Telephone-based cognitive behavioral therapy for depression in Parkinson disease: A randomized controlled trial

Roseanne D Dobkin, Sarah L Mann, Michael A Gara, Alejandro Interian, Kailyn M Rodriguez, Matthew Menza, Roseanne D Dobkin, Sarah L Mann, Michael A Gara, Alejandro Interian, Kailyn M Rodriguez, Matthew Menza

Abstract

Objective: To 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.

Methods: Seventy-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.

Results: T-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.

Conclusions: T-CBT may be an effective depression intervention that addresses a significant unmet PD treatment need and bypasses access barriers to multidisciplinary, evidence-based care.

Clinicaltrialsgov identifier: NCT02505737.

Classification of evidence: This study provides Class I evidence that for patients with depression and PD, T-CBT significantly alleviated depressive symptoms compared to usual care.

Copyright © 2020 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Neurology.

Figures

Figure 1. Consolidated Standards of Reporting Trials…
Figure 1. Consolidated Standards of Reporting Trials (CONSORT) diagram
Flow diagram of study participation. CBT = cognitive-behavioral therapy; MoCA = Montreal Cognitive Assessment; TAU = treatment as usual.
Figure 2. Magnitude of Hamilton Depression Rating…
Figure 2. Magnitude of Hamilton Depression Rating Scale (HAM-D) score change over time by study condition
Participants in telephone-based cognitive-behavioral therapy (CBT) showed a marked, durable decrease in clinician-rated depression symptoms (HAM-D) over the course of the trial, compared to treatment as usual (TAU) participants' persistent depressive symptomatology.
Figure 3. Clinical Global Impression Improvement Scale…
Figure 3. Clinical Global Impression Improvement Scale (CGI-I) distributions at end of treatment and 6-month follow-up
CGI-I score distributions at end of treatment (A; 3 months postbaseline) and 6-month follow-up (B; 9 months postbaseline) reflect the clinical significance and durability of telephone-based cognitive-behavioral therapy (CBT) treatment gains over treatment as usual (TAU).

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Source: PubMed

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