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Citation: Kotera, Y.; Young, H.;
Maybury, S.; Aledeh, M. Mediation of
Self-Compassion on Pathways from
Stress to Psychopathologies among
Japanese Workers. Int. J. Environ. Res.
Public Health 2022,19, 12423.
https://doi.org/10.3390/
ijerph191912423
Academic Editor: Richard Gray
Received: 6 September 2022
Accepted: 27 September 2022
Published: 29 September 2022
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International Journal of
Environmental Research
and Public Health
Article
Mediation of Self-Compassion on Pathways from Stress to
Psychopathologies among Japanese Workers
Yasuhiro Kotera 1,* , Holly Young 2, Sarah Maybury 2and Muhammad Aledeh 2
1School of Health Sciences, University of Nottingham, Nottingham NG7 2HA, UK
2College of Health, Psychology and Social Care, University of Derby, Derby DE22 1GB, UK
*Correspondence: yasuhiro.kotera@nottingham.ac.uk
Abstract:
As 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 are key components 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 in 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 understanding the mechanism of how self-compassion improves mental health and inform
effective methods to implement self-compassion interventions to the Japanese workforce.
Keywords: self-compassion; stress; psychopathology; mental health; Japanese workers; mediation
1. Introduction
1.1. Poor Mental Health among Japanese Workers
Stress damages our ability to cope with life’s challenges and causes problems with
social functioning [
1
], leading to diverse mental health problems including depression and
anxiety [
2
]. In Japan, a high number of workers report mental health issues, with over 60%
of employees reporting intense depression and anxiety [3].
The number of Japanese workers diagnosed as depressed has increased steadily year
on year over the past two decades [
4
]. There was a seven-fold increase in the number of
compensation-claims for mental health problems within the Japanese workforce between
2000 and 2015 [
1
], and half of all suicides of the employed in Japan in 2015 were due to
work-related causes [
2
]. During the second wave of the COVID-19 pandemic, April–May
2020, one-third of Japanese healthcare workers reported experiencing burnout [
3
]. At the
time of writing, late-August to early September 2022, Japan is undergoing the seventh wave,
and the mental health difficulties are expected to continue [
4
]. Research has shown that
Japanese employees who experience poor communication with colleagues and supervisors,
high levels of job overload and low levels of job satisfaction are at high risk of depression [
5
].
At work, the effects of poor mental health can include poorer performance and achieve-
ment [
6
], lost productivity, absenteeism, presenteeism, and substance abuse [
7
]. Subse-
quently, mental health at work is recognised as a pressing global issue, with the United
Nations and many developed countries implementing responses to this challenge [
8
,
9
].
The problem is also seen as a national responsibility in Japan [
10
]. The government has
addressed the issue over the past two decades by implementing initiatives focusing on
Int. J. Environ. Res. Public Health 2022,19, 12423. https://doi.org/10.3390/ijerph191912423 https://www.mdpi.com/journal/ijerph
Int. J. Environ. Res. Public Health 2022,19, 12423 2 of 11
occupational health consultations and medical examinations [
11
] as well as the work-style
reform act to reduce overtime working [
12
] and karoshi (i.e., death from overwork) [
13
].
However, 40% of companies in Japan have not engaged with the government’s work-style
reform and are unconvinced of its efficacy [
14
]. Japanese workers operate in a collectivistic
and success-driven society, and attitudes towards poor mental health are negative [
12
]. Re-
search has shown that Japanese workers believe poor mental health to be the result of such
factors as institutionalism and weak personality [
15
]. Furthermore, many Japanese people
(43%) report that they would be ashamed to seek help for mental health problems [
16
],
placing them at higher risk of developing psychopathologies [17].
1.2. High Stress as the Cause of Psychopathologies
The links between stress, depression and anxiety are well established [
18
]. Though
there are several established definitions [
19
], one common definition of psychological
stress is a physical, mental or emotional factor that causes bodily or mental tension, and
that requires behavioural adjustment [
20
,
21
]. Stress is a normal part of human existence
but has become of worldwide concern due to the prevalence of its chronic form and its
links with a wide range of health problems, from cardiovascular disease to suicide [
22
].
It is a highly individual phenomena, contingent on personal vulnerabilities and levels of
resilience [
23
] and is conceptualised as a key risk factor for individuals in the development
of depression and anxiety [
24
]. A considerable body of research has demonstrated that,
prior to major depressive episodes, stressors are present at a significantly higher level than
is usual, both in clinical and community samples [
25
]. That most depressive episodes
are preceded by stressful life events has been borne out of recent research into responses
to the COVID-19 pandemic, which has found high prevalence of anxiety and depression
in healthcare workers operating at the frontline of the crisis [
26
,
27
]. Work-related stress
is often a major source of psychological burden for individuals [
28
] and in Japan is the
leading cause of stress, ahead of other domains including health, finances and family [
29
].
Although work-related stress can have multiple causes, it is normally conceptualised as
arising when employees feel they have excessive demands placed on them which outweigh
their abilities and knowledge, often with accompanying feelings of minimal control over
work processes and little support from colleagues and supervisors [30,31].
Although depression and anxiety demonstrate high diagnostic comorbidity and are
strongly correlated in both clinical and non-clinical self-report samples, they are conceptu-
ally distinct constructs [
32
,
33
]. Depression is characterisedby feelings of sadness, emptiness,
irritability, hopelessness, emotional and motivational deficits [
34
], and is often linked to
problems with relationships, work, physical health and suicidal behaviour [
35
]. Anxiety is
distinguished by excessive worry and fear and associated behavioural disturbances [
34
].
It can be seen as the emotional response to the appraisal of threat [
36
] and is to some
extent characterised by a focus on apprehension as a stimulus [
37
]. Anxiety disorders are
wide ranging and encompass phobias and panic disorders [
38
]. Stress is a risk factor for
depression and anxiety, which are two different constructs.
1.3. Self-Compassion Protects Mental Health
Self-compassion is defined as kindness and understanding towards oneself in difficult
times [
39
]. Self-compassion has been identified as a protective factor for mental health in
many populations [
40
–
42
], including Japanese workers [
17
,
43
]. Self-compassion changes an
individual’s relationship with their problems, thereby reducing their psychological distress.
