In the UK, caring profession subjects—related to humans taking care of other humans, whether physically, mentally or spiritually (Kotera et al.
2018d)—are the most popular of all university disciplines. Of 700,000 students who applied to undergraduate programmes in UK universities, 60% of them applied to this discipline in 2014 (McGhee
2015). More than one in every five students studied either an undergraduate or postgraduate caring profession subject programme in the academic year 2015–2016 (Higher Education Statistics Agency
2017). This is unique to the UK. For example, business is the most popular subject in the USA (National Center for Education Statistics
2016) and in Germany (Muller
2016) and social science is most popular in Japan (Ministry of Education, Culture, Sports, Science and Technology-Japan
2015). One notable reason for this popularity in caring subjects in the UK relates to stable post-study employment: for instance, almost all the occupational therapy students are employed within 6 months of graduation (Association of Graduate Careers Advisory Services
2017).
Caring profession subjects include allied health (e.g. occupational therapy, physiotherapy), psychotherapy, nursing, social work and teaching (Kotera et al.
2018d). Despite its popularity, the mental wellbeing of caring subject students is challenging: UK social work students have high levels of depression, anxiety and stress (Kotera et al.
2019b); nursing students have poor mental wellbeing (Kotera et al.
2019); and more than one-third of occupational therapy and psychotherapy students have depression and low self-esteem (Boellinghaus et al.
2013). As these students are dealing, or will deal with patients’ lives, high rates of poor mental wellbeing, which can cause poor decisions (Blackmore et al.
2007; Brooks et al.
2002) is alarming. Mentally distressed healthcare workers are more likely to make errors, negatively impacting on client safety, which is the central element in education for caring profession (Melnyk et al.
2018; The Quality Assurance Agency for Higher Education
2013). Moreover, this relates to the current emphasis, associated with coronavirus disease 2019 (COVID-19), that caring professionals need to take care of themselves in order to offer care for others (Kotera et al.
2020a,
b; Spoorthy et al.
2020).
Usefulness of Positive Psychology for Mental Wellbeing
One contributing factor to caring students’ poor mental wellbeing may be their hesitancy to ask for help. For example, high caregiver identity was related to high shame about mental health problems (mental health shame; Kotera et al.
2019d) among students in caring subjects (Kotera et al.
2019b). Further, mental health shame was a positive predictor of mental health problems in therapeutic students (Kotera et al.
2019c). This may imply that offering these students ‘mental health’ support directly would not be effective, as they would not fully engage in such support because of shame (Kotera et al.
2018b). On the other hand, positive psychological approaches may be effective as these approaches could bypass their high mental health shame, focusing on nurturing what assets they have (Joseph and Linley
2006; Kotera and Ting
2019). Indeed, the importance of positive psychology has been recognised among therapeutic practitioners (Bannigan
2002; Joseph and Linley
2006; Maki and Endo
2018).
Positive psychology focuses on happiness and positivity, aiming to further strengthen one’s strengths and values (Seligman and Csikszentmihalyi
2000), as opposed to traditional psychology which primarily focuses on pathologies (i.e. what is impaired), aiming to dissect them out. Positive psychology perceives that all people have the potential (given the right skills and contexts), instead of focusing on what people lack (Kashdan and Ciarrochi
2013). Positive psychological approaches are recommended to prevent mental health problems in the general population (Forsman et al.
2015; Kobau et al.
2011) and in UK students (Denovan and Macaskill
2017).
Intervention studies have reported promising results. Acceptance and commitment therapy increased positive psychological outcomes and decreased depression in a randomised controlled trial (Bohlmeijer et al.
2015). A 5-week online positive psychology intervention, focusing on positive emotions (e.g. engagement and meaning), increased pregnant women’s life satisfaction and reduced depression (Corno et al.
2018). PhD students’ mental distress was alleviated after 8-week engagement and motivation training (Marais et al.
2018). Moreover, a 10-year longitudinal study on adults’ positive psychology and mental distress noted a relationship between heightened positive psychology constructs and mitigated mental distress (Keyes et al.
2010). Likewise, positive psychological constructs predicted large variance (28–53%) of mood disorders in a 3-year longitudinal study (Schotanus-Dijkstra et al.
2016). It is unsurprising that positive psychology has been recommended to counsellors who help empower clients to accomplish mental health, wellbeing and career goals (American Psychological Association
2015) by increasing their happiness and developing their strengths (Haktanir et al.
2016). These findings support the significant relationships between positive psychology constructs and mental wellbeing.
Academic engagement (hereafter ‘engagement’) is a particularly important positive psychological construct in higher education for its associations with various student outcomes including mental health (Liébana-Presa et al.
2014; Rogers et al.
2017), attainment (Casuso-Holgado et al.
2013; Neel and Fuligni
2013) and intrinsic motivation (Armbruster et al.
2009; Bicket et al.
2010). Engagement refers to the degree students are committed to make an effort in their academic work (Newman et al.
1992), and is related to mental health in 410 Australian students (Turner et al.
