JMIR RESEARCH PROTOCOLS Li et al

Protocol

The Relationship Between Self-Compassion and Resilience in

the General Population: Protocol for a Systematic Review and
Meta-Analysis

Xinyi Li1,2, BSc; Melina Aikaterini Malli2*, PhD; Theodore D Cosco3*, PhD; Guangyu Zhou1*, PhD
1
School of Psychological and Cognitive Sciences, Beijing Key Laboratory of Behavior and Mental Health, Peking University, Beijing, China
2
Oxford Institute of Population Ageing, University of Oxford, Oxford, United Kingdom
3
Department of Gerontology, Simon Fraser University, Vancouver, BC, Canada
*
these authors contributed equally

Corresponding Author:
Melina Aikaterini Malli, PhD
Oxford Institute of Population Ageing
University of Oxford
66 Banbury Road Oxford
Oxford, OX2 6PR
United Kingdom
Phone: 44 1865 612800
Email: [Link]@[Link]

Abstract
Background: Resilience can protect individuals from the negative impact of adversity, facilitating a swift recovery. The
exploration of protective factors contributing to resilience has been a central focus of research. Self-compassion, a positive
psychological construct that involves treating oneself with kindness, holds the potential to bolster resilience. Although several
studies have indicated an association between self-compassion and resilience, there is a lack of systematic reviews and meta-analyses
examining this relationship and the potential moderators and mechanisms.
Objective: This study aimed to systematically review the literature on the relationship between self-compassion and resilience
in the general population, perform a meta-analysis to quantify the effect size of their association, and explore potential moderators
(eg, age, gender, culture, and health status) and mediators.
Methods: We will search the Web of Science, PsycINFO, MEDLINE, Scopus, CINAHL, and CNKI databases for peer-reviewed
studies (including observational and experimental studies) that examined the relationship between self-compassion and resilience,
with no language restrictions. There are no restrictions regarding participants’ age, gender, culture, or health status. Qualitative
studies, conference abstracts, review articles, case reports, and editorials will be excluded. Two reviewers (XL and JH) will
independently screen the literature, extract data, and assess the quality of the eligible studies. If possible, the pooled effect size
between self-compassion and resilience will be meta-analyzed using a random-effect model. Meta-regression and subgroup
analysis will be conducted to examine the moderating roles of age, gender, culture, health status, and other potential moderators.
The characteristics and main findings of eligible studies will be summarized in tables and narrative descriptions. Results from
the meta-analysis, meta-regression, and subgroup analysis will be presented quantitatively.
Results: We registered our protocol with PROSPERO, conducted the search, and initiated the screening in April 2024. We
expect to start data analysis in October 2024 and finalize the review by March 2025.
Conclusions: The systematic review and meta-analysis will provide evidence on the protective role of self-compassion in
resilience under adversity. Our investigation into potential moderators will highlight the contexts and groups where the benefits
of self-compassion can be maximized. The findings are expected to provide valuable insights for health care professionals and
stakeholders, informing the development of interventions aimed at enhancing resilience by fostering self-compassion.
Trial Registration: PROSPERO CRD42024534390; [Link]
International Registered Report Identifier (IRRID): PRR1-10.2196/60154

(JMIR Res Protoc 2024;13:e60154) doi: 10.2196/60154

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KEYWORDS
self-compassion; resilience; resiliency; adversity; compassion; coping; coping styles; health status; meta-analysis; meta-regression

self-judgment, (2) common humanity versus isolation, and (3)

