Investigating the effect of eye movement desensitization and reprocessing on internalized stigma in patients with major depressive disorder: a randomized controlled trial

Abstract

Background

Major Depressive Disorder (MDD) is one of the most prevalent mood disorders, and internalized stigma remains a significant challenge faced by individuals. Novel therapeutic approaches, such as Eye Movement Desensitization and Reprocessing (EMDR), may help address this issue. This study aimed to investigate the effect of EMDR on internalized stigma in patients with MDD.

Methods

This study was a Randomized Controlled Trial (RCT) that included 66 patients with MDD at Shahid Rajaei Hospital in Yasuj, Iran, in 2025. Patients were selected using convenience sampling and randomly allocated to either the intervention group (n = 33; receiving seven individual EMDR sessions, each lasting 45–90 min) or the control group (n = 33; receiving standard treatment). Internalized stigma was assessed using the Internalized Stigma of Mental Illness (ISMI) scale at baseline, post-intervention, and three-month follow-up. Data were analyzed using descriptive statistics, paired and independent t-tests, repeated-measures analysis of variance, and analysis of covariance (ANCOVA) in SPSS version 27.

Results

The adjusted mean total internalized stigma score in the intervention group was significantly lower than in the control group at post-test (61.37 vs. 93.78) and three-month follow-up (54.02 vs. 97.16) (P < 0.01). A significant improvement was also observed across all subscales (Alienation, Stereotype Endorsement, Perceived Discrimination, Social Withdrawal, and Stigma Resistance) in favor of the intervention group at both time points (P < 0.001).

Conclusions

EMDR is an effective and non-invasive intervention that helps reduce internalized stigma in patients with MDD.

Trial registration

Iranian Registry of Clinical Trials (IRCT): IRCT20250111064354N1. Registered 9 March 2025, retrospectively registered.

Background

Major Depressive Disorder (MDD) is among the most common mental disorders globally, affecting over 250 million people. According to the World Health Organization (WHO), MDD impacts approximately 3.8% of the global population. The prevalence of MDD is approximately 5% in adults and 5.7% in older adults, and women have a 50% higher incidence than men [1, 2]. Epidemiological data further indicate that 3%–5% of the Iranian population is affected by MDD [3, 4].

The clinical presentation of MDD includes persistent depressed mood, anhedonia, sleep disturbances, psychomotor retardation, and suicidal ideation. According to DSM-5 criteria, a diagnosis requires at least five of these symptoms over a two-week period, with one symptom necessarily being depressed mood or loss of interest/pleasure [5]. Beyond individual suffering, MDD represents a significant global burden, resulting in severe long-term economic and social consequences [6].

While standard treatments—such as pharmacotherapy, psychotherapy, and electroconvulsive therapy—are effective, evidence suggests that combined psychotherapy and pharmacotherapy yield superior outcomes [7–9]. Despite this, only about half of individuals with depression seek professional help [10, 11]. This treatment gap is largely driven by barriers such as privacy concerns, fear of judgment, negative attitudes, and stigma [12, 13]. Among these, stigma is recognized as the primary obstacle to initiating and completing psychiatric rehabilitation [14]. It frequently results in patient resistance to treatment, symptom relapse, and the exacerbation of comorbidities [15, 16].

Mental health stigma is a multifaceted construct that manifests as public, structural, and internalized stigma [17]. Internalized stigma occurs when individuals fully accept society’s negative stereotypes, leading to diminished self-esteem, compromised identity, and social isolation [18, 19]. With an estimated 29% prevalence among MDD patients, internalized stigma significantly complicates clinical management [20]. Consequently, interventions focusing on increasing awareness and rectifying negative self-perceptions are essential [21].

