Mental health professionals are at high risk of experiencing work-related stress and burnout due to the challenging and highly emotive environments in which they work. This may lead to a range of physical and psychological symptomology which may affect them and also the quality of care provided to patients. This thesis presents a systematic review of the literature regarding the effectiveness of workplace interventions designed to reduce or prevent work-related stress and burnout when compared to no intervention or alternative interventions for mental health professionals working in adult mental health settings. The thesis then presents an empirical study, using the Job Demands-Resources model of burnout. Personal resources (styles of coping, self-compassion, cognitive fusion and valued living) were tested as (a) moderators of the relationship between job demands and exhaustion and (b) mediators of the relationship between job resources and disengagement within a sample of mental health nurses. Methods: A systematic review and meta-analysis of randomised controlled trials (RCTs), non-randomised controlled trials (N-RCTs), controlled before and after (CBA) and interrupted time series workplace (ITS) interventions were conducted. Primary outcomes were occupational stress and burnout. An assessment of strength of evidence was made using GRADE criteria. A quantitative cross-sectional survey of 214 mental health nurses was used to examine the role of: self-compassion, cognitive fusion, engaged living and coping in the development of burnout. Results Thirteen eligible studies were identified comprising 11 RCTs and 2 CBA’s. Overall, there was no beneficial effect of organisational and relaxations intervention was found for reducing burnout or work-related stress. There are some promising findings for the effectiveness of staff training and psychosocial interventions in the short and medium-term. Overall, the quality of studies was low due to risk of bias and a lack of precision due to low number of participants in each study. In the empirical paper, the moderating role of personal resources in the development of exhaustion was not supported. By contrast the mediating role of personal resource between job resources and disengagement was supported. Discussion At present, there is limited evidence for the effectiveness of workplace interventions. This is influenced by the low number of intervention studies and the quality of interventions to date for mental health professionals. There is preliminary evidence for the potential for third-wave cognitive behavioural interventions such as acceptance commitment therapy in reducing disengagement in mental health nurses. Interventions to reduce exhaustion need to include strategies to reduce job demands.

This thesis explored the relationships between 1) Self-compassion 2) Cognitive Emotion Regulation and 3) Mindfulness Based Stress Reduction (MBSR) and teacher stress in a foreign international school setting. The retrospective, multi-tiered study investigated a total of 177 expatriated teachers working in multiple international schools around the globe; at least 17 of whom indicated that they had completed a MBSR course. A mixed-methods approach was used over three stages utilising the following instruments: 1) an adapted stress impact survey, 2) Teacher Interview Protocol (TIP), 3) the short forms of the Cognitive Emotion Regulation Questionnaire (CERQ-SF), the Self-Compassion Scale (SCS-SF), and the Perceived Stress Scale (PSS-4). Results suggest that teachers’ beliefs about stress correlate with job satisfaction; 82.6% of respondents who reported that stress has ‘hardly any effect’ also reported that they liked their job overall; whereas, 76.9% and 36.4% of respondents that believed stress had affected their teaching ‘some’ or ‘a lot’ reported liking their job, respectively. Results also indicate that higher perceived stress is strongly correlated with both 1) decreased self-compassion (r = -.491, p < .001) and 2) increased use of non-adaptive cognitive emotion regulation strategies, such as Catastrophizing (r= < 0.392, p < .001). All five adaptive cognitive coping strategies were positively correlated with Self-Compassion, four were significant; only Refocus on Planning failed to reach significance at p < .05. The data indicated no statistically significant differences between MBSR and non-MBSR participants, regarding perceptions of stress (PSS-4), self-compassion (SCS-SF), and eight of the nine coping strategies (CERQ-S), with the exception being that MBSR participants experienced reduced Self-Blame (p < 0.007). Conclusions find that policies and practices aimed at supporting the three aspects of self-compassion offer one possible avenue to reducing teacher stress and maladaptive thinking strategies, and thereby increasing job satisfaction, for teachers working in a foreign country.

