Comparative Impact of Cognitive Rehabilitation versus Mindfulness-Based Stress Reduction on Hope and Self-Efficacy in Mild Cognitive Impairment

Document Type : Original Article

Authors

Department of Psychology, CT.B., Islamic Azad University, Tehran, Iran

10.30491/hpr.2026.567987.1529
Abstract
Background: Mild cognitive impairment (MCI) represents a transitional stage between normal age-related cognitive decline and dementia. In this population, psychological factors such as hope and self-efficacy are frequently impaired, contributing to reduced quality of life and potential progression to dementia.
Objectives: This study aimed to compare the effects of cognitive rehabilitation (CR) and mindfulness-based stress reduction (MBSR) on self-efficacy and hope in individuals with MCI.
Methods: A quasi-experimental pretest-posttest design with a control group and a three-month follow-up was employed. The study population comprised patients with MCI attending memory and cognitive rehabilitation clinics in Tehran in 2024. Forty-five participants were selected through convenience sampling and randomly allocated to three groups: CR (n = 15), MBSR (n = 15), and control (n = 15). Each intervention group received 10 sessions, while the control group received no intervention. Outcomes were assessed using the General Self-Efficacy Scale and the Adult Hope Scale. Data were analyzed with repeated-measures analysis of variance (ANOVA).
Results: CR significantly improved self-efficacy at posttest (P < 0.01), with effects well maintained (and slightly numerically increased) at the three-month follow-up. MBSR showed no significant immediate effect on self-efficacy but was superior to control at follow-up. Both CR and MBSR significantly increased hope (P < 0.05), with CR showing greater improvements at posttest (P < 0.05). Direct comparisons indicated CR superiority over MBSR mainly at posttest for both outcomes.
Conclusion: Both interventions provide psychological benefits for individuals with MCI, but CR appears to be more effective in strengthening self-efficacy beliefs and future-oriented motivation. Clinically, this suggests CR as a valuable adjunct to support autonomy in MCI patients.

