“Why are you drinking?” demanded the little prince.
“So that I may forget,” replied the tippler.
“Forget what?” inquired the little prince, who already was sorry for him.
“Forget that I am ashamed,” the tippler confessed, hanging his head.
“Ashamed of what?” insisted the little prince, who wanted to help him.
“Ashamed of drinking!”
from The Little Prince by Antoine de Saint-Exupéry

Is substance abuse (or any harmful or self-defeating behavior) a symptom or a cause of poor self-image? Maria Droste therapist Marta Oko-Riebau, MA, LPC, says it’s both. From the dialogue above, you can begin to see how easily that circle develops for the little prince’s acquaintance. Which came first – the shame or the drinking?

Marta practices Cognitive Behavioral Therapy (CBT) which looks at how thoughts, feelings and behavior interact and impact self-image. “You cannot directly change feelings. Telling yourself that you’re not going to be anxious or depressed won’t have the desired effect,” she says. “You can, however, change thoughts and behaviors, which can ultimately have a positive effect on your feelings and improve your self-esteem.”

The cognitive piece of CBT addresses what are known as cognitive errors. These are distorted thought patterns that lead to false conclusions and reinforce negative feelings. Some examples are: all-or-nothing thinking (“My project is a failure because it isn’t perfect.”); overgeneralizing (“I will never get a job because X Company didn’t hire me); catastrophizing (“He’s never going to forgive me”); or mind reading (“I know she hates me).

Learning to recognize these errors and make adjustments is something you can learn with practice. She explains that we all look for evidence that supports our thinking, even if our thinking is faulty. She works with her clients to recognize the errors and make small adjustments. It is important to note, however, that the goal is not to only have happy thoughts, Marta stresses. “In therapy, we work on having balanced thoughts that the client can believe.” So, rather than thinking, for example, “I love the way I look at my current weight,” which may be too big a leap for someone to make, start with something like, “I feel good about the way I spoke up in the meeting today.”

Marta works in this way with one young woman:

As a young teen, Leah (not her real name) developed a unique style. When she was bullied at school, her parents dismissed it as normal teenage growing pains and had a this-too-shall-pass attitude. However, it didn’t pass and Leah’s insecurity grew. She withdrew from activities and continued to have a difficult time socially, as well as at school and at work. At 18, she struggled with low self-esteem that centered on her looks, despite the fact that she is objectively attractive.

Marta worked with Leah on changing her thoughts around not being attractive. “She filtered everything through that belief,” Marta explains. “She felt she was constantly being judged because, in her words, she was ugly.”

In therapy, Marta explained to Leah that she was using her interpretation of events as evidence to support her belief, rather than the events themselves. Instead, she encouraged Leah to look at the evidence objectively, in particular, the evidence that did not support her negative belief about herself. “She came up with someone who recently complimented her smile and someone else who asked her out,” Marta says. “Eventually, when I asked her what she liked about her looks, she was able to say, ‘I like my smile.’” 

Cognitive errors filter experiences in a negative way. Leah learned to catch herself doing this and correct her thinking.

While thoughts impact feelings and behavior (McLeod, 2008), Marta and many other CBT practitioners find that addressing behavior can be most effective in accomplishing positive change, particularly when self-medicating is part of the problem. She encouraged Leah to find actions she could take right away to improve her self-image.

One thing she was able to try was changing her posture, to stand and sit in a more confident way.  Another was to say “hi” to three people, smile and look them in the eye. Leah found that when she did this, people would smile back.  Over time, she became more positive about herself and her future, including her plans to go to college.

“Self image is made up of all the ideas one has about one’s personality, abilities, etc.,” explains Marta. “When it comes to substance abuse, a positive self-image combined with healthy self-esteem is a huge protective factor.”

People who choose to use substances, or engage in other unhealthy behaviors, tend to surround themselves with others who do the same. “Healthy influences in your life are important. For teens, that includes family and other significant positive influences,” Marta says. “People with low self-esteem rely on their coping mechanism of choice, even if it is potentially harmful. Parents who are attentive not just when a crisis arises but throughout their child’s life will have a greater impact. Have the conversation instead of just hoping it’s not happening to your child.”

Most people, at some time, experience these cognitive errors that lead to negative feelings. So when does it become a problem? Marta explains it is a problem when you can’t get past it and it interferes with daily functioning. “When you are spending way too much time thinking about it. When it prevents you from doing what you want, and interferes with daily activities.”

Often society puts pressure on us to be a certain way that is contrary to how we truly are and this can negatively affect our self-image. “American society is very extroverted. Someone who is not that way may feel at a disadvantage and therefore believe a change is necessary,” says Marta. “Rather than forcing yourself to act in a way that is not natural to you, find things that are in line with your personality. Perhaps the issue is not that you don’t like to socialize, but simply that you prefer to engage with others one-on-one or in small groups rather than going to loud, crowded parties. Self-awareness is the first step to successful change. Ask yourself, ‘Is it better for me to accept this about myself or is it better for me to change it?’ Embrace the parts that are true to you and find balance.”

Lastly, Marta says, practice self-compassion. “Change is difficult and doesn’t happen in a linear fashion. When something doesn’t go well or you feel you’ve made a mistake, give yourself a break.”

Are you struggling with poor self-image and low self-esteem? To learn more about how CBT can help, or to connect with a therapist, contact the Maria Droste Access Center at 303-867-4600.


McLeod, S. (2008) Cognitive Behavioral Therapy. Simply Psychology. Retrieved on February 1, 2017, from http://www.simplypsychology.org/cognitive-therapy.html