Introduction mindfulness versus over-identification. Self-kindness refers to
Background treating oneself with understanding, warmth, and kindness,
instead of judging oneself harshly. Common humanity involves
Individuals in the modern era face a multitude of adversities recognizing suffering as shared experiences in human beings,
that can negatively impact their mental well-being, physical rather than perceiving it as isolating and unique to oneself.
health, and social functioning [1-4]. Such adverse life events Mindfulness involves developing an awareness of one’s pain
may contribute to the development of stress-related disorders, and approaching it with a balanced perspective, thereby avoiding
including anxiety, depression, and posttraumatic stress disorders excessive immersion in or over-identification with negative
[5], and can increase the risk of substance use, eating disorders, emotions or experiences. Higher levels of self-kindness,
and internet addiction [6]. In addition, prolonged activation of common humanity, and mindfulness, and reduced levels of
the stress response system due to adversity can increase the risk self-judgment, isolation, and over-identification, jointly
of cardiovascular diseases [7]. However, not all individuals contribute to a self-compassionate state of mind.
experiencing adversity exhibit negative outcomes. Some
individuals possess the capacity to maintain their health or Self-compassion has been proposed to be a potential resilience
recover swiftly when confronted with adversity, effectively factor in light of its positive roles in promoting mental health
demonstrating resilience in such challenging circumstances. and aiding in the management of stressful situations [19].
Promoting resilience is vital to prevent stress-related disorders Research indicates that self-compassion is positively correlated
by prioritizing the cultivation of personal strengths [5]. This with psychological well-being and the use of adaptive coping
approach can benefit individuals across different age groups; strategies [20,21] while being negatively associated with
for instance, it can help prevent children and adolescents from detrimental symptoms, such as rumination, stress, depression,
internalizing problems amid interpersonal tensions and academic and anxiety [22]. Furthermore, self-compassion appears to be
pressures [8,9], as well as mitigate work-related burnout in particularly beneficial during stressful events [23,24]. Evidence
adults [10,11]. Therefore, enhancing resilience could be a suggests that self-compassion could buffer the impact of
promising strategy to combat stress-related disorders and perceived stress on depression, anxiety, and negative affect up
facilitate well-being despite pervasive stressors. to 6 months later [25], and reduce the negative effect of poor
physical health on psychological health [23]. Collectively, these
Resilience can be conceptualized and operationalized in various findings indicate that self-compassion could possibly promote
ways, with no consensus yet reached among researchers. A total resilience under stressful life events.
of 3 common approaches are applied to define resilience,
including the trait-oriented, process-oriented, and Preliminary evidence has supported this claim by demonstrating
outcome-oriented perspectives [12,13]. Resilience can be positive correlations between self-compassion and resilience in
defined as a stable trait or ability to recover from adversity; as various populations, including adolescents, college students,
a dynamic process during which an individual deploys internal and adults [26-28]. Moreover, Gilbert’s [29] affect-regulation
and external resources to maintain well-being in adversity; or model could offer an evolutionary perspective to understand
as adaptive outcomes despite adversity, such as maintained the role of self-compassion as a protective resilience factor.
psychological well-being and the absence of psychopathology. According to this model, self-compassion originates from the
Accordingly, as a trait, resilience can be measured using safeness system, an evolved mechanism that fosters affiliative
psychometric scales [14]; as a process, it could be modeled as affects and a sense of calmness. The safeness system has the
an adaptive trajectory following adversity [15]; and as outcomes, capacity to downregulate the threat system, which is
it could be evaluated through measures of mental or physical hypothesized to activate in potentially threatening situations
health accounting for stressor loads [5]. To accommodate and elicit arousal responses [29,30]. Gilbert’s [29] theory
various approaches, we define resilient individuals as those suggests that self-compassion could mitigate threat-related
possessing the capacity to leverage personal, social, and reactions and induce soothing feelings in stressful situations,
environmental resources to cope with stressors, thereby thereby promoting resilient adaptation and recovery from
facilitating adaptive responses and health outcomes during and adversity.
after adversity [5,13]. Potential pathways through which self-compassion is linked to
Since the inception of resilience research, considerable attention resilience may involve emotion regulation and stress coping
has been devoted to identifying protective factors that may [20,31]. First, self-compassion has been shown to reduce
enhance resilience. One such potential protective factor is negative emotions and enhance positive emotions [21],
self-compassion [16]. Self-compassion refers to treating oneself indicating its potential effectiveness as an emotion regulation
with warmth and kindness in the face of failures, personal strategy. A systematic review identified emotion regulation as
inadequacies, or adversities [17]. According to the a mechanism through which self-compassion contributes to
self-compassion framework developed by Neff [18], mental health [31]. Second, as suggested in Gilbert’s [29] model,
self-compassion contains six components distributed across self-compassion may mitigate stress-related reactions, and
three dimensions, which are (1) self-kindness versus promote adaptive coping strategies [20,29]. Biological evidence

