A Systematic Review of Narrative-Based Therapy for Enhancing Self-Esteem and Psychological Well-Being in Children and Adolescents
Abstract
Objective: Self-esteem and psychological well-being are key determinants of mental health in children and adolescents. Narrative-based interventions (NBIs) are increasingly used to promote these outcomes. This systematic review aimed to evaluate the effectiveness of NBIs on self-esteem and psychological well-being in children and adolescents.
Method: A systematic search was conducted in Scopus and PubMed (January 2010 – March 2025). MeSH terms included narrative therapy, storytelling, self-esteem, psychological well-being, child, and adolescent. Two reviewers independently screened records, extracted data, and assessed quality using the Mixed Methods Appraisal Tool (MMAT). A total of 18 studies were included: seven randomized controlled trials (RCTs), three quasi-experimental, four qualitative, and four mixed-methods designs. Narrative synthesis was used due to heterogeneity.
Results: Fifteen studies (83.3%) reported positive effects on self-esteem or psychological well-being. Effect sizes ranged from small to large. Digital storytelling was most consistently associated with improved self-esteem (4 of 5 studies). Group narrative therapy showed stronger effects on behavioral symptoms (3 of 3 studies). Two studies reported null or mixed findings. Moreover, qualitative studies consistently reported themes of empowerment, healing, and identity transformation.
Conclusion: NBIs show promise for enhancing self-esteem and well-being, particularly digital storytelling and group narrative therapy. However, evidence quality is variable. High-quality RCTs with diverse populations and longer follow-ups are needed.
2. Morioka M, Nomura H. Narrative‐Based Approaches in Psychological Research and Practice. John Wiley & Sons Australia, Ltd Melbourne; 2021. p. 231-8.
3. Hu G, Han B, Gains H, Jia Y. Effectiveness of narrative therapy for depressive symptoms in adults with somatic disorders: A systematic review and meta-analysis. Int J Clin Health Psychol. 2024;24(4):100520.
4. Remein CD, Childs E, Beard J, Demers LB, Benjamin EJ, Wingerter SL. "Getting Started": A Pilot Introductory Narrative Writing Session for Interprofessional Faculty in Academic Health Sciences. Adv Med Educ Pract. 2022;13:265-74.
5. Gallagher AL, Brown J, Caroll C, Perkins E, VanDoren C, McEntegart A. The potential of narrative-based medicine interventions targeting hospital practitioner burnout: findings from a scoping review. Arts Health. 2024:1-24.
6. Kotera Y, Rennick-Egglestone S, Ng F, Llewellyn-Beardsley J, Ali Y, Newby C, et al. Assessing Diversity and Inclusivity is the Next Frontier in Mental Health Recovery Narrative Research and Practice. JMIR Ment Health. 2023;10:e44601.
7. Xufré Y, Pacheco M, Henriques MR, Gallifa J. Narrative interventions for children and adolescents in foster care: A scoping review. Children and Youth Services Review. 2026:108853.
8. Martínez-Casanova E, Molero-Jurado MDM, Pérez-Fuentes MDC. Self-Esteem and Risk Behaviours in Adolescents: A Systematic Review. Behav Sci (Basel). 2024;14(6).
9. Liu Q, Jiang M, Li S, Yang Y. Social support, resilience, and self-esteem protect against common mental health problems in early adolescence: A nonrecursive analysis from a two-year longitudinal study. Medicine (Baltimore). 2021;100(4):e24334.
10. Mu Y, Motevalli S. Mediating Role of Cognitive Flexibilities in the Relationship between Parenting Styles and Self-Esteem among Children. Iran J Psychiatry. 2025;20(2):200-8.
11. Evren C, Cicekci E, Umut G, Evren B, Durmus Cicek K. The Mediating Effects of Self-Esteem and Harm Avoidance on the Association between Social Anxiety Symptoms and Adult Attention Deficit Hyperactivity Disorder Symptom Severity in Turkish Inpatients with Alcohol Use Disorder. Iran J Psychiatry. 2021;16(3):281-9.
12. Nesrine Z, Touhemie DB, Hadjkacem I, Boudabous J, Chiha K, Ayédi H, et al. Assessment of Eating Disorders in Adolescents: Tunisian cross-sectional study. Eur Psychiatry. 2025;68(S1):S563-S4.