It does this by fostering a healthy relationship with and attitude towards the self [
44
]; by
being kind to oneself rather than judgmental, being mindful of painful thoughts rather than
overidentifying with them, and by viewing experiences as part of the human condition
rather than in isolation [
45
,
46
]. Self-compassion interventions have been successful in many
populations, producing significant improvements in psychosocial outcomes in multiple
randomised controlled trials [
47
] and in alleviating depression and anxiety in community
samples [
48
–
50
]. Furthermore, self-compassion interventions have been shown to be
Int. J. Environ. Res. Public Health 2022,19, 12423 3 of 11
more effective when administered to groups over individuals [
47
] and could therefore
be a valuable and economical tool for use with workplace populations. A systematic
review identified a negative association between work-related stress and self-compassion:
employees who are kind towards themselves in difficult situations tend to feel less stress
from work [
49
]. Moreover, organisational training that targeted self-compassion improved
employee wellbeing through reduction in work stress [
51
,
52
]. These findings highlight a
strong link between self-compassion and stress.
How self-compassion engages with the stress–psychopathology pathway remains to
be evaluated, however. Having compassion for oneself would imply that individuals may
act to prevent the experience of suffering via proactive wellbeing behaviours, potentially
preventing stress from developing into psychopathologies [
53
,
54
]. Samples suffering from
anxiety and depression, but not stress, have reported finding self-compassion of use in
managing these psychopathologies, as it is a meaningful concept to them [
55
]. However,
depression and anxiety were also reported to have a potentially negative impact on the
ability to be self-compassionate via different mechanisms: depression was linked to self-
loathing which was seen as a barrier to self-compassion, whilst an inability to think logically
due to a focus on the source of anxiety was seen to inhibit self-compassionate thought
processes [
55
,
56
]. It is clear from the evidence that self-compassion helps with mental
health, but how or why this occurs in the stress–psychopathologies relationship has not
been established. A compassion theory model, the three emotion regulatory systems, posits
that compassion activates our soothing emotion system, which is related to psychological
safety, reassurance, and calmness, leading to good mental health [
57
]. When we encounter
stressful situations, we perceive stress (though the level of perceived stress depends on
the individual’s coping skills such as cognitive reappraisal [
58
]), and that can result in
depression and/or anxiety. It is possible that self-compassion mediates these pathways
(namely stress–depression, and stress–anxiety pathways) by activating our soothing system.
However, differences in these constructs (i.e., depression and anxiety) may affect the way
in which self-compassion operates or involve different mechanisms altogether. These
relationships have not been evaluated in Japanese workers. To explore these relationships,
we used path analysis to examine whether self-compassion mediates the pathway from
stress to these two distinct but overlapping psychopathologies.
1.4. Study Aims
This study had two aims. First, the study aimed to evaluate the relationships among
self-compassion, depression, anxiety, and stress (Aim 1). Second, the study aimed to
examine whether self-compassion mediates the pathways from stress to psychopathologies,
namely depression and anxiety (Aim 2). Two hypotheses were established:
H1: Self-compassion mediates the pathway from stress to depression.
H2: Self-compassion mediates the pathway from stress to anxiety.
2. Materials and Methods
2.1. Participants
To be eligible, all participants recruited for the current study had to be 18 years and
above and be working at least three days a week at an organisation in Japan. Out of
201 Japanese workers who agreed to take part in this study, a convenience sample of
165 Japanese workers, of which were 125 males and 40 females (Age M = 47.20, SD = 11.85,
Range 20–73 years), 155 full-time workers, and 10 part-time workers completed a self-
reported measure about their mental health condition using self-compassion, depression,
anxiety, and stress. Ethical approval was granted by the University of Amsterdam Research
Ethics Committee (Ref: 2019-WOP-10266).
In this workers’ sample, 7.3% of participants worked in education and construction,
respectively (n= 12), 6.7% worked in retail, communication, and technologies, respectively
(n= 11), 4.9% worked in wholesale and transit, respectively (n= 8), while the remaining
Int. J. Environ. Res. Public Health 2022,19, 12423 4 of 11
workers worked in finance, manufacturing, hospitality, and caring industries. Most of these
workers (66%) had a university degree as their highest qualification (n= 110), 17% had an
advanced degree (n= 28), 15% had a high school diploma (n= 25) and 1% a middle school
diploma (n= 2). In comparison with the general working population, there were more
males in our sample (33 million male workers vs. 26 million female workers in Japan [
59
]);
however, our sample mean age was similar (43 years old [
60
]). The number of participants
satisfied the required sample size of 84 based on statistical power calculations (two tails,
pH1 (r) = 0.30,
α
= 0.05, Power = 0.80, pH0 = 0 [
61
]). There was no compensation for
participation. The study followed the Strengthening the Reporting of Observational Studies
in Epidemiology reporting guidelines [62].
2.2. Procedure
Once the consent form was submitted, participants received a link to the online self-
report scales. Before the analyses, data were screened for outliers and distribution. First,
correlation analyses were used to appraise the relationships between self-compassion,
depression, anxiety, and stress (Aim 1). Second, path analyses were conducted to elucidate
whether self-compassion mediates pathways from stress to depression, and stress to anxiety
(Aim 2). SPSS 27.0 (IBM, Armonk, NY, USA) and Process Macro (Columbus, OH, USA)
were used [63].
2.3. Measures
Two self-report measures were used to assess the levels of depression, anxiety, stress,
and self-compassion.
The Depression Anxiety and Stress Scale 21 (DASS-21) examined depression, anxiety
and stress experienced in daily life. This 21-item scale is a briefer version of the DASS-
42 [
64
]. The 21 items are organised into 3 subscales (seven items each): depression (e.g., ‘I
couldn’t seem to experience any positive feeling at all’), anxiety (e.g., ‘I felt I was close to
panic’), and stress (e.g., ‘I found it hard to wind down’). Each item is responded to on a
four-point Likert scale (0 = ‘Did not apply to me at all’ to 3 = ‘Applied to me very much, or
most of the time’). All subscales in the DASS-21 have good reliability (α= 0.87–0.94) [65].
Self-compassion was evaluated with the Self-Compassion Scale-Short Form (SCS-
SF) [
66
]. SCS-SF is a 12-item version of the original 26-item Self-Compassion Scale [
67
]. The
SCS-SF identifies to what degree one can be kind and understanding towards themselves
when facing difficulties [
67
]. A five-point Likert scale (1 = ‘Almost never ’ to 5 = ‘Almost
always’) is used to respond to the 12 items (e.g., ‘When I feel inadequate in some way, I try
to remind myself that feelings of inadequacy are shared by most people.’). The SCS-SF has
good reliability (α≥0.86 in all tested samples) [66].
3. Results
No outliers were identified. All skewness and kurtosis values indicated normal
distribution (skewness
−
2 to 2, kurtosis
−
7to7[
68
]). All variables demonstrated high
internal consistency (α> 0.70) (Table 1).
