Table 7 Themes from workshops with the Youth Advisory Group (YAG)

Positive aspects

Appropriate format

8

“Can be customized to an individual’s needs”

“Gives a routine, even during Covid-19 which gives a sense of comfort and normalcy”

“Get satisfaction after completing a set number of things/tasks, talk therapy is helpful but doesn’t provide these concrete aspects and makes me unsure of my progress”

“Therapist guidance and reminders would be helpful”

Improvement in symptoms, coping and functioning

4

“Doing one thing does not do away depression, but helps cope; e.g., just taking a shower makes the entire day better.”

“Better coping, fewer anxiety attacks, being more social”

Challenging aspects

Difficulty sustaining change

9

“Temporary- If I do something and feel better now, but how would I feel better over time and contribute to overall wellbeing?”

“Need to find foundational motivation within self for BA activities. Not everyone can do that, might be too much work, which may not work for everyone, depends on a person’s initial capacity and functioning. Every therapy doesn't work for everyone.”

Unintended adverse emotions

3

“Personal responsibility, not being able to complete activities might induce guilt/anxiety”

Lacks sensitivity to social and contextual factors

4

“Focus is on individual as responsible – needs cognizance of structures & institutions that cause psychological distress at a systemic level”

“Also depends on the environment- access to some activities, stigma based on gender identity (e.g.: a transman attending the gym, which restroom to use safely etc.)”

Additional strategies

Structure of intervention

11

“Give more clarity on key elements in BA, does activity scheduling mean you have to keep adding on more activities until it works if the first few activities don’t work?”

“Activities that are more personal rather than pre-decided would be helpful.”

“Consider role of social support, spiritual coping, mindfulness etc.”

“Buddy system or accountability partners included in therapy plan”

Education and dissemination of BA

8

“Also provide MH [mental health] resources for young people, their friends and family is needed”

“If not worded properly, BA can seem like we are blaming the person for having a mental illness but what it really means is that: while the fact that we are depressed/have anxiety is not our fault, how we deal with it is up to us. Depression and anxiety, ultimately, are not crippling or out of our control. Again, not trying to paint this as a mind over matter sort of thing but rather a ‘this is something we can learn to cope with' thing.”