Mental Health Attitudes, Self-Criticism, Compassion and Role Identity among UK Social Work Students

Article (PDF Available)inBritish Journal of Social Work 49(2) · August 2018with 400 Reads 
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DOI: 10.1093/bjsw/bcy072
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Although many social work students suffer from mental health symptoms, the majority of them do not seek help, because of shame. Accordingly, the purposes of this study were to evaluate social work students’ attitudes for mental health problems, and explore relationships among shame, mental health symptoms, self-criticism, self-compassion and role identity. First, eighty-four UK female undergraduate social work students completed a measure of attitudes towards mental health problems, and were compared with ninety-four UK female undergraduate students in other subjects. UK female undergraduate social work students had a higher level of negative perception in their community’s attitudes towards mental health problems. Second, eighty-seven UK social work students completed the attitudes, mental health, self-criticism, self-compassion and role-identity measures. Self-criticism, self-compassion and role identity were significantly related to mental health symptoms and identified as significant, independent predictors of mental health symptoms. This study confirmed that social work students consider that their community perceives mental health problems negatively and that their self-criticism, self-compassion and role identity relate to their poor mental health. The findings may help social work students, educators and researchers to deepen the understanding of their mental health symptoms and identify better solutions.
Mental health attitudes, self-criticism, compassion, and role identity among UK social work
Kotera, Y., Green, P., & Sheffield, D. (2018) Mental health attitudes, self-criticism, compassion,
and role identity among UK social work students. British Journal of Social Work. doi:
Although many social work students suffer from mental health symptoms, the majority of them
do not seek help, because of shame. Accordingly, the purposes of this study were to evaluate
social work students' attitudes for mental health problems, and explore relationships among
shame, mental health symptoms, self-criticism, self-compassion, and role identity. Firstly, 84 UK
female undergraduate social work students completed a measure of attitudes toward mental
health problems, and were compared with 94 UK female undergraduate students in other
subjects. UK female undergraduate social work students had a higher level of negative
perception in their community’s attitudes toward mental health problems. Secondly, 87 UK
social work students, completed the attitudes, mental health, self-criticism, self-compassion, and
role identity measures. Self-criticism, self-compassion, and role identity were significantly
related to mental health symptoms, and identified as significant, independent predictors of
mental health symptoms. This study confirmed that social work students consider that their
community perceives mental health problems negatively, and that their self-criticism, self-
compassion, and role identity relate to their poor mental health. The findings may help social
work students, educators, and researchers deepen the understanding of their mental health
symptoms and identify better solutions.
Keywords: help-seeking, self-criticism, compassion, role identity, social work students
More than a third of social work students indicate high levels of depressive symptoms and are at
high risk of clinical depression. Additionally, 40% reported having suicidal thoughts at some
point in their lives, with 4% reporting they were recent (Horton et al., 2009). Poor mental health
is related to reduced academic achievement and higher dropout (Poh Keong et al., 2015).
However, social work students do not seek help (Ting, 2011), and help-avoidance can be
problematic; leaving mental health symptoms untreated worsens the problems. Help-avoidance
was associated with depression in 700 social workers (Siebert, 2004). A major reason for help-
avoidance was stigma about mental health problems (Byrne, 2000; Eisenberg et al., 2007; Ting,
2011). Common stigmatised beliefs include people with mental health problems are weak,
incompetent, and could increase harmful attitudes, namely discriminatory behaviors toward
people with mental health problems, causing social isolation (Corrigan et al., 2001). Stigmatised
attitudes can also lead people to internalise negative views, which may cause feelings of shame
(Byrne, 2000). Social work students are afraid to seek help, as they aspire to help people with
mental health problems. About a quarter of 171 social work students reported stigma was the
main barrier for their help-seeking (Ting, 2011). Despite its significance, research into help-
avoidance in social work students has been limited, and requires more investigation (Reardon,
Though stigma and shame are highly related, they differ in that stigma is a social mark,
an undesirable quality to cause isolation (Lewis, 1999), whereas shame is an individual's
negative emotion of inadequacy, caused by failing to meet some standard (Tangney, 1990).
Stigma leads to a sense of shame (Corrigan et al., 2014). This discernment may help to interpret
previous findings. For example, while American university students with mental health problems
reported stigma was a major reason for their help-avoidance (Eisenberg et al., 2007), no
significant relationship between stigma and help-seeking was found in a longitudinal study
(Golberstein et al., 2009). It is possible that the students were aware of stigma yet still received
help because they did not experience shame.
Shame and recognition are particularly important to social workers, as these concepts
could impact their agency and empowerment (Frost, 2016). While recognition relates to feeling
of trust and acceptance, misrecognition pertains to being denied citizenship in a social life, being
evaluated unworthy of respect (Fraser, 2013). Shame is one salient psychosocial consequence of
misrecognition (Frost, 2016). Indeed, shame involves a negative emotion such as global
devaluation of the self, whereas guilt involves a condemnation of one’s unethical behaviour and
a concern about its negative influence on others (Tangney et al., 2007). Shame leads to concerns
over one’s image, causing hide, escape, and repair of one’s self-image (de Hooge et al., 2010),
whereas guilt leads to apology and compensation. Shame is general negative self-evaluations
(Benetti-McQuoid and Bursik, 2005), relating to worries about others' judgement on them: a
regret for who they are (Tangney and Dearing, 2002). This general, comprehensive nature
distinguishes shame from guilt, which is a regret for violating their moral code (Tangney and
Dearing, 2002). In other words, shame is comprehensive negative self-evaluations related to their
identity, hence it is a stable, pervasive attribute, rather than a transient behaviour (Tangney et al.,
2007). Gibson (2014) identified ‘social worker shame’ (p.417), thus shame is worthy and
appropriate to be measured in social work populations. No study to date explored shame about
mental health problems or about different dimensions of shame (internal, external, reflected
shame, and related attitudes). Accordingly, the present study aimed to evaluate different
dimensions of shame about mental health problems in social work students.
Shame and related psychological constructs
While psychological research generally has a segmented view on shame, focusing primarily on
one’s self, which may hinder our understanding of shame (Gilbert, 2007), social work research
has taken an integral view, considering psychological, social, and cultural contexts, and
including shame variants such as embarrassment and humiliation, acknowledging it may be
misnamed (Brown, 2006). Social workers encounter shame in various settings. For example,
people in poverty may feel shame about living in a poor area, leading to reduced dignity and self-
esteem (Jo, 2013). Social workers may need to understand this shame, in order to support them
effectively (Beddoe and Keddell, 2016). Social welfare beneficiaries may be fearful of benefit
agency staff who control their benefits, which implies to the beneficiaries that accessing benefits
is shameful, causing feelings of humiliation, distress and withdrawal (Morton et al., 2014).