13. Brueckmann M, Teuber Z, Hollmann J, Wild E. What if parental love is conditional …? Children's self-esteem profiles and their relationship with parental conditional regard and self-kindness. BMC Psychol. 2023;11(1):322.
14. Jankowiak B, Jaskulska S, Sanz-Barbero B, Waszyńska K, Claire KD, Bowes N, et al. Will I like myself if you hurt me? Experiences of violence and adolescents’ self-esteem. Sustainability. 2021;13(21):11620.
15. Agustiningsih N, Yusuf A, Ahsan A. Relationships Among Self-Esteem, Bullying, and Cyberbullying in Adolescents: A Systematic Review. J Psychosoc Nurs Ment Health Serv. 2024;62(5):11-7.
16. Berg M, Lindegaard T, Flygare A, Sjöbrink J, Hagvall L, Palmebäck S, et al. Internet-based CBT for adolescents with low self-esteem: a pilot randomized controlled trial. Cogn Behav Ther. 2022;51(5):388-407.
17. Gregory T, Sincovich A, Brushe M, Finlay-Jones A, Collier LR, Grace B, et al. Basic epidemiology of wellbeing among children and adolescents: A cross-sectional population level study. SSM Popul Health. 2021;15:100907.
18. Khaleghi A, Mohammadi MR, Pirzad Jahromi G, Zarafshan H. New Ways to Manage Pandemics: Using Technologies in the Era of COVID-19: A Narrative Review. Iran J Psychiatry. 2020;15(3):236-42.
19. Subramanyam AA, Somaiya M, De Sousa A. Mental health and well-being in children and adolescents. Indian J Psychiatry. 2024;66(Suppl 2):S304-s19.
20. Oriol X, Miranda R. The Prospective Relationships between Dispositional Optimism and Subjective and Psychological Well-being in Children and Adolescents: Oriol and Miranda. Appl Res Qual Life. 2024;19(1):195-214.
21. Yousefi Afrashteh M, Hasani F. Mindfulness and psychological well-being in adolescents: the mediating role of self-compassion, emotional dysregulation and cognitive flexibility. Borderline Personal Disord Emot Dysregul. 2022;9(1):22.
22. Green MC, Appel M. Narrative transportation: How stories shape how we see ourselves and the world. Adv Exp Soc Psychol. 70: Elsevier; 2024. p. 1-82.
23. An Z, Meng J, Mendiola-Smith L. The role of identification in soliciting social support in online communities. Comput Human Behav. 2020;104:106181.
24. Ghavibazou E, Hosseinian S, Ale Ebrahim N. Narrative therapy, applications, and outcomes: A systematic review. Narrative therapy, Applications, and Outcomes: A Systematic Review" Preventive Counseling. 2022;2(4).
25. Houston TK, Allison JJ, Sussman M, Horn W, Holt CL, Trobaugh J, et al. Culturally appropriate storytelling to improve blood pressure: a randomized trial. Ann Intern Med. 2011;154(2):77-84.
26. Jagatdeb S, Mishra S, Bajpai T, Sen S. “Externalizing the internalized:” Exploring externalizing conversations in narrative therapy with adolescents and young adults in the Indian context. Journal of Indian Association for Child and Adolescent Mental Health. 2024;20(2):153-60.
27. Petrovic M, Bonanno S, Landoni M, Ionio C, Hagedoorn M, Gaggioli A. Using the Transformative Storytelling Technique to Generate Empowering Narratives for Informal Caregivers: Semistructured Interviews, Thematic Analysis, and Method Demonstration. JMIR Form Res. 2022;6(8):e36405.
28. Aleixo A, Pires AP, Angus L, Neto D, Vaz A. A review of empirical studies investigating narrative, emotion and meaning-making modes and client process markers in psychotherapy. J Contemp Psychother. 2021;51(1):31-40.
29. Rajaei A, Jensen JF. Empowering patients in integrated behavioral health-care settings: A narrative approach to medical family therapy. The Family Journal. 2020;28(1):48-55.