3.1. Relationships, Self-Compassion, Depression, Anxiety and Stress (Aim 1)
Pearson correlations were used to evaluate the relationships among self-compassion,
depression, anxiety and stress in Japanese workers (Table 1). For gender, point biserial
correlations were calculated (1 = male, 2 = female).
Self-compassion was negatively associated with depression, anxiety and stress. De-
pression, anxiety and stress were positively inter-related. Age was associated with female
gender and negatively associated with anxiety.
Int. J. Environ. Res. Public Health 2022,19, 12423 5 of 11
Table 1. Correlations among self-compassion, depression, anxiety and stress in Japanese workers.
M SD Skewness Kurtosis α1 2 3 4 5 6
1 Age 47.20 11.85 - -
2Gender
(1=M,2=F) M(125), F(40) −
0.34 **
-
3 Self-Compassion 3.02 0.49 −0.80 2.88 0.77 0.08 −0.01 -
4 Depression 8.48 9.28 1.06 0.57 0.93 −0.14 0.03 −
0.54 **
-
5 Anxiety 4.99 6.59 1.64 2.55 0.87 −
0.22 **
−0.02 −
0.42 **
0.71 ** -
6 Stress 8.81 8.87 0.92 −0.06 0.90 -0.14 0.05 −
0.49 **
0.83 ** 0.82 ** -
** p< 0.01.
3.2. Mediation of Self-Compassion for Stress to Psychopathologies (Aim 2)
Two sets of path analyses were performed to appraise whether self-compassion medi-
ates pathways from stress to psychopathologies, namely depression and anxiety. Model
4 in the Process macro [
63
] with 5000 bootstrapping re-samples and bias-corrected 95%
confidence intervals (CIs) for indirect effects was used.
3.2.1. Stress–Depression Pathway
Self-compassion partially mediated the pathway from stress to depression as all
pathways were significant (Figure 1): from stress to depression (Direct effects b= 0.77,
p< 0.001
, BCa CI [0.67, 0.87]; Total effects b= 0.86, p< 0.001, BCa CI [0.77, 0.95]); from stress
to self-compassion (b=
−
0.03, p< 0.001, BCa CI [
−
0.03,
−
0.02]); and from self-compassion
to depression (b=
−
3.35, p< 0.001, BCa CI [
−
5.17,
−
1.52]). The indirect effect of stress on
depression through self-compassion was also significant (b= 0.09, BCa CI [0.02, 0.17]). H1
was supported.
Int. J. Environ. Res. Public Health 2022, 19, x FOR PEER REVIEW 5 of 5
Figure 1. Parallel Mediation Model: Self-Compassion mediated the Stress–Depression Pathway but
did not mediate the Stress–Anxiety Pathway. *** p < 0.001 (standardised coefficients).
4. Discussion
The mental health of Japanese workers has continued to worsen over the past 20
years, necessitating research into effective interventions to combat this growing trend.
Self-compassion, or being kind to oneself in the face of personal hardship and negative
events, has been shown to promote psychological wellbeing in Japanese workers [27].
While previous studies have demonstrated the value of self-compassion in promoting
psychological wellbeing [69], more research is needed to better understand the mecha-
nisms underpinning this relationship, which the current study aimed to do. Specifically,
this study evaluated the relationships between the stress–psychopathology pathway and
self-compassion, assessing whether self-compassion mediated pathways to depression
and anxiety among Japanese workers. Self-compassion partially mediated the pathway
from stress to depression (H1 supported), whereas it did not the pathway from stress to
anxiety (H2 not supported).
Self-compassion was found to be strongly associated with stress and psychopathol-
ogy, consistent with existing studies [70–72]. 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 [74–76]. 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].
Studies investigating this relationship specific to Japanese samples garnered compa-
rable results. After undergoing an enhancing self-compassion program (ESP) to target
poor mental health, Japanese participants reported a strengthened degree of self-compas-
sion after treatment was complete, as well as a significant reduction in negative thoughts
and emotions [78]. A comparative study between Japanese and Dutch workers found that
self-compassion for Japanese workers negatively predicted mental health problems, sug-
gesting that increased levels of self-compassion may bring improvements to their mental
wellbeing [12].
Figure 1. Parallel Mediation Model: Self-Compassion mediated the Stress–Depression Pathway but
did not mediate the Stress–Anxiety Pathway. *** p< 0.001 (standardised coefficients).
3.2.2. Stress–Anxiety Pathway
Self-compassion did not mediate the pathway from stress to anxiety (Figure 1). Al-
though pathways from stress to self-compassion (b=
−
0.03, p< 0.001, BCa CI [
−
0.03,
−
0.02]), from stress to anxiety (Direct effects b= 0.60, p< 0.001, BCa CI [0.53, 0.68]; Total
effects b= 0.61, p< 0.001, BCa CI [0.54, 0.67]) were significant, a pathway from self-
compassion to anxiety was not significant (b=−0.21, p= 0.76, BCa CI [−1.58, −1.16]). H2
was not supported.
Int. J. Environ. Res. Public Health 2022,19, 12423 6 of 11
4. Discussion
The mental health of Japanese workers has continued to worsen over the past 20 years,
necessitating research into effective interventions to combat this growing trend. Self-
compassion, or being kind to oneself in the face of personal hardship and negative events,
has been shown to promote psychological wellbeing in Japanese workers [
27
]. While previ-
ous studies have demonstrated the value of self-compassion in promoting psychological
wellbeing [
69
], more research is needed to better understand the mechanisms underpinning
this relationship, which the current study aimed to do. Specifically, this study evaluated the
relationships between the stress–psychopathology pathway and self-compassion, assessing
whether self-compassion mediated pathways to depression and anxiety among Japanese
workers. Self-compassion partially mediated the pathway from stress to depression (H1
supported), whereas it did not the pathway from stress to anxiety (H2 not supported).
Self-compassion was found to be strongly associated with stress and psychopathol-
ogy, consistent with existing studies [
70
–
72
]. 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
–
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].
Studies investigating this relationship specific to Japanese samples garnered compara-
ble results. After undergoing an enhancing self-compassion program (ESP) to target poor
mental health, Japanese participants reported a strengthened degree of self-compassion
after treatment was complete, as well as a significant reduction in negative thoughts and
emotions [
78
]. A comparative study between Japanese and Dutch workers found that
self-compassion for Japanese workers negatively predicted mental health problems, sug-
gesting that increased levels of self-compassion may bring improvements to their mental
wellbeing [12].
