Anxiety coaching sessions fail to stop freezing of gait in Parkinson’s
But some benefits were seen in analyses after end of brief, small program
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- Anxiety is known to trigger or significantly worsen freezing of gait, or FOG, a symptom common in people with Parkinson’s.
- However, an intervention program that involved anti-anxiety coaching did not significantly cut FOG episodes in a small clinical trial.
- The researchers say further studies with more patients and longer intervention periods are needed to identify effective treatments for anxiety-related FOG.
A short, personalized intervention teaching people with Parkinson’s disease ways to manage anxiety that can trigger or worsen freezing of gait (FOG) — a common symptom in which individuals can not move their feet forward — did not significantly cut the number of such episodes when compared with no immediate treatment in a small clinical trial.
No differences were seen between participants who took part in weekly counseling sessions, spanning about one month, and those who did not, the researchers noted. The meetings with the neuropsychologist were aimed at helping patients to better understand the link between anxiety and FOG, and to develop strategies to prevent freezing.
Still, in exploratory analyses after all participants had received the four sessions, the scientists found evidence of reductions in time spent frozen, anxiety, and stress. However, because there was no longer a control group at that point, the team could not determine whether these improvements were due to the program.
“Contrary to our hypothesis, the intervention did not result in a greater reduction in FOG … compared to the control group,” the researchers wrote, noting, however, that the study was both small and limited in time.
“Future research is warranted to identify effective interventions for anxiety-related FOG in people with [Parkinson’s],” the team concluded.
The study, “‘Managing the mental state’ to tackle anxiety-related freezing of gait in people with Parkinson’s disease: a randomized controlled trial,” was published in the journal npj Parkinson’s Disease.
Problems with walking, and particularly freezing gait, are common and disabling Parkinson’s symptoms. FOG causes a person to suddenly become unable to step forward despite intending to walk — often described as feeling as if one’s feet are glued to the floor.
Episodes can occur when starting to walk, turning, doing another task while walking, or moving through narrow spaces. Anxiety can also trigger or worsen freezing, such as when someone feels rushed or worries about freezing in public.
“FOG has a profound impact on daily life and is a major risk factor for falls, underscoring the need for effective … therapeutic approaches,” the researchers wrote. Still, “treating FOG remains challenging, as symptoms are frequently resistant to both pharmacological and nonpharmacological interventions,” the team added.
Assessing whether strategies for anxiety can cut freezing of gait
Some people with Parkinson’s develop their own ways to manage FOG-related anxiety, such as using relaxation techniques and positive self-talk, or reducing the pressure of being rushed.
Collectively known as “Managing the Mental State” strategies, these are among the compensatory approaches that people with Parkinson’s report as particularly helpful for alleviating walking difficulties, including FOG, according to the researchers.
What works, however, can vary from person to person and situation to situation. For example, a strategy that helps an individual who freezes while rushing to answer the door may not help someone anxious about experiencing FOG in front of others.
Such variations “underscore the potential benefit of adopting a tailored approach that addresses FOG-related anxiety to treat [freezing episodes],” the researchers wrote. “So far, however, such tailored strategies have never been evaluated in a systematic manner.”
To evaluate the effectiveness of a personalized Managing the Mental State intervention for reducing anxiety-related FOG, researchers in the Netherlands and the U.K. focused on a program offering sessions with a trained neuropsychologist. The team conducted a randomized controlled trial, dubbed TACKLING-FOG (NCT06302309), that ran from April 2024 through September 2025.
The trial enrolled 41 people with Parkinson’s who experienced multiple daily freezing episodes that occurred or worsened with anxiety or stress.
Participants were randomly assigned to either receive the intervention immediately or spend four weeks on a waitlist before receiving it. The intervention group comprised 21 people, including 14 men, while 20 individuals — 12 of them men — were in the waitlist group. The participants’ ages were similar, with a mean age of 69.2 in the intervention group and 71.3 in the waitlist group.
Some reductions in time frozen seen after trial’s end
The intervention involved four weekly, 60- to 90-minute sessions with the neuropsychologist. Participants learned about the link between anxiety and freezing, identified situations that triggered their episodes, and received personalized strategies aimed at preventing FOG. These included relaxation techniques and strategies for managing thoughts and emotions related to freezing.
The scientists measured freezing using a personalized walking course set up in each participant’s home, which included situations likely to trigger FOG. The main goal was to determine whether the intervention reduced the percentage of time spent frozen.
Among the 36 participants ultimately included in the main analysis, time spent frozen after four weeks did not differ significantly between the intervention and waitlist groups, meaning the trial did not meet its main goal.
“Directly after the intervention or waitlist period, there was no difference … in the reduction of percentage time frozen during the personalized walking trajectory,” the researchers wrote, noting that most secondary measures also did not differ between groups. Self-reported FOG and self-esteem favored the intervention, the team noted.
The researchers then conducted a planned exploratory analysis after the waitlist group had also received the intervention. Four additional participants withdrew before the final follow-up, which was completed by 32 people.
After merging both groups to examine changes over time … a reduction in the time spent frozen during the walking course directly following the intervention was observed.
Across the follow-up period, the proportion of time spent frozen during the walking task fell by a mean of 8.5 percentage points after the intervention, with the reduction maintained through 10 weeks.
“After merging both groups to examine changes over time … a reduction in the time spent frozen during the walking course directly following the intervention was observed,” the team wrote.
Anxiety, perceived stress, self-reported freezing severity, and Parkinson’s-related quality of life also improved over time. Participants also reported that anxiety had less influence on their freezing.
However, because everyone had received the intervention by this point, there was no untreated group for comparison. The researchers, therefore, could not determine whether the intervention caused the improvements. Repeated exposure to the walking assessment, for example, may have made participants more comfortable and less anxious.
The researchers noted that four sessions may also have been too few to change established anxiety patterns. Cognitive behavioral therapy for anxiety in Parkinson’s typically involves 6-12 weekly sessions. The program also did not include physiotherapy to address balance confidence and fear of falling.
“In this randomized controlled trial, a brief, four-session tailored psychoeducational and behavioral intervention aimed at reducing anxiety-related FOG did not result in a greater reduction in objectively measured FOG compared with a waitlist control condition,” the scientists concluded, though urging that further research be done.
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