Eye Movement Desensitization and Reprocessing (EMDR), developed by Francine Shapiro, is an evidence-based psychotherapy primarily used for psychological trauma [22–25]. According to the Adaptive Information Processing (AIP) model, EMDR facilitates the reprocessing of maladaptively stored memories through bilateral stimulation, guided recall, and cognitive restructuring [26, 27]. By integrating distressing memories into adaptive networks, EMDR modulates emotional and physiological responses, reducing maladaptive cognitions [28].

In patients with MDD, internalized stigma often manifests as self-blame, alienation, and social withdrawal, which are linked to entrenched negative self-representations. EMDR may target these maladaptive cognitive-affective patterns by processing self-stigmatizing memories and strengthening positive cognitions [29, 30]. While previous studies on MDD and stigma have explored interventions like Group Cognitive-Behavioral Therapy (GCBT) and Mindfulness-based cognitive therapy (M-MBCT) [31, 32], the specific impact of EMDR on internalized stigma remains under-researched.

Given that internalized stigma increases the psychological burden and avoidance of treatment, EMDR may serve as a critical intervention. Therefore, the present study was conducted to determine the effect of EMDR on internalized stigma in patients with MDD. We hypothesized that: (1) participants receiving EMDR would show a significant reduction in total internalized stigma compared to the control group; (2) EMDR would improve specific dimensions of internalized stigma, including alienation, stereotype endorsement, perceived discrimination, social withdrawal, and stigma resistance; and (3) these effects would be maintained at a three-month follow-up.

Methods

Study design and setting

This randomized controlled trial (RCT) was designed and reported in accordance with the CONSORT 2025 statement to ensure transparent and standardized reporting of all study procedures. The study aimed to investigate the effect of EMDR on internalized stigma in patients with MDD. The study was approved by the Ethics Committee of Yasuj University of Medical Sciences (IR.YUMS.REC.1403.160). Following registration with the Iranian Registry of Clinical Trials (IRCT20250111064354N1) and obtaining the study initiation permit from the Vice-Chancellor for Research, the researcher visited the Psychiatry Departments of Shahid Rajaei Hospital in Yasuj, affiliated with Yasuj University of Medical Sciences, to collect data during 2025.

Participants

Patients aged ≥ 18 years diagnosed with major depressive disorder (MDD) according to DSM-5 by a psychiatrist, with at least one prior hospitalization due to the severity of the disorder, were recruited from accessible patients using a convenience sampling approach. Although participants were selected based on availability, they were subsequently randomly assigned to either the intervention or control group using a block randomization method, ensuring adherence to RCT design principles. We acknowledge that the use of convenience sampling may limit the external validity of the findings, and this is discussed in the Limitations section. Inclusion criteria for the study consisted of: willingness and readiness to participate in EMDR sessions, ability to effectively communicate and cooperate with researchers and therapists, intact sensory functions— especially vision and hearing, hemodynamic stability without any underlying cardiovascular disease (such as hypertension or heart failure), and no concurrent enrollment in mindfulness courses or other Cognitive Behavioral Therapies (CBT). Exclusion criteria for the study included: attempted suicide or serious self-harm in the past month that resulted in hospitalization, and substance or alcohol dependence. All participants were required to be on a stable dose of antidepressant medication for at least four weeks prior to enrollment, and no changes in medication were permitted during the study to minimize confounding effects.

Participants who met the inclusion criteria were randomly assigned to either the intervention group (n = 36) or the control group (n = 36) using a block randomization method with block sizes that were multiples of two. The allocation sequence was generated through the Sealed Envelope™ online randomization service (an independent, web-based system designed to generate and conceal random allocation sequences). The allocation list was prepared in advance, and group assignments were concealed until the moment of participant enrollment to ensure allocation concealment [33]. During the study, six participants withdrew. One participant was excluded due to suicidal behavior following an exacerbation of their condition; another withdrew due to dissatisfaction with the treatment process; and the remaining participants were discharged at their own request and did not return to complete the study. Thus, 66 participants (n = 33 per group) completed the intervention (Fig. 1).

Fig. 1.

