In the UK, the number of people affected by Parkinson’s Disease is expected to rise to 172,000 by 2030 (Parkinson’s UK, 2023). Parkinson’s entails a loss of neurons and dopamine, resulting in over 40 symptoms that can be motor (e.g., tremors) and non-motor (e.g., depression; Bloem et al., 2021). Psychological symptoms are alarmingly common: depression and anxiety are reported in up to 40% of people with Parkinson’s, and poor psychological wellbeing interferes with medication adherence and quality of life (Malek & Grosset, 2014; Al-Khammash et al., 2023).
Current support programmes rarely focus on psychological wellbeing, but instead on decision-making and symptom management (Pigott et al., 2022). Unsurprisingly, little is known about the effectiveness and acceptability of psychological interventions, particularly third-wave therapies. Unlike second-wave therapies (e.g., CBT), which target maladaptive thinking patterns, third-wave approaches emphasise mindfulness, acceptance, and psychological flexibility. Theoretically, this approach may be especially relevant for living with a chronic, progressive condition.
Christodoulou and colleagues (2025) at University College London reviewed evidence on the effects of third-wave therapies on distress, wellbeing, and quality of life in people with Parkinson’s, while also identifying adaptations specific to this population.
Psychological wellbeing is often overlooked in Parkinson’s despite high prevalence of psychological morbidities, highlighting the need for tailored therapies.
Methods
The systematic review was pre-registered on Prospero and followed PRISMA guidelines and the PICOs framework.
Eligible studies involved adults over 18 with a formal Parkinson’s Disease diagnosis. RCTs, pilot RCTs, or non-randomised controlled trials were included in the review. The interventions involved third-wave psychotherapies (acceptance and commitment therapy, compassion-focused therapy, etc.), and were compared to either treatment as usual/waiting list, or other interventions (e.g., support groups, pharmacological treatment, etc.). The studies also had to include at least one of the following outcomes: psychological distress, psychological wellbeing, quality of life in Parkinson’s, and attrition rates.
Three independent reviewers screened studies, resolving discrepancies with a fourth reviewer. Data were extracted on demographics, design, intervention details, comparators, outcomes, and findings.
Quality was assessed using Effective Public Health Practice Project tool, looking at six domains, including selection bias and confounders.
Results
Ten RCTs were included. Nine took mindfulness-based approaches, and one tested acceptance and commitment therapy (ACT). Sample sizes were small (30 to 138 participants), and only one study was large enough to be considered well powered. Across the studies, a range of validated measures included Hospital Anxiety and Depression Scale (HADS), Depression Anxiety Stress Scale (DASS-21), and Parkinson’s Disease Questionnaire (PDQ-39). While this helped anchor findings in established clinical measures, variability in the measures introduced inconsistency across studies.
Psychological distress
There was substantial variation in the reported outcomes for psychological distress. One trial of mindfulness yoga (Kwok et al., 2019) found significant reductions in depression and anxiety compared to stretching and resistance training. A smaller study of a mindfulness meditation-based exercise programme (Son & Choi, 2018) also showed reduced depression. However, most interventions produced mixed or non-significant results. For instance, one study reported a reduction in trait anxiety but not depression (Buchwitz et al., 2021), and online MBCT led to only small, non-significant changes (Bogosian et al., 2021).
Wellbeing and quality of life
Similarly, the studies varied greatly in the reported effects on wellbeing and quality of life. Mindfulness yoga again appeared to show benefits in some aspects. However, other studies reported more mixed findings. For example, MBSR improved social support but not overall quality of life (Ayromlou et al., 2020), while online MBCT improved quality of life but not distress (Bogosian et al., 2021). Moreover, several studies found no meaningful differences on quality of life measures.
Adaptations for people with Parkinson’s
About half of the studies incorporated Parkinson’s-specific adaptations, such as:
- shorter sessions;
- seated yoga/meditation options;
- simplified language;
- flexibility for motor symptoms;
- remote delivery.
These adjustments appeared to make interventions more acceptable and feasible, but reporting was patchy and inconsistent across studies, making generalisation uncertain.
Mindfulness yoga stands out as the most promising approach for psychological support in Parkinson’s, with some reported improvements in distress, wellbeing, and quality of life.
Conclusions
The evidence base for third-wave therapies in Parkinson’s care remains limited and exploratory. Most studies were small, underpowered, with short follow-up periods, thus preventing firm conclusions about the intervention efficacy. The lack of meta-analytic synthesis further constrain interpretation.
While Mindfulness Yoga appears to be promising, there is a need for larger and more rigorous RCTs, especially for ACT, DBT, and CFT. The review also reiterates the need to explore how the interventions should be tailored to the needs and experiences of people with Parkinson’s.
