Subjective well-being among psychotherapists during the coronavirus disease pandemic: A cross-cultural survey from 12 european countries

Abstract

Objective
The aim of this study to examine the amount of the total variance of the subjective well-being (SWB) of psychotherapists from 12 European countries explained by between-country vs. between-person differences regarding its cognitive (life satisfaction) and affective components (positive affect [PA] and negative affect [NA]). Second, we explored a link between the SWB and their personal (self-efficacy) and social resources (social support) after controlling for sociodemographics, work characteristics, and COVID-19-related distress.

Methods
In total, 2915 psychotherapists from 12 countries (Austria, Bulgaria, Cyprus, Finland, Great Britain, Serbia, Spain, Norway, Poland, Romania, Sweden, and Switzerland) participated in this study. The participants completed the Satisfaction with Life Scale (SWLS), the International Positive and Negative Affect Schedule Short Form (I-PANAS-SF), the General Self-Efficacy Scale, and the Multidimensional Scale of Perceived Social Support.

Results
Cognitive well-being (CWB; satisfaction with life) was a more country-dependent component of SWB than affective well-being (AWB). Consequently, at the individual level, significant correlates were found only for AWB but not for CWB. Higher AWB was linked to being female, older age, higher weekly workload, and lower COVID-19-related distress. Self-efficacy and social support explained AWB only, including their main effects and the moderating effect of self-efficacy.

Conclusions
The results highlight more individual characteristics of AWB compared to CWB, with a more critical role of low self-efficacy for the link between social support and PA rather than NA. This finding suggests the need for greater self-care among psychotherapists with regard to their AWB and the more complex conditions underlying their CWB.

Full text

Journal of Psychiatric Research 154 (2022) 315–323
Available online 7 August 2022
0022-3956/© 2022 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
Subjective well-being among psychotherapists during the coronavirus
disease pandemic: A cross-cultural survey from 12 european countries
Angelika Van Hoy
a
,
*
, Marcin Rzeszutek
a
, Małgorzata Pięta
a
, Jose M. Mestre
b
,
´
Alvaro Rodríguez-Mora
b
, Nick Midgley
c
, Joanna Omylinska-Thurston
d
, Anna Dopierala
e
,
Fredrik Falkenstr¨
om
f
, Jennie Ferlin
g
, Vera Gergov
h
, Milica Lazi´
c
i
, Randi Ulberg
j
,
Jan Ivar Røssberg
j
, Camellia Hancheva
k
, Stanislava Stoyanova
l
, Stefanie J. Schmidt
m
,
Ioana R. Podina
n
, Nuno Ferreira
o
, Antonios Kagialis
p
, Henriette L¨
ofer-Stastka
q
,
Ewa Gruszczy´
nska
r
a
Faculty of Psychology, University of Warsaw, Stawki 5/7, 00-183, Warsaw, Poland
b
University Institute of Sustainability and Social Development (INDESS), Jerez de la Frontera, Universidad de C´
adiz, Department of Psychology, Puerto Real, (C´
adiz),
Spain
c
Child Attachment and Psychological Therapies Research Unit (ChAPTRe), Anna Freud Centre for Children and Families, 4-8 Rodney Street, London, N1 9JH, UK
d
School of Health and Society, University of Salford, Frederick Road Campus, Broad Street, Salford, M6 6PU, UK
e
School of Psychology, University of Lincoln, Brayford Pool, Lincoln, LN6 7TS, UK
f
Department of Psychology, Linnaeus University, SE-351 95, V¨
axj¨
o, Sweden
g
Link¨
oping University, 581 83, Link¨
oping, Sweden
h
Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Finland, P.O. Box 63, 00014, Helsinki, Finland
i
Department of Psychology, Faculty of Philosophy, University of Novi Sad, 2 Dr Zorana Đinđi´
ca, 21101, Novi Sad, Serbia
j
Insitute of Clinical Medicine, University of Oslo, P.O Box 1171, Blindern, 0315, Oslo, Norway
k
Department of Psychology, Head of Center for Psychological Counselling and Research, Soa University “St. Kliment Ohridski, 15 Tsar Osvoboditel Blvd., 1504, Soa,
Bulgaria
l
Department of Psychology, Faculty of Philosophy, South-West University “Neot Rilski”, 66 Ivan Mihaylov Street, 2700, Blagoevgrad, Bulgaria
m
Department of Clinical Child and Adolescent Psychology, Institute of Psychology, University of Bern, Fabrikstrasse 8, 3012, Bern, Switzerland
n
Laboratory of Cognitive Clinical Sciences, Department of Applied Psychology and Psychotherapy, University of Bucharest, 90 Panduri Street, sector 5, 050663
Bucharest, Romania
o
Department of Social Sciences, School of Humanities and Social Sciences, University of Nicosia, 46 Makedonitissas Avenue, CY, 2417, Nicosia, Cyprus
p
Department of Psychiatry, School of Medicine, University of Crete, 715 00, Heraklion, Greece
q
Department of Psychoanalysis and Psychotherapy, Medical University Vienna, W¨
ahringer Gürtel 18-20, A-1090 Vienna, Austria
r
Faculty of Psychology, SWPS University of Social Sciences and Humanities, Chodakowska 19/31, 03-815, Warsaw, Poland
ARTICLE INFO
Keywords:
Well-being
Psychotherapist
Perceived social support
Self-efcacy
Cross-cultural comparison
COVID-19
ABSTRACT
Objective: The aim of this study is to examine the amount of the total variance of the subjective well-being (SWB)
of psychotherapists from 12 European countries explained by between-country vs. between-person differences
regarding its cognitive (life satisfaction) and affective components (positive affect [PA] and negative affect
[NA]). Second, we explored a link between the SWB and their personal (self-efcacy) and social resources (social
support) after controlling for sociodemographics, work characteristics, and COVID-19-related distress.
