مقایسه اثربخشی بازتوانی شناختی و درمان مبتنی بر شفقت بر انعطاف‌پذیری شناختی سالمندان مبتلا به اختلال شناختی خفیف

Recognizing the needs and health status of the elderly is a decisive issue of any society, and to empower and improve the elderly’s conditions, innovative therapeutic and rehabilitative approches should be investigated. Therefore, the current study aimed to compare the effectiveness of cognitive rehabilitation and compassion-‌based therapy on cognitive flexibility of elderly people with mild cognitive impairment. This was a quasi-‌experimental study with pretest-‌posttest design with a control group and a one-month follow-‌up. The statistical population included all the elderly with mild cognitive impairment living in Tehran who referred to the health centers of Tehran University of Medical Sciences in 2021, among whom 42 people were selected using purpesful sampling method and randomly assigned to the cognitive rehabilitation, compassion-‌based therapy, and control groups. Each of the theraputetic methods of cognitive rehabilitation and compassion-‌based therapy was performed for the related experimental groups in eight 90- minute sessions, and the control group received no training at this time. The measure applied in this study included Dennis and Vander Wal’s cognitive flexibility questionnaire. The data were analyzed using analysis of covariance (ANCOVA) in SPSS-26 software. The results revealed that both cognitive rehabilitation and compassion-‌based therapy were effective on the variables of perceived control, perceived behavioral justification, and perceived choice in the elderly with mild cognitive impairment (p<0.05). However, cognitive rehabilitation was more effective than compassion-‌based therapy on perceived justification. Based on the results of the study, the educational packages of this study can be used in elderly care homes and centers to improve their quality of life.
References
Abdulabadi, H., Pilevar, S., & Sarmi, A. (2015). The Effect of cognitive rehabilitation on cognitive functions, memory, depression and anxiety in patients with multiple sclerosis. Shafaie Khatam. 4(3), 5-‌38. https://doi.org/10.32598/sija.2022.3272.1 [Persian]
Agapoff IV JR, Maixner S, Takeshita J, Nikogosyan G, Kirwin P. (2022). A Survey of geriatric psychiatry fellows and program directors: specialty choice, program choice, and program quality. Academic Psychiatry, 46(4):455-‌9. https://doi.org/10.1007/s40596-‌022-‌01611-‌6
Amini, S., Dehghani cham piri, A., Salehi, A., & Soltani zadeh, M. (2019). The Role of psychological capital and psychological flexibility in predicting loneliness in elderly. Aging Psychology, 5(1), 77-‌88. https://doi.org/10.22126/JAP.1970.1178 [Persian]
Ashori, M. (2019). Effect of cognitive rehabilitation program based on memory on executive functions and cognitive emotion regulation in children with hearing impairment. Psychology of Exceptional Individuals. 9(34), 197-‌217. https://doi.org/10.22054/jpe.2019.42397.1994
Au, T. M., Sauer-‌Zavala, S., King, M. W., Petrocchi, N., Barlow, D. H., & Litz, B. T. (2017). Compassion-‌based therapy for trauma-‌related shame and posttraumatic stress: Initial evaluation using a multiple baseline design. Behavior Therapy, 48(2), 207-‌221.‏ https://doi.org/10.1016/j.beth.2016.11.012 pmid: 28270331
Baker, D. A., Caswell, H. L., & Eccles, F. J. R. (2019). Self-‌compassion and depression, anxiety, and resilience in adults with epilepsy. Epilepsy Behavior, 90 (3), 154-‌161. https://doi.org/10.1016/j.yebeh.2018.11.025
Barbarulo, A. M., Lus, G., Signoriello, E., Trojano, L., Grossi, D., Esposito, M., Costabile, T., Lanzillo, R., Saccà, F., Morra, V. B., & Conchiglia, G. (2018). Integrated Cognitive and Neuromotor Rehabilitation in Multiple Sclerosis: A Pragmatic Study. Frontiers in Behavioral Neuroscience, 12, 196. https://doi.org/10.3389/fnbeh.2018.00196
Basaknejad, S., Aghajani Afjadi, A., & Abbaspour, Z. (1400). The Effectiveness of cognitive rehabilitation therapy oin cognitive flexibility and visuospatial component of working memory in patients with neurological disorders. Health Promotion Management, 10(6), 111-‌126. [Persian]
