Table 6 Results of thematic synthesis from qualitative studies

Themes from lived experience literature on BA intervention

Positive Aspects

Appropriate format

13

“I would definitely have chosen it [to have the homework assignments], because you get a better understanding of what the course is about [by having homework]. And you can repeat what you have learned at home, so that you learn it better.” [48]

“Talked about what I wanted to talk about (during sessions).” [47]

Enhanced mood

5

“I can understand how my behavior and my habits can affect my mood, I can change my depression by changing my behavior.” [49]

Improved functioning

9

“I spend much more time together with other people. Before the course, I just went home and straight to bed. Now, I force myself to socialize with friends and acquaintances … it makes me happy, and I want to do more of the things that make me feel that way …” [48]

Challenging aspects

Difficulty sustaining change

6

“When you’re home, you want to do other things. You don’t want to do assignments, which can be boring. When I’m home, I’d rather read a book of my own choosing.” [48]

"They [the homework assignments] were okay, there was nothing negative about them. It just took a lot of effort doing them.”[48]

Personal responsibility

3

“I felt I got a lot of responsibility for why I was depressed. And in a way, you were sitting there and saying, ‘I can’t help it, I didn’t do it on purpose’.” [48]

Aspects for improvement

Staggered sessions

5

“Top- up BA sessions following the end of treatment; this may help bridge the gap between reliance on the therapist and independence at home.” [47]

Simplified language

2

“Maybe use simpler language, so one can understand it better. I have noticed that there are many technical terms in the assignments.” [48]

Themes from lived experience literature on adaptive habitual coping

BA's alignment with habitual coping

Behavioural strategies

150

“I set myself reminders in my phone (for my academic activities), I used the calendar on my phone, I might physically write things down” [54]

“I found it very helpful to separate myself from whatever makes me feel depressed and relax and listen to music. Listening to music has really helped calm me down and forget about my worries.” [51]

“I think that…religion might help somebody go to a counsellor or therapist because um…what if God might be telling them that how maybe if they were thinking of hurting they self or killing their self, so they need a counsellor.” [52]

Cognitive restructuring

20

“So, I tell myself ‘you’re okay, you’re okay. Stay right here. What can you deal with right now? What is it that is stressing you out? Then you answer back. You have this but you have time. You’ve always done it before.’ I just reassure myself” [55]

Additional strategies to optimize BA

Role of social support

173

“My friend reminded me that I wasn’t alone. On occasions, she didn’t necessarily say that much, but when I was having an anxiety attack, she would give me a hug and we would just sit, and she would help me through it and help me breathe.” [55]

“My mother would always come to me whenever a problem was going on. I don’t know how. I wouldn’t even tell her anything was going on. She would just know something was not right.” [50]

Self- acceptance and self-care

85

“When I was younger I just felt stupid, I felt like my feelings weren’t valid... and now I’m in a place where I could really identify... like I do struggle with things and that’s okay. But there’s a way I could struggle that’s helpful not hurtful to myself and to my relationships.” [53]

“I don’t get embarrassed like if I did something wrong. I just get up and try again. Whereas before I wouldn’t.” [56]