Mediating effects of self-esteem on the relationship between self-compassion and empathy among Vietnamese university students.

DOI: https://doi.org/10.21203/rs.3.rs-1295956/v1

Abstract

Empathy is a critical element of subjective well-being and is an important personality trait for undergraduate students. To improve undergraduate students’ empathy, the current study examines the relationship between self-compassion and empathy and the mediating role of self-esteem underlying this relationship. Participants were six hundred and twenty-two (320 males and 302 females) students from five Vietnamese universities, aged 18-21 years ( M age = 19.5; SD age = 0.95 years), who completed self-compassion scale (SCS), empathy scale in adults (BES-A), and self-esteem scale of Toulouse (ETES).The results indicated that (1) self-compassion was positively associated with empathy; (2) and self-esteem mediated the relationship between the two variables. Therefore, enhancing undergraduate students’ self-compassion may be an efficacious way to improve undergraduate students’ empathy. However, additional study is needed to elucidate the roles of self-compassion in the educational context.

Introduction

Empathy is a multifaceted concept that entails both affective and cognitive elements; and these elements consist of “the capacity to experience the emotions of another” and “the capacity to comprehend the emotions of another” respectively (Jolliffe & Farrington, 2006, p. 589). For instance, empathetic individuals can connect to and understand someone else’s suffering by putting themselves in their shoes (Hemmerdinger et al., 2007; Sinclair et al., 2017). More interestingly, research on empathy has been extensively conducted in the field of health professions education, demonstrating that empathy is a crucial personality trait for students (e.g., Huang et al., 2019; Sa et al., 2019). Preliminary findings have found positive associations between empathy towards others and subjective well-being among college students (Wei et al., 2011). For example, students with higher empathy reported higher levels of life satisfaction (Coll et al., 2020) and lower levels of negative affect and higher levels of happiness (Tkach, 2005; Wei et al., 2011). However, young adults in college are unlikely to have an in-depth understanding of themselves or others, particularly the interconnected nature of their own and others’ suffering that comes with getting older and having necessary life experiences (Grotevant et al., 1999; Marcia, 1994). Therefore, it is important to cultivate empathy in undergraduate students.

Various studies have demonstrated a link between self-compassion and empathy (e.g., Lyvers et al., 2020; Marshall et al., 2020; Welp & Brown, 2014). However, their research findings have been limited, and empirical research on mediating mechanisms in the relationships between self-compassion and empathy remains unclear. Regarding the research findings, several studies have demonstrated a positive association between self-compassion and empathy (as measured by Toronto Empathy Questionnaire) (Lyvers et al., 2020) while other research has supported mixed results (Marshall et al., 2020) or they did not report any relationships between self-compassion and empathetic concern which is a subscale of empathy (Neff & Pommier, 2013). Previous studies have also shed light on the direct influences of (1) self-compassion on empathy (Lyvers et al., 2020; Welp & Brown, 2014), (2) self-compassion on self-esteem (Souza & Hutz, 2016; Barry et al., 2015), and (3) self-esteem on empathy (Huang et al., 2019; Sa et al., 2019). Due to the inconsistencies in previous work and a few studies on the mediating mechanisms between self-compassion and empathy, there has been a need for more research to investigate the factors that may intervene in the relationships between self-compassion and self-esteem (see Marshall et al., 2020). This is also the gap that this current study seeks to cover. Our research aimed to uncover the factors that contribute to achieving and sustaining undergraduate students’ empathy. 

 Self-compassion and empathy

Cross-sectional studies have found a positive link between self-compassion and empathy (e.g., Lyvers & Thorberg, 2020; Marshall et al., 2020; Neff & Pommier, 2013; Welp & Brown, 2014). According to Yang and colleagues (2019), ‘self-compassion involves treating oneself with kindness rather than harsh judgment, viewing imperfection as an inherent part of shared human experience rather than seeing them as isolating, and being mindful of painful feelings rather than over-identifying with them’ (p. 2035). Since one primary component of self-compassion involves feeling connected to the wider human experience of suffering without isolating and separating oneself (Neff, 2003), self-compassionate students should be able to perceive and respond sensitively to their own and others’ suffering. Therefore,  self-compassion improves different elements of empathy and provides special qualities of being motivated by love, forgiveness, and kindness (Sinclair et al., 2017). For example, in a sample of 384 college undergraduates, higher levels of self-compassion were significantly related to greater perspective taking as a subscale of empathy (Neff & Pommier, 2013). Among 253 young adults from two Australian universities, all three positive self-compassion subscales - self-kindness, common humanity, and mindfulness were significantly positively associated with empathy (Lyvers et al., 2020). Similarly, cognitive empathy is positively related to self-compassion among adolescent students (Marshall et al., 2020).  From the arguments and evidence above, we assumed that self-compassion is significantly positively correlated with empathy. 

Self-esteem as a mediator in the relationship between self-compassion and empathy

To the best of our knowledge, no recent studies have examined self-esteem as a mediator in the link between self-compassion and empathy. Nonetheless, our research hypothesized that self-esteem mediates the relationship between self-compassion and empathy. Self-esteem refers to an individual’s overall positive evaluation of the self, including two different components: competence and worth (Cast & Burke, 2002; Rosenberg et al., 1995) and increasing from adolescence (Orth & Robins, 2014). Cross-sectional and experimental studies have supported a positive correlation between self-esteem and empathy (e.g., Huang et al., 2019; Sa et al., 2019; Stotland & Dunn, 1963). In particular, at the University of Washington, undergraduate students with high self-esteem were more empathetic towards someone who worked on similar tasks (Stotland & Dunn, 1963). This finding suggests that students with high degrees of self-esteem are less preoccupied with themselves and more likely to “lose themselves” in other people (Stotland & Dunn, 1963, p. 539). Sa et al. (2019) also found a positive relationship between self-esteem and empathy in all 515 freshmen. In a cross-sectional study of 1690 medical students in Shanghai, self-esteem positively correlated with empathy (Huang et al., 2019). Similarly, according to Social Identity theory (Tajfel & Turner, 2004), individuals' self-esteem emerges from the social group to which they live and feel belonging to. Moreover, if individuals tend to have a good perception of the group, especially group members, they can have more empathy and positive emotions (e.g., happiness, optimism, and pride). In this situation, self-esteem may positively correlate with empathy. 