Another example is parents’ shame about their children’s mental health problems, which could
harm their family and therapeutic relationships (Cohen-Filipic and Bentley, 2015). Thus, social
work students need to be able to work with shameful issues of service users (Bentley et al.,
Shame also exists among social workers themselves. Although shame has not been
studied thoroughly in social work, Gibson (2016) found social worker shame negatively affects
their job satisfaction, retention, and ethics: social workers may feel shame about telling anyone
that they were assaulted (Enosh et al., 2013), bullied at work (van Heugten, 2010) or service
users committing suicide (Ting et al., 2006). Social worker shame is related to the devalued and
inadequate feelings (Gibson, 2006). Social workers perceive they are less respected by their
service users and other professionals (Lynch, 2011): nurses are metaphorised as angels, while
social workers are metaphorised as child catchers (Bailey and Liyanage, 2012). Social workers
reported that they feel devalued as they are not placed higher in the local authority hierarchy
(Coffey et al., 2009). This creates shame-based fear where they feel fearful about their future
position in the organisation, which is dependent on those of higher rank (Smith et al., 2003).
Feelings of inadequacy are experienced particularly in comparison with expectations on
them. Many social workers perceive that their society does not condone any mistakes, feeling
shame-based fear that they must always be a perfect practitioner (Gibson, 2016). For example,
social workers reported being over-scrutinised, causing them to feel their work is not good
enough (Smith et al., 2003). Some service users are disappointed in social workers as they are
ordinary people (Pockett, 2002), while their code of ethics portray them as perfect practitioners
(British Association of Social Workers [BASW], 2012). Often social workers feel torn between
their understanding of their role and their perception of expectations of them (Leichtentritt,
2011). This gap between the ideal and reality may lead social workers to feel inadequate and
incompetent (Weuste, 2005), which are strong indicators of shame (Nelson and Merighi, 2002).
Shame and the fear of shame are a serious problem to social workers, because these feelings can
be perceived as being worse than the fear of physical assault (Enosh et al., 2013). Additionally,
shame can affect many behaviours that good social work practice entails: observations,
communication, and judgements, which are crucial to develop healthy self-concept and
therapeutic relationships (Gibson, 2016). Therefore, an exploration of shame is highly relevant to
social work practice (Gibson, 2016).
Shame is associated with mental health symptoms (Tangney and Dearing, 2002),
including depression (Matos and Pinto-Gouveia, 2009), anxiety (Tangney et al., 1992), paranoia
(Matos et al., 2013), post-traumatic stress disorder (Harman and Lee, 2010), eating disorders
(Troop et al., 2008), and personality disorders (Rüsch et al., 2007). Unsurprisingly, shame
predicts the levels of mental health problems in university students (Arimitsu, 2001).
Self-criticism and self-reassurance are related to shame and mental health symptoms
(Gilbert et al., 2010). Self-criticism and shame can activate our threat system, while a low level
of self-reassurance can hinder our well-being (Gilbert, 2010). However, no study has focused on
whether shame and self-criticism are related to mental health symptoms in social work students.
Self-compassion is related to shame, mental health, and self-criticism. Self-compassion
promotes resilience against mental health problems, and reduces self-criticism (Trompetter et al.,
2017). Self-compassion is an understanding and kindness to the self during times of suffering,
aiming to ease the suffering (Neff, 2003). Good mental health is associated with self-compassion
(Muris et al. 2016): compassion-based interventions (Gilbert, 2009) reduce mental health
symptoms, shame, and self-criticism (Braehler et al. 2013; Gilbert and Procter 2006).
Forgiveness of self, one of the effects of compassion, is positively related to self-esteem among
American social work students (Turnage et al., 2012). To date, no study has explored
relationships between self-compassion, mental health, and other related psychological constructs
in social work students.
Lastly, as qualitative responses of 171 social work students about the reason for help-
avoidance (Ting, 2011) suggested, social work students’ caregiver identity might be related to
their shame about mental health problems. Research has reported that caregivers in other
professions (e.g. nursing, counselling) often fail to recognise their personal problems (Kottler
and Hazler, 1996; Nace, 1995). Role identity theory (McCall and Simmons, 1978) posits that
behaviour is shaped by perceptions of self in personal and professional roles. Social workers
have multiple professional and personal identities (Brody, 2010) defining how they should
behave (e.g. helper, manager, mediator). This may make it difficult for them to acknowledge that
they have similar problems to their service users, because their ideal self-image conflicts with
their problems (Siebert and Siebert, 2005). However, no study to date explored correlations
between role identity and shame about mental health problems in this population.
In this study, therefore, we first examined the levels of shame about mental health
problems in UK social work students, comparing with similar university students from other
disciplines (Gilbert et al., 2007). Because the comparison population comprised female
undergraduate students, only female undergraduate social work students were used for this
analysis. Second, we explored the relationships between shame, mental health, self-criticism,
self-compassion, and role identity in the whole sample. Finally, we examined which of these
variables predicted mental health levels. This study focused on symptoms of depression, anxiety,
and stress because these were the most common types of mental health problems in both the
general public and students (Aronin and Smith, 2016; European Community, 2005).
Participants, aged 18 years or older, were social work students at a UK university. Of 106 full-
time students (88 undergraduates and 28 postgraduates) completed the ATMHP, 84 were female
undergraduate students (77 British, 6 African, 1 other European; age range 18-58, mean=30.29,
SD=9.13 years). Though we did not explicitly exclude Asian students, there were no Asian
student participants in this study. The representativeness of our sample to the general population
was still maintained as the number of Asian students studying social work in the UK is small
(Skills for Care, 2016). The 84 female undergraduate students were compared with 94 non-Asian
UK female undergraduate students from two UK universities in life science subjects including
psychology (Gilbert et al., 2007). Asian students were excluded to permit comparison (age range
18-46; mean=20.93, SD=4.92 years).