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also suggested that self-compassion could reduce stress-related Objectives

reactions, as indicated by lower levels of salivary alpha-amylase The primary aim of the systematic review and meta-analysis is
[32], reduced daily cortisol levels, and baseline inflammation to investigate the relationship between self-compassion and
[33,34]. resilience. The relationship between 6 components of
The association between self-compassion and resilience may self-compassion (ie, self-kindness, self-judgment, common
differ across different demographic groups, taking into account humanity, isolation, mindfulness, and over-identification) and
characteristics such as age, gender, culture, and health status. resilience, and self-compassion and resilience measured with
Some evidence suggests that self-compassion has a more different methods (eg, measured using scales or as health
pronounced effect on well-being as individuals age [35], is more outcomes related to the stressor), will also be investigated. The
effective in reducing rumination in adult women compared with secondary aim is to explore the moderating effects of age,
men [36], and has a greater impact on psychological health in gender, culture, and health status in the relationship between
adults with poorer health status [23]. In addition, a cross-cultural self-compassion and resilience, along with other potential
study found that self-compassion was a stronger predictor of moderators. Finally, the potential mechanisms between
life satisfaction in Taiwan than in Thailand, indicating a self-compassion and resilience will be investigated.
moderating role of cultural backgrounds such as Confucianism
and Buddhism [37]. Methods
To date, one scoping review has provided an initial overview Design and Registration
of the association between self-compassion and resilience in
The protocol was developed following the PRISMA-P (Preferred
work situations [19]. However, the nonsystematic nature of the
Reporting Systematic Review and Meta-Analysis Protocols)
search, the practice-oriented focus, and the specific context of
guidelines [40] and the standardized Joanna Briggs Institute
this review have limited its ability to comprehensively
approach for conducting systematic reviews of association [41].
investigate the evidence. It is also crucial to extend this
The checklist for PRISMA-P can be found in Multimedia
investigation to other populations, such as emerging adults and
Appendix 1. A brief version of this protocol was preregistered
the retired population, due to the unique challenges they face
in the International Prospective Register of Systematic Reviews
[19,38]. Furthermore, despite the existence of meta-analyses
(PROSPERO; protocol ID: CRD42024534390).
assessing the link between self-compassion and well-being or
psychopathology [21,39], there is still a lack of quantitative Ethical Considerations
synthesis on the effect size between self-compassion and This study is a systematic review and meta-analysis based on
resilience. In addition, the specific associations between different secondary analysis of publicly available data from previously
components of self-compassion and resilience have not been published studies. No new data collection or direct interaction
systematically explored. Such an analysis is essential to with human participants will be involved. Therefore, ethical
determine the inclusion of self-compassion in approval will not be required for this study.
resilience-enhancing interventions and to identify which
components of self-compassion should be targeted. Finally, Eligibility Criteria
there is limited knowledge about how this relationship may vary We developed the inclusion and exclusion criteria following
across different subgroups, such as those defined by age, gender, the PEO (Population, Exposure of interest, and Outcome)
culture, and health status. Addressing this gap could help framework [41], which is applicable in reviews addressing
identify which groups are most likely to benefit from associations between variables. Inclusion and exclusion criteria
self-compassion, thereby informing the design of more targeted are summarized in Textbox 1.
and effective interventions.

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Textbox 1. Inclusion and exclusion criteria.

Inclusion criteria

• Study types

• Peer-reviewed empirical studies using quantitative methods and full texts that explore the association between self-compassion and resilience

• Population

• General population

• Exposure

• Self-compassion assessed using validated scales

• Outcome

• Resilience measured using validated scales, and self-compassion measured as a moderator between a stressor and health outcomes, or other
validated measurements

• Resilience explicitly stated as the study focus or framework

Exclusion criteria

• Study types

• Qualitative studies, conference abstracts, review articles, case reports, and editorials

• Population

• Nonhuman subjects

• Exposure

• Studies without a validated measure of self-compassion; studies measuring compassion as a broad concept rather than focusing specifically
on self-compassion