CONSORT flow diagram of participant selection, enrollment, and follow-up

Intervention

Following informed consent and completion of a sociodemographic form and baseline ISMI assessment, the intervention was conducted by a trained researcher under the supervision of an experienced EMDR therapist. The EMDR was implemented according to the standard eight-phase protocol [26], adapted to up to seven phases depending on individual clinical progress. Sessions were scheduled every other day, starting with a 90-minute introductory session followed by 45-minute sessions thereafter.

• Phase 1: Essential client information was collected, and treatment plans were formulated.

• Phase 2: The treatment plan and expectations were reviewed, and self-control techniques and relaxation methods were introduced.

• Phase 3: The objective of this phase is to access target memories for processing by exploring various aspects of the core memory. At this stage, the patient rated the intensity of their feelings using the Validity of Cognition (VOC) scale (1–7; 1 = completely false, 7 = completely true) and the Subjective Units of Distress (SUD) scale (0–10; 0 = no distress, 10 = worst possible) [34, 35]. These ratings were used both to monitor the patient’s response during memory recall and as auxiliary outcome measures for the intervention. The individual’s level of subjective distress at the moment of recalling the unpleasant memory was assessed using the SUD scale. Simultaneously, a pleasant memory was elicited from the patient to prepare for replacement.

• Phase 4: During Phase 4, bilateral stimulation (BS) was administered using the trained researcher’s finger movements (typically 15–30 movements per set), while the patient focused on the distressing memory, associated negative cognitions, and emotional responses. SUD and VOC ratings were assessed repeatedly throughout this phase to guide the intervention and track changes in subjective distress and cognition.

• Phase 5: The strongest connection with the most appropriate positive cognition related to the core event. The patient was instructed to think about the target event while simultaneously holding the selected positive cognition in mind.

• Phase 6: The patient examined the parts of their body, identifying and reprocessing any physical tension or discomfort.

• Phase 7: The patient returned to a state of relaxation and balance; thoughts, emotions, and physical attributes were examined.

• Phase 8: The outcome of the reevaluation was examined; participants again completed the SUD and VOC scales. Based on these assessments, planning for subsequent sessions was conducted [36].

Ultimately, after completing 7 sessions (post-intervention) and at the three-month follow-up, a post-test was administered using the ISMI scale. In contrast, the control group received only the standard routine care during this period.

Measurements

Internalized stigma of mental illness scale

A 29-item, four-point Likert scale (strongly agree (4), agree (3), disagree (2), and strongly disagree (1)), designed by Ritscher et al. (2003). The total score ranges from 29 to 116, with higher scores indicating a higher level of internalized stigma. It comprises five subscales: Alienation (6 items; items: 1, 5, 8, 16, 17, 21), Stereotype Endorsement (7 items; items: 2, 6, 10, 18, 19, 23, 29), Perceived Discrimination (5 items; items: 3, 15, 22, 25, 28), Social Withdrawal (6 items; items: 4, 9, 11, 12, 13, 20), and Stigma Resistance (5 items; items: 7, 14, 24, 26, 27) [37]. The Persian version of the ISMI scale is a valid and reliable instrument for assessing internalized stigma in psychological and psychiatric research in Iran (Cronbach’s α = 0.74–0.94) [38]. In a pilot study with 30 patients, Jacobson et al. (2013) reported high reliability (Cronbach’s α = 0.87) [39]. The internal consistency of the instrument was acceptable, with a Cronbach’s alpha coefficient of 0.746.

