Getting a grip on anxiety in PD
An estimated 40% of people with Parkinson’s disease (PD) experience anxiety significant enough to interfere with daily life. Anxiety may appear years before Parkinson’s disease is diagnosed, and can affect quality of life even more than motor symptoms. Anyone who has experienced anxiety knows that it is uncomfortable and unwanted. The good news is that anxiety in PD is highly treatable, and there are many different ways you can choose to manage it.
What does anxiety look like?
Anxiety isn’t the same for everyone. Some people experience worried or negative thoughts, have a hard time concentrating, or trouble remembering things. Anxious thoughts may be characterized by “what if” statements or anticipating negative outcomes about future events. Others may notice feelings of irritability, panic, nervousness, or dread. Physical symptoms of anxiety can include excessive sweating, tension, and an increased heart rate. Individuals may also avoid the daily activities they once enjoyed because of fear of what “might happen,” and as a result, their world becomes smaller and smaller. Some people may experience all of the above! Anxiety may come and go, or be present to some degree, all of the time. If you notice any of these symptoms, you are not alone!What can I do about it?
Most people experience some anxiety from time to time. If you’ve noticed any of the symptoms above, especially if symptoms are frequent, distressing, and/or making life harder for you, it’s always a good idea to let your healthcare providers know. They can help you to monitor your symptoms and come up with an effective treatment plan. Your doctor may be able to adjust your PD regimen or prescribe additional medications to help with anxiety, if appropriate or needed. Additionally, there are several non-pharmacological treatments that may be effective for treating anxiety in PD.Non-pharmacological Treatments for Anxiety
There are several interventions that have been shown to be excellent complements or alternatives to pharmacological treatment for anxiety. Cognitive Behavioral Therapy (CBT) is a popular non-medication approach and includes strategies that can be implemented with the support of a trained mental health professional, or at home, in self-help form.Cognitive-Behavioral Therapy
Cognitive behavioral therapy, or CBT, is a type of talk therapy that targets thoughts and behaviors that cause and maintain anxiety. It is a structured and active approach that focuses on concrete coping skills, incorporates multiple techniques, and is tailored to individual needs. CBT is an evidence-based treatment predicated on the theory that thoughts, behaviors, and emotions are very much connected to each other. So, if you are feeling anxious, chances are there are things you are doing (or not doing!) that are motivated by anxiety, and that there are worried or negative thoughts circling your brain. Most of the time, these anxious thoughts are not as true as they feel and are based more on fear than fact. Left unchecked, this interconnection between thoughts, feelings, and behaviors becomes a vicious cycle and can maintain and worsen symptoms of both anxiety and PD. CBT teaches individuals tools they can use to break these harmful patterns, giving back a sense of control and empowerment.CBT tools: Scheduling and goal setting
Waking up and having a clear sense what the day ahead holds can help to manage anxiety. Setting a daily schedule that includes reasonable, measurable goals (e.g., return 2 phone calls, attend Rock Steady Boxing class, listen to audio book for 30 minutes) can help to remove uncertainty about what the day will bring and enhance a sense of accomplishment.CBT tools: Increasing meaningful and social activities
Ensuring that your schedule includes meaningful and enjoyable activities is integral to managing anxiety. What brings you joy? What hobbies do you enjoy? What have you always wanted to try but placed on the back burner? Volunteering to help others, having lunch with a friend, or checking out a class or group offered at the local library are all things that increase the “feel good” chemicals in the brain and are an important part of breaking the cycle of anxiety.CBT tools: Exercise!!!
One of the behaviors encouraged in CBT is exercise, and for good reason: exercise decreases anxiety and depression, and has been found to enhance cognitive function, gait, balance, and quality of life in individuals with PD. There is no time like the present to get started! Boxing, dance, and yoga classes for PD may be available nearby, and you can always get started with walking or light weights. If you notice yourself thinking “I can’t do that,” then take note – this is quite possibly a negative or worried thought popping up and likely isn’t true.There’s no need to start with running a marathon. Chair yoga, some simple stretching, or 10 minutes of walking are all great ways to start. Pace yourself and set realistic daily goals, scheduling around off-time. If you are having trouble thinking of ways to get moving, checking with a PD-literate physical therapist can help.
