<![CDATA[Chronic Low Self-Esteem (CLSE) in patients with severe mental disorders is characterized by a persistent negative self-evaluation and diminished self-confidence. Restructuring thought patterns and improving behavior can be facilitated through Cognitive Behavioral Therapy (CBT) nursing interventions. This study aims to describe changes in cognitive, emotional, and behavioral responses in a patient with CLSE following the implementation of CBT combined with positive affirmation therapy. A descriptive case study design based on the nursing care process was applied to Mr. R, a 20-year-old male diagnosed with CLSE, who was hospitalized at the West Java Provincial Psychiatric Hospital. Clinical data were collected through observation, in-depth interviews, psychiatric nursing assessments, and medical record reviews. The CBT intervention was administered over five sessions during a four-day hospitalization period (September 7–10, 2025), with each session lasting 15–20 minutes, alongside positive affirmation exercises performed twice daily for 10 minutes. Changes in cognitive, emotional, and behavioral responses were observed in the patient following the intervention. The patient demonstrated the ability to recognize negative automatic thoughts, verbalize and write positive affirmation statements, express feelings openly, perform daily activities independently, and interact with others in the ward. Conclusion: The implementation of nurse-delivered CBT combined with positive affirmations demonstrated changes in cognitive responses and adaptive behaviors in a patient with Chronic Low Self-Esteem, although the clinical observations from this single case cannot be generalized to the broader population. This intervention can be implemented in a structured manner as part of psychiatric nursing care in psychiatric hospitals.]]>
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