Background: Self-compassion which may be shaped by early attachment experiences involves being kind to oneself at times of difficulty and is consistently linked to psychological well-being. Self-compassion may be particularly useful in adolescence during which, difficulties associated with physiological and psychosocial transitions can lead to psychological distress. Aims: The aims of this thesis were twofold. First: to review the literature exploring the relationship between self-compassion and psychological distress in adolescents. Second: a research study to investigate the emerging theory that self-compassion may offer a healthier self-relating construct than self-esteem. The study examined whether self-compassion or self-esteem mediated the relationship between attachment and depression and anxiety in adolescents attending child and adolescent mental health services (CAMHS). Method: A systematic search of articles related to the relationship between self-compassion and psychological distress in adolescents was conducted. The quality of included papers was assessed. In the research study, 53 adolescents (mean age 15.52 years; 75% female) attending CAMHS presenting with symptoms of anxiety and/or depression were asked to complete five self-report questionnaires measuring: self-compassion, self-esteem, quality of life, satisfaction with attachment relationship and current symptoms of depression and anxiety. Results: The systematic review revealed 25 studies for inclusion. Studies reported an inverse relationship between self-compassion and psychological distress in adolescents. Quality ratings illustrated variation in methodological quality of included studies. In the research study self-compassion and self-esteem were both negatively correlated with depression and anxiety. The mediating impact of self-compassion was only apparent in the relationship between attachment availability and depression, but not anxiety. Contrary to the hypothesis, self-esteem mediated the relationship between attachment security and depression and anxiety to a greater extent than self-compassion. Conclusions: Self-compassion may have clinical implications in improving psychological well-being among adolescents. Future studies with different measures of self-compassion; varying study designs and consideration of contextual factors would increase understanding of the relationship between self-compassion and psychological distress in adolescents.

Literature Review: The current review presents a recent review of the effectiveness of psychological therapies to treat sleep difficulties (such as insomnia and nightmares) in sufferers of posttraumatic stress disorder (PTSD). The review also aimed to investigate whether there are differences in the effectiveness of specific psychological therapies to treat sleep disturbances in PTSD, such as between the different types of psychological therapies such as cognitive behavioural therapy for insomnia (CBT-I) and imagery rehearsal therapy (IRT). Eleven studies were included in the review that met the inclusion and exclusion criteria. Results are presented in tables and a descriptive account is included. The review demonstrates that psychological therapies are effective for the treatment of insomnia and other sleep difficulties such as nightmares. However, firm conclusions cannot be drawn about the effectiveness of different types of psychological therapies as studies predominantly used CBT and only one non-CBT study was included in the review. Comparisons between the effectiveness of different CBT approaches is also not possible as there was a large range of diversity in the study characteristics and also there were only a small number of studies for each intervention, which therefore limits the generalisability of results in the current review. It may be that different CBT interventions such as CBT-I or EERT and IRT may be better suited to treat insomnia and nightmares respectively, but further research needs to be conducted into which of these approaches are beneficial for different PTSD specific sleep difficulties. Empirical Paper: Initial studies demonstrate that self-compassion reduces symptoms of PTSD in Armed Forces Veterans (AFV), however the use of self-compassion approaches in AFV is under-researched. The current study utilised self-report and psychophysiological measures to investigate whether a single self-compassion experimental induction reduced hyperarousal symptoms (PTSD Cluster E symptoms) and increased feelings of social connectedness in AFV. The study hypothesised that there would be a decrease in hyperarousal symptoms and an increase in social connectedness, which would be associated with PTSD severity. Fifty-three AFV who had been deployed to a combat zone took part in the study, of which n = 15 (28.3%) currently met criteria for PTSD and n = 4 (7.5%) met criteria for Subsyndromal PTSD on the PCL-5. Participants listened to a recording of a Loving Kindness Meditation for self-compassion (LKM-S) and psychophysiological recordings were taken throughout. Participants completed state measures of hyperarousal and social connectedness before and after the LKM-S. Findings partially demonstrated that self-compassion can be elicited in an AFV population. However, changes on the self-report measures were largely not supported by psychophysiological measures, apart from skin conductance levels (SCL). The longevity of the effects observed in the study were not measured and should be investigated in future studies. Although this study has demonstrated that self-compassion can be elicited within the AFV population, further research is needed including to test a longer self-compassion intervention.

Depression, anxiety, and stress in the college undergraduate population have been steadily rising over the past decade. Trait self-compassion has been shown to be significantly and negatively related to perceptions of stress and symptoms of depression and anxiety. Research has indicated that self-compassion inductions are effective in increasing state self-compassion. In general, selfcompassion inductions are designed to be easily self-administered. Current research on Internetbased interventions indicates that self-administered therapeutic techniques are effective in reducing self-reported depression, anxiety, and stress. The goal of the current study was to compare the effects of self-compassionate journaling, narrative journaling, and a true control group on depression, anxiety, stress, and self-compassion. There was not a significant time x induction interaction, nor did time or condition have a significant effect on outcomes.

