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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
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... A study investigating self-compassion as a protective factor against stress in adolescents, highlighted that participants with enhanced self-compassion reported less perceived stress, as well as a reduced physiological stress response when faced with stressful social situations [73]. Higher levels of self-compassion can provide a shield against mental health issues, as this impacts an individual's coping strategy when dealing with stressful life events [74][75][76]. Self-compassion is associated with a reduction in catastrophising when faced with challenges, and therefore can protect against the occurrence of more acute and lasting periods of distress such as in chronic depression [77]. ...
... Furthermore, as suggested by Hong [83], there are distinct cognitive processes underlying their symptoms. Anxiety is associated with worry, thought patterns aimed at solving uncertain events to obtain a sense of control [75]. Conversely, depression is associated with rumination, the persistent focus on one's negative emotions, past events and potential negative future outcomes [75]. ...
... Anxiety is associated with worry, thought patterns aimed at solving uncertain events to obtain a sense of control [75]. Conversely, depression is associated with rumination, the persistent focus on one's negative emotions, past events and potential negative future outcomes [75]. Both worry and rumination possess similarities and can co-occur in anxiety and depression [84]; however, worry has been found to be a unique predictor of symptoms associated with anxiety [85]. ...
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As the awareness of mental health increases worldwide, how to improve mental health has begun to be discussed in many countries. Stress is known to cause diverse physical and mental health problems including psychopathologies. On the other hand, our previous studies identified that self-compassion, kindness and understanding towards oneself, is a key component for good mental health in many populations including Japanese workers. The government reports that Japanese workers suffer from high rates of mental health problems. However, the mechanism of how self-compassion helps their mental health remains to be evaluated. Accordingly, this study aimed to elucidate how self-compassion intervenes pathways from stress to psychopathologies, namely depression and anxiety. One hundred and sixty-five Japanese workers completed an online survey regarding self-compassion, depression, anxiety and stress. Correlation and path analyses were conducted. These four variables were significantly inter-related. While self-compassion mediated the pathway from stress to depression, it did not mediate the pathway from stress to anxiety. These exploratory insights assist in understand the mechanism of how self-compassion improves mental health, and inform effective methods to implement self-compassion interventions to the Japanese workforce.
... Moreover, shame causes us to focus our attention inward and see ourselves negatively, related to self-criticism (Gilbert, 2010). In particular, shame for mental health problems (i.e., mental health shame), believing that mental health problems equate to weakness and inadequacy , have been reported as strongly associated with poor mental health (Kotera, Cockerill, et al., 2020;Kotera et al., 2018;Kotera et al., 2019a). ...
... This difference may explain the smaller effect of self-compassion on mental health for social work students in this study. As self-criticism has previously been identified as a mental health risk factor for social work students (Kotera et al., 2018), it is also likely that self-criticism is inhibiting the protective effect of self-compassion for this population . ...
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Poor mental health of healthcare students is a cause for concern in many universities. Though previous research has identified mental health shame and self-compassion as critical in this student group, how these variables differ across different healthcare disciplines remains to be evaluated. Healthcare students (n=344; counselling, occupational therapy, social work, and nursing) completed measures regarding these variables. MANOVA and regression analyses were performed. (1) Counselling and nursing students were more depressed than occupational therapy students; (2) nursing students were more anxious than occupational therapy and social work students; (3) occupational therapy students had more positive attitudes towards mental health than the others; and (4) nursing students worried about their own reputation associated with their family more than counselling students. Self-compassion was the strongest predictor of mental health in all groups, however the effect sizes varied: largest in nursing and smallest in social work students. Findings will help inform effective interventions for students in each healthcare discipline.
... At the same time, they indicated that their self-criticism, self-compassion, and role identity were related to their poor mental health. These findings must be considered to deepen understanding of mental health symptoms and identify better solutions for social work students (Kotera, Green, & Sheffield, 2019). Training holistically involves equipping them with technical and emotional competencies (SEC) for personal well-being and work success (Rosa, Riberas, Navarro-Segura, & Vilar, 2015). ...
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There is a social and cultural problem related to suicide in advanced societies. From a professional point of view, social workers intervene to achieve social welfare and health for the people with whom they work without being exempt from suffering suicidal ideation themselves. The present research aims to analyze suicidal ideation in undergraduate students of Social Work. Through a quantitative methodology, this phenomenon is analyzed in a large sample of students belonging to Spanish universities (n=1005). In the statistical study, a frequency analysis, a cross-table analysis, and a binary logistic regression are developed, taking as reference the dependent variable: the risk of suicidal ideation. The predictor variables of suicidal risk are: sex, type of social relationships, bullying in previous stages, consumption of antidepressant medication, increased anxiety after COVID-19, and economic difficulties in continuing studies. Universities should not be oblivious to the problems of their students but should incorporate specific programs for the treatment and prevention of suicidal risk, promoting quality education about the U.N. Sustainable Development Goals.
