Document Type : Original Article
Authors
1 PhD student of Psychology, Department of Psychology, Islamic Azad University, Shahrekord Branch, Shahrekord, Iran
2 Associate Professor, Department of Psychology, Islamic Azad University, Shahrekord Branch, Shahrekord, Iran
3 Assistant Professor, Department of Psychology, Islamic Azad University, Shahrekord Branch, Shahrekord, Iran
Abstract
Introduction: Cardiovascular diseases are among the most lethal physical diseases of the 21st century, posing a greater threat to human life than any other disease and problem. This research compared the effectiveness of mindfulness-based stress reduction and emotion-focused therapy on the cognitive flexibility of cardiovascular patients in Isfahan City.
Methods: The research was conducted using a quasi-experimental design with a pre-test post-test and a three-month follow-up with a control group. The statistical population included 380 male cardiovascular patients admitted to Shahid Chamran Cardiovascular Hospital in Isfahan in the winter of 2023. Forty-five patients were selected by purposive sampling and assigned to two experimental groups and one control group. Patients in the first experimental group received eight 90-minute sessions of mindfulness-based stress reduction, while those in the second experimental group received eight 90-minute sessions of emotion-focused therapy. The measurement tools were the Cognitive Flexibility Questionnaire (Dennis & Vanderwaal, 2010) and a short clinical interview. Research data were analyzed through mixed variance analysis using SPSS version 24 software.
Results: The results showed that both intervention methods increased the average cognitive flexibility and its components, including alternatives, control, and alternatives for human behaviors of patients (P≤0.01). No significant difference was observed between the effectiveness of the two methods (P≥0.01).
Conclusion: According to the research results, it is possible to use the intervention method of mindfulness-based stress reduction program and emotion-focused therapy to improve the cognitive flexibility of cardiovascular patients.
Keywords
- Einarson TR, Acs A, Ludwig C, Panton UH. Prevalence of cardiovascular disease in type 2 diabetes: a systematic literature review of scientific evidence from across the world in 2007–2017. Cardiovascular diabetology. 2018;17:1-19.
- Ranjbaran R, Aliakbari Dehkordi M, Saffarinia M, Alipour A. Effect of health promoting lifestyle training on vitality, psychological well-being and blood pressure of women with cardiovascular disease. Iranian Journal of Cardiovascular Nursing. 2019;8(1):98-109.
- Dannemann S, Matschke K, Einsle F, Smucker MR, Zimmermann K, Joraschky P, et al. Is type-D a stable construct? An examination of type-D personality in patients before and after cardiac surgery. Journal of psychosomatic research. 2010;69(2):101-9.
- Rafieipour A, Sakeni Z, Ramesh S, Mazloom Al-Hosseini N. Cardiovascular Diseases: Psychological Risk Factors. Journal of Research in Behavioural Sciences. 2019;17(3):467-82.
- Abedi Noghondar M, Marghzari M, Taleghani A. The Effect of Emotion-Focused Therapy on Action Flexibility and Death Anxiety iIn Patients with Coronary Artery Disease. Journal of Psychology new Ideas. 2022;12(16):1-15. [In Persian].
- Beglari M, Maleki M, Ghaeeni S. The Relationship between Cardiorespiratory Fitness with Cognitive Flexibility. Sport Psychology Studies (ie, mutaleat ravanshenasi varzeshi). 2017;6(21):89-102. [In Persian].
- Sadeghi M, Moradizadeh S. Study and comparison of type-D personality, social support and cognitive flexibility in normal and cardiac patients. Yafteh. 2018;20(2):41-52.
- Abaeian L, Asadzadeh H, Nasrollahi B. Brain/Behavioral systems in patients with obsessive-compulsive disorder, cardiovascular and normal people. medical journal of mashhad university of medical sciences. 2021;64(1):2467-81. [In Persian].
- Dennis JP, Vander Wal JS. The cognitive flexibility inventory: Instrument development and estimates of reliability and validity. Cognitive therapy and research. 2010;34:241-53.
- Dolan SL, Martin RA, Rohsenow DJ. Self-efficacy for cocaine abstinence: pretreatment correlates and relationship to outcomes. Addict Behav. 2008;33(5):675-88.
