Themes identified within the current analysis

Participants described their acquisition and increased use of a range of proactive strategies designed to address the causes of their anxiety, following intervention attendance. This theme included three sub-themes:  Seeking social support;

 Making a step-by-step plan;  Using coping self-talk.

In response to question five: “Have you used any different strategies for

managing your worries, since you attended the programme?”, the majority

commented that the intervention had increased their awareness of social support for addressing/managing their anxieties, post-intervention. Participant A commented: “You speak to someone and then they could give

Negative

means of

coping

with/managing

anxieties

Self-

harm

Harming

other

people

Comfort

eating

164 you advice”, whilst participant B commented: “The people that we were working with...’cos I never knew, I just thought that they were...just a normal teacher, but now I know that I can go up to them and talk to them”, adding “I feel now as though I can talk to more people”.

To a lesser extent, participants commented on the benefits of learning to gradually address their anxieties via a structured step-by-step behavioural plan, following intervention participation. Whilst this sub-theme is apparent across various discussions within the FG transcript, this is a behaviourally- orientated strategy introduced within the sessions, which provided students with an understanding of the actions they could take to address their worries and therefore most likely a contribution of CBT to participants’ anxiety management skills. For example, participant A commented: “You could think

how to make it better. If you have a problem, you think what you have to do to try and solve it”. A similar number of participants indicated that they use

‘coping self-talk’ post-intervention, as a means of encouraging themselves to persevere during times of anxiety, for example, participant B commented: “It

(self-talk) makes you feel that you have said it aloud and not just in your head. So it just makes you feel better in a way”.

Positive means of coping with/managing anxieties

In contrast, the second theme encapsulated ‘positive’ means of managing/coping with anxieties. This theme and the associated sub-themes differ from the previous theme in that they represent means of containing or coping with worries, as opposed to actively seeking to address the triggers/causes of anxiety in order to reduce anxieties in future. It should be noted that the definition of these sub-themes as ‘positive’ represents the perspective of the current author and of those individuals assisting with the inter-rater evaluations of the current themes; it may be that other readers may interpret the sub-themes within this category in a different sense. This theme included four sub-themes:

 Taught physical relaxation strategies;  Appropriate/taught distraction strategies;  Physical exercise;

165  Recognition that self-harm does not solve anxieties.

This theme demonstrates the highest prevalence, in terms of the number of data extracts referring to those sub-themes above, whilst also encapsulating the highest range of contributions from differing participants.

Many participants commented that they use physical relaxation strategies post-intervention, particularly in response to FG discussions “Have you used

any different strategies for managing your worries, since you attended the programme?” and “What strategies, if any, have you found to be the most useful?”, for example, participant B commented that “clenching your fists”

helps to temporarily relieve anxiety. This is considered an appropriate strategy following guidance from existing literature (Stallard, 2005; 137) and represents a taught strategy, introduced within the programme and is therefore considered to be a contribution of CBT to participants’ anxiety management skills. Many participants also reported the use of various appropriate/taught distraction strategies, for example participant C commented that they “go on the iPad or something”, whilst participant B commented that “listening to calm music (makes you feel relaxed)”, again these strategies prevent participants from dwelling on their worries, and were deemed appropriate following reference to existing literature (Stallard, 2005; 101).

To a lesser extent, participants indicated that they have started engaging with physical exercise as a means of managing anxiety; for example participant B commented “things like going shopping, going swimming, things that take

your mind off it but also things like physical exercise”. The division of the

theme ‘self-harm’ into ‘self harm’ and ‘recognising that self-harm does not solve anxieties’ (section 4.3.4.4) resulted in the inclusion of the latter sub- theme within this theme, as viewing self-harm as a ineffective coping strategy was considered to be a positive post-intervention outcome. Comments here included “If you self-harm or something and when you have done it, you

probably feel better that you have taken it out on yourself and not someone else. But the next day, you regret it...and feel guilty”.

166 Negative means of coping with/managing anxieties

Conversely, the third theme encapsulates participants’ recognition of ‘negative’ coping strategies. As with the previous theme, these sub-themes represent means of containing/coping with worries, as opposed to actively seeking to address the triggers/causes of anxiety in order to reduce anxieties in future. The definition of these sub-themes as ‘negative’ represents the perspective of the current researcher and those individuals assisting with the inter-rater evaluations of the current themes, and other readers may have alternative interpretations of these. This theme included three sub-themes:  Self-harm;

 Harming others;  Comfort eating.

Many participants commented on their use of self-harm as a coping mechanism, for example, participant B commented: “sometimes maybe you

do something to yourself, harm yourself or something, if you are feeling worried” this sub-theme was apparent across all focus group discussions,

and through post-focus group safeguarding discussions with the students in question, it was identified that this strategy represented a mechanism that these students had utilised prior to intervention participation. A smaller number of participants also indicated that they may act out towards others when feeling anxious, for example participant A commented: “I take it out on

my sister and she understands and then I...feel much better if I punch her”. A

similar number of participants indicated that they may comfort eat when anxious, for example participant A commented: “You just get something

really fattening, then you eat it and then think “why did I eat that?”.

The overall story

A Thematic Analysis of participants’ feedback regarding their attendance of a CBT-based intervention has provided insight into their perceptions of their anxiety regulation skills post-intervention, and the manner in which the intervention contributed to these skills. Four participants contributed to Phase Two of this study.

167 Participants’ feedback indicates that CBT-based support has aided their development/acquisition of key skills designed to actively address their anxiety triggers; ‘seeking social support’ and ‘making a step-by-step plan’ were key sub-themes in this respect.

Participants also indicated that intervention attendance had provided them with the opportunity to consider positive anxiety management/coping strategies. This theme encapsulated participants’ views regarding their acquisition and development of a number of strategies which may alleviate the emotional, physiological and cognitive effects of anxiety (i.e. ‘Physical exercise’, ‘Taught physical relaxation strategies’ and ‘Appropriate/taught distraction strategies’ respectively), albeit these strategies do not directly address those triggers leading to their anxieties and therefore may not reduce the occurrence of anxieties in future.

The third and final theme; ‘negative means of coping with/managing anxieties’, highlighted that participants continued to undertake some less advisable strategies as a response to their anxieties (i.e. ‘comfort eating’, ‘self-harm’ and ‘harming others’).

This analysis also highlighted that some contradictions exist between themes and sub-themes within data set (appendix 30). Firstly, as previously alluded to, participants may employ an array of coping strategies post-intervention, some of which may address the causes of anxiety in order to reduce future anxieties, whilst other strategies may merely provide containment or respite from the impacts of anxiety.

Contradictions also exist between sub-themes. For example, some participants indicated that they may turn to others for social support and advice, yet some of these same participants acknowledge that they may take their anxieties out on these same parties (e.g. family members). Similarly, some participants acknowledged that they have previously or recently self- harmed as a result of feeling anxious, whilst some of these same participants also questioned the appropriateness/helpfulness of self-harm as a response to anxiety.

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