Taking action for Athlete wellbeing: strengthening psychosocial support through interactive group work

ABSTRACT

This article provides an exploration into the social context of elite sport and details how a participatory action research methodology was used to develop, deliver, and evaluate two interactive group work interventions, “connection workshops” and “mental health literacy training.” Located within a professional Australian National Rugby League (NRL) and designed to strengthen the psychosocial support available to athletes within the high-performance environment, four connection workshops and three mental health literacy training sessions were facilitated within “The Club.” Qualitatively evaluated through seventeen one-on-one semi-structured interviews with athletes, coaches, and support staff, results indicated that these programs had strengthened the presence of psychosocial protective resources within the high-performance environment, with an increase in athletes’ help-seeking behavior resulting from improved accessibility and quality of interpersonal supports.

KEYWORDS:

• Participatory action research
• interactive group work
• athlete wellbeing
• mental health

Introduction

While there are an infinite number of unpredictable variables determining any individual’s health, access to social connections and the support given/received through community and group networks is an undeniably significant factor (Jowett & Lavallee, 2007; Rees, 2007; Rees et al., 2015; Sheridan et al., 2014). So much so, that researchers have gone as far as to suggest that human beings’ need for connection and group membership is the most important characteristic of our health (Forsyth & Burnett, 2010). It is unsurprising, given our intuitive and instinctive nature, that we should seek out connection, a sense of belonging, and shared identity from groups (Baumeister & Leary, 1995; Katagami & Tsuchiya, 2016). Yet, despite wide consensus on the importance of social connections for wellbeing, definitions appear to vary markedly between disciplines. As Veiel and Baumann (quoted in Rees & Hardy, 2000, p. 4) state, “if asked, almost every researcher in the field will present a more or less precise definition of support, but, more than likely, it will be different from that of his or her colleagues.” What appears largely consistent across these variations however, are the terms used to define the constructs of psychosocial support, such as network size, social integration, quantity and quality of relationships, social resources, availability, and satisfaction with support (Rees & Hardy, 2000). Through a more pragmatic approach, Sheridan et al. (2014, p. 198) promote the definition provided by Shumaker and Brownell (1984): that psychosocial support involves “an exchange of resources between at least two individuals perceived by the provider or recipient to be intended to enhance the wellbeing of the recipient.” This research project advocates for psychosocial approaches to wellbeing support within high-performance contexts and explores interactive group work solutions to empower them.

The social context of elite sport

Notwithstanding the lack of consensus between academics in defining social connections, it continues to be one of the most researched protective mental health resources, with a strong base of evidence demonstrating the essential nature of connection, belonging, and shared identity as fundamental basic human needs (Rees & Hardy, 2000). As argued by Umberson and Karas Montez (2010, p. 54), those who are more socially connected are “healthier and live longer than their more isolated peers,” and the consequences of social connection/isolation on individuals’ mental health (Chapman et al., 2005; Kiecolt-Glaser et al., 2002; Thoits, 1995), physical health (McEwen, 1998; Seeman et al., 2002; Uchino, 2004), health-related behavior (Umberson & Karas Montez, 2010), and mortality risk (Brummett et al., 2001; Kiecolt-Glaser et al., 2002; Robles & Kiecolt–Glaser, 2003), are well established across the literature. In fact, so significant is the value of social connection that it has long been promoted by The World Health Organisation as a priority area for global, national, and local public health policy. Yet, despite momentum advocating for socially supportive environments as an effective early intervention and prevention approach within holistic models of health care (Rees, 2007), Loughead et al. (2016) argue that these perspectives have sparsely been considered within the context of elite sport. This is a surprise perhaps, given the over-representation of mental health issues among elite athletes, their predisposition to social isolation during periods of injury, and the short-termed, transient, and insecure nature of careers at the elite level (Dessauvagie, 2018; Du Preez et al., 2017; Lane et al., 2020; Rice et al., 2016). Martin et al. (2016) explore these factors and argue that given the social nature of sporting organizations and athletes’ proclivity to working in groups, understanding the interpersonal and relational elements unique to high-performance environments is an essential consideration for practitioners and researchers working in athlete wellbeing.

