory proposes that individuals are born with intrinsic motivations to explore, absorb and master their surroundings. With this basis, the theory identifies three core psychological needs: relatedness, competency and autonomy. These needs are seen as essential in promoting motivation, personal growth and well-being and when any of these needs are compromised, self-esteem is affected (Ryan & Deci, 2004).
Figure 1: The Core Psychological Needs in Self Determination Theory (Legault, 2020)
1.3 The Value of Self-Esteem
Since the first conceptualisation of self-esteem in 1890, the concept, along with its reported benefits, has gained traction in both the scientific community and amongst the general public. From the late 1980’s, low self-esteem became associated with a host of social problems such as substance abuse, welfare and teenage pregnancy (Mruk, 2013). In the book, The Social Importance of Self-Esteem, Smelser (1989, p1) states that
“many, if not most, of the major problems plaguing society have roots in the low
self-esteem of the many people who make up society. It is supposed that those
citizens who appreciate themselves and have a sense of personal empowerment will
cultivate their own personal responsibility and will attend to the tasks necessary for
the welfare for the community and the society” (Mecca et al., 1989)
Current thinking on self-esteem generally emphasises its significance for both individuals and society. As self-esteem can affect the full behaviour spectrum, it is thought that a healthy self-esteem may support success in areas, including relationships, education, employment, mental health and physical health (Orth & Robins, 2022). These benefits could be explained by both interpersonal and intrapersonal factors. For example, high self-esteem could assist individuals in making and keeping close social relationships, which may lead to positive outcomes in other areas of life. Those with high self-esteem are also generally more resistant to life’s challenges, persisting in the face of failure which again could lead to better outcomes in work, relationships and health (Orth & Robins, 2022).
However, although high self-esteem appears to be reputed for its benefits, some refute the validity of such statements and argue that high self-esteem is associated with negative traits such as narcissism, and aggression (Baumeister et al., 1996). Narcissism and high-self esteem may share some similarities (for example regarding oneself positively and scoring highly on measures such as the Rosenberg scale of self-esteem). Nevertheless there are some important differences that are important to clarify. Narcissism is when an individual has an unreasonably high sense of their own importance (Mayo Clinic, 2023), yet research also suggests that narcissists hold fragile views of themselves (Donnellan et al., 2005). In contrast to healthy self-esteem which is characterised by robustness and an ability to recover from setbacks, narcissism can involve intense shame of perceived shortcomings, sometimes leading to aggressive behaviours (Brummelman & Sedikides, 2020). These differences become important when looking at the effects each construct has on social relationships, mental health, and behaviour (Orth & Robins, 2022).
1.4 Redefining Self-Esteem
It is important to consider the definition of self-esteem being used when examining its benefits. Although high self-esteem has been reported to have potential negative effects (Baumeister et al., 2003), others argue that this view is as a result of a limited, unidimensional definition; that self-esteem is not only about feeling ‘good about one’s self’ which can easily be associated with negative traits such as narcissism. Instead, a differentiation between high self-esteem and “genuine” or “authentic” self-esteem has been made (Mruk, 2013). Such approaches identify several types of self-esteem. Although these approaches still associate low self-esteem with negative states such as depression and anxiety, another form of self-esteem has been identified: defensive self-esteem. It is this type that may have the negative traits of narcissism or aggression that critics have associated with self-esteem that is “too high” (Mruk, 2013).
A two-factor approach, in which self-esteem is defined in terms of a relationship between competence and worth, may help to explain the differences between defensive and genuine self-esteem. Nathaniel Branden (1969) offered one of the first definitions viewing self-esteem in this way when he stated that self-esteem could be seen as the integrated sum of self-confidence and self-respect (Mruk, 2013). To clarify this definition, Mruk (2013) explored how one component may look without the other, stating: “competence without worthiness can result in negative acts of human behaviour, such as lying, stealing, or injuring others for personal gain; whereas feelings of worthiness without doing something to earn them is narcissism”. (p29)
This seems to combine both the definitions outlined previously – the definition of self-competence (as suggested by James, 1890) and the definition of self-worth (as suggested by Rosenberg). This two-factor approach has been prevalent in the scientific community under a few different guises, from the “dual model” of self-esteem (Franks & Marolla, 1976), to a “two-factor” theory (Tafarodi & Swann, 1995). More recently, a “multidimensional approach” (Harter, 1999; Marsh & Craven, 2006; O’Mara et al., 2006) has become more prevalent.
1.5 Self-Esteem in Adolescence
This review explores the impact of self-esteem interventions in adolescence; an age range chosen for a number of reasons. Firstly, adolescence is increasingly recognised as a sensitive period in development and therefore plays a significant role in individual developmental trajectories (Anderson, 2021). Meta-analyses of self-esteem development also show significant decline in both self-esteem (Orth & Robins, 2022) and subjective well being (Marquez & Long, 2020) in early adolescence, highlighting the value of targeting this life stage.
Recent research using data from the UK’s Millennium Cohort (a total of 11,231 adolescents) has shown evidence of a dramatic decrease in adolescents’ subjective well being over the last decade (Katsantonis et al., 2022). In this study, trends between subjective well being and self-esteem were analysed with cross-lagged modelling showing that self-esteem predicted later changes in subjective well being. This suggests that self-esteem is an important contributor to adolescents’ subjective well being and is worthy of focused intervention. In contrast, subjective well being did not predict changes in self-esteem (Katsantonis et al., 2022).
