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Self-care and Well-being in Mental Health

Professionals: The Mediating Effects of Self-
awareness and Mindfulness

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 Joumal ofMentat Heatth Counseling
Volume 32/Number 3/July 2010/Pages 247-264

Self-care and Well-being in Mental Health

Professionals: The Mediating Effects of
Self-awareness and Mindfulness

Kelly C. Richards
C. Estelle Campenni
Janet L. Muse-Burke

Because mental health professionals are susceptible to impairment and burnout that may negatively
affect clinical work, it is ethically imperative that they engage in self-care. Previous research has found
direct ejfects of self-care on self-awareness and well-being (e.g.. Coster & Schwebet. ¡997). Likewise,
mindfulness has been found to positively affect well-being (Brown & Ryan, 2003). However, no studies
currently available demonstrate a link between self-awareness and well-being. Mindfulness may be the
link needed to support this association. A survey of mental health professionals (N= ¡48) revealed that
mindfulness is a significant mediator between self-care and well-being. Consequently, mental health
professionals are encouraged to explore their involvement in and beliefs about self-care practices.

According to the core ethical principles of counseling, counselors have a

responsibility to do no harm, benefit others, and pursue excellence in their pro-
fession (American Counseling Association [ACA], 2005; American Mental
Health Counselors Association, 2010). Mental health professionals are suscep-
tible to impairment in their professional lives that can undermine their thera-
peutic efficacy (Coster & Schwebel, 1997). Coster and Schwebel find that men-
tal health professionals are vulnerable to, e.g., vicarious trauma, substance
abuse, relational difficulties, and depression. Therefore, to adhere to their ethi-
cal principles, it is important that counselors engage in self-care (e.g., exercise)
to decrease the possibility of impairment and enhance their well-being.
The present study explored the link between self-care by mental health pro-
fessionals and their general well-being. Previous research has found direct
effects of self-care on well-being (e.g.. Coster & Schwebel, 1997) and self-
awareness (e.g., Mackey & Mackey, 1994); however, no studies demonstrate a

Kelly C. Richards, C. Estelle Campenni, and Janet L. Muse-Burke are affiliated with Marywood
University. Correspondence concerning this article should be addressed to Kelly C Richards,
Marywood University, Department of Psychology and Counseling, 2300 Adams Avenue, Scranton,
Pennsylvania ¡8509-¡598. E-maH: [email protected].

247
248 JOURNAL OF MENTAL HEALTH COUNSELING

link between self-awareness and well-being. This omission is interesting con-

sidering that mindflilness, which has been associated with self-awareness, has
been shown to have a direct effect on well-being (e.g.. Brown & Ryan, 2003).
This study therefore examined the direct effect of self-care on self-awareness
and mindfulness and how these associations affect the well-being of mental
health professionals.

What Is Self-care?
The literature reveals few attempts at an operational definition of self-care,
and there is minimal agreement among definitions. For example, Pincus (2006)
defined self-care vaguely as something "one does to improve [the] sense of sub-
jective well-being. How one obtains positive rather than negative life out-
comes" (p. 1). Other researchers have defined self-care by describing activities
believed to constitute self-care. Carrol, Gilroy, and Murra (1999) classify self-
care as including "intrapersonal work, interpersonal support, professional
development and support, and physical/recreational activities" (p. 135). With
these definitions in mind and after a thorough literature review, some general
themes in self-care have been identified. Researchers have explored physical
(Mahoney, 1997), psychological (Norcross, 2000), spiritual (Valente &
Marotta, 2005), and support (Guy, 2000) components of self-care.
Physical. The physical component of self-care has been loosely defined as
incorporating physical activity (Carroll et al., 1999), which in this context is
characterized by bodily movement that results in the utilization of energy,
which can occur through exercise, sports, household activities, and other daily
functioning (Henderson & Ainsworth, 2001). The intensity of physical activity
and the amount of time spent on it can vary dramatically, but recommendations
from the U.S. Department of Health and Human Services and the U.S.
Department of Agriculture (2005) suggest at least 30 minutes of physical activ-
ity for most days throughout the week is necessary to receive benefits
Although there seem to be many specific advantages of physical activity
(Dishman, 2003), it also appears to have a general Wellness benefit. It has been
shown to decrease symptoms of anxiety and depression (Callaghan, 2004;
Dishman). Further, Lustyk, Widman, Paschane, and Olson (2004) found that an
increase in the volume and frequency of exercise increased the health compo-
nent of quality of life. For instance, physical activity has been shown to
increase women's satisfaction with their body functioning and their ability to
cope with daily stress (Anderson, King, Stewart, Camacho, & Rejeski, 2005).
Clearly, physical activity promotes a general sense of well-being.
Psychological. Psychological self-care refers to seeking one's own personal
counseling (Coster & Schwebel, 1997; O'Connor, 2001). Personal counseling
can be defined as psychological treatment for any type of distress or impairment
(Norcross, 2005). Patterson (1966) states that counseling is a process
Richards, Campenni, and Muse-Burke / SELF-CARE AND WELL-BEING 249

