Predicting Perceived Stress Based on Maladaptive Schemas: The Mediating Role of Psychological Flexibility and Dark Personality Traits in Patients Undergoing Cardiovascular Surgery

Abstract

Background: Although surgery in patients with cardiovascular disease usually leads to improved cardiac function and reduced physical problems, these patients often face numerous psychological problems, especially stress, because of their history of heart disease and the experience of surgery itself. The experience of stress can disrupt the recovery process and even lead to an exacerbation of cardiovascular problems. Aims: the present study aimed to predict perceived stress based on early maladaptive schemas and to investigate the mediating role of cognitive flexibility and dark personality traits in cardiovascular patients with a history of surgery. Methods: This study was a correlational research conducted using Structural Equation Modeling (SEM). The population included patients with cardiovascular disease with a history of surgery in Kermanshah in 2024. Sampling was conducted in Imam Ali Hospital. Cardiovascular. A total of 287 patients were selected using convenience sampling. Participants responded to Young Schemas Questionnaire-Short Form (YSQ-SF), Short Dark Triad Scale (SD-T), Cognitive Flexibility Inventory (CFI), and Perceived Stress Scale (PSS). The data were analyzed using SPSS-25 and R software. Results: The results of the study indicated that the conceptual model had an acceptable fit. The direct effect of early maladaptive schemas, cognitive flexibility, and dark personality traits on perceived stress was 0.23, -0.37, and 0.49, respectively, all of which were significant (P = 0.01). Moreover, the indirect effects of early maladaptive schemas through the mediating roles of dark personality traits and cognitive flexibility were estimated to be 0.22 and 0.21, respectively, and these paths were also statistically significant (P = 0.01). Fit indices for χ²/df, GFI, CFI, AGFI, IFI, and TLI were 1.44, 0.96, 0.95, 0.93, 0.97, and 0.97, respectively. Conclusions: The study suggests that in the treatment programs of cardiovascular patients with a history of surgery, attention should be paid to strengthening cognitive flexibility and modifying early maladaptive schemas as strategies to reduce dark personality traits and, consequently, reduce perceived stress.