Parkinson’s Anxiety – How Cognitive Behavioral Therapy Can Take Back Control

Parkinson’s Anxiety – Introduction

Parkinson’s Anxiety can be overwhelming, but there is a way to take back control. In this blog post, we will explore how Cognitive Behavioral Therapy (CBT) can help individuals facing Parkinson’s Anxiety regain their sense of empowerment.

Whether you are living with Parkinson’s disease or supporting a loved one, understanding the impact of anxiety and discovering effective strategies through CBT can make a significant difference in managing this aspect of the condition.

Join us as we delve into the world of Parkinson’s Anxiety and learn how CBT can pave the way to a more balanced and fulfilling life.

Parkinson’s Anxiety – How Prevalent is it?

How prevalent is it and how does it affect our quality of life? Anxiety is a common but often overlooked mood-related non-motor symptom in people living with Parkinson’s.

Let’s look at some of the statistics related to Parkinson’s Anxiety

• “40% of patients with Parkinson’s experience anxiety”¹
• “Over one-fourth of PD patients report clinically significant anxiety symptoms, and anxiety disorders are common in PD, with an average point prevalence of 31% and lifetime prevalence up to 49%”²
• “Anxiety in PD patients has been associated with several negative outcomes including worse emotional well-being, daily functioning, and health-related quality of life”²
• In a study of 64 Parkinson’s patients 40.6 % had an anxiety disorder.³

I’ve been living with Early onset Parkinson’s for 14 years since I was diagnosed at the age of 46. I started to experience panic attacks several years before my Parkinson’s diagnosis. I participated in Cognitive Behavioral Therapy, and it helped me to overcome my panic attacks. While I still do get anxious at times, using the strategies learned during Cognitive Behavioral Therapy helps me manage my anxiety.

References

1. Anxiety, ParkinsonsFoundation.org
2. Predictors or Anxiety in Parkinson’s Disease: results from a 3-year longitudinal cohort study, Neurological Sciences, Gibson, et.al, 11 October 2022.
3. Depression and Anxiety among Patients with Parkinson’s Disease: frequency, risk factors and impact on quality of life, The Egyptian Journal of Neurology, Psychiatry, and Neurosurgery, Khedr, et.al, 09 December 2020.

Types of Parkinson’s Anxiety

Before we examine the different types of Anxiety in Parkinsons disease, it is important to note that the general population can experience these different types of anxiety. These anxiety types are not strictly related to people living with Parkinson’s.

People with Parkinson’s disease can develop anxiety well before they are diagnosed with the disease, often times many years before. They can also develop anxiety during the course of their disease.

• Generalized Anxiety Disorder
  • People with Parkinson’s disease are more susceptible to Generalized Anxiety Disorder (GAD), characterized by persistent worry and nervousness.
  • Causes – GAD can stem from both psychological and biological factors. The psychological factors include anxieties about managing daily life with Parkinson’s symptoms, while the biological factors involve changes in brain chemistry, particularly lower levels of GABA, a calming neurotransmitter.
  • Symptoms of GAD in this context can include excessive fretting, difficulty concentrating, muscle tension, fatigue, and even worsen tremors.
  • Treatment options for GAD alongside Parkinson’s often involve a combination of medication adjustments to address the neurotransmitter imbalance, and therapeutic approaches like cognitive behavioral therapy to manage worry and improve coping skills.
• Panic Attacks
  • Causes – Panic attacks can be particularly terrifying for those with Parkinson’s disease. These episodes of intense anxiety, often triggered by stress or fear of worsening symptoms, come on abruptly and reach a peak within minutes.
  • Physical symptoms like shortness of breath, chest pain, dizziness, and sweating can mimic Parkinson’s tremors or “off” periods, causing further distress. The root cause lies in the same altered brain chemistry that contributes to anxiety in general.
  • Fortunately, treatment options exist. Medications like selective serotonin reuptake inhibitors (SSRIs) can help regulate neurotransmitters, while relaxation techniques such as deep breathing and meditation can equip individuals with tools to manage panic in the moment.
• Social Anxiety Disorder and Social Avoidance
  • Social anxiety disorder, or social avoidance, is a common anxiety response in Parkinson’s disease. The fear of embarrassment due to tremors, slurred speech, or slow movement can lead people to withdraw from social situations.
  • Causes – social avoidance can be triggered by both the physical limitations of Parkinson’s and the worry of being judged by others.
  • Symptoms include feelings of intense anxiety in social settings, avoidance of public places, and preoccupation with negative self-evaluation.
  • Treatment focuses on managing both the underlying anxiety and the motor symptoms of Parkinson’s. Medication adjustments can address anxiety, while therapies like cognitive behavioral therapy (CBT) help individuals develop coping mechanisms to navigate social situations with confidence. Additionally, support groups specifically for people with Parkinson’s can provide a safe space for social interaction and shared experiences.

Therapies for Parkinson’s Anxiety

Cognitive Behavioral Therapy (CBT)

What is CBT?

Cognitive behavioral therapy (CBT) is a structured, evidence-based form of psychotherapy that focuses on the connection between thoughts, feelings, and behaviors. It equips individuals with practical tools to identify and change unhelpful thinking patterns that contribute to anxiety and emotional distress. CBT is a collaborative process where the therapist works with the patient to:

• Identify negative thoughts: CBT helps individuals recognize automatic thoughts that arise in response to situations. These thoughts are often distorted or unhelpful, such as catastrophizing (always thinking the worst is about to happen) or fortune-telling (projecting in your mind scenarios that you think can or will happen.
• Challenge negative thoughts: The therapist guides the patient in examining the evidence supporting and contradicting these negative thoughts. This process helps develop more balanced and realistic thinking patterns.
• Develop coping skills: CBT teaches practical strategies for managing anxiety, such as relaxation techniques, deep breathing exercises, and exposure therapy. Exposure therapy involves gradually confronting feared situations in a safe and controlled environment.