"involving a special kind of relationship between a person who asks for help
with a psychological problem...and a person who is trained to provide that
help" (p. 1). Because counselors spend a significant amount of time providing
services to others, it is suggested that they themselves seek the benefits of
counseling.
Among the benefits found through participation in personal counseling is
alleviation of symptoms of distress and impairment (Macran, Stiles, & Smith,
1999). Through qualitative interviews with therapists, researchers have also
identified other personal and professional benefits (Mackey & Mackey, 1994;
Macran et al.). Personal counseling supports personal development by allowing
one both to understand how to care for oneself and to develop an awareness of
one's boundaries and limitations (Mackey & Mackey; Macran et al.,).
Professional development, which is understood as building awareness of skills
that can benefit one's career, has also been demonstrated to be a result of per-
sonal counseling. Because empathy requires understanding of another person,
personal counseling has been shown to enhance counselors' empathie skills
(Mackey & Mackey; Macran et al.). Given the personal and professional devel-
opment that results, it appears that becoming aware of oneself is a significant
advantage of personal counseling (Coster & Schwebel, 1997; Mackey &
Mackey; Macran et al.; Norcross, 2005).
Spiritual. The spiritual component of self-care also must be defined loosely,
given how broadly its meaning can be interpreted. Spirituality can be generally
described as a sense of the purpose and meaning of life and the connection one
makes with this understanding (Estanek, 2006; Hage, 2006; Perrone, Webb,
Wright, Jackson, & Ksiazak, 2006; Saucier & Skrzypinksa, 2006). This defini-
tion is vague enough to ensure that all beliefs of spirituality, including religion,
are addressed. Behaviors sometimes considered spiritual, such as meditation,
may also be included (Schure, Christopher, & Christopher, 2008).
Boero et al. (2005) investigated the spiritual/religious beliefs and quality of
life of health workers. They found that spirituality plays a significant, positive
role in their quality of life. Physical well-being, such as health, was also fouhd
to be significantly, positively infiuenced by spirituality (Boero et al.).
Mental health has been shown to be related to spirituality (Wong, Rew, &
Slaikeu, 2006). It was found that greater spirituality reported by adolescents
was associated with more positive mental health (Wong et al.). In another study
using qualitative interviews, helping professionals discussed their spirituality
and its benefits to them. It was reported to promote not only quality of life but
also a sense of self-awareness (Hamilton & Jackson, 1998). Hamilton and
Jackson suggest that self-awareness is central to developing and maintaining
spirituality; therefore, it might be supposed that spirituality is important for the
development and continued progression of self-awareness.
Support. The support component of self-care includes the relationships and
250 JOURNAL OF MENTAL HEALTH COUNSELING

interactions that develop from both professional and personal support systems.
Professional support is defined as consultation and supervision from peers, col-
leagues, and supervisors and the continuation of professional education (Coster
& Schwebel, 1997; O'Connor, 2001; Stevanovic & Rupert, 2004). Personal
support is defined as relationships with spouse, companion, friends, and other
family members (Coster & Schwebel; Stevanovic & Rupert).
Like personal therapy, support from others can benefit personal and profes-
sional development. Koocher and Keith-Spiegel (1998) suggest that mental
health professionals should participate in routine professional communications
with colleagues to reduce the possibility of bumout. Through consultation and
supervision, it is possible to recognize and understand oversights and errors
(Koocher & Keith-Speigel; O'Connor, 2001). Also, professional support can
help guide a counselor through ethical and other clinical difficulties with cases
(Coster & Schwebel, 1997). Mental health professionals surveyed indicated
that professional support was the main reason for their well-being because it
gave them input into various situations (Coster & Schwebel). Because profes-
sional development can occur through professional support as well as personal
counseling, self-awareness may also develop from such support systems.
Stevanovic and Rupert (2004) surveyed licensed psychologists about their
career satisfactions and found that it is important not to use personal support for
professional Stressors because personal support provides different benefits.
Specifically, it satisfies the common need to belong because it establishes rela-
tionships outside the professional world. It therefore provides a healthy balance
in that mental health professionals will experience their lives through both
career and outside of work (Coster & Schwebel, 1997; Stevanovic & Rupert).
This balance can help prevent or alleviate symptoms of bumout and mental
exhaustion, or becoming a workaholic. It has been suggested that personal sup-
port enhances psychological well-being (life satisfaction and mood) and phys-
ical health subjectively and objectively (Walen & Lachman, 2000).

