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Roper A, Pacas Fronza G, Dobkin RD, Beaudreau SA, Mitchell LK, Pachana NA, Thangavelu K, Dissanayaka NN. A Systematic Review of Psychotherapy Approaches for Anxiety in Parkinson's Disease. Clin Gerontol 2024; 47:188-214. [PMID: 35634720 DOI: 10.1080/07317115.2022.2074814] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Anxiety is common in Parkinson's disease (PD), negatively impacting daily functioning and quality of life in PD patients and their families. This systematic review evaluates the effectiveness of different psychotherapeutic approaches for reducing anxiety in PD and provides recommendations for clinical practise. METHODS Following PRISMA guidelines, 36 studies were included and risk of bias was evaluated. RESULTS We identified cognitive behavioral therapy (CBT), mindfulness-based therapies, acceptance and commitment therapy, and psychodrama psychotherapies. There is good evidence-base for anxiety reduction using CBT approaches, but with mixed results for mindfulness-based therapies. Other therapeutic approaches were under researched. Most randomized control trials examined anxiety as a secondary measure. There was a paucity of interventions for anxiety subtypes. Secondarily, studies revealed the consistent exclusion of PD patients with cognitive concerns, an importance of care partner involvement, and a growing interest in remote delivery of psychotherapy interventions. CONCLUSIONS Person-centered anxiety interventions tailored for PD patients, including those with cognitive concerns, and trials exploring modalities other than CBT, warrant future investigations. CLINICAL IMPLICATIONS Practitioners should consider PD-specific anxiety symptoms and cognitive concerns when treating anxiety. Key distinctions between therapeutic modalities, therapy settings and delivery methods should guide treatment planning.
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Affiliation(s)
- Amy Roper
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- School of Psychology, The University of Queensland, Brisbane, Australia
| | - Gabriela Pacas Fronza
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Roseanne D Dobkin
- Department of Psychiatry, Rutgers University, Robert Wood Johnson Medical School, Piscataway, New Jersey, USA
| | - Sherry A Beaudreau
- School of Psychology, The University of Queensland, Brisbane, Australia
- Sierra Pacific Mental Illness Research, Education, and Clinical Centers (MIRECC), Palo Alto Veterans Administration Health Care System & Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA
| | | | - Nancy A Pachana
- School of Psychology, The University of Queensland, Brisbane, Australia
| | - Karthick Thangavelu
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Nadeeka N Dissanayaka
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- School of Psychology, The University of Queensland, Brisbane, Australia
- Department of Neurology, Royal Brisbane & Women's Hospital, Brisbane, Australia
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Bogosian A, Hurt CS, Hindle JV, McCracken LM, Vasconcelos e Sa DA, Axell S, Tapper K, Stevens J, Hirani PS, Salhab M, Ye W, Cubi-Molla P. Acceptability and Feasibility of a Mindfulness Intervention Delivered via Videoconferencing for People With Parkinson's. J Geriatr Psychiatry Neurol 2022; 35:155-167. [PMID: 33504245 PMCID: PMC8678660 DOI: 10.1177/0891988720988901] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Mindfulness-based group therapy is a rapidly growing psychological approach that can potentially help people adjust to chronic illness and manage unpleasant symptoms. Emerging evidence suggests that mindfulness-based interventions may benefit people with Parkinson's. The objective of the paper is to examine the appropriateness, feasibility, and potential cost-effectiveness of an online mindfulness intervention, designed to reduce anxiety and depression for people with Parkinson's. We conducted a feasibility randomized control trial and qualitative interviews. Anxiety, depression, pain, insomnia, fatigue, impact on daily activities and health-related quality of life were measured at baseline, 4, 8, and 20 weeks. Semi-structured interviews were conducted at the end of the intervention. Participants were randomized to the Skype delivered mindfulness group (n = 30) or wait-list (n = 30). Participants in the mindfulness group were also given a mindfulness manual and a CD with mindfulness meditations. The intervention did not show any significant effects in the primary or secondary outcome measures. However, there was a significant increase in the quality of life measure. The incremental cost-effectiveness ratio was estimated to be £27,107 per Quality-Adjusted Life Year gained. Also, the qualitative study showed that mindfulness is a suitable and acceptable intervention. It appears feasible to run a trial delivering mindfulness through Skype, and people with Parkinson's found the sessions acceptable and helpful.
