Anxiety & Parkinson’s

Written by Alexus Njemanze

What is Parkinson’s disease?

Parkinson's disease is a neurodegenerative disorder that affects movement control and coordination. It is characterized by the progressive loss of dopamine-producing cells in a specific brain region called the substantia nigra. The symptoms of Parkinson's disease can vary from person to person and typically develop gradually over time. The primary motor symptoms include tremors, bradykinesia, rigidity, or postural instability. In addition to these motor symptoms, Parkinson's disease can cause non-motor symptoms, including cognitive changes, mood changes, sleep disturbances, and autonomic dysfunction. These symptoms can significantly impact an individual's quality of life and daily functioning.

What is Anxiety?

Anxiety is a common mental health condition characterized by persistent and excessive worry or fear about everyday situations. It is your mind and body's natural response to stress and potential threats, alerting and protecting us from danger. However, when anxiety becomes persistent, excessive, and interferes with daily life, it may indicate an anxiety disorder. Anxiety disorders involve intense and uncontrollable worries or fears disproportionate to the situation. It can significantly impact an individual's well-being, relationships, and overall quality of life.

Anxiety Symptoms

Anxiety can manifest with a variety of symptoms, which can vary from person to person. Here is a list of common symptoms associated with anxiety: 

• Excessive worry or fear

• Restlessness                                       

• Irritability 

• Difficulty concentrating

• Sleep disturbances 

• Muscle tension 

• Rapid heartbeat

• Shortness of breath

• Sweating 

• Dizziness/lightheadedness 

• Gastrointestinal problems 

• Panic attacks 

• Avoidance behaviors 

• Social withdrawal

*DISCLAIMER* It is important to note that the presence of these symptoms alone does not necessarily indicate an anxiety disorder. A formal diagnosis should be made by a qualified healthcare professional based on a comprehensive evaluation of symptoms, medical history, and individual circumstances.

Types of Anxiety 

• Generalized Anxiety Disorder (GAD)

• Social Anxiety Disorder 

• Panic Disorder 

• Phobias 

Anxiety & Parkinson’s Disease 

Individuals with Parkinson's disease (PD) frequently experience anxiety (Upneja et al., 2021). Despite having a prevalence of 20 to 40%, anxiety is a common symptom of PD yet frequently goes unrecognized and untreated (Upneja et al., 2021). Anxiety significantly impacts caregiver burden, treatment compliance, and cognition and can also increase the risk of falls. Anxiety is a non-motor symptom of PD and can exacerbate the challenges of daily living.

           Anxiety can worsen motor symptoms in PD. The fear and worry associated with anxiety can increase muscle tension, leading to greater rigidity and difficulty initiating movements. This can further contribute to a sense of helplessness and frustration for individuals with PD, impeding their ability to perform daily activities and impacting their overall quality of life.

          Studies indicate anxiety in PD can lead to cognitive impairments, such as executive dysfunction, attention deficits, and memory problems (Shields et al., 2016). These cognitive impairments can further hinder the ability to plan and execute tasks. Anxiety can also contribute to a phenomenon known as "anxious apprehension" in individuals with PD. Anxious apprehension refers to a state of heightened vigilance and anticipation of adverse outcomes, which can manifest as excessive worry and hypervigilance. This state of constant worry can lead to cognitive overarousal, making it challenging to filter out irrelevant information and maintain cognitive efficiency. This, in turn, can hinder attention, processing speed, and overall cognitive performance.

          Emotional and social well-being can also be dramatically compromised by symptoms of anxiety. PD is already associated with an increased risk of depression, and anxiety often coexists with depression. The constant worry, restlessness, and feelings of unease experienced by individuals with anxiety can contribute to a downward spiral of negative emotions and worsen the overall mental health of individuals with PD.  Social withdrawal, avoidance of social interactions, and increased self-consciousness can surface under these conditions. Subsequently, feelings of loneliness and isolation may emerge further contributing to mental health deterioration and general well-being.