Methods: In total, 2915 psychotherapists from 12 countries (Austria, Bulgaria, Cyprus, Finland, Great Britain,
Serbia, Spain, Norway, Poland, Romania, Sweden, and Switzerland) participated in this study. The participants
* Corresponding author.
E-mail addresses: angelikahoun@psych.uw.edu.pl (A. Van Hoy), marcin.rzeszutek@psych.uw.edu.pl (M. Rzeszutek), mj.pieta@uw.edu.pl (M. Pięta), josemi.
mestre@uca.es (J.M. Mestre), alvaro.rodriguezmora@uca.es (´
A. Rodríguez-Mora), nick.midgley@annafreud.org (N. Midgley), j.omylinska-thurston1@salford.ac.
uk (J. Omylinska-Thurston), adopierala@lincoln.ac.uk (A. Dopierala), fredrik.falkenstrom@liu.se (F. Falkenstr¨
om), jennie.ferlin@liu.se (J. Ferlin), vera.gergov@
helsinki. (V. Gergov), milica.lazic@ff.uns.ac.rs (M. Lazi´
c), randi.ulberg@medisin.uio.no (R. Ulberg), j.i.rossberg@medisin.uio.no (J.I. Røssberg), hancheva@
phls.uni-soa.bg (C. Hancheva), avka@abv.bg (S. Stoyanova), stefanie.schmidt@unibe.ch (S.J. Schmidt), ioana.podina@fpse.unibuc.ro (I.R. Podina), ferreira.n@
unic.ac.cy (N. Ferreira), med2p1080166@med.uoc.gr (A. Kagialis), henriette.loefer-stastka@meduniwien.ac.at (H. L¨
ofer-Stastka), egruszczynska@swps.edu.pl
(E. Gruszczy´
nska).
Contents lists available at ScienceDirect
Journal of Psychiatric Research
journal homepage: www.elsevier.com/locate/jpsychires
https://doi.org/10.1016/j.jpsychires.2022.07.065
Received 19 February 2022; Received in revised form 25 July 2022; Accepted 29 July 2022

Journal of Psychiatric Research 154 (2022) 315–323
316
completed the Satisfaction with Life Scale (SWLS), the International Positive and Negative Affect Schedule Short
Form (I-PANAS-SF), the General Self-Efcacy Scale, and the Multidimensional Scale of Perceived Social Support.
Results: Cognitive well-being (CWB; satisfaction with life) was a more country-dependent component of SWB
than affective well-being (AWB). Consequently, at the individual level, signicant correlates were found only for
AWB but not for CWB. Higher AWB was linked to being female, older age, higher weekly workload, and lower
COVID-19-related distress. Self-efcacy and social support explained AWB only, including their main effects and
the moderating effect of self-efcacy.
Conclusions: The results highlight more individual characteristics of AWB compared to CWB, with a more critical
role of low self-efcacy for the link between social support and PA rather than NA. This nding suggests the need
for greater self-care among psychotherapists regarding their AWB and the more complex conditions underlying
their CWB.
The issue of psychological health and well-being of psychotherapists
is a highly understudied research topic in psychotherapy and clinical
psychology, which have traditionally focused almost exclusively on the
clients of psychotherapy rather than the psychotherapists themselves
(Laverdi`
ere et al., 2018; 2019). However, providing psychotherapy is
related to multidimensional psychological distress and a constant
requirement for empathy, which all pose a signicant risk of emotional
problems among psychotherapists (e.g., Raquepaw and Miller, 1989;
Rosenberg and Pace, 2006; Rupert and Morgan, 2005; Rzeszutek and
Schier, 2014). Until now, previous research has focused more on the
negative aspects of psychotherapists’ mental health (i.e., psychothera-
pists’ burnout; see systematic reviews: Lee et al., 2020; Simionato and
Simpson, 2018); however, far fewer studies have examined the problem
of psychological well-being among psychotherapists (Brugnera et al.,
2020; Laverdi`
ere et al., 2018, 2019). In other words, while there is
relatively high empirical evidence on the negative mental consequences
of the psychotherapy occupation, little is known about how psycho-
therapists can enhance their well-being and quality of life. It is some-
what surprising that this last topic is still so neglected because previous
systematic reviews have highlighted that clients choose to work with
psychotherapists who they perceive as psychologically healthy and
satised with their own lives (Lambert and Barley, 2001; Wogan and
Norcross, 1985). Conversely, several studies have shown that a low
quality of life among psychotherapists could deteriorate the therapeutic
alliance and the entire therapeutic process (Enochs and Etzbach, 2004;
Holmqvist and Jeanneau, 2006). The aforementioned issues are espe-
cially vital in light of the COVID-19 pandemic when psychotherapists
were forced to tackle many new challenges regarding their therapeutic
practice (Brillon et al., 2021). COVID-19 distress and related obstacles
evoked high levels of depression and anxiety in this specic sample,
which signicantly deteriorated their personal well-being (Brillon et al.,
2021). In this study, we explore the relationship between social support
and the subjective well-being of psychotherapists from 12 European
countries in the COVID-19 pandemic and the possible moderating effect
of self-efcacy on that association.
A large body of empirical evidence exists on how social support ex-
erts its mitigating effect on stressful events and enhances individual
well-being in the general population (Cohen and Wills, 1985; Schwarzer
and Knoll, 2007), in the clinical samples (Wang et al., 2021), and in the
special case of occupational stress (Łuszczynska and Cieslak, 2005). In
particular, although previous studies have observed the main and
buffering effects of social support in stress adaptation, these ndings are
full of inconsistencies, especially regarding the buffering mechanism of
perceived support (Gleason et al., 2008; Łuszczynska and Cieslak,
2005). For example, Gleason et al. (2008) described the phenomenon of
the mixed blessing of receiving support, when receiving support can
sometimes have a detrimental impact on the well-being under stress, as
it may create feelings of guilt, dependency, or inefciency in the sup-
port’s recipient. Several authors claim that the reason for such incon-
sistent results is still the relative lack of studies on personal moderators
in the social support-stress association (e.g., Łuszczynska et al., 2011;
Stetz et al., 2006). In the current study, we focused on the cognitive
personal moderator, which is self-efcacy (Łuszczynska et al., 2005).
