Cognitive Behavioral Group Therapy Can Help Treat Parkinson’s Patients’ Depression, Study Finds

José Lopes, PhD avatar

by José Lopes, PhD |

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cognition and Parkinson's

Cognitive behavioral group therapy reduced Parkinson’s patients’ depression and anxiety, an Italian study reports.

Parkinson’s patients experience both movement and non-movement symptoms, including depression, anxiety, apathy, fatigue, pain, and impulse control disorders.

Cognitive behavioral therapy, or CBT, is a well-established strategy for reducing depression and apathy. But evidence supporting its use in Parkinson’s patients has dealt mostly with individual rather than group therapy. Groups give patients with a similar disorder a chance to interact with each other and share information and experiences.

Although the  limited research on group CBT in Parkinson’s has demonstrated that it can help treat patients’ psychiatric and neurological symptoms, no study used a control group to help validate the findings.

So a team of researchers conducted a study comparing the benefits of group CBT with that of a psychoeducational approach to treating Parkinson’s. The psychoeducational approach has proved beneficial in treating other neuropsychiatric disorders.

The study, “Cognitive behavioral group therapy versus psychoeducational intervention in Parkinson’s disease,” was published in the journal Neuropsychiatric Disease and Treatment, 

Researchers said the study’s main goal was to see if cognitive behavioral group therapy could improve Parkinson’s patients’ psychiatric, movement and non-movement symptoms.

The research team assigned 20 Parkinson’s patients diagnosed with a psychiatric disorder but showing no evidence of cognitive impairment to either a 12-week cognitive behavioral therapy group or a psychoeducational protocol.

Researchers used the Unified Parkinson’s Disease Rating Scale and the non-motor symptoms scale as measures of neurological symptoms. They assessed the severity of psychiatric symptoms with three scales. The team evaluated patients before the start of the trial and at the end of the 12-week treatment.

A psychiatrist and neurologist conducted the once-a-week, 90-minute group CBT sessions. The therapists were trained in using practical skills to change mood-related thoughts, behaviors, and movement symptoms. Researchers also looked at whether patients avoided social situations, engaged in family conflict, lacked assertiveness, had trouble with problem-solving, and what coping strategies they had.

The psychoeducational group met every two weeks. A different psychiatrist and neurologist than the ones in the CBT group conducted the therapy.

Sessions focused on information and explanations about Parkinson’s disease and possible implications for the patients’ lives. The four main topics were illness awareness, sticking with treatment, early detection of movement and non-movement symptoms, and achieving lifestyle continuity. Each session included an initial presentation, an exercise and a group discussion. Disease management and side effects were also covered.

The results showed that group CBT was an effective treatment for depression and anxiety in all of the Parkinson’s patients who completed the study. It also reduced the severity of patients’ other non-movement symptoms, such as apathy. In contrast, the psychoeducational protocol did not change patients’ symptoms, researchers said.

Because both groups had similar disease severity at the start of the study, the researchers said it was unlikely that differences in severity confounded the results.

This study demonstrated that group CBT did a better job of improving Parkinson’s patients’ psychiatric symptoms than psychoeducational treatment. But the research had its limitations. One was that the number and duration of psychoeducational sessions did not match those of the CBT sessions. Other limitations were the relatively small number of patients studied and the fact that the main measure of participants’ psychiatric condition was patient self-reports.

Nonetheless, the study suggested that group CBT should be considered along with standard drug therapy for treating the mental health symptoms of people with chronic and disabling illnesses, particularly depression and anxiety.