These patterns of decline could be due to a number of different factors. Pubertal hormones are likely to play a significant role in neurological development and the enhanced neuroplasticity identified during this period (Laube et al., 2020; Sisk, 2017). In addition, adolescence is a stage of life which is characterised by transitions and changes to interpersonal relationships (Salmela-Aro, 2011). One of the most significant transitions that takes place is the one from primary to secondary education: one which is linked with decrements in well-being, peer relationships and attainment (Evans et al., 2018). Peer relationships take on increased importance during adolescence as they help to foster identity development (Bowlby, 1969; Erikson, 1968) yet relationships tend to be particularly affected by the secondary school transition (Eccles et al., 1993). This is also a time when antagonistic relationships and bullying increases (Brown & Larson, 2009).
Within the last two decades, the growth of technology and social media has added additional stressors to the lives of many. Today’s adolescents are navigating an online world in which social comparison can be hard to escape. Social media has the potential for the user to compare their own lives to the, often highly enhanced, projected lives of others at any hour of the day (Cingel et al, 2022). Perhaps as a result of this, research has found that adolescents with a higher than average use of social media experience poorer sleep quality, lower self-esteem and higher levels of anxiety and depression (Woods & Scott, 2016).
Adolescence is documented to be a particularly vulnerable time for girls, who show a steady deterioration in self-esteem (in contrast to fluctuating self-esteem in boys) as well as rates of depression twice that of boys (Marcotte et al., 2002). This has been attributed to various factors including negative attitudes towards gender roles (Helgeson, 2016), and concerns over physical appearance (Sherrow, 2001; Harter, 1993). In light of the research on changes in social relationships during the secondary school transition, it is worth noting that while adolescent males’ levels of self-esteem appear to be influenced most by achievement, adolescent females’ self-esteem shows a greater level of reactivity to social relationships. As a result, female adolescents may benefit more from teacher and peer support (Kilpatrick-Demaray & Kerres-Malecki, 2003).
1.6 Self-Esteem Interventions
Taking into account the above, it would seem that raising genuine self-esteem is a worthwhile goal to pursue, especially among adolescents. A school based intervention may be one of the best ways of achieving this due to relative ease of delivery. Previous meta-analyses looking at self-esteem or self concept interventions have found promising results and made some key recommendations for practice. For example, findings from Haney and Durlak’s (1998) meta analysis suggest that self-esteem interventions can significantly improve children and adolescents’ self-esteem, as well as making additional improvements to behaviour, self-reported personality functioning, and academic performance (Haney & Durlak, 1998). However, Haney & Durlak used a unidimensional approach to explore self-esteem which has been criticised by some to be limited. A multi-dimensional approach was explored by both Marsh & Craven (2006) and O’Mara et al., (2006). Both studies emphasise the benefits that self-esteem interventions can offer but also identify certain conditions for optimal interventions.
Marsh and Craven (2006) suggested that the long-term impact of interventions was likely to be stronger if both performance and self-concept were increased. They felt self-concept may not be sustained over time without additional work on skills that may enhance feelings of competence. With this understanding, they developed the reciprocal-effects model (REM) which underlines a bi-directional relationship between a specific component of self-concept (e.g., academic self-concept) and performance in a related area (e.g., academic achievement). Marsh and Craven outline this concept in the following way “people who perceive themselves to be more effective, more confident, and more competent accomplish more than people with less positive self-perceptions (‘‘I believe; therefore, I am’’) (Marsh & Craven, 2006, p134). This theory has clear links to the two-factor approach which suggests that self-esteem exists as a combination of both self-concept and self-worth.
Notably, both Marsh and Craven and O’Mara believed that an individual’s self concept is made up of different domains (e.g. physical appearance, athletic, academic). Through this understanding, the “most powerful effects of self-concept are based on specific components of self-concept most logically related to specific outcomes (a multidimensional perspective), rather than on the global component of self-concept represented in global measures of self-esteem (a unidimensional perspective)” (Marsh & Craven, 2006). As a result, they believe that “optimal” interventions should focus on enhancing self-concept in specific domains relevant to the goals of the intervention (O’Mara, 2006).
Although this suggests that the biggest effect sizes can be found in domain specific measures of self-concept, they acknowledge that global concept or self-esteem is also increased to a smaller extent. Given the benefits that global self-esteem can have both on wellbeing and outcomes, this suggests that the overall impact on global self-esteem should not be ignored and that more domain specific interventions could be a viable way of achieving this.
Another finding of note involved the target population for intervention. Interventions targeting adolescents with pre-existing problems (e.g. low self-esteem, behavioural problems or learning disabilities) were more effective than global or preventive interventions. This may be due to the fact that individuals without pre-existing problems may have relatively high levels of self-esteem so could show less of an increase following intervention (O’Mara, 2006). Although everyone can arguably benefit from enhanced self-esteem, this finding suggests that self-esteem interventions may be especially valuable for “at risk” populations and may be a pertinent way of closing the achievement gap, often present between those “at risk” and those who are not (O’Mara, 2006).
2. Method
2.1 The Research Question
This systematic review explores the research question: Are school-based self-esteem interventions effective in improving the self-esteem of adolescents?
In order to gain an up to date understanding of current self-esteem interventions and their effectiveness, a systematic review was conducted. Systematic reviews are a type of literature review that are designed to synthesise the available evidence relating to a specific research question. In doing so, information collated can then be used to inform policy or, in this case, support decisions about the use of interventions.
2.2 The Search Strategy
The review was a collaborative project with two fellow MA students. Collaboration is helpful when conducting systematic reviews as it helps to provide inter-rater reliability: the degree to which two or more people are consistent with their responses (Morling, 2020). During February and March 2023, scoping searches were made focusing on self-concept and school-based interventions. These initial searches indicated conflicting views in terminology, often with self-concept and self-esteem being used interchangeably. The definition that we have used defines self-esteem as the overarching view of self-concept with self concept itself consisting of different domains (Marsh & Craven, 2006; O’Mara et al, 2006). This was because we were primarily interested in interventions that support mental health, of which global self-esteem is viewed as playing an important role (Orth & Robins, 2022; Mruk, 2013; Nathaniel Brandon, 1986). Literature suggests the adolescent age range could be targeted as it is during this period that global self-esteem faces greatest decline (Katsantonis et al., 2022; Orth & Robins, 2022). As the focus was on school based interventions, we capped the upper age limit at 16, the time when many countries end compulsory education. This helped us to develop our inclusion and exclusion criteria, recorded on Table 1.