For the second and third aims of the study, 87 social work students (80 female, 7 male)
completed all five self-report measures. The age range was 18–58 (mean=30.76, SD=9.53) years;
14% were postgraduates; 8% were international students (from other European countries and
Attitudes Towards Mental Health Problems (ATMHP). ATMHP comprises 35 four-point Likert
items measuring attitudes towards mental health problems and shame, in four sections: i) their
community’s and family’s attitudes towards mental health problems (their perception of how
their community and family perceive mental health problems), ii) their community external
shame and family external shame (their perception of how their community and family would
perceive them if they had a mental health problem, respectively), iii) their internal shame (how
they perceive themselves if they had a mental health problem), and iv) their family-reflected
shame (how their family would be perceived if they had a mental health problem) and self-
reflected shame (fears of reflected shame on themselves, associated with a close relative having a
mental health problem). All of the subscales had good Cronbach’s alphas of between .85 and .97
(Gilbert et al., 2007).
Forms of Self-Criticising/Attacking & Self-Reassuring Scale (FSCSR). FSCRS (Gilbert et
al., 2004) evaluates people’s perception of themselves in difficult times. The 22 five-point Likert
scale items assess two forms of self-criticalness (inadequate-self and hated-self), and one form of
self-reassurance (reassured-self). Inadequate-self relates to a sense of personal inadequacy (e.g.
‘I am easily disappointed with myself’; nine items), hated-self to a desire to hurt or persecute the
self (e.g. ‘I have become so angry with myself that I want to hurt or injury myself’; five items),
and reassured-self to a sense of self-support (e.g. ‘I am able to remind myself of positive things
about myself’; eight items). Cronbach’s alphas were between .86 and .90.
Depression Anxiety and Stress Scale (DASS21). This 21-item, four-point Likert scale is a
short-form of DASS42 (Lovibond and Lovibond, 1995) comprising three seven-item subscales;
depression (e.g. ‘I felt that I had nothing to look forward to’), anxiety (e.g. ‘I felt I was close to
panic’) and stress (e.g. ‘I found it difficult to relax’). These subscales had good reliability; α=.87-
.94 (Antony et al., 1998).
Self-Compassion Scale-Short Form (SCS-SF). This self-report measure is a shortened
version of the Self-Compassion Scale, comprising 12 five-point Likert items (Neff, 2003).
Cronbach’s alpha was high (.86).
Role Identity Scale (RIS). This eight-item measure evaluates participants’ caregiver role
identity by considering how they view themselves as a caregiver, and how they perceive others
view themselves as a caregiver (Siebert and Siebert, 2005). Participants endorse how much they
agree to each item (e.g. ‘It is my responsibility to be helpful to family and friends’) on a five-
point Likert scale. The internal consistency was high (α=.78).
After consenting to participate to the study, participants were sent links to the online scales,
which were followed by the debrief. In case students were distressed by issues raised by the
study, information about available mental health services was provided. Available mental health
services inside and outside the university were introduced to ensure any issues might be
addressed in a sensitive manner. Ethics approval was obtained from the University Research
Ethics Committee.
The collected data was, first, screened for the assumptions of parametric tests. Second, t-
tests were conducted to examine difference between the two groups (Aim 1). Third, correlations
between their attitudes, mental health, self-criticism, self-compassion, and caregiver role identity
were explored (Aim 2). Finally, multiple regression analyses were conducted to examine the best
independent predictors of depression, anxiety, and stress (Aim 3).
Analyses were conducted using IBM SPSS version 23.0. There were no outliers in ATMHP
responses for t-tests. Skewness values ranged from .26 to 1.55, Kurtosis values ranged from -.58
to 2.35 and the Cronbach’s alpha was .94. For the correlation and regression analyses, two scores
in RIS and one score in ATMHP were identified as outliers, using the outlier labelling rule
(Hoaglin and Iglewicz, 1987), hence were winsorised (Tukey, 1962). Skewness values ranged
from -1.41 to 1.64, and Kurtosis values from -.68 to 3.04. Cronbach’s alpha for ATMHP was .95,
FSCRS was .70, DASS was .93, SCS was .84, and RIS was .83; demonstrating high internal
Next, differences in attitudes toward mental health problems between the female social
work students and the female life science students, were compared using t-tests.
Table 1 Comparison between female undergraduate social work students and life science
Female undergraduate
social work students
Female undergraduate
life science students
Subscale (Range)
CA (0-12)
FA (0-12)
CES (0-15)
FES (0-15)
IS (0-15)
FRS (0-21)
SRS (0-15)
CA=Community Attitudes; FA=Family Attitudes; CES=Community External Shame;
FES=Family External Shame; IS=Internal Shame; FRS=Family-Reflected Shame; SRS=Self-
Reflected Shame.
Superscript indicates significant difference between the two groups (aP<.05).
The female social work students had significantly higher community attitudes (how negatively
they perceive their community viewed mental health problems) than the life science female
students (Table 1). In our sample, there were no differences in any subscale between the male
(n=4) and female social work students.
Of total 15 subscales, data in eight subscales were square-root-transformed to satisfy the
assumption of normality: family attitude, family external shame, family-reflect shame, self-
reflected shame, role identity, depression, anxiety, and hated-self. Pearson’s correlations were
used to examine relationship between attitude, mental health, self-criticism, self-compassion, and
caregiver role identity in 87 UK social work students.
Table 2 Correlations among ATMHP subscales and demographics in UK social work students
1 CA
2 FA
5 IS
GN=Gender (1=male, 0=female); CA=Community Attitudes; FA=Family Attitudes;
CES=Community External Shame; FES=Family External Shame; IS=Internal Shame;
FRS=Family-Reflected Shame; SRS=Self-Reflected Shame. *p<.05; **p<.01.
There were positive relations between the different dimensions of shame, and community and
family attitudes (Table 2). Age was positively related to community and family attitudes. Among
female students only, the same correlations were found.
Table 3 Correlations among ATMHP, DASS, FSCRS, RIS, and SCS in UK social work
students (n=87)
Dep=Depression; Anx=Anxiety; Strs=Stress; CA=Community Attitudes; FA=Family Attitudes;
CES=Community External Shame; FES=Family External Shame; IS=Internal Shame; FRS=Family-
Reflected Shame; SRS=Self-Reflected Shame; ISelf=Inadequate-Self; RSelf=Reassured-Self;
HSelf=Hated-Self; RI=Role Identity; SC=Self-Compassion. *p<.05; **p<.01.