Statistical analysis

Sample size was calculated using the G*Power software (version 3.1.9.7). Based on the study by Sarah Gonzalez et al. [40], based on an effect size of 0.16, a = 0.50, Power = 0.80, two groups, three measurements, correlation among repeated measures = 0.50, No sphericity correction = 1, yielding n = 33 per group (adjusted to n = 36 for 10% attrition). Data were analyzed using SPSS version 27. Data Normality was assessed via the Shapiro-Wilk test. Descriptive statistics, including the adjusted means, standard errors, tables, and graphs, were used, depending on the distribution, independent samples t-test or Mann-Whitney U test was used for continuous variables, and the chi-square test was applied for categorical variables. Repeated measures analysis, repeated measures analysis of covariance (RM-ANCOVA), and separate analyses of covariance (ANCOVA) were performed as appropriate to evaluate changes over time and to adjust for covariates. A p- value less than 0.05 was considered statistically significant. Missing data were handled using a complete-case (per-protocol) approach. Participants who withdrew before post-intervention assessment were excluded from the final analysis. The attrition rate was low (8.3%) and balanced between groups. No imputation techniques were applied due to the low proportion of missing data.

Sociodemographic information form

Collected data on age, gender, marital status, education, employment status, duration of hospitalization, and duration of illness.

Results

Table 1 presents the baseline sociodemographic and clinical characteristics of the participants in the two study groups.

Table 1.

Sociodemographic and clinical information of the sample baseline characteristics, including gender, marital status, education level, and employment status, show no statistically significant difference between the intervention and control groups

Scale	Level	Intervention	Control	Test	P-value
Gender	Male	6(18.2%)	6(18.2%)	= 0.000	1.00
	female	27(81.8%)	27(81.8%)
Marital status	Single	12(36.4%)	9(27.3%)	= 0.629	0.428
	Married	21(63.6%)	24(72.7%)
Education	Below high school diploma	26(78.8%)	26(78.8%)	= 0.000	1.000
	Above high school diploma	7(21.2%)	7(21.2%)
Job	Employed	8(24.2%)	8(24.2%)	= 0.739	0.691
	Unemployed	12(36.4%)	9(27.3%)
	Homemaker	13(39.4%)	16(48.5%)
Age (mean ± SD)		33.18 ± 9.01	34.97 ± 8.57	t = − 0.825	0.412
Duration of hospitalization Median (IQR) (month)		4(3)	4(2.5)	Z=-0.169	0.866
Duration of illness Median (IQR) (month)		24(48)	24(43)	Z=-0.342	0.733

(P-value > 0.05). No statistically significant difference was observed in mean age, distribution of duration of hospitalization and, duration of illness between the two groups (P-value > 0.05) (Table 1)

The analysis of pre-test scores for the variables of Stereotype Endorsement and Stigma Resistance revealed that the two groups were homogeneous, with no statistically significant difference observed at baseline (P-value > 0.05). Consequently, including the pre-test scores as a covariate in the model was not required for these variables. However, for the other variables—including Alienation, Perceived Discrimination, Social Withdrawal, and total stigma score-the pre-test values showed a statistically significant difference between the two groups (P-value < 0.05) (Table 2). Therefore, the pre-test scores of these variables were entered into the model as covariates to assess the intervention effect while controlling for initial differences.

Table 2.

Baseline comparison between intervention and control groups

Scale	Group	Mean	SE	Test	P-value
Alienation	Intervention	19.00	0.56	t = − 2.47	0.018
	Control	20.15	0.23
Stereotype Endorsement	Intervention	20.73	0.44	t = 0.055	0.956
	Control	20.69	0.32
Perceived Discrimination	Intervention	14.91	0.38	t = − 2.95	0.004
	Control	16.36	0.31
Social Withdrawal	Intervention	17.78	0.51	t = − 3.79	< 0.001
	Control	20.00	0.29
Stigma Resistance	Intervention	13.00	0.36	t = − 1.43	0.156
	Control	13.63	0.26
Total stigma	Intervention	85.42	1.52	t = − 3.42	0.001
	Control	91.21	0.74