Table 1: Inclusion and Exclusion Criteria
| Inclusion criteria | |
| Population | Adolescents (aged 9-16) |
| Intervention | Interventions in which improving children’s global self-esteem is one of the primary outcomes |
| Outcome | Impact on self-esteem – quantitative measures |
| Study design | All |
| Setting | In school |
| Language | English |
| Exclusion criteria | |
| Studies published before 2006 | |
A more rigorous search of literature was conducted between 11th April 2023 and 8th May 2023 using the following databases: Research Gate, PubMed, British Education Index, ERIC, Education Source, APA Psychnet, Psychinfo and Google Scholar. Initial searches gave hundreds of irrelevant results until we limited search terms to the title and abstract. As a team, we found that different databases required different search terms to maximise the relevance of the results. The exact search terms and databases used are displayed in Table 2. The decision to exclude studies published before 2006 was made due to previous meta-analyses (O’Mara et al., 2006; Marsh & Craven, 2006) of self-esteem interventions. To avoid repetition of this research, we chose to examine the research conducted since then.
Table 2 : Database Search Terms
| Database | Date of search | Search terms | Number of results |
| PubMed | 11/04/23 | (adolescen* OR child* OR young people) AND (school* OR school-based) AND “self-esteem intervention” | 3 |
| PubMed | 11/04/23 | (adolescen* OR child* OR young people) AND (school* OR school-based) AND “self-esteem improv*” | 4 |
| Google Scholar | 13/04/23 | allintitle: school “self esteem intervention” | 12 |
| PubMed | 24/04/23 | (school) AND (repeated measures) AND (children OR adolescent) AND (“self-esteem”) AND (improve OR increase) intervention Filter – Clinical trials and randomised controlled trials, 2006-2023 | 11 |
| British Education Index | 24/04/23 | TI self esteem AND TI intervention | 3 |
| ERIC | 01/05/23 | “self-esteem intervention” AND adolescent AND school | 4 |
| ERIC, British Education Index, Education Source | 08/05/23 | TI: Self-esteem OR self-worth OR self-concept TI: Intervention AB: Adolescents OR school | 14 |
| APA PsychNet, PsychInfo | 08/05/23 | Title: self-esteem AND Title: intervention AND Abstract: adolescen* OR Abstract: school AND Peer-Reviewed Journals only | 21 |
2.3 Screening and Selection
After collating links to the articles found, we created a screening tool on Microsoft forms based on our inclusion and exclusion criteria (see Figure 2). To ensure inter-rater reliability, each article was screened by two of the groups. This left us with 16 articles for our review.
Figure 2: Screening Tool Questions
- Your name
- Authors name
- Article title
- Year published
- Journal name
- Is there an intervention
(if yes, questions continue)
- Is the intervention population children between 9-16 years old?
- Is improving participants’ global self-esteem a primary intended outcome of the intervention?
- Does the intervention take place in a school setting?
- Does the study include quantitative measures of self-esteem?
- Included at this stage?
All members of the group screened the full papers and discussed them in relation to our inclusion/exclusion criteria. Due to some errors in the initial screening process, three studies that fell outside of our initial age-range for inclusion had been screened in (Andrade, 2021; Steese, 2006; Sundgot-Borgen, 2020). After discussion, we decided to increase the age range to 18 as this is widely accepted to be adolescence and many adolescents remain in full time education. This meant that two of the three studies were included but the final study’s (Andrade, 2021) population ranged from age 7-11 which we felt was below the target population of adolescents that we were focusing on. We did a final screen of all the studies to check there were no others that should be screened in after our change in inclusion criteria. Other reasons for exclusion are noted in Table 3.
Table 3: Study Screening and Selection
| Reference | Included at screening? | Obtained paper? | Included at selection? | Reason for exclusion |
| Amin (2020) | Yes | Yes | Yes | |
| Andrade (2021) | Yes | Yes | No | Sample is 7-11 years old – some participants were out of the adolescent age range. |
| Boulton (2017) | Yes | Yes | Yes | |
| Brouzos (2020) | Yes | Yes | No | Self-esteem is measured but not targeted in the intervention |
| Dalgas-Pelish (2006) | Yes | Yes | Yes | |
| Darrow (2009) | Yes | Yes | Yes | |
| Datu (2021) | Yes | Yes | Yes | |
| Dhawan (2019) | Yes | Yes | Yes | |
| Kawser (2021) | Yes | Yes | No | Uses Bangla’s self-concept scale, not a self-esteem scale |
| Laberge (2012) | Yes | Yes | No | Self-esteem was measured but not targeted. Children who opted into the physical activities already had higher self-esteem. |
| Meti (2022) | Yes | Yes | Yes | |
| Muller (2021) | Yes | Yes | Yes | |
| Park (2015) | Yes | Yes | Yes | |
| Steese (2006) | Yes | Yes | Yes | |
| Sundgot-Borgen (2020) | Yes | Yes | Yes | |
| Sælid (2017) | Yes | Yes | No | Sample is 16-19 years old. |
The full screening and selection process is outlined in the PRISMA diagram (Figure 3).
Figure 3: PRISMA diagram of screening and selection
2.4 Data Extraction
The data extraction process involved identifying the relevant data from each study and inputting it into a data table in order to understand it in relation to our research question (Boland et al., 2017). To minimise data extraction errors, each study had at least two people examine the data and input it into the data extraction table. Where there were disagreements, we discussed them as a whole group. The full data extraction table can be seen in Appendix B and an descriptive outline of each intervention can be seen in Appendix C. Two summary tables were created for ease of viewing: one highlighting study and participant characteristics (Table 4, p23) and the other highlighting the results (Table 6 p29).