Table 3 shows relationships between shame, self-criticism, mental health symptoms, role
identity, and self-compassion. Shame was positively related to depression, inadequate- and
hated-self; and negatively to reassured-self and self-compassion. Mental health symptoms were
positively related to inadequate-self and hated-self, and negatively related to reassured-self, role
identity and self-compassion. Self-compassion was positively related to reassured-self and
negatively related to inadequate-self and hated-self.
Finally, multiple regression analyses were conducted to explore the relative contribution of self-
criticism, role identity, and self-compassion measures to mental health in 87 UK social work
students; ATMHP was excluded for its relation to mental health symptoms was not as strong as
the others (Table 4). At step one, gender and age were entered to adjust for their effects, and at
step two, all the scores for self-criticism, role identity, and self-compassion were entered.
Because of the many predictor variables, adjusted coefficient of determination was reported.
Multicollinearity was not a concern (tolerance values .88).
Table 4 Multiple regression: Mental health for shame, self-criticism, role identity, and self-
compassion in UK social work students (n=87)
Step 1
Adj. R2
Step 2
Δ Adj.R2
ISelf=Inadequate-Self; RSelf=Reassured-Self; HSelf=Hated-Self; RI=Role Identity; SC=Self-
Compassion; B=unstandardised regression coefficient; SEB=standard error of the coefficient;
β=standardised coefficient; *p<.05; **p<.01.
After adjustment for the demographics, self-criticism, role identity, and self-compassion
predicted 24% of the variance for depression, 13% for anxiety, and 30% for stress. Reassured-
self was the only independent predictor for depression; role identity was the only independent
predictor for anxiety; and role identity and self-compassion were independent predictors for
This study evaluated the attitudes toward mental health problems among UK social work
students, and investigated relationships between their attitudes, mental health, self-criticism, role
identity, and self-compassion. We found that female social work students perceived more
negative attitudes toward mental health problems in their community than female life science
students, but there was no other difference between the two groups. Their attitudes and shame
about mental health problems were highly correlated. Their mental health symptoms, shame,
self-criticism, role identity, and self-compassion were also related to each other, albeit more
modestly. Multiple regression analyses revealed self-criticism, role identity, and self-compassion
were significant predictors of mental health symptoms. We will discuss each finding in turn
Community attitude was higher in social work students than life science students, who
were younger than the social work students. Social work students reported that their community
perceives mental health problems as something to be kept secret, and views people with mental
health problems as weak (Gilbert et al., 2007). This may be related to their expectation of
themselves as social workers who are exposed to mentally challenging situations (Cohen-Filipic
and Bentley, 2015; Morton et al. 2014); thus, they need to be mentally well enough to help those
who are mentally distressed. Students may perceive that social workers are not expected to have
mental health problems and having those problems could mean they are not fit to be social
workers. Previous research suggests that clients expect social workers to provide high-quality
services (Malley and Fernandez, 2010) and make the society better (Braye and Preston-Shoot,
2006): having mental health problems may be perceived as a barrier to deliver those services and
meet those expectations. Professional expectations of social workers contribute to stress and
strain (Lev-Wiesel, 2003), and violations of these expectations can lead to self-doubt and
workplace conflict (Savaya et al., 2011). A recent qualitative study revealed high expectations
could cause distress and recommended the professional body to provide them with more
psychological support (Graham and Shier, 2014). Additionally, social work is a client-centred
profession, thus expectations could conflict with various policies they must follow (Beresford et
al., 2008). They often work inter-professionally but other professionals may not have a clear
understanding of the role of social workers (Graham and Shier, 2014). The complexity of social
work environments may hinder social workers from meeting their expectation (Ruch, 2002). The
high score in community attitudes may betray high expectations of themselves, difficulty of
meeting those expectations, and the consequences of failing to meet them. The lack of clarity
about social workers’ role and duties may cause unrealistic expectations in social workers
(Graham and Shier, 2014), so clarification of the role and duties of social workers to other
professionals and service users may be useful. Students can learn and practice informing others
of their boundaries during their studies, which may reduce their perceived negative attitudes.
Additionally, in order to reduce their overall shame about mental health problems, compassion
training may help them cope with shame (Gilbert, 2009), as it reduced shame and self-criticism
in high shame participants (Gilbert and Procter, 2006). For example, inter-professional
conferences may be an appropriate setting to implement this type of training. The researchers of
this study were involved in a compassion training workshop at such a conference, and the
attendants (including practitioners and students in social work, nursing, and occupational
therapy) left positive feedback: student attendants learned that self-compassion was important to
professionals too, to help overcome their shameful feelings. Indeed, shame is less visible in our
daily life, thus such an irregular setting with professionals and trainees who value caring and are
aware of safety, would help to facilitate discussions of shame in a compassionate manner.
Another form of implementation may be action learning groups, where a small number of
students/practitioners meet regularly to discuss complicated and challenging issues (Abbott and
Taylor, 2013). Sensitive, yet potent affects such as shame can be coped with compassionately in
such settings.
The positive relations between the different dimensions of shame and attitudes may
illustrate the multi-dimensional nature of shame. Internal, external, and reflected shame are
interlinked with each other (Gilbert, 2002), and one’s perception of how their community and
family see mental health problems are related to these shame dimensions (Gilbert et al., 2007).
Though not as strong, the relations among mental health symptoms, shame, and self-criticism
accord with previous findings in Japanese workers (Kotera et al., 2018). Shame was strongly
related to depression and self-criticism. This aligns with previous findings suggesting the
significant impact of shame on mental health (Tangney and Dearing, 2002), and may support
attempts to target shame as a means to reduce self-criticism and improve mental health. For
example, education about mental health problems may be useful: learning that mental health
problems could happen to anybody and having those problems does not mean they are not fit to
be a social worker, may reduce shame about mental health problems (Watson et al., 2017).
Mental health symptoms were strongly related to self-criticism, role identity, and self-
compassion. As previously reported (Gilbert et al., 2010), high self-reassurance and low self-
criticism may be conducive to mental health. The relation between mental health symptoms and
role identity may highlight social work students’ expectations about their future job role, as
discussed above. High expectations of the caregiver role may cause them mental distress (Lev-
Wiesel, 2003). The negative relation between mental health symptoms and self-compassion
echoes previous findings (Braehler et al. 2013; Gilbert and Procter 2006): the impact of self-
compassion on mental health was illustrated in this study too. Considering those correlations
with mental health symptoms, it may be helpful to include compassion training in the social
work curriculum (Toole and Craighead, 2016). Developing self-compassion may reduce self-
criticism and improve mental health. For role identity, self-awareness training may be useful so
that students are more aware of their own values and attitudes that may affect their work
(O’Connor et al., 2003). Although self-awareness training has been already used in some social
work programmes (Australian Association of Social Workers, 1994), this type of training,
focusing on their caregiver identity, may protect their mental health.