This table presents the group × time interaction effect for all scales. The interaction effect was significant for all measures (P < 0.001) except for " stigma resistance” (P-value > 0.05). The significant interaction indicates that the pattern of score changes over time differed between the intervention and control groups. Due to the significance of the interaction, the main effects of time and group alone are not independently interpretable. Since there was no significant difference in stigma resistance scores between the two groups before the intervention, the baseline scores for this variable were homogeneous and thus did not require statistical control. Furthermore, the Group × Time interaction for this variable was not statistically significant(Table 3). Consequently, the main effects of time and group can be interpreted independently. Both the main effect of time and the main effect of group were statistically significant. Specifically, the Stigma Resistance score was significantly higher in the intervention group compared to the control group (P-value < 0.001). Additionally, the Stigma Resistance score at the follow-up was significantly higher than immediately post-intervention (P-value < 0.001) (Table 4).

Table 3.

Interaction effect of group × time for all scales (Repeated Measures ANCOVA and Repeated Measures)

Scale	Interaction F	P-value	η²	Interpretation
Total stigma	146.98	< 0.001	0.70	Significant interaction → different change over time between groups
Alienation	96.49	< 0.001	0.61	Significant interaction
Perceived Discrimination	29.65	< 0.001	0.32	Significant interaction
Social Withdrawal	95.38	< 0.001	0.60	Significant interaction
Stereotype Endorsement	99.03	< 0.001	0.61	Significant interaction
Stigma Resistance	2.72	0.104	0.041	Not significant → interpret main effects

Table 4.

Adjusted post-intervention and follow-up comparisons between groups (ANCOVA or independent t-test where appropriate)

Scale	Time	Intervention Mean	Control Mean	Test (F or t)	P-value	η²
Total stigma	Post-test	61.37	93.78	F = 641.64	< 0.001	0.911
	Follow-up	54.02	97.16	F = 1986.87	< 0.001	0.969
Alienation	Post-test	11.77	21.47	F = 785.54	< 0.001	0.926
	Follow-up	9.39	22.19	F = 1386.34	< 0.001	0.956
Perceived Discrimination	Post-test	9.29	17.19	F = 257.03	< 0.001	0.803
	Follow-up	7.86	17.95	F = 1044.69	< 0.001	0.943
Social Withdrawal	Post-test	10.83	20.96	F = 533.86	< 0.001	0.894
	Follow-up	8.73	21.84	F = 1135.70	< 0.001	0.947
Stereotype Endorsement	Post-test	12.78	22.87	t = − 20.30	< 0.001	> 0.8
	Follow-up	10.45	23.61	t = − 33.99	< 0.001	> 0.8
Resistance to Stigma	Post-test	16.54	11.42	F = 12.15	< 0.001	0.160
	Follow-up	17.39	11.72	F = 12.15	< 0.001	0.160

For a more detailed analysis of the other measures, group differences were examined independently at each time interval, as detailed in Table 4.

This table presents the results of comparisons between the intervention and control groups at the post-test and follow-up. For the measures in which the pretest scores differed between the two groups (Total stigma, Alienation, Perceived Discrimination, Social Withdrawal), ANCOVA was used, controlling for the pretest scores, to examine the true effect of the intervention on the outcomes. For scales in which pretest scores were homogeneous between the groups (Alienation), an independent samples t-test was employed.

The results indicated that for all measures, the intervention group had significantly lower scores than the control group at both post-test and follow-up assessments (P < 0.01 to P < 0.001). This demonstrates the positive effect of the intervention on reducing stigma, Alienation, Perceived Discrimination, Social Withdrawal, and Stereotype Endorsement.

The pretest scores as covariates were also significant, confirming the appropriateness of controlling for baseline differences. The Adjusted R-squared (Adjusted R²) values across the models were remarkably high, ranging from 0.93 to 0.98, which indicates the strong explanatory power of the model in accounting for the variance in outcomes. This high value further supports the strength of the intervention effect and the group differences (Table 4).