- Carbonella JY, Timpano KR. Examining the Link Between Hoarding Symptoms and Cognitive Flexibility Deficits. Behav Ther. 2016;47(2):262-73.
- Dong G, Lin X, Zhou H, Lu Q. Cognitive flexibility in internet addicts: fMRI evidence from difficult-to-easy and easy-to-difficult switching situations. Addict Behav. 2014;39(3):677-83.
- Marko M, Riečanský I. Sympathetic arousal, but not disturbed executive functioning, mediates the impairment of cognitive flexibility under stress. Cognition. 2018;174:94-102.
- Deak GO, Wiseheart M. Cognitive flexibility in young children: General or task-specific capacity? J Exp Child Psychol. 2015;138:31-53.
- Gunduz B. Emotional intelligence, cognitive flexibility and psychological symptoms in pre-service teachers. Educational research and reviews. 2013;8(13):1048-56.
- Bryan CJ, Ray-Sannerud B, Heron EA. Psychological flexibility as a dimension of resilience for posttraumatic stress, depression, and risk for suicidal ideation among Air Force personnel. Journal of Contextual Behavioral Science. 2015;4(4):263-8.
- Wersebe H, Lieb R, Meyer AH, Hofer P, Gloster AT. The link between stress, well-being, and psychological flexibility during an Acceptance and Commitment Therapy self-help intervention. Int J Clin Health Psychol. 2018;18(1):60-8.
- Lee Y, Kang NI, Lee KH, Piao Y, Cui Y, Kim SW, et al. Effects of antipsychotics on rumination in patients with first-episode psychosis. Prog Neuropsychopharmacol Biol Psychiatry. 2020;103:109983.
- Kuehner C, Schricker IF, Nayman S, Reinhard I, Zamoscik V, Kirsch P, et al. Effects of Rumination and Mindful Self-Focus Inductions During Daily Life in Patients With Remitted Depression: An Experimental Ambulatory Assessment Study. Behav Ther. 2023;54(5):902-15.
- Taylor Sh, Sirois F, Molnar D. Health psychology 5ce. New York: McGraw-Hill Ryerson; 2020.
- Jalali D, Abdolazimi M, Alaei Z, Solati K. Effectiveness of mindfulness-based stress reduction program on quality of life in cardiovascular disease patients. Int J Cardiol Heart Vasc. 2019;23:100356.
- Bare A. Mindfulness-based treatment approaches clinicians guide to evidence base and applications. New York: Holt Rinehart and Winston; 2006.
- Kord B. The prediction of subjective well-being based on meaning of life and mindfulness among cardiovascular patients. Iranian Journal of Psychiatric Nursing. 2018;5(6):16-23.
- Ghasemi N. The Comparison of Anxiety Sensitivity and Coping Stress Strategies between Patients with Non-Cardiac Chest Pain, Cardiac Patients and Normal Subjects. Knowledge & Research in Applied Psychology. 2017;17(3):45-58. [In Persian].
- Sperry L. Handbook of diagnosis and treatment of DSM-5 personality disorders: Assessment, case conceptualization, and treatment: Routledge; 2016.
- Praissman S. Mindfulness-based stress reduction: a literature review and clinician’s guide. J Am Acad Nurse Pract. 2008;20(4):212-6.
- Sullivan MJ, Wood L, Terry J, Brantley J, Charles A, McGee V, et al. The Support, Education, and Research in Chronic Heart Failure Study (SEARCH): a mindfulness-based psychoeducational intervention improves depression and clinical symptoms in patients with chronic heart failure. Am Heart J. 2009;157(1):84-90.
- Kabat-Zinn J, Hanh TN. Full catastrophe living: Using the wisdom of your body and mind to face stress, pain, and illness: Delta; 2005.
- Alsubaie M, Dickens C, Dunn BD, Gibson A, Ukoumunne OC, Evans A, et al. Feasibility and acceptability of mindfulness-based cognitive therapy compared with mindfulness-based stress reduction and treatment as usual in people with depression and cardiovascular disorders: A three-arm randomised controlled trial. Mindfulness. 2020;11(1):30-50.
- Garland EL, Gaylord SA, Fredrickson BL. Positive reappraisal mediates the stress-reductive effects of mindfulness: An upward spiral process. Mindfulness. 2011;2:59-67.