However, various studies have suggested that self-compassion and self-esteem are positively correlated (Barry et al., 2015; Reilly et al., 2014; Souza & Hutz, 2016). Theoretically, self-compassion is based on feelings, concerns, and non-judgmental comprehension of oneself and others, whereas self-esteem is based on positive self–evaluation (Neff & Vonk, 2009). Neff (2003) also revealed that self-compassion and self-esteem are equivalent predictors of happiness, optimism and positively impact mental health. For instance, students with high levels of compassion and self-esteem experience fewer negative emotions when receiving bad feedback (Leary et al., 2007). This means that self-compassion could be positively correlated with self-esteem as both contribute to reducing negative feelings (Donald et al., 2018; Reilly et al., 2014). Empirically, the ‘self-compassion-as-antecedent’ model suggests that self-compassion is highly associated with self-esteem (Souza & Hutz, 2016). In other words, self-compassionate individuals have a forgiving attitude toward their faults and failures (Neff et al., 2005), and such forgiveness is found to lead to less negative self-evaluations, such as social comparison and self-rumination, thus enhancing therefore self-esteem (Neff & Vonk, 2009). Similarly, Reilly and colleagues (2014) revealed that higher levels of self-compassion were positively correlated with higher self-esteem in male students with lower trait shame. This finding suggests that men who are self-compassionate have a higher sense of self-esteem than those who do not forgive their faults. Similarly, Barry and colleagues (2015) found that self-compassion signals “a relatively secure and positive sense of self”, which demonstrated a significant positive association with self-esteem in a sample of 251 male adolescents (p. 122). In summary, self-compassion predicts self-esteem, which in turn can promote empathy. Thus, self-esteem can play a mediating role in the relationship between self-compassion and empathy.

In the current study 

In this study, self-esteem was hypothesized to be a mediator in the link between self-compassion and empathy. According to Self-compassion theory, self-compassion is conceptualized as to include three main elements: (i) to enrich feelings of caring and kindness towards oneself; to acknowledge that suffering is a common part of the human condition; and to believe that oneself and others deserve kindness and understanding (Neff, 2003). Being caring and kind to oneself protects individuals against their engagement in (positive or negative) self-evaluation or conformity to ideal standards to consider themselves acceptable, which may maintain positive self-esteem (Neff, 2003). Moreover, the notion that all humans suffer and deserve human kindness is inherent in self-compassion, which may motivate compassionate responses towards others (e.g, empathy) (Neff, 2003). The Self-compassion theory has also acknowledged that gender can affect the above variables (self-compassion, self-esteem, and empathy) (Neff, 2003). Additionally, several studies have indicated that gender influences self-compassion (Neff, 2003), self-esteem (Bleidorn et al., 2016; Helwig et al., 2017; Orth et al., 2012, 2014), and empathy (Christov-Moore et al., 2014). From the above studies and theories, gender can be a factor that impacts the aforementioned variables. This is why gender was controlled for in our hypothesized model to examine the relationships among self-compassion, self-esteem and empathy. 

Hypothesis 1: Self-compassion is positively associated with empathy.

Hypothesis 2: Self-esteem will mediate the relationship between self-compassion and empathy. 

Methodology

Participants and procedures

The survey instrument was sent to 622 Vietnamese participants from five universities located in Ho Chi Minh City, Vietnam. The participants' ages ranged from 18 to 21 years (Mage= 19.5; SDage= 0.95 years). Among the 622 students, 320 (51.4) were male and 302 (48.6%) were female. Regarding school year, 101 (16.2%), 208 (33.4%), 214 (34.4%), and 99 (15.9%) were freshmen, sophomores, juniors, and seniors respectively.

Procedure

Ethical approval was obtained from the corresponding author’s university. This study was designed using a convenience sampling method to select participants.

Our sampling approach aimed to (a) obtaining a nationally diverse sample from undergraduate universities in Vietnam through Google. (b) Students were contacted from various university majors (e.g., social work, psychology, social science, medicine, and engineering). (c) Participating university students were contacted by our group, provided with information about the research aims, and asked for their consent to participate. (e) The participants completed the study measures using an anonymous self-report questionnaire. (f) Students took an average of 20 minutes to complete all questions, including demographic information, self-compassion, self-esteem, and empathy.

Measures

Self-compassion scale (SCS)

The Self-Compassion Scale (SCS) introduced by Neff (2003) was used, with a total of 26 items. It has six dimensions measured on a 5-point Likert scale ranging from 1 (almost never) to 5 (almost always). The scale adapted to Vietnamese students (Nguyen et al., 2020; Quang et al., 2021) has good reliability and validity. Our Confirmatory Factor Analysis (CFA) showed that the measurement model achieved a satisfactory fit at X2/df =3.07 (p < .001); CFI = .90; TLI = .90; RMSEA = .06, and 90% CI = [.06,.07], Cronbach’s alpha = 0.90.