Psychological studies on protective factors against work-related
stress focused solely at rst on the work environment (e.g., organiza-
tional structure, type of management) or on the stable individual char-
acteristics of employees (e.g., age, personality; see review and meta-
analysis by Alarcon et al., 2009; Lee et al., 2013). However, the afore-
mentioned variables are usually difcult to change; thus, in the next
period, researchers concentrated on more modiable individual features
of workers, including cognitive coping with work-related stress (Shoji
et al., 2016). One of the widely explored concepts within that eld of
study is self-efcacy, which the father of this construct dened as a
person’s beliefs in his or her ability to have control over challenging
demands (Bandura, 1997). In terms of occupational stress, self-efcacy
is conceptualized as the individual condence that one has the skills
to cope with specic work-related tasks, work-related challenges, and
the accompanying stress and its consequences (Shoji et al., 2016). Some
authors have observed that self-efcacy may act as a personal resource
against work-related stress and strain (e.g., Hahn et al., 2011) and
mitigate the process of employees’ adaptation to organizational changes
and conicts within it (Unsworth and Mason, 2012). Self-efcacy can be
assessed as either a domain-specic term or a general (global) construct
(Łuszczynska et al., 2005). In our study, we followed this latter
approach, as it enables us to measure this construct in the process of
general stress adaptation and to better capture its possible interaction
effects with other variables (Łuszczynska et al., 2005).
One of the still unresolved research questions is the mutual rela-
tionship between social support and self-efcacy in enhancing well-
being under stress (Carmeli et al., 2020; Hohl et al., 2016). In other
words, it is not entirely known whether, in this process, those constructs
mutually reinforce each other or compensate for deciencies in one
resource to another. Initially, social cognitive theory (Bandura, 1997)
suggests two potential interactions of these resources, known as syner-
gistic versus compensation effects (e.g., Dishman et al., 2009; Warner
et al., 2011). On the one hand, the synergistic effect highlights that the
interaction of social support and self-efcacy may have a stronger effect
on well-being than each of them separately. For example, if a higher
level of social support is positively related to well-being at all levels of
self-efcacy, but at the same time, this effect is stronger for higher levels
of self-efcacy, and we have a synergistic effect. On the contrary, when
an interaction of these two constructs is signicant only if one of them is
at a low intensity, we have a compensatory effect. For example, if I am
low in self-efcacy, I may prot emotionally much more from receiving
support compared to when I am high in this cognitive resource and I rely
only on my own abilities, so receiving support could be an admission of
weakness for me (Warner et al., 2011).
In this study, we assumed that the aforementioned effects could
differ depending on the subjective well-being (SWB) components we
measured, i.e., cognitive well-being (CWB; life satisfaction) versus af-
fective well-being (AWB; positive affect [PA] and negative affect [NA]).
According to the classic denition, SWB is operationalized as people’s
satisfaction with their lives as a whole or with the individual domains of
their lives and includes two main components: satisfaction with life,
which is the cognitive aspect of subjective well-being (CWB), and af-
fective well-being (AWB), i.e., positive and negative emotional reactions
A. Van Hoy et al.

Journal of Psychiatric Research 154 (2022) 315–323
317
to peoples’ lives (Diener et al., 1985, 2016). It has been proved that high
levels of SWB are related to good health, longevity, and optimal human
functioning (Fredrickson, 2013; Steptoe et al., 2015). Several authors
have found that these two elements are associated, but separable con-
structs, especially regarding their temporal stability, various predictors,
and different backgrounds (Eid and Diener, 2004; Kaczmarek et al.,
2015; Luhmann et al., 2012a). More specically, it has been proven that
CWB is relatively stable throughout a person’s entire life, but also de-
pends mostly on external circumstances (e.g., income, job status, current
life situation; see Diener et al., 2016; Lyubomirsky, 2011). In other
words, between-country differences (see e.g. economic situation) may
signicantly impact the level of CWB between study participants. On the
other hand, AWB is a much more dynamic state and is highly
person-dependent, usually rooted in individual personality differences
(e.g., Schimmack et al., 2002; Steel et al., 2008). Thus, in this
cross-cultural study, these two SWB components may reveal various
levels of country-versus intrapersonal sources of variance among psy-
chotherapists as well as their different associations with social support
and self-efcacy (synergistic versus compensation effect).
Present study
The aim of this study was twofold. First, we examined how much of
the total variance of subjective well-being (SWB) of psychotherapists
from 12 European countries during the COVID-19 pandemic was
explained by between-country differences when we compared cognitive
well-being (CWB; life satisfaction) and AWB (PA and NA). Second, at the
individual level, we examined the relationship between SWB and per-
sonal (self-efcacy) and social resources (perceived social support). In
particular, we tested a moderating effect (synergistic vs. compensatory)
of self-efcacy on the social support–SWB association to explore
whether this effect is different for the SWB components. We imple-
mented a multilevel approach to reect the fact that the psychothera-
pists were nested in the national samples. Thus, we focused on the
relationships at the individual level (Level 1) after adjusting for
between-country differences in the variables under study (Level 2). We
also controlled the results for sociodemographic, work-related charac-
teristics, and COVID-19-related distress. To the best of our knowledge,
there is no cross-cultural research on the abovementioned issues in a
specic sample of psychotherapists. Thus, our study is mainly explor-
ative, but we formulated at least two directional hypotheses:
Hypothesis 1. In the case of the CWB, there would be high between-
country differences among the participants.
