Cognitive Flexibility in Women with Multiple Sclerosis: A Comparison of the Effectiveness of Compassion-Based and Mindfulness-Based Interventions
Keywords:
Cognitive flexibility, mindfulness-based intervention, self-compassion-based intervention, women, multiple sclerosis, psychological interventionsAbstract
Objective: The present study was designed to compare the effectiveness of mindfulness-based and self-compassion-based interventions on cognitive flexibility in women with multiple sclerosis (MS).
Methodology: This research employed a quasi-experimental design with a pretest–posttest structure and three groups (mindfulness, self-compassion, and control). Thirty-six women diagnosed with MS were randomly assigned to three groups of twelve participants each. The interventions consisted of eight weekly group sessions, while the control group received no intervention. Cognitive flexibility was assessed using the Dennis and Vander Wal Cognitive Flexibility Questionnaire. Data were analyzed using paired-samples t tests, multivariate analysis of covariance (MANCOVA), and Tukey post hoc tests.
Findings: The findings indicated that both interventions led to significant increases in cognitive flexibility and its subscales compared with pretest scores (p < .01). The mindfulness group demonstrated the greatest improvement, followed by the self-compassion group, and finally the control group. Between-group differences were also statistically significant, and post hoc analyses confirmed the specific loci of these differences.
Conclusion: Mindfulness-based and self-compassion-based interventions effectively enhance perspective-shifting abilities and cognitive regulation in women with MS; however, mindfulness appears to provide a more direct and faster pathway to improving cognitive flexibility. These findings underscore the importance of incorporating contemporary psychological interventions alongside pharmacological treatments to promote cognitive functioning and quality of life in patients with MS.
Downloads
References
Abbaszadegan, A., Ghahramani, Y., Gholami, A., Hemmateenejad, B., Dorostkar, S., Nabavizadeh, M., & Sharghi, H. (2015). Research Article The Effect of Charge at the Surface of Silver Nanoparticles on Antimicrobial Activity against Gram-Positive and Gram-Negative Bacteria: A Preliminary Study.
Akey-Torku, B., & Dai, B. (2020). The Influence of Transformational Leadership on Work Engagement and Employee Commitment. International Journal of Scientific Research in Science and Technology, 71-83. https://doi.org/10.32628/ijsrst207118
Ashoori, M., Kachooei, M., & Vahidi, E. (2023). The mediating role of experimental avoidance in the relationship between self-compassion and psychological well-being in people with multiple sclerosis. Ebnesina, 24(4), 67-78.
Baraz Pordanjani, s., karimipor, f., & ebrahimi dastgerdi, m. (2012). Evaluation of the relationship between self - esteem and burnout in nurses of hospitals of Ahvaz Jundishapur University of Medical Sciences. IJNR, 7(27), 44-51. http://ijnr.ir/article-1-1094-en.html
Beer, S., Khan, F., & Kesselring, J. (2012). Rehabilitation interventions in multiple sclerosis: an overview. Journal of neurology, 259(9), 1994-2008.
Benedict, R. H., Amato, M. P., DeLuca, J., & Geurts, J. J. (2020). Cognitive impairment in multiple sclerosis: clinical management, MRI, and therapeutic avenues. The Lancet Neurology, 19(10), 860-871.
Bossa, M., Manocchio, N., & Argento, O. (2022). Non-Pharmacological treatments of cognitive impairment in multiple sclerosis: A review. NeuroSci, 3(3), 476-493.
Chiesa, A., & Serretti, A. (2009). Mindfulness-Based Stress Reduction for Stress Management in Healthy People: A Review and Meta-Analysis. The Journal of Alternative and Complementary Medicine, 15(5), 593-600. https://doi.org/10.1089/acm.2008.0495
Dehghan-Nayeri, N., Khakbazan, Z., Ghafoori, F., & Nabavi, S. M. (2017). Sexual dysfunction levels in iranian women suffering from multiple sclerosis. Multiple sclerosis and related disorders, 12, 49-53.
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(3), 241-253.
Dizaj, K. M., Makvand, H. S., & Sabahi, P. (2023). Effects of Mindfulness-Based Cognitive Therapy on Anxiety Sensitivity in Patients with Multiple Sclerosis.
Dweck, C., & Yeager, D. (2020). A growth mindset about intelligence. In G. Walton & A. J. Crum (Eds.), Handbook of Wise Interventions: How Social Psychology Can Help People Change (pp. 9-35). Guilford. https://psycnet.apa.org/record/2020-23031-001
Emadian, A. S., Emadian, A. S., Dehrouyeh Tabaghdehi, H., & Leila, S. (2022). The effectiveness of mindfulness-based cognitive therapy on anxiety, rumination, and fatigue in women with multiple sclerosis. Journal of Jiroft University of Medical Sciences, 9(1), 863-874.