Self-esteem scale of Toulouse (ETES)

The Self-Esteem Scale of Toulouse consisted of 33 items. Respondents indicated their extent of agreement with each item on a scale ranging from 0 = strongly disagree to 4 = strongly agree. Participants were asked to complete the Vietnamese version of the self-esteem scale of Toulouse (ETES) in Vietnam for students (Trinh et al., 2017). ETES includes five subscales: Physical self (PS), Academic future self (AF), Emotional self (ES), Social self (SS), and Family self (FS) (Linh et al., 2017). CFA showed that the measurement model obtained an adequate fit at: X2/df =2.75 (p < .001); CFI= 0.90; TL= .91; RMSEA =.05; and 90% CI = [.05, .06].

Empathy scale in adults (BES-A)

Empathy is to understand and share others’ thoughts or feelings, requiring people to place themselves in another's position (Bellet et al., 1991). Jolliffe and colleagues (2006) developed the Basic Empathy Scale (BES) with 20 items for students in England. It includes two components: cognitive and affective empathy (Jolliffe & Farrington, 2006). There have been several studies have attempted to test the psychometric properties of the BES in different cultures and languages, such as Italian (Albiero et al., 2009), French (D'Ambrosio et al., 2009), Slovak (Čavojová et al., 2012), Portuguese (Anastacio et al., 2015), Spanish (Villadangos et al., 2016), and German (Heynen et al., 2016).

In 2013, Carré and colleagues validated the English version of the Basic Empathy Scale on French adult participants (BES-A). Participants responded on a 5-point Likert scale ranging from 1 = strongly disagree, to 5 = strongly agree. In the three-factor model, five items assessed emotional contagion (EC) (Items 2, 5, 11, 15, and 17), eight items assessed cognitive empathy (CE) (Items 3, 6,9, 10, 12, 14, 16, and 20), and six items assessed emotional disconnection (ED) (Items 1, 7, 8, 13, 18, and 19). The BES-A was chosen to collect data for this study as the content of the scale was more suitable for the participants. Furthermore, no Vietnamese version has been translated and validated to measure Vietnamese students' empathy. The BES-A was translated into Vietnamese by two Vietnamese researchers proficient in English. Subsequently, an independent translator translated the scale again from Vietnamese to English. Then a pilot test with ten participants from five universities in Ho Chi Minh City was conducted to verify the Vietnamese version of the BES-A. The students involved in the study were asked to evaluate the language of each subscale. In the next step, the language could be revised if students felt that it was inappropriate in the Vietnamese context or hindered their understanding. Finally, our study used AMOS software to analyze CFA of the BES-A Scale. The relevance of the model was accepted at χ2/df = 4.06 (p < .001), GFI = .95; TLI = .90; CFI =.90; RMSEA =.07, and 90% CI = [.06, .08]. In this study, the cronbach alpha for the overall scale was .66.

Data analysis

The data were analyzed using SPSS 20 and AMOS 24. First, CFA was conducted to confirm the adequacy of the factor structure for BES-A. Second, we investigated the correlations among self-compassion, self-esteem, and empathy. Third, we examined the mediation model, so path analysis which is a subset of Structural Equation Modeling (SEM) was used to test the direct and indirect effects of self-compassion on empathy. The model included three latent variables (self-compassion, self-esteem, and empathy) comprising 11 parameters. Finally, we evaluated the model fit, following the requirements of a good model fit proposed by Hu and colleagues (1999). A good model fit needs to satisfy the following criteria: Root Means the Square Error of Approximation (RMSEA) < .08, Comparative Fit Index (CFI) >.90, and Tucker-Lewis Index (TLI)> .90, Comparative fit index (CFI) > 0.90.

Measurement model

We test three latent variables (self-compassion, self-esteem, and empathy) and 11 observed variables in the model. The results indicated a satisfactory model fit: χ2 (35, N = 622) = 155.80, p < .001; CFI = .96; TLI = .90; GFI = .92; RMSEA = .08, 90% CI [.06, .09], which demonstrated that the respective indicators were the true representatives of their latent factors.

Results

Common method bias test

In this study, we collected data using students’ self-reports, which may lead to a popular bias deviation approach. To test this phenomenon, we used a single-factor Harman test for all the measurement items. The analysis revealed that all 11 variables had value greater than one. The first factor was responsible for 21.65 percent of the overall variation, which is less than 40% (Kock, 2015).

Table 1 shows that self-compassion, self-esteem, and empathy were positively correlated (.11 to 49, p < .01). Gender was negatively correlated with self-esteem (r=-.12, p <.01) and positively correlated with empathy (r = .17, p <.01). However, gender was not significantly correlated with self-compassion (r=-.03, p=.73).

Constructs

M

SD

1

2

3

4

1.Gender 

1.49

.50

1

 

 

 

2. Self compassion

3.27

.43

-.03

1

 

 

3. Self Esteem

3.02

.36

-.12**

.49**

1

 

4. Empathy

45.07

6.18

.17**

.24**

.11**

1

**p < 0.01, *p< 0.05

Structural model

After controlling for gender, the structural model examined the relationships among self-compassion, self-esteem, and empathy. The results showed a good fit for the data:  (χ2/41 (N=622) = 183.19, p<.001, GFI = .95; CFI =.90; TLI = .90; RMSEA = .08, and 90% CI = [.07, .09]).  First, the direct path coefficient from self-compassion to empathy was significant (β =.30, p < .05, 95% CI [ .17; .42]), supporting hypothesis 1. Both the path coefficients from self-compassion to self-esteem (β =.34, p<.05, 95% CI [ .17, .51]) and from self-esteem to empathy were significant (β =.59, p< .05, 95% CI [0.45, .73]). Third, as shown in table 2, the indirect effect of self-compassion on empathy mediated by self-esteem was estimated at (β =.50, p<.01, 95%CI [0.10;0.60]), indicating self-compassion on empathy via self-esteem, supports hypothesis 2. Finally, the fully mediated model had an acceptable fit to the data: (χ2/41 (N=622) = 183.19, p<.001, GFI = .95; CFI =.90; TLI =.90; RMSEA =.08, and 90% CI = [.07, .09]). 