Discussion

This study investigated the effect of EMDR on internalized stigma and its dimensions (Alienation, Stereotype Endorsement, Perceived Discrimination, Social Withdrawal, and Stigma Resistance) in patients with MDD. Assessments at three time points: pre-intervention, post-intervention, and at a three-month follow-up, EMDR significantly reduced total internalized stigma compared to the control group. Improvements were also observed in specific dimensions, including Stereotype Endorsement and Stigma Resistance. Within the intervention group, scores decreased significantly over time, while no significant changes were observed in the control group. These findings, supported by RM-ANOVA (P < 0.001), highlight the efficacy of EMDR in reducing internalized stigma in patients with MDD.

The findings of the present study align with previous research demonstrating the efficacy of psychological interventions in reducing stigma and improving mental health outcomes. For example, Group Cognitive-Behavioral Therapy (GCBT) has been shown to reduce internalized stigma and improve treatment adherence in patients with MDD [41], while Mixed-Mode Mindfulness-Based Cognitive Therapy (M-MBCT) increased resilience and self-esteem and significantly reduced stigma in patients with schizophrenia [42]. Similarly, EMDR has been reported to alleviate depressive symptoms, enhance quality of life, and reduce PTSD-related stigma in clinical populations [26, 43]. Compared with these studies, our research extends the evidence by demonstrating a targeted effect of EMDR on internalized stigma in patients with MDD, addressing both cognitive and emotional components of stigma. Minor differences in effect sizes and specific stigma dimensions may be attributable to variations in sample characteristics, intervention protocols, and cultural contexts, highlighting the importance of context-specific application of EMDR.

The results suggest that EMDR is effective in reducing internalized stigma among patients with MDD. Mechanistically, EMDR may facilitate this reduction by reprocessing maladaptive memories, decreasing self-blame and shame, and fostering adaptive cognitive restructuring through the activation of the AIP model and bilateral stimulation (BS) [26]. Specifically, Phase 3 and 4, involving memory recall and bilateral stimulation, likely helped participants process distressing self-related beliefs, reducing alienation and stereotype endorsement, while Phase 5 and 6 reinforced adaptive cognitions and mitigated social withdrawal. This pathway aligns with prior findings demonstrating EMDR’s capacity to reduce self-stigma and improve psychosocial functioning in patients with psychiatric conditions [29, 44].

Despite a non-significant upward trend at follow-up, possibly due to MDD’s progressive nature, community reintegration challenges, and waning hospital support. These findings align with numerous studies validating the effectiveness of psychological interventions in mitigating stigma and enhancing mental health. For instance, M-MBCT improved resilience, self-esteem, and stigma of patients with schizophrenia [32]. GCBT reduced stigma and improved treatment adherence among individuals with MDD [31]. Similarly, EMDR has shown a positive impact on the quality of life in patients with MDD [45] and depression in patients with myocardial infarction [46], as well as pain intensity and subjective distress in cancer patients [47], and Post Traumatic Stress Disorder (PTSD) symptoms with mental health stigma in veterans [23]. Our study extends this by demonstrating EMDR’s targeted impact on internalized stigma, a key barrier to adherence in mental illness outpatients [48] through AIP model activation and Bilateral Stimulation (BS), which reprocesses maladaptive memories and fosters healthier neural storage in a healthier and less threatening form [26]. Overall, these results suggest that EMDR not only alleviates core clinical symptoms of depression but also targets the psychosocial components associated with internalized stigma. By addressing maladaptive self-beliefs and enhancing adaptive cognitive-emotional processing, EMDR can contribute to integrated treatment models and improved management strategies for MDD.

An observed baseline imbalance in certain demographic variables (e.g., age or education level) may be attributable to the use of convenience sampling and the relatively small sample size, which can introduce random variability despite block randomization. To address this potential confounding, we employed [insert statistical correction method used, e.g., ANCOVA or covariate adjustment] to control for baseline differences. This correction method adjusts the post-intervention and follow-up comparisons for initial discrepancies, reducing the risk of bias and enhancing the internal validity of the study. By accounting for baseline imbalances, the observed effects of EMDR on internalized stigma are more reliably attributed to the intervention rather than to pre-existing differences between groups. Nevertheless, the presence of baseline variability highlights the importance of cautious interpretation and suggests that future studies with larger, fully randomized samples may further strengthen the generalizability of the findings. The findings indicate that EMDR can help develop integrated treatment models by filling existing gaps in the treatment of psychiatric disorders, ultimately leading to improved management strategies for MDD.

