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The Effectiveness of Online Group Cognitive and Behavioral Therapy on Self-Esteem and Forgiveness in Young Adult Women after Romantic Relationship Break Up

The end of a romantic relationship may impact an individual, one of which is low self-esteem that causes the individual to feel difficult, hesitant, and reluctant to start another relationship with a new partner. It also can affect the psychological well-being of the individual. Self-esteem is one crucial aspect of human development, in this case, in having a romantic relationship. Therefore, this study aims to develop an intervention program to help young adults improve their self-esteem and their ability to forgive after a breakup from a romantic relationship. This intervention was implemented online, once a week for eight weeks, to 8 participants, all-females with low self-esteem and difficulty forgiving after a romantic relationship break. The age was ranging between 20-25 years old. This study developed intervention based on Fennel's self-esteem intervention module and Worthington's forgiveness intervention module. Based on the results of Rosenberg's Self-Esteem Questionnaire (RSEQ) and Heartland Forgiveness Scale (HFS) scores, there are differences in scores among the participants before and after participating in group intervention sessions (the mean RSEQ increased by 8.5 points and mean HFS increased by 13.25 points). Besides, there are no significant differences in scores among the participants in the control group. It shows that this online group intervention with a CBT approach effectively helps the young female adults to improve self-esteem and the ability to forgive after a breakup from a romantic relationship. Furthermore, it works effectively during pandemic conditions when face-to-face meeting is not permitted.


INTRODUCTION
Emerging adulthood happens when an individual is exploring and has a high optimism regarding his future [1]. One of the explorations that an individual does is building romantic relationships with other people. To make a romantic relationship requires some good interpersonal skills [2] and self-esteem [3] within the individual. A romantic relationship is one aspect that affects the formation of personality, psychological well-being of the individual in the present and the future, also overall life satisfaction [4] [5].
Indeed, the individual wants happiness and satisfaction in his romantic relationship. Relationship satisfaction is a subjective assessment given by an individual towards the romantic relationship he/she is currently in [6]. Factors that affect relationship satisfaction and success include commitment between partners [7] [8], trust [8], communication [9], and external factor, such as partner's personality and also stress [10]. Nevertheless, not all romantic relationships can work out as expected, primarily when the relationship cannot fulfill the factors that affect the relationship's success and satisfaction. Those things will impact the relationship and bring it to an end.
The result of this preliminary study that was done online on 120 young adult women age 18-25 years old in Indonesia shows that the end of a romantic relationship brings some problems, such as: 1) difficulties in forgetting and forgiving the former partner, 2) still has negative feelings (for instance, anger, disappointment, and sadness) to the former partner's treatments, 3) feels underappreciated by the former partner that makes her feels not good enough for other people, and 4) has traumas and is scared to start a new relationship after the toxic breakup. The survey results, mainly on points 3 and 4, show that young adult women have low self-esteem after their broken romantic relationships. Low self-esteem is one of the causes that make an individual have trouble accepting the condition post-breakup. Self-esteem is the subjective perception of individuals in assessing their interactions with others and interpreting other people's reactions to themselves [11].
With the end of a romantic relationship, individuals judge themselves as those who failed to maintain their relationships and negatively evaluate themselves. This condition later brings the emergence of insecurity and pulling themselves from their social environment [12]. With the emergence of that feeling, an individual feels worthless and guilty after the romantic relationship ends [13]. Individuals who experienced the end of a romantic relationship also tended to have negative emotions towards their expartner, whereas that feeling tends to hard to vent [14] and brings impacts the individual's functioning [15]. This condition influences them in accepting the breakup and their efforts to start new relationships with new people. Therefore, it is necessary to do an intervention program to help young adult women to deal effectively with the post-breakup in romantic relationships.
CBT is one of the effective therapies that can improve self-esteem [16]. This therapy identifies the individual's core belief that is less adaptive or dysfunctional and changes it to be more realistic using behavior modification techniques [17]. CBT believes that feeling and behavior result from thoughts (cognition). Thus, intervention towards cognitive aspects of the individual can change his behavior and feeling [18]. Intervention in this research refers to the self-esteem module developed by Fennel [19]. In her research, Fennel [19] mentioned that the essence of low self-esteem is in the individual's core belief in seeing themselves thoroughly. In this research, the researcher designed intervention by modifying the therapy group participants' conditions. For example, this study adds one session for forgiveness to help the participants release their emotions.
On the other hand, intervention related to forgiveness refers to Worthington's REACH intervention module [15]. Worthington [15] explained that forgiveness to oneself, other people, or situation must be through two processes, namely acceptance, and restoration of self-esteem through replacing the feeling of self-blame with self-affirming emotions. The therapy participants have to increase their self-awareness and self-evaluation [15].
This research does the intervention online since Indonesia is currently making a Large-Scale Social restrictions regulation (PSBB) in its regions. Online therapy is the perfect alternative to provide mental health services to people during a pandemic [20]. Nevertheless, researcher has not found any research or module regarding self-esteem with the CBT approach done online in Indonesia. Thus, this research aims to see the effectiveness of online CBT in increasing selfesteem and forgiving young adult women after breakups. Researchers hope that this research will increase self-esteem and forgive the young adult women dealing with post-breakup conditions, especially those who became the participants in this research.