Eydi-Baygi, M., Aflakseir, A., Imani, M., Goodarzi, M. A., & Harirchian, M. H. (2022). Mindfulness-based cognitive therapy combined with repetitive transracial magnetic stimulation (rTMS) on information processing and working memory of patients with multiple sclerosis. Caspian journal of internal medicine, 13(3), 607.
Faguy, K. (2016). Multiple sclerosis: an update. Radiologic technology, 87(5).
Fisher, P. L., Salmon, P., Heffer-Rahn, P., Huntley, C., Reilly, J., & Cherry, M. G. (2020). Predictors of emotional distress in people with multiple sclerosis: A systematic review of prospective studies. Journal of Affective Disorders, 276, 752-764.
Gallant, S. N. (2016). Mindfulness meditation practice and executive functioning: Breaking down the benefit. Consciousness and cognition, 40, 116-130.
Gilbert, P. (2014). The origins and nature of compassion focused therapy. British journal of clinical psychology, 53(1), 6-41.
Han, A. (2022). Effects of mindfulness-and acceptance-based interventions on quality of life, coping, cognition, and mindfulness of people with multiple sclerosis: a systematic review and meta-analysis. Psychology, health & medicine, 27(7), 1514-1531.
Hashemi, S. A. (2018). The effectiveness of group self-compassion training on teachers’ job burnout and job satisfaction. 2018. https://sid.ir/paper/227527/en
Kamijo, N., & Yukawa, S. (2018). The role of rumination and negative affect in meaning making following stressful experiences in a Japanese sample. Frontiers in Psychology, 9, 2404.
Karampampa, K., Gustavsson, A., Miltenburger, C., Kindundu, C. M., & Selchen, D. H. (2012). Treatment experience, burden, and unmet needs (TRIBUNE) in multiple sclerosis: the costs and utilities of MS patients in Canada. Journal of Population Therapeutics and Clinical Pharmacology= Journal De La Therapeutique Des Populations Et De La Pharmacologie Clinique, 19(1), e11-25.
Kaski, D., Dominguez, R. O., Allum, J. H., & Bronstein, A. M. (2013). Improving gait and balance in patients with leukoaraiosis using transcranial direct current stimulation and physical training: an exploratory study. Neurorehabilitation and neural repair, 27(9), 864-871.
Kenner, M., Menon, U., & Elliott, D. G. (2007). Multiple sclerosis as a painful disease. International review of neurobiology, 79, 303-321.
Khaligh-Razavi, S.-M., Sadeghi, M., Khanbagi, M., Kalafatis, C., & Nabavi, S. M. (2020). A self-administered, artificial intelligence (AI) platform for cognitive assessment in multiple sclerosis (MS). BMC neurology, 20(1), 193.
Kirby, J. N., Tellegen, C. L., & Steindl, S. R. (2017). A meta-analysis of compassion-based interventions: Current state of knowledge and future directions. Behavior therapy, 48(6), 778-792.
Longley, S. L., Watson, D., & Noyes Jr, R. (2005). Assessment of the Hypochondriasis Domain: The Multidimensional Inventory of Hypochondriacal Traits (MIHT). Psychological assessment, 17(1), 3-14. https://doi.org/10.1037/1040-3590.17.1.3
Longley, W. A. (2022). Cognitive rehabilitation in multiple sclerosis. Australian journal of general practice, 51(4), 233-237.
Mahmoudi, M., Saberi, H., & Bashardoust, S. (2022). A Model for Psychological Distress Based on Insecure Attachment Mediated by Alexithymia in Students at Islamic Azad Universities in Tehran. Journal of Health Reports and Technology, 8(2). https://doi.org/10.5812/ijhls-122195
Manocchio, N., Argento, O., Bossa, M., Spanò, B., Pellicciari, L., Foti, C., & Nocentini, U. (2025). The Role of the Cerebellum in Multiple Sclerosis-Related Fatigue and Disability. Journal of Clinical Medicine, 14(8), 2840.
Marafioti, G., Cardile, D., Culicetto, L., Quartarone, A., & Lo Buono, V. (2024). The Impact of Social Cognition Deficits on Quality of Life in Multiple Sclerosis: A Scoping Review. Brain Sciences, 14(7), 691. https://doi.org/10.3390/brainsci14070691
Mirmoeini, P., Bayazi, A., & Khalatbari, S. (2022). A comparison of the effects of acceptance and commitment therapy and compassion-focused therapy on worry severity and resilience in patients with multiple sclerosis. Journal of Arak University of Medical Sciences, 25(1), 88-103.
