JMIR Publications

ABSTRACT

Background:

Face-to-face hearing voices peer support groups (HVGs), a survivor-led initiative which enables individuals who hear voices to engage with the support of peers, have a longstanding history in community settings. HVGs are premised on the notion that forming authentic, mutual relationships enables the exploration of one’s voice hearing experiences and, in turn, reduces subjective distress. As such, group cohesion is assumed to be a central mechanism of change in HVGs. The rise of digital mental health support, coupled with the COVID-19 pandemic, has resulted in many HVGs adapting to online delivery. However, to date no studies have examined the implementation of these online groups and the adaptations necessary to foster cohesion.

Objective:

This study aimed to understand the experience of group cohesion amongst HVG facilitators in online groups compared to face-to-face groups. Specifically, we examined: 1) the ways in which the medium through which groups run (online or face-to-face) impacts group cohesion; and 2) how facilitators adapted HVGs to foster group cohesion online.

Methods:

Semi-structured qualitative interviews were conducted with 11 facilitators with varied experience of facilitating online and face-to-face HVGs. Data were analysed using reflexive thematic analysis.

Results:

The findings are organised into three themes and associated subthemes: 1) non-verbal challenges to cohesion (lack of differentiation; transitional space; inability to see the whole picture; expressions of empathy); 2) discursive challenges to cohesion (topic-based conversation; depth of disclosure); and 3) necessary adaptations for online groups (fostering shared experience; using the unique context to demonstrate investment in others). Despite challenges in both the setting and content of online groups, facilitators felt that group cohesion was still possible to achieve online, but that it had to be facilitated intentionally.

Conclusions:

This study is the first to specifically investigate group cohesion in online HVGs. Participants noted numerous challenges to group cohesion when adapting to run online, including the unnaturally linear narrative flow of dialogue in online settings; lack of transitional spaces, and associated small talk before and after the group; ease of disengagement online; inhibited sharing; and absence of shared physical presence online. Though these challenges were significant, facilitators nevertheless emphasised that the benefits provided by the accessibility of online groups outweighed these challenges. Necessary adaptations for cultivating group cohesion online are outlined and include capitalising on moments of humour and spontaneity, using group activities, encouraging information sharing between participants using the chat and screen sharing features, and utilising objects from participants’ environments to gain deeper insight into their subjective worlds.