Basharpour, S., Rahimi, S. & Sedaqat, M. (2018). The Role of psychological flexibility and emotion processing styles in predicting death anxiety in the elderly. Psychology of Aging, 5(2), 131-‌141. https://doi.org/ 10.22126/JAP.1970.1177 [Persian]
Beirami, M., Hashemi, T., Khanjani, Z., Nemati, F., & Rasulzadeh, H. (2021). The Effectiveness of cognitive rehabilitation based on motor control in improving executive functions (cognitive flexibility, working memory, reaction time, response inhibition, sustained attention) in students with attention deficit disorder. Modern Psychological Research, 16(61), 1-‌18. https://doi.org/ 20.1001.1.27173852.1400.16.61.1.4 [Persian]
Bell, T., Montague, J., Elander, J., & Gilbert P. (2020). A Definite feelǦit moment: 2 Embodiment, externalisation and emotion during chairǦwork incompassionǦ focused therapy. Counselling and Psychotherapy Research, 20(1), 143-‌153. https://doi.org/10.1002/capr.12248
Choi, J., & Twamley, E. W. (2013). Cognitive rehabilitation therapies for Alzheimer’s disease: a review of methods to improve treatment engagement and self-‌efficacy. Neuropsychology Review, 23, 48-‌62.‏ https://doi.org/10.1007/s11065-‌013-‌9227-‌4
Cook, J. A., Morrow, M., & Battersby, L. (2017). Intersectional policy analysis of self-‌directed mental health care in Canada. Psychiatric Rehabilitation Journal, 40(2), 244–251. https://doi.org/10.1037/prj0000266
Dennis, J. P., & Vander Wal, J. S. (2010). The Cognitive flexibility inventory: instrument development and estimates of reliability and validity. Cognitive Therapy and Research, 34, 241-‌253. https://doi.org/10.1007/s10608-‌009-‌9276-‌4
Duarte, J., & Pinto-‌Gouveia, J. (2017). Mindfulness, self-‌compassion and psychological inflexibility mediate the effects of a mindfulness-‌based intervention in a sample of oncology nurses. Journal of Contextual Behavioral Science, 6(2), 125-‌133. https://doi.org/10.1016/j.jcbs.2017.03.002
Ehret, A. M., Joormann, J., & Berking, M. (2018). Self-‌compassion is more effective than acceptance and reappraisal in decreasing depressed mood in currently and formerly depressed individuals. Journal of Affective Disorders, 226, 220-‌226.‏ https://doi.org/10.1016/j.jad.2017.10.006 pmid: 28992586
Fazli, A., Shakiba, Sh., & Dolatshahi, B. (2022). The Effectiveness of cognitive rehabilitation in the improvement of cognitive deficits in patients with chronic schizophrenia based on cognitive levels. Iran Psychiatry and Clinical Psychology, 28(1), 2-‌19. http://ijpcp.iums.ac.ir/article-‌1-‌3471-‌fa.html [Persian]
Ghodrati Torbati A, Nejat H, Toozandehjani H, Samari A A, Akbari Amarghan H. (2020). Effect of compassion-‌focused therapy (cft) on blood cortisol and cognitive-‌emotion regulation in drug abusers. Jundishapur J Health Science;12(1) Article: 100148. https://doi.org/10.5812/jjhs.100148 10.5812/jjhs.100148
Gilbert, P. (2014). The Origins and nature of compassion focused therapy. British Journal of Clinical Psychology, 53(1), 6-‌41.‏ https://doi.org/ 10.1111/bjc.12043
Gretchen O. R., Kim W., Seth A. G. (2021). Mindfulness and cognitive training interventions in mild cognitive impairment: impact on cognition and mood, The American Journal of Medicine, 134(4), 444-‌455. https://doi.org/ 10.1016/j.amjmed.2020.10.041
Grodin, J., Clark, J. L., Kolts, R., & Lovejoy, T. I. (2019). Compassion focused therapy for anger: A pilot study of a group intervention for veterans with PTSD. Journal of Contextual Behavioral Science, 13,27-33. https://doi.org/10.1016/j.jcbs.2019.06.004
Hosseini, F. (2018). Investigating the effectiveness of cognitive rehabilitation of working memory in the cognitive functions of anxious female high school students. Master's Thesis, Faculty of Psychology, Higher Education Institute of Cognitive Sciences. [Persian]
Hulbert Williams, N. J., Storey, L., & Wilson, K.G. (2015). Psychological interventions for patients with cancer: psychological flexibility and the potential utility of Acceptance and Commitment Therapy. European Journal of Cancer Care, 24(1), 15-‌27. https://doi.org/10.1111/ecc.12223
