The contribution of cognitive behavioural factors to social anxiety in Parkinson's disease.

BACKGROUND: Social anxiety is prevalent in idiopathic Parkinson's disease but why this is, is not yet well understood. Social cognitions, safety-seeking behaviours and internally focused attention are all known to predict social anxiety in the general population. These associated factors have not yet been explored in idiopathic Parkinson's disease, where disease severity and motor symptoms might also influence the experience of social anxiety. AIMS: This study aimed to explore the relationship between cognitive behavioural factors and social anxiety in Parkinson's disease. METHOD: Using a cross-sectional design, 124 people with Parkinson's disease completed self-report questionnaires including measures of Parkinson's disease severity, social anxiety, negative social cognitions, safety-seeking behaviours, internally focused attention, anxiety and depression. RESULTS: The final regression model accounted for 71.6% of variance in social anxiety. Cognitive behavioural variables accounted for the largest magnitude of unique variance (43.5%). Sex, anxiety and depression accounted for 23.4%, and Parkinson non-motor symptom severity for 4.7%. Negative social cognitions and safety-seeking behaviours were statistically significant predictors, while an internal focus of attention was not. CONCLUSIONS: Social anxiety in Parkinson's disease is associated with negative social cognitions and safety-seeking behaviours. Findings indicate the need for further research into cognitive behavioural approaches to social anxiety in Parkinson's disease.

Diagnostic Overshadowing of Anxiety in Parkinson Disease: Psychosocial Factors and a Cognitive-Behavioral Model.

Anxiety in Parkinson disease (PD) is highly prevalent yet frequently underdiagnosed and undertreated, and historically overshadowed in research by a focus on depression. Recently, interest in anxiety has been building with the recognition of its significant impact on quality of life in PD. Anxiety is typically conceptualized as one of many "nonmotor" manifestations of neurologic change, with minimal consideration of potentially important psychosocial factors. This narrative review used a systematic search strategy to identify and synthesize the available evidence for psychosocial risk factors for anxiety. Thirty relevant articles were located and reviewed, and demographic, disease/pharmacologic, and psychosocial risk factors for anxiety in PD were identified. A prominent finding was that individuals with motor fluctuation appeared to be more vulnerable to anxiety. A cognitive-behavioral model of anxiety in PD is proposed and illustrated with a clinical example.

The Impact of Health Anxiety in Multiple Sclerosis: A Replication and Treatment Case Series.

BACKGROUND: Multiple sclerosis (MS) is commonly associated with psychological complications. Previous research by Hayter and colleagues (2016) found that in patients with MS, health anxiety (HA) can account for part of the variance in quality of life (QoL) independent of physical and cognitive impairment caused by the disease. MS patients with HA perceived their intact physical and cognitive performance as impaired relative to those without HA and attributed the impairment to MS. These misperceptions might be useful targets in the treatment of HA in MS using cognitive behaviour therapy (CBT). AIMS: Study 1 sought to replicate the main findings from Hayter et al. (2016). Study 2 examined the impact of HA-focused CBT in a case series. METHOD: In Study 1, twenty participants with MS were screened for HA and assigned to either a high or low HA group. They completed assessments of cognitive and physical functioning before rating their performance on these tasks, followed by measures of QoL, mood and physical disability. Four participants in the high HA group subsequently received six sessions of CBT using a consecutive AB case series in Study 2. RESULTS: Study 1 replicated the main findings from the earlier study. In Study 2, three of the four patients who received treatment showed substantial improvements in HA and mood and all showed improvement in QoL. CONCLUSION: Given the high rates of HA in MS patients and its impact on QoL, this case series suggests that a brief CBT intervention could significantly improve patients' wellbeing.

Health anxiety in stroke survivors: a cross-sectional study on the prevalence of health anxiety in stroke survivors and its impact on quality of life.

PURPOSE: To explore the prevalence of health anxiety in stroke survivors and its relative impact on quality of life. MATERIALS AND METHODS: A cross-sectional design was used including between group comparisons of high and low health anxious stroke survivors. Stroke survivors (n = 105) were recruited via online stroke community forums. Participants completed measures of health anxiety (Short Health Anxiety Inventory), general anxiety and depression (Hospital and Anxiety and Depression Scale), disability (WHO Disability Assessment Schedule), and quality of life (Quality of Life Index). Demographics and medical histories were also assessed. RESULTS: Thirty percent of the sample scored above the clinical cut off for health anxiety. Stroke survivors with high health anxiety (HiHA) were found to have significantly lower quality of life (p < 0.001) and higher rates of depression (p < 0.001). Regression analysis found health anxiety to be a significant predictor of quality of life (ß = -0.12; p < 0.05) in addition to levels of depression (ß = -0.33; p < 0.001) and disability (ß = -0.53; p < 0.001). CONCLUSIONS: Almost a third of stroke survivors were experiencing clinical levels of health anxiety, with HiHA significantly associated with lower quality of life. Future research should explore the use of existing evidence based psychological interventions for health anxiety in this population.Implications for rehabilitationOur findings suggest almost one in three stroke survivors residing in the community have clinical levels of health anxiety.High health anxiety in stroke survivors was significantly related to lower levels of quality of life.Given this finding, evidence-based treatments for health anxiety may improve quality of life and reduce distress for a significant proportion of stroke survivors.Rehabilitation approaches aimed at improving overall quality of life for stroke survivors should consider both physical and psychological interventions, with levels of physical disability, depression and anxiety all significantly associated with quality of life.

Reducing excess stiffness in Stiff Person Syndrome using CBT: A case study.

BACKGROUND: Stiff Person Syndrome (SPS) is a rare neurological condition, characterised by rigidity in the trunk and limbs. Comorbid anxiety is common and known to exacerbate stiffness. OBJECTIVE: This case study examines the extent to which psychological treatment of comorbid anxiety alleviated stiffness in a patient whose condition was exacerbated by social anxiety. METHODS: A patient was treated using cognitive behavioural therapy, focussing on reducing anxiety and therefore stiffness by addressing rumination, self-focussed attention, and distressing cognitions relating to walking in public. The patient's walking, stiffness, and anxiety were assessed during and post-therapy using questionnaires. RESULTS: Walking, stiffness, and anxiety improved during treatment. At five months' follow up, while the improvement in anxiety was maintained, walking and stiffness had deteriorated. The patient and his Neurologist felt that this deterioration was biological, rather than psychological in nature. CONCLUSIONS: This is the first published case where SPS has been ameliorated (albeit temporarily) using psychological therapy, and has important implications for future research and treatment.