Table 6. Themes and sample quotes from the HeLM acceptability interviews.

Themes	Summary	Quotes
Diversity of expectations	Participants joined the course with different expectations of it. Two hoped to get benefit for their heart condition and high blood pressure as well as their depression. Another two wanted something to help with their depression and anxiety, so they could see things in a different and calmer way. One woman joined the course as she had a personal interest in learning cognitive therapy and meditation. One other participant joined the course without any expectations and he reported that he had no enough information about the course.	“Well basically that I'd come out feeling calmer and look at things in a different perspective. Instead of being a black and white person seeing things in a calmer way perhaps” (Participant 3) “I wanted to know about depression. Because you never know enough about it and maybe that's probably why we're depressed because we don't know enough how we need to avoid some things (Participant 7)
Motivation	The reasons that made people to take part in the course were different, such as meeting other people, the experience its self (e.g., trying new things, coming to the university or learning meditation). One participant said that it was an opportunity and he thought he should take advantage of it. Other participants pointed out that the nature of MBCT, as a kind of psychotherapy, would not cause them any harm. Another mentioned attending so it would be possible to avoid psychiatric medications. Two participants wanted to deal with their physical conditions (heart conditions and blood pressure) and depression. Another two participants wanted to get help with their depression.	“I wanted something to help me, I felt I needed some help with my condition both with the mental condition I found myself in after I got ill and the illness itself and I thought anything like this is at least worth trying” (Participant 2) “Because at the time I was feeling rather down, and I thought it would be a way of speaking to somebody, mixing with different people and communicating to me is pretty important anyway” (Participant 3) “I'm a supporter of anything that will take us away from chemicals. This is not a chemical or a physical intervention, it's about the mind. and therefore, you can only benefit from it” (Participant 5)
Challenges 1.Being in group	Five of the seven participants joined the group with some worries around being in a group, mainly being worried about talking to new people, talking about personal issues with others and/or due to a language barrier. However, these people’s experience was positive, with reporting that the environment was encouraging, and they worked well as a team. One of the things that seemed to help people to deal with their worries is that there was no pressure to talk or share feelings about depression or their physical symptoms, such as having a heart attack or stroke, if they did not wish to do so. Participant 1 did not see the course as a group therapy but more as an opportunity to share personal experiences with others, while Participant 5 said that being in a group helped in not being introspective.	“Oh, my God, I was worried. First because of my language and second it was really difficult to meet new people, you know that feeling, having looked at you, you know, maybe someone start to ask you know what you've done before but yes it was a really different experience I was talking to nice people” (Participant 7). “I haven't ever taken part in what I understand to be group therapy, but I think it is people sharing their experiences” (Participant 1) “I think that if it were not a group it would be very easy to become extremely introspective in your perceptions of what was going on and why you were doing it. When you have a group, there is this group thing that takes over”. (Participant 5)
2. Making mindfulness a priority	Four participants agreed that making the course a priority in their lives had been a challenge for them. They reported how they needed to push themselves and had to allocate time to undertaking homework every day.	“If I were in your position I would be very aware that people have difficulties and you have to persuade them to priorities this project, the exercises” (Participant 5).
Effective techniques	1. Orientation session: The seven participants seemed to agree that the orientation session with the therapist was very helpful in terms of providing good information about the course and what was going happen. They reported that the therapist was easy to talk to. 2. Exercises: The seven participants agreed that the 3-step breathing space was useful for different reasons. For example, participant 5 thought that it is short and that it suited his lifestyle as he could use it anywhere, while participant 2 said that he felt better regarding his breathing with this exercise. The body scan was useful for four participants. For example, participant 1 described her experience with it as it helped her to see how lucky she was comparing to other people who had physical problems. Also, talking to other people and the therapist seemed to be helpful to some participants. 3. Homework and Questionnaires Participants 1, 3, 6 and 7 described their experience with doing homework as being easy, but they had to allocate time to undertaking it. Participant 4 thought that it was demanding. Participants 2 and 5 thought that the homework was flexible, and it had helped them to do what they wanted to do. Regarding the questionnaires, participants agreed that completing them was fine. However, some said that some items did not apply to them and some were repetitive. 4. The course overall It seemed that the course as overall was acceptable to people. For example, three participants liked how flexible it was. Participant 1 described the course as delivering “A more relaxed attitude to life”.	“The breathing space suits my life and the way I live” (Participant 5). “When I'm faced with a stressful situation the first thing that happens is my breathing shuts down a little bit, there is already a heart condition that causes a problem with that so it's twice as bad but then I think about the responsive breathing, the breathing practice and It does seem to help there's no doubt about that” (Participant 2). “It was quite demanding and filling in the forms but then if you didn't have the forms I think there wouldn't have been the incentive to keep going so yes it was quite demanding, but I think it probably needed to be quite demanding” (Participant 4). “A more relaxed attitude to life. I remember we were asked that question in the group and the answer just came to me. I hadn't articulated it before. I felt that the words had been put into my mouth almost without having to think about them” (Participant 1).
Ineffective techniques	1. Exercises: Six out of the seven participants found that the movement exercise was not helpful. Four said that as they had other physical complaints that limited their ability to do it. Participant 3 said that it was very slow, so she did not like it. While participant 7 thought that it did not help her to feel calm. However, participant 5, who had hypertension, found this exercise helpful. 2. Handouts. Participant 2 pointed to that there was a need to emphasise more the fact that this course was for people with CVD. He also mentioned that some of terms in the handout needs to be explained further, such as automatic pilot.	“Do you know I've gone to the whole 8 weeks and this business about it being special for heart conditions, hasn't really been emphasized very much. I know that's what you've got because you've got two groups, a control group and all the rest of it but there wasn't a lot of mention of that of the physical side of people's conditions in the course. It was about the mindfulness itself” (Participant 2).
Physical/Psychological benefits	The benefits that participants obtained from the course were mainly around breathing, understanding depression and facing stress. For example, two participants reported that the course had helped them regarding their breathing and three said that it was helpful in terms of having another way of controlling stress as well as providing them with a different way of seeing things. One participant thought that after having the course she was able to understand depression better.	“I think it's helped some of the way I think about things, not necessarily to do with my illness but maybe to do with if I feel depressed I can think 'these are just thoughts' I try to if I'm thinking very negative thoughts I could sometimes look at the thoughts and think I don't need to think like this, so it had helped me” (Participant 4). “First I feel very clear about that now, about depression and that so I can explain to someone myself what this is and how you can fight that” (Participant 7).