Cognitive-behavioral therapy for anxiety in Parkinson's disease

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.Accepted manuscrip

Cognitive Behavioral Therapy in Movement Disorders. A Review

In addition to motor symptoms, patients with movement disorders often complain of psychiatric disturbances, including mood, anxiety, and impulse-control disorders and psychosis. These abnormalities are often misdiagnosed and left untreated, thus resulting in a worse prognosis and lower quality of life. Besides the use of standard pharmacological treatments, psychiatric abnormalities can be treated by means of nonpharmacological approaches. These approaches include various types of psychological therapies, the most widely used being cognitive behavioral therapy (CBT). We reviewed all articles, conducted until 2014, that contained primary data derived from clinical trials and case reports on the effect of CBT in the most common movement disorders. One randomized, controlled study and several uncontrolled studies on the efficacy of CBT in Parkinson's disease (PD) have shown a short-term benefit of depression and anxiety. In Tourette's syndrome (TS), CBT has been assessed in a number of large controlled clinical trials that have demonstrated an improvement in psychiatric disturbances and tics. There are no controlled studies on the efficacy of CBT in other types of movement disorders, such as dystonia, Huntington's disease, and essential tremor. Only a limited number of studies have evaluated the efficacy of CBT in the management of psychiatric disorders in movement disorders. The evidence available suggests that CBT is useful in TS and probably useful in PD. We recommend the planning of randomized, controlled clinical trials to investigate the effects of CBT and group CBT in the treatment of psychiatric disturbances in movement disorders

Cognitive rehabilitation, self-management, psychotherapeutic and caregiver support interventions in progressive neurodegenerative conditions: a scoping review

BACKGROUND: Despite their potentially significant impact, cognitive disability may be overlooked in a number of progressive neurodegenerative conditions, as other difficulties dominate the clinical picture. OBJECTIVE: We examined the extent, nature and range of the research evidence relating to cognitive rehabilitation, self-management, psychotherapeutic and caregiver support interventions in Parkinsonian disorders, multiple sclerosis (MS), frontotemporal dementias (FTD), motor neuron disease and Huntington’s disease. METHODS: Scoping review based on searches of MEDLINE and CINAHL up to 15 March 2016. RESULTS: We included 140 eligible papers. Over half of the studies, and almost all the randomised controlled trials, related to MS, while a number of single case studies described interventions for people with FTD. CR interventions addressed functional ability, communication and interaction, behaviour or memory. The majority of psychotherapy interventions involved cognitive behavioural therapy for depression or anxiety. Self-management interventions were mainly available for people with MS. There were few reports of interventions specific to caregivers. Numerous methodological challenges were identified. CONCLUSIONS: The limited range of studies for all conditions except MS suggests a need firstly to synthesise systematically the available evidence across conditions and secondly to develop well-designed studies to provide evidence about the effectiveness of CR and other psychological interventions

Anxiety in Parkinson's disease: relation to cognition and potential of non-pharmacological interventions

In addition to the classic motor symptoms, Parkinson’s disease (PD) causes a variety of non-motor symptoms that compromise quality of life and daily functioning. Anxiety, in particular, is prevalent and debilitating, but under-studied and under-treated. There is urgent need to understand the relation of anxiety to other non-motor symptoms, and to develop evidence-based treatments. Cognitive-behavioral therapy (CBT) and aerobic and resistance exercise are promising non-pharmacological treatment strategies for anxiety in PD, with potential to simultaneously reduce additional PD symptoms. Study 1 assessed a large sample of non-demented individuals with mild to moderate PD (N=77) and examined the relation between self-reported anxiety (Beck Anxiety Inventory [BAI]) and cognition with a focus on executive function and attention (Trail Making, Verbal Fluency, Digit Span). The majority of participants reported subclinical symptoms of anxiety (BAI ≤18). Higher anxiety correlated with poorer set-shifting, as well as with more advanced disease stage and severity. Study 2 implemented a single-case experimental design to evaluate the utility and feasibility of a 12-week cognitive-behavioral intervention for individuals with PD who also met criteria for a DSM-5 anxiety disorder (N=9). Weekly therapy sessions were conducted in-person (N=5) or via secure videoconferencing (N=4). At post-treatment, five participants reported significant reductions in anxiety and two additional participants reported significant reductions in comorbid depression. Most improvements were maintained at 6-week follow-up. Effects of CBT on secondary outcome measures (e.g., cognition, motor symptoms, sleep) varied widely across participants. Adherence and retention were high, as was satisfaction with treatment. Study 3 reviewed the effects of aerobic and resistance exercise on disturbances of mood, cognition, and sleep in PD and healthy adults. The literature supports aerobic and resistance exercise as feasible and promising adjunct treatments for mood, cognition, and sleep in PD, contingent upon additional exercise research that systematically targets non-motor symptom outcomes. Together these studies show that even subclinical anxiety is associated with cognitive disturbance in mild-moderate PD, and provide preliminary evidence for the effectiveness of CBT (in-person and internet-delivered), as well as aerobic and resistance exercise, as encouraging and viable treatments for anxiety in this disorder.2019-09-29T00:00:00

