Table 3.

Exemplar of coded data: stage one theme one (translating principles into practice)

Constituent theme and elements	Participant responses
The underlying principles
Learning to live with symptoms	‘I like that it’s about acceptance and accepting um the bad feelings you have rather than um fighting them all the time…yeah sort of living in spite of rather than trying to get rid of um, because it doesn’t work…it’s realistic.’ (Grace, potential patient)
Connecting to the natural world	‘That greater sense of being one with it all… I think that’s a very positive thing because it diffuses one’s own emotion…it puts what you are going through in context and that’s what this seemed to me in a way, um rather than being the centre of our universe as it were, we are part of it.’ (Claire, potential patient)
Viewing all emotions as natural phenomena	‘It’s a compassionate way of looking at yourself and what you’ve experienced as opposed to you shouldn’t be feeling like this.’ (Nicola, potential patient)
The vicious cycle of symptom aggravation	‘It does get into a cycle…you always tend to lean towards the, it, it almost feels easier to feel sad…and you do generally go over and over and over the unpleasant things.’ (Sarah, potential patient)
Rest	‘Giving yourself a bit of space…healing space, because I don’t always think there’s that in other kinds of therapies, there’s not that kind of re-charging space, um yeah, that’s nice.’ (Grace, potential patient)
Discrepancies between principles and practice
Connection to the natural world	‘I liked the nature thing, but I didn’t hear that brought in.’ (Beth, potential patient)
Rest	‘I suppose what I construed from what I read is it’s more like actually if you don’t feel able then rest should be the mainstay of what you’re doing, rather than an hour in your day or a few minutes in your marathon…so I, yeah, I guess I feel kind of slightly less clear about the use of that sort of natural healing.’ (Hayley, therapist)
Resulting confusion	‘I don’t think that that [vignettes] matched this [summary of principles] at all, um really, so I’m going away from this…still wondering what Morita Therapy is.’ (Estelle, potential patient)
Communication difficulties
Confusion in positive reinterpretation	‘My question to him would be if they’re flip sides then are they equal, so am I supposed to be worrying and enjoying something equal at the same time because I would disagree with that…I would say most of the time you should be looking at the positive and focusing on that…not you should be half worrying and half doing this.’ (Beth, potential patient)
	‘I remember somebody saying to me once nothing is either good or bad, it’s the way we react to it….somebody could get that impression…What I was going through with my parents…I’d be very interested to see how anybody could reframe for me in an acceptable way.’ (Claire, potential patient)
Barriers to implementation
Diaries	‘I’ve always struggled with er sort of self-reflection in terms of writing… I think sometimes if it’s been a bad day, it kind of just all comes out and then I read it the next day and I just, it just looks like a load of rubbish… That’s, that’s the one thing that puts me off about doing it.’ (Mark, potential patient)
Action-taking	‘I find my depression and anxiety um quite paralysing, so saying about be anxious but get on with doing something, I find that I can’t.’ (David, potential patient)
Rest	‘Actually just saying hey just rest, I don’t find that very helpful because I need some order and structure and I think okay if I’m gonna rest at this point, who’s gonna clean the fish tank out, who’s gonna cook dinner, what do I do.’ (Sarah, potential patient)
Balancing action-taking and rest	‘Um dealing a little bit with this like paradox with action and also inaction, which is new… What are the parameters of rest, how is it structured…I’d like a little bit more structure around once you got to action.’ (Paul, therapist)

Note: Names changed to pseudonyms to protect confidentiality