• Outcome

• Studies with no validated measurements of resilience

• Studies that do not explicitly state resilience as the primary focus or framework

short version [42], or youth version [43], and may include

Type of Studies measurements of its components (eg, self-kindness,
Only peer-reviewed empirical studies using quantitative methods self-judgment, common humanity, isolation, mindfulness, and
will be included. The study designs will cover observational over-identification). Experimental studies manipulating levels
studies (eg, cross-sectional surveys and longitudinal studies) of self-compassion should include manipulation checks using
that investigated the relationship between self-compassion and validated scales, such as the State Self-Compassion Scale [44].
resilience, and experimental studies involving the manipulation Randomized controlled trials (RCTs) will be eligible for
of self-compassion levels. Experimental studies will be inclusion if the interventions are specifically designed to target
synthesized separately to examine the causal relationship self-compassion, such as the Mindful Self-Compassion
between self-compassion and resilience. Qualitative studies, intervention [45]. For studies in which compassion is a key
conference abstracts, review articles, case reports, and editorials variable, data specifically relating to compassion directed toward
will be excluded. No restrictions will be applied regarding the oneself, or self-compassion, should be reported. For instance,
language of the studies. if the Compassionate Engagement and Action Scales [46,47]
were used, the study should include data on the self-compassion
Population
subscale. Studies that discuss compassion solely as a broad
We will explore the general population, including individuals concept without a focus on self-compassion will be excluded.
of different ages (including children, adolescents, youth, and
adults), genders, cultures, and health statuses. Studies involving Outcome
nonhuman subjects will be excluded. This review will focus on resilience as the primary outcome.
We will not limit the definitions or measurements of resilience
Exposure of Interest
and will include studies explicitly indicating resilience as a
The exposure of interest in this study is self-compassion. The study focus and using validated measurements to assess
eligible studies should adopt a validated measure of resilience, such as using resilience scales (eg, the
self-compassion, such as the Self-Compassion Scale [18], its
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Connor-Davison Resilience Scale [47], the Resilience Scale for confounders), outcome (measurement of resilience and its
Adults [48], Resilience Scale [49], and the Brief Resilience Cronbach α, definition, and domain of resilience), main findings,
Scale [14]). It is noteworthy that 1 common method to assess and potential moderators and mediators. In addition, if the
resilience is to examine health outcomes related to specific literature reported an RCT study, the intervention type, timing,
stressful events or stressor loads [12,15]. In this context, the and duration will be extracted. If there are missing data
role of self-compassion in promoting resilience may be observed necessary for effect size calculation or quality assessment, the
through its moderating effect on the adverse effect of stressful authors will be contacted up to 3 times within a month to request
events on health outcomes, even if resilience is not directly the information.
measured. We will include studies that use this approach to
measure self-compassion as a resilience factor but will exclude
Risk of Bias Assessment
those that apply this approach without explicitly focusing on The risk of bias of all individual studies and overall evidence
resilience. will be assessed independently by 2 reviewers (XL and HX).
Cohen κ will be calculated to evaluate the interrater reliability.
Search Strategy Any discrepancy will be addressed through discussions between
We will perform a systematic literature search in electronic 2 reviewers and consultation from a senior reviewer (GZ).
databases, including Web of Science Core Collection (Clarivate), Standardized critical appraisal checklists developed by the
PsycINFO (Ovid), MEDLINE (Ovid), Scopus, CINAHL Joanna Briggs Institute will be applied to evaluate the
(EBSCO), CNKI (Chinese database). No filters will be used methodological quality of each study [50]. Different checklists
during the search stage. Search strings will encompass 2 will be adopted based on study design, covering observational
categories, which are (1) self-compassion, and (2) resilience. study (ie, cross-sectional and longitudinal study),
For self-compassion, the search terms could be quasi-experimental study, experimental study, or RCT study.
“self-compassion* OR (compassion near/5 (self OR oneself)).” The appraisal of observational studies will take into account
For resilience, the search terms could be “resilient*.” The selection bias, information bias, and confounding, while the
Boolean operator “AND” will be applied between (1) and (2). appraisal of experimental or quasi-experimental studies will
The detailed search strategies can be found in Multimedia consider selection bias, performance bias, attrition bias,
Appendix 2. Furthermore, we will complement the search by detection bias, and reporting bias [51]. The quality of each study
screening similar articles (eg, those recommended by PubMed) will be rated as high, low, or unclear in each domain. Exclusion
and using backward- and forward-chain searching using the top will not be implemented based on study quality, but the appraisal
10 relevant studies to identify any overlooked literature. outcome will be incorporated in the sensitivity analysis (by
omitting studies rated as high risk of bias) to assess the influence
Screening Procedure of risk of bias on results.
Abstract and title screening and full-text screening will be
conducted in Covidence, which is a web-based systematic The overall publication bias of evidence in the systematic review
review tool. All search results will be imported into Covidence will be assessed by drawing a funnel plot and conducting
and deduplicated automatically. The titles and abstracts will be sensitivity analyses using publication bias tests if there are at
screened independently by 2 reviewers (XL and JH) to evaluate least 10 studies [52,53]. If the publication bias is identified, the
their initial eligibility. The full text of a publication will be trim-and-fill method will be used to compensate for it [54].
retrieved if at least 1 of the reviewers deems it potentially The overall certainty of evidence will be assessed using the
eligible. Following this, 2 reviewers will independently screen GRADE (Grading of Recommendation Assessment,
the full text according to the eligibility criteria and note down Development and Evaluation) [55]. The GRADE assesses the
the exclusion reasons. Any disagreement in the screening overall certainty of evidence using 5 indices: risk of bias,