Finally, multiple regression analyses revealed self-criticism, role identity, and self-
compassion predicted 13-30% of mental health symptoms. Reassured-self, role identity, and self-
compassion were significant predictors of mental health symptoms. These results resonate with
our correlational analyses; mental health was related to self-criticism, self-compassion, and role
identity. Again, compassion training and self-awareness training may help social work students
to reduce self-criticism, enhance self-compassion, and develop a sound identity as a social
These findings and suggestions need to be considered in relation to the values and
principles of social workers which highlight challenging injustice, discrimination, and abuse of
the human rights, while maintaining confidentiality, accurate records, and trustful relationships
with other professionals and service users (BASW, 2012). These high and diverse demands on
social workers may explain their high levels of shame and self-criticism, as they constantly
compare themselves against their values and principles. Additionally, social workers have
diverse internal moral standards to evaluate their own work, hence their self-image (Stanford,
2010) and moral dilemma can cause psychological distress, often experienced in caring
professions (Weinberg, 2009). Believing that you have not met these expectations can lead to
feelings of inadequacy (Weuste, 2005), which relates to shame and poor mental health (Gibson,
2016). This imbalance between the demands/expectation and self-care in social workers
emphasises the importance of our findings and suggestions such as the provision of compassion
training to increase self-compassion and self-care (Dunne et al., 2016). Especially recently, the
importance of self-evaluation, acknowledging imperfection of one’s work, has been highlighted
among social workers (e.g. Brown, 2010), who believe in high personal accomplishment
(McFadden, 2015). While self-efficacy is essential for successful social work, recognising
inadequacy is equally important. For example, the Mirror method– self- and peer-evaluation of
practice using the internal mirror and rear-view mirror –has been practiced among Finnish social
workers to accumulate tacit knowledge and cope with imperfection (Yliruka, 2011). Similarly,
our suggested training would also help to embrace imperfection, as perfectionism is fostered by
high self-criticism (Shafran et al., 2010), which can be mitigated by self-compassion (Gilbert and
Procter, 2006).
There are several limitations to this study. First, the sample sizes were relatively small.
Second, in our t-test analysis, we compared only female undergraduate students; while the
majority of social work students are female, this finding requires replication in a larger and more
diverse sample. Third, 20% of the respondents dropped out. Though no compensation for
participation might explain this, the length of the scales might also, especially the ATMHP.
Fourth, though there was no association between shame and perceived risk of disclosing personal
information in UK samples (Gilbert et al., 2007), measuring shame using a self-report scale
might limit its accuracy. Fifth, the participants were recruited through convenience sampling.
Sixth, the causal direction of these related psychological constructs has not been evaluated. In the
future, longitudinal data would help illuminate the temporal patterning of the observed
relationships and may help develop interventions that would increase our understanding of
causality. Additionally, evaluation of training for self-compassion, self-criticism, and role
identity would be valuable.
Despite poor mental health, high help-avoidance in social work students has been focused upon
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  • ... Selfcompassion was associated with mental health, and a stronger independent predictor for mental health than shame and motivation in 144 UK students (Kotera et al. 2019a). Cultivating self-compassion could lead to better mental health (Kotera et al. 2019c). While previous research reported that self-compassion mediated the relationship between mental health attitudes and mental health in a Japanese population (Kotera et al. 2019b), the role selfcompassion plays in this relationship (negative mental health attitudes and mental health problems) among Malaysian students has not been explored. ...
    ... Half of students within the cohort reported struggling with stress resulting from academic work (University Partnerships Programme 2017). Likewise, though some initiatives have taken place nationally (e.g. the 'Time to Talk' campaign led by mental health charities), their attitudes towards mental health problems were still negative: Students believed that their family and classmates would consider mental health problems as shameful, and reported feeling ashamed that they would be thought of as having a mental health problem (Kotera et al. 2019c). Among diverse subjects in the UK universities, social work subjects had similar male-female ratio to Malaysian students (86% female; Skills for Care 2018). ...
    ... Our comparative evaluation of mental health between Malaysian students and UK students, highlighted the serious nature of mental health status in Malaysia. Consistent with previous findings (Hezmi 2018;Ministry of Health 2016), Malaysian students scored higher on all the subscales for mental health problems and negative mental health attitudes than UK students, who were also known to have challenging mental health and negative mental health attitudes (Kotera, Green & Sheffield 2019c). Because poor mental health is linked with diverse negative consequences (e.g. ...
    Full-text available
    Poor mental health of university students is becoming a serious issue in many countries. Malaysia - a leading country for Asia-Pacific education - is one of them. Despite the government’s effort to raise awareness, Malaysian students’ mental health remains challenging, exacerbated by the students’ negative attitudes towards mental health (mental health attitudes). Relatedly, self-compassion and resilience have been reported to improve mental health and mental health attitudes. Malaysian students (n=153) responded to paper-based measures about mental health problems, negative mental health attitudes, self-compassion and resilience. Scores were compared with 105 UK students, who also suffered from poor mental health and negative mental health attitudes, to make a cross-cultural comparison, to contextualise Malaysian students’ mental health status, using t-tests (Aim 1). Correlation, path, and moderation analyses were conducted, to evaluate the relationships among these mental health constructs (Aim 2). Malaysian students scored higher on mental health problems and negative mental health attitudes, and lower on self-compassion and resilience than UK students. Mental health problems were positively associated with negative mental health attitudes, and negatively associated with self-compassion and resilience. While self-compassion mediated the relationship between negative mental health attitudes and mental health problems (high self-compassion weakened the impacts of negative mental health attitudes on mental health problems), resilience did not moderate the same relationship (the level of resilience did not influence the impact of negative mental health attitudes on mental health problems). Self-compassion training was suggested to counter the challenging mental health in Malaysian university students.
  • ... While the importance of this profession has been more recognised recently (Gill, 2017) it is still in its infancy regarding researching mental health 4 conditions of social care students. Social care education programmes can be mentally challenging to many students (Kotera, Green & Sheffield, 2019). More than a third of social care students reported serious depressive symptoms (Horton et al., 2009). ...