Hypothesis 2. In the case of the AWB, there would be high between-
people differences among the participants.
Hypothesis 3. A moderating effect of self-efcacy would be observed
on its relationship with perceived social support, for both SWB compo-
nents (CWB and AWB). The synergistic vs. compensatory character of
this effect is a subject of exploration.
Methods
Participants
In our cross-cultural survey, we used standardized questionnaires in
an online format (see below) using a specialized online platform to
interview psychotherapists from 12 European countries: Austria,
Bulgaria, Cyprus, Finland, Great Britain, Serbia, Spain, Norway, Poland,
Romania, Sweden, and Switzerland. The process of gathering data in all
these countries took place between June 2020 and June 2021 during the
second and third waves of the COVID-19 pandemic. The online ques-
tionnaires were sent to the professional psychotherapeutic associations
of various therapeutic modalities in each country and distributed among
their members.
A total of 2915 psychotherapists from 12 countries representing
various psychotherapeutic modalities agreed to participate in this study.
The eligibility criteria included certication (or being in the process of
certication) in a particular psychotherapeutic school and practice for at
least one year. The study participants lled out the online versions of the
questionnaire, along with detailed sociodemographic and work-related
questions. In the rst part of the survey, we also asked participants
how the COVID-19 pandemic had inuenced their practice and to what
extent they suffered from COVID-19-related psychological distress. In
each country, participating in the research was anonymous and volun-
tary, and the participants received no remuneration. The overall study
protocol was accepted by the ethics committee of the Polish coauthors of
this study. Below, detailed sociodemographic, work-related data and
data on the impact of the COVID-19 pandemic on therapeutic practice
among psychotherapists in all countries are presented.
According to the above-mentioned tables, we see that age distribu-
tions were similar among all countries (mean range =37–53 years). In
all countries, female psychotherapists were overrepresented (83%)
when compared to male participants. The majority of participants
declared being in some form of stable relationship (n =75%). Also, the
majority of psychotherapists held psychology degrees and worked with
adult clients. Working in a private workplace was also characteristic of
most of the psychotherapists. Furthermore, most of the psychotherapists
ran a psychotherapy service and submitted their work for supervision at
least once a month. However, the majority of Spanish therapists did not
employ supervision at all, whereas Austrian psychotherapists used it on
a quarterly basis. The therapeutic modalities were distributed differ-
ently in all the included countries. For example, cognitive behavioral
therapy appeared to be the more common therapeutic approach in
Cyprus, Spain, Poland, and Romania, while psychodynamic therapy was
mostly prevalent in Bulgaria, Norway, and Sweden. In Austria and
Switzerland, Gestalt therapy was used most by the participants, and
integrative psychotherapy was mostly mentioned by psychotherapists in
the United Kingdom. Years of experience varied from an average of eight
years in Bulgaria, Cyprus, Poland, Romania, and Serbia to 10–16 years
in Austria, Finland, Spain, Norway, Switzerland, Sweden, and the United
Kingdom. The usual weekly workload ranged from a couple of hours a
week to more than 20 h a week. More specically, in Bulgaria, Cyprus,
Romania, and Serbia, the weekly workload ranged from one to 10 h. The
typical workweek in Sweden and the United Kingdom was between 10
and 20 h. The latter two workload categories were equally distributed
among Austrian, Spanish, and Swiss psychotherapists. Finland, Norway,
and Poland had the most psychotherapists who worked more than 20 h
each week. Last but not least, there was a widespread tendency to work
partially online during the COVID-19 epidemic, and this was the case for
psychotherapists in 11 different nations (Austria, Bulgaria, Cyprus,
Finland, Spain, Norway, Poland, Romania, Serbia, Switzerland, and
Sweden). The majority of UK therapists were still exclusively offering
their services online at the time of data collection.
Measures
Below, we present the study questionnaires that were adapted for all
countries and presented to the participants in their native language
versions.
Life satisfaction was measured using the Satisfaction with Life Scale
(SWLS; Diener et al., 1985). The SWLS is an internationally renowned
tool to assess cognitive aspects of SWB and consists of ve items, each
assessed on a seven-point scale ranging from 1 (strongly disagree) to 7
(strongly agree; e.g. In most ways my life is close to my ideal; The conditions
of my life are excellent; I am satised with my life). A higher total score
indicates a higher level of life satisfaction. The Cronbach coefcients for
the SWLS in all 12 countries varied from 0.84 in the English version to
0.89 in the Norwegian and Bulgarian versions.
PA and NA were assessed using the International Positive and
Negative Affect Schedule Short Form (I-PANAS-SF; Thompson, 2007).
A. Van Hoy et al.

Journal of Psychiatric Research 154 (2022) 315–323
318
The I-PANAS-SF consists of 10 items derived from the original 20-item
PANAS questionnaire (Watson et al., 1988). The ve PA items were
active, determined, attentive, inspired, and alert. The ve negative items
were afraid, nervous, upset, hostile, and ashamed. Participants were asked
to rate these adjectives, depending on the extent to which each one
depicted the way they had felt generally during the last month. The
Cronbach coefcients for the I-PANAS-F in all 12 countries varied for PA
from .68 in the Spanish version to 0.77 in the Finnish version, and for NA
from 0.66 in the Austrian version to 0.80 in the Serbian version.
To examine the participants’ level of self-efcacy, we chose the
General Self-Efcacy Scale (GSES; Schwarzer and Jerusalem, 1995),
which is a well-known 10-item tool to measure the general (global)
construct of self-efcacy. Respondents rate various statements on a
4-point Likert scale (from NO to YES), and the global index of
self-efcacy is obtained as the sum of all items. GSES, the most popular
questionnaire to assess this cognitive resource, has been adapted in
nearly 28 nations (Łuszczynska et al., 2005). The Cronbach coefcients
for the GSES in all 12 countries varied from 0.82 in the Spanish version
to .93 in the Norwegian version.
