Cognitive-Behavioral Therapy for Anxiety in Parkinson’s Disease

Abstract

Parkinson’s disease (PD) is characterized by motor symptoms, but nonmotor symptoms also significantly impair daily functioning and reduce quality of life. Anxiety is prevalent and debilitating in PD, but remains understudied and undertreated. Much affective research in PD focuses on depression rather than anxiety, and as such, there are no evidence-based treatments for anxiety in this population. Cognitive-behavioral therapy (CBT) has shown promise for treating depression in PD and may be efficacious for anxiety. This exploratory study implemented a multiple-baseline single-case experimental design to evaluate the utility and feasibility of CBT for individuals with PD who also met criteria for a DSM-5 anxiety disorder ( n = 9). Participants were randomized to a 2-, 4-, or 6-week baseline phase, followed by 12 CBT sessions, and two post treatment assessments (immediately post treatment and 6-week follow-up). Multiple outcome measures of anxiety and depression were administered weekly during baseline and intervention. Weekly CBT sessions were conducted in-person ( n = 5) or via secure videoconferencing ( n = 4). At post treatment, seven of the nine participants showed significant reductions in anxiety and/or depression, with changes functionally related to treatment and most improvements maintained at 6-week follow-up. Effects of CBT on secondary outcomes varied across participants, with preliminary evidence for reduction in fear of falling. Adherence and retention were high, as were treatment satisfaction and acceptability. The findings of this pilot study provide preliminary evidence for the utility of CBT as a feasible treatment for anxiety and comorbid depressive symptoms in PD and highlight the potential of telehealth interventions for mood in this population.

Individually Tailored Internet-Based Cognitive-Behavioral Therapy for Daily Functioning in Patients with Parkinson’s Disease: A Randomized Controlled Trial

“…For anxiety symptoms and general disability however, the significant effects are not accompanied with a significant improvement in the ICBT-group, suggesting the effect could be partly explained by deterioration in the control group as discussed above. The somewhat weak results on anxiety symptoms differs from those seen in a small preliminary study of CBT (face to face and videoconferencing) for people with anxiety and PD where the results on anxiety were promising [35]. Another small study of telephone-delivered CBT for anxiety and depression in PD, did however conclude that the intervention reduced symptoms of depression, but not anxiety [9].…”

Mild cognitive impairment, psychiatric symptoms, and executive functioning in patients with Parkinson's disease

“…These findings also highlight the importance of developing behavioral treatments for PD patients with anxiety and examining the effect of psychosocial interventions on EF. The effect of behavioral interventions, such as cognitive‐behavioral therapy, are understudied in patients with PD with a recent pilot study suggesting utility with anxious and depressed PD patients . Lastly, these findings also speak to the clinical importance of identifying the optimal time window in the PD disease process to target efforts to prevent and treat anxiety.…”

Clinical practice guidelines based on evidence for cognitive‐behavioural therapy in Parkinson's disease comorbidities: A literature review

“…This means that even when we do not tailor treatment directly for anxiety, we can still reduce its symptoms with this kind of treatment. Other smaller research studies also support using CBT for anxiety in Parkinson's disease (Dissanayaka et al, 2017; Heinrichs, Hoffman, & Hofmann, 2001; Reynolds, Saint‐Hilaire, Thomas, Barlow, & Cronin‐Golomb, 2019). Beneficiary results are usually visible and maintained at the follow‐up clinical assessment.…”