In our sample, the stress–depression pathway was mediated by self-compassion,
however the same effect was not present in anxiety. This suggests that when stress impacts
depression, the level of self-compassion affects this pathway, whereas this does not occur
in anxiety. These results are contrary to the past studies that have shown self-compassion
to be a mediator of anxiety [
69
,
79
]. The difference found in the current study may come
down to the different nature of anxiety and depression, namely the cognitive content
specificity of each condition [
80
]. The cognitive content specificity hypothesis argues that
specific features differentiate psychological disorders both at a symptomatic and diagnostic
level [
81
]. Anxiety disorders are associated with a magnified sense of threat and danger,
versus depression, which can result in a negative lens of oneself, one’s surroundings
and prospects [
82
]. 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
]. 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
]. While these distinctions
between anxiety and depression have been challenged [
86
] when considered in relation
to the tenets of self-compassion, they may have some explanatory power for the findings
of the current study. Self-compassionate individuals are more likely to employ adaptive
emotional regulation techniques, whereby negative situations are perceived as temporary
and manageable [
87
]. This works to engender resilience and counter the development of
depressive symptoms specifically, but not necessarily anxiety symptoms, by reducing the
tendency towards rumination and experiential avoidance [88].
Int. J. Environ. Res. Public Health 2022,19, 12423 7 of 11
Based on these findings, an intervention focused on self-compassion should target
depression more than anxiety in employees [
89
–
92
]. Compassion-focused therapy may be
used to reduce the self-criticism and shame commonly experienced by individuals with
depression, to shift the focus on fostering kindness and acceptance of oneself, and sense
of being connected to others [
93
]. Acceptance and commitment therapy (ACT) may also
be effective, incorporating elements of mindfulness to reduce self-judgment, feelings of
isolation, and direct their focus to the individual they would like to be instead of punishing
themselves for their perceived shortcomings [
79
]. In a study investigating the mental health
of Swedish social workers, three 3 h sessions of ACT, with a specific focus on stress man-
agement, led to a significant decrease in stress and burnout [
94
]. Additionally, mindfulness
training has been shown not only to reduce work-related stress, but also enhance workplace
engagement and peer relationships [
95
]. Considering the continued challenges with work
mental health in COVID-19, these insights may be especially helpful to the Japanese work-
force and those who work with them. During the pandemic, in addition to stress, loneliness
was highlighted as salient among workers in Japan [
31
]. A recent meta-analysis reported,
though the study quality needs to be improved, these compassion- or mindfulness-based
interventions are effective for reducing loneliness [
96
]. These compassion and mindfulness
interventions are recommended for Japanese workers today.
A helpful intervention for workers experiencing anxiety could include forest bathing
(shinrin-yoku), whereby individuals surround themselves by nature, usually by walking in
a forest and practicing mindfulness [
22
,
97
,
98
]. A therapy programme originating in Japan,
forest bathing is a familiar practice in the country, and has been found to be especially
effective in reducing anxiety levels in the Japanese workforce [
99
]. Moreover, in a society
where poor mental health is associated with shame and stigma [
17
], it may be easier to
implement a local practice to address mental health needs. As mental health continues to be
a global concern, forest bathing provides a cost-effective and accessible method to address
the needs of individuals facing various mental health disorders in Japan and beyond,
with studies demonstrating its effectiveness in Taiwan [
100
], Italy [
101
], and Poland [
102
].
In the Polish example, a short, one-day forest recreation, which consisted of observing,
listening to, and touching elements of the forest saw an increase in the physiological and
psychological wellbeing in students and young workers [
90
]. This traditional Japanese
approach can be used for today’s Japanese employees.
Limitations of this study need to be noted. First, our sample was male oriented and
consisted of highly educated people, workers from various industries, and a mixture of
full-time and part-time workers; therefore, generalisability of our findings needs further
evaluation. Indeed, whether these differences are associated with mental health difference
remains to be evaluated [
103
,
104
]. Second, our recruitment only focused on participants
who were comfortable using an online survey; therefore, we missed those who did not feel
comfortable using this form of survey. Third, we used self-report scales; thus, response
biases might have been present [
105
]. Relatedly, some of the used scales are being debated
for their accuracy (e.g., SCS-SF [
106
]). Fourth, our study employed cross-sectional design;
therefore, causality of these associations was not evaluated.
5. Conclusions
We found that self-compassion was indeed negatively associated with stress and
psychopathology in Japanese workers. Moreover, when stress impacted depression, the
level of self-compassion was important, whereas when stress impacted anxiety, a significant
impact was not found with self-compassion. Our findings can help managers, HR staff and
organisational psychologists to identify an effective way to introduce self-compassion to
workplaces to protect employee mental health.
Author Contributions:
Conceptualization, Y.K.; methodology, Y.K.; software, Y.K.; validation, All
authors; formal analysis, Y.K.; investigation, all authors; resources, Y.K.; data curation, Y.K.; writing—
original draft preparation, all authors; writing—review and editing, all authors; project administra-
tion, Y.K. All authors have read and agreed to the published version of the manuscript.
Int. J. Environ. Res. Public Health 2022,19, 12423 8 of 11
Funding: This research received no external funding.
Institutional Review Board Statement:
Ethical approval was granted by the University of Amster-
dam Research Ethics Committee (Ref: 2019-WOP-10266).
Informed Consent Statement:
Informed consent was obtained from all subjects involved in the study.
Data Availability Statement:
The data presented in this study are available on request from the
corresponding author. The data are not publicly available due to ethical restrictions.
Conflicts of Interest: The authors declare no conflict of interest.
References
1.
Kotera, Y.; Sheffield, D. NLP for Japanese workers’ mental well-being: Pilot study. Ment. Health Rev. J.
2019
,24, 183–194.
[CrossRef]
2.
National Police Agency. Heisei 27nenchuuniokeru Jisatsunojoukyou [Suicides in Japan, 2015]; National Police Agency: Tokyo,
Japan, 2016.
3.
Matsuo, T.; Kobayashi, D.; Taki, F.; Sakamoto, F.; Uehara, Y.; Mori, N.; Fukui, T. Prevalence of Health Care Worker Burnout During
the Coronavirus Disease 2019 (COVID-19) Pandemic in Japan. JAMA Netw. Open 2020,3, e2017271. [CrossRef] [PubMed]
4.
AERA. How Would You Cope with Corona-Depression This Summer During the 7th Wave? 2022. Available online: https:
//dot.asahi.com/wa/2022072700012.html (accessed on 3 September 2022).
5.