This study has several limitations that should be considered when interpreting the findings. First, the relatively long sampling period may have introduced temporal variations in patient characteristics, clinical status, and treatment contexts, which could influence the outcomes. Second, participants were recruited from a single clinical setting using a convenience sampling approach, potentially limiting the generalizability of the results to other psychiatric populations, clinical settings, or cultural contexts. Third, although all participants were required to maintain stable antidepressant medication during the study, the potential influence of individual differences in pharmacological response cannot be completely ruled out. Finally, the study focused exclusively on patients with Major Depressive Disorder, and therefore, the findings may not be directly applicable to patients with other psychiatric disorders. Future research using multi-center designs, larger and more diverse samples, and longer follow-up periods is recommended to confirm the replicability and broader applicability of EMDR in reducing internalized stigma.

Based on the findings of this study, it is recommended that future research investigate the efficacy of EMDR in reducing internalized stigma across other types of depressive disorders. Additionally, comparing EMDR with other therapeutic interventions and examining the effectiveness of group-based EMDR on internalized stigma reduction are also warranted.

Conclusions

The findings of this study clearly demonstrate that EMDR intervention significantly reduced total internalized stigma in patients with MDD. By targeting the anxieties and negative emotions associated with stigma, this method helps patients reconstruct their perspective on their illness and personal worth. Moreover, given that internalized stigma is a key factor contributing to resistance against rehabilitative treatments and, ultimately, the persistence and exacerbation of MDD, this approach can positively influence overall therapeutic outcomes. These findings highlight the potential of EMDR as an adjunctive approach in the prevention and treatment of stigma, as well as in increasing treatment adherence and improving quality of life among stigma-vulnerable populations, and suggest the integration of EMDR in healthcare systems and the treatment process for individuals with MDD.

Abbreviations

AIP

Adaptive Information Processing

ANCOVA

Analysis of Covariance

BS

Bilateral Stimulation

CBT

Cognitive Behavioral Therapies

DSM-5

Diagnostic and Statistical Manual of Mental Disorders

EMDR

Eye Movement Desensitization and Reprocessing

GCBT

Group Cognitive-Behavioral Therapy

IRCT

Iranian Registry of Clinical Trials

ISMI

Internalized Stigma of Mental Illness

M-MBCT

Mixed-Mode Mindfulness-based cognitive therapy

MDD

Major Depressive Disorder

PTSD

Post Traumatic Stress Disorder

RCT

Randomized Controlled Trial

RM-ANOVA

Analysis of Variance with Repeated Measures

SUD

Subjective Units of Distress

VOC

Validity of Cognition

WHO

World Health Organization

Author contributions

MB: Designed the study, wrote the protocol, supervised data collection, and reviewed & edited. NS: writing—original draft, data collection. PR: conducted literature searches and provided summaries of previous research studies. MM and NR: Data curation and statistical analysis. PR, MM, and NR are advisors in the project. All authors contributed to and have approved the final manuscript.

Funding

This article is derived from the Master’s thesis of the second author. The study was conducted with the financial and administrative support of the Research Vice-Chancellor of Yasuj University of Medical Sciences.

Data availability

The data and materials presented in this study are available on request from the corresponding author.

Declarations

Ethics approval and consent to participate

The study was approved by the Ethics Committee of Yasuj University of Medical Sciences (IR.YUMS.REC.1403.160). All participants provided written informed consent to participate in the study after being fully informed about the purpose, methods, potential risks, and benefits of the study.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.