The neuropsychiatry of Parkinson's disease: advances and challenges

In people with Parkinson's disease, neuropsychiatric signs and symptoms are common throughout the disease course. These symptoms can be disabling and as clinically relevant as motor symptoms, and their presentation can be similar to, or distinct from, their counterparts in the general population. Correlates and risk factors for developing neuropsychiatric signs and symptoms include demographic, clinical, and psychosocial characteristics. The underlying neurobiology of these presentations is complex and not well understood, with the strongest evidence for neuropathological changes associated with Parkinson's disease, mechanisms linked to dopaminergic therapy, and effects not specific to Parkinson's disease. Assessment instruments and formal diagnostic criteria exist, but there is little routine screening of these signs and symptoms in clinical practice. Mounting evidence supports a range of pharmacological and non-pharmacological interventions, but relatively few efficacious treatment options exist. Optimising the management of neuropsychiatric presentations in people with Parkinson's disease will require additional research, raised awareness, specialised training, and development of innovative models of care

The Effects of Yoga Versus Mindfulness on Anxiety in Individuals with Parkinson’s Disease

Parkinson’s disease is a progressive neurodegenerative disease that causes debilitating motor deficits in addition to many non-motor symptoms. Tremors, stiffness, and abnormal gait changes are easily recognized as disabling; however, effects from anxiety are more insidious to disease burden which negatively affect both motor and psychological capabilities. Anxiolytics or antidepressants are often prescribed but can cause adverse side effects, prompting the need for alternative treatments. Yoga and mindfulness therapies are favorable alternative treatments known to reduce anxiety. This two-arm, single-blinded randomized controlled trial compares effects of yoga and mindfulness therapies in the reduction of anxiety for patients with Parkinson’s disease. Yoga is hypothesized to have greater statistically significant effect in reducing anxiety compared to mindfulness due to its combined mental and physical benefits. However, if both interventions demonstrate positive outcomes, both may prove to be beneficial adjunctive treatments for patients with anxiety in Parkinson’s disease or other neurodegenerative movement disorders

Protocol for the saMS trial (supportive adjustment for multiple sclerosis): a randomized controlled trial comparing cognitive behavioral therapy to supportive listening for adjustment to multiple sclerosis

BackgroundMultiple Sclerosis (MS) is an incurable, chronic, potentially progressive and unpredictable disease of the central nervous system. The disease produces a range of unpleasant and debilitating symptoms, which can have a profound impact including disrupting activities of daily living, employment, income, relationships, social and leisure activities, and life goals. Adjusting to the illness is therefore particularly challenging. This trial tests the effectiveness of a cognitive behavioural intervention compared to supportive listening to assist adjustment in the early stages of MS.MethodsThis is a two arm randomized multi-centre parallel group controlled trial. 122 consenting participants who meet eligibility criteria will be randomly allocated to receive either Cognitive Behavioral Therapy or Supportive Listening. Eight one hour sessions of therapy (delivered over a period of 10 weeks) will be delivered by general nurses trained in both treatments. Self-report questionnaire data will be collected at baseline (0 weeks), mid-therapy (week 5 of therapy), post-therapy (15 weeks) and at six months (26 weeks) and twelve months (52 weeks) follow-up. Primary outcomes are distress and MS-related social and role impairment at twelve month follow-up. Analysis will also consider predictors and mechanisms of change during therapy. In-depth interviews to examine participants’ experiences of the interventions will be conducted with a purposively sampled sub-set of the trial participants. An economic analysis will also take place. DiscussionThis trial is distinctive in its aims in that it aids adjustment to MS in a broad sense. It is not a treatment specifically for depression. Use of nurses as therapists makes the interventions potentially viable in terms of being rolled out in the NHS. The trial benefits from incorporating patient input in the development and evaluation stages. The trial will provide important information about the efficacy, cost-effectiveness and acceptability of the interventions as well as mechanisms of psychosocial adjustment.Trial registrationCurrent Controlled Trials ISRCTN91377356<br/