Young adults of college age are at particular risk for psychopathology, non-suicidal self-injury (NSSI) and consequent suicidal behavior, perhaps in a continuum of increasing severity. However, not all persons who experience psychopathological symptoms, or who self-harm, go on to engage in suicidal behavior, perhaps due to protective factors such as self-compassion that buffer this progression. We examined the mediating effect of NSSI on the relation between anxiety/depressive symptoms and suicide risk, and the moderating role of self-compassion on these linkages. Our collegiate sample (N=338) completed: Beck Depression Inventory, Beck Anxiety Inventory, Self-Harm Inventory, Suicidal Behavior Questionnaire-Revised, and the Self-Compassion Scale. Students with greater psychopathology reported more engagement in NSSI and, consequently, more suicide risk; self-compassion weakened the psychopathology-NSSI linkage. Therapeutically addressing risk factors for suicidal behavior (e.g., psychopathology, NSSI), and promoting self-compassion, may halt progression from symptomology to self-harm, thereby ultimately reducing suicide risk in college students.

High self-compassion has been shown to provide many benefits for overall well-being. Some studies have suggested that the environment in which an individual grew up could have some effect on this trait in adulthood. The present research examined the relationship between the parenting style with which an individual was raised and their later adulthood self-compassion and compassion for others. It was hypothesized that the responsiveness of the parent would be directly related to the way that an individual learns to respond to themselves and others. Authoritative parenting style was expected to be related to higher self-compassion and compassion for others as it is characterized by parents who respond positively to their child. Authoritarian parenting was expected to be related to lower levels of each construct as it is characterized by negative responses to the child’s actions. It was found that both authoritative and authoritarian parenting styles are associated with higher levels of self-compassion. The two parenting styles considered to negatively affect children raised in the style, authoritarian and permissive, were found to be related to higher levels of compassion for others. Future research directions for the relationship are discussed.

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Among the 19.3 million veterans residing in the U.S., suicide is a primary mental health concern, with risk for suicide among veterans being 21% higher than for the general population. Increased suicide risk for veterans may be linked to strong negative emotions associated with the requirements of being in the military. For instance, many veterans describe feelings of guilt, defined as remorse or responsibility for one's actions, such as for experiences during combat exposure (e.g., having to kill someone). Shame, or the belief that there is something inherently wrong or defective with the self, often occurs following a violation of personal values or morals (e.g. participation in violence, missing important family events during deployment), and frequently coexists with feelings of guilt. As well, many members of the military experience sexual trauma, which may induce shame. For some veterans, suicide may become a viable alternative to these overwhelming negative feelings. However, not all veterans are at risk for suicide, perhaps due to individual-level protective factors. One such factor is self-compassion, which is composed of self-kindness, community, and mindfulness. Positive emotions (i.e. selfcompassion) may buffer against negative feelings about the self or one's actions (i.e. guilt and shame), thereby decreasing suicide risk. Our study aimed to test these associations in the context of moderation analyses. At the bivariate level, we hypothesized that guilt and shame would be negatively related to self-compassion and positively related to suicide risk. Also, we hypothesized that self-compassion would be negatively related to suicide risk. At the multivariate level, we hypothesized that self-compassion would moderate the relations between guilt and suicide risk, and between shame and suicide risk, weakening both associations. Our sample of veterans (N=422) was primarily white (n=366) and male (n=291). Participants completed self-report measures including the Differential Emotions Scale-IV, Self-Compassion Scale Short-Form, and Suicide Behaviors Questionnaire-Revised. Bivariate correlations and multivariate analyses, per Hayes (2013), were conducted covarying age, sex, and ethnicity. In bivariate correlations, guilt and shame were positively related to suicide risk (p

A recent review suggested that self-compassion promotes use of adaptive rather than maladaptive coping. Less is known about how self-compassion is linked to stress and coping in the context of a chronic stressor. Across two primarily female chronic illness samples, inflammatory bowel disease (N = 155) and arthritis (N = 164), a model linking self-compassion to lower stress through coping styles and coping efficacy was tested. Path analyses revealed significant indirect effects for adaptive coping styles (active, positive reframing, and acceptance), and negatively for maladaptive coping styles (behavioral disengagement and self-blame) in both samples. Findings suggest that the relative balance of adaptive and maladaptive coping strategies used by self-compassionate people is associated with better coping outcomes in the context of chronic illness.