Table 2. Direct and indirect effect of variables.

Variables

Estimate

95% CI

Lower

Upper

SCS →SE

.34

.17

.51

SE     → EP

.59

.45

.73

SCS→ EP

.30

.17

.42

G→SE

-.15

-.25

-.06

G →SCS

.01

-.09

.12

G →EP

-.06

-.15

.03

SCS→SE→EP

.50

.10

.60

 Note: G: Gender; SCS: self-compassion; SE: self-esteem; EP: empathy 

Discussion

Self-compassion and Empathy          

The present study confirms that self-compassion plays a significant role in empathy. Specifically, this finding is congruent with previous studies indicating that self-compassion is a positive predictor of empathy (Lyvers & Thorberg, 2020; Marshall et al., 2020; Neff & Pommier, 2013; Welp & Brown, 2014), supporting hypothesis 1. Attachment theory (Bowlby, 1969, 1982) emphasizes that caring for and protecting others are based on the capacity of empathy, love, and positive behaviors to support others, meaning that empathy is the foundation of compassion for others. Specifically, individuals with higher self-compassion levels demonstrate better levels of empathy (e.g., tolerating and helping other people) (Neff & Pommier 2013; Sinclair et al., 2017). Our findings confirmed that self-compassion is correlated with empathy, which is in line with previous studies indicating that self-compassion and empathy are related as they both ask people to relate themselves to others (Birkett et al., 2014; Birnie, 2010).   

The mediation role of self-esteem between self-compassion and empathy

After controlling gender, self-esteem significantly mediated the impact of self-compassion on empathy. SEM analysis showed that self-esteem played a mediating role in the relationship between self-compassion and empathy. In other words, high self-compassion can create empathy and self-esteem, which supports our second hypothesis - hypothesis 2. 

In the first phase of the single pathway from self-compassion to self-esteem, our results are consistent with previous findings that self-compassion is significantly positively associated with self-esteem (Barry et al., 2015; Reilly et al., 2014; Souza & Hutz, 2016). Neff (2003) argued that self-compassion helps increase a sense of self-worth as an obvious outcome of being kind to oneself and acknowledging common humanity: 

Self-compassionate participants were more likely to have high self-esteem than those who lacked self-compassion. This relationship was expected, as those individuals who are kind to themselves, recognize their common humanity, and can take a balanced emotional perspective on themselves should also be likely to have a higher sense of self-worth than those who are harshly critical of themselves, feel isolated in their failure or inadequacy, and who are over-identified with their feelings (p. 241).

Furthermore, self-compassion and self-esteem can help people attenuate and avoid negative feelings, and both play essential roles in self-regulation processing (Neff, 2011). Another study also proved the effect of self-compassion on self-esteem (Neff & Vonk, 2009), which suggests that self-compassion could effectively contribute to increasing self-esteem because it provides self-esteem with positive elements (e.g., non-judgmental understanding of self-esteem based on positive self-evaluation) (Neff et al., 2011; Neff & Vonk, 2009). Namely, self-esteem may increase when an individual has high levels of self-compassion. Therefore, consistent with our hypothesis, self-compassion could predict the increase of self-esteem. 

In the second phase of the single pathway from self-esteem to empathy, our study showed that the effect of self-esteem on empathy was positively correlated. This finding agrees with previous studies showing that self-esteem is associated with empathy (Huang et al., 2019; Sa et al., 2019; Stotland & Dunn, 1963). According to top-down theory (Brief et al., 1993), individuals tend to experience and react to events and circumstances either positively or negatively (Marshall et al., 2015). Specifically, if individuals live in a less safe or unhealthy environment, they have lower self-esteem, which can lead to negative mental outcomes (such as violence and aggressive behaviors) and less empathy (Neff & Vonk, 2009). In contrast, if individuals live in good condition, their high personal self-esteem can lead to good empathic expression (Fredrickson, 2001; Neff, 2003).  Therefore, living environment can affect empathy by influencing self-esteem. The argument is that self-compassion leads to more effective empathy practices via self-esteem, such as using self-compassion as a mechanism for emotional regulation.  Thus, self-esteem can influence empathy, supporting our hypothesis.

Finally, the current study adds to the growing literature indicating that self-esteem, understood as disposition, can partially mediate the effects of self-compassion on empathy. In addition, our present findings provide increasing evidence that self-compassion may be a protective factor (Neff, 2003). For example, Holas et al. (2021) demonstrated that self-compassion significantly predicts empathy in almost all areas of psychology, including positive psychology, psychological health, motivation, and interpersonal functioning, in which self-compassion plays a role in increasing empathy via self-esteem.

