Sahranavard 2018.

Study characteristics
Methods	Study design: RCTStudy grouping: parallel groupUnit of randomisation: individualsPower (power & sample size calculation, level of power achieved): power achieved in 1‐way covariate analysis in MANCOVA (multivariate analysis of covariance) indicates adequacy of sample size (anxiety sensitivity: 0.97; hope: 0.82; positive and negative affect: 0.57; anxiety: 1.00; hardiness: 0.82; self‐efficacy: 0.92)Imputation of missing data: not specified
Participants	Country: Iran Setting: female students from Birjand University of Medical Science; training setting not specified Age: mean = 22.00 (SD = 1.11); range = 20 ‐ 24 years Sample size (randomised): 30 Sex: 30 women Comorbidity (mean (SD) of respective measures in indicated, if available) at baseline: anxiety symptoms (BAI): IG: 13.40 (6.16); CG: 13.46 (5.16) Population description: female medical students of Birjand University of Medical Sciences Method of recruitment: recruited at Birjand University of Medical Sciences in Iran; method of recruitment not specified (selected by available sampling) Inclusion criteria: 1) having the BDI score higher than 16; 2) living in the dormitory; and 3) being informed and satisfied; according to Sahranavard 2018, also participants with higher than average score on the BAI Exclusion criteria: 1) unsatisfied students; 2) being graduates; 3) those who did not live in the dormitory; and 4) having BDI < 16; according to Sahranavard 2018, also students with lower than average score on the BAI Attrition (withdrawals and exclusions): not specified Reasons for missing data: not specified
Interventions	Intervention: stress‐management‐based cognitive‐behavioural group treatment (n = 15) delivery: face‐to‐face; group setting providers: clinical psychologist; therapists in this study have master’s degree‐level education in psychology and have all specialised expertise in CBT duration of treatment period and timing: 6 x 90‐minute sessions twice a week (i.e. 3 weeks treatment duration) description: SESSION 1: awareness of stress and its coping ways: self‐awareness; administering the pre‑test, explaining stress‐causing factors and the importance of stress management, how to respond to stress‐causing factors, creating a list of such factors, and relaxation practice SESSION 2: do not be indifferent to stress: mental methods; becoming aware of spontaneous thoughts, understanding the relationship between thoughts and feelings, understanding the physical symptoms, relaxation practice along with diaphragmatic breathing SESSION 3: adapt to life: physical methods of coping with stress; explaining the relationship between thoughts and excitement, identifying negative thoughts and understanding their effects on behaviour, imagination and relaxation practice SESSION 4: study skills, exam preparation and time management; awareness of reasonable and unreasonable self‐talks, relaxation practice in the form of imagination along with diaphragmatic breathing SESSION 5: group power: interpersonal relations skills; replacing reasonable thoughts, autogenetic training of heaviness and warmth feeling (sunlight meditation practice), relaxation practices in the form of mental imagination along with positive self‐induction SESSION 6: treat yourself to merit: cultivate self‐esteem and honour, prevent depression and anxiety and deal effectively with them; training efficient dealing, autogenic training of heartbeat, breath, stomach, and forehead SESSION 7 (see Sahranavard 2019): administering responses of efficient dealing, autogenic training along with imagination and self‑induction SESSION 8 (see Sahranavard 2019): training anger management and mantra meditation SESSION 9 (see Sahranavard 2019): training assertiveness, breath count meditation SESSION 10 (see Sahranavard 2019): social support, a total review of the programme, and creating a personal stress management plan compliance: not specified integrity of delivery: not specified economic information: not specified theoretical basis: cognitive‐behaviour therapy (CBT); CBT is a type of psychotherapy that helps the student to dissect the relationships among their emotions, cognitions, and behaviours to identify and reframe irrational and self‐defeating thoughts, which in turn improves their mood and alters their behaviours. Research and clinical practice have shown CBT to be effective in reducing symptoms and relapse rates in a wide variety of psychiatric disorders Control: wait‐list control (n = 15)
Outcomes	Outcomes collected and reported: anxiety sensitivity ‐ Anxiety sensitivity questionnaire positive affect ‐ PANAS negative affect ‐ PANAS hope ‐ Hope scale self‐efficacy ‐ Schwarzer’s General Self‐Efficacy Scale anxiety ‐ BAI hardiness ‐ Ahvaz Hardiness Inventory Depression (BDI) no outcome measure, but only assessed at baseline Time points measured and reported: 1) pre‐intervention; 2) post‐intervention (1 week after training) Adverse events: not specified
Notes	Contact with authors: We contacted the authors for any withdrawals/exclusions from the study and the number of participants analysed. We also asked for the post‐intervention means and SDs for positive and negative affect separately and whether the CBT group included 6 or 10 sessions. We received no response to 2 inquiries Study start/end date: not specifiedFunding source: no specific funding for this work; nil financial support and sponsorshipDeclaration of interest: no conflicts of interest disclosedEthical approval needed/obtained for study: approved by the Research Ethics Committee of the Birjand University of Medical Sciences (Birjand, Iran)Comments by study authors: not relevant Miscellaneous outcomes by the review authors:Sahranavard 2018 and Sahranavard 2019 are 2 reports of the same study (n = 30 randomised) with different outcomes reportedCorrespondence: Dr Sara Sahranavard; Department of Psychology, Faculty of Medicine, Birjand University of Medical Science; Social Determinants of Health Research Center, Faculty of Health, Birjand University of Medical Sciences, Tehran, Iran; sahranavard_sara@yahoo.com; alesaleh70@yahoo.com
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Quote: "A sample of 30 participants were selected through the available sampling method and randomly assigned into experimental (CBT) and control groups (each group, 15 female student)." Judgement comment: insufficient information about random‐sequence generation to permit judgement of ‘Low risk’ or ‘High risk’; verified baseline comparability of groups for sociodemographic characteristic age (unclear for other sociodemographic variables); baseline comparability for outcome variables unclear (i.e. statistical significance not specified)
Allocation concealment (selection bias)	Unclear risk	Judgement comment: insufficient information about allocation concealment to permit judgement of ‘Low risk’ or ‘High risk’
Blinding of participants and personnel (performance bias) Subjective outcomes	High risk	Judgement comment: blinding of participants and personnel probably not done (face‐to‐face intervention) and the outcome is likely to be influenced by lack of blinding
Blinding of outcome assessment (detection bias) Subjective outcomes	High risk	Judgement comment: insufficient information about blinding of outcome assessment; but due to potential performance bias (no blinding of participants), the review authors judge that the participants' responses to questionnaires may be affected by the lack of blinding (i.e. knowledge and beliefs about intervention they received)
Incomplete outcome data (attrition bias) All outcomes	Unclear risk	Judgement comment: insufficient reporting of attrition/exclusions to permit judgement of ‘Low risk’ or ‘High risk’ (n = 15 randomised to each group; but unclear if there were any missing data or if potential missing data were imputed; number of participants analysed in each group not stated)
Selective reporting (reporting bias)	Low risk	Judgement comment: no study protocol or trial registration available but it is clear that the published reports include all expected outcomes, including those that were prespecified