tVhat Is Self-awareness?
A comprehensive literature review reveals minimal discussion of the con-
struct of self-awareness, making defining it difficult. Additionally, most of the
research that has examined self-awareness is outdated. Brown and Ryan (2003)
suggest that it is simply "knowledge about the self (p. 823). Others suggest
that self-awareness is awareness or knowledge of one's thoughts, emotions, and
behaviors and can be considered a state; therefore, it can be situational
(Fenigstein, Scheier, & Buss, 1975). It is believed to be similar to or synony-
mous with other constructs, such as self-consciousness (Fenigstein et al.; Webb,
Marsh, Schneiderman, & Davis, 1989) and insight (Grant, Franklin, &
Langford, 2002; Roback, 1974). Because this study is exploring self-care
and its benefits, which have been shown at times to be self-awareness, it is
Richards, Campenni, and Muse-Burke / SELF-CARE AND WELL-BEING 251

important to emphasize distinguishing self-awareness as a state. The outcome

of a behavior usually tends to be a state; therefore, self-awareness may be a
possible outcome of self-care.

What Is Mindfulness?
Once again, definition is a daunting task. Mindfulness has only recently been
introduced to Westernized culture and there is still uncertainty about its exact
definition. Researchers have a consensus understanding that it is maintaining
awareness of and attention on one's surroundings; however, several models
have been proposed for a more precise definition (see Bishop et al., 2004;
Shapiro, Carlson, Astin, & Freedman, 2006; Stemberg, 2000). It has been sug-
gested that the practice of mindfulness may facilitate insight, which can be
understood as awareness of oneself and one's motives (Rosenzweig, Reibel,
Greeson, & Brainard, 2003; Schmidt, 2004). Because insight and self-aware-
ness have been described similarly, any conneetion between self-awareness and
mindfulness should be explored.
Despite the suggested similarities between self-awareness and mindfulness,
some researchers have begun to identify subtle differences. Brown and Ryan
(2003) believe self-awareness to be "knowledge about the self (p. 823),
whereas mindfulness can be understood as knowledge and awareness of one's
experience in the present moment (Byrne, 2007; Hirst, 2003). More specifi-
cally. Brown and Ryan propose that self-awareness is an internal awareness of
one's cognitions and emotions, and mindfulness is both internal and external,
being awareness of both one's cognitions and emotions and the surrounding
environment.
Mindftilness has been used as an intervention for physical ailments in the
form of structured mindfulness meditation instruction, knovra as mindfulness-
based stress reduction (MBSR; Bishop, 2002). Through this meditation, the
patient begins to develop an understanding of the self and ultimately an ability
to regulate the self (Bishop). The technique teaches people to notice, accept,
and regulate their emotions and thoughts (Bishop). MBSR has been used suc-
cessfully to reduce stress (Rosenzweig et al., 2003) and relieve medical illness
(Bishop; Kabat-Zinn et al., 1998), psychological distress (Williams, Teasdale,
Segal, & Soulsby, 2000), and physical and emotional pain (Roth, 1997).

Purpose and Hypotheses

Research has thus established that mindfulness has a strong link with self-
awareness and well-being (Brown & Ryan, 2003), and that self-care has a direct
effect on self-awareness (Hamilton & Jaekson, 1998) and well-being (Lustyk et
al., 2004). However, it has not clearly delineated the direct link between self-
awareness and well-being. Although it appears that self-care leads to well-being
(Coster & Schwebel, 1997), it has yet to be determined if self-awareness
252 JOURNAL OF MENTAL HEALTH COUNSELING

mediates the relationship between self-care and well-being. If mindfulness and

self-awareness are associated, and mindfulness leads to well-being, it would
seem logical that there would be a chain linking self-care to self-awareness to
well-being. This study explored such links by examining self-care practices,
self-awareness, mindfulness, and well-being in mental health professionals.

The following hypotheses were examined:

Hypothesis 1 : A significant, positive correlation between self-awareness and
mindfulness will be found.
Hypothesis 2: The path from self-care to mindfulness to well-being will be
significantly stronger than the direct path from self-care to well-being.
Hypothesis 3: The path from self-care to self-awareness to well-being will be
significantly stronger than the direct path from self-care to well-being.