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Affiliation(s)
- Angeliki Bogosian
- Division of Health Services Research and Management, City, University of London, London, United Kingdom,Angeliki Bogosian, Division of Health Services Research and Management, City, University of London, London, United Kingdom.
| | - Catherine S. Hurt
- Division of Health Services Research and Management, City, University of London, London, United Kingdom
| | - John V. Hindle
- School of Psychology, Bangor University, Bangor, United Kingdom
| | - Lance M. McCracken
- Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
| | | | - Sandra Axell
- Division of Health Services Research and Management, City, University of London, London, United Kingdom
| | - Katy Tapper
- School of Psychology, City, University of London, London, United Kingdom
| | - Jemima Stevens
- School of Psychology, City, University of London, London, United Kingdom
| | - P. Shashi Hirani
- Division of Health Services Research and Management, City, University of London, London, United Kingdom
| | - Marya Salhab
- Division of Health Services Research and Management, City, University of London, London, United Kingdom
| | - Wenrong Ye
- Amaris Technology Consulting Co., Ltd, Huang Pu District Shanghai
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Zarotti N, Eccles FJR, Foley JA, Paget A, Gunn S, Leroi I, Simpson J. Psychological interventions for people with Parkinson's disease in the early 2020s: Where do we stand? Psychol Psychother 2021; 94:760-797. [PMID: 33174688 DOI: 10.1111/papt.12321] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 09/27/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE To explore the heterogeneity of the literature on psychological interventions for psychological difficulties in people with Parkinson's disease (PD). METHODS A scoping review was performed across five major databases (MEDLINE Complete, PsycINFO, CINAHL, Academic Search Ultimate, and Cochrane Library) up to June 2020. RESULTS From an initial return of 4911 citations, 56 studies were included, of which 21 were RCTs. A relatively wide range of therapeutic models have been adopted with people with PD, from common therapies such as cognitive behavioural therapy (CBT) and mindfulness, to less frequent approaches, for example, acceptance and commitment therapy (ACT) and psychodrama. The clinical implications of the findings are discussed, and suggestions are provided for future research on intervention studies and key psychological outcomes. CONCLUSIONS CBT appears to be effective in treating depression and sleep disorders in people with PD, while psychoeducation programmes alone should be avoided. The use of CBT to improve anxiety, quality of life, and impulse control, as well mindfulness-based interventions, should be undertaken with some caution because of insufficient research and inconsistent results. As we enter the new decade, more high-quality evidence is required for psychological interventions in people with PD in general and to corroborate preliminary positive findings on the adoption of less frequent approaches such as ACT. PRACTITIONER POINTS Parkinson's disease is a progressive neurodegenerative condition associated with several psychological difficulties which be targeted by psychological interventions. Currently, cognitive behavioural therapy (CBT) can be recommended to treat depression and sleep disorders in people with Parkinson's, while psychoeducation alone should be avoided. Caution is advised regarding the use of CBT and mindfulness-based interventions to improve anxiety, quality of life, and impulse control. Further evidence is required for less common approaches, such as acceptance and commitment therapy, psychodrama, and EMDR.
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Affiliation(s)
- Nicolò Zarotti
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, UK
| | - Fiona J R Eccles
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, UK
| | - Jennifer A Foley
- Department of Neuropsychology, National Hospital of Neurology & Neurosurgery, London, UK.,UCL Queen Square Insitute of Neurology, Queen Square, London, UK
| | - Andrew Paget
- Department of Neuropsychology, National Hospital of Neurology & Neurosurgery, London, UK.,UCL Queen Square Insitute of Neurology, Queen Square, London, UK
| | - Sarah Gunn
- Department of Neuroscience, Psychology and Behaviour, University of Leicester, UK
| | - Iracema Leroi
- Global Brain Health Institute, Trinity College Dublin, Ireland
| | - Jane Simpson
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, UK
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Dhingra A, Janjua AU, Hack L, Waserstein G, Palanci J, Hermida AP. Exploring Nonmotor Neuropsychiatric Manifestations of Parkinson Disease in a Comprehensive Care Setting. J Geriatr Psychiatry Neurol 2021; 34:181-195. [PMID: 32242493 DOI: 10.1177/0891988720915525] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Parkinson disease (PD) is a debilitating neurological condition that includes both motor symptoms and nonmotor symptoms (NMS). Psychiatric complaints comprise NMS and are collectively referred to as neuropsychiatric manifestations. Common findings include atypical depressive symptoms, anxiety, psychosis, impulse control disorder, deterioration of cognition, and sleep disturbances. Quality of life (QoL) of patients suffering from NMS is greatly impacted and many times can be more debilitating than motor symptoms of PD. We expand on knowledge gained from treatment models within a comprehensive care model that incorporates multidisciplinary specialists working alongside psychiatrists to treat PD. Insight into background, clinical presentations, and treatment options for patients suffering from neuropsychiatric manifestations of PD are discussed. Identifying symptoms early can help improve QoL, provide early symptom relief, and can assist tailoring treatment plans that limit neuropsychiatric manifestations.
