Telephone-based cognitive behavioral therapy for depression in Parkinson disease

Abstract

ObjectiveTo determine whether, for patients with depression and Parkinson disease (PD), telephone-based cognitive-behavioral treatment (T-CBT) alleviates depressive symptoms significantly more than treatment as usual (TAU), we conducted a randomized controlled trial to evaluate the efficacy of a 10-session T-CBT intervention for depression in PD, compared to TAU.MethodsSeventy-two people with PD (PWP) were randomized to T-CBT + TAU or TAU only. T-CBT tailored to PWPs’ unique needs was provided weekly for 3 months, then monthly during 6-month follow-up. CBT targeted negative thoughts (e.g., “I have no control”; “I am helpless”) and behaviors (e.g., social withdrawal, excessive worry). It also trained care partners to help PWP practice healthy habits. Blind raters assessed outcomes at baseline, midtreatment, treatment end, and 1 and 6 months post-treatment. Analyses were intent to treat.ResultsT-CBT outperformed TAU on all depression, anxiety, and quality of life measures. The primary outcome (Hamilton Depression Rating Scale score) improved significantly in T-CBT compared to TAU by treatment end. Mean improvement from baseline was 6.53 points for T-CBT and −0.27 points for TAU (p < 0.0001); gains persisted over 6-month follow-up (p < 0.0001). Improvements were moderated by a reduction in negative thoughts in the T-CBT group only, reflecting treatment target engagement.ConclusionsT-CBT may be an effective depression intervention that addresses a significant unmet PD treatment need and bypasses access barriers to multidisciplinary, evidence-based care.Clinicaltrials.gov identifierNCT02505737.Classification of evidenceThis study provides Class I evidence that for patients with depression and PD, T-CBT significantly alleviated depressive symptoms compared to usual care.

Remote delivery of psychological interventions for Parkinson's disease

“…A summary of study characteristics for telehealthbased psychological interventions for anxiety and depression in PD is provided in Table 1. To date, only five such studies have been published: Three of these involved telephone-delivered CBT (Veazey et al, 2009;Dobkin et al, 2011b;Calleo et al, 2015), one involved a hybrid of CBT-based bibliotherapy and telephone support (Lawson et al, 2013), and one involved internet-administered CBT (in the form of self-paced, online modules) with supplementary telephone support (Kraepelien et al, 2015). All were pilot studies, and targeted comorbid depression and/or anxiety symptoms in older PD patients through one-on-one CBT.…”

“…Telephone-administered CBT designed to simulate face-to-face treatment appears to be the most trialed remote delivery method for psychological interventions in this population. In more recent trials, CBT has been adapted to incorporate PD-specific symptom management and include caregivers (Dobkin et al, 2011b;Calleo et al, 2015), and also allows patients to specifically tailor certain aspects of skill training (Calleo et al, 2015). Results are promising but variable, with significant improvements reported for anxiety only (Veazey et al, 2009), depression only (Calleo et al, 2015), or both depression and anxiety (Dobkin et al, 2011b).…”

Occupational therapists' perceptions of psychosocial strategies for clients with Parkinson's disease

“…Psychosocial strategies refer to approaches that include cognitive, behavioral, and interpersonal methods (Barlow & Durand, ). Research currently supports the utilization of a range of psychosocial strategies for the treatment of psychological non‐motor symptoms in PD, including, but not limited to, goal setting, positive reinforcement, cognitive behavioral therapy (CBT), motivational interviewing (MI), relaxation, social support, and mindfulness (Butterfield et al, ; Dobkin et al, ; Lee et al, ; Pickut et al, ; Saeedian et al, ).…”

“…Research has highlighted that alternative methods of delivering psychosocial strategies to individuals with PD might need to be examined to address barriers to mental health care. Psychosocial strategies delivered via technology or by specialist allied health professionals, such as occupational therapists, have been identified as possible alternatives that might counter identified barriers, and subsequently facilitate the optimal management of psychological non‐motor symptoms in PD (British Psychological Society, ; Dobkin et al, ).…”

Assessment and Management of Neuropsychiatric Symptoms in Parkinson’s Disease

“…A further limiting factor for CBT interventions are practical obstacles to attending therapy, such as living in remote areas, lack of transportation or caregiver support, or fluctuations in motor symptoms [39]. There has been a recent effort to develop telehealth interventions, which have indicated feasibility and good retention rates, but require larger scale evaluation [40][41][42][43][44][45].…”