Honda, A.; Date, Y.; Abe, Y.; Aoyagi, K.; Honda, S. Work-related Stress, Caregiver Role, and Depressive Symptoms among
Japanese Workers. Saf. Health Work 2014,5, 7–12. [CrossRef] [PubMed]
6.
Kotera, Y.; Green, P.; Sheffield, D. Work-life balance of UK construction workers: Relationship with mental health. Constr. Manag.
Econ. 2020,38, 291–303. [CrossRef]
7. World Health Organization. Addressing Comorbidity between Mental Disorders and Major Noncommunicable Diseases; World Health
Organization: Geneva, Switzerland, 2017.
8. United Nation. Sustainable Development Goals; United Nation: New York, NY, USA, 2015.
9. Kestel, D. Mental Health in the Workplace; World Health Organization: Geneva, Switzerland, 2019.
10.
The Prime Minister of Japan and His Cabinet. Work-Style Reform Follow-Up Meetings; The Prime Minister of Japan and His Cabinet:
Tokyo, Japan, 2016.
11.
Iwasaki, K.; Takahashi, M.; Nakata, A. Health Problems Due to Long Working Hours in Japan: Working Hours, Workers’ Compensation
(Karoshi), and Preventive Measure; Industrial Health: Tokyo, Japan, 2006; Volume 44, pp. 537–540.
12.
Kotera, Y.; van Laethem, M.; Ohshima, R. Cross-Cultural Comparison of Mental Health between Japanese and Dutch Workers:
Relationships with Mental Health Shame, Self-Compassion, Work Engagement and Motivation. Cross Cult. Strateg. Manag.
2020
,
27, 511–530. [CrossRef]
13.
Kotera, Y.; Vione, K.C. Psychological Impacts of the New Ways of Working (NWW): A Systematic Review. Int. J. Environ. Res.
Public Health 2020,17, 5080. [CrossRef]
14.
Teikoku Databank. Survey on Companies’ Attitudes Towards the Work-Style Reform [Hatarakikatakaikaku Nitaisuru Kigyouno
Ishikichousa]. 2020. Available online: https://www.tdb.co.jp/report/watching/press/p200106.html (accessed on 15 July 2022).
15.
Ando, S.; Yamaguchi, S.; Aoki, Y.; Thornicroft, G. Review of mental-health related stigma in Japan. Psychiatry Clin. Neurosci.
2013
,
67, 471–482. [CrossRef]
16.
Kawakami, K. Kokoro no Kenkou ni Tuiteno Ekigakuchousa ni Kansuru Kenkyuu [Research about Epidemiology of Men-
tal Health]. 2006. Available online: http://www.ncnp.go.jp/nimh/keikaku/epi/Reports/H18WMHJR/H18WMHJR01.pdf
(accessed on 15 July 2022).
17.
Kotera, Y.; Gilbert, P.; Asano, K.; Ishimura, I.; Sheffield, D. Self-criticism and self-reassurance as mediators between mental health
attitudes and symptoms: Attitudes toward mental health problems in Japanese workers. Asian J. Soc. Psychol.
2018
,22, 183–192.
[CrossRef]
18.
Yang, L.; Zhao, Y.; Wang, Y.; Liu, L.; Zhang, X.; Li, B.; Cui, R. The Effects of Psychological Stress on Depression. Curr.
Neuropharmacol. 2015,13, 494–504. [CrossRef]
19.
Monroe, S.M.; Cummins, L.F. Stress: Psychological Perspectives. In International Encyclopedia of the Social & Behavioral Sciences, 2nd
ed.; Wright, J.D., Ed.; Elsevier: Oxford, UK, 2015; pp. 583–587.
20.
Shah, S.M.A.; Mohammad, D.; Qureshi, M.F.H.; Abbas, M.Z.; Aleem, S. Prevalence, Psychological Responses and Associated
Correlates of Depression, Anxiety and Stress in a Global Population, During the Coronavirus Disease (COVID-19) Pandemic.
Community Ment. Health J. 2021,57, 101–110. [CrossRef]
21. Nakao, M. Work-related stress and psychosomatic medicine. Biopsychosoc. Med. 2010,4, 4. [CrossRef] [PubMed]
22.
Kotera, Y.; Richardson, M.; Sheffield, D. Effects of Shinrin-Yoku (Forest Bathing) and Nature Therapy on Mental Health: A
Systematic Review and Meta-analysis. Int. J. Ment. Health Addict. 2020,20, 337–361. [CrossRef]
23.
Fink, G. Stress, Definitions, Mechanisms, and Effects Outlined: Lessons from Anxiety. In Stress: Concepts, Cognition, Emotion, and
Behavior; Handbook of Stress Series; Elsevier: San Diego, CA, USA, 2016; Volume 1, pp. 3–11.
Int. J. Environ. Res. Public Health 2022,19, 12423 9 of 11
24.
Maercker, A.; Brewin, C.R.; Bryant, R.; Cloitre, M.; Van Ommeren, M.; Jones, L.M.; Humayan, A.; Kagee, A.; Llosa, A.E.; Rousseau,
C.; et al. Diagnosis and classification of disorders specifically associated with stress: Proposals for ICD-11. World Psychiatry
2013
,
12, 198–206. [CrossRef] [PubMed]
25. Hammen, C. Stress and Depression. Annu. Rev. Clin. Psychol. 2005,1, 293–319. [CrossRef] [PubMed]
26.
Pappa, S.; Ntella, V.; Giannakas, T.; Giannakoulis, V.G.; Papoutsi, E.; Katsaounou, P. Prevalence of depression, anxiety, and
insomnia among healthcare workers during the COVID-19 pandemic: A systematic review and meta-analysis. Brain Behav.
Immun. 2020,88, 901–907. [CrossRef] [PubMed]
27.
Kotera, Y.; Ozaki, A.; Miyatake, H.; Tsunetoshi, C.; Nishikawa, Y.; Tanimoto, T. Mental health of medical workers in Japan during
COVID-19: Relationships with loneliness, hope and self-compassion. Curr. Psychol. 2021,40, 6271–6274. [CrossRef]
28.
Hassard, J.; Teoh, K.R.H.; Visockaite, G.; Dewe, P.; Cox, T. The cost of work-related stress to society: A systematic review. J. Occup.
Health Psychol. 2018,23, 1–17. [CrossRef]
29.
Ministry of Health, Labour and Welfare. National Survey of Health 2004; Ministry of Health, Labour and Welfare: Tokyo, Japan,
2006.
30. World Health Organization. Occupational Health: Stress at the Workplace; World Health Organization: Geneva, Switzerland, 2007.
31.