Social support was evaluated using the Multidimensional Scale of
Perceived Social Support (MSPSS; Zimet et al., 1990). The MSPSS is a
12-item questionnaire created to measure perceived social support from
three sources: family, friends, and a signicant other, as well as the total
support level. In our study, we followed the total support index. Par-
ticipants rated several sentences on a 7-point Likert-type scale from 1
(very strongly disagree) to 7 (very strongly agree). The MSPSS is also an
internationally renowned tool for assessing various aspects of perceived
social support. The Cronbach coefcients for the total support scale in all
12 countries varied from 0.93 in the Polish and Swiss versions to 0.97 in
the Cyprian version.
Data analysis
Multilevel analysis was performed to reect a two-level data struc-
ture: persons (i.e., 2915 psychotherapists) nested in 12 European
countries (Bryk and Raudenbush, 2002). The separate models were
tested for the cognitive and two affective components of the SWB. The
level 1 variable was individual scores centered on the group mean,
which in this case is the mean for a given country. The level 2 variables
were means for each country centered on the grand mean, which is an
average across all countries for a given variable (Enders and Toghi,
2007).
To verify Hypotheses 1 and 2, an intraclass correlation coefcient
(ICC) was calculated based on an unconditional model to obtain the
amount of overall variance in SWB explained by a grouping variable (i.
e., country; Gelman and Hill, 2007).
Next, to examine the interaction assumed in Hypothesis 3, variables
were introduced into the models in four steps. In the rst step, socio-
demographic, and work-related characteristics and COVID-19-related
distress were added. Continuous variables were centered on the group
mean (e.g., age, work experience, and pandemic-related stress), and
categorical variables were dummy-coded (sex: female =0, male =1;
relationship status: single =0, in a stable relationship =1; weekly
workload: 0 =less than 20 h, 1 =20 h and more; supervision: 0 =
quarterly or less, 1 =once a month or more). The second step introduced
level 1 self-efcacy and perceived social support, and the third step
introduced level 2 values of these variables to control for possible
between-country differences. The fourth step brought in the level 1
interaction of self-efcacy x social support. Simple slope analyses were
conducted using the calculation tools provided by Preacher et al. (2006).
For random effects, the covariance structure of the variance com-
ponents (VC) was assumed. The maximum likelihood (ML) estimation
method was used, and all statistical analyses were performed using IBM
SPSS Statistics version 27. This paper presents only the resultant models.
Results
Table 1 presents the descriptive statistics. As can be seen, countries
differ in terms of the average values of SWB components. Fig. 1 shows
that the dispersion of these differences is larger for CWB than for AWB.
Accordingly, ICC indicates that for CWB, as many as 53.7% of the total
Table 1
Descriptive statistics for the studied variables among the sample of psycho-
therapists (N =2915) according to country of origin.
Country n Mean SD Range Kurtosis Skewness
Satisfaction with Life
Austria 151 27.66 4.82 16–35 −0.76 −0.14
Bulgaria 217 14.24 5.60 5–33 0.80 0.43
Cyprus 202 24.31 5.73 8–35 −0.51 −0.24
Finland 254 25.53 5.23 5–35 −0.99 1.53
Norway 225 24.72 5.44 5–35 −0.81 1.02
Poland 340 24.49 4.34 5–35 −0.42 0.91
Romania 202 12.67 4.60 5–29 1.01 1.26
Serbia 237 14.34 4.72 5–30 0.51 0.31
Spain 320 14.51 5.57 5–33 0.81 0.38
Sweden 275 24.07 5.86 5–35 −0.75 0.23
Switzerland 205 28.01 4.50 12–35 −1.08 1.16
United Kingdom 287 16.12 6.06 5–34 0.66 −0.25
Positive affect
Austria 151 16.03 3.27 6–25 −0.25 0.09
Bulgaria 217 16.16 2.80 5–23 −0.09 0.66
Cyprus 202 16.32 2.76 5–22 −0.44 0.69
Finland 254 17.14 2.70 10–24 −0.18 0.07
Norway 225 14.40 2.43 5–20 −0.53 1.07
Poland 340 15.90 2.91 8–25 −0.19 0.00
Romania 202 16.27 2.93 5–25 −0.36 2.09
Serbia 237 19.35 2.31 12–25 −0.25 0.37
Spain 320 16.85 2.70 9–24 −0.10 −0.14
Sweden 275 15.44 2.81 7–22 −0.08 −0.23
Switzerland 205 15.96 3.02 9–24 0.10 −0.12
United Kingdom 287 16.31 3.62 7–25 0.05 −0.24
Negative affect
Austria 151 8.76 2.06 5–15 0.97 1.30
Bulgaria 217 14.24 5.60 5–33 0.80 0.43
Cyprus 202 24.31 5.73 8–35 −0.51 −0.24
Finland 254 8.58 1.72 5–13 −0.06 −0.41
Norway 225 8.78 2.27 5–20 1.20 3.78
Poland 340 10.92 2.57 6–22 0.73 0.76
Romania 202 9.42 2.68 5–20 1.40 3.46
Serbia 237 11.15 3.07 5–20 0.40 −0.26
Spain 320 8.84 2.75 5–21 1.38 2.13
Sweden 275 8.94 2.33 5–16 0.77 0.40
Switzerland 205 9.03 2.09 5–14 0.37 −0.19
United Kingdom 287 9.35 2.89 5–23 1.08 1.54
General self-efcacy
Austria 151 30.42 5.13 15–40 −0.55 0.42
Bulgaria 217 29.43 5.00 10–40 −0.90 1.97
Cyprus 202 30.04 5.12 10–40 −0.58 1.31
Finland 254 31.10 4.20 15–40 −0.72 1.74
Norway 225 30.19 5.87 10–48 −0.36 0.38
Poland 340 31.13 3.61 18–40 0.21 0.68
Romania 202 32.76 4.54 10–40 −1.45 5.69
Serbia 237 32.91 4.27 20–40 −0.43 −0.11
Spain 320 32.20 3.83 22–40 0.09 −0.44
Sweden 275 29.50 3.76 17–40 −0.46 1.06
Switzerland 205 31.07 3.68 22–40 0.30 −0.10
United Kingdom 287 30.63 3.55 19–40 0.35 0.63
Social Support
Austria 151 65.46 18.11 15–84 −1.15 0.34
Bulgaria 217 65.70 16.16 12–84 −1.36 1.16
Cyprus 202 66.09 17.24 21–84 −1.09 0.03
Finland 254 67.65 15.37 12–84 −1.15 0.63
Norway 225 66.28 15.71 12–84 −1.03 0.28
Poland 340 67.98 12.18 12–84 −1.54 3.80
Romania 202 72.64 11.83 12–84 −2.04 5.61
Serbia 237 69.84 14.74 26–84 −1.41 1.15
Spain 320 69.67 12.40 12–84 −1.23 1.94
Sweden 275 68.55 15.21 12–84 −1.19 0.82
Switzerland 205 70.96 11.11 13–84 −1.51 4.12
United Kingdom 287 62.76 14.49 12–84 −0.76 0.20
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Journal of Psychiatric Research 154 (2022) 315–323
319
variance is explained by between-country differences. The analogical
values for AWB were much lower and equal to 12.8% and 8.9% for PA
and NA, respectively.
