Telehealth CBT improves quality of life in veterans with Parkinson's disease and comorbid depression

OBJECTIVES: Parkinson's disease (PD) is associated with significant impairments in health-related quality of life (HRQoL). Little is known about the impact of psychotherapy on HRQoL in PD. This study aimed to assess the effects of virtual cognitive-behavioral therapy on HRQoL among veterans with PD, and to identify possible mediators for change. METHODS: Veterans with both PD and primary depressive disorders (n = 90) were recruited nationwide and randomized to PD-informed cognitive-behavioral therapy (CBT) or treatment as usual (TAU). The 10-session telehealth CBT intervention focused on behavioral activation, cognitive restructuring, and stress management, with strategies for problem-solving PD-related challenges highlighted throughout. The TAU group received routine VA care with clinical monitoring by study staff. HRQoL was measured with the SF-36, which included summary scores for physical and mental quality of life, along with eight health domain subscales. Depression (HAM-D), behavioral activation (BADS), and automatic negative thoughts (ATQ) were assessed as mediators of CBT and HRQoL in parallel and parallel-serial mediation models.n. RESULTS: There were significant group-by-time effects for physical (p = 0.007) and mental quality of life (p = 0.04) such that the CBT group improved in both by end-of-treatment, while the control group did not. Depression mediated the relationship between CBT and physical quality of life in both parallel (B = 1.90, 95% CI [0.06, 3.94]) and parallel-serial (B = 1.35, 95% CI [0.01, 3.13]) models. CONCLUSIONS: Cognitive-behavioral therapy holistically improves both the physical and mental challenges that Parkinson's disease places on everyday life. The routine assessment and management of depression in PD is a key component of evidence-based interdisciplinary care.