Sleep disturbances can be another troublesome non-motor symptom of Parkinson’s that can be exacerbated by anxious feelings. The interaction between sleep disturbances and anxiety in PD forms a cyclical relationship. Sleep disruptions can exacerbate anxiety symptoms, leading to increased worry, irritability and difficulty coping with daily challenges. Conversely, anxiety can contribute to heightened physiological arousal and psychological distress, further interrupting sleep patterns. One of the primary sleep disorders associated with PD is insomnia, which refers to difficulties in falling asleep, staying asleep, or experiencing non-restorative sleep. Anxiety can contribute to racing thoughts, worry, and restlessness which makes it difficult for individuals with PD to relax and initiate sleep, making it harder to achieve a state of relaxation conducive to sleep.

Best Practices for Managing Anxiety 

• Stress Management Techniques: Incorporating stress management techniques into daily routines can help reduce anxiety. These techniques may include deep breathing exercises, progressive muscle relaxation, meditation, mindfulness practices, and yoga. Engaging in activities that promote relaxation and self-care, such as taking walks in nature, listening to calming music, or engaging in hobbies, can also be beneficial. You can access our Relax and Reset series on YouTube which addresses many of these modalities.  There are also several apps such as Calm or Breethe that can help you with breathing and meditation.

• Regular Exercise: Physical exercise has been shown to positively affect both motor and non-motor symptoms of PD, including anxiety. Engaging in regular exercise, such as walking, swimming, cycling or Parkinson’s-specific fitness classes can help reduce anxiety levels and improve overall well-being. It's important to consult a healthcare professional to determine the most appropriate exercise program based on individual abilities and limitations.

• Support Groups: Participating in support groups specific to PD can provide a sense of community, understanding, and validation. Interacting with others who share similar experiences can help alleviate feelings of isolation and anxiety. Support groups can also serve as a platform to exchange coping strategies and learn from one another. There are a number of Parkinson’s organizations that offer support groups. You can visit www.powerforparkinsons.org for virtual and local Austin, TX support groups for people with Parkinson’s and separate groups for caregivers.

• Healthy Lifestyle Habits: Maintaining a healthy lifestyle can have a positive impact on anxiety levels. This includes getting sufficient sleep, eating a balanced diet, limiting caffeine and alcohol consumption, and avoiding tobacco and recreational drugs. Prioritizing self-care, establishing a regular routine, and engaging in activities that bring joy and relaxation can also contribute to anxiety reduction.

• Seek specialists to provide support & guidance: There are several healthcare professionals that can assist with the management of PD and anxiety, such as a movement disorder specialist, general neurologist, psychiatrist, psychologist, social worker or occupational therapist. 

Various Providers who can help Manage Anxiety and PD:

One of the best ways to live well with Parkinson’s is to have the right support team of family, friends, healthcare professionals, and communities like PFP! 

The Role of a Psychiatrist 

A psychiatrist plays a vital role in supporting individuals with PD who are also experiencing anxiety. Psychiatrists are medical doctors specializing in mental health and are trained to diagnose, treat, and manage various mental health conditions, including anxiety disorders. Here's how a psychiatrist can assist individuals with PD and anxiety:

• Accurate diagnosis: A psychiatrist can conduct a comprehensive evaluation to accurately diagnose anxiety disorders in individuals with PD. They assess the nature and severity of anxiety symptoms, considering the interaction between PD symptoms and anxiety. This helps ensure appropriate treatment planning tailored to the specific needs of the individual.

• Medication management: Psychiatrists can prescribe and manage medications for anxiety disorders in individuals with PD. They have expertise in psychopharmacology and understand how PD medications and anxiety treatments can interact. They can determine the most suitable medication options, adjust dosages, and monitor for any potential side effects or drug interactions.

The Role of a Psychologist 

Psychologists are mental health professionals trained in assessing, diagnosing, and treating various psychological conditions, including anxiety disorders. Here's how a psychologist can assist individuals with PD and anxiety:

• Assessment and diagnosis: Psychologists can conduct comprehensive assessments to evaluate the presence and severity of anxiety symptoms in individuals with PD. They use standardized measures and clinical interviews to determine the specific type of anxiety disorder and its impact on daily functioning.

