The aim of the pilot study was to evaluate the experience of joint well-being workshops on ED patients and the clinical team providing specialist ED clinical services. Principle workshop goals were supporting patient-recovery and addressing staff work-place stress. Significant statistical results derived from patients’ self-report questionnaires pre and post-workshop showed enhanced mood and three areas of increased positive feelings related to taking time out for self namely; deserving, feeling good about, and enjoying. For the MDT, feelings of deserving taking time out for self, and overall mood post-workshop reached statistical significance. Feedback forms indicated patients evaluated workshops as enjoyable and relevant to self-care practices, and fairly useful, with potential improvements. MDT feedback found workshops enjoyable, useful and relevant. Six core themes were identified through qualitative thematic analysis from the patients’ focus group and MDT interviews: Enjoyment, well-being and recovery, relationships, content, structure and future ideas. Both groups highlight the potential benefits of joint well-being workshops, with some limitations being identified in the current implementation. Workshops addressed areas of well-being underpinning recovery and self-determination in patients and burn-out in staff, including; self-compassion, self-care feelings of deserving, social tension and isolation, mood, and motivation.
4.1. Quantitative Analysis
The greatest effect size was found in mood improvement from analysis of pre- and post-workshop data, with a medium effect size for both patients (r = 0.49) and the MDT (r = 0.41). The immediate benefit of enhanced mood was echoed in feedback form ratings and qualitative themes. Specifically for patients, enjoyment focused on external, pleasurable or interesting activities. For the MDT, it was stress-free time, enjoying increased productivity and mood post workshops. Current research into well-being highlights that self-compassion and taking time for yourself relates to higher levels of happiness, alongside the reduction of negative mood and thinking [8
]. What is new to the literature, to the best of our knowledge, is the finding in this study of an immediate positive impact on mood in both groups. This increases the potential usefulness of future workshops, perhaps targeting stressful times such as in-take or post-meal.
Patient’s responses to Q1: “I enjoy taking time out for myself”, showed a small effect size (r = 0.28). As expected, pre-intervention ratings scores were low, consistent with evidence that patients fear self-compassion or treating themselves with kindness [7
]. This key component of well-being is a particular patient difficulty [7
], therefore any statistically significant change could have important implications in fear reduction around self-compassion. Implications are that regular workshops, or longer duration of this type of treatment, could potentially have a greater impact. This score did not significantly change for staff, consistent with the literature of non-ED controls not having a fear of self-compassion [7
A medium effect size (r = 0.32) was found for patients for Q2: "Taking time out for myself feels good" suggesting the workshop produced a shift in patient self-compassion. This is important in the complex ED patient profile where shame and guilt feature strongly, and self-compassion is lacking [27
], particularly in adolescence, where self-compassion has been found to be positively correlated with body satisfaction [28
]. This suggests workshops could influence body perception. Interestingly, MDT ratings recorded no change for Q2, indicating no fear of self-compassion and prior recognition that taking time out for self feels good (M = 4.56).
Both staff and patients reported a lack of deserving associated with self-care, in line with the literature [27
]. It was of note that the results suggest this improved post-workshop, with increased ratings in each group of Q3: “I feel that I deserve to take time out for myself”. Medium effect sizes were observed (patients: r = 0.31; MDT: r = 0.38). Workshops seemed to promote a shift in attitudes to self-care. Potentially, gradual and frequent exposure through workshops will increase patient self-compassion and well-being in both patients and staff.
No significance was found in either group for Q4: “I don’t take time out for myself very often” (Table 1
and Table 2
). This is a likely fact of hospital life, and we would therefore not expect any change.
4.2. Qualitative Analysis
Thematic analysis of qualitative data from both groups identified six core themes: Enjoyment, recovery and well-being, relationships, content, structure and future ideas (Table 3
). The theme of enjoyment re-enforced statistical analysis, with enhanced well-being experienced individually and in the group dyad, with a sense of shared enjoyment. Mood benefits linked to well-being and self-compassion are important, as discussed previously.
Recovery and well-being, the second theme, was felt to be universally applicable, a message the workshops successfully promoted. Recovered ED patients have identified well-being as a fundamental aspect of their recovery [4
], and the importance of encouraging and promoting well-being in ED treatment was a major theme for patients and the MDT. There was a recognition that everyone can enhance psychological functioning irrespective of illness. However, while staff described the benefit from a stress-free “oasis”, they also focused on patient well-being during interviews, and felt their primary function during workshops was still to support patients. It would be important to explore with the MDT how this perception could be changed, as staff felt the ability to take time for themselves was directly correlated to burnout.
Relationship dynamics, the third theme, featured frequently with both groups and workshops provided an opportunity to build empathy and trust. Well-being was felt to have a huge potential for recovery. Research suggests reducing patient isolation is also important in recovery [11
], and all participants noted this benefit. The MDT discussed a strained environment was previously identified in EDUs [12
], and workshops were seen as breaking down barriers and improving communication and relationships. Reducing relationship tension also reduces workplace stress in EDUs [12
]. However, the analysis showed relationship improvements differed due to facilitators and levels of interactive activities in workshops, which is useful knowledge for future workshop design.
The fourth theme, content, was felt to be appropriate by all participants. It was mainly well-received and contributed to well-being: Yoga was the favourite workshop. However, the same content by the same facilitator (a professional make-up artist) was perceived differently on different days, and staff linked this to the dramatic variation in daily atmosphere dealing with a life-threatening illness. Patients felt that learning skills to take away was important, whilst acknowledging this may not appeal to staff: Engaging both groups equally in content is challenging.
The fifth theme of structure reflected anxiety associated with the unpredictability of the workshop programmes, but only for patients. Whilst challenging participants to push boundaries is positive in promoting coping and resilience, the sporadic scheduling of workshops was potentially unhelpful in a practical sense. Patients requested regular workshops and regular smaller groups for the time between workshops. The MDT expressed difficulty finding time to attend. To reduce patient anxiety and increase the potential for all participants to attend, a regular schedule should be implemented enabling all participants to block time in diaries and treatment plans.
Both groups enthusiastically discussed ideas for future workshops, which constituted the final theme. Ideas focused on more creative, interactive, and less directed workshops. In particular, patients found recovered facilitators with an ED very helpful role models, while staff emphasised the importance of fun. The high level of engagement suggests an opportunity to involve participants and enhance proactiveness, motivation and self-agency.
4.3. Future Research and Limitations
Future research could examine the effect of collaboration further by comparing staff only, and patients only workshops, investigating the issue of staff feeling that the space was primarily for patients. Furthering our understanding of self-compassion is indicated, possibly through the use of the Self-Compassion Scale [30
] before and after well-being workshops. Furthermore, the interpretation of the reported improved relationships reducing stress in staff, and patients, should be investigated. A longitudinal study linking well-being interventions and recovery to BMI would also be interesting. With the frequency of patients with high autistic traits, it might be interesting to research how the workshops were received differently.
One limitation of this study is that a well-being questionnaire was only created after the benefits to both groups were clear, limiting the valid sample size. Furthermore, due to the naturalistic nature of this study, there were varying relationships between each member of the groups and this aspect was not controlled for. Another limitation was the wording of Q4 on the well-being questionnaire where the double negative confused some participants. Furthermore, this study only captures short-term effects. The concept of well-being may have varied over our wide age-range; however, for this pilot study, we wanted to be inclusive of all age ranges and aimed to choose workshops that were relevant to all.