2.5 Quality Assessment
Assessing the quality of each study is an essential aspect of systematic reviews as it allows researchers to consider the ‘weight’ of evidence each study can bring to the overall results and conclusion (Boland et al., 2017). The quality assessment tool used for this review was the EPPI weight of evidence tool (EPPI, n.d.). The EPPI weight of evidence tool asks 16 questions (Appendix D) which consider methodological soundness; the appropriateness of the study design to answering the review question; and relevance of the focus of the study to reach a final conclusion about overall study ‘weight’ shown as N16 (Table 5, p26). The full analysis table can be viewed in Appendix E.
Table 4: Study and Participant Characteristics
| Study Authors (date) | Study Title | Participants (number, age, gender distribution F & M) | Participants (additional characteristics) | Context | Design | Intervention | Intervention (time period) | Self-esteem measure |
| Amin et al. (2020) | Effectiveness of a culturally adapted cognitive behavioural therapy-based guided self-help(CACBT-GSH) intervention to reduce social anxiety and enhance self-esteem in adolescents: a randomized controlled trial from Pakistan | N = 76, Age range = 13-16Mean age = 14.84F = 34M = 42 | Identified as socially anxious. | 6 private schools in Multan, Pakistan | RCT | Culturally adapted CBT intervention | 1 session per week. 8 weeks. | RSES (Urdu translation) |
| Boulton & Boulton (2017) | Modifying Self-Blame, Self-Esteem, and Disclosure Through a Cooperative Cross-Age Teaching Intervention for Bullying Among Adolescents | N = 41 Age range = 14-16Mean age = 14.5 F = 21M = 20 | Peer-identified victims of bullying | 3 secondary schools, UK | RCT Wait-list control group | Cross-age teaching of social issues (CATS) Targetted | Approx. 3 weeks | Harter’s Self-Perception Profile for Children |
| Dalgas-Pelish. (2006) | Effects of a Self-Esteem InterventionProgram on School-Age Children | N= 98 Age range = 10-12 F = 59 M = 39 | N/A | 6 elementary schools, Midwest US | Quasi-experimental Pretest & posttest Repeated measures No control | Self Esteem Improvement Program (SEEP) | 4 sessions per 3-4 weeks. 9-12 weeks. | CSEI |
| Darrow et al. (2009) | The effect of participation in a MusicMentorship Program on the self esteemand attitudes of at-risk students | N = 24 Age = not given F = 24 | At risk for academic failure Female only | Public secondary schools, Florida US | Independent measures Pretest & posttest x3 conditions | Music mentorship. x2 music program conditions; 1 involved additional mentorship of others. | 1 session per week | CFSEI-3 |
| Study Authors (date) | Study Title | Participants (number, age, gender distribution F & M) | Participants (additional characteristics) | Context | Design | Intervention | Intervention (time period) | Self-esteem measure |
| Datu et al.(2021) | Can kindnesspromote medialiteracy skills, self-esteem, and social self-efficacyamong selectedfemale secondaryschool students?An interventionstudy | N = 300 Age range = 11-13Mean age = 12.47 F = 300 | N/A Female only | 1 girls’ school, Hong Kong | Repeated measures Pretest & posttest No control | Kindness intervention | 2 x 55-minute sessions | RSES |
| Dhawan et al. (2019) | “I am not scared of looking at myself in the mirror now”:Fostering Healthy Self-Esteem in Indian Female Adolescents | N = 125 Age range = 14-16Mean age = 15.31 F = 125 | Identified as having low self-esteem Female only | 4 government co-educational schools, Delhi, India | Independent measures Pretest & posttest Waitlist control | Cognitive Behavioural Therapy Intervention | Three x 120-minute sessions. 1 each 4-5 days | RSES |
| Meti et al. (2022) | Effectiveness of a Tailored Psychosocial Intervention on Self-Esteem ofAdolescents Studying in Selected HighSchools of Bagalkot | N = 60 Age range = 13-16Mean age = 15.26 F = 35M = 25 | N/A | 2 high schools, Bagalkot, India | RCT | Tailored psychosocial intervention | 7 x 45 minute sessions. 1 per day for 7 days | RSES |
| Muller et al. (2021) | Short breaks at school: effects of a physical activityand a mindfulnessintervention on children’s attention, readingcomprehension,and self-esteem | Study 1 N = 162 Age range = 10-11Mean age 10.13 F = 89 M = 73 Study 2 N = 79 Age range = 11-12Mean age 11.39 F = 38 M = 41 | N/A | 3 elementary schools, Germany | Independent measures Pretest & posttest Control group | Study 1 Physical activity breaks Study 2 Mindfulness breaks | Study 1 and 2 10 x 10-minute sessions. 1 per day for 2 school weeks | RSES |
| Study Authors (date) | Study Title | Participants (number, age, gender distribution F & M) | Participants (additional characteristics) | Context | Design | Intervention | Intervention (time period) | Self-esteem measure |
| Park & Park (2015) | Effects of Self-esteem Improvement Program on Self-esteem and PeerAttachment in Elementary School Children with Observed ProblematicBehaviors | N = 47 Age range 10-11Mean age = unknown F = 24 M = 23 | Identified as having problematic behaviours | 2 elementary schools, South Korea | Quasi-experimental Nonequivalent control Pretest-posttest | Self-esteem improvement programme | 12 sessions | RSES (Korean translation) |
