Abstract
Background:Parkinson’s disease (PD) is often associated with psychological distress and lowered daily functioning. The availability of psychological interventions tailored for people with Parkinson is very limited.Objective:To study if guided individually-tailored internet-based cognitive behavioral therapy (ICBT) provide additional value to standard medical treatment for PD.Methods:Seventy-seven individuals with PD and self-reported problems with general function measured with the Work and Social Adjustment Scale (WSAS > 15) were randomized to 10 weeks of either ICBT combined with standard medical treatment, or standard medical treatment plus being on waitlist to ICBT (CONTROL). Change in the main outcome WSAS, as well as secondary measures such as quality of life, depression, anxiety and insomnia symptoms were investigated post treatment.Results:Participants receiving ICBT reported significantly higher functioning after treatment (WSAS group difference –4.56, controlled effect size g = 0.69, significant group by time interaction, Wχ2= 26.23, p = 0.001). However, only around one third of participants in the treatment group were classified as treatment responders, defined as having a 30% reduction on the WSAS post treatment. Patient involvement and ratings of ICBT credibility were high. Symptoms of anxiety, depression and insomnia symptoms were significantly lower after treatment compared to CONTROL. There were also positive effects on Parkinson-specific function and quality of life in the treatment group.Conclusions:ICBT as an addition to standard medical treatment was credible and improved functioning for some individuals with PD. Still, the treatment needs further development in order to help a larger proportion of individuals with PD.Trial registration number:ClinicalTrials.gov NCT02627885.
Highlights
Parkinson’s disease (PD) is often primarily associated with motor symptoms, there are common psychological and other non-motor symptoms that strongly affect daily functioning and quality of life
There is suggestive evidence that psychological treatments based on cognitive-behavioral approaches can alleviate depressive and anxiety symptoms in PD [1, 4], reduce impulse control behaviors [5], and reduce caregiver burden [6]
Since all available time points were used in the GEEanalysis, the SCREEN time point was considered the baseline for Work and Social Adjustment Scale (WSAS) and WHODAS-2 and the PRE time point for the remaining outcomes
Summary
Parkinson’s disease (PD) is often primarily associated with motor symptoms, there are common psychological and other non-motor symptoms that strongly affect daily functioning and quality of life. There is suggestive evidence that psychological treatments based on cognitive-behavioral approaches can alleviate depressive and anxiety symptoms in PD [1, 4], reduce impulse control behaviors [5], and reduce caregiver burden [6]. Self-help interventions like telephone- or internet-based treatments have the potential to extend the reach of these treatments. Objective: To study if guided individually-tailored internet-based cognitive behavioral therapy (ICBT) provide additional value to standard medical treatment for PD. Change in the main outcome WSAS, as well as secondary measures such as quality of life, depression, anxiety and insomnia symptoms were investigated post treatment.
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