Objective: To investigate the feasibility and efficacy of online-based Cognitive Behavioral Therapy (CBT) for anxiety in Parkinson’s disease (PD).

Background: Anxiety symptoms in Parkinson’s disease are highly prevalent and often lead to decreased quality of life and tolerability of treatment medications. We have previously shown that CBT improves anxiety symptoms in PD. Because this trial was a single-arm open trial, we needed to demonstrate the efficacy of CBT in an RCT. However, weekly visits for in-person CBT were not feasible due to the Covid-19 outbreak. Online CBT as a treatment for depression, pain, and diabetes has been shown to be as effective as face-to-face CBT. Therefore, we chose to use online small-group CBT.

Method: The study was a randomized, wait-list controlled Trial for 8 sessions of manualized online small-group CBT program. The small group consisted of one clinical psychologist and four PD patients. The primary endpoint was defined as the degree of improvement of HAM-A (Hamilton Anxiety Scale), and the secondary endpoint was evaluated by the degree of improvement of HAM-D (Hamilton Depression Scale), GAD-7 (Generalized Anxiety Disorder -7), PHQ-9(Patient Health Questionnaire-9), and PDQ39(Parkinson’s Disease Questionnaire-39).
After registering in the clinical trial registration system (UMIN000044247), we obtained approval from the Research Ethics Committee, Faculty of Medicine, Juntendo University (H20-0080) to launch this clinical study.

Results: 32 PD with anxiety symptoms enrolled and 28 of them completed the study. Of the 4 who dropped out, 1 withdrew from the study, 2 discontinued due to worsening depressive symptoms during the waiting period, and 1 discontinued due to surgery for a comorbidity. In the RCT, there was no significant difference in HAM-A improvement between the CBT group and the waiting group. Comparing before and after CBT intervention, there was no difference in improvement in HAM-A, but significant improvement in HAM-D and PDQ-39.

Conclusion: Small group online CBT led by a clinical psychologist was feasible at the Corona Vortex. It did not significantly improve anxiety in PD, but did improve depression and quality of life.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/a-randomized-wait-list-controlled-trial-of-the-feasibility-and-efficacy-of-small-group-online-based-cognitive-behavioral-therapy-for-anxiety-in-parkinsons-disease/