Efficacy of cognitive behavioral therapy for anxiety and depression symptoms in Parkinson's disease patients: a systematic review and meta-analysis

Why clinicians should know about it

• Picked for Neurology (clinical) (paper of the day, 7 November 2026): Meta-analysis of CBT for anxiety and depression in Parkinson disease

Abstract

BACKGROUND: Anxiety and depression are highly prevalent non-motor symptoms in Parkinson's disease (PD), severely compromising health-related quality of life. Conventional pharmacological management is frequently constrained by adverse effects, polypharmacy, and pharmacokinetic interactions. Cognitive Behavioral Therapy (CBT) represents a promising structured non-pharmacological strategy, but an updated, comprehensive synthesis of clinical trial evidence is warranted. OBJECTIVE: To systematically evaluate the efficacy and clinical safety profile of CBT for alleviating anxiety and depressive symptoms in patients with PD. METHODS: A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted in accordance with the PRISMA 2020 guidelines. PubMed, Embase, the Cochrane Library, and Web of Science were searched from database inception to October 2025. RCTs evaluating CBT (≥ 4 sessions over ≥ 4 weeks) versus control conditions (e.g., treatment as usual, waitlist, active controls) in adults with PD reporting anxiety and/or depression outcomes were included. Two reviewers independently screened literature, extracted data, and assessed methodological quality using the Cochrane Risk of Bias tool. Standardized mean differences (SMDs) with 95% confidence intervals (CIs) were pooled via random-effects models. Subgroup, sensitivity, and publication bias analyses were performed. RESULTS: Twenty-one RCTs comprising 892 patients with PD (CBT: n = 465; control: n = 427) were included. Meta-analysis demonstrated that CBT was associated with statistically significant reductions in anxiety symptoms (16 studies; SMD = -0.66, 95% CI -0.83 to -0.50; P < 0.001; I2 = 79.1%) and depressive symptoms (14 studies; SMD = -0.61, 95% CI -0.78 to -0.44; P < 0.001; I2 = 86.6%). Subgroup analyses indicated enhanced therapeutic effects in interventions with durations exceeding 10 weeks and when evaluated using population-adapted instruments (e.g., GAI, GDS). Leave-one-out sensitivity analyses confirmed the robustness of pooled estimates, and Egger's tests revealed no significant publication bias. CONCLUSION: CBT produces significant, clinically meaningful reductions in anxiety and depressive symptoms in patients with Parkinson's disease. Despite substantial between-study heterogeneity and variations in intervention delivery, structured CBT should be recommended as an integral component of multidisciplinary PD care. Larger multicenter RCTs with standardized disease-specific core outcome sets and longer follow-up are warranted.

Abstract as published, via PubMed.