... Mental health problems are heavily stigmatised (Corrigan, 2004a), influencing individual attitudes towards those experiencing mental health problems, including the self. Attitudes towards mental health problems have been shown to impact mental health in a number of populations and cultures (Abolfotouh et al., 2019;Kotera, Adhikari, et al., 2021;Kotera, Gilbert, et al., 2019;Kotera, Green, & Sheffield, 2018;Kotera & Maughan, 2020), with evidence that negative attitudes towards mental health problems are associated with an increase in mental health problems (Kotera, Conway, et al., 2019;. Negative attitudes, derived from negative cultural stigma, result in shame when an individual is experiencing a mental health problem (Cabral Master et al., 2016;Gilbert et al., 2007). ...
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How a person perceives mental health problems impacts their mental health. Negative attitudes towards mental health problems are associated with shame, leading to poor mental health. Poor mental health is a cause for concern in Japan, especially among healthcare professionals. To date, no established measure exists in the Japanese language. The Attitudes Towards Mental Health Problems Scale (ATMHPS) is a well-used self-report measure employed in many studies, which led to the development of the short form (SATMHPS). We aimed to develop the Japanese version of (S)ATMHPS: J-(S)ATMHPS. Nursing professionals in Japan (n=300) completed J-(S)ATMHPS and J-DASS-21. Confirmatory factor analysis was performed, and the internal consistencies of subscales were calculated. The original seven-factor structure model was replicated in J-SATMHPS. Internal consistencies for all J-(S)ATMHPS subscales were high. All subscales were associated with mental health. J-(S)ATMHPS can be used as a reliable measure for the attitudes towards mental health problems in Japanese.
... People do not have to hide their loved ones with mental disorders; instead, they do not show avoidance attitudes toward them. In individualistic countries, people expressed a preference for participating in rehabilitation activities [7,8,20,29,39,42,49,56,61]. ...
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Introduction: Schizophrenia is a chronic disabling and the most stigmatizing mental disorder worldwide. The stigma experienced by family caregivers impacts their lives in different ways. This study reports the results of qualitative synthesis to understand the perceptions and experiences of stigma in families of people with schizophrenia spectrum disorders across various socio-cultural contexts. Methods: An initial comprehensive search was performed in databases like Web of Science, PsycINFO, CINAHL, Scopus, and Ovid-based MEDLINE. By searching, 3560 studies were found, of which 16 articles were included in the present study. A meta-synthesis was done according to the meta-ethnographic approach. Result: Three themes were generated: perpetuated stigma by general misunderstandings about schizophrenia, mental health inequality contributes to structural stigma, and long-term family caregiving stigmas, attitudes, and coping strategies. These themes indicated the essential experiences of stigma in families of people with schizophrenia, which appeared due to unknown and socio-cultural misconceptions of schizophrenia that led to emotional challenges for family caregivers. Conclusion: This study addresses stigma-related issues, and coping strategies used almost exclusively by family caregivers. Health policymakers and healthcare professionals working in mental health institutions should consider this data. Substantial steps must be taken to combat stigma, with education initiatives topping the list.
... Distance education has been foregrounded as the type of education that offers equal opportunities to all individuals, especially those with disabilities (Maharjan, Dahal, & Pant, 2022;Papadakis, 2021). While such a claim is indisputable, most distance education programs are delivered online (Kotera et al., 2019), therefore housing issues for people with disabilities do not hold any relevance as they do not severely hinder access and, the educational experience of students with disabilities (Bervell & Umar, 2020). ...
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The primary purpose of this research is to design and implement educational material through the method of distance learning to teach Braille to adult educators. Another main aim of this study is to probe into the possibilities distance learning offers learners and to what extent it can be conducive to a proper and effective teaching of Braille to adult educators. More specifically, the educational material was examined by three experts in distance learning education who contributed to its evaluation and further development. Subsequently, the educational material was examined by five educators who evaluated it.
... Shame is a strong affect compromising people's mental wellbeing (Kim et al., 2011), and related to diverse mental distresses including depression (Matos & Pinto-Gouveia, 2010), anxiety (Tangney et al., 1992), and post-traumatic stress disorder (Harman & Lee, 2010). Moreover, this type of shame can deter people asking for help, which can result in poorer clinical outcomes (Kotera et al., 2019b). Mental health shame has been reported as being strongly correlated with mental health problems cross-culturally (Kotera et al., 2018, indicating a need to be evaluated in a comparative study. ...