30. Bandura A. Social cognitive theory in cultural context. Applied psychology. 2002;51(2):269-90.
31. Khaleghi A, Pirzad Jahromi G, Zarafshan H, Mostafavi SA, Mohammadi MR. Effects of transcranial direct current stimulation of prefrontal cortex on risk-taking behavior. Psychiatry Clin Neurosci. 2020;74(9):455-65.
32. Hong QN, Fàbregues S, Bartlett G, Boardman F, Cargo M, Dagenais P, et al. The Mixed Methods Appraisal Tool (MMAT) version 2018 for information professionals and researchers. Education for information. 2018;34(4):285-91.
33. Looyeh MY, Kamali K, Shafieian R. An exploratory study of the effectiveness of group narrative therapy on the school behavior of girls with attention-deficit/hyperactivity symptoms. Arch Psychiatr Nurs. 2012;26(5):404-10.
34. Ofoegbu TO, Asogwa UD, Eseadi C, Ogbonna CS, Eskay M, Obiyo NO, et al. Effect of rational digital storytelling intervention on depression among adolescent-athletes with special educational needs. Journal of Rational-Emotive & Cognitive-Behavior Therapy. 2021;39(2):217-37.
35. Karibwende F, Niyonsenga J, Nyirinkwaya S, Hitayezu I, Sebuhoro C, Simeon Sebatukura G, et al. A randomized controlled trial evaluating the effectiveness of narrative therapy on resilience of orphaned and abandoned children fostered in SOS children's village. Eur J Psychotraumatol. 2022;13(2):2152111.
36. Ruini C, Albieri E, Ottolini F, Vescovelli F. Once upon a time: A school positive narrative intervention for promoting well-being and creativity in elementary school children. Psychol Aesthet Creat Arts. 2022;16(2):259.
37. Nelson G, Van Andel AK, Curwood SE, Hasford J, Love N, Pancer SM, et al. Exploring outcomes through narrative: the long-term impacts of Better Beginnings, Better Futures on the turning point stories of youth at ages 18-19. Am J Community Psychol. 2012;49(1-2):294-306.
38. Cashin A, Browne G, Bradbury J, Mulder A. The effectiveness of narrative therapy with young people with autism. J Child Adolesc Psychiatr Nurs. 2013;26(1):32-41.
39. German M. Developing our cultural strengths: Using the'Tree of Life'strength-based, narrative therapy intervention in schools, to enhance self-esteem, cultural understanding and to challenge racism. Educational & child psychology. 2013;30(4).
40. Goodman R, Newman D. Testing a digital storytelling intervention to reduce stress in adolescent females. Storytelling, Self, Society. 2014;10(2):177-93.
41. Anderson KM, Cook JR. Challenges and opportunities of using digital storytelling as a trauma narrative intervention for traumatized children. Adv Soc Work. 2015;16(1):78-89.
42. Nsonwu MB, Dennison S, Long J. Foster care chronicles: Use of the arts for teens aging out of the foster care system. J Creat Ment Health. 2015;10(1):18-33.
43. Fletcher S, Mullett J. Digital stories as a tool for health promotion and youth engagement. Can J Public Health. 2016;107(2):e183-e7.
44. Gubrium AC, Fiddian-Green A, Lowe S, DiFulvio G, Del Toro-Mejías L. Measuring Down: Evaluating Digital Storytelling as a Process for Narrative Health Promotion. Qual Health Res. 2016;26(13):1787-801.
45. Moore T. Strengths-based narrative storytelling as therapeutic intervention for refugees in Greece. World Federation of Occupational Therapists Bulletin. 2017;73(1):45-51.
46. Gubrium A, Fiddian-Green A, Lowe S, DiFulvio G, Peterson J. Digital storytelling as critical narrative intervention with adolescent women of Puerto Rican descent. Crit Public Health. 2019;29(3):290-301.
47. Jalali F, Hashemi SF, Hasani A. Narrative therapy for depression and anxiety among children with imprisoned parents: A randomised pilot efficacy trial. J Child Adolesc Ment Health. 2019;31(3):189-200.
48. Arslan G, Yıldırım M, Zangeneh M, Ak İ. Benefits of Positive Psychology-Based Story Reading on Adolescent Mental Health and Well-Being. Child Indic Res. 2022;15(3):781-93.