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Affiliation(s)
- Amitha Dhingra
- Department of Psychiatry and Behavioral Sciences, 12239Emory University School of Medicine, Atlanta, GA, USA
| | - A Umair Janjua
- Department of Psychiatry and Behavioral Sciences, 12239Emory University School of Medicine, Atlanta, GA, USA
| | - Laura Hack
- Department of Psychiatry and Behavioral Sciences, 12239Emory University School of Medicine, Atlanta, GA, USA
| | - Gabriella Waserstein
- Department of Psychiatry and Behavioral Sciences, 12239Emory University School of Medicine, Atlanta, GA, USA
| | - Justin Palanci
- Department of Psychiatry and Behavioral Sciences, 12239Emory University School of Medicine, Atlanta, GA, USA
| | - Adriana P Hermida
- Department of Psychiatry and Behavioral Sciences, 12239Emory University School of Medicine, Atlanta, GA, USA
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Bogosian A, Rixon L, Hurt CS. Prioritising target non-pharmacological interventions for research in Parkinson's disease: achieving consensus from key stakeholders. RESEARCH INVOLVEMENT AND ENGAGEMENT 2020; 6:35. [PMID: 32595982 PMCID: PMC7315468 DOI: 10.1186/s40900-020-00212-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 06/15/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND In 2014 Parkinson's UK conducted a research prioritisation exercise with stakeholders highlighting important clinical research questions. The exercise highlighted the need for effective interventions to be developed and tested to tackle a range of non-motor symptoms including: sleep quality, stress and anxiety, mild cognitive impairment, dementia and urinary problems. The present work set out to build on this exercise by prioritising types of non-pharmacological interventions to be tested to treat the identified non-motor symptoms. METHODS A Patient and Public Involvement exercise was used to reach consensus on intervention priorities for the treatment of non-motor symptoms. A Delphi structure was used to support the feedback collected. A first-round prioritisation survey was conducted followed by a panel discussion. Nineteen panellists completed the first-round survey (9 people with Parkinson's and 10 professionals working in Parkinson's) and 16 participated in the panel discussion (8 people with Parkinson's and 8 professionals working in Parkinson's). A second-round prioritization survey was conducted after the panel discussion with 13 people with Parkinson's. RESULTS Physical activity, third wave cognitive therapies and cognitive training were rated as priority interventions for the treatment of a range of non-motor symptoms. There was broad agreement on intervention priorities between health care professionals and people with Parkinson's. A consensus was reached that research should focus on therapies which could be used to treat several different non-motor symptoms. In the context of increasing digitisation, the need for human interaction as an intervention component was highlighted. CONCLUSION Bringing together Parkinson's professionals and people with Parkinson's resulted in a final treatment priority list which should be both feasible to carry out in routine clinical practice and acceptable to both professionals and people with Parkinson's. The workshop further specified research priorities in Parkinson's disease based on the current evidence base, stakeholder preferences, and feasibility. Research should focus on developing and testing non-pharmacological treatments which could be effective across a range of symptoms but specifically focusing on tailored physical activity interventions, cognitive therapies and cognitive training.
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Affiliation(s)
- Angeliki Bogosian
- Division of Health Services Research and Management, City, University of London, London, UK
| | - Lorna Rixon
- Division of Health Services Research and Management, City, University of London, London, UK
| | - Catherine S. Hurt
- Division of Health Services Research and Management, City, University of London, London, UK
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Hurt CS, Cleanthous S, Newman SP. Further explorations of illness uncertainty: carers’ experiences of Parkinson’s disease. Psychol Health 2017; 32:549-566. [DOI: 10.1080/08870446.2017.1283041] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Catherine S. Hurt
- Centre for Health Services Research, School of Health, City, University London, London, UK
| | | | - Stanton P. Newman
- Centre for Health Services Research, School of Health, City, University London, London, UK
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