In Germany, more than two-thirds of employees report mental health issues, while in Japan, more than half of the country’s workforce are mentally distressed. Although both countries are socio-economically developed in similar ways, their cultures differ strongly. This article investigates mental health constructs among German and Japanese employees. A cross-sectional design was employed in which 257 German and 165 Japanese employees completed self-report scales regarding mental health problems, mental health shame, self-compassion and work motivation. T-tests, correlation and regression analyses were conducted. Results show that German employees have significantly higher levels of mental health problems, mental health shame, self-compassion and work motivation than Japanese employees. While many correlations were similar, mental health problems were associated with intrinsic motivation in Germans, but not in Japanese. Shame was associated with both intrinsic and extrinsic motivation in Japanese, but not in Germans. Self-compassion – defined as a complex of compassion, humanity, care and unconditional, compassionate love – was associated with gender and age in Japanese, but not in German employees. Lastly, regression analysis uncovered that self-compassion was the strongest predictor of mental health problems in Germans. In Japanese employees, mental health shame is the strongest predictor of mental health problems. Results can guide managers and psychologists in internationalised organisations to effectively approach employee mental health.
The sensationalized reports of adverse reactions following human papillomavirus (HPV) vaccination in Japan in 2013 caused the government to suspend its vaccination program recommendation. This resulted in a steep drop in the HPV vaccination coverage from the previous 70% to less than 1%, which situation lasted for about eight years. Although vaccination coverage has been recovering since the government resumed active recommendations for HPV vaccination in 2022, the coverage is still far from the 90% as recommended by the World Health Organization...
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kritik diri adalah perasaan menyalahkan diri sendiri karena sesuatu yang tidak mereka terima di kehidupan nyata hingga mengutuk pemikiran serta menimbulkan depresi. Tujuan dilakukan penelitian ini yaitu untuk melihat bagaimana gambaran kritik diri pada mahasiswa S1 Universitas Negeri Jakarta angkatan 2018-2021. Metode yang digunakan dalam penelitian ini adalah metode penelitian kuantitatif deskriptif dengan jenis penelitian survei. Penelitian survei dilakukan terhadap mahasiswa S1 Universitas Negeri Jakarta Angkatan 2018-2021. Teknik pengumpulan data dilakukan dengan menyebarkan angket The Forms Of Self-Criticising/Attacking & Self-Reassuring Scale (FSRCS) yang dikembangkan oleh Gilbert dan sudah di adaptasi, melalui google form. Pengambilan sampel menggunakan metode non-probabilitas dengan Teknik accidental sampling. Hasilnya menunjukkan bahwa gambaran terhadap tiga aspek kritik diri mahasiswa S1 Universitas Negeri Jakarta terhadap 186 responden angkatan 2018-2021 berada dalam kategori sedang yaitu pada aspek inadequate self sebanyak 116 orang atau 62%, aspek reassured self sebanyak 134 orang atau 72% dan aspek hated self sebanyak 154 orang atau 83%. Sedangkan rata-rata skor secara keseluruhan dilihat dari masing-masing aspek 186 mahasiswa S1 Universitas Negeri Jakarta angkatan 2018-2021 berada pada aspek inadequate self dengan skor 23,1 yaitu mahasiswa merasa dirinya tidak memadai ketika menghadapi suatu kegagalan atau kemunduran yang di alaminya. Disarankan untuk penelitian berikutnya perlu dikembangkan variabel atau intervensi moderator yang lain, sehingga nantinya dapat membantu mahasiswa dalam meminimalisir kritik diri yang ada pada dirinya.
The way social workers discursively construct ‘service user’ identities in everyday interactions (interviews, conversations and text) can affect quality of relationships and practice outcomes. Even though research has focused on the construction of ‘service user’ identities by professionals and service users, little has been done to explore such discursive formulations by pre-qualifying social work students. This is especially relevant, given the strengthening of the ‘expert by experience’ identity in social work education. This paper seeks to make visible mechanisms of student identity constructions as to ‘who a service user is’, and implications for practice through the examination of student written work pre- and post- a module focussing on lived experience. A critical discursive psychology approach was followed, recognising the interplay between localised professional encounters and wider contexts of power relations. The findings show a shift in the ‘service user’ identities employed by the students mainly based on individualistic discourses and deserving/undeserving themes (substance misuse the result of vulnerability, rather than selfishness, domestic abuse narratives denoting resilience rather than victimhood). The effect to practice showed shifts between the reflective, expert, person-centred and critical/radical practitioner, mainly stressing the need for professional growth at an individual level, with less emphasis on addressing social inequality. The paper argues that predominantly individualistic discourses can perpetuate de-politicised or oppressive categorisations of ‘service users’ and calls for further critical engagement with the discursive micro-practises enacted and developed in the social work classroom, if we are to unveil and challenge narrow, or stigmatising categorisations early on.
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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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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.
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.
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.
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.
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.
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.