Table 3.

Summary of the superordinate themes across all qualitative interviews.

Superordinate theme	Summary description of theme	Subthemes and supporting quotes
The immense impact of pain on daily life	Participants spoke candidly about the enormous impact pain had on their quality of life. For all, they rarely experienced any relief from their pain. They shared how the physical aspects of pain restricted even basic activities of daily living. This experience of loss, left them with little sense of enjoyment or fulfilment in life and the accounts given felt quite hopeless and helpless. It left people questioning their identity, meaning and purpose in life.	Physical aspects of pain Even if they could give me something that would give me one day a week where I could go for a walk. (Pete) Influence of pain on construction of identity It’s about enabling us individuals with persistent pain to present as normal people, with problems that aren’t their fault and this is how they are trying to get through their day. (Alun) Experience of loss It prevents me from doing many of the things that I used to do. (Steve)
Meaning of connection and belonging in the group	Connection was a significant component of the group. Being in the group brought people together and participants spoke of valuing the opportunity to connect with others. It appeared to help reduce feelings of isolation and there was a sense that people could engage in the suffering they experienced together. The ending of the group was difficult for many and some were left wondering how they could maintain this sense of connection after the group had finished.	Valuing connection I think when you come together as a group, you know you’re all there for similar reasons. (Mary) Connection reducing feelings of isolation It’s being with other people that are the same and don’t judge you. (Pete) The impact of the loss of connection with the group It took me a long time to be able to get things out there from what I wanted to say, and felt comfortable saying, and then it was all over and I just, you know, it was too soon for me. (Pete)
Engaging with the emotions connected to the pain experience	Participants shared examples of times where they had felt emotions such as shame, hopelessness and embarrassment in connection to their pain. The safe environment created in the group by facilitators and the other group members allowed participants to show vulnerability and engage with difficult emotions connected to their experience of pain.	Sharing negative feelings connected to pain It became quite deep discussions at times; we all had different problems and it seemed to bring the problems to the surface at a time, for some people, so we had good discussions. (Steve) Engaging with emotions connected to pain It took me a long time to be able to get things out there from what I wanted to say and felt comfortable saying. (Pete) Showing vulnerability Over time I did start to open up more myself and I think that’s good. (Mary)
Recognising the process of the change in the group	Change was talked about as a process by participants. Change happened at a different pace for different people and a key part of that process seemed to be developing acceptance of pain and of their current situation. There was an overall sense that the group had been a helpful and powerful experience for people. There was also recognition that this was only the start of the journey of change. Participants acknowledged that there may be hurdles to overcome to fully integrate some of the ideas from the group into daily life.	Change occurring over time Yes, as I say, I have learnt to accept my condition whereas before I was frustrated by it and often angry by it. I don’t get that now; I’ve learnt to control that. (Steve) The powerful experience of being in the group I actually came away from it thinking this has been an invaluable experience and to be quite frank, it’s something I will cherish. (Alun) Change being hard to achieve … its comfort back here, I know what I’m doing, I know where I am and if I go forward I’m not really sure what I’m going to. (Mary)
Applying learning from the group	Participants shared how they had applied their learning from the group. In doing so, they spoke of developing new ways of coping through being more self-compassionate and kinder towards themselves and considered how this had impacted upon the interactions they had with others. Specific parts of the CFT approach were referred to, such as understanding the tricky brain and the process of developing the compassionate self which allowed participants to start to feel less self-critical. Mindfulness was viewed as beneficial and many had integrated this into daily life.	Developing new ways of coping I soon realised that I still need to invest a certain element of time into myself before I can start trying to support other people’s problems. (Alun) Specific techniques of the CFT approach The next best thing was the way they explained the mind and how it was working … you understood a bit more of why you might be feeling the way you were feeling. (Mary) So, understanding the dynamic between the compassionate self and the critical self, for me, they were very closely linked. (Alun) Changes to daily life … through the group it’s helped me not to dip or peak, just come to a nice level which is making day to day life more manageable. (Alun)