Contributions and limitations 

First, our results suggest that the adaptation of the BES-A by Carré et al. (2013) is the first study to translate and validate the BES-A scale in the Vietnamese context, which helps us better understand this concept and provides an instrument for future studies in Vietnam and research evidence for further research in the world. Second, our research helps enrich the literature on the mediating role of self-esteem in the relationship between self-compassion and empathy while controlling gender, which has received minimal attention. Third, the findings of this study suggest that undergraduate students practice exercises to enhance self-compassion to improve empathy, especially in the context of Covid 19 with a lot of anxiety and stress (Hawes et al., 2021; Luo et al., 2019; Liu & Wang, 2021). Fourth, integrating self-compassion education into counselor school education is a practical option for many universities and produces counseling skills with a more enriched relationship with themselves and others (Nelson et al., 2018). Finally, psychiatrists, counselors, and therapists in Vietnam need to develop psychoeducational training programs for Vietnamese students to practice self-compassion and empathy to create happy schools in the country (e.g., Tandazo Rigazio, 2021; Teding van Berkhout & Malouff, 2016).

However, our study had certain limitations. First, the use of self-reports for data collection is a limitation of this research. Thus, participants may respond with bias to the questionnaire (Dalton & Ortegren, 2011). Future studies should consider conducting longitudinal and experimental studies to reduce bias. Second, all the study variables were collected through students' online self-reports, so a standard common bias test is likely to affect the results. Future researchers may apply a wide range of data collection methods to reduce standard method bias and increase the validity of the research results. Finally, as our study was only conducted on a Vietnamese sample from one city in Vietnam, it cannot be a representative sample for Vietnamese students in the whole country. Future studies should be conducted in different areas of the nation and other countries as well in order to compare the similarities and differences among a variety of groups.   

Declarations

The author(s) declared no potential conflicts of interest concerning the research, authorship, and/or publication of this article.

Conflict of Interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants followed the ethical standards of the institutional and/or national research committee and the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study

Data availability statement

The authors confirm that the data supporting the findings of this study are available.

Contributors

Minh Anh Quang Tran: Study design, Statistical analysis, Writing-review & editing.

Nguyen Ngoc Thao Chau , Tú Anh Hà, Minh Anh Quang Tran Manuscript preparation, Writing-review & editing

Thien An- Nguyen Dang, Vinh Tai Ngo, Minh Anh Quang Tran: Data collection.

Nguyen Ngoc Thao Chau , Tú Anh Hà, Minh Anh Quang Tran: Respone reviewers.

All authors approved the final manuscript for publication.