METHOD

Participants
The study surveyed 148 mental health professionals holding a bachelor's
degree or higher and pracdcing in the northeastern United States. According to
Cohen (1992), based on the number of variables used a minimum of 108 par-
ticipants is required to achieve power of .80 with an alpha of .01 and a medium
effect size (r = .30). The participants were 77.1% women; the average age was
42.38 years {SD = 14.88); and 94.3% were White, 2.1 % Asian American, 2.1 %
Ladno/Latina, 0.7% African American, and 0.7% Native American. In terms of
educational level, the participants were somewhat evenly distributed (30.6%
bachelor's, 41.7% master's, 0.7% educadonal specialist/ABD, 26.4% doctor-
ate, and 0.7% other). Their specialties were in social work (43.3%), counseling
psychology (24.8%), clinical psychology (23.4%), other (7.1%), and general
psychology (1.4%). Participants reported that they currently provide mental
health services, defined as seeing clients for assessment, therapy, and psycho-
logical testing in a variety of settings; some respondents worked in muldple set-
tings, including community mental health center (15.5%), inpadent hospital
(5.4%), partial hospitalization program (8.1%), practicum/intemship (12.8%),
private pracdce (40.5%), Veterans Affairs clinic (0.7%), nonprofit organization
(2.0%), children's welfare center (4.7%), university counseling center (9.5%),
and other mental health setting (8.8%). Average years in practice was 13.8
years {range = 0 - 40).

Measures
Self-care. Participants were given a broad definidon of self-care ("Self-care
refers to any activity that one does to feel good about oneself. It can be catego-
rized into four groups which include: physical, psychological, spiritual, and
Richards, Campenni, and Muse-Burke / SELF-CARE AND WELL-BEING 253

support") and definitions for the four components. They were asked to indicate
how often they are involved in such behaviors based on a 7-point Likert-type
scale ranging from "One or more times daily" (0) to "Never" (6). There were
four questions, one for each aspect of self-care. For example, one item asked
participants to identify how often they engaged in physical activities (exercise,
sports, household activities, etc.). Since each question was developed to assess
a component of self-care that is independent of the others, inter-item reliability
could not be assessed. Items were reverse-scored to produce final scores of zero
to 24. Higher scores indicate greater propensity for self-care.
Participants were also asked to indicate their views of the importance of each
self-care component. They were again provided with a broad definition of self-
care and the definitions of its four components. They were asked to indicate the
extent to which they agreed with each of four statements pertaining to the
importance of self-care activities, ranging from "Disagree Strongly" (0) to
"Agree Strongly" (6). The possible final range of scores was zero to 24, with
higher scores indicating greater agreement with the importance of self-care.
Again, reliability could not be assessed for this measure.
Self-awareness. The Self-Refiection and Insight Scale (SRIS; Grant et al.,
2002) has two subscales, self-refiection and insight. Grant and colleagues
defined self-refiection (p. 821) as "the inspection and evaluation of one's
thoughts, feelings, and behavior" and insight as "the clarity of understanding
one's thoughts, feelings, and behavior." The self-reflection subscale can be fur-
ther divided into the need for self-reflection and engagement in self-reflection,
which have been shown to be subcomponents but are not separated out from the
main self-refiection subscale (Grant et al.). The SRIS consists of 20 self-report
items, to be rated on a 6-point Likert-type scale ranging from (1) "Strongly
Disagree" to (6) "Agree Strongly." Eight of the items are to be reverse-scored.
Possible scores range from 20 to 120, with higher scores indicating more self-
awareness. Grant et al. report that SRIS has high internal consistency, with
Cronbach's alphas of .91 (self-refiection subscale) and .87 (insight subscale).
The SRIS has also been shown to have good seven-week test-retest reliability
with alphas of .77 (self-refiection subscale) and .78 (insight subscale). Grant et
al. found the SRIS to demonstrate good convergent and discriminant validity in
that both subscales,were not related to depression; the insight subscale was not
correlated with anxiety, alexithymia, or stress; and the insight subscale was pos-
itively related to self-regulation and cognitive flexibility. Cronbach's alphas for
the current sample were .78 (self-reflection) and .94 (insight).
Mindfulness. The Mindful Attention Awareness Scale (MAAS; Brown &
Ryan, 2003) was utilized in the present study to assess individuals' levels of
mindfulness. The MAAS is a 15-item self-report measure scored on a 6-point
Likert-type scale, ranging from (1) "Almost Always" to (6) "Almost Never."
Possible scores range from one to six, with higher scores indicating greater
254 JOURNAL OF MENTAL HEALTH COUNSELING