Moeinzadeh, N., Souri, A., & Shamir, A. S. (2025). Comparison of the Effectiveness of Compassion-Based and Mindfulness-Based Therapies on Dysfunctional Communication Beliefs in Women with Multiple Sclerosis. Iranian Journal of Neurodevelopmental Disorders, 4(2), 1-10.
Nabavi, S. M., & Sangelaji, B. (2015). Cognitive dysfunction in multiple sclerosis: Usually forgotten in the clinical assessment of MS patients. Journal of research in medical sciences, 20(5), 533-534.
Neff, K. D., & Germer, C. K. (2013). A pilot study and randomized controlled trial of the mindful self‐compassion program. Journal of clinical psychology, 69(1), 28-44.
Nery-Hurwit, M., Yun, J., & Ebbeck, V. (2018). Examining the roles of self-compassion and resilience on health-related quality of life for individuals with Multiple Sclerosis. Disability and health journal, 11(2), 256-261.
Nourali, M. M. (2013). Examining the effectiveness of group mindfulness-based cognitive therapy (MBCT) on increasing self-efficacy and reducing depressive symptoms in patients with multiple sclerosis (MS) aged 25–45 years [Master’s thesis, Islamic Azad University, Shahroud Branch]. Shahroud. Islamic Azad University, Shahroud Branch].
Ortega, L. A., Tracy, B. A., Gould, T. J., & Parikh, V. (2013). Effects of chronic low- and high-dose nicotine on cognitive flexibility in C57BL/6J mice. Behavioural Brain Research, 238, 134-145. https://doi.org/10.1016/j.bbr.2012.10.032
Ortega, L. A., Tracy, B. A., Gould, T. J., & Parikh, V. (2013). Effects of chronic low-and high-dose nicotine on cognitive flexibility in C57BL/6J mice. Behavioural brain research, 238, 134-145.
Reynard, A. K., Sullivan, A. B., & Rae-Grant, A. (2014). A systematic review of stress-management interventions for multiple sclerosis patients. International journal of MS care, 16(3), 140-144.
Roca, P., Vazquez, C., Diez, G., Brito-Pons, G., & McNally, R. J. (2021). Not all types of meditation are the same: Mediators of change in mindfulness and compassion meditation interventions. Journal of Affective Disorders, 283, 354-362.
Sahraian, M. A., Khorramnia, S., Ebrahim, M. M., Moinfar, Z., Lotfi, J., & Pakdaman, H. (2010). Multiple sclerosis in Iran: a demographic study of 8,000 patients and changes over time. European neurology, 64(6), 331-336.
Simpson, R., Simpson, S., Ramparsad, N., Lawrence, M., Booth, J., & Mercer, S. W. (2019). Mindfulness-based interventions for mental well-being among people with multiple sclerosis: a systematic review and meta-analysis of randomised controlled trials. Journal of Neurology, Neurosurgery & Psychiatry, 90(9), 1051-1058.
Smith, A. M., Walker, L. A., Freedman, M. S., DeMeulemeester, C., Hogan, M. J., & Cameron, I. (2009). fMRI investigation of disinhibition in cognitively impaired patients with multiple sclerosis. Journal of the neurological sciences, 281(1-2), 58-63.
Stapleton, T., Ashburn, A., & Stack, E. (2001). A pilot study of attention deficits, balance control and falls in the subacute stage following stroke. Clinical rehabilitation, 15(4), 437-444.
Taghizadeh, M., & Farmani, A. (2013). Examining the role of cognitive flexibility in predicting hopelessness and resilience among university students. Quarterly Journal of Cognitive Psychology, 2(1), 67-75.
Titz, C., & Karbach, J. (2014). Working memory and executive functions: effects of training on academic achievement. Psychological research, 78(6), 852-868.
Walton, C., King, R., Rechtman, L., Kaye, W., Leray, E., Marrie, R. A., Robertson, N., La Rocca, N., Uitdehaag, B., & van Der Mei, I. (2020). Rising prevalence of multiple sclerosis worldwide: Insights from the Atlas of MS. Multiple Sclerosis Journal, 26(14), 1816-1821.
Yavari Kateb, M., Arabameri, E., Rostami, R., Gharayagh Zandi, H., & Moghadas Tabrizi, Y. (2025). The effects of a tDCS-mindfulness program on selective attention in skilled badminton players. Sport Sciences and Health Research, 17(1), 55-68.
Zarei, A., Poursharifi, H., & Babapour, J. (2016). The role of body image dissatisfaction and mental health in prediction of adolescent obesity among girls.
Downloads
Published
Submitted
Revised
Accepted
Issue
Section
License
Copyright (c) 2025 Nazila Moeinzadeh, Ahmad Souri, Aboutaleb Saadati-Shamir (Author)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