    ... Particularly social care students are afraid to seek help, as they aspire to help people with mental health problems. Their strong caregiver identify was associated with poor mental health and high mental health shame (Kotera, Green & Sheffield, 2019;Kotera, Green & Van Gordon, 2018;Ting, 2011). Despite these relationships, mental health attitudes and caregiver identity of Irish social care students have not been explored in-depth to date. ...
    ... The present study focused on shame instead of stigma, because shame is strongly related to professional identify and mental health of healthcare students (Kotera, Green & Sheffield, 2019). Shame relates to a sense of inadequacy, compared with some internal or external standard (Tangney, 1990), whereas stigma is an undesirable social mark causing isolation (Lewis, 1999). ...
    Full-text available
    Mental health is a concern in the Republic of Ireland, and in particular mental health of higher education students is challenging. Further, their poor mental health may be negatively impacted by their negative mental health attitudes and caregiver identity, which can yield high self-criticism and low self-reassurance. Accordingly, this study aimed to (i) elucidate the relationships among these five constructs, and (ii) assess the impact of self-criticism and self-reassurance in the relationship (a) between mental health attitudes and mental health, and (b) between caregiver identity and mental health. One-hundred twenty-nine Irish undergraduate students completed self-report measures regarding these constructs. Correlation and path analyses were conducted. Overall all variables were related to each other, in particular family-related shame subscales were strongly related to mental health problems. In path analysis, self-criticism completely mediated the relationship between mental health attitudes and mental health, while self-reassurance did not. Likewise, self-criticism also completely mediated the relationship between caregiver identity and mental health, while self-reassurance did not. The findings suggest the importance of self-criticism to their mental health. While current literature highlights the importance of mental health attitudes such as stigma and caregiver identity such as low self-awareness, our results indicated that it was their self-criticism that predicted poor mental health. Their mental health may be more effectively improved by targeting self-criticism. Compassion training, peer-support groups, and reframing were recommended to counter self-criticism. Our findings will help educators and researchers to identify an alternative and effective means to improve mental health in Irish students.
  • ... Further, the majority reported the reason for not turning to their employer was shame (Alderson, 2017). Indeed, mental health shame has been reported as a barrier for help-seeking in various populations including university students ( Gilbert et al., 2007;Kotera, Green & Sheffield, 2019) and adult workers (Kotera, Adhikari & Van Gordon, 2018a), and it has been positively associated with mental health problems ( Gilbert et al., 2007;Kotera et al., 2018a;2019). ...
    ... Further, the majority reported the reason for not turning to their employer was shame (Alderson, 2017). Indeed, mental health shame has been reported as a barrier for help-seeking in various populations including university students ( Gilbert et al., 2007;Kotera, Green & Sheffield, 2019) and adult workers (Kotera, Adhikari & Van Gordon, 2018a), and it has been positively associated with mental health problems ( Gilbert et al., 2007;Kotera et al., 2018a;2019). ...
    ... In our correlation analysis (Table 3), mental health problems were positively related to mental health shame (i.e., negative attitudes, external shame, internal shame, and reflected shame), and amotivation, while they were negatively related to self-compassion. This echoed previous findings (e.g., Houkes et al., 2003;Kotera et al., 2018b;Kotera et al., 2019;Raes, 2011), suggesting broad negative implications of poor mental health. Contrary to previous findings (Bryant & Garnham, 2015;Lomas, 2014) and our hypothesis, masculinity was not related to mental health shame. ...
    Full-text available
    Despite their poor mental health, many UK construction workers do not seek out help, because of shame for mental health problems relating to masculinity. The purposes of this study were to investigate relationships among mental health shame, mental health problems, masculinity, self-compassion, and motivation, and examine whether self-compassion would mediate the relationship between mental health shame and mental health problems. Construction workers (N = 155) completed measures for those five constructs. The five constructs were adequately correlated with each other, but masculinity and motivation were not related to shame. Self-compassion partially mediated the relationship between mental health shame and mental health problems. Findings may help construction workers understand the importance of mental health shame with mental health problems, and identify better solutions for poor mental health. Brief online self-compassion training was recommended to reduce shame and enhance self-compassion, and may be accessible for construction workers who work at diverse sites and hours.
  • ... Self-compassion -being understanding and accepting of one's weaknesses and inadequacies (Neff, 2003a) -has been receiving increasing attention (Lopez et al., 2015), particularly in the fields of mental health and psychology (Barnard and Curry, 2011;Kotera et al., 2018a;Kotera et al., 2018b;Kotera et al., 2018c;. A meta-analysis of 20 studies reported large (as defined Cohen, 1988) associations between self-compassion and various types of mental distress including depression and anxiety (MacBeth and Gumley, 2012). ...
    ... The positive constructs may be explained by significant relationships between self-compassion and positive affects (e.g., happiness and optimism) and personality traits (e.g., agreeableness) (Neff et al., 2007). On the other hand, the negative constructs may be explained by the strong associations with mental health problems (e.g., depression, anxiety, stress) and shame (Kotera et al., 2018b;Kotera et al., 2018c;Leary et al., 2007;Neff, 2003a;Raes et al., 2011). ...
    Full-text available
    Objectives The Self-Compassion Scale-Short Form (SCS-SF) was developed as an economical alternative for the Self-Compassion Scale (SCS), one of the few scales to assess self-compassion. Despite the active use of the SCS-SF, a psychometric evaluation of this scale remains limited. This study analysed the factor structure, reliability, and construct validity of the SCS-SF in UK university student populations. Methods Of 365 students approached, 333 completed the SCS-SF, and other measures including negative psychological constructs (mental health problems, self-criticism, and mental health shame) and positive psychological constructs (self-reassurance, resilience, and wellbeing). Data were analysed through confirmatory factor analyses and correlations. Results CFA revealed that the six-factor structure, reported in the validation paper, was not replicated. The positive factor, consisting of the three positive subscales, was not strongly related to any variable, but moderately related to reassured-self, resilience, wellbeing, and inadequate-self. The negative factor, consisting of the three negative subscales, was strongly related to inadequate-self, and moderately related to resilience, reassured-self, stress, wellbeing, depression, and internal shame. Coefficients in the negative factor were in general larger than those in the positive factor. The total SCS-SF score was most strongly related to inadequate-self, followed by resilience. Inter-correlations of the six subscales did not follow Neff (2003b)'s theoretical model of self-compassion nor the full-scale factor solution. Conclusions Findings do not accord with the common use of the global SCS-SF score as an assessment of six factors of self-compassion, and suggest a two factor solution assessing self-criticism and self-compassion.