Mindfulness interventions may help people with Parkinson’s, but larger and more rigorous trials are needed in this field of third wave interventions.
Strengths and limitations
As Parkinson’s is projected to be one of the leading neurological conditions by 2050 (Su et al., 2025), there is increasing need for holistic care. This review highlights gaps in psychological interventions and offers a strong rationale for investigating third-wave therapies in particular.
The evidence base, as reported in this review, remains preliminary. Most studies were small and exploratory, with only one being adequately powered. The heterogeneity of the findings undermines any ability to draw any conclusions about the efficacy of third-wave therapies for Parkinson’s. Moreover, participants often self-selected, and the outcomes relied on self-report, introducing potential bias into the results.
The studies came from the UK, Germany, Australia, Iran, and South Korea, offering some international breadth. The review also acknowledged potential sources of bias, such as the reliance on self-report measures, high drop-out rates, and variable control conditions.
Consideration of Parkinson’s-specific adaptations was also essential, as the intervention’s success may depend on the effects of fatigue, cognitive slowing, and fluctuating medication effects in Parkinson’s.
Finally, most participants were white and well-educated, limiting generalisability. Importantly, racial, ethnical, and other social disparities are linked to genetic predisposition to Parkinson’s, healthcare-seeking behaviours and healthcare inequalities, and other social deprivation factors (Aamodt et al., 2023; Heimrich et al., 2023), making it crucial to increase sample diversity in future research.
This timely systematic review draws attention to the gaps in psychologically focused research into Parkinson’s support.
Implications for practice
A 2019 Neurological Alliance survey found that 30% of individuals with conditions including Parkinson’s, who sought psychological support, were not referred for mental health services, and 40% reported unmet mental health needs. The demand for psychological support is clear, but it is not sufficient to default to the traditional CBT approach. The findings by Christodoulou et al. (2025) have implications for clinical practice by asking what support works and how to adapt it. However, I would also be interested in the format of this support (e.g., online, with spouses, etc.), its minimal duration, any benefits for medication adherence, and the follow-up effects.
From my own research and volunteering, I’ve been fortunate to hear directly from people with Parkinson’s and their families at the Parkinson’s Centre for Integrated Therapy. Many described how existing services focus on symptom control but rarely on the emotional or existential challenges of diagnosis. This resonates with the review’s finding that psychological wellbeing remains peripheral in Parkinson’s care. Similarly, my master’s dissertation, which explored the experiences of spouses and family members, echoed the findings as carers repeatedly spoke about lack of accessible wellbeing resources and psychological support.
As Sheryl Jedlinsky put in her memoir, Parkinson’s is the New Normal – a new experience that needs psychological support just as much as medical treatment. The review by Christodoulou and colleagues contributes to the ongoing discussion on the provision of psychological care for people with Parkinson’s. The review also complements the recently published BPS guidance on a matched-care framework for Parkinson’s (Foley & Mobley, 2025 – see p. 7). Third-wave therapies may become a valuable component of Parkinson’s care, but larger, better-powered RCTs are needed, especially for therapies such as ACT, DBT and CFT.
Additionally, future studies need to document the development of new psychological interventions. This means building the intervention program with a solid theoretical rationale by drawing on existing research on chronic illness, qualitative studies of lived experience, and other conceptually relevant fields. Equally, it is vital to co-produce the interventions with people with Parkinson’s to reflect the needs and increase acceptability.
Finally, reflecting on this as a clinical psychology student, I am keen to see a critical interrogation of which therapeutic techniques are deemed generalisable and hence included in the toolkit for nationwide psychological support. With Parkinson’s being such a diverse condition physiologically and psychologically, it adds a layer of complexity alongside the traditional intersectional lens to therapeutic care.
Psychological care should not be optional in Parkinson’s, and third-wave approaches deserve serious attention alongside medical care.
Statement of interests
Sofiia recently completed an MSc in Clinical Psychology at the University of Kent, where her dissertation focused on the experiences of carers of people with Parkinson’s. She has also volunteered at the Parkinson’s Centre for Integrated Therapy. She has no other conflicts of interest.
Edited by
Dafni Katsampa.
Links
Primary paper
Christodoulou, D., Reeves, S., Carvalho, N. M. V. d., Stellman, J., & Gould, R. L. (2025). A systematic review of third-wave therapies to reduce distress and improve wellbeing and quality of life in people with Parkinson’s disease. Clinical Gerontologist, 1-24. https://doi.org/10.1080/07317115.2025.2511957
Other references
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