METHOD
This research uses a quasi-experiment method with a pretest-posttest nonequivalent control group design. The quasi-experiment method was used to see the CBT effectiveness in increasing self-esteem in the research participants. In this design, one group will receive the intervention (experiment group), while the other groups became the control groups. Individuals who can take part in this research must meet the following conditions: 1) women 18 to 25 years old, 2) heterosexual sexual orientation, 3) not in a romantic relationship with the opposite sex, 4) have problems related to post-breakup conditions that have occurred in the span of 6 months to 1 year. The candidates were registered by an online survey link that the researcher shared on social media, such as Instagram and Twitter. After that, they went through a screening process where the researcher narrowed down candidates who registered according to the criteria. The candidates who did not match the criteria were eliminated. Of 123 registrants, 25 participants met the criteria given. They were then assessed in interviews to understand the participants' problems and synchronize the schedules for interventions. Pre-session Introduction, reading the group therapy rules and filling out the pre-test 2 Self-esteem and post breakup condition Intervention background explanation, self-esteem, relation with the end of a romantic relationship, and CBT therapeutic techniques which will be given to participants. 3 ABC concept from CBT The introduction of thought processes that can influence feelings and behavior through ABC concepts, education regarding the forms of cognitive distortion, and grounding techniques. 4 Forgiveness Introduction to forgiveness, discuss the behavior that shows self-forgiveness, validations and helped to process negative emotions that are felt with empty chair technique, introductions to spell/mantra, and butterfly hugs technique.

Healthy vs Unhealthy Relationship
Explains and discusses characteristics of an unhealthy relationship, characteristics of a healthy relationship, factors that make it difficult for participants to build new relationships, tips for building healthy relationships in the future. Also, discusses their experiences related to those two forms of the relationship, and help the participants to do a self-reflection based on the relationship experiences in the past. 6 Behavioral Activation and Dispute Practices how to manage cognitive distortions by providing reinforcement to oneself and fellow participants, gives sugar cubes from each participant to each participant.

Anticipation Plan and Posttest
Formulates an anticipatory plan in case similar problems arise after the end of online group therapy, share changes felt during the intervention activity, and post-test completion Interview in assessment process aimed to ask the participants' identities (name, age, job, sex, current relationship status, sexual orientation, place of residence), identified problems that were faced by the participants (this intervention focuses on the problems post-breakup), identified the complaints experienced, measured the severity of the complaints, gained information regarding the efforts that have been made to resolve their complaints, and asked their willingness to join online group therapy. From the assessment results, the researcher then chose 8 participants for each control group and experimental group, considering that the participants share similar problem nuances.
Participants in the experimental group received online group therapy intervention using the CBT approach. The intervention was carried out in 7 sessions with a duration of each session between 90-120 minutes, as explained in Table 1. All information regarding the implementation and the number of participants will be informed to prospective participants at the initial interview session. Each session always began with an ice-breaking activity to warm up the session and check for technical problems (such as internet, voice, camera position) experienced by the participants. In the implementation, participants' obstacles clashed schedules between participants' agendas, and of the participant's headsets malfunction in the middle of the session. Researchers then solved this problem by rescheduling the session, agreed by the facilitator team and the participants, and asked participants who had problems with their headsets to write questions, opinions, or stories in the chat column during the session.

