The Impact of Group Cognitive Behavioral Therapy on the Mental Health, Stigma, and Social Capital of Patients with Severe Psychiatric Disorders (Bipolar Disorder, Schizophrenia, and Schizoaffective Disorder) and Its Effect on Their Caregivers

To determine the effect of cognitive-behavioral group therapy on the mental health, stigma, and social capital of patients with severe psychiatric disorders and on the stigma and social capital of caregivers of patients in comparison with a matched control group

To investigate the effectiveness of a group cognitive behavioral therapy intervention on improving severe psychiatric symptoms. A controlled, parallel-group, triple-blind, randomized study on 60 patients and their caregivers. Simple randomization on available samples using statistical randomization software

30 severely mentally ill patients from the Community Mental Health Services Center (Siraj) and caregivers from the Siraj Center and 30 other patients and caregivers from psychiatric clinics To maintain concealment, researchers, outcome assessors, and data analysts will be blinded to group allocation, which will be administered by two participants who are not involved in the study.

- Diagnosis confirmed by two psychiatrists according to DSM-5-TR - Mental status "stable" (PANSS score below threshold). - Age between 18 and 65 years. - Informed consent.

Patients with severe mental disorders at the Siraj Mental Health Community Center, East Karaj, and their caregivers

Determining the effect of group CBT intervention on depression, anxiety, suicidal thoughts, stigma, quality of life, and social capital of patients with severe psychiatric disorders in comparison with the control group

Randomization in this study will be straightforward and will rely on the available samples through simple randomization. Once eligible patients have been identified, statistical randomization software will be utilized to assign them to either the intervention or control groups. This randomization will be conducted on an individual basis. Patients will be divided into the two groups based on relevant psychiatric diagnoses and demographic criteria. To ensure impartiality, the researchers conducting the study (who will be implementing group training using cognitive behavioral therapy), the outcome assessor, and the researcher analyzing the data will be kept unaware of the assignment of patients to the intervention and control groups. The allocation will be managed by two participants who are not involved in the research design.

The researchers conducting this study, who will implement group training using cognitive behavioral therapy and the outcome assessors who will collect the data, as well as the researcher who will analyze it, will be unaware of how patients are allocated to either the intervention or control groups. Patient allocation will be managed by two participants who are not involved in the study's design. Therefore, the study will be conducted in a triple-blind manner. The authors drafting the manuscript will also remain unaware of the patient allocations, including their identities and referral sites. All patients and caregivers considered for participation in the study will be fully informed about the study before it begins, and written informed consent will be obtained from them prior to the start of the research.

In order to maintain maximum confidentiality of patient information