Enhancing resilience, coping and self-talk of employees in large organisations; the development and mixed methods piloting of an online mental health and well-being toolkit

Connor–Davidson resilience scale (CD-RISC; Connor and Davidson, 2003).

This is a 25 item self-report scale which assesses resilience. As well as providing an overall score, it includes subscales relating to; hardiness, coping, adaptability/flexibility, meaningfulness/purpose, optimism, regulation of emotion and cognition and self-efficacy. Each item is rated on a five-point Likert scale (0–4) to indicate how much a particular statement, for example, “I like challenges” applies over the last month. If the situation has not occurred, then participants answer based on how they think they may have felt. The total score ranges from 0 to 100, with a higher score reflecting greater resilience. The scale has strong psychometric properties in terms of internal consistency (α = 0.89), test-retest reliability and convergent validity (Connor and Davidson, 2003).

Depression anxiety stress scale 21 (DASS-21; Lovibond and Lovibond, 1995).

This is a 21-item self-report measure of depression, anxiety and stress. Each subscale consists of seven items. Participants read each item, for example, “I felt down-hearted and blue”, and respond using a four-point Likert scale to indicate how much the statement applies to them over the past week. The scale has good internal consistency (Total scale α = 0.93; Depression =0.88; Anxiety =0.82; Stress =0.90; Henry and Crawford, 2005), adequate item-scale convergence (Sinclair et al., 2012) and construct validity (Henry and Crawford, 2005).

Coping self-efficacy scale (CSE; Chesney et al., 2006).

This is a 26-item measure of self-perceived ability to cope when faced with threats and challenges. Participants are asked how confident they are that they can cope with the challenges presented in 26 statements, for example, “When things aren’t going well for you, how confident are you that you can - talk positively to yourself”. Items are scored on an 11-point Likert scale (0–10). It has good internal consistency (α = 0.73–0.84; Mahmoudi et al., 2015) and strong test–retest reliability (Chesney et al., 2006).

Warwick-Edinburgh mental well-being scale (WEMWBS; Tennant et al., 2007).

This is a 14-item self-report scale of mental well-being including positive affect, functioning and interpersonal relationships. Participants respond to each item, for example, “I’ve been feeling useful”, using a five-point Likert scale to indicate how much the statement applies to their experience over the past two weeks. The WEMWBS has good content validity, internal consistency (α = 0.91) and test-retest reliability at one week follow up (ICC = 0.83).

Positive effect on well-being.

The “Positive Effect on Well-being” theme highlighted several facets that were deemed beneficial. The subtheme, “Building Resilience”, refers to participants’ ability to adapt to challenges and demonstrates how the intervention improved their ability to cope, “[…] it’s obviously give me sort of permission to sort of stop and think” (Participant 1: P1). The application of the strategies changed participants’ level of self-care, “it’s OK to have that time and being my own best friend” (P1) and enabled them to feel more relaxed. A key phrase used was “I’m doing a good job” (P4), which supports the intervention’s use of encouragement to recognise their successes and strengths. Participants also explained that connecting to other people was another key factor in their well-being, which increased their self-knowledge and provided the motivation to seek out companionship to raise their mood; “The main thing that I uh, that it’s made me change in myself is trying to connect with people more often um, in a more meaningful way” (P4).

An important aspect of resilience is having the motivation to apply the appropriate strategy. The positive impact of this is illustrated by Participant 9 “I felt that I had coping mechanisms […] I could put measures in place to help me. So the sessions have most definitely helped me massively”. Participants described how the sessions boosted their motivation to apply the strategies which they already knew but did not use. The programme resulted in an increase in self-confidence and enabled them to “feel more assertive” (P4):

I guess I don’t question myself so much anymore […] I just feel more confident in why I wanted to say what I did or why I wanted to do what I did (P4).