Why CBT for Anxiety in Parkinson’s?

Parkinson’s disease often brings a multitude of anxieties. People with Parkinson’s may worry about:

• Managing symptoms: The fear of tremors, falls, or “off” periods in public can be a significant source of anxiety.
• Progression of the disease: Uncertainty about the future and the potential for worsening symptoms can fuel anxiety.
• Social isolation: The fear of embarrassment due to physical limitations can lead to withdrawal from social activities, further increasing anxiety and loneliness.

CBT is a powerful tool for addressing these anxieties in Parkinson’s because:

• It is skills-based: CBT equips individuals with concrete tools to manage their anxiety in the moment and over time.
• It targets negative thought patterns: By addressing distorted thinking, CBT helps reduce the emotional intensity of anxiety-provoking situations.
• It is adaptable: CBT can be tailored to address specific anxieties related to Parkinson’s disease.

Benefits of CBT for Anxiety in Parkinson’s:

Studies have shown CBT to be effective in reducing anxiety symptoms in individuals with Parkinson’s disease. Benefits can include:

• Reduced anxiety and worry: CBT helps individuals learn to manage their anxieties effectively, leading to a calmer and more peaceful state of mind.
• Improved coping skills: By learning practical tools, individuals are better equipped to handle challenging situations with confidence.
• Enhanced quality of life: Reduced anxiety can lead to greater participation in social activities and a more fulfilling life.

CBT is a valuable addition to the treatment plan for individuals with Parkinson’s who experience anxiety. By learning to manage negative thoughts and develop coping skills, individuals can find relief from anxiety and improve their overall well-being.

References:

Cognitive Behavorial Therapy, Mayoclinic.org.

How Cognitive Behavioral Therapy Can Help You Live Well with Parkinson’s, Davisphinney.org, Roseanne Dobkin PhD, August 4, 2021.

What is Cognitive Behavioral Therapy? apa.org

For more information on stay in the present and overcoming stress and anxiety read my article

Parkinson’s Anxiety – My Personal Journey

I wanted to share with you my experience with “my friend” anxiety and the effect it has on my quality of life.

I began experience intense panic attacks in my mid to late thirties which seemed not to be related to any particular stressors. In fact, there were several times when I was sleeping that I was woken up by a panic attack.

As I continued to experience panic attacks, I slowly began to avoid situations that I thought were the cause. These included being in large groups, heights (particularly flying) and confined spaces. Essentially any situation where I didn’t feel like I was in control and could flee from if I felt a panic attack coming on.

Finally, I got to the point where I knew I needed to seek professional guidance to help me overcome and manage the panic attacks. So, I scheduled an appointment with a behavioral Therapist who specialized in Anxiety. She suggested that I participate in Cognitive Behavioral Therapy (CBT). She recommended that I work with an individual, who I call Zelda, who has overcome Agoraphobia (fear of leaving her house) and used CBT to overcome it and regain her life.

I began working with Zelda once a week using Cognitive Behavioral Therapy to overcome my panic attacks. I’ll admit it was slow the first several weeks, because I was still experiencing the panic attacks. However, after practicing the skills she was teaching me, the panic attacks were beginning to be less intense and occurring less frequently.

After I had grasped the CBT concepts, Zelda began exposing me to things that I had avoided due to panic attacks, e.g. crowded places, heights and confined spaces such as elevators. When I was in college, my roommate and I were stuck in an elevator for an hour where the lights had gone out and we were in complete darkness.

After doing exposure therapy, my panic attacks had subsided, and I was back to living my life like I had prior to experiencing panic attacks. Let’s just say it was great to finally be living my best life again.

A few years later, I was diagnosed with early onset Parkinsons Disease PD at the age of 46. a few years after my diagnosis, I began to experience Parkinson’s anxiety. However, this time I was able to utilize the Cognitive Behavioral Therapy techniques I had learned from Zelda several years before to overcome my Parkinson’s anxiety.

I hope by sharing my journey with Parkinson’s anxiety that you can see there are therapies available to help you overcome your Parkinson’s Anxiety and lead a great quality of life.

For more information on overcoming Parkinson’s Anxiety and it’s impact on your quality of life, such as social avoidance read my articles.

Parkinson’s Anxiety – Additional Therapies

In addition to Cognitive Behavioral Therapy, there are other types of therapies that can be used independently or in conjunction with CBT.

Beyond CBT, several other therapies can be helpful for managing anxiety in Parkinson’s disease.

• Mindfulness-Based Stress Reduction (MBSR) teaches meditation and relaxation techniques to promote present-moment awareness and emotional regulation.
• Exposure therapy gradually exposes individuals to anxiety-provoking situations in a safe setting, helping them develop coping mechanisms and reduce fear.
• Relaxation techniques like deep breathing and progressive muscle relaxation can offer immediate relief from anxiety symptoms.

Additionally, occupational therapy can address anxiety related to daily tasks by developing strategies to manage them effectively, fostering a sense of control and reducing stress.

Parkinson’s Anxiety – Conclusion

Parkinson’s Anxiety is a common and often misunderstood aspect of living with Parkinson’s disease. It affects individuals in different ways and can manifest as various types of anxiety.

However, there is hope. Cognitive behavioral therapy, along with additional therapies, offers effective strategies for managing and alleviating anxiety symptoms.

By seeking the right support and implementing these therapies, individuals with Parkinson’s can improve their overall well-being and quality of life.

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References:

https://www.nia.nih.gov/health/parkinsons-disease