References

  1. Albiero, P., Matricardi, G., Speltri, D., & Toso, D. (2009). The assessment of empathy in adolescence: A contribution to the Italian validation of the “Basic Empathy Scale.” Journal of Adolescence, 32(2), 393–408. https://doi.org/10.1016/j.adolescence.2008.01.001
  2. Alvaro, C., Lyons, R. F., Warner, G., Hobfoll, S. E., Martens, P. J., Labonté, R., & Brown, R. E. (2010). Conservation of resources theory and research use in health systems. Implementation Science, 5(1). https://doi.org/10.1186/1748-5908-5-79
  3. Anastacio, S., Vagos, P., Nobre-Lima, L., Rijo, D., & Jolliffe, D. (2016). The Portuguese version of the Basic Empathy Scale (BES): Dimensionality and measurement invariance in a community adolescent sample. European Journal of Developmental Psychology. https://doi.org/10.1080/17405629.2016.1167681
  4. Arimitsu, K., & Hofmann, S. G. (2015). Cognitions as mediators in the relationship between self-compassion and affect. Personality and Individual Differences, 74, 41–48. https://doi.org/10.1016/j.paid.2014.10.008
  5. Barry, C. T., Loflin, D. C., & Doucette, H. (2015). Adolescent self-compassion: Associations with narcissism, self-esteem, aggression, and internalizing symptoms in at-risk males. Personality and Individual Differences, 77, 118-123. https://doi.org/10.1016/j.paid.2014.12.036
  6. Bellet, P. S. (1991). The Importance of Empathy as an Interviewing Skill in Medicine. JAMA: The Journal of the American Medical Association, 266(13), 1831. https://doi.org/10.1001/jama.1991.03470130111039
  7. Birkett, M. (2014). Self-compassion and empathy across cultures: Comparison of young adults in China and the United States. International Journal of Research Studies in Psychology, 3(3), 25–34. https://doi.org/10.5861/ijrsp.2013.551
  8. Birnie, K., Speca, M., & Carlson, L. E. (2010). Exploring self-compassion and empathy in the context of mindfulness-based stress reduction (MBSR). Stress and Health, 26(5), 359–371. https://doi.org/10.1002/smi.1305
  9. Bleidorn, W., Arslan, R. C., Denissen, J. J., Rentfrow, P. J., Gebauer, J. E., Potter, J., & Gosling, S. D. (2016). Age and gender differences in self-esteem—A cross-cultural window. Journal of Personality and Social Psychology, 111(3), 396. https://doi.org/10.1037/pspp0000078
  10. Bowlby, J. (1982). Attachment and loss: Vol. 1. Attachment (2nd ed.). (NY: Basic).
  11. Brief, A. P., Butcher, A. H., George, J. M., & Link, K. E. (1993). Integrating bottom-up and top-down theories of subjective well-being: The case of health. Journal of Personality and Social Psychology, 64(4), 646–653. https://psycnet.apa.org/doi/10.1037/0022-3514.64.4.646
  12. Coll, M. G., Navarro-Mateu, D., Giménez-Espert, M. D. C., & Prado-Gascó, V. J. (2020). Emotional Intelligence, Empathy, Self-Esteem, and Life Satisfaction in Spanish Adolescents: Regression vs. QCA Models. Frontiers in Psychology, 11. https://doi.org/10.3389/fpsyg.2020.01629.
  13. Carré, A., Stefaniak, N., D’Ambrosio, F., Bensalah, L., & Besche-Richard, C. (2013). The Basic Empathy Scale in Adults (BES-A): Factor structure of a revised form. Psychological Assessment, 25(3), 679–691. https://doi.org/10.1037/a0032297
  14. Carson, J., Harman, K., Webb, S., Kimonis, E., & Kuipers, E. (2011). Assessing and measuring self-esteem in mental health: a comparison of scales in current use. Mental Health and Learning Disabilities Care, 4, 336–339.
  15. Čavojová, V., Sirota, M., & Belovičová, Z. (2012). Slovak validation of the Basic Empathy Scale in pre-adolescents. Studia Psychologica, 54(3).
  16. Christov-Moore, L., Simpson, E. A., Coudé, G., Grigaityte, K., Iacoboni, M., & Ferrari, P. F. (2014). Empathy: Gender effects in brain and behavior. Neuroscience & Biobehavioral Reviews, 46(P4), 604–627. https://doi.org/10.1016/j.neubiorev.2014.09.001.
  17. Cast, A. D., & Burke, P. J. (2002). A theory of self-esteem. Social forces, 80(3), 1041-1068. https://doi.org/10.1353/sof.2002.0003.
  18. Dalton, D., & Ortegren, M. (2011). Gender differences in ethics research: The importance of controlling for the social desirability response bias. Journal of Business Ethics, 103(1), 73-93. https://doi.org/10.1007/s10551-011-0843-8.
  19. D’Ambrosio, F., Olivier, M., Didon, D., & Besche, C. (2009). The basic empathy scale: A French validation of a measure of empathy in youth. Personality and Individual Differences, 46(2), 160–165. https://doi.org/10.1016/j.paid.2008.09.020
  20. De Corte, K., Buysse, A., Verhofstadt, L. L., Roeyers, H., Ponnet, K., & Davis, M. H. (2007). Measuring Empathic Tendencies: Reliability And Validity of the Dutch Version of the Interpersonal Reactivity Index. Psychologica Belgica, 47(4), 235. https://doi.org/10.5334/pb-47-4-235
  21. Donald, J. N., Ciarrochi, J., Parker, P. D., Sahdra, B. K., Marshall, S. L., & Guo, J. (2018). A worthy self is a caring self: Examining the developmental relations between self‐esteem and self‐compassion in adolescents. Journal of Personality, 86(4), 619–630. https://doi.org/10.1111/jopy.12340
  22. Findlay, L. C., Girardi, A., & Coplan, R. J. (2006). Links between empathy, social behavior, and social understanding in early childhood. Early Childhood Research Quarterly, 21(3), 347-359. https://doi.org/10.1016/j.ecresq.2006.07.009
  23. Galanou, C., Galanakis, M., Alexopoulos, E., & Darviri, C. (2014). Rosenberg Self-Esteem Scale Greek Validation on Student Sample. Psychology, 05(08), 819–827. https://doi.org/10.4236/psych.2014.58093
  24. Grotevant, H. D., Cooper, C. R., Lerner, R., & Castellino, D. (1999). Patterns of interaction in family relationships and the development of identity exploration in adolescence. Adolescents and their families: Structure, function, and parent-youth relationships, 103-116.
  25. Guasp Coll, M., Navarro-Mateu, D., Giménez-Espert, M., & Prado-Gascó, V. J. (2020). Emotional Intelligence, Empathy, Self-Esteem, and Life Satisfaction in Spanish Adolescents: Regression vs. QCA Models. Frontiers in psychology, 11, 1629. https://doi.org/10.3389/fpsyg.2020.01629.