Javadzadeh, Z., Nejati, V., & Pushneh, K. (2023). The Effectiveness of Baran's cognitive rehabilitation program in the executive functions of children with high-‌functioning autism. Rehabilitation Medicine,12(1),132-145. https://doi.org/10.22037/JRM.2021.112500.2205 [Persian]
Johnco, C., Wuthrich, V. M., & Rapee, R. M. (2014). The influence of cognitive flexibility on treatment outcome and cognitive restructuring skill acquisition during cognitive behavioural treatment for anxiety and depression in older adults: Results of a pilot study. Behaviour Research and Therapy, 57, 55-‌64.‏ https://doi.org/10.1016/j.brat.2014.04.005
Keel, C., & Pidgeon, A. M. (2017). Mediating role of self-‌compassion, emotional regulation on the relationship between, and Psychological Distress. Journal of Basic and Applied Research., 3(3), 107-‌113. https://www.jbarbiomed.com/index.php/home/article/view/159
Kim J-‌H, Han J-‌Y, Park G-‌C, Lee J-‌S. (2020). Cognitive Improvement Effects of Electroacupuncture Combined with Computer-‌Based Cognitive Rehabilitation in Patients with Mild Cognitive Impairment: A Randomized Controlled Trial. Brain Sciences, 10(12), 984. https://doi.org/10.3390/brainsci10120984
Kola A. (2021). Examination of Cognitive Flexibility over Time in Response to a Cognitive Rehabilitation Program in Pediatric Traumatic Brain Injury Patients, Ph.D. Thesis, Texas Woman's University. https://hdl.handle.net/11274/13232
Krieger, T., Reber, F., von Glutz, B., Urech, A., Moser, C. T., Schulz, A., & Berger, T. (2019). An internet-‌based compassion-‌focused intervention for increased self-‌criticism: a randomized controlled trial. Behavior Therapy. 50(2), 430-‌445.‏ https://doi.org/10.1016/j.beth.2018.08.003 pmid: 30824257
Maggio M. G., De Luca R., Manuli A., Buda A., Cuzzola M. F., Leonardi S., D’Aleo G., Bramanti P., Russo M., Calabrò R. S. (2020) Do patients with multiple sclerosis benefit from semi-‌immersive virtual reality? A randomized clinical trial on cognitive and motor outcomes. Applied Neuropsychology: Adult 0:0, pages 1-‌7. https://doi.org/0.1080/23279095.2019.1708364
Masuda, C., Aggarwal, L., Bray, M. L., Cheung, C. K., Kim, B. J., Wen, A., ... & Masaki, K. (2022). Preventive Care and Outcomes of Interprofessional Medicare Annual Wellness Visits for Older Adults. International Journal of Environmental Research and Public Health, 19(24), 16752.‏ https://doi.org/10.3390/ijerph192416752
Matos, M., Carvalho, S. A., Cunha, M., Galhardo, A., & Sepodes, C. (2017). Psychological flexibility and self-‌compassion in gay and heterosexual men: How they relate to childhood memories, shame, and depressive symptoms. Journal of LGBT Issues in Counseling, 11(2), 88-‌105. https://doi.org/10.1080/15538605.2017.1310007
Mingming, Y., Bolun, Z., Zhijian, L., Yingli, W., & Lanshu, Z. (2022). Effectiveness of computer-‌based training on post-‌stroke cognitive rehabilitation: A systematic review and meta-analysis. Neuropsychological Rehabilitation, 32(3), 481-‌497. https://doi.org/10.1080/09602011.2020.1831555
Miranda, R., Valderrama, J., Tsypes, A., Gadol, E., & Gallagher, M. (2013). Cognitive inflexibility and suicidal ideation: Mediating role of brooding and hopelessness. Psychiatry Research, 25(1): 390-‌399. https://doi.org/10.1016/j.psychres.2013.02.033
Neff, K. D. (2016). Does self-‌compassion entail reduce self-‌judgment, isolation, and over-‌identification? A response to Muris, Otgaar, and Petrocchi. Mindfulness. 7(3), 791-‌797. https://doi.org/10.1007/s12671-‌016-‌0531-‌y
Neff, K. D. (2016). The self-‌compassion scale is a valid and theoretically coherent measure of self-‌compassion. Mindfulness, 7(1), 264-‌274. https://doi.org/10.1007/s12671-‌015-‌0479-‌3
Nie, P., Liu, F., Lin, S., Guo, J., Chen, X., Chen, S., & Lin, R. (2022). The effects of computer assisted cognitive rehabilitation on cognitive impairment after stroke: A systematic review and meta-‌analysis. Journal of Clinical Nursing, 31(9-‌10), 1136-‌1148. https://doi.org/10.1111/jocn.16030
Parhoon H, Moradi A, Hasanabadi H, Akbari M E. (2019). Effectiveness of cognitive rehabilitation on Executive Function and Self-care Behavior in patients with Brest Cancer. Behavioral Sciences. 16 (3), 365-‌378.