| Steese et al. (2006) | Understanding Girls’ Circle as an Intervention on Perceived Social Support, Body Image, Self Efficacy, Locus of Control and Self-Esteem | N = 63 Age range = 10-17, Mean age = 13 F = 63 | Female only | 9 Girls’ Circle groups across the US | Repeated measures, pretest & posttest. No control | Girls’ Circle curriculum | 10 x 90/120-minute sessions over 10 weeks. | RSES |
| Sundgot-Borgen et al. (2020) | The Norwegianhealthy body image interventionpromotes positiveembodimentthrough improvedself-esteem | N = 1254 then 1278 and 1080 at follow upsAge range = 16-17Mean age 16.8 F = 57%M = 43% | N/A | 30 high schools, Norway | Cluster RCT | Healthy Body Image intervention | 3 x 90-minute session, once every 4 weeks over 3 months. | RSES |
Table 5: EPPI Weight of Evidence Analysis Summary
| Study | N13: Taking account of all quality assessment issues, can the study findings be trusted in answering the study question(s) | N14: Appropriateness of research design and analysis for addressing the question, or sub-questions, of this specific systematic review | N15: Relevance of particular focus of the study (including conceptual focus, context, sample and measures) for addressing the question of this specific systematic review | N16: Overall weight of evidence |
|---|---|---|---|---|
| Amin et al. (2020) | High | High | Med | High |
| Boulton & Boulton (2017) | High | High | Med | High |
| Dalgas-Pelish (2006) | Med | Low | Med | Med |
| Darrow et al. (2009) | Med | Med | Med | Med |
| Datu et al. (2021) | Low | Low | Low | Low |
| Dhawan et al. (2019) | Med | High | High | High |
| Meti et al. (2022) | Med | Med | High | Med |
| Muller et al. (2021) | Med | Med | Med | Med |
| Park and Park (2015) | High | Med | Med | Med |
| Steese et al. (2006) | Low | Med | Med | Med |
| Sundgot-Borgen et al. (2020) | High | High | Med | High |
2.6 Methods of Synthesis/Analysis
After data extraction, a more thorough examination of each study was made in order to analyse the non-numerical data. These findings were grouped into thematic categories to identify patterns across the studies and synthesise the results. The initial notes from this process can be seen in Appendix F The key findings are highlighted in the Results section (p31)
3 Results
3.1 Study and Participant Characteristics
The selected studies were deliberately from 2006 onwards, but eight were recent, having been conducted in the last ten years. The context of the studies is varied, with five of them conducted in Asia, three in Europe and two in the USA. Four studies in this review had only female participants (Darrow et al., 2009; Datu et al., 2020; Dhawan et al, 2019; Steese et al., 2006). As was previously discussed, girls have a higher likelihood of experiencing both low self-esteem and low subjective wellbeing (Marcotte et al., 2002). Therefore, in two studies, the choice to focus interventions only on girls was deliberate, under the belief that interventions may need to be specifically developed to address the particular challenges adolescent girls face (Dhawan et al, 2019; Steese et al., 2006). In one case (Datu, 2020) it was due to convenience sampling.
Out of the eleven studies, three used a randomised control trial (RCT). The others were quasi-experimental designs and had at least one key element of an RCT missing. Three studies did not have a control group (Dalgas-Pelish et al., 2006; Steese et al, 2006; Datu et al, 2020), meaning that internal validity was impacted. Differences like these affect the trustworthiness of each study and were considered during the quality assessment process (Table 5, p26)
3.2 Study Results
All studies reported increases in self-esteem, however some of these increases were more significant than others (Table 6). The table highlights both statistical significance and effect size. Effect sizes are usually viewed as the most important outcome of empirical studies as they allow researchers to present the magnitude of the reported effects in a standardised metric (Lakens, 2013). Unfortunately, not all of the studies reported an effect size so analysis has been made based on careful consideration of results that were reported and other contextual factors. Studies are considered to be statistically significant when the P value is less than .05 (Morling, 2020). On this basis, six out of the eleven studies were statistically significant (Amin, 2020; Boulton & Boulton, 2017; Dhawan et al., 2019; Meti et al, 2022; Park & Park, 2015; Sundgot-Borgen, 2020). The effect size provides different information to statistical significance as it communicates the strength of the relationship between two variables, thus offering more practical use. The terms weak, moderate and strong are used to describe effect sizes of .1, .3 and .5 respectively (Morling, 2020). We can see that one study had a low effect size (Datu et al., 2021) but others (Amin et al., 2020; Boulton & Boulton, 2017; Sundgot-Borgen et al., 2020) had a very strong effect size. The other seven studies had none reported.