This view comes well supported by the literature, with researchers such as Jowett and Lavallee (2007) having linked psychosocial support to individual and group outcomes, citing evidence of improved group cohesion, coping with competitive stress, managing and preventing slumps in performance and burnout, and resistance to injury distress. As stated clearly by Haslam (2014, p. 13, cited in Slater et al., 2017), “there is now a colossal literature that speaks to the importance of internalized group memberships for peoples” sense of self, for their psychology more generally, and for their behavior.’ Given the consensus regarding the value of psychosocial support, the next steps into progress will undoubtedly come from developing best-practice standards and interventions that can support elite sporting organizations in strengthening these qualities. Although this is sparsely explored within an elite sporting context, Slater et al. (2017) suggest that the sector should take confidence from the successful application of such approaches within health, clinical, and organizational contexts, and should expect no different results in high-performance settings.

Elite sport-specific intervention methods

As psychosocial support becomes increasingly recognized as a vital protective resource for athletes’ wellbeing, so do trials and evaluations of environmental interventions designed specifically to improve athletes’ sense of connection within socially supportive environments. Gorczynski et al. (2019, p. 715) advocate for the benefits of these forms of support but caution that collective action is required to “not only develop and use knowledge, but also change attitudes, overcome stigma, and provide and take opportunities to get help.” This is because, as Moreland et al (as cited in Kuettel & Larsen, 2020). highlight, wellbeing support systems are most effective when the many stakeholders (athletes, coaches, administrators, and managers, etc.) of high-performance environments exhibit attributes (attitudes and behaviors) which work as facilitators of that system. Put simply by Gulliver et al. (2012, p. 12), facilitators involve “positive attitudes from peers, and positive relationships with providers” and this, according to O’Connor and Cavanagh (2013), informs how positive and negative attitudes, opinions, and behaviors toward wellbeing are predictive of athletes’ flourishing or languishing at the individual level (Fredrickson & Losada, 2005; Waugh & Fredrickson, 2006), dyadic level (Gottman & Levenson, 1992) and team or group level (Losada & Heaphy, 2004). Importantly, as Henriksen and Stambulova (2017, p. 279) argue, interventions designed to increase “facilitators” must be implemented, with the view of improving sporting cultures holistically across all levels. Informing the two interactive group work interventions delivered as part of this projects participatory action research methodology, connection workshops and mental health literacy training, Henriksen and Stambulova (2017) provide the following guidelines:

• Conduct the intervention inside the athletes’ natural setting rather than in an office.

• Involve the entire environment (e.g., coaches, managers, teammates) in the intervention.

• Aim to optimize the entire environment around the athlete or team.

• See the athletes as whole human beings and to facilitate the development of a holistic package of psychosocial resources (e.g., knowledge, skills, attitudes, network) that will be of use for the athletes both in and outside of sport.

Disclosure statement

The de-identified site of this research project, referred to as “The Club,” is a professional NRL club that approached the School of Social Sciences at Western Sydney University to fund a joint stipend for PhD research into the wellbeing experiences of their athletes and to evaluate the supports provided to them. The data used for this article was sourced from this project, which was submitted for examination in 2022 and approved in 2023. Human Research Ethics Approval (HREA) Code: H13172.

Methodology

Participatory action research is a methodology used in the case of solving a targeted set of issues, by empowering groups, organizations, or communities to evaluate, explore and expand their strategies toward solution (Bryman, 2012). Through these efforts, theory and action are combined in the pursuit of change in a “cyclical process of thinking, acting, data gathering and reflecting” (Savin-Baden & Major, 2013, p. 245). Participatory action research then, as an approach to social research which encourages change through intervention, utilizes the creative potential of exploratory and intervention-oriented approaches. The researcher, both observer and collaborator, engages in what Flick (2014, p. 78) describes as “the constructed processes of social interchange,” whereby virtue of these interactions, the researcher becomes an active agent operating within, and contributing to, the same structures as their participants. Therefore, participatory action researchers are expected to consistently collaborate with their research participants to understand their experience more closely and produce actions informed from their insights. As an exploratory and intervention-oriented methodology, participatory action research enabled this project to pursue both an “inquiry” (to investigate athlete experiences of health and wellbeing) and “impact” (to inform intervention strategies that seek to support these experiences) research goals.

