LRT is a three-hour course consisting of introduction, mutual counseling, active listening training and wrap up. Each module has its goals (see Table 1 for details). In the mutual counseling session, participants share their difficulties based on a theme provided by LRT staff. One example of a theme would be “What would you do if your depressed friend sent you an e-mail at two a.m.?” Participants discuss how they would react in such situations, what kind of words they would choose to talk to the person, etc. Discussions are recorded and used as a resource for promoting Light Ring’s activities. During the active listening training sessions, participants learn seven listening skills (line of vision, posture, voice, back-channel feedback, repetition, summarizing and questioning) through role-play. Participants rotate between the roles of listener, speaker, and observer during the session. Every time one role-play finishes, the observer gives feedback to the other two roles. The degree of attain-

ment is checked using a list of listening skills (Table 2). Approximately 20 people participate in each LRT. The program is held every other month and is supervised by a coaching professional. Staffs of Light Ring advertise LRT through media advertisements (television programs), webpages, Twitter, Facebook, and e-mails sent to past participants.

Participants who joined LRT were recruited through media advertisements, Twitter, and e-mails sent to past participants of LRT. To be eligible, participants had to be over 18 years old, fluent in Japanese and have participated in LRT. Although achieving saturation was not a criteria used to establish the sample size, saturation was

observed during analysis through the consistency and redundancy of information during the interviews [18] . Exclusion criteria, evaluated by a psychiatric social worker, were the presence of significant psychopathological symptoms that would make participation in the study potentially hazardous for the participant.

We followed the ethical guideline published by Japanese Association of Industrial Counseling [19] . The first author acted as the independent evaluator and did not participate in the intervention development or delivery. Data collection occurred between July 2012 and April 2014. Participants were informed about the purpose of the study and were asked to participate in post-program interviews. More details were sent via e-mail to those that agreed to participate. The e-mail included assurances that participation was voluntary, confidential, and that responses would not be linked to respondents’ identities. Participants were informed that they could refuse or discontinue participation in the study any time. Informed consent was sought when the e-mail was returned. AI conducted semi-structured interviews either immediately after the program or a week later. Interviews were conducted where privacy was assured including a café. The questions were, “How many times have you participated in LRT?” “Are you supporting someone now?” “What did you expect to gain from this program?” “How satisfied are you with the program? Could you explain the reason?” and “Has anything changed since you participated in the program? If so, could you explain the change in detail?” Instead of tape-recording the interviews, the interviewer wrote detailed memos immediately after the interviews concluded. Questions were generated based on psychological measurements [20] [21] . Interviews took at most 90 min to complete. Although such situation never happened, AI had contacts with a professional counselor or other medical professionals in case of anything unexpected happened to the study participants during or after the interviews.

Content analysis was utilized to interpret the data [22] and participants’ reasons for enrolling in and perceived learning from LRT were extracted. Two researchers (MK and MF) developed mutually agreed coding strategies for each theme. Responses were coded individually by both interviewers and then reviewed jointly. Consensus on coding differences was reached through discussion. We adopted case studies to observe the relationships among the themes.

Out of 128 participants of LRT, 59 people declined to participate along the way. Narratives were collected from 69 participants. A total of 36 males (52.2%) and 33 females (47.8%) participated in this study. All participants were in their 20 s or 30 s. Among the participants, 34 (49.3%) were employed, 18 (26.1%) were students, 8 (11.6%) were counselors, 4 (5.8%) were other and 5 (7.2%) were unknown. Welfare-related workers, psychiatric counselors, lawyers, and nurses were categorized as counselors. All participants could communicate in Japanese. Participants who were currently supporting, who had supported before, or who were willing to support but had no particular experience in supporting others, were interviewed. Those who already had someone to support were supporting their boy/girlfriends or anyone that goes together.

Purposes of joining LRT were reported to be meeting new peers, gaining new techniques for supporting others, relaxing through meeting peers, or assuring their competence to support others. Some said that they joined because they were interested in the organization itself. Most participants seemed that they had already registered for LRT before they joined LRT (no data), while at least one participant joined without registration.

Participants wished to meet new peers and gather information on where they might be able to meet more peers. Participants’ defined a peer as someone with whom they could share their worries and talk about their experiences with for a long period.

Other than the hope of acquiring long-lasting friendships, participants expected to encounter one-time friendship at LRT. Participants expected to gain new techniques for supporting others, relax through meeting peers, and assure their competence to support others through discussions with those who have experience in these fields or strong interest in supporting others.

Participants who were interested in the organization itself were those who were looking for a place to work or were supervisors of Light Ring. Not everyone that was interested in Light Ring itself began work for the organization afterwards.

After joining LRT, participants felt they gained new techniques for supporting others, relaxed through meeting peers, assured their competence to support others, acquired new peers, reflected on their own condition, and gained self-confidence and increased motivation. Reflecting on their own conditions and assuring their competence to support others seemed to have a big impact on the participants, as indicated by the high frequency of the code. Participants reported that it was helpful to receive feedback, and to be told what they can do as well as what they need to learn.

Here we present two case studies to help illustrate the relationship among the concepts. We also show examples of the concepts extracted above.

H.E. (male in his 20s).

H.E. was supporting his girlfriend who had been depressed. He felt he was not competent enough to support her effectively because he lacked stability (“I need assistance because I also am easy to be emotionally dragged.”) and he was not confident of his supporting technique (“I think I need to let her air out her feelings but I don’t know how.” “When she is so depressed that she doesn’t say a word, I have no idea how I can communicate with her.”) His purposes of joining LRT were to gain new techniques for support, as well as to meet peers so that he could share his concerns with them. In LRT, he exchanged ideas with others and learned through counseling and active listening, as well as self-care. He started to distinguish being a supporter from simply being himself and engaging in daily activities.

S.S. (male in his 20s).

S.S. had been supporting depressed people through social network services and face-to-face meetings. When talking with his clients, he tried to be easy to talk to (“I say ‘yahho-’ (‘hello’ in spoken language in Japanese) often.”), to share his painful experiences (“I also have experience of being bullied in school. You seem to be highly anxious, too. Are you okay?”), to rest enough when supporting others (“I do not talk to them [his clients] when I am not in good condition. If I do, then I am afraid I might accuse them. The frequency of interviews depends on my physical capacity and timing.”) and to have the client engage as much as he/she could do. However, he felt that he might not have the answers his clients were searching for due to a lack of knowledge and/or com- mon sense. Through his LRT participation, he gained confidence after receiving positive reactions from others at his age. Learning about self-caring techniques made him want to learn more about this field. Participation in the interviews also gave him the chance to reflect on his abilities and to confirm his competences.