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Study aim: The primary hypotheses test whether MMIH reduces emotional distress (depression, anxiety, OCI-R) and increases life satisfaction. Secondary hypotheses focus on the effects of MMIH on reducing RNT, maladaptive meta-beliefs, psychological inflexibility, and enhancing mindfulness. The mechanism of change hypothesis examines whether changes in meta-beliefs predict improvements in symptoms and broader processes beyond mindfulness. Design: This study was a three-arm randomized controlled trial (RCT) following CONSORT 2010 and longitudinal ‎measurement at three time points: baseline, post-treatment, and 6-month follow-up ‎.‎ Settings and conduct: Participants were recruited from September 3 to May 17, 2025, using a multi-tiered referral and outreach strategy to enhance representativeness and reduce self-selection bias. Participants/Inclusion and exclusion criteria: Eligibility criteria included: (a) meeting DSM-5 diagnostic criteria for at least one disorder in anxiety disorders, depressive disorders, and obsessive-compulsive and related disorders; (b) age 18 or older; and (c) provision of written informed consent. Exclusion criteria included: (a) current or past diagnosis of psychotic disorders, bipolar disorders, severe personality disorders, substance use disorders, or any debilitating medical condition (e.g., uncontrolled chronic illness); and (b) current suicidality. Intervention groups: MMIH is a 10-week manualized group therapy (90 minutes/week), delivered by ‎certified clinicians trained in the MMIH protocol. Main outcome variables: Obsessive–Compulsive Inventory–Revised; Satisfaction with Life Scale; Meta-Inner Humor Scale; Mindful Attention Awareness Scale; Repetitive Thinking Questionnaire – 10 ' Acceptance and Action Questionnaire–II; Metacognitions Questionnaire–30; Self-Compassion Scale – Short Form; Patient Health Questionnaire – 9 item; State–Trait Anxiety Inventory
IRCTID: IRCT20130904014564N2
  1. Comparing the Efficacy and Mechanisms of Change of Meta-Inner Humor Therapy (MIHT) versus ‎Mindfulness-Based Cognitive Therapy (MBCT) for Generalized Anxiety Disorder with or without ‎Major Depressive Disorder: A Multilevel Longitudinal Randomized Controlled Trial
  2. Effectiveness and Mechanisms of Action of Meta-Inner Humor Therapy (MIHT) in Obsessive Compulsive ‎Disorder: Evidence from Ecological Momentary Assessment and Multilevel Network Modeling
  3. Effectiveness of metacognitive therapy in improving sign and symptoms and metacognitive beliefs and quality of life in patients with obsessive-compulsive disorder
  4. Metacognitive Therapy, Fluvoxamine, or Combination Treatment in Obsessive-Compulsive Disorder: A randomized clinical trial
  5. The effectiveness of cognitive behavioral therapy based on exposure and response prevention on reduction of obsessive compulsive symptoms, changing P300 component and improving executive functioning in scrupulosity and contamination obsessions
  6. The Effectiveness of Emotional Schema Therapy on Emotion - Cognitive Regulation, Relationship Beliefs, Body Self - Relation, Partner- Related Obsessive-Compulsive Symptoms, Ambivalence in students
  7. Comparing the Efficacy of Meta-Cognitive and Cognitive-Behavioral Therapy on Obsession and Compulsion symptoms of Patients with Obsessive-Compulsive Disorder (OCD)
  8. Comparison of the Efficacy of Acceptance and Commitment Therapy and Cognitive-Behavior Therapy on experiential avoidance, values and symptom in adolescent Obsessive-Compulsive Disorder
  9. The study of effects meta-cognitive skills training based -on mindfulness on depression, anxiety, stress and well being of systemic lupus erythematosus patients
  10. Comparison of the Effectiveness of Mindfulness-Integrated Cognitive Behavioral Therapy (MiCBT) and Exposure and Response Prevention (ERP) in Individuals with Obsessive-Compulsive Disorder with a History of Childhood Maltreatment
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