Kotera, Y.; Ozaki, A.; Miyatake, H.; Tsunetoshi, C.; Nishikawa, Y.; Kosaka, M.; Tanimoto, T. Qualitative Investigation into the
Mental Health of Healthcare Workers in Japan during the COVID-19 Pandemic. Int. J. Environ. Res. Public Health
2022
,19, 568.
[CrossRef]
32.
Sowislo, J.F.; Orth, U. Does Low Self-Esteem Predict Depression and Anxiety? A Meta-Analysis of Longitudinal Studies. Psychol.
Bull. 2013,139, 213–240. [CrossRef]
33.
Kotera, Y.; Conway, E.; van Gordon, W. Mental health of UK university business students: Relationship with shame, motivation
and self-compassion. J. Educ. Bus. 2019,94, 11–20. [CrossRef]
34. World Health Organization. Mental Disorders; World Health Organization: Geneva, Switzerland, 2022.
35.
Kotera, Y.; Lyons, M.; Vione, K.; Norton, B. Effect of Nature Walks on Depression and Anxiety: A Systematic Review. Sustainability
2021,13, 4015. [CrossRef]
36.
Sylvers, P.; Lilienfeld, S.O.; LaPrairie, J.L. Differences between trait fear and trait anxiety: Implications for psychopathology. Clin.
Psychol. Rev. 2011,31, 122–137. [CrossRef] [PubMed]
37.
Kogan, C.S.; Stein, D.J.; Maj, M.; First, M.B.; Emmelkamp, P.M.G.; Reed, G.M. The Classification of Anxiety and Fear-Related
Disorders in the ICD-11. Depress. Anxiety 2016,33, 1141–1154. [CrossRef] [PubMed]
38.
Kotera, Y.; Dosedlova, J.; Andrzejewski, D.; Kaluzeviciute, G.; Sakai, M. From Stress to Psychopathology: Relationship with
Self-Reassurance and Self-Criticism in Czech University Students. Int. J. Ment. Health Addict. 2021,20, 2321–2332. [CrossRef]
39.
Asano, K.; Tsuchiya, M.; Ishimura, I.; Lin, S.; Matsumoto, Y.; Miyata, H.; Kotera, Y.; Shimizu, E.; Gilbert, P. The development of
fears of compassion scale Japanese version. PLoS ONE 2017,12, e0185574. [CrossRef]
40.
Kotera, Y.; Conway, E.; van Gordon, W. Ethical Judgement in UK Business Students: Relationship with Motivation, Self-
Compassion and Mental Health. Int. J. Ment. Health Addict. 2019,17, 1132–1146. [CrossRef]
41.
Kotera, Y.; Green, P.; Sheffield, D. Mental health of therapeutic students: Relationships with attitudes, self-criticism, self-
compassion, and caregiver identity. Br. J. Guid. Couns. 2019,49, 701–712. [CrossRef]
42.
Kotera, Y.; Adhikari, P.; Sheffield, D. Mental health of UK hospitality workers: Shame, self-criticism and self-reassurance. Serv.
Ind. J. 2021,41, 1076–1096. [CrossRef]
43.
Kotera, Y.; Asano, K.; Kotera, H.; Ohshima, R.; Rushforth, A. Mental Health of Japanese Workers: Amotivation Mediates
Self-Compassion on Mental Health Problems. Int. J. Environ. Res. Public Health 2022,19, 10497. [CrossRef]
44. Neff, K. Self-Compassion: An Alternative Conceptualization of a Healthy Attitude Toward Oneself. Self Identity 2003,2, 85–101.
[CrossRef]
45.
Kotera, Y.; Rhodes, C. Pathways to Sex Addiction: Relationships with Adverse Childhood Experience, Attachment, Narcissism,
Self-Compassion and Motivation in a Gender-Balanced Sample. Sex. Addict. Compulsivity 2019,26, 54–76. [CrossRef]
46.
Kotera, Y.; Llewellyn-Beardsley, J.; Charles, A.; Slade, M. Common Humanity as an Under-acknowledged Mechanism for Mental
Health Peer Support. Int. J. Ment. Health Addict. 2022, 1–7. [CrossRef]
47.
Ferrari, M.; Hunt, C.; Harrysunker, A.; Abbott, M.J.; Beath, A.P.; Einstein, D.A. Self-Compassion Interventions and Psychosocial
Outcomes: A Meta-Analysis of RCTs. Mindfulness 2019,10, 1455–1473. [CrossRef]
48.
Ferrari, M.; Yap, K.; Scott, N.; Einstein, D.A.; Ciarrochi, J. Self-compassion moderates the perfectionism and depression link in
both adolescence and adulthood. PLoS ONE 2018,13, e0192022. [CrossRef] [PubMed]
49.
Kotera, Y.; van Gordon, W. Effects of Self-Compassion Training on Work-Related Well-Being: A Systematic Review. Front. Psychol.
2021,12, 630798. [CrossRef]
50.
Young, H.; Kotera, Y. Menopause and body image: The protective effect of self-compassion and mediating role of mental distress.
Br. J. Guid. Couns. 2022,50, 321–338. [CrossRef]
51.
Suyi, Y.; Meredith, P.; Khan, A. Effectiveness of Mindfulness Intervention in Reducing Stress and Burnout for Mental Health
Professionals in Singapore. Explore 2017,13, 319–326. [CrossRef]
52.
Beshai, S.; McAlpine, L.; Weare, K.; Kuyken, W. A Non-Randomised Feasibility Trial Assessing the Efficacy of a Mindfulness-Based
Intervention for Teachers to Reduce Stress and Improve Well-Being. Mindfulness 2016,7, 198–208. [CrossRef]
Int. J. Environ. Res. Public Health 2022,19, 12423 10 of 11
53.
Kotera, Y.; Cockerill, V.; Chircop, J.G.E.; Forman, D. Mental health shame, self-compassion and sleep in UK nursing students:
Complete mediation of self-compassion in sleep and mental health. Nurs. Open 2021,8, 1325–1335. [CrossRef]
54.
Kotera, Y. De-stigmatising self-care: Impact of self-care webinar during COVID-19. Int. J. Spa Wellness
2021
,4, 213–217. [CrossRef]
55.
Pauley, G.; McPherson, S. The experience and meaning of compassion and self-compassion for individuals with depression or
anxiety. Psychol. Psychother. Theory Res. Pract. 2010,83, 129–143. [CrossRef] [PubMed]
56.