To understand the participatory action research process as it was applied to this project, it is necessary to provide an overview of the three stages of data collection and describe the sequence in which they occurred. Stage 1: “Interviews,” initiated the cyclical process of data gathering, analysis, and reflection that is essential to the inductive elements of the participatory action research process. Data collected through interviews during Stage 1 were then deductively compared against the literature at the 6-month point to determine the merit of initial findings and to inform the participatory action research activity of the following stage, in consultation with athletes and the broader Athlete Wellbeing & Education team. Emerging from this period of deductive reflection was the transition into Stage 2, characterized by the delivery of “connection workshops,” and subsequently Stage 3, characterized by the delivery of “mental health literacy workshops.” Semi-structured interviews, conducted across all 3 stages of data collection, were then used to evaluate the impact of these interventions and feed into the participatory action research planning process, as described in the “data collection” and “data analysis” sections. The sequence of data collection methods is illustrated in the following table (Table 1).

Table 1. Data collection timeline.

Interactive group work interventions

“Connection workshops” were designed to improve the structural conditions of support within the high-performance environment by strengthening interpersonal relationships and increasing help-seeking opportunities between athletes. Facilitated by an experienced social work group work practitioner and in-group athlete leader, connection workshops provided a space for athletes to reflect and share their lived experiences, from both inside and outside of football, to deepen their mutual understanding of one another. Recruitment was carried out in consultation with the researched organizations Athlete Wellbeing & Education team and General Manager, where together, it was decided that four two-hour workshops would be delivered to the Under 21’s team. In total, between 30–35 athletes and 1–5 members of coaching staff were present at each of the four workshops.

“Mental health literacy training”, designed to improve group members’ capacity to identify and respond to mental health concerns, was delivered organizationally wide to athletes and staff by the researcher during the final 6-month data collection period. The program, aligned with industry best-practice standards (Mental Health First Aid, n.d.), involved three two-hour workshops that were adapted and tailored to a rugby league-specific context. Informed by participant feedback, the program’s content was developed in collaboration with The Club’s Athlete Wellbeing & Education Team, who outlined the following learning objectives: recognize the signs and symptoms of mental illness, understand protective and risk factors unique to elite athletes, know the common mental health disorders among athletes and the evidence-based (medical, psychological, and social) treatments used to address them, develop conversational support skills, and appreciate appropriate crisis response actions.

Participatory process

Post-connection workshop debriefs of 60-minutes in duration, involving workshop facilitators, members of the wellbeing and education team, coaching staff, and 2–3 athlete participants, were incorporated into Lewin’s (1958) systems model of action research (Figure 1), as depicted by Bond (2014):

Figure 1. Systems model of action research (Bond, 2014).

Providing a semi-structured methodology to workshop planning, the following three critical reflection questions were presented to participants:

1. did we learn anything new about the athlete experience?

2. what wellbeing needs were raised by group members?

3. how might we be able to better support these needs inside and outside of future workshops?

Through this process, actions for change were then reported and integrated into the planning of future workshops (feedback loop A), before data collection via interviews (to be discussed) provided data relating to results, subsequently incorporated into future workshops, and more general recommendations for future strategic planning (feedback loops B and C). As an example of general recommendations passed through feedback loop C, the need for improved mental health literacy was highlighted across all data collection avenues throughout the delivery of connection workshops as a strategy for de-stigmatizing mental illness and supporting the development of socially supportive environments within high-performance systems.

Data collection methods

Semi-structured interviews are a versatile and widely used evaluative method within participatory action research projects. Offering a platform for researchers to explore and interpret participants’ perspectives and insights, interviews are a valuable tool for exploring the nuances of lived experience (Punch, 1998). As a qualitative data collection method, semi-structured interviews are a way of identifying and exploring shared and common knowledge within a specific context or cohort (Savin-Baden & Major, 2013). From the researcher’s perspective, it enables the investigation of underlying issues and barriers, as well as successes and opportunities for improvement, providing context-specific insights that inform the cyclical participatory action research process (Jones, 1985). As part of this research project, seventeen participants were interviewed from within The Club and NRL, for between 60–90 minutes. These consisted of current athletes, retired athletes, player development managers (PDMs), athlete wellbeing and education managers (AW&E), strength and conditioning (S&C) coaches, career coaches, house parents, program facilitators, and a head coach. Given the organizational context and the potential risk of identifying participants, all interviewees are de-identified for privacy and ethical reasons.