Table 6: Summary of Study Results
| Study | Study aim | Independent measure | Dependent Variable | Significant Result | Effect size |
| Amin (2020) | Reduce social anxiety and improve self-esteem. | Guided self-help using CACBT (CaCBT-GSH) | Self-esteem (Rosenberg scale) | p<.001 | Cohen’s d = 3.21 |
| Boulton (2017) | Support victims of peer victimisation through enhancing self-esteem, encouraging disclosure and minimising self-blame. | Cross Age Teaching of Social Issues (CATS) | Harter’s self-perception profile for children | p<.001 | Cohen’s d = 1.14 |
| Dalgas-Pelish (2006) | Improve self-esteem | Self-Esteem Enhancement Program (SEEP) | CSEI | Not significant | None reported |
| Darrow (2009) | Improve self-esteem | Music mentorship Programme | CFSEI-3 | Not significant | None reported |
| Datu (2021) | Improve self-esteem and media literacy | Kindness intervention on media literacy skills | Self-esteem (Rosenberg scale) | Not significantp-adjusted value: .06 | Cohen’s d = .12 |
| Dhawan (2019) | Improve self-esteem | Cognitive behavioural workshop | Self-esteem (Rosenberg scale) | p=0.015 | None reported |
| Meti (2022) | Improve self-esteem | Tailored psychosocial intervention | Self-esteem (Rosenberg scale) | p<0.001 | None reported |
| Muller et al. (2021) | Improve attention and understand the role of self-esteem as a moderator | Physical activity or mindfulness breaks | Self-esteem (Rosenberg scale) | Not significant. Self-esteem significantly moderated the relationship between intervention/control and attention performance gain. | |
| Park and Park (2015) | Improve self-esteem and peer attachment | Self-esteem improvement programme. Understanding self, purpose and relationships. | Self-esteem (Rosenberg scale) | p<0.001 | None reported |
| Steese et al. (2006) | Improve self-esteem, body image, self-efficacy, locus of control and perceived social support | Girl’s circle – community group based curriculum | Self-esteem (Rosenberg scale) | Not significant – p>0.5 | Paired-samples t-test t(53) = -0.572 |
| Sundgot-Borgen et al. (2020) | Improve body image and self-esteem | Healthy body image intervention | Self-esteem (Rosenberg scale) | p=.017 for boys and p=.003 for girls | Unstandardised beta is 1.32 |
It is important to examine the broader context when examining study outcomes. To begin this process, Table 7 shows the combined statistical significance and WOE for each study. As the effect size was not reported for a number of studies, the judgement of whether studies had a low, medium or high effect on self-esteem was therefore based on the data that was reported. In some cases, this was only the statistical significance, in other cases, it combined this data with the reported effect size and an overall judgement was made according to the criteria outlined above. However, as a result of these inconsistencies, caution should be taken when interpreting these results.
Table 7: Combined Statistical Significance and WOE
3.3 Synthesis of Themes
An examination of the studies’ non-numerical data identified three core themes in terms of the intervention approach: (1) psychoeducational strategies, (2) internalisation of pro-self-esteem messages (3) social connection, (4) media literacy. These are displayed on Table 8 along with the studies which used them and some of the more specific strategies they utilised (a more in depth summary of each intervention is outlined in Appendix C).
Table 8: Study Themes
| Theme | Specific strategies | Studies |
| Psychoeducational strategies | Psychosocial education | Meti et al (2022) |
| CBT self-help strategies with homework tasks | Amin et al. (2020) | |
| Dhawan et al. (2019) | ||
| Enhancing Awareness through critical thinking | Park & Park (2015) | |
| Steese et al. (2006) | ||
| Sundgot-Borgen et al. (2020) | ||
| Mindfulness | Muller et al. (2021) | |
| Attitudinal Change | Cognitive dissonance | Boulton & Boulton (2017) |
| Dhawan et al. (2019) | ||
| Relational-cultural-theory | Steese et al. (2006) | |
| Elaboration likelihood model | Sundgot-Borgen et al. (2020) | |
| Social connection | Responsibility/helping role | Boulton & Boulton (2017) |
| Darrow et al. (2009) | ||
| Connection building | Boulton & Boulton (2017) | |
| Dhawan et al. (2019) | ||
| Park & Park (2015) | ||
| Steese et al. (2006) | ||
| Sundgot-Borgen et al. (2020) | ||
| Theme | Specific strategies | Studies |
| Media Literacy | Looking for and performing acts of kindness on online media platforms | Datu et al. (2021) |
| Workshops/discussions to increase awareness and encourage constructive use | Dalgas-Pelish (2006) | |
| Dhawan et al. (2019) | ||
| Sundgot-Borgen et al. (2020) |
Psychoeducational interventions were the most common, with a total of seven studies using some elements of a psychoeducational approach. This type of approach involves educating individuals or groups about mental health; bringing greater self-awareness or teaching strategies that can be used to support self-esteem. In the studies examined, this process varied from teaching participants CBT strategies that could be used to challenge negative thinking (Amin et al, 2020) to developing a mindfulness practice to bring awareness to thoughts (Muller et al., 2021).
Four studies involved strategies which helped participants to change their attitude or outlook to one more supportive of healthy self-esteem. This included Boulton and Boutlon’s study whereby the teaching of certain messages to younger students helped to “recalibrate” their self beliefs (Boulton & Boulton, 2017). In Sundgot-Borgen et al.’s study, this was achieved through the use of the Elaboration Likelihood Model: an approach aimed at encouraging attitudinal change (Sundgot-Borgen at al., 2020).
Another common theme involved developing social connections: a total of six studies used at least some elements of building connections with others. In some cases, this involved taking on responsibilities related to helping others (Boulton et al., 2017; Darrow et al., 2009) and in others, the intervention focused on developing supportive relationships and a sense of community (Boulton et al., 2017; Dhawan et al., 2019; Park & Park, 2015; Steese et al., 2006; Sundgot-Borgen et al., 2020;).
The final common theme was a focus on media literacy. This is perhaps unsurprising given the developments of social media over the past decade (Cingel et al, 2022) and the ever increasing impact it has on adolescent mental health (Cingel et al, 2022; Woods & Scott, 2016). A total of four studies used media literacy elements in the intervention (Datu, 2021; Dalgas-Pelish et al., 2006; Dhawan et al., 2019; Sundgot-Borgen, 2020). These involved increasing awareness of media influences on self-esteem and encouraging use of social media in a more caring and constructive way.
4. Discussion
4.1 Main Findings
Self-esteem is a major aspect of individual mental health and has a profound impact on many life outcomes. Adolescents in general, and girls in particular, are an especially vulnerable group in terms of their self-esteem as it is in this life stage that it shows the most significant decline (Katsantonis et al., 2022; Marcotte et al., 2002; Orth & Robins, 2022). This systematic review aimed to identify whether school-based interventions can be utilised to increase self-esteem in adolescents. Findings indicate that this is the case, with a slight majority of studies showing statistically significant outcomes, though study results varied. Collectively, the collated data is in line with previous meta-analyses (Haney & Durlack, 1998; O’Mara et al., 2006) who found that self-esteem interventions can increase participant self-esteem. A few common themes of the studies were identified, some of which link to existing literature on the subject.
