Effect of a Self‐Regulation Skills Training Program on Cognitive Flexibility in Patients With Heart Failure: A Randomized Controlled Trial

Abstract

ABSTRACT Background Psychological well‐being is a critical component of disease management and recovery in patients with cardiovascular disorders. Cognitive flexibility, as a key psychological determinant, significantly influences adaptive functioning and health‐related outcomes. Self‐regulation skills training has recently gained attention as an effective approach to enhancing mental health in individuals with chronic illnesses. This study aimed to assess the effect of a self‐regulation skills training program on improving cognitive flexibility among patients with heart failure. Materials and Methods This randomized controlled trial included 69 hospitalized patients with heart failure who were randomly assigned to an intervention group (n = 35) or a control group (n = 34). Cognitive flexibility was assessed at baseline, immediately after the intervention, and 1 month later using the Cognitive Flexibility Inventory. The intervention group received six sessions of self‐regulation skills training over 3 weeks. The data were analyzed using SPSS software with independent t‐tests, chi‐square tests, Mann–Whitney tests, and repeated‐measures ANOVA. This trial was registered in the Iranian Registry of Clinical Trials (IRCT20160927030002N4). Results The findings demonstrated a significant time × group interaction for total cognitive flexibility scores (F [2,66] = 16.66, p < 0.001, partial η2 = 0.34). Immediately afterward, the intervention group showed significantly higher cognitive flexibility compared with those of the control group (mean difference = 8.78 points; 95% CI: 3.64–13.92; Cohen's d = 0.80). At 1‐month follow‐up, the cognitive flexibility scores in the intervention group showed a slight decline compared with post‐intervention levels but remained modestly higher than baseline, whereas no meaningful change was observed in the control group. Conclusions The findings suggest that self‐regulation skills training may serve as an effective intervention for enhancing cognitive flexibility and supporting the psychological well‐being of patients with heart failure.