Data analysis

Thematic analysis is a widely utilized evaluative method within qualitative participatory action research projects. Based on the exercise of synchronized summarizing, coding, and conceptualizing, it is an ideal approach to analysis in projects containing a significant amount of qualitative data for its capacity to systematically categorize and organize information (Punch, 1998; Walter, 2013). Moreover, thematic analysis enables researchers to integrate data into the strategic development of their participatory action research interventions, as an evaluative tool aiding in the integration of participant voices into the planning process, refinement of strategy, and implementation of research findings. Largely contingent on the act of coding, or the systematic tagging of data segments as they relate to research goals, thematic analysis involves indexing of data into retrievable concepts based on the researcher’s interpretation of meaning found within participant responses.

Results

Qualitative evaluations of the “connection workshops” and “mental health literacy training” indicates that these programs had strengthened the presence of psychosocial protective resources within the high-performance environment, with an increase in athletes’ help-seeking behavior resulting from improved accessibility and quality of interpersonal supports. Regarding “connection workshops,” the program appears to have provided athletes with an opportunity to provide and receive peer support. Moreover, participant feedback suggests that connection workshops had created a rupture to the discursive norms of the high-performance environment, allowing athletes to interact in a vulnerable but supported manner, within a controlled environment, providing a sense of connection and deepening of relationships. “mental health literacy training” added value to the intervention by improving the supportive resources available to athletes and organizational members’ ability to identify the signs and symptoms of mental illness (in self and others), to provide appropriate referral, information relating to treatment, and general improvements relating to an understanding of positive mental health management and illness prevention. The following discussion unpacks these findings and demonstrates how connection workshops and mental health literacy training, as interactive group work strategies, can be used to improve the environmental conditions of wellbeing within high-performance systems, in relation to both cultural (reducing stigma) and systemic (opportunity and facilitation of help-seeking) elements.

Connection workshops

As interventions that “promote an increased sense of unity and cohesiveness and enable the team to function together more smoothly and effectively” (Newman, 1984, p. 27), connection workshops are, generally speaking, premised upon the mutual sharing of personal life experiences to improve interpersonal relationships, adaptive cognitions (self-efficacy and satisfaction), and overall work conditions (Dryden, 2006; Dunn & Holt, 2004). Often referred to as “personal-disclosure mutual sharing” (PDMS), these types of interventions are described by Barker et al. (2014, p. 187) as the “communication of morals, beliefs, attitudes, and personal motives which in turn augment perceptions, meanings, constructs, and understanding … PDMS may augment athletes” perceptions of closeness, similarity, and bonding which represents group integration,’ as relating to the five characteristics of the collective (Martin et al., 2016, p. 222):

• common fate (e.g., a group outcome).

• mutual benefit (i.e., participation with others is necessary and rewarding).

• social structure (e.g., presence of group norms, individual roles).

• group processes (e.g., meaningful and sustained communication).

• self-categorization (i.e., members view themselves as a group).

Expanding on this emerging field of literature, the development and facilitation of “connection workshops” was guided by the insight of this research project’s participants, with the added value of contemporary group work theory. Operating under the premise of “the many” mentoring “the many” (Huizing, 2012), the connection workshops used a strengths-based approach through the exchange of stories, whereby group members were encouraged to conceive, capture, and infer the experience of their peers from their own in a co-constructed dialogue. As a participatory action research intervention, the workshops were designed to motivate peer support, improve the strength of interpersonal relationships, adaptive cognitions (self-efficacy and satisfaction), and socially-supportive environmental conditions. As an approach to group work practice that positions each participant as both mentor and mentee to each member of the group, connection workshops explore the individual and shared lived experiences of participants, to create opportunities for peer support to take place. Reflecting on their experience of the connection workshops, participants in this research project found the program improved relationships and trust, decreased stigmatizing attitudes, and increased help-seeking behavior. The following quote by an athlete participant gives some insight into these experiences:

I saw some blokes I’ve known for years share stuff that I’ve never heard before. Seriously. I feel heaps closer to them.