- Delizonna LL, Williams RP, Langer EJ. The effect of mindfulness on heart rate control. Journal of Adult Development. 2009;16:61-5.
- Momeni J, Omidi A, Raygan F, Akbari H. Comparing the Effects of Mindfulness-Based Stress Reduction and Cognitive Behavioral Therapy on the Quality of Life of Patients with Cardiovascular Disease. Int J Body Mind Culture. 2018;5(2):94-103.
- Bohlmeijer E, Prenger R, Taal E, Cuijpers P. The effects of mindfulness-based stress reduction therapy on mental health of adults with a chronic medical disease: a meta-analysis. J Psychosom Res. 2010;68(6):539-44.
- Lundgren O, Garvin P, Nilsson L, Tornerefelt V, Andersson G, Kristenson M, et al. Mindfulness-Based Stress Reduction for Coronary Artery Disease Patients: Potential Improvements in Mastery and Depressive Symptoms. J Clin Psychol Med Settings. 2022;29(3):489-97.
- Yook Y-S, Kang S-J, Park I. Effects of physical activity intervention combining a new sport and mindfulness yoga on psychological characteristics in adolescents. International Journal of Sport and Exercise Psychology. 2017;15(2):109-17.
- Amiri N, Hobbi MB, Dehaaqin V, Aghamiri MS, Mousavi SA. The Impact of Mindfulness-Based Cognitive Therapy (MBCT) on the Cognitive Flexibility of Disabled Veterans’ Wives. Military Psychology. 2019;10(39):51-64.
- Nila K, Holt DV, Ditzen B, Aguilar-Raab C. Mindfulness-based stress reduction (MBSR) enhances distress tolerance and resilience through changes in mindfulness. Mental Health & Prevention. 2016;4(1):36-41.
- Greenberg L, Warwar S, Malcolm W. Emotion-focused couples therapy and the facilitation of forgiveness. J Marital Fam Ther. 2010;36(1):28-42.
- Johnson SM. Attachment theory in practice: Emotionally focused therapy (EFT) with individuals, couples, and families: Guilford Publications; 2019.
- Greenberg LS, Goldman RN. Clinical handbook of emotion-focused therapy: American Psychological Association; 2019.
- Salarirad Z, Leilabadi L, Salehi M, Mujembari AK. Effectiveness of emotion-focused therapy on anxiety and quality of life in women with breast cancer. Iranian Journal of Health Psychology; Vol. 2022;5(3).
- Lakani N, Akbari B. The Effectiveness of Cognitive Emotion Regulation on Emotional Regulation, Cognitive Flexibility, and Mental Happiness among Students with Internet-addicted: A Pilot Study. Health. 2021;8(3):453-67. [In Persian].
- Rathgeb-Schnierer E, Green M. Profiles of Cognitive Flexibility in Arithmetic Reasoning: A CrossCountry Comparison of German and American Elementary Students. Journal of Mathematics Education. 2023;10(2):1-16.
- Zarieh S, NADERI F, ASGARI P, BAKHTIAR PS. The effectiveness of emotion-focused therapy in psychological flexibility and internal cohesion among cardiovascular patients with obesity. Mashhad J of Med Scie. 2021;64(3):3364-75. [In Persian].
- Gili S, Sadeghi Zavareh V, Haghayegh SA, Alizadeh Ghavidel A, Rezayi Jamalloi H. The Comparison of Effectiveness of Emotion-Focused Therapy and Transcranial Direct Current Stmulation on Anxiety and Depression of Patients with Coronary Artery Disease. Health Psychology. 2021;9(36):45-62.
- Prochaska JO, Norcross JC. Systems of psychotherapy: A transtheoretical analysis: Oxford University Press; 2018.
- Mao L, Li P, Wu Y, Luo L, Hu M. The effectiveness of mindfulness-based interventions for ruminative thinking: A systematic review and meta-analysis of randomized controlled trials. J Affect Disord. 2023;321:83-95.
- Ettehadieh S. Comparison the effectiveness of acceptance and commitment group therapy and commitment group therapy with emotion-focused group therapy on attachment injury and cognitive flexibility in infertile women. Ferdosi University of Mashhad. 2016. [In Persian].
- American Psychiatric Association. A summary of Diagnostic and statistical manual of mental disorders. 5th ed, Washington: American Psychiatric Press; 2013.