Multilevel analysis showed that both self-efcacy and perceived so-
cial support and their interaction were not signicant for CWB. By
contrast, for AWB, self-efcacy and social support were independently
associated with higher PA and lower NA. A moderating effect of self-
efcacy on the relationship between AWB and social support was also
noted for both valences. Table 2 presents these results.
Further analysis of simple effects revealed slightly different patterns
for PA and NA. As illustrated in Fig. 2, for self-efcacy lower than the
national sample average, the relationship between perceived social
support and PA was insignicant (γ =0.002, SE =0.004, z =0.55, p =
.58), whereas for values equal to (γ =0.011 SE =0.004, z =2.75, p =
.006) or higher than the average (γ =0.0197, SE =0.005, z =3.72, p <
.001), this relationship was positive. These ndings mean that higher
perceived social support was related to higher PA at higher values of
self-efcacy; thus, synergistic effects of these resources were observed,
but present only in individuals with sufciently high self-efcacy rela-
tive to their national sample average. Furthermore, as simple slopes
were signicant outside the region described with the following bounds
(−13.64; −1.69) of self-efcacy, we identied a number of participants
in each country for whom there was no signicant relationship between
social support and PA. Table 3 presents these results. The percentage is
highest for Spain (41.3%) and lowest for Bulgaria (21.66%), with a value
for the whole sample equal to 30.60%.
Fig. 3 presents the results of the same analysis for NA. The simple
slopes for perceived social support and NA are signicant for all self-
efcacy values, but the strength of this relationship becomes greater
with higher self-efcacy values (for values lower than a national sample
average γ = − 0.131, SE =0.003, z = − 39.57, p <.001; for values equal
to a national sample average γ =-0.144, SE =0.003, z = − 44.44, p <
Fig. 1. Country averages in subjective well-being: a) life satisfaction, b) positive affect and c) negative affect. The dotted lines depict grand means.
A. Van Hoy et al.

Journal of Psychiatric Research 154 (2022) 315–323
320
.001; for values higher than a national sample average γ = − 0.157, SE =
0.004, z = − 37.48, p <.001). Thus, in this case, a synergistic effect of
these resources was observed across all the values of self-efcacy, which
was conrmed by the fact that simple slopes are signicant for all the
participants (they are insignicant in a region between −67.19 and
−37.42, which is outside the range of group-centered values of self-
efcacy in our study).
Additionally, notable differences across SWB components were
found for the control variables. The CBW was independent of all the
studied sociodemographic and work-related characteristics, as well as
the self-reported distress due to the pandemic. For higher AWB, two
variables were signicant regardless of valence: older age and lower
COVID-19-related distress. Two other variables were valence-specic
covariates. Namely, for higher PA, being female was a signicant
correlate, whereas for lower NA, a signicant correlate was higher than
20 h per week workload. Being in a stable intimate relationship, years of
professional experience, and working under supervision were unrelated
to SWB in the studied sample of psychotherapists.
Discussion
The results of our study were in accordance with our rst two hy-
potheses, as we found that among psychotherapists, CWB was more
country-dependent, while AWB was mostly related to individual char-
acteristics. Specically, we observed that nearly 54% of the total vari-
ance in life satisfaction was explained by belonging to national samples,
compared to only about 13% of the overall variance in PA and 9% in NA.
This nding may be treated as another argument for the distinctiveness
of cognitive and affective components of SWB (e.g., Busseri and Sadava,
2011; Diener et al., 2016), as well as its potentially different back-
ground, which is dependent on shared external conditions in the case of
life satisfaction and more individualized factors in the case of affect
(Schimmack et al., 2002). The existing literature has provided various
explanations for this phenomenon. Some authors have attributed these
Table 2
Results of multilevel analysis of subjective well-being among psychotherapists
(level 1, N =2915) from 12 countries (level 2).