  26. Hawes, M. T., Szenczy, A. K., Klein, D. N., Hajcak, G., & Nelson, B. D. (2021). Increases in depression and anxiety symptoms in adolescents and young adults during the COVID-19 pandemic. Psychological Medicine, 1–9. https://doi.org/10.1017/S0033291720005358
  27. Helwig, N. E., & Ruprecht, M. R. (2017). Age, gender, and self-esteem: A sociocultural look through a nonparametric lens. Archives of Scientific Psychology, 5(1), 19–31. https://doi.org/10.1037/arc0000032
  28. Hemmerdinger, J. M., Stoddart, S. D., & Lilford, R. J. (2007). A systematic review of tests of empathy in medicine. BMC medical education, 7(1), 1-8. https://doi.org/10.1186/1472-6920-7-24
  29. Heynen, E. J. E., Van der Helm, G. H. P., Stams, G. J. J. M., & Korebrits, A. M. (2016). Measuring Empathy in a German Youth Prison: A Validation of the German Version of the Basic Empathy Scale (BES) in a Sample of Incarcerated Juvenile Offenders. Journal of Forensic Psychology Practice, 16(5), 336–346. https://doi.org/10.1080/15228932.2016.1219217
  30. Holas, P., Kowalczyk, M., Krejtz, I., Wisiecka, K., & Jankowski, T. (2021). The relationship between self-esteem and self-compassion in socially anxious. Current Psychology, 1-6. https://doi.org/10.1007/s12144-021-02305-2.
  31. Huang, L., Thai, J., Zhong, Y., Peng, H., Koran, J., & Zhao, X.-D. (2019). The positive association between empathy and self-esteem in Chinese medical students: a multi-institutional study. Frontiers in psychology, 10. https://doi.org/10.3389/fpsyg.2019.01921
  32. Hu, L., & Bentler, P. M. (1999). Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural Equation Modeling: A Multidisciplinary Journal, 6(1), 1–55. https://doi.org/10.1080/10705519909540118.
  33. Fredrickson, B. L. (2001). The role of positive emotions in positive psychology: the broaden-and-build theory of positive emotions. American psychologist, 56(3), 218-226. https://doi.org/10.1037/0003-066X.56.3.218
  34. Jolliffe, D., & Farrington, D. P. (2006). Development and validation of the Basic Empathy Scale. Journal of Adolescence, 29(4), 589–611. https://doi.org/10.1016/j.adolescence.2005.08.010.
  35. Lau, B. H.-P., Chan, C. L.-W., & Ng, S.-M. (2020). Self-Compassion Buffers the Adverse Mental Health Impacts of COVID-19-Related Threats: Results From a Cross-Sectional Survey at the First Peak of Hong Kong’s Outbreak. Frontiers in Psychiatry, 11. https://doi.org/10.3389/fpsyt.2020.585270
  36. Leary, M. R., Tate, E. B., Adams, C. E., Batts Allen, A., & Hancock, J. (2007). Self-compassion and reactions to unpleasant self-relevant events: The implications of treating oneself kindly. Journal of Personality and Social Psychology, 92(5), 887–904. https://doi.org/10.1037/0022-3514.92.5.887
  37. Linh, T. T., Huong, T. T., & Trang, N. M. (2017). Development and Validation of the Self-Esteem Scale of Toulouse (ETES) in Vietnam. Open Journal of Social Sciences, 05(01), 114–125. https://doi.org/10.4236/jss.2017.51010
  38. Liu, Q., & Wang, Z. (2021). Perceived stress of the COVID-19 pandemic and adolescents’ depression symptoms: The moderating role of character strengths. Personality and Individual Differences, 182, 111062. https://doi.org/10.1016/j.paid.2021.111062
  39. Luo, Y., Meng, R., Li, J., Liu, B., Cao, X., & Ge, W. (2019). Self-compassion may reduce anxiety and depression in nursing students: a pathway through perceived stress. Public Health, 174, 1-10. https://doi.org/10.1016/j.puhe.2019.05.015.
  40. Lyvers, M., Randhawa, A., & Thorberg, F. A. (2020). Self-compassion in relation to alexithymia, empathy, and negative mood in young adults. Mindfulness, 11(7), 1655-1665. https://doi.org/10.1007/s12671-020-01379-6.
  41. Kock, N. (2015). Common method bias in PLS-SEM: A full collinearity assessment approach. International Journal of e-Collaboration (ijec), 11(4), 1-10. https://doi.org/10.4018/ijec.2015100101.
  42. MacBeth, A., & Gumley, A. (2012). Exploring compassion: A meta-analysis of the association between self-compassion and psychopathology. Clinical Psychology Review, 32(6), 545–552. https://doi.org/10.1016/j.cpr.2012.06.003
  43. Marcia, J. E. (1994). The empirical study of ego identity. In T. L. G. G. H. A. Bosma, H. D. Grotevant, & D. J. de Levita (Eds.), Identity and development: An interdisciplinary approach (pp. 67-80): Sage Publications, Inc.
  44. Marshall, S. L., Ciarrochi, J., Parker, P. D., & Sahdra, B. K. (2020). Is self‐compassion selfish? The development of self‐compassion, empathy, and prosocial behavior in adolescence. Journal of research on adolescence, 30, 472-484. https://doi.org/10.1111/jora.12492
  45. Marshall, S. L., Parker, P. D., Ciarrochi, J., Sahdra, B., Jackson, C. J., & Heaven, P. C. L. (2015). Self-compassion protects against the negative effects of low self-esteem: A longitudinal study in a large adolescent sample. Personality and Individual Differences, 74, 116–121. https://doi.org/10.1016/j.paid.2014.09.013
  46. Neff, K. (2003). Self-compassion: An alternative conceptualization of a healthy attitude toward oneself. Self and Identity, 2(2), 85-101. https://doi.org/10.1080/15298860309032
  47. Neff, K. (2004). Self-compassion and psychological well-being. Constructivism in the Human Sciences, 9(2), 27-38.
  48. Neff, K. D. (2009). The Role of Self-Compassion in Development: A Healthier Way to Relate to Oneself. Human Development, 52(4), 211–214. https://doi.org/10.1159/000215071
  49. Neff, K. D. (2011). Self-Compassion, Self-Esteem, and Well-Being. Social and Personality Psychology Compass, 5(1), 1–12. https://doi.org/10.1111/j.1751-9004.2010.00330.x
  50. Neff, K. D., & Pommier, E. (2013). The Relationship between Self-compassion and Other-focused Concern among College Undergraduates, Community Adults, and Practicing Meditators. Self and Identity, 12(2), 160–176. https://doi.org/10.1080/15298868.2011.649546