Participant 6 linked managing their self-talk to being able to resist engaging, “[…] be more assertive because I’m staying away from the emotional engaging in the emotional elements”. This links with the “More able to manage emotions” theme and indicates how the themes are interlinked.

A number of participants mentioned that the programme improved their sleep, “I probably would have over-worried to the point of losing sleep […]. However, by doing some of the methodologies I didn’t […] the worry had kind of subsided” (P8). Participants applied the strategies at night to shift their focus away from worry and onto more beneficial factors:

I’m certainly sleeping better […] just being able to, to give names to things to know to when you’re laying there in at night, in bed, catastrophising and you’re thinking, actually, that’s what I’m doing (P4).

Several participants gave examples of the techniques they used and how this impacted their ability to manage their self-talk and emotions. Having a conscious awareness of what was happening enabled them to focus and not get caught up in emotional thoughts “Just having that mind and thinking, um, thinking logically about things, that’s, that’s been probably the most crucial for me” (P3). Participants used these techniques to target their critical self-talk and de-escalate specific emotions, “I think more positive. You know, sometimes I’m really impatient and I’m just using a tool and I think, you know, it’s OK” (P5). The strategies enabled participants to shift from an emotional response to a practical one:

[…] kind of taking something that is kind of playing on your mind and having some sort of action plan to deal with those things and then sort of like dealing with it […] (P6)

Consciously acknowledging their achievement created a twofold effect; firstly, the de-escalation was reinforced and, secondly, acknowledging their achievement lifts their mood and increases their confidence in their ability to cope.

Regarding the impact of the training, Participant 7 stated “I feel I’ve gained something and given myself a pat on the back and saying you know you’ve done amazing” demonstrating their ability to praise themselves for an achievement. The phrase “I am complimenting myself now” indicates that the programme elicited a positive change in their self-talk, which can be linked to well-being. Participant 10 also uses the strategies to refocus their thoughts on to the “good things that are happening”, “I have taken that further and have used the worry tree and think, well, we’ll park that now we can’t do anything with it”.

The subtheme “Able to recognise and challenge negative thoughts” draws on the CBT concept of automatic thoughts and how challenging these can have a positive impact on well-being. Participant 3 described how they reduced the power of negative thoughts through distraction techniques, “[…] as long as I was filling my mind with other things, whether that be family, friends, things I enjoyed it kind of kept it at bay”. Participants also recognised NATs (critical self-talk) in others, showing how the intervention changed their perception of their own and other’s self-talk. Despite being sceptical, participants challenged critical self-talk and reframed their thinking, “I have been batting off that poison parrot as well. How is this gonna work? How is this gonna work? But it does” (P7). This positive outlook, acknowledgement of their achievements and self-praise illustrate the significant impact the training has on their resilience, ability to cope and well-being.

Benefit of learning process.

The subtheme “Integrated New Strategies” highlights how participants integrated the information and strategies into their lives, “[…] going for a swim or you know being a bit more conscientious about having some downtime and spending time perhaps in the garden or relaxing” (P1). Participants also made changes to their everyday thinking, such as daily gratitude “I’ve started implementing the strategies, I’m thinking more I suppose as well every day about what I’m grateful for” (P9). The integration of strategies into participants’ regular routine indicates that the impact of the intervention is more likely to be sustained, “I’ve adapted them into my daily life really and use them accordingly. I’ve gone back to them so many times […] it’s helped amazingly” (P7). To achieve an impact it was essential that the strategies were transferable to the real world, a factor that has been effective, “I have definitely used them” (P2), “I think about many of them daily” (P2).

Several participants were already using some techniques, “A lot of what we talked about is probably stuff that I sort of do without realising it” (P3). This legitimised participants’ existing strategies and reinforced their continued use by underpinning them with research and also provided an understanding of why they worked, “Which were ones I was already using but didn’t know they had a terminology base behind them” (P8). This increase in conscious awareness was beneficial as the underpinning knowledge was validating and confidence building, “being more mindful of the fact I'm doing it has been the most important […] being a being a bit more self-aware about it as being the best part” (P3). Linking the strategies to participants’ personal experience helped to legitimise the programme as it corroborated its usefulness in the real world, “and you did actually feel well, actually, I’m actually doing these things so that reinforced what we were talking about” (P1).

