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Cognitive Behavioral Therapy for Anxiety in Parkinson Disease
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Anxiety disorder is a potentially disabling association of Parkinson disease (PD). This was a single-blinded, multicenter, randomized controlled trial testing a cognitive behavioral therapy (CBT) intervention for the treatment of anxiety in patients with PD. There was an improvement compared with the clinical monitoring–only control in both the Hamilton Anxiety Rating Scale (primary outcome) and the Parkinson Anxiety Scale (PAS), but only the improvement in PAS was statistically significant. The mean PAS score declined from 25 to 15.1 in the CBT group and from 21.7 to 16.5 in the group that received clinical monitoring only.
- Even though the primary outcome was negative, the results suggest benefit with CBT for anxiety in PD, warranting further research.
abstract
This abstract is available on the publisher's site.
Access this abstract nowBACKGROUND
Anxiety disorders are among the most prevalent and disabling neuropsychiatric syndromes in patients with Parkinson's disease (PD), but no randomized controlled treatment trials of anxiety have been published to date.
OBJECTIVE
The aim of this study was to assess the effectiveness of cognitive behavioral therapy (CBT) in the treatment of anxiety in patients with PD.
METHODS
Forty-eight patients with PD with anxiety were randomized 1:1 between CBT and clinical monitoring only (CMO). The CBT program was developed to specifically address anxiety symptoms in PD and consisted of 10 weekly sessions. Assessments were conducted by blinded assessors at baseline, at the end of the intervention, after 3 months, and after 6 months (CBT group only). Main outcome measures were the Hamilton Anxiety Rating Scale (HARS) and the Parkinson Anxiety Scale (PAS).
RESULTS
Both the CBT and CMO groups showed clinically relevant improvement. Although there was no between-group difference in outcome on the Hamilton Anxiety Rating Scale (6.7-point reduction in the CBT group versus 3.9-point reduction in the CMO group; P = 0.15), there was both a statistically significant and a clinically relevant between-group difference on the total PAS in favor of CBT (9.9-point reduction in the CBT group versus 5.2-point reduction in the CMO group; P = 0.012), which was due to improvement on the PAS subscales for episodic (situational) anxiety and avoidance behavior. This greater improvement was maintained at 3- and 6-month follow-ups.
CONCLUSION
CBT is an effective treatment for anxiety in patients with PD and reduces situational and social anxiety, as well as avoidance behavior. © 2021 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
Additional Info
Cognitive Behavioral Therapy for Anxiety in Parkinson's Disease: A Randomized Controlled Trial
Mov. Disord. 2021 Nov 01;36(11)2539-2548, AJH Moonen, AEP Mulders, L Defebvre, A Duits, B Flinois, S Köhler, ML Kuijf, AC Leterme, D Servant, M de Vugt, K Dujardin, AFG LeentjensFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
Although Parkinson’s disease (PD) is primarily known as a movement disorder, it is accompanied by many nonmotor symptoms, including neuropsychiatric symptoms like anxiety. The neurodegenerative process underlying PD is an important etiological factor; however, these symptoms can partially be explained as a psychological reaction to the development of disabling motor and nonmotor symptoms. The progressive nature of the disease—and often unpredictable fluctuations in motor function—can give rise to worries, anxiety, and even panic attacks. The impact of PD on mental wellbeing was recognized in the first description of PD, “An essay on the shaking palsy”: James Parkinson described PD as a “highly afflictive disease that is considered by the unhappy sufferer as an evil, from the domination of which he had no prospect of escape.”1
About one-third of PD patients develops an anxiety disorder,2 with a strong negative impact on quality of life.3 Unfortunately, evidence-based treatment options are limited. To date, there are no randomized controlled trials (RCTs) studying the effectiveness of pharmacotherapy for anxiety in PD. Moreover, commonly used medications like antidepressants can cause adverse effects,4-6 and adding extra medications can decrease overall treatment adherence in PD patients.7 Therefore, nonpharmacological interventions like psychotherapy became increasingly popular over the past years.
Moonen and colleagues are the first to compare the effects of a cognitive behavioral therapy (CBT) program with clinical monitoring only in 48 PD patients suffering from clinically relevant anxiety in a multicenter RCT. The authors tailored the CBT program to the specific needs of PD patients, informed by previous focus groups with patients and their caregivers.8 The between-group difference on their primary outcome measure, the Hamilton Anxiety Rating Scale, failed to reach statistical significance. However, the CBT group did show a larger decrease in anxiety as measured with the Parkinson Anxiety Scale, which is likely a better outcome measure for PD patients as it is designed to be insensitive to the comorbid nonmotor symptoms of PD. CBT mainly reduced episodic anxiety, avoidance behavior, and social anxiety. This RCT therefore demonstrates that CBT is an effective treatment, potentially giving James Parkinson’s unhappy sufferers the tools to stop PD-related anxiety from dominating their lives.
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