Comparing the Effectiveness of Cognitive Rehabilitation Therapy and Mindfulness-Based Therapy on the Anxiety of Patients With Hypertension: A Randomized Clinical Trial

Hypertension is one of the most common chronic diseases in the world. It is considered one of the most important public health issues in the world and causes millions of deaths due to stroke and cardiovascular and kidney diseases. Research shows that people with hypertension suffer psychological, emotional, and social challenges. Stress, depression, and anxiety are among the most common psychological problems in this group of patients. Cognitive rehabilitation therapy and mindfulness–based therapy are among the treatments that studies have shown can affect anxiety. Therefore, the present study was conducted to compare the effects of cognitive rehabilitation therapy and mindfulness–based therapy on the anxiety of patients with hypertension.

This double–blind clinical trial and quasi–experimental study has a pretest–posttest and follow–up design with a control group. The statistical population consisted of all the people with hypertension living in Rasht City, Iran, who were referred to the specialized heart hospital in the city in 2021. From this community, 51 qualified volunteers entered the study by the convenience sampling method and were randomly assigned to groups of cognitive rehabilitation therapy, mindfulness–based therapy, and control group (17 people in each group). The inclusion criteria were as follows: informed consent and willingness to participate in the research, having high blood pressure (according to the medical record), anxiety more than average (anxiety score 16–40 according to the Beck Anxiety Inventory), ability to read and write, age range from 30 to 60 years, not abusing drugs and alcohol, not suffering from severe personality and clinical disorders, lacking a history of head trauma and recent brain injuries, not receiving electric shock or special treatment in the last six months, and not participating in psychotherapy courses at the same time or in the last two months. The exclusion criteria were as follows: absence of more than two sessions, unwillingness to continue psychotherapy, a possible complication of the subject and the occurrence of an accident and the absence or event affecting the research variables. Beck Anxiety Inventory (Beck et al., 1988) was employed in this research. Cognitive rehabilitation therapy was conducted face–to–face and individually for the first experimental group (using the computer in 10 sessions of 60 minutes once a week) at the Cardiovascular Diseases Research Center located in Heshmat Hospital in Rasht. Mindfulness–based therapy sessions were held for 2 months (8 sessions, one 90–minute session each week) for another experimental group online (through Skyroom software) and the control group did not undergo any type of psychotherapy at the same time. For data analysis in descriptive statistics, mean and standard deviation chart were used. For inferential statistics, the Chi–square test, 1–way analysis of variance, analysis of variance of repeated measurements, and Bonferroni post hoc test were used. Data analysis was done in SPSS software version 26 at a significance level of 0.05.

The results showed that the effects of time (p<0.001), group (p<0.001), and the interaction of group and time (p<0.001) on the anxiety variable were significant. The posttest (p<0.001) and follow–up scores (p<0.001) of the anxiety variable in the mindfulness group and cognitive rehabilitation group decreased significantly compared to the pretest scores. In contrast, there was no significant difference between the anxiety scores of the control group at different times (p>0.05). There was a significant difference between cognitive rehabilitation and mindfulness groups in terms of effectiveness in the posttest and follow–up on reducing anxiety compared to the control group (p<0.001). While there was no significant difference between the two experimental groups in the posttest (p=0.616) and follow–up (p=0.221) in terms of effectiveness in reducing anxiety.

According to the research findings, cognitive rehabilitation therapy and mindfulness–based therapy were effective on the anxiety of patients with hypertension, and there was no significant difference between the two therapies. Therefore, both types of psychotherapies are equally beneficial to help patients with hypertension manage a chronic and life–threatening disease.