The efficacy of psychological interventions for anxiety in Parkinson’s disease: a systematic review and meta-analysis including mindfulness and mind–body approaches

Vollständiger Abstract

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Abstract Background Anxiety is a prevalent and clinically significant non-motor symptom in individuals with Parkinson’s disease (PD), yet the overall efficacy of psychological interventions for anxiety in this population remains unclear. This meta-analysis aimed to evaluate the effectiveness of psychological and mind–body interventions in reducing anxiety symptoms among individuals with PD and to explore potential differences according to theoretical orientation. Methods Randomized controlled trials (RCTs) examining psychological or mind–body interventions reporting anxiety outcomes in individuals with PD were systematically identified in four databases searched to 27 July 2026. Effect sizes were calculated as standardized mean differences using Hedges’ g within a random-effects model, with between-study variance estimated by restricted maximum likelihood and inference based on the Hartung–Knapp adjustment. Heterogeneity was assessed using Cochran’s Q and I² statistics, and a prediction interval was calculated. Subgroup analyses compared cognitive–behavioral and interpersonal therapies with mindfulness- and mind–body-based approaches, and active with inactive control conditions. Sensitivity analyses, including leave-one-out procedures and exclusion of trials at high risk of bias, were performed. Publication bias was examined using funnel plot inspection and Egger’s regression test, and the certainty of evidence with GRADE. Results Across 13 comparisons from 13 trials and 877 participants, psychological and mind–body interventions were associated with a statistically significant reduction in anxiety symptoms (Hedges’ g = − 0.46, 95% CI [− 0.67, − 0.25]). Heterogeneity was moderate (I² = 40.7%, 95% CI 0% to 79%), and the 95% prediction interval, − 1.00 to + 0.08, included the null. Cognitive–behavioral and interpersonal therapies showed a significant effect (g = − 0.57), whereas the estimate for mindfulness- and mind–body-based approaches was smaller and its interval included the null (g = − 0.25); there was no statistical evidence of subgroup differences. Subgroup findings should be interpreted cautiously because of the small number of comparisons within each category. Eleven of the thirteen comparisons used an inactive control condition (g = − 0.53), and the estimate against active comparators was imprecise (g = − 0.22). A similar reduction was observed at follow-up in nine trials (g = − 0.39). Sensitivity analyses confirmed the stability of the pooled effect, and no clear evidence of publication bias was detected. Conclusions Psychological and mind–body interventions may reduce anxiety symptoms in individuals with PD, and a similar reduction was observed at follow-up. However, the clinical interpretation of this effect requires caution because different anxiety scales were used across trials, the number of included studies was limited, several studies were rated as having a high risk of bias, the prediction interval included the null, and the effect derives principally from comparisons with inactive control conditions. The overall certainty of the evidence was very low. Although no statistically significant differences between theoretical approaches were observed, this subgroup finding should be interpreted as exploratory, and larger trials recruiting participants with clinically significant anxiety, using active comparators and standardized follow-up, are needed before firm clinical recommendations can be made.