In this statement, the athlete participants observes a visceral shift in team dynamics and reports a stronger sense of connection resulting from the connection workshops. In a further evaluation, via survey, all connection workshop participants were asked to rate the perceived impact of the connection workshops on a 10-point Likert scale (0 = none at all; 10 = a noticeably significant positive impact) on personal development (avg. 7.61), team connection (avg. 7.22), and playing performance (avg. 6.32). Subjective as this feedback may be, athletes and high-performance coaching staff confidently expressed their belief in the diverse value of connection workshops. Sharing their observations in relation to performance, the head coach of the participating team stated:

We started the year 0 in 6 before the workshops and then after the workshops we finished 9 in 1. I won’t say that it was a fluke. I think it had a lot to do with the side coming together as a group and the quality of the workshops, I think, really brought our team together.

While the head coach’s view on the team’s upturn in performance is conjecture, their belief that connection workshops can have an impact on performance is supported by an emerging body of literature (Barker et al., 2014; Dunn & Holt, 2004; Evans et al., 2013; Woodcock & Francis, 1994) and in particular, Dunn and Holt’s (2004) evaluations of PDMS workshops, which demonstrate enhanced understanding (of self and others), increased cohesion (closeness and playing for each other), and improved confidence (confidence in teammates and feelings of invincibility). Importantly, in the view of wellbeing advocates participating in this research project, these benefits are vital, as they are the incentive that will likely earn the interest of head coaches and see wellbeing readily integrated into the high-performance system. As reiterated by an athlete participant, these approaches carry significant potential for impact:

I just think that there is so much value in this stuff for an NRL squad. There’s just so much value in that deep connection and that vulnerability.

Mental health literacy training

Mental health literacy is a term used to describe the knowledge of individuals pertaining to the signs and symptoms of mental illness, positive mental health management and preventative measures, treatment options for mental illness and crisis scenarios, and attitudes and actions toward help-seeking behavior (Breslin et al., 2017; Gorczynski et al., 2020; Jorm, 2000; Jorm et al., 1997; Sebbens et al., 2016). Importantly, as stated by Gorczynski et al. (2020, p. 715), mental health literacy not only involves developing and using knowledge, but also “changing attitudes, overcoming stigma, and providing and taking opportunities to get help.” Education in the form of mental health literacy training, which develops individuals and groups’ capacity to recognize the warning signs and symptoms of illness, understand effective management and treatment of illness, and support others who may be developing an illness, is becoming increasingly prevalent (Moll et al., 2018).

Qualitative evaluations of the mental health literacy training indicated participation improved athletes’ trust in the environmental conditions within which they operate, and importantly, improved the quality and confidence of support provided to them by members of the high-performance environment. Highlighting the impact and value of tailored mental health literacy training, an athlete participant shared the following qualitative feedback:

I mean, we don’t talk about it [mental health]. Being a footy player runs pretty deep, you know what I mean? So I reckon those workshops help to chip away at that stuff a bit. Knowing what it is and who to talk to when you’re stuck – that sort of thing – it makes a difference.

Here the participant highlights the role that psychoeducation can have in increasing mental health literacy and help-seeking behavior within an elite sporting context. Their view comes well supported by the literature, with evidence demonstrating the impact of mental health literacy on the improvement of wellbeing cultures within high-performance systems (Gorczynski et al., 2020, p. 715) and with positive impacts cited in relation to levels of negative affect (Longshore & Sachs, 2015), knowledge of mental health disorders (Pierce et al., 2010; Sebbens et al., 2016), levels of stigma (Bapat et al., 2009), confidence to support others experiencing poor mental health (Breslin et al., 2017; Pierce et al., 2010; Sebbens et al., 2016), and confidence to seek support from a mental health professional (Bapat et al., 2009). Given the breadth of support for mental health literacy training programs, both anecdotal and evidence-based, leaders of elite sporting organizations should feel confident in implementing these programs within their Athlete Wellbeing & Education strategies.