RESULT
Group interventions were done in 7 sessions and held every Monday at 2-4pm (Indonesian time). This intervention involved one facilitator, one co-facilitator, one observer, one application technician, and eight female participants with an age range 21 to 25. Based on the results of the subjective units of distress scales given verbally in the assessment interview, the eight participants felt disturbed by post-breakup problems in the range 3-4 (scale 1-4). Each participant has successfully followed the entire series of group therapy sessions up to the last session.

Session 1 -Pre-session
Pre-session consisted of an introductory session and group therapy rules. The participants and the facilitator team get to know each other. The facilitators explained the rules for undergoing therapy, including confidentiality and the prohibition of uploading material or documentation in screenshots or any form of intervention activities on any social media. In this session, the facilitator also encouraged the participants to fill out an informed consent, a confidentiality agreement sheet, and fill in the pre-test link.

Session 2 -Self-esteem and Post Breakup Conditions
Generally, each participant has similar problem nuances, namely having low self-esteem after the end of a romantic relationship, and it was not easy to forgive herself, her ex-partner, and the conditions associated with the event, as shown in Table 2. This situation makes them feel guilty because they feel the end of the relationship due to their behavior. They feel that they are not good women because their ex-partners mistreated them. Besides, they have negative emotions, such as anger, resentment, sadness, and disappointment towards themselves and their ex-partners. This feeling cannot be removed easily. They have difficulties accepting any changes in conditions after separating from their ex-partners, such as not hanging out with group friends with the ex-partner in it or feeling afraid to open social media because they were not brave enough to see their ex-partner's activities again.
In this session, each participant still has some negative emotions. Some participants cried when telling their stories, and also when they listened to other participants' stories. The exciting thing about this session is that without being given direction by the facilitator, each participant listening to another participant's story automatically provides validation and support for what has been passed by each participant. The participants were also seen to be attentive and actively listen to the stories of each participant.

Session 3 -ABC Concept From CBT
Participants analyzed the conditions they experienced with the ABC model and identified cognitive distortion form they often felt. Participants were also invited to reflect on the impact of cognitive distortions that often arise. Overall, most participants experienced types of cognitive distortion, such as selfblaming and overgeneralization. From this session, the participants seemed less comfortable with recognizing the cognitive distortions they had. Even so, they seem quite attentive and can understand the material well. What participants reported benefiting from this session was the grounding relaxation technique exercise. This technique gives feeling comfortable and calm after processing and exploring negative thoughts to be no longer entangled with their own thoughts and feelings.

Session 4 -Forgiveness
Some participants said that they were quite afraid that the intervention would be in lecturing from this session. There was one participant who admitted that she had wanted to leave this activity. However, at the end of this session, the participants felt that the intervention was beneficial. This session helped the participants process and release their negative emotions so that the impact at the end, they felt much more relieved. The butterfly hugs activity was also found to help reduce negative tension after processing emotions and uncomfortable experiences during the session.

Session 5 -Healthy vs. Unhealthy Relationship
Generally, the participants seemed to be attentive in this session. Several participants were seen taking notes of some information from the material presented. Participants also appeared to be more active in giving questions, opinions, and telling their experiences related to romantic relationships, compared to previous sessions. Each participant could relate to the information provided by stating that they can learn from the previous relationship and use it for the future to be better at preserving a relationship. The exciting thing about this session was that several participants showed visible changes in their facial expressions and behavior. For example, they looked more expressive and active compared to the previous session. Several participants also shared their experiences of doing unhealthy relationship behaviors in previous relationships. They received insights that this experience can be used as learning material for the future, not just regretting it and then blaming themselves. The participants felt proud of themselves for having the courage to admit their mistakes.