CBT Tools: Relaxation exercises
Relaxation exercises like meditation, guided imagery, deep breathing, and progressive muscle relaxation can help bring a sense of relaxation and inner peace, feelings which are incompatible with anxiety. Some people with PD notice a decrease in physical symptoms like tremor, stiffness, and dyskinesia while doing these exercises. There are many free recordings available on the internet – try a few to find one that you like! The more you practice, the more helpful the technique will be!CBT Tools: Perform an experiment
People with anxiety can sometimes discount how helpful or enjoyable something might be or avoid a healthy and safe activity (I’m not referring to sky diving or rock climbing here….) because they think the outcome will be negative, or simply because they don’t “feel like” doing it. If you notice yourself doing this – set up an experiment. Test out the activity with the support of a trusted family member or friend and monitor the outcome. This way you will have concrete evidence to help guide your decision making for the future. For example, if you don’t want to attend a holiday gathering because you fear nobody will talk to you, plan to go to the party for 1 hour and monitor the outcome. How many different people did you speak with? What did you talk about? Were the conversations pleasant or meaningful? Did you laugh? Did people outright ignore you or go out of their way to avoid you or be mean? Pay attention to all of these details. You may be pleasantly surprised. If you don’t test out your negative predictions, you never give yourself the opportunity to prove them wrong.CBT Tools: Healthy sleep habits
It is very common to have difficulty sleeping when struggling with anxiety. Healthy sleep hygiene habits like having a sleep routine, keeping a consistent sleep schedule, and limiting caffeine before bed can help. If you do wake up in the middle of the night, instead of watching the clock and thinking “oh no, this is horrible” try telling yourself “ I have tools to deal with this or it is OK if I don’t always sleep 8 hours in a row” and consider getting out of bed, listening to calming music, or doing a relaxation exercise. This simple shift may be enough to help you drift off to sleep!CBT Tools: Rethink the big picture
We all “talk to ourselves” in the form of thoughts all of the time, but most people don’t stop to think about the contents of this internal dialogue unless they are prompted to do so. Anxiety is strongly associated with negative thoughts that are not as true as they feel and/or worries that are out of proportion to the situation. It is very important to pay attention to the content of your thoughts as you go through your day. This will make it easier to “press pause’ on extreme negative thoughts such as “Nothing brings me satisfaction anymore,” examine the validity of that thought more closely, and ultimately replace the original negative thought with a healthier, more balanced, and more realistic thought, after further consideration (“I really enjoy time with friends and family, when I pace myself and take my medications on time”). So how do you know when to check in with yourself about your thoughts? While everybody is different, if you find yourself avoiding or opting out of once enjoyed daily activities, feel “stuck in the mud” with regards to your motivation, notice a downward shift in your mood, and/or that you are thinking in terms of extremes, absolutes or worst case scenarios, with no room for middle ground, it may be important to consider an alternative perspective.Remember: anxiety is a temporary state – not a permanent condition. If you find that worrying takes up a lot of time, interferes with other activities or weighs heavily on your mind, it is time to take action. Talk to your care providers for professional support and know that there are many options you can employ to tackle it. You have Parkinson’s…. but Parkinson’s does not have to have you.
Roseanne D. Dobkin, PhD has presented at the 3rd World Parkinson Congress in Montreal, the 4th World Parkinson Congress in Portland and the 5th World Parkinson Congress in Kyoto. She is currently a Professor of Psychiatry at the Robert Wood Johnson Medical School at Rutgers University.
Lauren St. Hill, LSW is a Research Associate at the Robert Wood Johnson Medical School at Rutgers University.
Ideas and opinions expressed in this post reflect that of the author(s) solely. They do not necessarily reflect the opinions of the World Parkinson Coalition®