propensity to be mindful. Reliability was good, with alphas ranging fi^om .82 to
.87. During a test-retest analysis (Brown & Ryan), the measure did not produce
significantly different scores between Time 1 and Time 2, again indicating reli-
ability. Based on two different confirmatory factor analyses utilizing student
and general adult samples, the MAAS was found to measure a single factor.
Good convergent validity has been demonstrated in that this measure was found
to correlate with emotional intelligence, openness to experience, and well-
being (Brown & Ryan). Discriminant validity was shown by a low correlation
between the MAAS and self-examination, self-monitoring, and neuroticism
(Brown & Ryan). Cronbach's alpha for the current sample was .89.
Well-being. This study used the Schwartz Outcomes Scale-10 (SOS-10; Biais
et al., 1999) to evaluate participants' well-being. It consists of 10 self-report
items assessing psychological health that are rated on a 7-point Likert-type
scale ranging from (0) "Never" to (6) "All of the time or nearly all of the time."
Possible scores range from zero to 60, with higher scores indicating greater
psychological health. Biais and colleagues report that the SOS-10 has high
internal consistency, with Cronbach's alpha >.9O over three samples. It has also
been shown to have good test-retest reliability (r = .87) across a one-week study
with a nonpatient population (Biais et al.). Further, there were no fioor or ceil-
ing effects found among patient or nonpatient populations. The SOS-10 was
found to have high convergent validity in that it had a significant positive cor-
relation with positive affect, sense of coherence, self-esteem, and general life
satisfaction (Biais et al.). It also was found to have high discriminate validity,
as demonstrated by its significant negative correlation with negative affect,
hopelessness, fatigue, and psychiatric symptoms (Biais et al.). Cronbach's
alpha for the current sample was .88.
Demographics. The questionnaire asked about age, gender, race/ethnicity,
educational degree, field of study, and professional practices.

Procedure
Two methods were used to mail 415 survey packets, including a self-
addressed, postage-paid envelope. First, those identified as mental health pro-
fessionals under the "Counseling Services" and "Psychologists" sections of the
phonebook in northeastern Pennsylvania were contacted. Second, counseling
and clinical psychology graduate students who were actively providing mental
health services were solicited through personal contact with training directors.
Reminder postcards were mailed one week after the surveys. Completion of the
survey packet constituted agreement to participate. The retum rate was
35.7%—148 surveys. The order of the questionnaires was counterbalanced to
decrease potential response bias; but the questionnaire on self-care importance
was always last so those responses would not infiuence responses to the other
measures.
Richards, Campenni, and Muse-Burke / SELF-CARE AND WELL-BEING 255

RESULTS

Before analysis the data were screened using Mahalanobis distance to assess
for outliers. This analysis identified three multivariate outliers, which were
removed from the data.

Descriptive Statistics
The descriptive statistics for each measure are found in Table 1. Bivariate
correlations were conducted on all measures (see Table 1). Self-care frequency
is significantly, positively correlated with self-care importance (r = 0.34, p <
.001) and well-being (r = 0.228, p = .008). Self-awareness was also positively
correlated with self-care importance (/- = 0.325, p < .001), well-being (r =
0.174, p = .045), and mindfulness {r = 0.293, p < .001). The connection
between self-awareness and mindfrilness supports the hypothesis that these two
constructs would be significantly correlated. Additionally, mindfulness (r =
0.179, p = .035) and well-being (r = 0.208, p = .014) were found to be posi-
tively correlated with self-care importance, though the associations were
weaker. Lastly, mindfulness was found to be positively, strongly correlated with
well-being (r = 0.541, p< .001).
Table 1. Descriptive Statistics and Pearson Correiations for Current Study's Scales

Pearson Correlations

Scale Mean (SD) SCF SCI SRIS MAAS SOS-

10
SCF 15.38(3.75) —
SCI 20.77 (3.74) .335"* —
SRIS 94.35(12.96) .104 .325*** —
Self-reflection 58.45(10.75)
Insight 38.71 (5.47)
MAAS 4.28 (0.73) .151 .179* .293** —
SOS-10 48.38 (7.25) .228** .208* .174* .541*** -
Note. SCF = Self-care Frequency; SCI = Self-care Importance: SRIS = Self-Reflection
and Insight Scale (Grant et al., 2002); MAAS = Mindful Attention Awareness Scale (Brown
& Ryan, 2003); SOS-10 = Schwartz Outcomes Scale-10 (Biais et al., 1999)
• p < .05
** p = .001
*** p < .001

Mediational Analysis
According to Baron and Kenny (1986), a mediational analysis is used to
assess the indirect effects of one variable between an independent and an out-
come variable. This model demonstrates that a relationship may exist between
256 JOURNAL OF MENTAL HEALTH COUNSELING