Session 6 -Behavioral Activation and Dispute
Participants learn to fight their cognitive distortions by asking themselves whether the thought is a fact. They also learn to use a suitable mantra to counter the thought. This activity is carried out in pairs with fellow participants, supervised by the team of facilitators. From this activity, the participants got insights from helping their friends doing dispute. This activity has opened a new perspective on a problem or cognitive distortion that was felt. Besides, they realize that it turns out that other people can see the positive side in themselves, which often escapes their view and becomes a reminder of the positive side they have. The activity continued by giving sugar cubes from each participant for each participant. In this session, the emotions and atmosphere of the participants were more optimistic than before. It can be seen from the facial expressions, a lighter tone of voice, and the participants' enthusiasm in participating in the activities given during the session.

Session 7 -Anticipation Plan and Post-test
This session encouraged the participants to develop strategies that can be done to feel calmer and better in managing their negative thoughts and emotions, also mention other support they might get from others. In this session, participants were also invited to share the changes they felt and their benefits after attending the entire session. Generally, participants felt there was a change in behavior that was much better than before, such as no longer being afraid to open social media, being able to anticipate when they were feeling negative emotions, and there were some participants who were judged by their peer group friends that they became more open than before. The participants felt that this activity was very beneficial for them because they can accept their conditions and feel peace with negative emotions and thoughts that had been bothering them.
Generally, participants seemed to have positive energy, as seen in their smiles and gestures on the screen. Participants also seemed to show their initiative in expressed their feelings and thoughts during the entire session. Participants looked to be braver in telling their opinions and experiences regarding the process they have been through. In the story sharing activity related to what was obtained from the entire session, several participants took the initiative to tell stories. Besides, overall, the participants mentioned that their goal in participating in this online group therapy activity was achieved, and the material and activities provided were considered to be very helpful for them in dealing with post-breakup problems. At the end of this session, participants fill out the post-test link.
We can see from Table 3 that after the group therapy, there was an increase in self-esteem and forgiveness scores related to post-breakups in all of the eight participants. Meanwhile, Table 4 explains that eight participants in control group do not significantly change self-esteem and forgiveness scores regarding post-romantic relationships. There was a decrease in self-esteem and forgiveness scores in three participants. It can be said that young adult female participants who did not get group therapy with a cognitive behavioral therapy approach that was done online did not show any change or a significant increase in self-esteem and their abilities to forgive after their romantic relationships ended.

Discussion
Based on the research result, we can see an increase in self-esteem scores on all of the group therapy participants, as stated in Table 3. Qualitatively, all of the participants said that they feel confident, can recognize themselves better and are less likely to be influenced by negative thoughts that arise. Participants said that they tend to accept their weaknesses and strengths and, the end of their romantic relationships can be a lesson for the future. It shows that online group therapy with CBT approach effectively improves young adult female participants' self-esteem between 18 to 25 years old who just ended their romantic relationships. This result also follows the previous research, which found that therapy with a CBT approach is adequate to improve self-esteem [19] [21].  1  25  27  40  25  42  2  21  31  48  26  45  3  25  19  26  21  27  4  23  28  51  25  49  5  24  25  49  29  59  6  21  25  45  28  47  7  21  24  45  27  48  8  20  27  49  29  Moreover, there was an increase in the forgiveness scores on seven out of eight participants who attended the whole session, as mentioned in Table  3. Forgiveness therapy that was given to the participants included writing, the empty chair, and introduction to some relaxation techniques that are felt to be useful for the participants as a way to neutralize the emerging negative emotions, vent the emotions that could not be released before, and become one of the forms of more adaptive stress coping.