One common theme was the use of psychological practices aimed at building self-esteem. In this review, the most effective studies (Amin et al., 2020; Boulton & Boulton, 2017; Dhawan et al., 2019), identified by both their high statistical significance and their weight of evidence, included elements of cognitive restructuring or psychosocial education, whether that is by using CBT strategies (Amin et al., 2020; Dhawan et al., 2019) or encouraging attitudinal change (Boulton & Boulton, 2017; Dhawan et al., 2019).
There is increasing evidence that CBT can be used to raise self-esteem: meta-analyses have suggested that CBT can increase self-esteem in depressed adolescents (Taylor & Montgomery, 2007) and adults with existing low self-esteem (Kolubinski et al., 2018). Its use as a preventative tool in a school setting could therefore be of great value. Another notable feature the CBT style interventions was their use of “homework tasks” which allow participants to revisit the taught content and practise the skills in their own lives. This closely resembles individual CBT, where follow up “homework” activities are seen as being an essential component of the therapy (Beck, 1979). This approach has the bonus of having participants spending more time developing the skills (e.g. reframing negative thoughts) while lessening the impact on curriculum time.
A few studies used strategies designed to change the attitudes of participants. Two studies (Boulton & Boulton, 2017; Dhawan et al., 2019) specifically aimed to create feelings of cognitive dissonance. They involved activities designed to encourage new beliefs or behaviours that would feel discordant with previous beliefs and behaviours, therefore leading to change. Another approach to changing attitudes was seen in the Elaboration Likelihood Model (Sundgot-Borgen et al., 2020). With this approach, content was delivered in such a way as to promote careful and critical consideration of the information presented, leading to enduring and resistant attitude change (Sundgot-Borgen et al., 2020). Given the positive outcomes seen in these studies, it would seem that these strategies are worth exploring further in future research.
Another key theme was that of social connection. Many interventions included social elements and in some cases it was a central aspect of the design (Boulton & Boulton, 2017; Park & Park, 2015; Steese et al., 2006; Sundgot-Borgen et al., 2020). Generally, this element of the interventions appeared to have a positive effect. Even where studies didn’t report a significant increase in self-esteem, the social aspect was viewed positively by the participants. In some cases, the social element had other benefits, such as feelings of responsibility and competence (Boulton & Boulton, 2017; Darrow et al., 2009) or enhanced connection and social support (Dhawan et al., 2019; Park & Park, 2015; Steese et al., 2006; Sundgot-Borgen et al., 2020). These, in turn, may act as moderators of self-esteem even where a statistical increase is not reported.
The social aspect of some interventions may be important due to the fact that it engages one of our core psychological needs: that of relating to others (Ryan & Deci, 2004). Strong social connections are often viewed as protective factors to wellbeing (Bowlby, 1969; Erikson, 1968) with peer attachments regarded as especially important for self-esteem and wellbeing during adolescence (Gorrese & Ruggieri, 2013; Millings et al., 2012). Dalgas-Pelish found that their intervention was effective for children who self-identified as having a close friend (or friends). Where this was not the case, the intervention had the opposite effect. This perhaps highlights the usefulness that interventions that help to build connections can have on self-esteem, especially in populations that have existing social difficulties.
Given the increased presence of media technology since previous meta-analyses of self-esteem interventions (Haney & Durlack, 1998; O’Mara et al., 2006), it is not surprising that this has become a more prominent theme in recent studies. Studies generally focused on increasing constructive use of social-media (Datu, 2020; Sundgot-Borgen) or developing awareness of the impact misuse may have on self-esteem. Notably, both content and outcome is varied across studies so it appears to be an area where further research is needed before any conclusions are drawn.
O’Mara (2006) and Marsh and Craven (2006) highlighted that interventions where both skills and self-concept were developed had the largest effect sizes: a finding which may be explained by the core need of competence. In this review, the interventions focused on developing global self-esteem, so did not involve the development of skills in a specific domain (e.g. academic or athletic). This is not to say that skills were not developed in the studies, in fact, many of the interventions supported the development of self-management skills such as those related to self-awareness and emotional regulation. Increased competence in these psycho-social areas may have important implications for self-esteem and overall mental health as well as acting as a protective factor in the longer term.
The amount of time each intervention lasted for varied significantly though it didn’t appear to correlate with the effect on self-esteem. Boulton & Boulton (2017) and Dhawan et al., (2019) both had some of the highest impact on self-esteem but were short in duration (both consisting of 3 2-hour sessions). The researchers in each case were explicit about their intention to be impactful yet brief with time constraints of the school curriculum in mind. In contrast, Darrow et al. (2006) was the longest but with a much smaller impact on self-esteem. This finding is useful as interventions which can be delivered with little impact on the curriculum are more likely to be well-received by education stakeholders.
4.2 Strengths and Limitations of Included Studies
Overall, the methodological quality of the included studies were moderate. All of the studies appeared ethically sound and the majority outlined their study with adequate detail and justification for decisions made. However, many of the study participants were recruited through convenience sampling so do not fully represent the population of interest (Morling, 2020). Few of the studies met the criteria for a Randomised Control Trial (RCT) which are considered the gold standard of research due to their potential to support causal claims (Morling, 2020) (e.g. a particular intervention causes an increase in self-esteem). In some cases, the intervention and control groups were not randomised, leaving them vulnerable to bias. Additionally, three studies had no control group leaving them at higher risk of historical bias (i.e. an occurrence outside of the intervention causing changes to self-esteem). One study noted that pretest sensitization effects may have occurred where they did use a control group as both the intervention and control groups had assessed significantly higher self-esteem during the posttest (Dhawan et al., 2019). Thus, the conclusions of studies without a control group should be viewed with greater caution.