SWL PA NA
Estimate (SE) Estimate (SE) Estimate (SE)
Fixed effects
Intercept 20.30 (1.43)
***
16.05 (0.31)
***
9.58 (0.23)
***
Level 1 control
variables
Sex 0.39 (0.27) −0.27 (0.14)
**
−0.01 (0.11)
Relationship
status
0.44 (0.24) 0.16 (0.12) −0.13 (0.10)
Age 0.01 (0.01) 0.03 (0.01)
***
−0.05 (0.01)
***
Work
experience
−0.01 (0.01) 0.01 (0.01) −0.00 (0.01)
Weekly
workload
−0.17 (0.22) 0.19 (0.11) −0.24 (0.09)
**
Supervision 0.40 (0.23) 0.1 (0.12) 0.10 (0.10)
COVID-19-
related
distress
0.09 (0.10) −0.18 (0.05)
***
0.72 (0.04)
***
Level 1 variables
Self-efcacy
w
0.04 (0.03) 0.17 (0.01)
***
−0.12 (0.01)
***
Social support
w
0.01 (0.01) 0.01 (0.00)
**
−0.01 (0.00)
***
Level 2 variables
Self-efcacy
b
−3.27 (1.58) 0.87 (0.28)
**
0.32 (0.24)
Social support
b
0.56 (0.72) −0.13 (0.12) −0.05 (0.10)
Level 1
interaction
Self-efcacy
w
*
Social
support
w
−0.001 (0.001) 0.002 (0.001)
***
−0.003 (0.000)
***
Random effects
Residual
variance
27.48 (0.73)
***
7.40 (0.20)
***
4.81 (0.13)
***
Between-
country
variance
23.65 (9.71)
**
0.63 (0.27)
**
0.48 (0.20)
**
Note. ***p <.001, **p <.05, *p <.01; SWL =satisfaction with life, PA =
positive affect, NA =negative affect, SE =standard error, indexes: w =within-
country, b =between-country.
Fig. 2. Simple slopes of moderating effect of self-efcacy on a relationship
between perceived social support and positive affect: Level 1 interaction. Self-
efcacy and social support were centered around the within-country means.
Slopes are probed at a mean value of self-efcacy and one standard deviation
above and below this mean.
Table 3
Simple Slope Analysis of Self-Efcacy x Social Support on Positive Affect:
Number and Percentage of Participants with Insignicant Simple Slopes.
Country Sample Size Insignicant Simple Slopes
Number % of Sample Size
Austria 151 38 25.17
Bulgaria 217 47 21.66
Cyprus 202 59 29.21
Finland 254 70 27.56
Norway 225 74 32.89
Poland 340 104 30.59
Romania 202 73 36.14
Serbia 237 94 39.66
Spain 320 132 41.25
Switzerland 205 74 36.10
Sweden 275 64 23.27
United Kingdom 287 63 21.95
Total 2915 892 30.60
Fig. 3. Simple slopes of moderating effect of self-efcacy on a relationship
between perceived social support and negative affect: Level 1 interaction. Self-
efcacy and social support were centered around the within-country means.
Slopes are probed at a mean value of self-efcacy and one standard deviation
above and below this mean.
A. Van Hoy et al.

Journal of Psychiatric Research 154 (2022) 315–323
321
differences to measurement bias (i.e., time frames used to measure these
two components), with a relatively short time perspective for affect, and
a global, unspecied period of time for life satisfaction (Kim-Prieto et al.,
2005). Other authors have highlighted the structural distinctions be-
tween the SWB components, which persist even when we control for the
time frame of assessment (Diener et al., 2006; Luhmann et al., 2012a).
Namely, life satisfaction deals with the global evaluation of life events,
whereas AWB is based on the assessment of recent activities and events,
which are much more dynamic and transient; as such, AWB reects
rather momentary well-being. The latter may explain why cognitive and
affective components of SWB differ in their temporal stability and
sensitivity to various major life events (Luhmann et al., 2012b). For
example, a meta-analysis conducted by Luhmann et al. (2012b) revealed
that critical life events, such as childbirth, divorce, or retirement, may
have a much more powerful and persistent impact on cognitive SWB
components in the long run compared to affective ones. The same deals
with other external circumstances, such as changes in income, job status,
or the current socio-economic situation in a particular country.
Conversely, AWB is much more uid and is rooted mostly in personality
characteristics (Schimmack et al., 2002).
The above nding corresponds to the fact that, in our study, at the
individual level, life satisfaction among psychotherapists from 12
countries was unrelated to all the analyzed psychological, sociodemo-
graphic, and work-related variables, including distress caused by the
pandemic. It seems that this cognitive component of SWB is resistant and
not susceptible to any of the assessed factors, particularly the COVID-19
pandemic. This null result may be an interesting adjunct to a still highly
understudied topic, which is the psychological well-being of psycho-
therapists (Laverdi`
ere et al., 2018; 2019).
On the other hand, we found signicant associations between the
studied variables and AWB among our participants. Namely, better AWB
was associated with sociodemographic data (being female, older age),
some work-related characteristics (higher weekly workload), and lower
experience of COVID-19 distress. Regarding participants’ gender, some
studies have found that male psychotherapists suffer more from work-
related distress and are thus more vulnerable to burnout in this occu-
pation compared to female psychotherapists (Rupert and Kent, 2007). It
is often connected with sex differences in self-efcacy, which is usually
higher among females working in helping professions (Purvanova and
Muros, 2010). Regarding the participants’ age, our nding is in line with
other, yet scarce, studies, which showed that older psychotherapists
declare higher levels of well-being (Brugnera et al., 2020) and suffer less
from burnout (Rupert and Kent, 2007) than their younger colleagues. In
terms of workload, we found that workloads higher than 20 h per week
were linked to less NA. We should take into account the specic period
when this study was conducted, i.e., the COVID-19 pandemic, when, for
many people, including psychotherapists (Brillon et al., 2021), staying
professionally active could serve as a method of coping with chronic and
uncontrollable conditions. However, we should also consider the other
direction —people who were feeling better (less NA, higher PA) might
be better able to work during the pandemic. Nevertheless, the
COVID-19-related distress was signicantly associated with low positive
and high NA in this sample. The impact of this distress was revealed only
in the case of the affective component of SWB, which indicates the
limited consequences of the pandemic on the evaluation of individual
SWL. Further research using a longitudinal design would help conrm
this suggestion.