URL: http://rbs.mui.ac.ir/article-‌1-‌618-‌fa.html [Persian]
Plys, E., Jacobs, M. L., Allen, R. S., & Arch, J. J. (2022). Psychological flexibility in older adulthood: a scoping Review. Aging & Mental Health,27(3), 453-465.‏ https://doi.org/10.1080/13607863.2022.2036948
Podda, J., Tacchino, A., Pedullà, L., Monti Bragadin, M., Battaglia, M. A., & Brichetto, G. (2022). Focus on neglected features of cognitive rehabilitation in MS: Setting and mode of the treatment. Multiple Sclerosis Journal, 28(7), 1009-‌1019. https://doi.org/10.1177/1352458520966300
Powell, T. (1400). Brain injury workbook, exercises for cognitive rehabilitation. (Trans. by Hossein Zare and Shokoofeh Mousavi). Arjmand. [Persian]
Rostampour Brenjestanaki, M., Abbasi, G., & Mirzaian, B. (2020). Effectiveness of Compassion-‌focused Therapy on Psychological Flexibility recovery and Self-‌criticism decrease in Mothers with Mentally Retarded Children. Biannual Journal of Applied Counseling, 10(2), 1-‌18. https://doi.org/ 10.22055/jac.2020.33836.1749
Rustampour Brinjistanaki, M., Abbasi, Q. & Mirzaian, B. (2019). The Effectiveness of compassion-‌based therapy in improving psychological flexibility and reducing self-‌criticism in mothers with intellectually disabled children. Applied Counseling, 20, 1-‌18. https://doi.org/10.22055/JAC.2020.33836.1749 [Persian]
Salari, N., Darvishi, N., Ahmadipanah, M., Shohaimi, S., & Mohammadi, M. (2022). Global prevalence of falls in the older adults: a comprehensive systematic review and meta-‌analysis. Journal of orthopaedic surgery and research, 17(1), 1-‌13.‏ https://doi.org/10.1186/s13018-‌022-‌03222-‌1
Shahabi, R. (2019). Normal cognitive aging: age related cognitive changes in elderly. Aging Psychology, 5(2), 101-‌116.‏ https://doi.org/10.22126/JAP.1970.1179 [Persian]
Sohlberg, M. M., & Turkstra, L. S. (2011). Optimizing cognitive rehabilitation: Effective instructional methods. Guilford Press.‏ https://psycnet.apa.org/record/2011-‌20613-‌000
Soltani, I., Shareh, H., Bahrainian, S., A., & Farmani, A. (2012). The Mediating role of cognitive flexibility in the relationship between coping styles and resilience with depression. Researcher, 18(2), 88-‌96. http://pajoohande.sbmu.ac.ir/article-‌1-‌1518-‌fa.html [Persian]
Tohidi Far, M., Kazemian Moghadam, K., & Harun Rashidi, H. (2021). The Effectiveness of compassion-‌based therapy on loneliness and cognitive flexibility of elderly men. Psychological Studies, 17(2), 116-‌97. https://sid.ir/paper/412143/fa [Persian]
Torkhan, M., Neshatdoost, H., & Tarkhan, M. (2019). The Effectiveness of compassion-‌based intervention in cognitive flexibility and social adequacy of women with marital conflicts. Social Cognition, 9(2), 137-‌152. https://doi.org/10.30473/sc.2021.55199.2603 [Persian]
Zare, H. & Siahjani, L. (2017). The effectiveness of cognitive rehabilitation in mental state and memory performance in the elderly with mild Alzheimer. New Cognitive Sciences, 20(3), 51-‌66. http://icssjournal.ir/article-‌1-‌795-‌en.html [Persian]
Zare, H., Cherami, F. & Sharifi, A. (2019). The Effectiveness of computerized cognitive rehabilitation in working memory and cognitive flexibility of children with learning disabilities. Cognitive Strategies in Learning, 8(15), 1-‌18. https://www.noormags.ir/view/fa/articlepage/1696279/. [Persian]
Ziereis, S., & Jansen, P. (2015). Effects of physical activity on executive function and motor performance in children with ADHD. Research in developmental disabilities. 38, 181-‌191. https://doi.org/ 10.1016/j.ridd.2014.12.005