Telephone-Based, Clinician-Guided Self-Help Cognitive Behavioral Therapy for Depression in Parkinson's Disease (dPD): The Responder Cases of "Alice" and "Carl," and the Nonresponder Cases of "Ethan" and "Gary"

Abstract

Roseanne Dobkin and her colleagues (e.g., Dobkin, Interian, Durland, Gara, Menza, 2018) have developed a 10-session, individual cognitive-behavioral treatment (CBT) program for treating depression in individuals with Parkinson’s disease (dPD). The program has been found to yield statistically and clinically significant success in both uncontrolled group trial designs and randomized clinical trials—originally in a face-to-face version, and then in a telehealth version, using telephone therapy sessions and guided self-help materials for patients. This latter version is herein called "Teleheath Guided Self-Help for dPD," or "TH-GSH-dPD," for short. Applying Fishman, Messer, Edwards, and Dattilio’s (2017) "case studies within psychotherapy trials" methodological model, the present research was designed to complement the group research findings by my conducting systematic, pragmatic case studies (Fishman, 2013) with four patients representative of those in the telehealth studies, given the names of "Alice" (and her caregiver husband "Bob"); "Carl" (and his caregiver wife "Doris"); "Ethan" (and his caregiver wife, "Fay"); and "Gary" (and his caregiver mother, not named). Specifically, Alice and Carl were representative of those patients in the group studies with positive, responsive outcomes; and Ethan and Gary were representative of those patients in the group studies with negative, nonresponsive outcomes. Each case combines (a) quantitative data, comprised of demographic information, psychiatric diagnostic data, neurocognitive data, caregiver distress, and treatment outcome measures; and (b) qualitative data, consisting of recordings of the telephone therapy sessions, my treatment notes, my observations as the therapist, and systematic, post-treatment "Exit Interviews" I conducted with each of the patients and their caregivers about their therapy experience. Each of the four case studies aims (a) to provide a detailed, thickly described portrait of the TH-GSH-dPD treatment process; and (b) to explore the presence and influence of barriers and facilitators of treatment in an idiographic context. Regarding point (b), the following variables that cut across the case studies are explored as appearing to be particularly impactful: patients’ worldviews, patients’ cognitive functioning, caregiver involvement, and homework adherence.

Lessons Learned: Conducting Cases of Manualized, Telephone-Based, Cognitive Behavioral Treatment for Depression in Parkinson’s Disease (dPD)

“…My own self-reflection along with feedback from colleagues helped me bring awareness to the possible negative influence of my own concerns about maintaining rapport within a telehealth modality. Dr. Dobkin's clinical supervision of the four cases, described in my case study article (Durland, 2020) and Mann et al's Commentary has helped me to recognize that my prioritization of adherence to the research study treatment protocol, while well intentioned, interfered with my ability to individually tailor treatment effectively to Alice, Bob, Ethan, and Gary. I've concluded that it is this ability for self-reflection, done individually and in peer supervision/consultation, that is paramount for best practice and has to remain a major focus in my ongoing clinical work.…”

“…

My current clinical practice has been shifted to a telehealth format for the last three months due to the COVID-19 pandemic, and it seems an apt moment to reexamine my participation in Dr. Roseanne Dobkin's research on manualized telehealth therapy for depression in Parkinson's disease patients (dPD), using a protocol titled "Teleheath Guided Self-Help for dPD," or "TH-GSH-dPD," for short (Dobkin et al, 2020). My participation involved, in part, being the therapist in four case studies I have written about with "Alice," "Carl," "Ethan," and "Gary" (Durland, 2020). In these case studies, a subset of those in Dr. Dobkin's group studies, I explored my clinical decisionmaking, seeking insight into how best to flexibly apply the dPD protocol to meet the needs of a heterogeneous clinical population.

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The “cases within trials” (CWT) method: An example of a mixed methods research design.

“…Examples of pragmatic case studies that met peer-reviewed standards for publication can be found in the journal Pragmatic Case Studies in Psychotherapy (https://pcsp.nationalregister.org/). Pragmatic case studies in this journal that were representatively drawn from RCTs can be found in articles by Burckell and McMain (2011), Ciuca et al (2017), Durland (2020), Frankl et al (2020, Goldman et al (2011), Schultz et al (2017. For more details on the CWT method, including the META project and three other detailed examples that each follow the full outline in Table 13.2, see Fishman et al (2017).…”

The efficacy of telephone‐delivered cognitive behavioral therapy in people with chronic illnesses and mental diseases: A meta‐analysis

“…Several studies addressed the efficacy of T‐CBT on people with mental diseases with or without chronic physical diseases, revealing that T‐CBT was associated to a reduction of several psychological symptoms and an improvement of well‐being. For example, RTCs demonstrated that T‐CBT was more effective than control conditions to promote smoking cessation (Wu et al, 2017), to reduce depression and anxiety symptoms (Durland, 2020; Lawn et al, 2019), to reduce alcohol, food, or drugs addictions in patients with physical problems (Cassin et al, 2020; Meng et al, 2021). However, the comparison on the efficacy of T‐CBT versus other interventions (i.e., treatment as usual [TAU]) yielded contrasting results: some studies found that T‐CBT was more effective than TAU condition on ameliorating the psychological status of people with chronic diseases (Dobkin et al, 2020; Piette et al, 2011; Sockalingam et al, 2022; Yeung et al, 2022), whereas other studies did not (Allen et al, 2016; Ang et al, 2010; Doyle et al, 2017; McBeth et al, 2012).…”