2017). Students’ commitment to their academic work is positively related to their mental wellbeing. The positive associations between engagement and mental wellbeing have been found in student populations in other countries too (e.g., Datu
2018; Suárez-Colorado et al.
2019). However, research into these relationships in UK university students has been scarce, particularly in UK therapeutic students.
Intrinsic motivation, closely related with engagement, is another key positive psychological construct, related to mental wellbeing (Baard et al.
2004; Bailey and Phillips
2016; Locke and Latham
2004). Intrinsic motivation, opposing extrinsic motivation, is one type of motivation in Self-Determination Theory, one of the most researched motivation theories (Deci and Ryan
1985). Self-Determination Theory presumes that every individual has an innate predisposition to direct their psychological power to self-actualisation, while maintaining social connections (Deci and Ryan
1985). Intrinsic motivation is present in activities that are naturally satisfying and fulfilling (i.e., being involved in the activity itself is a reward), whereas extrinsic motivation is relevant to activities that are a means to an end (e.g., money and status that can be brought as a result of the activities; Kotera et al.
2018d).
Intrinsic motivation is related to positive outcomes including better performance (Baard et al.
2004), wellbeing (Bailey and Phillips
2016), life satisfaction (Locke and Latham
2004), prosocial behaviour (Gagné
2003) and ethical judgement (Kotera et al.
2018a). In contrast, extrinsic motivation is related to negative outcomes such as burnout (Houkes et al.
2003), shame (Kotera et al.
2018a), depression (Blais et al.
1993), compromised performance (Vallerand
1997) and poor ethical judgement (Kotera et al.
2018a). Students’ intrinsic motivation was related to academic performance in Israeli nursing students (Khalaila
2015) and meaningfulness in Norwegian health and social work students (Utvær
2014); however, these relationships have not been thoroughly investigated in UK therapeutic students in relation to mental health.
Though emotional resilience (hereafter ‘resilience’) has been defined in varied ways (e.g. Pooley and Cohen
2010; Ungar
2008), resilience is considered a generic term entailing internal resources to help an individual to overcome adversity, and expand themselves from such experiences (Grant and Kinman
2014). The importance of resilience in practice has been noted in the professional ethical and capability framework (e.g. British Association for Counselling and Psychotherapy
2018; College of Occupational Therapists
2014). Resilient practitioners are aware of their strengths and agency, and are able to reframe adversity as an opportunity for growth (Russ et al.
2009; Harrison
2013). Indeed, resilient people are not exempt from being affected by life challenges; however, they tend not to be overwhelmed by those challenges permanently (Tugade and Fredrickson
2004). Enhancing resilience was associated with better mental wellbeing, along with improved psychological outcomes such as self-efficacy, mindfulness and compassion (Robertson et al.
2015). Resilience can be maintained with psychological resources such as motivation, reframing life challenges into growing experiences (Bryan et al.
2017)—essential to therapeutic students (British Association for Counselling and Psychotherapy
2018; College of Occupational Therapists
2014).
Lastly, self-compassion has been increasingly paid attention to, for its relevance to mental wellbeing (Ehret et al.
2015; Kotera et al.
2018b,
2019; Muris et al.
2018). Self-compassion—being understanding and accepting of one’s weaknesses and inadequacies (Gilbert
2009)—protects mental wellbeing by supporting resilience (Trompetter et al.
2017). Self-compassion is strongly related to mental wellbeing (Ehret et al.
2015; Hayter and Dorstyn
2014; Muris et al.
2018), and a significant predictor of mental wellbeing in UK social work students (Kotera et al.
2019b). In addition, numerous studies reported that self-compassion mediated the relationship between positive mental constructs and mental wellbeing (Beaumont et al.
2016; Fong and Loi
2016; Neff and Mcgehee
2010; Zhang et al.
2016), suggesting that self-compassion would be a mediator of the relationship between resilience and mental wellbeing (Trompetter et al.
2017). Resilience Theory posits that how we cope with difficulties, rather than the difficulties themselves, matters more to our wellbeing (Van Breda
2018). Treating oneself in a caring manner is conducive to one’s coping, emphasising one’s strengths in the process of resilience (Fergus and Zimmerman
2005). Moreover, Social Mentality Theory suggests how we treat ourselves originates from how we treat others (Gilbert
2000). Therapeutic students aspire to help others; therefore, based on this theory, they may be also willing to help themselves. Accordingly, whether self-compassion would mediate the relationship between resilience and mental wellbeing in therapeutic students needs to be examined.
Despite the significant relationships between mental wellbeing and these positive psychological constructs, these have not yet been explored among UK therapeutic students in depth. This study, therefore, aimed to explore the relationships between mental wellbeing, engagement, motivation, resilience and self-compassion. Two sets of hypotheses were tested:
H1: Mental wellbeing will be associated with (a) engagement, (b) motivation, (c) resilience and (d) self-compassion.
H2: Self-compassion will mediate the relationship between resilience and mental wellbeing.
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