• Psychotherapy: Psychologists provide evidence-based psychotherapy to individuals with PD and anxiety. Various therapeutic modalities can be utilized, including cognitive-behavioral therapy (CBT), which helps individuals identify and modify negative thought patterns and behaviors contributing to anxiety. Other approaches, such as acceptance and commitment therapy (ACT), mindfulness-based therapies, or psychodynamic therapy, may also be employed based on individual needs and preferences.

The Role of a Clinical Social Worker

A clinical social worker can play a crucial role in supporting individuals with PD who are also experiencing anxiety. Clinical social workers are trained mental health professionals who specialize in providing counseling and support to individuals and families facing various challenges. Here's how a clinical social worker can assist individuals with PD and anxiety:

• Counseling and emotional support: Clinical social workers can provide individual counseling sessions to address anxiety symptoms and the emotional impact of living with PD. They offer a safe and supportive environment for individuals to express their feelings, fears, and concerns related to PD and anxiety. Through counseling, individuals can gain insight, develop coping strategies, and work towards reducing anxiety symptoms.

• Coping strategies and stress management: Clinical social workers can help individuals develop effective coping strategies and stress management techniques specific to PD and anxiety. They can teach relaxation exercises, mindfulness techniques, and provide tools for managing anxiety triggers.

• Support for caregivers and families: PD and anxiety can affect not only individuals with the condition but also their caregivers and family members. Clinical social workers can offer support, counseling, and education to caregivers, helping them understand and navigate the challenges associated with PD and anxiety. They can also facilitate family therapy sessions to improve communication, enhance coping skills, and strengthen relationships.

• Advocacy and resource coordination: Clinical social workers are skilled in navigating healthcare systems and community resources. They can assist individuals with PD and anxiety in accessing appropriate services, support groups, and community resources.

• Support groups and group therapy: Clinical social workers can facilitate support groups specifically tailored to individuals with PD and anxiety. These groups offer opportunities for peer support, sharing experiences, and learning from others facing similar challenges.

The Role of Occupational Therapy (OT)

OT can play a valuable role is supporting individuals with PD who are also experiencing anxiety. OT focuses on enhancing functional abilities and improving overall well-being through a variety of interventions. Here's how occupational therapy can assist individuals with PD and anxiety:

• Anxiety management techniques: Occupational therapists (OTs) can teach individuals with PD coping strategies and techniques to manage anxiety. This may include deep breathing exercises, relaxation techniques, mindfulness practices, and stress management strategies. By incorporating these techniques into daily routines, individuals can reduce anxiety levels and improve overall mental well-being.

• Activity and routine modification: OTs can help individuals identify activities and routines that may trigger or worsen anxiety symptoms. They can assist in modifying or adapting these activities to reduce anxiety levels while still promoting engagement and participation. OTs  may also provide guidance on pacing, prioritizing tasks, and finding a balance between activity and rest to manage anxiety more effectively.

• Environmental modifications: OTs can assess the home environment and make recommendations for modifications that promote a calm and supportive atmosphere. This may include organizing and decluttering spaces, optimizing lighting and noise levels, and creating a comfortable and safe environment that reduces anxiety triggers.

• Energy conservation techniques: Anxiety can be physically and mentally draining for individuals with PD. OTs can provide education and strategies for energy conservation 

• and fatigue management. This may involve teaching techniques for pacing activities, optimizing work-rest cycles, and promoting efficient energy use to prevent excessive fatigue and minimize anxiety-related exhaustion. 

• Activity Management/meaningful occupations: OTs can help individuals with PD identify and engage in meaningful activities and occupations that promote a sense of purpose, fulfillment, and positive emotions. By participating in activities that bring joy and fulfillment, individuals can experience a reduction in anxiety symptoms and an overall improvement in quality of life.

• Education and Self-management: OTs can help individuals understand the relationship between anxiety and PD symptoms and empower them with self-management techniques. This may include educating on medication management, stress reduction strategies, and the importance of self-care in managing both PD and anxiety.

By addressing anxiety through occupational therapy interventions, individuals with PD can gain valuable tools and strategies to better manage their anxiety symptoms, enhance their daily functioning, and improve their overall quality of life.