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

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.

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 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 (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).