process will be resolved through discussions between 2 inconsistency, indirectness, imprecision, and publication bias
reviewers, and consultation from a senior researcher (GZ). [55]. The quality of the evidence will be categorized into 4
Cohen κ will be calculated to assess the consistency between degrees: high, moderate, low, or very low.
the 2 reviewers. A flowchart will be drawn to demonstrate the
process of screening according to PRISMA [40]. Data Synthesis
First, a narrative synthesis will be reported, showing study
Data Extraction characteristics, such as year of publication, country, participants
A total of 2 reviewers (XL and HX) will independently extract and sample size, and study design. Studies with similar study
information from the eligible literature in Covidence using a designs and measurement of the outcome (ie, resilience) will
standardized information extraction form. The form will be be grouped together and summarized in tables. The potential
developed following the PRISMA guideline and revised by moderators and mechanisms between self-compassion and
piloting on the first few literature. The extracted information resilience will be summarized narratively.
will include study characteristics (ie, author and year, title,
journal, country, study design, and relevant study aim), A meta-analysis will be conducted on relatively homogeneous
population information (ie, demographic information, health studies stratified by study designs and measures (eg, by using
status, age range, and mean, and gender proportion), exposure scales or calculating moderating effects), if there are at least 5
of interest (ie, measurement of self-compassion and its Cronbach studies in each analysis [56]. We will assess the heterogeneity
α, unadjusted and adjusted effect size, CI and P value, and of studies in each analysis using I2 statistic, with a value of
larger than 75% indicating a considerable heterogeneity [57].
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Due to the broad populations that are eligible for inclusion, examine the association between self-compassion (overall and
heterogeneity is assumed to exist. Therefore, to account for its components) and resilience in the general population. In
between-study variance, we will apply a random-effect addition, it aims to explore the moderating influences of age,
meta-analysis to calculate the pooled effect sizes (ie, correlation gender, cultural background, and health status, as well as
coefficients for observational studies, and Cohen d for potential mediators in this relationship. Given the established
experimental studies) between self-compassion and resilience. role of self-compassion in coping with adversity, we anticipate
The average connection between each component of finding a positive association between self-compassion and
self-compassion and resilience will also be calculated for studies resilience, along with insights into the relevant moderators and
providing necessary data. The Cronbach α will be used to correct mediators.
the effect sizes, accounting for measurement unreliability. A
Enhancing resilience in the general population is crucial for
forest plot will be drawn to illustrate the confidence interval of
maintaining psychological and physical well-being amidst
the relationship of interest in each study.
diverse stressors and adversities [61,62]. Resilience-focused
Furthermore, subgroup analyses and meta-regression will be interventions targeting children and adolescents have been
conducted to identify potential moderators in this relationship effective in reducing internalizing symptoms, such as anxiety
and to address heterogeneity in the evidence. Subgroup analyses and depressive symptoms [8]. By strengthening their ability to
will be stratified by age groups (adolescents, young adults, and cope with adversity, such as experiences of maltreatment, these
older adults), gender (women vs men), cultural backgrounds interventions can help reduce the intergenerational transmission
(eg, cultures influenced by Buddhism vs Confucianism; Western of depression and provide long-term benefits throughout their
vs Eastern cultures), and health status (clinical vs nonclinical lives [63]. Similarly, enhancing resilience in older adults has
populations). In addition, we will compare effect sizes across pronounced effects in promoting successful aging, longevity,
studies with different study designs and varying methodological and reducing depression [64].
quality. A meta-regression will be used to further investigate
Although there are valuable studies aiming to address the
potential moderators, including age, gender proportion, culture,
associations between adversity, or risk factors and resilience
health status, and risk of bias. As for the potential mediators, if
[65,66], identifying modifiable resilience factors like
there are multiple studies investigating the same mediator, we
self-compassion and understanding the underlying mechanisms
will use the meta-analytical structural equation modeling method
could offer insights into preventing stress-related disorders in
to synthesize the mediation effect quantitatively [58]. All the
challenging situations before they develop. Considering the
statistical analyses will be conducted in R (R Core Team, version
conducive role of self-compassion on well-being, coping, and
4.2.0), using packages such as metaphor [59] or meta [60].
reducing psychopathological symptoms in adversity, it could
We will document the search and screening process using the be a protective factor to promote resilience [16,20].
PRISMA flowchart and present the characteristics and main
To date, although there is one scoping review exploring their
findings of eligible studies through tables and narrative
relationship in work contexts [19] and a chapter providing a
descriptions. The results obtained from meta-analysis,
narrative overview of this relationship [53,67], a systematic and
meta-regression, and subgroup analysis will be reported in a
quantitative examination of this association has not yet been
quantitative manner.
conducted. The absence of such a synthesis could lead to
insufficient evidence supporting the targeted use of
Results self-compassion as an intervention for enhancing resilience, as
We registered our protocol with PROSPERO, conducted the well as an unclear understanding of its potency and the specific
search, and initiated the screening in April 2024. We expect to roles of its components. Specifically, discerning which
start data analysis in October 2024 and finalize the review by component has a stronger connection with resilience and in
March 2025. which group the benefits of self-compassion are more
pronounced could inform the design of targeted interventions,
Discussion maximizing effectiveness and efficiency. The findings of this
systematic review and meta-analysis will be applied in practice
To the best of our knowledge, this study will be the first by disseminating results and insights on intervention design to
systematic review and meta-analysis to comprehensively health care professionals and stakeholders.

