Self-esteem can be defined as a “favourable global interpretation of oneself” (Baumeister, Smart, & Boden, 1996, p. 5). Low self-esteem has been linked to depression (Overholser et al., 1995; Ryan et al., 1987; Butler et al, 1994, Kernis et al, 1991), where negative life events/situations can activate negative evaluations of the self in those with labile self-esteem (DeHart & Pelham, 2007). Having low self-esteem has also been associated with persecutory delusions (Freeman et al., 1998) as individuals attribute negative events and disappointments to the intentional actions of others in an effort to protect themselves from negative beliefs about themselves (Bentall et al., 2001).

Explicit self-esteem has been defined as an individual’s conscious feelings of self-worth and acceptance (Rosenberg, 1965). Implicit self-esteem can be defined as a relatively automatic, overlearned and nonconscious evaluation of the self that guides spontaneous reaction to self-relevant stimuli (Greenwald & Banaji, 1995). Individuals with high self-esteem are more effective in coping with threats to self-esteem compared to those with low-self-esteem (Baumgardener & Arkin, 1987; Schlenker, 1987). 

Self-esteem intervention:
Some of the more effective coping strategies associated with high self-esteem include solution-oriented activity and/or cognitive reinterpretation (Schutz, 1998). These strategies involve individuals generating alternative solutions to problems and learning about how they think about themselves and their environment. Specifically, approaching situation with a positive, co-operative, solution-oriented outlook is related to high self-esteem (Schutz).
It has been found that repeated exposure to positive stimuli can increase self-esteem, even in cases where the stimuli is non-specific to the individual (Baccus et al., 2004)

Stress
Stress can be defined as “an ongoing process that involves individuals transacting with their environments, making appraisals of the situations they find themselves in, and endeavoring to cope with any issues that may arise’ (Fletcher et al., 2006).

Stress management intervention:
According to Evers et al., 2006, there is ‘no consensus on what patterns or combinations of techniques constitute effective stress management’ though combined techniques produce more significant results (Murphy, 1996). However, it has been determined that using a combination of techniques aimed at stress management produced more significant outcomes than programs aimed at single-strategy intervention (Murphy, 1996).

In a systematic review of effective stress management techniques, the following were found to be elements of effective stress management interventions:
A) Reduce stressors (demands)
B) Modify cognitive appraisals
C) Reduce negative affect states, increase positive affect states
D) Facilitate effective coping behaviours (Evers et al., 2006; Rumbold et al., 2011)

Exercise
“regular moderate physical activity may reduce stress and prevent stress-induced suppression of the immune system” (Fleshner, 2005). It has also been suggested that having a regular physical exercise routine can help muscle tension associated with stress and serve as a protective factor in managing stressors (Bellarosa & Chen, 1997).

Relaxation
Relaxation practice is considered a positive, easy-to-use, cost-effective way of managing one’s stress. Progressive muscle relaxation (PMR) is a popular relaxation intervention that lasts typically 20-40 minutes. The benefits of PMR include lowered heart rate, blood pressure and cortisol levels, as well as improved sleep quality (Krajewski et al., 2011; Kwekkeboom et al., 2008; McCallie et al., 2006; Pawlow & Jones, 2005).

Sleep/social support
Self-care practices such as sleep hygiene and strong social support have been linked to lower levels of perceived stress (Myers et al., 2012)

Cognitive Reappraisal/Cognitive Restructuring
Emotion Regulation has been found to be an important factor in managing stress (Goldin et al., 2008). Part of regulating emotions includes cognitive reappraisal, where individuals re-evaluate stressors in a way that alters the emotional impact (Gross & John, 2003). Stress management interventions that include a cognitive restructuring element have been found to be more effective than those who do not include this component (Forman, 1990).

Assertiveness training
In assertiveness training, individuals learn to differentiate between passive, aggressive, passive-aggressive and assertive behaviours. Secondly, individuals work to identify their personal rights, modify their thinking patterns and practice assertive actions (Lange & Jakubowski, 1976). Assertiveness training enables individuals to communicate their concerns to others in an appropriate manner, which allows them to influence their social environment
(Schwartz, 1980).

Stress Inoculation
Stress inoculation involves learning effective coping skills to manage stress (Bellarosa & Chen, 1997). This type of intervention typically involves three stages including the identification of stressors and coping strategies as well as learning relaxation, assertiveness, problem-solving and cognitive restructuring. These techniques are then practiced under stressful conditions to facilitate mastery (Meichenbaum, 1985).

Mindfulness Based Stress Reduction
One of the emerging stress management practices includes Mindfulness Based Stress Reduction (MBSR), which was developed by Kabat Zinn in 1979 (Smith et al., 2004). This practice has been described not as a technique but rather practiced as a way of life even in the absence of illness (Ott, 2004) and includes an 8 week program of meditation and hatha yoga exercises with an additional 7.5 hour intensive meditation retreat that is taken in silence (Kabat-Zinn et al., 1992). Studies done with cancer patients using MBSR versus control groups did not yield significant differences on mood or stress (Speca et al., 2000; Shapiro et al., 2003). One important finding among studies however, was a positive relationship between increased practice using MBSR and positive stress outcomes (Myers et al., 2012; Smith et al., 2004), which may account for some of the differences among effectiveness findings for MBSR.

References
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