Participants appreciated the in-depth explanation of cognitive and behavioural processes. This engaged participants in self-discovery and normalised and de-stigmatised their experience. The sharing of experiences had a compound effect within the group as it magnified the message that these thoughts and behaviours are normal, “[…] it was really nice to understand why our bodies react like they do. Why our mind reacts like it does and it helps. It normalizes it almost” (P4). Participant 9 expanded on this, stating that naming the things that they do made them realise that they are “not alone in all of this”, a realisation that was as they put it “that helps me massively”. Participants’ negative self-perception and critical self-talk had the potential to have a corrosive effect on their well-being and this change in their perspectives, through normalisation, could have a positive impact on their well-being.

Wider application of strategies.

This theme focuses on the range of contexts in which participants shared and applied the techniques, “I could filter in personally and in work and with the team and with everybody really. And I think anybody can sort of get that” (P1). The wide range of applications may have increased participants’ eagerness to share them, “I can encourage them to take part and myself really and my family” (P1), “I felt like kind of like share with the team immediately” (P6), “I’m telling everybody” (P7). To share the strategies, participants need confidence in their relevance and a clear understanding to be able to communicate them effectively. Participant 6 indicated that their depth of understanding enabled them to confidently explain the strategies to their colleagues and adapt it to their own needs:

Understanding the theory behind it as it helped me to explain it better. I guess to my guys and not only explaining it better, but then because I have understood it better. I’m able to adapt that as well.

The usefulness of the strategies extends from the individual to their interpersonal relationships, “I genuinely found it useful, useful for me personally, but also I think useful for my relationship with my team and helping them with their resilience” (P2). This dissemination means that the intervention will achieve a wider impact beyond the study participants. Interestingly, participants shared the information through everyday interactions rather than formally, “I’ve not sat down and gone ‘right, we’re doing this for resilience, but just little, little things like I mentioned about bringing them back into the now […]” (P2). This everyday use is likely to reinforce the techniques as they become integrated into participant’s behaviour. The positive perspective of the programme is further supported by the participant’s recommendation of the programme to others, as both organisations enrolled more staff onto the programme, “I think it’s something that could be really rolled out to lots of, to everybody. I think in the organisation I think everybody could get something from there” (P1).

Participants described how recognising and managing their own stress helped them to be more attuned to stress in others. This resulted in them actively encouraging the use of the techniques, “I’ve noticed more about other people and kind of going on about things outside of their control” (P2). Participant 2 applied the training by identifying which intervention strategy would be helpful, “it’s just about bringing people back into the now”. The word “just” in their response indicates their confidence in knowing the appropriate strategy and when and how it could be applied. This also emphasises their confidence in the strategy’s efficacy. The psychoeducation contributed to the way participants view thoughts and behaviours. Since the intervention, participants have viewed things from a new perspective and used their new knowledge to inform their behaviour, “I have noticed now, particularly since those kind of workshops that, I’ve notice more about other people and kind of going on about things outside of their control”.

Positive session experience.

This theme draws together different aspects of the session experience based on participants’ feedback. Despite initial concerns regarding the online discussion, no one felt that the intervention was less impactful or effective because it was delivered online. In fact, the majority of responses were positive, “I thought it was a really good use of technology” (P4). Particular factors that made the experience positive included the small group size, the trainer’s session management, the content, the speed and duration of the delivery:

I think that was right that there was just a small group of us. I think the content was right. I think that the speed of delivery was good as well […]. It may be that the online format provided a good balance between being able to interact without feeling exposed (P6).