Advances in Social Science, Education and Humanities Research, volume 530
Qualitatively, the seven participants felt more accepting of their former couples' treatments in the post-breakup condition. They also accepted the fact that the cause of their relationship termination is due to their and their former couples. Participants said that the acceptance process is a way to forgive themselves, others, and conditions. Through the interview and assessment process, it is known that generally, the participants had difficulties to vent their emotions and negative thoughts they felt after the end of their romantic relationships. Because of their unpleasant experiences, they vent these thoughts and emotions to friends or people around them. They tended to get judged or did not feel that they are heard well by the other people. Therefore, they chose to keep their negative thoughts and emotions to themselves. Therefore, expressive writing and empty chair activities helped them in doing catharsis on the emotional outburst they felt.
On the other hand, there is one participant who experienced a decrease in forgiveness score. To get into this, the researcher did a more-in-depth interview with that particular participant after the intervention activities ended. It showed that the participant felt that ending a romantic relationship is not a thing that deserves forgiveness. She felt that the mistake was indeed in her former partner's hand and, there were some different expectations between her and her former partner; however, she did not feel that she deserved the treatments that her ex did to her. The particular participant was not ready to achieve the forgiving and accepting condition from the post-breakup, which later affected to her forgiveness score.
If seen as a whole, the study's results indicate that online group therapy with CBT approach effectively increased the ability to forgive on female, young adults age 18 to 25 years old with the postbreakup condition. This result is also following the previous research, which said that therapy with CBT approach is effective in increasing the ability to forgive [14][22] [15].
The researcher found some things that became a limitation from this group intervention. First, adequate Internet connection and device becomes one factor that must be considered in every session. Internet connection became something that was always ensured in this intervention activity; however, sometimes, some unpredictable conditions that need to be considered. For instance, insufficient participant's Internet quota can interrupt the session, so the participants should change to another device. Also, the participants' device (like the headset) was broken so that participants could not speak directly. As a result, participants whose devices were broken wrote their comments and opinions on the Zoom application's chat column. For this reason, it will be better for the next study if researchers can encourage participants to ensure that their internet signal is strong enough and that the devices used can function optimally to follow the intervention session well.
Besides, the right environmental conditions help participants to concentrate on following the intervention session. Some participants experienced some distractions due to their family members or people around them who asked them to talk in the middle of a discussion session on the ongoing intervention. Therefore, the next research may ask the participants to prepare a conducive room for them to attending the session without distraction from their surroundings.
The researcher had help from a co-facilitator, who is also the researcher's partner, to support the intervention sessions. This co-facilitator understood his duties and responsibilities in this intervention activity, organizing and overseeing the Zoom application process and observing each participant. Based on this online group intervention activity, the researcher understood that doing online observations was quite challenging; therefore, we needed an optimal accuracy to capture behavior changes in participants. Thus, it will be better Advances in Social Science, Education and Humanities Research, volume 530 if a team of co-facilitators accompany the facilitator. The facilitator only relied on the cameras that showed only from the shoulders to the participants' heads. If the participants had unstable Internet connection, they had to turn their videos off to communicate more efficiently. It had become a challenging thing for the facilitator team to observe thoroughly and can only depend on the verbal interactions with particular participants.
The facilitator's emotional and energy stabilities are also crucial in doing the online group therapy. The number of online interactions at each session can quickly drain the facilitator's energy and emotions. It can affect how the facilitator carries out the session. In some sessions, such as sessions 2 and 3, the facilitator's energy and emotion stabilities drained pretty quickly; thus, she needed to be replaced by the co-facilitator to carry out the session. The facilitator had to do things to get better fast by providing a few personally useful things for a quick energy boost.

Conclusion
This research proves that group therapy intervention with the CBT approach succeeded in overcoming a decrease in self-esteem and forgiving in the young female adults whose romantic relationships have ended within six months to 1 year. Even though this intervention was done online, it proved effective and efficient in helping the participants of this research.

AUTHORS' CONTRIBUTIONS
PBUK designed, analyzed the result, and wrote the manuscript of this study. LH guided, supervised, and reviewed the manuscript of this study. Both authors read and approved the final manuscripts.