Keywords


1.       Petersen RC. Mild Cognitive Impairment. Continuum (Minneap Minn). 2016;22(2 Dementia):404–18. doi:10.1212/con.0000000000000313
2.       Gao J, Liu L, Yang Z, Fan J, Alzheimer’s Disease Neuroimaging Initiative. Predictors of Transition from Mild Cognitive Impairment to Normal Cognition and Dementia. Behav Sci. 2025;15(11):1552. doi:10.33 90/bs15111552
3.       Wiels WA, Wittens MM, Zeeuws D, Baeken C, Engelborghs S. Neuropsychiatric symptoms in mild cognitive impairment and dementia due to AD: relation with disease stage and cognitive deficits. Front Psychiatry. 2021;12:707580. doi:10.3389/ fpsyt.2021.707580
4.       Papa D, Ingenito A, von Gal A, De Pandis MF, Piccardi L. Relationship Between Depression and Neurodegeneration: Risk Factor, Prodrome, Consequence, or Something Else? A Scoping Review. Biomedicines. 2025;13(5):1023. doi:10.3390/ biomedicines13051023
5.       Avery J, Thomas D, Myshakivska O. The effect of Mild Cognitive Impairment (MCI) on psychological distress among older adults in Ukraine. BMC Geriatr. 2023;23(1):248. doi:10.1186/s12877-023-03906-1
6.       Molamohseni F, Marashian FS, Bavi S. Effects of Positive Psychology Training on Self-Efficacy and Quality of Academic Life in Students with a Parental Death Experience. Hosp Pract Res. 2024;9(2):475-80. doi:10.30491/hpr.2024.475805.1447
7.       Tonga JB, Eilertsen DE, Solem IKL, Arnevik EA, Korsnes MS, Ulstein ID. Effect of Self-Efficacy on Quality of Life in People with Mild Cognitive Impairment and Mild Dementia: The Mediating Roles of Depression and Anxiety. Am J Alzheimers Dis Other Demen. 2020;35:1533317519885264. doi:10.1177/1533317519885264
8.       Wissel S, Frey A, Sell R, Frantz S, Stoll G, Stoerk S. Cognitive impairment negatively impacts self-efficacy in patients with chronic heart failure patients: results from the Cognition. Matters-HF study. Eur Heart J. 2022;43(Supplement_2):ehac544-948. doi:10.1093/ eurheartj/ehac544.948
9.       Lee J, Cho E, Kim H, Lee KH, Kim E, Ye BS. The development and evaluation of a self-efficacy enhancement program for older adults with mild cognitive impairment. Appl Nurs Res. 2023;73:151726. doi:10.1016/j.apnr.2023.151726
10.     Kurasz AM, DeFeis B, Locke DEC, De Wit L, Amofa P, Smith G, et al. Psychometric properties of the self-efficacy for managing mild cognitive impairment scale. Int J Geriatr Psychiatry. 2021;36(1):174–81. doi:10.1002/gps.5411
11.     Amiri S, Khosravi Saleh Baberi F, Hashemi Hendikosh E, Jalili M. Enhancing Cognitive-Attentional Functioning and Life Expectancy Hope through Acceptance and Commitment Therapy in Depressed Youth. Hosp Pract Res. 2025;10(3):719-25. doi:10.30491/hpr.2025.524219.1493
12.     Lee BC, Choe YM, Suh GH, Keum M, Kim SG, Kim HS, et al. Implications of helplessness in depression: diagnosing mild cognitive impairment and analyzing its effects on cognitive decline in older adults. Front Aging Neurosci. 2024;16:1378676. doi:10.3389/ fnagi.2024.1378676
13.     Yang Y, Zhang X, Zhang D, Su Y. Frailty and suicidal ideation among older adults living alone in the community: a moderated mediation model of perceived burdensomeness and positive emotions. Front Public Health. 2024;12:1392424. doi:10.33 89/fpubh.2024.1392424
14.     Srivastava A, Bhat A, Agarwal V. A study on the effectiveness of individual centered goal-oriented cognitive rehabilitation in vascular dementia. Cereb Circ - Cogn Behav. 2025;9:100399. doi:10.1016/j. cccb.2025.100399
15.     Kirsch-Darrow L, Tsao JW. Cognitive rehabilitation. CONTINUUM: Lifelong Learning in Neurology. 2021; 27(6):1670-81. doi:10.1212/con.0000000000001075
16.     Choi J, Twamley EW. Cognitive rehabilitation therapies for Alzheimer's disease: a review of methods to improve treatment engagement and self-efficacy. Neuropsychol Rev. 2013;23(1):48–62. doi:10.1007/ s11065-013-9227-4
17.     Abdulhussain Fadhi A, Mohammed AH, Mohammed IM, Shnain AlM, Oudaha KH, Yaseen Hasan S. Investigating the Effect of Cognitive Rehabilitation on the Memory Improvement of Patients with Alzheimer. Iran Rehabil J. 2023;21(2):319. doi:10.32598/irj. 21.2.2066.1
18.     Kriakous SA, Elliott KA, Lamers C, Owen R. The Effectiveness of Mindfulness-Based Stress Reduction on the Psychological Functioning of Healthcare Professionals: a Systematic Review. Mindfulness (N Y). 2021;12(1):1–28. doi:10.1007/s12671-020-01500-9
19.     Sheybani F, Dabaghi P, Najafi S, Rajaeinejad M. Effectiveness of Mindfulness-based Stress Reduction (MBSR) on Patients with Chronic Pain: A Randomized Clinical Trial. Iranian J Psychiatry Clin Psychol. 2022;28(2):182. doi:10.32598/ijpcp.28.2.1627.2
20.     Javadzade N, Esmaeili SV, Omranifard V, Zargar F. Effect of mindfulness-based stress reduction (MBSR) program on depression, emotion regulation, and sleep problems: A randomized controlled trial study on depressed elderly. BMC Public Health. 2024;24(1): 271. doi:10.1186/s12889-024-17759-9
21.     Marciniak R, umec R, Vyhn lek M, Bend čkov  K, L zničkov  P, Forte G, et al. The Effect of Mindfulness -Based Stress Reduction (MBSR) on Depression, Cognition, and Immunity in Mild Cognitive Impairment: A Pilot Feasibility Study. Clin Interv Aging. 2020;15:136581. doi:10.2147/cia. S249196
22.     Tran T, Donnelly C, Nalder E, Trothen T, Finlayson M. Mindfulness-based stress reduction for community-dwelling older adults with subjective cognitive decline (SCD) and mild cognitive impairment (MCI) in primary care: a mixed-methods feasibility randomized control trial. BMC Primary Care. 2023;24(1):44. doi:10.1186/s12875-023-02002-y
23.     Babak A, Hakimi SMH, Mousavi SZ, Motamedi N. Effect of mindfulness-based stress reduction on mental health and sleep quality in women with type 2 diabetes mellitus: A randomized controlled trial. J Shahrekord Univ Med Sci. 2025;27(1):34–40. doi:10.34172/jsums.1003
24.     Sherer M, Maddux JE, Mercandante B, Prentice-Dunn S, Jacobs B, Rogers RW. The Self-Efficacy Scale: Construction and Validation. Psychol Rep. 1982;51(2):663–71. doi:10.2466/pr0.1982.51.2.663
25.     Bahramiyan H. Reliability, validity, and factorial analysis of coping self-efficacy scale. Clin Psychol Pers. 2018;15(2):215-226. doi:10.22070/cpap.2020. 2830
26.     Snyder CR, Sympson SC, Ybasco FC, Borders TF, Babyak MA, Higgins RL. Development and validation of the State Hope Scale. J Pers Soc Psychol. 1996; 70(2):321–35. doi:10.1037//0022-3514.70.2.321
27.     Nooripour R, Farmani F, Brand S, Ghanbari N, Ilanloo H, Matacotta JJ, et al. Psychometric characteristics of Persian version of adult Hope scale (AHS) in Iranian females with multiple sclerosis (MS). J Kermanshah Univ Med Sci. 2022;26(2):e123276. doi:10.5812/ jkums-123276
28.     Egele VS, Klopp E, Stark R. An empirical ranking of the importance of the sources of self-efficacy for physical activity. Health Psychol Behav Med. 2025;13 (1):2567322. doi:10.1080/21642850.2025.2567322
29.     Twamley EW, Burton CZ, Vella L. Compensatory cognitive training for psychosis: who benefits? Who stays in treatment?. Schizophr Bull. 2011;37(suppl_2): S55-62. doi:10.1093/schbul/sbr059
30.     Mousavi SA, Jarareh J, Mohammadiarya AR, Karami B, Mohammadi RK. Effects of cognitive rehabilitation on the psychological capital of the elderly with dementia. Arch Neurosci. 2021;8(3):e114507. doi:10.5812/ans. 114507
31.     Mart nez-P rez I, Garc a-Rodr guez A, Morales-Rodr guez FM, P rez-M rmol JM. Mindfulness Abilities Are Associated with Anxiety Levels, Emotional Intelligence, and Perceived Self-Efficacy. Sustainability. 2023;15(6):4729. doi:10.3390/su15064729
 

Articles in Press, Accepted Manuscript
Available Online from 30 June 2026