Cognitive-behavioral therapy in people with Parkinson's disease and caregivers: A mixed method systematic review on clinical applications and therapeutic outcomes.

内容摘要

BackgroundCognitive behavioral therapy (CBT) has emerged as a promising intervention in Parkinson's disease (PD), although the available evidence remains heterogeneous in design and quality.ObjectiveThe present mixed method systematic review aims to synthesize the evidence on CBT in people with PD (PwPD) and caregivers, focusing on clinical applications and therapeutic outcomes across symptom domains.MethodsA systematic search of PubMed, Web of Science, Scopus and Cochrane databases was conducted for studies published between 1980 and 2025, following PRISMA guidelines. Eligible studies evaluated clinical applications and therapeutic outcomes of CBT-based interventions in PwPD and/or caregivers and included randomized controlled trials, observational studies, case series and single-case reports. Findings were synthesized narratively, and certainty of evidence was assessed using a simplified GRADE approach.ResultsFifty-four studies met inclusion criteria. The most robust evidence was observed for depression, with several RCTs supporting the efficacy of CBT, resulting in moderate certainty of evidence. Evidence for anxiety and sleep disorders suggests potential benefit; however, certainty was low due to heterogeneity and small sample sizes. Evidence for impulse control disorders, cognitive outcomes, motor symptoms, and caregiver -related outcomes remain limited, with low to very low certainty, Effects on motor symptoms were inconsistent and likely indirect.ConclusionsCBT represents a flexible and transdiagnostic intervention for treating non-motor symptoms in PwPD and for caregivers. While moderate-certainty evidence supports CBT use for depression, evidence for other domains remains limited. These findings should be interpreted with caution, and further large-scale, well designed RCTs are needed to strengthen the evidence base and clarify optimal therapeutic targets and delivery format. Cognitive-behavioral therapy for mood and other non-motor symptoms in people with Parkinson and caregivers.Parkinson's disease is usually know for movement issues such as tremor or slowness. However, many people also experience depression, anxiety, sleep distubances, cognitive difficulties, impulse-control disorders. These symptoms can strongly affect daily life and quality of life, and they can also increase stress and burden for caregivers.Cognitive-behavioral therapy or CBT is a psychotherapy that helps people identify unhelpful thoughts and behaviors and replace them with more helpful ones. CBT can include techniques such as behavioral activation (doing more meaningful activities), cognitive restructuring (changing unhelpful thinking patterns), and strategies tailored to specific problems (for example CBT for insomnia).In this systematic review, we searched major scientific databases for studies published between 1980 and 2025 that tested CBT-based interventions in people with Parkinson's disease and/or their caregivers. In total, 54 studies met the inclusion criteria.Overall, the strongest evidence supports CBT for depression in Parkinson's disease, with many studies showing meaningful symptom improvement. Evidence for anxiety has increased especially when anxiety is the main treatment target. CBT for insomnia also shows consistent benefits fot subjective sleep outcomes. There is promising but more limited evidence that CBT may help impulse-control disorders, daily functioning and caregiver burden, particularly when caregivers are involved in treatment. Effects on motor symptoms were inconsistent and seem indirect rather than a direct improvement in movement.In summary, CBT appears to be a flexible and useful option for several non-motor symptoms in PD. Future larger and well-designed studies are needed to clarify which patients benefit most and how to deliver CBT in the most effective and accessible way. These findings support integrating psychological care into routine Parkinson's disease management whenever possible.