MA&R
The intervention consisted of 22 sessions—11 group sessions and 11 one-to-one sessions that took place alternately. In the group sessions, participants were introduced to topics related to activities, health, recovery, and strategies for activity engagement. The group sessions were facilitated by the peer worker and the occupational therapist, who provided a combination of theoretical knowledge and experienced-based knowledge. The topics were introduced, using didactic presentations, reflective questions from the MA&R workbook, and peer exchange. Some group sessions also utilized other methods, such as storytelling and photovoice activities. In the one-on-one sessions, each participant met with the occupational therapists and the peer worker. These sessions provided opportunities for the participants to reflect on and discuss topics from the group sessions, such as the connection between activity engagement and states of flow. Group sessions typically lasted 90 min, including a break of 10–15 min, while one-on-one sessions typically lasted between 30 to 60 min [In addition to the scheduled sessions, participants were also offered individual support to engage in activities. Individual support was optional and based on the participants’ wishes and goals. The support was flexible and could be provided in multiple ways, such as companionship, practical help, supportive conversations or help to create new strategies for activity engagement. For instance, a participant who wanted to exercise regularly in the gym was offered companionship by the occupational therapist to enhance a sense of commitment and build a routine around exercising. Another participant who wished to write a book was offered guidance and advice from the peer worker, who was an author[Meaningful Activities and Recovery was organized into two modules: MA&R I with two weekly sessions focusing on exploring and recognizing meaningful activities, and MA&R II with two monthly sessions allowing participants to engage in new meaningful activities at their own pace. The intervention was delivered in facilities in the participating sites, in participants’ homes or in the community. Providers received training in the methods used beforehand (a 3-h workshop and individual preparation) and consecutive supervision (1,5 h × 6). Supervision was given by the first author, who developed MA&R.Participants allocated to the MA&R intervention were also offered standard mental health care, as MA&R was investigated as an add-on to usual care in this RCT.