an independent and an outcome variable, while an additional variable (a medi-

ator) may be significantly correlated with both. This mediator variable may
account for a significant portion of the correlation between the independent and
the outcome variables. The mediator, which explains the "how or why" of a
relationship, may be described as an "internal psychological" variable that
accountz for the relationship between two "external physical" constructs or
experiences (Baron & Kenny, p. 1176). An evaluation of the indirect effects that
exist between the direet effects of the independent and outcome variables may
weaken or eliminate these direct effects.
Multiple conditions must be met to conduct the mediational analysis pro-
posed by Baron and Kenny (1986). A series of simple and multiple regressions
is conducted to determine if these are satisfied. The first condition that must be
met is the presence of a significant relationship between the independent and
the outcome variable. There also needs to be a significant relationship between
the independent and the mediating variable. Next, it is essential that there be a
significant relationship between the mediator and the outcome variable. Lastly,
the significant relationship between the independent and the outcome variable
must diminish when the effects of a mediating variable are held constant. Baron
and Kenny reasoned that a "perfect mediation" is present when there is no
longer a relationship between the independent and the outcome variable when
the mediating variable is held constant (p. 1177).
Self-care Importance, Mindfulness, and Well-being. A mediational analysis
was conducted to assess the indireet effects of self-care on well-being. In the
first step, it was found that self-care importance was significantly, positively
correlated with well-being (r = .208,/? = .014). In the second, it was found that
mindfulness was significantly, positively correlated with self-care importanee
(r = .179, i> = .035). In the third, mindfulness significantly affected well-being
when self-care importance was controlled for {R^ = .292, F[l, 137] = 56.594,/?
< .001, Beta = .520,p <.OO1). Finally, it was found that self-care importance no
longer accounted for a significant amount of the variance of well-being after the
variance for mindfulness was controlled {R' = .013, F[l, 136] = 2.496, p =
.116).
A Sobel test was conducted to statistically assess the significance of the indi-
rect effect of the self-care importance -• mindfulness -* well-being relation-
ship. The results were significant, z = 2.09, p = .036, which supports the indi-
rect effect of mindfulness as a mediator between self-eare importance and well-
being (see Table 2 and Figure 1). This indicates that mindfulness is a signifi-
eant mediator of self-care importance and well-being in mental health profes-
sionals, a finding that supports the hypothesis that the direct effects between
self-care and well-being are mediated by mindfulness.
Richards, Campenni, and Muse-Burke I SELF-CARE AND WELL-BEING 257

Table 2. Mediational Regression Analysis: Self-Care Importance, Mindfulness, and

Well-Being

R R2 R2 change Beta
Analysis One:
Well-Being on Self-Care Importance .208 .043 .208*

Analysis Two:
Mindfulness on Self-Care Importance .179 .032 .170*

Analysis Three:
Step 1 : Well-Being on Mindfulness .541 .292 .520**
Step 2: Well-Being on Self-Care Importance .552 .305 .013 .115
* = p < .05
** = p < .001

Figure 1. Mediational Regression Analysis of Self-care Importance, Mindfulness, and

Well-being

Mindñilness

.179* / \ .520*

Self-Care Importance >- Well-Being

.208* (.115 ns)
* = p < .05
** = p<.001

Self-care Frequency, Mindfulness, and Well-being. To assess whether mind-

fulness is a significant mediator of the reladonship between self-care and well-
being in mental health professionals, first self-care frequency was explored. In
the initial step of the mediational analysis, self-care frequency and well-being
were significantly, posidvely correlated (r = .228, p = .014), but self-care fre-
quency and mindfulness were not (r = .151,p = .079), indicating that mindful-
ness is not a significant mediator between self-care frequency and well-being.
Thus the hypothesis that self-care and well-being are directly mediated by
mindfulness is not supported.
Self-care Importance, Self-awareness, and Well-being. In the first step of the
analysis of whether self-awareness mediated the relationship between self-care
importance and well-being, it was found that self-care importance was signifi-
candy, posidvely correlated with well-being (r = .208,;? = .014). In the second
step, self-awareness and self-care importance were significantly, positively cor-
related (r = .325, p < .001). The third step indicated that self-awareness did not
258 JOURNAL OF MENTAL HEALTH COUNSELING

significantly account for the variance in well-being when self-care importance

is controlled for (R' = .030, F[l, 137] = 4.115,p= .045, Beta = .l20,p = .183).
Therefore, self-awareness was not a significant mediator in the relationship
between self-care importance and well-being in mental health professionals,
refuting the hypothesis.
Self-care Frequency, Self-awareness, and Well-being. To determine if self-
awareness is a significant mediator of self-care and well-being in mental health
professionals, self-care frequency was found to be significantly, positively cor-
related with well-being (r = .228, p = .014), but not with self-awareness (r =
.104,/? = .237), indicating that self-awareness did not significantly mediate the
relationship between self-care frequency and well-being and offering no sup-
port for the hypothesis that the path from self-care to self-awareness to well-
being is stronger than the direct path from self-care to well-being.