Participants strongly expressed that they enjoyed being part of the programme, “I really enjoyed the training” (P5).

Participants attributed their enjoyment to how “comfortable” the session was. The label “comfortable” is made up of a number of factors which enabled participants to engage with the session, “It was a really kind of comfortable session that you could participate, ask questions” (P2). Comfortability related to participants’ feeling of safety within the session. This was due the absence of risk and confidence that the sessions would not pose any threat to their well-being, despite touching on sensitive aspects of mental health. The initial contracting provided participants with guidance on the session management and created a safe learning space. The trainer underlined the importance of self-care and empowered participants to participate as much or as little as they felt comfortable. The contract enabled the group to set their own rules, for example agreeing to maintain confidentiality, to respect others and to consider the feelings of themselves and others when sharing information.

The content of the intervention was given consistent positive feedback from the participants, with particular reference to the ease of the techniques. This supports the use of examples and analogies to make it easy for participants to transfer the techniques to real world situations:

There’s so much on there that was really, really achievable […] you can literally pick it up and it can go into like your sort of virtual as I call it like a virtual toolbox (P1).

Which aspects of the intervention they found helpful was dependant on the participant; this supports the “toolkit” approach as participants chose from the range of techniques which were appropriate for them, “I found the training really, really helpful” (P1). The descriptors “helpful” and “useful” were consistently used when describing the strategies and the intervention as a whole.

When the term “helpful” was used by the participants, it was often followed by examples with the use of adverbs such as “really”, “amazingly” and “so much” which were repeated for greater emphasis. When extrapolating meaning from the transcripts, examples like these indicate the degree of “helpfulness”. As the outcomes were highly noted and valued, the techniques taught are likely to be maintained, “really, really good, really helpful” (P6). Over the four weeks, no absences occurred despite significant changes to working patterns due to the imposition of a second COVID-19 pandemic lockdown during the intervention delivery. This could be related to the participant’s comments about the sessions being helpful, useful and enjoyable, “I really look forward to Thursday mornings. I really did I thoroughly enjoyed them all and I took something away from all of it” (P10).

The delivery subtheme emphasises the importance of feeling safe and having confidence in the competence of the trainer:

The way that (trainer) kind of like managed the interactions of everybody, so everybody had a chance to kind of like talk and to kind of like feedback and to participate in the training (P6).

This sense of safety was an important aspect of the intervention, indicating that the competence of the trainer is a key factor in the intervention’s impact “So the person delivering it definitely does have a big impact on the value of the training when it’s delivered” (P6). The trainer’s approach engendered confidence in the intervention, “I believed in [Trainer]” (P7) which created a positive cycle of motivation. In describing how the intervention resonated with them, Participant 2 went on to quote the trainer, showing how their words were memorable and indicated the importance of programme delivery, particularly communication. The depth of response that the communication style elicited is likely to be a factor in the level of motivation it engendered, “[…] it hit home” (P2). Participant 8 also described the trainer as “relatable” which created a bridge between the session content and the participant’s lives, enabling them to model their own behaviour. Overall, the trainer’s ability to maintain attention and engagement contributed to participants’ positive evaluation of the programme and how it benefits their self-esteem and resilience:

I was just constantly listening and listening. I found it really interesting and I really recommend this to other people and also to people who’ve got low self-esteem or low resilience (P5).

Data triangulation.

The quantitative and qualitative findings were triangulated to explore the extent to which they supported each other (Bryman, 2012). Figure 3 is a visual map of the outcome of the data triangulation and illustrates how the statistically significant changes seen in the quantitative outcomes correspond to the themes and subthemes identified in the qualitative data. For example, the statistically significant improvement in coping self-efficacy links to participants’ positive experience, learning process, application of strategies and overall positive effect on their well-being. In addition, the statistically significant increase in hardiness corresponds with participants’ greater ability to recognise and challenge negative thoughts identified through the positive effect on well-being theme.