Acknowledgments
We would like to express our gratitude to Carolyn Smith, an outreach librarian from the University of Oxford, for her assistance
with the search strategies, inclusion and exclusion criteria. XL would like to express appreciation for the scholarship and support
provided by the Institute of Population Research and Office of International Relations at Peking University, for the exchange
program with the University of Oxford.

Data Availability
The datasets generated and analyzed during the systematic review and meta-analysis will be available in the Open Science
Framework repository.

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Authors' Contributions
XL, the guarantor of the study, conceived the study idea and design and drafted the protocol. MAM, TDC, and GZ contributed
to the critical revision of the draft. All authors contributed to developing the eligibility criteria, search terms, strategies for
information extraction, and data analysis. All authors have read and approved the protocol before submission.

Conflicts of Interest
None declared.

Multimedia Appendix 1
PRISMA-P (Preferred Reporting Systematic Review and Meta-Analysis Protocols) checklist.
[DOCX File , 28 KB-Multimedia Appendix 1]

Multimedia Appendix 2
Search strategies for electronic databases.
[DOCX File , 16 KB-Multimedia Appendix 2]

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Abbreviations
PEO: Population, Exposure of interest, and Outcome
PRISMA: Preferred Reporting Systematic Review and Meta-Analysis
PRISMA-P: Preferred Reporting Systematic Review and Meta-Analysis Protocols
RCT: randomized controlled trial
GRADE: Grading of Recommendation Assessment, Development and Evaluation

Edited by T Leung; submitted 03.05.24; peer-reviewed by W Collinge, NE Fares-Otero; comments to author 17.07.24; revised version
received 20.09.24; accepted 29.10.24; published 05.12.24
Please cite as:
Li X, Malli MA, Cosco TD, Zhou G
The Relationship Between Self-Compassion and Resilience in the General Population: Protocol for a Systematic Review and
Meta-Analysis
JMIR Res Protoc 2024;13:e60154
URL: [Link]
doi: 10.2196/60154
PMID:

©Xinyi Li, Melina Aikaterini Malli, Theodore D Cosco, Guangyu Zhou. Originally published in JMIR Research Protocols
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reproduction in any medium, provided the original work, first published in JMIR Research Protocols, is properly cited. The
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