49. Baldiwala J, Kanakia T. Using narrative therapy with children experiencing developmental disabilities and their families in India: A qualitative study. J Child Health Care. 2022;26(2):307-18.
50. Teixeira EG, Monteiro A, Barros R. Well-being through digital storytelling: an analysis of young people’s stories. Journal of Turkish Science Education. 2025;22(3):542-60.
51. Dunwoodie K, Macaulay L, Newman A. Qualitative interviewing in the field of work and organisational psychology: Benefits, challenges and guidelines for researchers and reviewers. Applied Psychology. 2023;72(2):863-89.
52. Dolczewski M. Semi-structured interview for self-esteem regulation research. Acta Psychol (Amst). 2022;228:103642.
53. Dil N, Castiglioni A, Kim K, Aravind N, Torre D. Use and implementation of focus groups. Med Teach. 2024;46(3):317-9.
54. Hughes A, Lamb D. A grounded theory example of using focus groups to collect qualitative research data. Nurse Res. 2025.
55. Rahiem MD. Storytelling in early childhood education: Time to go digital. International Journal of Child Care and Education Policy. 2021;15(1):4.
56. Pandian A, Baboo SB, Yi LJ. Digital storytelling: Engaging young people to communicate for digital media literacy. Jurnal Komunikasi: Malaysian journal of communication. 2020;36(1):187-204.
57. Benoit V, Gabola P. Effects of Positive Psychology Interventions on the Well-Being of Young Children: A Systematic Literature Review. Int J Environ Res Public Health. 2021;18(22).
58. Flückiger C, Munder T, Del Re AC, Solomonov N. Strength-based methods - a narrative review and comparative multilevel meta-analysis of positive interventions in clinical settings. Psychother Res. 2023;33(7):856-72.
59. Menard RG, Robinson KD, Lane DE, Lane WD. Group approach to narrative therapy: A review of the literature. Journal of Counseling Research and Practice. 2018;3(1):4.
60. McKenzie-Smith L. Are narrative therapy groups effective for people with intellectual disabilities? A critical review of the literature. Tizard Learning Disability Review. 2020;25(4):213-22.
61. Jørgensen CB, Behrmann JT, Blaabjerg J, Pettersen KA, Jensen de López KM. Narrative therapy with children: A qualitative interview study with Danish therapists about the application of narrative practices. Couns Psychother Res 2024;24(1):295-307.
62. Ophir Y, Rosenberg H, Tikochinski R, Efrati Y. Health Side Story: Scoping Review of Literature on Narrative Therapy for ADHD. Healthcare (Basel). 2025;13(11).
63. Rizzi V, Pigeon C, Rony F, Fort-Talabard A. Designing a creative storytelling workshop to build self-confidence and trust among adolescents. Think Skills Creat. 2020;38:100704.
64. Xue Y, Wang J. DIGITAL STORYTELLING IN ENGLISH: A PSYCHOLOGICAL INTERVENTION FOR ENHANCING MENTAL WELL-BEING AND INTERCULTURAL COMMUNICATION AMONG INTERNATIONAL STUDENTS. Schizophr Bull. 2025;51(Supplement_4):S359-S.
65. Ogbeiwi O, Khan W, Stott K, Zaluczkowska A, Doyle M. A systematic review of digital storytelling as psychotherapy for people with mental health needs. Journal of Psychotherapy Integration. 2024;34(2):115.
66. McMahon M, Patton W. A story telling approach to narrative career counselling: Application of the systems theory framework of career development. Narrative Career Counselling: Routledge; 2024. p. 60-72.
67. Kellas JK. Communicated narrative sense-making theory: Bridging storytelling, relationships, and well-being. Engaging theories in interpersonal communication: Routledge; 2021. p. 117-29.
68. Gofman M, Kivity Y, Bar-Kalifa E, Vidan Z, Hasson Ohayon I, Tuval-Mashiach R, et al. Narrative Reconstruction as an Intervention for Posttraumatic Stress Disorder: A Pilot Delayed Intervention Quasi-Randomized Controlled Trial. J Trauma Stress. 2021;34(1):92-103.
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| Section | Review Article(s) | |
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