Kotera, Y.; Green, P.; Sheffield, D. Mental Health Shame of UK Construction Workers: Relationship with Masculinity, Work
Motivation, and Self-Compassion. Rev. Psicol. Trab. Organ. 2019,35, 135–143. [CrossRef]
57. Gilbert, P. The Compassionate Mind: A New Approach to Life’s Challenges; Constable and Robinson Ltd.: London, UK, 2010.
58.
Kotera, Y. A qualitative investigation into the experience of neuro-linguistic programming certification training among Japanese
career consultants. Br. J. Guid. Couns. 2018,46, 39–50. [CrossRef]
59.
National Statistics Center. National Census in the Year of Heisei 27. 2015. Available online: https://www.e-stat.go.jp/stat-
search/files?page=1&layout=datalist&toukei=00200521&tstat=000001080615&cycle=0&tclass1=000001080697&tclass2=00000
1084495&stat_infid=000031414894&tclass3val=0 (accessed on 15 July 2022).
60.
Ministry of Health Labour and Welfare. The Basic Survey on Wage Structure. [Chinginkouzoukihontoukeichousa]. 2019.
Available online: https://www.mhlw.go.jp/toukei/itiran/roudou/chingin/kouzou/z2018/dl/13.pdf (accessed on 15 July 2022).
61.
Faul, F.; Erdfelder, E.; Buchner, A.; Lang, A.-G. Statistical power analyses using G*Power 3.1: Tests for correlation and regression
analyses. Behav. Res. Methods 2009,41, 1149–1160. [CrossRef] [PubMed]
62.
Elm, E.V.; Altman, D.G.; Egger, M.; Pocock, S.J.; Gøtzsche, P.C.; Vandenbroucke, J.P. Strengthening the reporting of observational
studies in epidemiology (STROBE) statement: Guidelines for reporting observational studies. Br. Med. J.
2007
,335, 806–808.
[CrossRef]
63.
Hayes, A.F. Introduction to Mediation, Moderation, and Conditional Process Analysis: A Regression-Based Approach; Guilford Press:
New York, NY, USA, 2013.
64.
Lovibond, S.; Lovibond, P. Manual for the Depression Anxiety Stress Scales, 2nd ed.; Psychology Foundation of Australia: Sydney,
NSW, Australia, 1995.
65.
Antony, M.M.; Bieling, P.J.; Cox, B.J.; Enns, M.W.; Swinson, R.P. Psychometric properties of the 42-item and 21-item versions of
the Depression Anxiety Stress Scales in clinical groups and a community sample. Psychol. Assess. 1998,10, 176–181. [CrossRef]
66.
Raes, F.; Pommier, E.; Neff, K.D.; van Gucht, D. Construction and factorial validation of a short form of the Self-Compassion Scale.
Clin. Psychol. Psychother. 2011,18, 250–255. [CrossRef]
67. Neff, K.D. The Development and Validation of a Scale to Measure Self-Compassion. Self Identity 2003,2, 223–250. [CrossRef]
68.
Hair, J.F., Jr.; Anderson, R.E.; Babin, B.J.; Black, W.C. Multivariate Data Analysis: A Global Perspective, 7th ed.; Pearson Education:
Upper Saddle River, NJ, USA, 2010.
69.
MacBeth, A.; Gumley, A. Exploring compassion: A meta-analysis of the association between self-compassion and psychopathology.
Clin. Psychol. Rev. 2012,32, 545–552. [CrossRef]
70.
Kotera, Y.; Tsuda-McCaie, F.; Edwards, A.-M.; Bhandari, D.; Williams, D.; Neary, S. Mental Health Shame, Caregiver Identity, and
Self-Compassion in UK Education Students. Healthcare 2022,10, 584. [CrossRef]
71.
Kotera, Y.; Lieu, J.; Kirkman, A.; Barnes, K.; Liu, G.H.T.; Jackson, J.; Wilkes, J.; Riswani, R. Mental Wellbeing of Indonesian
Students: Mean Comparison with UK Students and Relationships with Self-Compassion and Academic Engagement. Healthcare
2022,10, 1439. [CrossRef] [PubMed]
72.
Kotera, Y.; Andrzejewski, D.; Dosedlova, J.; Taylor, E.; Edwards, A.-M.; Blackmore, C. Mental Health of Czech University
Psychology Students: Negative Mental Health Attitudes, Mental Health Shame and Self-Compassion. Healthcare
2022
,10, 676.
[CrossRef] [PubMed]
73.
Bluth, K.; Roberson, P.N.E.; Gaylord, S.A.; Faurot, K.; Grewen, K.M.; Arzon, S.; Girdler, S.S. Does Self-Compassion Protect
Adolescents from Stress? J. Child Fam. Stud. 2016,25, 1098–1109. [CrossRef]
74.
Allen, A.B.; Leary, M.R. Self-Compassion, Stress, and Coping. Soc. Personal. Psychol. Compass
2010
,4, 107–118. [CrossRef]
[PubMed]
75.
Kotera, Y.; Green, P.; Sheffield, D. Mental Health Attitudes, Self-Criticism, Compassion and Role Identity among UK Social Work
Students. Br. J. Soc. Work 2019,49, 351–370. [CrossRef]
76.
Kotera, Y.; Green, P.; Sheffield, D. Roles of Positive Psychology for Mental Health in UK Social Work Students: Self-Compassion
as a Predictor of Better Mental Health. Br. J. Soc. Work 2019,50, 2002–2021. [CrossRef]
77.
Stutts, L.A.; Leary, M.R.; Zeveney, A.S.; Hufnagle, A.S. A longitudinal analysis of the relationship between self-compassion and
the psychological effects of perceived stress. Self Identity 2018,17, 609–626. [CrossRef]
78.
Arimitsu, K. The effects of a program to enhance self-compassion in Japanese individuals: A randomized controlled pilot study. J.
Posit. Psychol. 2016,11, 559–571. [CrossRef]
79. Barnard, L.K.; Curry, J.F. Self-compassion: Conceptualizations, correlates, & interventions. Rev. Gen. Psychol. 2011,15, 289–303.
80.
Beck, R.; Perkins, T.S. Cognitive Content-Specificity for Anxiety and Depression: A Meta-Analysis. Cogn. Ther. Res.
2001
,25,
651–663. [CrossRef]
81.
Lamberton, A.; Oei, T.P. A test of the cognitive content specificity hypothesis in depression and anxiety. J. Behav. Ther. Exp.
Psychiatry 2008,39, 23–31. [CrossRef]
82. Beck, A.T. Cognitive Therapy and the Emotional Disorders; International Universities Press: New York, NY, USA, 1976.
Int. J. Environ. Res. Public Health 2022,19, 12423 11 of 11
83.