Many of the studies measured self-esteem using the Rosenberg scale: identified as the most frequently used scale of self-esteem in psychological research (Mruk, 2013). Although it is considered to have a high reliability and validity (Jordan, 2020) the scale is very general, asking only ten questions which intend to measure stable, trait self-esteem. Some of the studies in this review reported concerns with the self-esteem measure used, suggesting that a more nuanced scale, such as the Harter Self Perception Profile for adolescents (Harter, 1988) may be more useful in analysis and recommendation. Marsh and Craven (2006) and O’Mara et al. (2006) noted the limitations of the Rosenberg scale from a multi-dimensional perspective of self-esteem. Although this review focuses on a global view of self-esteem, it recognises that self-esteem is made up of many elements. A measurement which is able to pick up on more subtle distinctions may be able to more clearly identify the mechanisms at work in the interventions and more clearly note which specific areas benefit.
4.3 Strengths and Limitations of the Review Process
The strengths and limitations of this study warrant consideration. This systematic review involved three researchers whose collaboration gave strength to the findings. Each step of the screening process involved the agreements of at least two of the group and when disagreements occurred, these were discussed as a three. The quality of the studies were also assessed in order to understand the weight of evidence they may give to overall findings. Again, this process had at least two people working together to ensure inter-rater reliability.
As with all studies, there are also limitations. A systematic review aims to find all of the current literature relevant to the research question but this can be challenging. One issue all systematic reviews have is publication bias, in which positive results are much more likely to be published than negative results (Morling, 2020). Although a strong effort was made to find all relevant literature, our search strategy could have been more comprehensive in a few ways. Firstly, our search only included English papers which may lead to bias and limit generalisability (Morling, 2020). Due to having an over abundance of results during our search, we decided to limit the search terms to title and abstract but this may also have limited the search. Due to these limitations, this review may not include all of the relevant data. However, effective piloting of the search strategy and the involvement of three people in the search and screening process brings confidence that the included sample is representative of the existing available data.
4.4 Generalisability of Findings
The variety of contexts of each study adds external validity to this review and thus offers some generalisability to the findings. Despite increased awareness of the importance of diversity, the majority of psychological studies are conducted with WEIRD (White, Educated, Industrialised, Rich, and Democratic) populations (Sanches de Oliveira & Baggs, 2023). This limits the applicability of the findings to different contexts. This is particularly important in an area such as self-esteem that may be viewed differently across cultures. For example, Asian cultures are typically collectivist whereas WEIRD cultures have a much greater focus on the individual (Erez, 2011; Sanches de Oliveira). The focus on the individual in the concept of self-esteem means it may be perceived differently in a typically Western society.
The types of school, students, sample size and baseline data varied. Although the studies were conducted in different countries, the fact they were English studies may mean they were conducted from a Western viewpoint and in some cases, involved participants from international or private schools who may not reflect the average citizen from that country.
In many cases, there is evidence that the interventions were adapted for the culture. This involved translation of standard measurements and in some cases, the use of culturally adapted interventions or measurements. In some cases, the materials for the intervention were developed based on interaction with those in the local community. These strategies are in line with an EMIC approach to studying different cultures, allowing for a deeper understanding of the culture in question (Hwang, 2016).
The number of studies which focused on girls was unexpected but demonstrates the recognition of female adolescents having particular needs that may be best addressed by specialised interventions. In one study which involved both male and female participants, the researchers identified that some differences between gender outcomes were apparent and recommended further research to explore the impact of interventions on each gender separately. Consequently, it appears that gender differences should continue to be explored in future research in order for the most appropriate interventions to be made available for the population in question.
4.5 Implications
This review has implications for the various stakeholders involved in secondary education, including school teachers, leaders and counsellors. Findings indicate that self-esteem interventions can be worthwhile, especially given the benefits that can be gained across life domains and the particular needs of adolescents. This review also suggests that effective interventions do not require an especially large amount of time to be worthwhile, a common concern in a time-constrained secondary curriculum. Many of the interventions aim to change mindsets or teach skills that can then be continuously worked upon by the participant themselves, increasing the likelihood of a lasting impact.
Future research should address some of the limitations of currently published findings. It should consider the measures being used to address self-esteem. To achieve a clearer overview of individual challenges, a more thorough measurement than the Rosenberg scale may be called for. Some strengths have come from adapting interventions for the specific population, however, this may be challenging to scale up to larger populations. It would be worth seeing whether the interventions developed in this way could be effective with different populations or if delivered by people less familiar with the content.
Greater use of RCTs will help to establish causation and therefore strengthen findings. Another methodological factor to address is that of follow up assessments: in this review, the majority of the studies included did not utilise a follow up, a factor which limited the findings and leads to questions about the impacts in the long term. We would hope that interventions could have a lasting impact so this is something that should be included to ensure the most rigorous and comprehensive findings.
5 Conclusion
From this review, we can conclude that self-esteem interventions can work, which is in line with the existing literature. However intervention designs vary considerably with some resulting in better outcomes than others. Interventions appear to have the best results when based on theory (such as Cognitive Behavioural Theory). Those that develop skills that participants can practise in their own time may produce better results and help to create lasting change, though studies which utilise follow up assessments are required to assess this.
It appears that interventions do not require a big time commitment: positive results could be seen in just six hours. Interventions which were specifically designed for or adapted to the population, also had more positive results than those which were not. Further research would help to ascertain whether such interventions can be scaled up and delivered by those who did not develop them.
The current research may be limited by the measure of self-esteem used, something which future research could address by utilising more nuanced measurement tools. Furthermore, further research should aim to investigate the lasting impact of interventions by including follow up assessments into their design in order to see if effects are carried over into the longer term.
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