For AWB, we received partial conrmation of our last hypothesis.
Namely, for both PA and NA, we found moderating effects of self-
efcacy on their relationship with perceived social support in the form
of a synergistic effect. In other words, a higher level of social support
was positively related to AWB, but this effect was boosted by higher
levels of self-efcacy (Dishman et al., 2009; Warner et al., 2011).
Nevertheless, we also observed slight differences in this synergistic
relationship for each valence. Namely, for PA, low self-efcacy negated
the positive effect of perceived social support. Thus, if psychotherapists
are low in self-efcacy within their national sample, their perception of
social support is benign for PA. The likely mechanism is that such a
person cannot effectively discount support from others for the mainte-
nance of PA. Furthermore, this null effect was not equally distributed
across the countries; therefore, it can be regarded as somehow country
dependent. Conversely, in the case of NA, we observed a pure synergistic
effect because social support was negatively related to NA at every level
of self-efcacy, and this relationship was observed in all participants but
with a different strength. Thus, in our study, individual self-efcacy was
more critical for the association of perceived social support with PA than
for NA. These results may add some new theoretical input to research on
self-efcacy (Hohl et al., 2016; Shoji et al., 2016), especially in the
context of its interplay with other individual resources. These results
also point to the diverse mechanisms underlying the role of PA and NA in
adaptation to stressful situations (Fredrickson, 2001).
Strengths and limitations
Our study has several strengths, including a large international
sample of psychotherapists from 12 different countries; the critical
period of this research, i.e., the COVID-19 pandemic; and the multilevel
methodological approach, which may all constitute a substantial
contribution to the literature. Nevertheless, some limitations should be
underscored. First, due to organizational obstacles, we could not prop-
erly control for psychotherapeutic modalities or work-related charac-
teristics among the samples of our participants. In other words, these
samples cannot be treated as representative samples of psychotherapists
of the countries from which they are sampled, which is a common bias in
studies on the psychological functioning of this professional group
(Simionato and Simpson, 2018). Second, the cross-sectional design of
our study prevented any causal inferences. Lastly, we cannot forget
about the two typical biases in cross-cultural research: the reference
group effect (Heine et al., 2002) and the response style effect (Van de
Vijver and Leung, 1997). The rst is associated with using familiar
others as a benchmark for self-reported comparison; the latter is rooted
in culture-related differences in response styles. Both of these biases can
be reduced by a multilevel design and adequate centering of the vari-
ables, but only to some extent. It is therefore worth noting that the ob-
tained results are not generalizable and are relative to the specicity of
the national samples that participated in the study.
Conclusion
From a theoretical viewpoint, the results of our study call for more
research in a multilevel design on the mechanisms and correlates of
subjective well-being in various occupational settings (Bakker, 2015).
This design offers much deeper insight than the most frequent
single-level approach. Examining SWB predictors with the most valid
representation of their real-life complex hierarchical structure may lead
to more advanced knowledge of what is actually highly individualized
and what depends on the nesting of the person in the overarching con-
texts of their functioning. This approach is crucial in cross-cultural
comparisons, where a multilevel viewpoint has seldom been employed
(Disabato et al., 2016). A wider context of being rooted in a given time
and society can counterbalance the widespread study of resources only
at the individual level (Hobfoll et al., 2018).
From a practical perspective, our ndings highlight the possibility
for greater effectiveness of self-care regarding the AWB of psychother-
apists, which is much more dependent on intra- and external factors
compared to their overall life satisfaction. Specically, our results
showed that, for AWB, self-efcacy acts synergistically with social
support, with its low values undoing the positive effects of social support
for PA. Thus, interventions to enhance this cognitive resource, popular
in various work settings (e.g., Lloyd et al., 2017), could be tailored to
this specic occupational group. In this way, our ndings may add to a
more in-depth discussion on the education and training of
A. Van Hoy et al.

Journal of Psychiatric Research 154 (2022) 315–323
322
psychotherapists in the international context.
Conicts of interest
All the authors declare no conict of interest.
Ethical approval
All procedures performed in studies involving human participants
were in accordance with the ethical standards of the institutional and/or
national research committee and with the 1964 Helsinki Declaration
and its later amendments or comparable ethical standards.
CRediT authorship contribution statement
Conceptualization: Angelika Van Hoy, Marcin Rzeszutek
Data curation: Angelika Van Hoy, Marcin Rzeszutek, Małgorzata
Pięta, Jose M. Mestre, ´
Alvaro Rodríguez Mora, Nick Midgley, Joanna
Omylinska-Thurston, Anna Dopierala, Fredrik Falkenstr¨
om, Jennie
Ferlin, Vera Gergov, Milica Lazi´
c, Randi Ulberg, Jan Ivar Røssberg,
Camellia Hancheva, Stanislava Stoyanova, Stefanie Schmidt, Ioana
Podina, Nuno Ferreira, Antonios Kagialis, Henriette L¨
ofer-Stastka
Formal analysis: Marcin Rzeszutek, Ewa Gruszczy´
nska
Methodology: Marcin Rzeszutek
Supervision: Marcin Rzeszutek
Writing – original draft: Marcin Rzeszutek, Ewa Gruszczy´
nska,
Angelika Van Hoy
Acknowledgments
This project has received funding from the New Ideas of POB V
project implemented within the scope of the “Excellence Initiative -
Research University” Program, by the Ministry of Science and Higher
Education in Poland (number PSP: 501-D125-20-5004310).
Appendix A. Supplementary data
Supplementary data to this article can be found online at https://doi.
org/10.1016/j.jpsychires.2022.07.065.
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