Hong, R.Y. Worry and rumination: Differential associations with anxious and depressive symptoms and coping behavior. Behav.
Res. Ther. 2007,45, 277–290. [CrossRef] [PubMed]
84.
Kircanski, K.; LeMoult, J.; Ordaz, S.; Gotlib, I.H. Investigating the nature of co-occurring depression and anxiety: Comparing
diagnostic and dimensional research approaches. J. Affect. Disord. 2016,216, 123–135. [CrossRef] [PubMed]
85.
Muris, P.; Roelofs, J.; Meesters, C.; Boomsma, P. Rumination and Worry in Nonclinical Adolescents. Cogn. Ther. Res.
2004
,28,
539–554. [CrossRef]
86.
McLaughlin, K.A.; Borkovec, T.D.; Sibrava, N.J. The Effects of Worry and Rumination on Affect States and Cognitive Activity.
Behav. Ther. 2007,38, 23–38. [CrossRef]
87.
Finlay-Jones, A.L.; Rees, C.S.; Kane, R.T. Self-compassion, emotion regulation and stress among Australian psychologists: Testing
an emotion regulation model of self-compassion using structural equation modeling. PLoS ONE 2015,10, e0133481. [CrossRef]
88.
Rodman, A.M.; Jenness, J.L.; Weissman, D.G.; Pine, D.S.; McLaughlin, K.A. Neurobiological markers of resilience to depression
following childhood maltreatment: The role of neural circuits supporting the cognitive control of emotion. Biol. Psychiatry
2019
,
86, 464–473. [CrossRef]
89.
Trompetter, H.R.; De Kleine, E.; Bohlmeijer, E.T. Why Does Positive Mental Health Buffer Against Psychopathology? An
Exploratory Study on Self-Compassion as a Resilience Mechanism and Adaptive Emotion Regulation Strategy. Cogn. Ther. Res.
2017,41, 459–468. [CrossRef]
90.
Kotera, Y.; Ting, S.H. Positive Psychology of Malaysian University Students: Impacts of Engagement, Motivation, Self-Compassion,
and Well-being on Mental Health. Int. J. Ment. Health Addict. 2021,19, 227–239. [CrossRef]
91.
Zessin, U.; Dickhäuser, O.; Garbade, S. The Relationship Between Self-Compassion and Well-Being: A Meta-Analysis. Appl.
Psychol. Health Well-Being 2015,7, 340–364. [CrossRef]
92.
Kotera, Y.; Ting, S.-H.; Neary, S. Mental health of Malaysian university students: UK comparison, and relationship between
negative mental health attitudes, self-compassion, and resilience. High. Educ. 2021,81, 403–419. [CrossRef]
93. Gilbert, P.; Simos, G. Compassion Focused Therapy: Clinical Practice and Applications; Routledge: London, UK, 2022.
94.
Brinkborg, H.; Michanek, J.; Hesser, H.; Berglund, G. Acceptance and commitment therapy for the treatment of stress among
social workers: A randomized controlled trial. Behav. Res. Ther. 2011,49, 389–398. [CrossRef] [PubMed]
95.
Lyddy, C.J.; Schachter, Y.; Reyer, A.; Julliard, K. Transfer of Mindfulness Training to the Work Setting: A Qualitative Study in a
Health Care System. J. Contin. Educ. Health Prof. 2016,36, 240–248. [CrossRef] [PubMed]
96.
Teoh, S.L.; Letchumanan, V.; Lee, L.-H. Can Mindfulness Help to Alleviate Loneliness? A Systematic Review and Meta-Analysis.
Front. Psychol. 2021,12, 633319. [CrossRef] [PubMed]
97.
Clarke, F.; Kotera, Y.; McEwan, K. A Qualitative Study Comparing Mindfulness and Shinrin-Yoku (Forest Bathing): Practitioners’
Perspectives. Sustainability 2021,13, 6761. [CrossRef]
98.
Kotera, Y.; Fido, D. Effects of Shinrin-Yoku Retreat on Mental Health: A Pilot Study in Fukushima, Japan. Int. J. Ment. Health
Addict. 2021, 1–13. [CrossRef]
99.
Furuyashiki, A.; Tabuchi, K.; Norikoshi, K.; Kobayashi, T.; Oriyama, S. A comparative study of the physiological and psychological
effects of forest bathing (Shinrin-yoku) on working age people with and without depressive tendencies. Environ. Health Prev. Med.
2019,24, 46. [CrossRef]
100.
Chen, H.-T.; Yu, C.-P.; Lee, H.-Y. The Effects of Forest Bathing on Stress Recovery: Evidence from Middle-Aged Females of Taiwan.
Forests 2018,9, 403. [CrossRef]
101.
Roviello, V.; Roviello, G.N. Less COVID-19 deaths in southern and insular Italy explained by forest bathing, Mediterranean
environment, and antiviral plant volatile organic compounds. Environ. Chem. Lett. 2022,20, 7–17. [CrossRef]
102.
Bielinis, E.; Bielinis, L.; Krupi´nska-Szeluga, S.; Łukowski, A.; Takayama, N. The Effects of a Short Forest Recreation Program on
Physiological and Psychological Relaxation in Young Polish Adults. Forests 2019,10, 34. [CrossRef]
103.
Hori, D.; Oi, Y.; Ohtaki, Y.; Andrea, C.-S.; Takahashi, T.; Shiraki, N.; Ikeda, T.; Ikeda, Y.; Doki, S.; Sasahara, S.; et al. Association
between flourishing mental health and occupational stress among workers of Tsukuba Science City, Japan: A cross-sectional
study. Environ. Health Prev. Med. 2019,24, 64. [CrossRef] [PubMed]
104.
Nishikitani, M.; Nakao, M.; Inoue, M.; Tsurugano, S.; Yano, E. Associations between Workers’ Health and Working Conditions:
Would the Physical and Mental Health of Nonregular Employees Improve If Their Income Was Adjusted? Medicines
2022
,9, 40.
[CrossRef] [PubMed]
105.
Kotera, Y.; Tsuda-McCaie, F.; Maughan, G.; Green, P. Cross-cultural comparison of mental health in social work students between
UK and Ireland: Mental health shame and self-compassion. Br. J. Soc. Work 2021,52, 3247–3267. [CrossRef]
106.
Kotera, Y.; Sheffield, D. Revisiting the Self-compassion Scale-Short Form: Stronger Associations with Self-inadequacy and
Resilience. SN Compr. Clin. Med. 2020,2, 761–769. [CrossRef]