DISCUSSION

The purpose of this study was to examine the relationship between mental
health professionals' self-care practices and general well-being by investigating
the indirect effects of self-awareness (knowledge of one's thoughts, emotions,
and behaviors) and mindfulness (awareness of and attention to oneself and
one's surroundings). Some results were consistent with the predictions, in that
self-care practices may have both direct and indirect effects on well-being.
As predicted, self-awareness and mindfulness were found to be significantly,
positively correlated, which is consistent with previous studies (e.g.. Brown &
Ryan, 2003; Wall, 2005). Although these constructs seem similar and are cor-
related, it is important to note the differences between them. Specifically, self-
awareness is considered to be knowledge of one's thoughts, emotions, and
behaviors; mindfulness is maintaining awareness of and attention to oneself
and one's surroundings. Our results suggest that when self-awareness increases,
so does mindfulness, and vice versa. This adds support for the relationship
between self-care importance, self-awareness, and well-being because mindful-
ness was found to be a significant mediator within the relationship.
Likewise, as hypothesized, mindfulness in mental health professionals was
found to be a significant mediator of the relationship between self-care impor-
tance and well-being. Specifically, it appears that the link between perceived
importance of self-care and well-being is indirectly affected by mindfulness.
This suggests that, to receive the full benefits of well-being from perceiving
self-care as important, one must achieve a state of mindfulness. Although few
previous studies discuss these connections, the findings of this study are con-
sistent with past research in that self-care importance and mindfulness have
been shown to be associated (Christopher, Christopher, Duncan, & Schure,
2006), and mindfulness and well-being have also been found to be correlated
Richards, Campenni, and Muse-Burke / SELF-CARE AND WELL-BEING 259

(Brown & Ryan, 2003; Rosenzweig et al., 2003).

Further, because mindftilness is considered to be a purposeful state (Brown
& Ryan, 2003; Shapiro et al., 2006), it may be that those who practice it believe
in its importance and value being mindful, so that valuing of self-care activities
may infiuence the intentional component of mindfulness. For example, an indi-
vidual who values engaging in self-care activities, such as going for a nature
hike, may also be better able to practice mindfulness. In addition, mindfulness
is considered to be a state of being, rather than something individuals do
(Rothaupt & Morgan, 2007), suggesting that belief in the value and importance
of self-care may elicit a mindful state. These individuals may believe that self-
care practices are important to enhance their well-being. For example, counsel-
ing students who found value and importance in self-care activities like yoga
and meditation reported feeling more mindftil and experiencing overall growth
and Wellness (Christopher et al., 2006). This indicates that the link between
mindfial and self-care behaviors, feelings, and outcomes may be important.
Notably, mindfulness was not found to be a significant mediator of the rela-
tionship between self-care frequency and well-being in mental health profes-
sionals. This suggests that the frequency of participation in self-care activities
may relate to enhanced well-being without necessarily requiring a state of
mindfulness. These findings do not support the present study's predictions. The
fact that there is minimal literature connecting self-care ftequency and mindftil-
ness is reinforced by the fact that this study did not find self-care frequency and
mindfulness to be significantly correlated.
Although these findings did not support the hypothesis, they have important
implications. Specifically, the significant, positive correlation between self-
care frequency and well-being indicates that increased participation in self-care
activities is associated with increased general well-being. These findings are
supported in the literature (e.g., Boero et al., 2005; Coster & Schwebel, 1997;
Lustyk et al., 2004), which suggests that an increase in self-care activities
increases well-being. Moreover, mindflilness does not infiuence the effects in
this relationship, indicating that participation in self-care activities is associated
with increased Wellness, and mindftilness may not indirectly affect this rela-
tionship. This may indicate that self-care activities do not necessarily require
awareness of self and surroundings; rather, the simple act of participation in
self-care behaviors infiuences overall Wellness.
The relationship between mindfulness and well-being may also be more
complex than is examined here. For instance, for some individuals, mindfulness
may enhance well-being, providing a sense of grounding and perspective,
while, it may cause others to attend more astutely to personal struggles and neg-
ative aspects of their lives, causing a decrease in Wellness.
The fact that self-awareness was not found to be a significant mediator of the
relationship between self-care and well-being suggests that self-care appears to
260 JOURNAL OF MENTAL HEALTH COUNSELING