This is important given the concerning over-representation of athletes in mental health issues (46.4% of athletes experienced symptoms of at least one mental illness) such as depression (27.2%) (Gulliver et al., 2012). For Castaldelli-Maia et al. (2019), stigma plays a critical role in underpinning the prevalence rates of mental ill-health among athletes; similarly for the previously quoted participant, concerns over the impact of stigma within the culture of elite sports remains an unresolved issue for the sector and one that is difficult to resolve, given the intense pressure on athletes to consistently exhibit mental and physical resilience. Shared by another athlete of this research project, they recall the familiar trope that “rugby league is a hard sport played by hard men” and believe that these attitudes manifest into beliefs that mental health issues and help-seeking behaviors are perceived as a sign of weakness. A cultural concern for elite-level rugby league athletes, Kola-Palmer et al. (2020) have conducted one of very few studies specifically focused on the help-seeking behaviors of professional rugby league athletes in Australia and found issues related to stigma as contributing to their participants’ common experiences of embarrassment, fear, and shame during periods of mental ill-health. Discussed by an athlete of this research project, the stigma impacting rugby league athletes is an ever-present and visceral discourse within high-performance cultures:

The stigma around males having to be tough is a difficult one, especially when you’re a footy player. You know, we’re thinking that we have to be tough and personally, I think a lot of the boys don’t speak up about things because of it.

Mental health literacy training, as an intervention redressing attitudes and actions toward help-seeking behavior (Breslin et al., 2017; Gorczynski et al., 2020; Jorm, 2000; Jorm et al., 1997; Sebbens et al., 2016), has the potential to normalize mental health, challenge the stigma present within high-performance cultures, and promote norms of behavior which better facilitate help-seeking and access to support. As a participant of this projects mental health literacy training stated, “it’s changed my mind about a lot of things.” As the only other study exploring mental health literacy within an NRL context, Ravulo’s (2015) mixed-methods evaluation of the Mental Health First Aid course, reiterates the capacity of mental health literacy training for change, highlighting how these programs facilitate consciousness raising in regard to stigmatizing beliefs. As one of their participants shared, “Having lived with mental illness for the past 16 years, the MHFA Instructor has shed a lot more light on my problems I face on a daily basis” (Ravulo, 2015, p. 8).

Implications & future research

Findings from this research project support the view that psychosocial support and the value of connection are significant mental health and wellbeing protective factors. For Slater et al. (2017), this relates to the linkage between individuals and groups as a core feature of wellbeing, and implies that stronger individual connections within, and to groups, improve measures of self-efficacy and protective mental health resources by improving an individual’s ability to manage stress (Haslam et al., 2005), vulnerabilities to burnout (Haslam et al., 2009), and capacity to manage mental health issues such as depression (Cruwys et al., 2014). The following set of pragmatic recommendations were developed through this projects participatory action research methodology and can be used to strengthen these properties through effective psychosocial support within high-performance environments:

• Delivering connection workshops in partnership with athletes can make a critical contribution to the strengthening of athletes’ psychosocial support networks by normalizing and de-stigmatizing help-seeking behavior. Designed to develop trust within the high-performance environment, increase athletes’ access and opportunities for psychosocial support, and provide a dedicated space and time for athletes to communicate, connection workshops are a unique intervention that create an interrupted space for athletes to interact within. Connection workshops will function most effectively when partnered with mental health literacy training as a means of equipping group members with relevant knowledge and skills to provide support.

• Training all members within the HP environment (coaches, managers, athletes, etc.) with athlete-specific mental health literacy training will further improve the strength of athletes’ psychosocial support networks. These programs should educate participants on identifying the signs and symptoms of mental illness, positive mental health management and preventative measures, treatment options for mental illness, appropriate crisis response actions, and skills to facilitate help-seeking behavior (communicative aids and referral pathways). Moreover, these programs need to be sport-specific and reflect the unique cultural conditions of different sports. Having these programs critically evaluated should be made a priority.

Given the encouraging results of the interventions trialed as part of this study, future research can expand on the growing evidence base supporting interactive group work within an elite sporting context with a more robust and comprehensive evaluation of their impact. Research with both qualitative and standardized quantitative methods is necessary, with a particular focus given to the long-term efficacy of these strategies. Additionally, research exploring the relative impact of these interventions within the digital and/or virtual realm, as well as evaluating their applicability across a variety of sporting domains, would further develop this evidence-base.

Disclosure statement

No potential conflict of interest was reported by the author(s).