Anonymised qualitative results.

<div><p>Behavioral Activation Therapy (BAT) is widely used in Western countries, and digital interventions based on BAT are also increasingly common. This study explored how BAT can be adapted for Chinese employees. Through twelve co-design workshops conducted online, a total of 46 Chinese employees actively participated in the process of defining positive activities for behavioural activation therapy. Using Hofstede’s cultural dimensional theory as a framework and considering the traditional influence of Confucianism and the dynamic nature of China’s contemporary socio-cultural transformation, we identified and examined culturally sensitive and controversial activities that emerged during the study. Our findings indicate that Chinese participants, when compared to their western counterparts, generally displayed less favourable attitudes towards activities such as extreme sports, religion, charitable work, family or after-work social activities. Additionally, they demonstrated less willingness to express emotions openly, provide constructive upward feedback, or seek assistance from mental health experts. Our research indicates that the implementation of behavioural activation activities, as validated in Western literature and classified into three layers in our study—general, workplace-related, and mental health-related—needs to be carefully adapted to align with the current Chinese cultural and societal context, this includes recommending leisure activities that are lighter and less risky, provide cultural sensitive advisory that facilitate effective workplace communication, and consider offering mental health self-help knowledge toolkits.</p></div>