CBT and Mindfulness Psychotherapy for Parkinson’s Disease

Abstract Parkinson’s Disease (PD) is a neurological condition caused by the loss of dopamine neurons in the brain. The number of people affected is estimated to be over 10,000,000 world-wide and that number is expected to double by the year 2050. More men than women are affected by the disease and the prevalence is higher in western countries. PD is characterised by the cardinal signs of motor symptoms including tremor, bradykinesia and muscle rigidity. In addition, non-motor symptoms can occur as a result of the disease process or the medical treatment of the motor symptoms. People with PD on average live as long as their age matched peers without PD; however their quality of life is substantially lower during that time which can be largely attributed to the untreated non-motor symptoms of PD. The treatment for PD has focused on medications and surgical interventions to reduce the intensity of the motor symptoms. Side effects of medications and unrealised expectations of patients’ post- surgery contribute largely to the non-motor symptoms of depression, anxiety, impulse control and sleep disorders. Non pharmacological treatments can provide measurable and lasting improvement in the person’s quality of life and in particular psychological strategies incorporated in Cognitive Behavioural Therapy (CBT) achieve good outcomes for those living with PD. Mindfulness interventions are being investigated to identify potential benefits for people living with PD. Psychological interventions, although unable to identify and modify physical causes of disease processes, are able to significantly improve the person’s quality of life, subjective illness experience and can provide support and treatment to the wider family system often affected by the persons’ illness. The main study was a dyad based CBT intervention for anxiety in PD. Participants who completed the intervention displayed significant improvements over a range of well-being measures including anxiety, cognition, PD related impairment, and carers demonstrated reduced caregiver burden. The significant reduction in anxiety was maintained at 3 month post intervention, at which time an additional anxiety measure also showed improvement. The CBT intervention showed several secondary gains in the PD specific measure of cognition, the PD-CRS. This may have been in part due to the reduction in anxiety. The second study compared the results of the CBT intervention in study one to another psychotherapy intervention in PD, based on mindfulness. Comparison of the two interventions indicated several differences between the two groups at pre intervention assessment, including higher impact of PD impairment and decreased quality of life for participants in the Mindfulness Intervention. Participants in the anxiety specific CBT intervention demonstrated higher levels of anxiety at pre assessment, potentially identifying a self-selecting bias for participation in the intervention. The significant difference found between the groups on a measure of anxiety was not linked to either group or time on followup assessment and the findings were not replicable across anxiety measures. Overall, there were few differences found between the intervention groups at post treatment assessment, despite both interventions reporting significant improvements in anxiety levels for the participants. This study demonstrates significant findings of a CBT intervention for anxiety in PD, and in addition showed significant reduction in caregiver burden, a finding not often produced in research into chronic diseases. Beneficial findings were also found for a group Mindfulness Intervention