enhance one's well-being without necessarily requiring a state of self-aware-

ness to intervene the effects in the relationship. These findings were the same
for self-care frequency and self-care importance, which suggests that the pre-
dictions of this study were not supported. Nevertheless, self-awareness and
well-being were found to be significantly, positively correlated, which suggests
that with an increase in self-awareness, there is an increase in well-being. When
thinking about these findings, it may be important to consider the relationship
between self-awareness and well-being independent of self-care. Although
research has so far found no link between self-awareness and well-being, this
may be an important relationship. For example, insight-oriented psychotherapy
tends to value the importance of insight and awareness as a means of enhanc-
ing mental health (i.e., well-being). Furthermore, though previous studies seem
to indicate that self-awareness is enhanced through self-care, the relationship
seems to be much more evident for psychological and spiritual aspects of self-
care than for physical and support components (e.g.. Coster & Schwebel, 1997;
Hamilton & Jackson, 1998; Norcross, 2005; Valente & Marotta, 2005).
Self-care frequency and self-care importance were found to be significantly,
positively correlated. This suggests that with more frequent participation in
self-care activities, their perceived importance rises, and vice versa. It makes
sense that individuals participate in activities they value. For example, Garfield
and Kurtz (1976) discuss psychotherapists' beliefs in the importance of per-
sonal therapy, which influenced their decisions to enter treatment. Furthermore,
self-care frequency and importance were found to be significantly, positively
correlated with well-being, which is consistent with previous findings (Lustyk
et al., 2004; Schnauzer, 2006; Valente & Marotta, 2005; Wong et al., 2006).
Self-awareness was found to be significantly, positively correlated with
self-care importance but not frequency. This indicates that self-awareness may
not be necessary to participation in self-care activities; however, awareness of
the importance of these behaviors is key. Because self-awareness is described
as "knowledge about the self," (Brown & Ryan, 2003, p. 823), it would seem
probable that self-awareness would enable an individual to understand what
may be important, including activities to better oneself

CONCLUSIONS

Mental health professionals' frequency of participation in and views of the

importance of self-care activities have been found to be significantly associated
with their general well-being. In attempting to understand how self-care affects
well-being, it was found that mindfulness (awareness of and attention to self
and surroundings) indirectly influences the relationship between self-care
importance and well-being but not the relationship between self-care frequency
and well-being. This study also examined the role of self-awareness
Richards, Campenni, and Muse-Burke / SELF-CARE AND WELL-BEING 261

(knowledge of one's thoughts, emotions, and behaviors) in the relationship

between self-care and well-being. Although no significant effects were found to
explain self-awareness as an intervening variable in that relationship, it was
found to be significantly associated with self-care importanee and well-being.
Limitations and Future Research. This study had several limitations. First,
the sample may have limited the findings. Because the surveys were mailed,
those who returned them were self-selected. Any differences between individ-
uals who returned surveys and those who did not could not be examined.
Social desirability may also have limited this research. Because mental health
professionals help their clients increase general well-being, they may have been
compelled to positively bias their reports of participation in self-care activities
and overall Wellness. Determining what an individual believes to be "'socially
desirable' depends on one's reference group" (Kirkpatrick, 1993, p. 266). This
suggests that what some mental health professionals consider socially desirable
may not be considered socially desirable by other groups. Therefore, it may be
appropriate for future research to explore social desirability.
Moreover, most of the sample were White women. This limits the generaliz-
ability of the results to that group. Page and eoUeagues (1997) suggest that men
and women experience self-awareness differently, which may also affect the
generalizability of the findings. Future research should therefore expand the
sample to a more diverse group.
The sample has other limitations. For instance, participants reported working
within a variety of settings, but there were too few participants in each job set-
ting for the groups to be compared. The type of work setting may have signif-
icantly infiuenced reports of engagement in and value of self-care, but differ-
ences could not be assessed. Additionally, participants were graduate students,
professionals, or both, but were not asked to specify their professional level.
Their status may also significantly impact the reports of engagement in and
value of self-care. Thus, it may be important for future research to explore how
work setting and student/professional status may relate to self-care.
Implications for Counseling Practice. The results indicate that the frequency
with which mental health professionals participate in self-care activities and the
importance they place on them is associated with overall well-being, which
suggests that self-care is important to the functioning of mental health profes-
sionals. Indirectly mindfulness also affeets the relationship between self-care
importance and well-being, which suggests that one who perceives self-care as
important will receive the benefits of well-being after first achieving mindful-
ness. However, mindfulness may not be necessary for mental health profession-
als to achieve the benefits of actively participating in self-eare.
Counselors are responsible for their own Wellness and awareness of the
effects they may have on their elients (ACA, 2005; AMHCA, 2010). Since they
may be susceptible to impairment in their professional lives that has a negative
262 JOURNAL OF MENTAL HEALTH COUNSELING

impact on their clinical work (e.g.. Coster & Schwebel, 1997), it is important
for them to adhere to pracdces to enhance overall well-being. Counselors who
wish to maintain and improve their personal Wellness as well as their profes-
sional effecdveness are encouraged to explore their frequency of involvement
with and perceptions of the importance of self-care. They are also encouraged
to examine their state of mindfulness, which may further enhance their well-
being. Like the programs developed by Christopher et al. (2006) and Schure et
al. (2008), counselor training programs should explore the utility of developing
self-care and Wellness activides for their students within the curriculum. If self-
care pracdces become part of their training, counselors may be more likely to
participate and find the value in self-care.

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