  • ... Today, many UK doctors (72%) believe that education and training would help reduce the sense of shame in their workplace, by fostering openness in the culture (Moberly, 2015). Moreover, high levels of shame towards mental health problems were reported in UK students, who are afraid that seeking help would mean that they would violate some standard (Kotera, Conway & Van Gordon, 2019a;Kotera, Green & Sheffield, 2019b). ...
    ... Strong associations between mental health and mental health shame were in line with previous findings (e.g., Kotera et al., 2019aKotera et al., , 2019bKotera et al., , 2019c. In both workforces, workers who felt strong shame tended to have mental health problems. ...
    Full-text available
    Although often categorised by cultural differences (e.g., collectivism and individualism), Japan and the United Kingdom have several cultural commonalities. One of them is that both countries are known to have a ‘shame culture’; people in these countries often recognise shame in their lives relating to their cultural virtues. While shame can lead to social conformity, this negative affect associated with a sense of inadequacy can also damage our wellbeing. Because of the rapid advancement of technologies in these economically developed countries in the 4IR, workers are put under greater pressure, which is associated with more mental health problems. Their challenged mental health is further exacerbated by strong shame associated with mental health problems. Accordingly, we examined mental health shame in UK and Japanese workers. Four hundred workers (131 Japanese and 269 UK workers) completed measures of mental health and mental health shame, specifically negative attitudes, external, internal, and reflected shame. The results showed that Japanese workers had higher levels of mental health problems and shame than UK workers. In both countries, mental health and shame were overall associated with each other, apart from some family- related variables in Japanese workers. Family reflected shame was a significant predictor in Japanese workers, while self reflected shame was a significant predictor in UK workers. We discuss the implications of these findings with particular reference on how to reduce mental health shame in Japanese and UK workplaces and the provision of solutions for better work mental wellbeing, relating to the advantages of technologies. Because shame often involves perception of others, online interventions may be useful as they can be undertaken by each worker at a private place (instead of their office). Such individualised interventions enabled by the technologies of the 4IR may help to address shame-associated mental health problems in modern workplaces.
  • ... UK social work students are often hesitant to ask for help for mental health problems, because of shame and negative attitudes towards them (Author's own, 2018b). Instead of approaching mental health problems directly, strengthening positive psychological constructs may be an effective helping approach. ...
    ... Sensitivity: Internal need to meet the values and principles of social workers, requiring high levels of work in a wide range of demands: challenging injustice and discrimination, while maintaining trusted relationships with other professionals and service users (BASW, 2012). This may relate to high levels of self-criticism and shame about not meeting the standards (Author's own, 2018b). On the other hand, for example, business students have less clearly-defined pathways to, and more choices of employment, giving them psychological leeway, which allows them to interpret that not meeting one set of criteria can be a matter of 'fit', rather than a lack of competency (Author's own, 2018a). ...
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    Despite high shame about mental health symptoms among UK social work students, positive psychological approaches to their mental health have not been investigated in depth. Emotional resilience has been a core skill in social work practice, however its relationship with mental health is still unclear. Therefore, the primary purposes of this cross-sectional study were to (i) examine the relationships between mental health and positive psychological constructs, namely resilience, self-compassion, motivation, and engagement, and (ii) determine predictors of mental health in UK social work students. An opportunity sampling of 116 UK social work students (102 females, 14 males; 96 undergraduates, 20 postgraduates) completed five measures about these constructs. Correlation and regression analyses were conducted. Mental health was associated with resilience, self-compassion, and engagement. Self-compassion was a negative predictor, and intrinsic motivation was a positive predictor of mental health symptoms. Resilience did not predict mental health symptoms. The findings highlight the importance of self-compassion to the challenging mental health of UK social work students; they caution against the overuse and misunderstanding of resilience in the social work field.
  • ... Internal stigma, a culture of dominance and masculinity (Evans, Pistrang, & Billings, 2013), as well as emotional self-control (Bell & Eski, 2016) were identified as playing an essential role in influencing individual reactions to stress (Stuart, 2017) and has been noted as one of the key reasons officers resist seeking help (Stuart, 2017). It is worth mentioning that shame impacts an individual's decision whether or not to disclose their condition (Kotera, Green, & Sheffield, 2019a;Stuart, 2004). This is particularly evident in professions which encourage masculinity (Kotera, Green, & Sheffield, 2019b). ...
  • ... Labels commonly associated with mental ill health not only have the potential to stigmatise, but to alienate individuals as well. The social stigma attached to mental ill health, and the discrimination people face, makes it difficult for them to seek any psychological intervention (Kotera et al. 2018b;Kotera & Ting, 2019). Furthermore, officers who experience increased stigma tend to have negative opinions about seeking psychological support (Soomro and Yanos 2018). ...
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    Police work is a high-risk profession that can cause mental health conditions. With increasing sickness levels and falling police numbers, it is essential prompt mental health treatment be implemented. The study aims to explore institutional negativity and stigma in the police force toward mental ill health. Semi-structured interviews attended by five police officers with thematic analysis captured i) police culture, ii) the stigma of mental illness, iii) disclosure of mental illness and iv) breaking down barriers. Findings indicate police culture and attitudes to mental health may contribute to the causes of psychological illness, rather than the nature of the job itself. Increased education and awareness surrounding mental health have been shown to be fundamental in how an officer reacts to stress, but change is needed at a managerial level. Future research needs to explore the effects of mental health stigma on ethnicity and gender in the police force.