  51. Neff, K. D., & Vonk, R. (2009). Self-Compassion Versus Global Self-Esteem: Two Different Ways of Relating to Oneself. Journal of Personality, 77(1), 23–50. https://doi.org/10.1111/j.1467-6494.2008.00537.x
  52. Nelson, J. R., Hall, B. S., Anderson, J. L., Birtles, C., & Hemming, L. (2018). Self–compassion as self-care: A simple and effective tool for counselor educators and counseling students. Journal of Creativity in Mental Health, 13(1), 121-133. https://doi.org/10.1080/15401383.2017.1328292
  53. Nguyen, T. M., Xiao, X., Xiong, S., Guo, C., & Cheng, G. (2020). Effects of parental educational involvement on classroom peer status among Chinese primary school students: A moderated mediation model of psychological Suzhi and family socioeconomic status. Children and Youth Services Review, 111, 104881. https://doi.org/10.1016/j.childyouth.2020.104881.
  54. Novak, L., Malinakova, K., Mikoska, P., van Dijk, J. P., Dechterenko, F., Ptacek, R., & Tavel, P. (2021). Psychometric Analysis of the Czech Version of the Toronto Empathy Questionnaire. International journal of environmental research and public health, 18(10), 5343. https://doi.org/10.3390/ijerph18105343.
  55. Orth, U., & Robins, R. W. (2014). The Development of Self-Esteem. Current Directions in Psychological Science, 23(5), 381–387. https://doi.org/10.1177/0963721414547414
  56. Orth, U., Robins, R. W., & Widaman, K. F. (2012). Life-span development of self-esteem and its effects on important life outcomes. Journal of Personality and Social Psychology, 102(6), 1271–1288. https://doi.org/10.1037/a0025558
  57. Pollak, K. I., Alexander, S. C., Tulsky, J. A., Lyna, P., Coffman, C. J., Dolor, R. J., Gulbrandsen, P., & Ostbye, T. (2011). Physician Empathy and Listening: Associations with Patient Satisfaction and Autonomy. The Journal of the American Board of Family Medicine, 24(6), 665–672. https://doi.org/10.3122/jabfm.2011.06.110025.
  58. Quang, A. M. T., Van Pham, M., Mai, T. T., Le, G. N. H., & Song, G. A. N. (2021). Self-compassion and Students' Well-Being Among Vietnamese Students: Chain Mediation Effect of Narcissism and Anxiety. Journal of Rational-Emotive & Cognitive-Behavior Therapy, 1-16. https://doi.org/10.1007/s10942-021-00431-1.
  59. Rakes, G. C., & Dunn, K. E. (2010). The Impact of Online Graduate Students’ Motivation and Self-Regulation on Academic Procrastination. Interactive Online Learning, 9(1), 78–93.
  60. Reilly, E. D., Rochlen, A. B., & Awad, G. H. (2014). Men’s self-compassion and self-esteem: The moderating roles of shame and masculine norm adherence. Psychology of Men & Masculinity, 15(1), 22–28. https://doi.org/10.1037/a0031028
  61. Rosenberg, M., Schooler, C., Schoenbach, C., & Rosenberg, F. (1995). Global Self-Esteem and Specific Self-Esteem: Different Concepts, Different Outcomes. American Sociological Review, 60(1), 141-156. https://doi.org/10.2307/2096350
  62. Sa, B., Ojeh, N., Majumder, M. A. A., Nunes, P., Williams, S., Rao, S. R., & Youssef, F. F. (2019). The Relationship Between Self-Esteem, Emotional Intelligence, and Empathy Among Students From Six Health Professional Programs. Teaching and Learning in Medicine, 31(5), 536–543. https://doi.org/10.1080/10401334.2019.1607741
  63. Sinclair, S., Beamer, K., Hack, T. F., McClement, S., Raffin Bouchal, S., Chochinov, H. M., & Hagen, N. A. (2017). Sympathy, empathy, and compassion: A grounded theory study of palliative care patients’ understandings, experiences, and preferences. Palliative Medicine, 31(5), 437–447. https://doi.org/10.1177/0269216316663499
  64. Souza, L. K. d., & Hutz, C. S. (2016). Self-compassion in relation to self-esteem, self-efficacy and demographical aspects. Paidéia (Ribeirão Preto), 26, 0181-0188. https://doi.org/10.1590/1982-43272664201604
  65. Stotland, E., & Dunn, R. E. (1963). Empathy, self-esteem, and birth order. The Journal of Abnormal and Social Psychology, 66(6), 532–540. https://doi.org/10.1037/h0042891
  66. Tandazo Rigazio, V. (2021). Effects of a self-compassion training program on university students’ mental health: a randomized controlled trial. (Master’s in Clinical Psychology Department), Universidad San Francisco, Quito, Ecuador. Retrieved from http://repositorio.usfq.edu.ec/handle/23000/11098
  67. Tajfel, H., & Turner, J. C. (2004). The Social Identity Theory of Intergroup Behavior. In J. T. Jost & J. Sidanius (Eds.), Political psychology: Key readings (pp. 276–293). Psychology Press. https://doi.org/10.4324/9780203505984-16
  68. Teding van Berkhout, E., & Malouff, J. M. (2016). The efficacy of empathy training: A meta-analysis of randomized controlled trials. Journal of counseling psychology, 63(1), 32. https://psycnet.apa.org/doi/10.1037/cou0000093
  69. Tkach, C. T. (2005). Unlocking the treasury of human kindness: Enduring improvements in mood, happiness, and self-evaluations. (Doctor of Philosophy in Psychology), University of California, Riverside.
  70. Villadangos, M., Errasti, J., Amigo, I., Jolliffe, D., & García-Cueto, E. (2016). Characteristics of Empathy in young people measured by the Spanish validation of the Basic Empathy Scale. Psicothema, 28(3), 323–329. DOI: 10.7334/psicothema2016.6.
  71. Wei, M., Liao, K. Y. H., Ku, T. Y., & Shaffer, P. A. (2011). Attachment, self-compassion, empathy, and subjective well-being among college students and community adults. , 79(1),. Journal of Personality, 79(1), 191–221. DOI: 10.1111/j.1467-6494.2010.00677.x
  72. Welp, L. R., & Brown, C. M. (2014). Self-compassion, empathy, and helping intentions. The Journal of Positive Psychology, 9(1), 54–65. https://doi.org/10.1080/17439760.2013.831465.
  73. Yang, Y., Guo, Z., Kou, Y., & Liu, B. (2019). Linking self-compassion and prosocial behavior in adolescents: The mediating roles of relatedness and trust. Child Indicators Research, 12(6), 2035-2049. https://doi.org/10.1007/s12187-019-9623-2.