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    This study aimed to evaluate shame for mental health problems, and explore relationships between shame, self-criticism, self-reassurance, and mental health among UK hospitality workers, because this group of workers suffer from poor mental health yet report strong shame. An opportunity sample of 114 UK hospitality workers completed measures examining shame for mental health problems, self-criticism, self-reassurance, and mental health problems. A high proportion of workers scored over the midpoint in almost all the shame subscales. Shame, self-criticism, self-reassurance, and mental health were related to one another. External shame and self-criticism were positive predictors, and self-reassurance was a negative predictor for mental health problems. While self-criticism moderated the relationship between shame and mental health problems, self-reassurance did not. Online compassion training was recommended as it can reduce self-criticism and shame, can be undertaken without colleagues knowing and tailored to specific work patterns. Keywords: mental health; mental health shame; mental health attitudes; self-criticism; self-reassurance; UK hospitality workers; emotional labor
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    Malaysia plays a key role in education of the Asia Pacific, expanding its scholarly output rapidly. However, mental health of Malaysian students is challenging, and their help-seeking is low because of stigma. This study explored the relationships between mental health and positive psychological constructs (academic engagement, motivation, self-compassion, and wellbeing), and evaluated the relative contribution of each positive psychological construct to mental health in Malaysian students. An opportunity sample of 153 students completed the measures regarding these constructs. Correlation, regression, and mediation analyses were conducted. Engagement, amotivation, self-compassion, and wellbeing were associated with, and predicted large variance in mental health. Self-compassion was the strongest independent predictor of mental health among all the positive psychological constructs. Findings can imply the strong links between mental health and positive psychology, especially self-compassion. Moreover, intervention studies to examine the effects of self-compassion training on mental health of Malaysian students appear to be warranted.
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    Stigma is a significant barrier to recovery and full community inclusion for people with mental illnesses. Social work educators can play critical roles in addressing this stigma, yet little is known about their attitudes. Social work educators were surveyed about their general attitudes about people with mental illnesses, attitudes about practice with people with mental illnesses, and attitudes about students with mental illnesses. On average, educators’ general and practice attitudes were not negative. However, respondents did view a student with a mental illness differently from a “typical social work student.” Findings suggest that we, as social work educators, must raise our awareness and address our own attitudes to support students and uphold our social work values.
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    Social workers often feel ill-prepared to effectively engage parents in conversations about guilt, shame, and blame related to their children’s mental health or substance use challenges. To address that problem, we suggest that specific content should be integrated into social work courses to teach students how to acknowledge and sensitively manage these issues in their practice with families across cultures and family forms. Content, activities, and assignments are offered, built around three learning strategies (enhanced lecture, case-based learning, and experiential learning) to help students build therapeutic relationships based on a deep appreciation of parents’ emotional experiences.
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    Self-compassion interventions may be uniquely suited to address body image distress (BID), as change-based strategies may have limited utility in a cultural context that so highly values appearance. The current study evaluated a version of an Internet-based self-compassion training, which had previously shown promising results, but was limited by high attrition. The intervention period was reduced from three weeks to one week in the present study to improve retention. Eighty undergraduate women endorsing body image concerns were randomized to either self-compassion meditation training or a waitlist control group. Results suggest that brief exposure to the basic tenets of self-compassion holds promise for improving aspects of self-compassion and BID. Attrition was minimal, but compliance with meditation practice instructions during the week was low. Efforts are needed to improve engagement, but this approach has the potential to be an acceptable and cost effective method to reduce BID.
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    This paper reports on findings from the first study into the role of self-conscious emotions in child protection social work practice. This ethnographic case study employed constructionist grounded theory methods to develop a conceptual understanding of the emotional experiences of the social workers. Integrating data from 246.5 h of observations, 99 diary entries, 19 interviews, and 329 pages of documents, a conceptual framework is presented to understand the emotional experiences of the social workers, before using this framework to analyse the case organisation and experiences of those within it. Pride, shame, and humiliation can be considered to be strategically used as a mechanism of control by constructing contextually specific boundaries for shameful and praiseworthy behaviour. By policing these boundaries the actions of the organisation and the social workers could be regulated to ensure they developed institutionally acceptable identities, enabling the organisation to gain legitimacy. While the analysis that has been provided here is specific not only to the organisation that the research took place in, but also to the time in which the data were collected within the organisation, case studies provide important insights into one context that can be useful to understand the processes in others.
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    To test the hypothesis that self-compassion predicts better physical health and that this is partially mediated through health-promoting behaviours, 147 adults completed self-report measures of self-compassion, health-promoting behaviours and physical health. Self-compassion and health-promoting behaviours were negatively associated with physical symptom scores. Self-compassion was positively associated with health-promoting behaviours. A bootstrapped mediation model confirmed a significant direct effect of self-compassion on physical health through health-promoting behaviours (R(2) = 0.13, b = -8.98, p = 0.015), which was partially mediated through health-promoting behaviours (R(2) = 0.06, b = -3.16, 95 per cent confidence interval [-6.78, -0.86]). Findings underscore the potential health-promoting benefits of self-compassion.
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    Growing evidence suggests that positive mental health or wellbeing protects against psychopathology. How and why those who flourish derive these resilient outcomes is, however, unknown. This exploratory study investigated if self-compassion, as it continuously provides a friendly, accepting and situational context for negative experiences, functions as a resilience mechanism and adaptive emotion regulation strategy that protects against psychopathology for those with high levels of positive mental health. Participants from the general population (n = 349) provided measures at one time-point on positive mental health (MHC-SF), self-compassion (SCS-SF), psychopathology (HADS) and negative affect (mDES). Self-compassion significantly mediated the negative relationship between positive mental health and psychopathology. Furthermore, higher levels of self-compassion attenuated the relationship between state negative affect and psychopathology. Findings suggest that especially individuals with high levels of positive mental health possess self-compassion skills that promote resilience against psychopathology. These might function as an adaptive emotion regulation strategy and protect against the activation of schema related to psychopathology following state negative affective experiences. Enhancing self-compassion is a promising positive intervention for clinical practice. It will not only impact psychopathology through reducing factors like rumination and self-criticism, but also improve positive mental health by enhancing factors such as kindness and positive emotions. This may reduce the future risk of psychopathology.
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    The experience of poverty as shameful is felt by some people living in poverty due to the internalisation of stigmatising neo-liberal discourses which construe poverty as the consequence of individual failings of effort, competence or morality. A critical response requires an analysis of poverty as primarily caused by structural factors, as without this critical perspective, social workers can become complicit with a responsibilisation agenda based on stigma. Many social work students were raised in the neo-liberal era where the post-war consensus on welfare had diminished and thus may be blind to the assumptions embedded in current discourse about people in poverty. Increasing inequalities in many western countries may mean infrequent contact between people from different class backgrounds and exposure to the realities of poverty. To address the potential risk of social workers reinforcing poverty stigma we propose teaching which explicitly addresses the discrepancies between a structural analysis of poverty and current individualistic discourses that produce stigma. Suggested methods include using complex case studies, and bringing service user voices into the classroom, and the use of the arts, alongside exploring how moral panics are created by regimes of shame, surveillance and control which underpin welfare policy.