Hostname: page-component-78c5997874-v9fdk Total loading time: 0 Render date: 2024-11-02T18:50:51.848Z Has data issue: false hasContentIssue false
  • English
  • Français

The contribution of cognitive behavioural factors to social anxiety in Parkinson’s disease

Published online by Cambridge University Press:  07 September 2021

Kirsty Nash ,
Leon Dysch ,
Jenna Todd Jones ,
Ruth MacQueen  and
Elizabeth Marks
Kirsty Nash*
Affiliation:
Department of Psychology, University of Bath, Bath, UK
Leon Dysch
Affiliation:
Clara Cross Centre, St Martins Hospital, Bath, UK
Jenna Todd Jones
Affiliation:
Clara Cross Centre, St Martins Hospital, Bath, UK
Ruth MacQueen
Affiliation:
Clara Cross Centre, St Martins Hospital, Bath, UK
Elizabeth Marks
Affiliation:
Department of Psychology, University of Bath, Bath, UK
*
*Corresponding author. Email: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Background:

Social anxiety is prevalent in idiopathic Parkinson’s disease but why this is, is not yet well understood. Social cognitions, safety-seeking behaviours and internally focused attention are all known to predict social anxiety in the general population. These associated factors have not yet been explored in idiopathic Parkinson’s disease, where disease severity and motor symptoms might also influence the experience of social anxiety.

Aims:

This study aimed to explore the relationship between cognitive behavioural factors and social anxiety in Parkinson’s disease.

Method:

Using a cross-sectional design, 124 people with Parkinson’s disease completed self-report questionnaires including measures of Parkinson’s disease severity, social anxiety, negative social cognitions, safety-seeking behaviours, internally focused attention, anxiety and depression.

Results:

The final regression model accounted for 71.6% of variance in social anxiety. Cognitive behavioural variables accounted for the largest magnitude of unique variance (43.5%). Sex, anxiety and depression accounted for 23.4%, and Parkinson non-motor symptom severity for 4.7%. Negative social cognitions and safety-seeking behaviours were statistically significant predictors, while an internal focus of attention was not.

Conclusions:

Social anxiety in Parkinson’s disease is associated with negative social cognitions and safety-seeking behaviours. Findings indicate the need for further research into cognitive behavioural approaches to social anxiety in Parkinson’s disease.

Keywords

anxietycognitive behaviouralParkinson’s diseasepsychological therapysocial anxiety
Type
Main
Information
Behavioural and Cognitive Psychotherapy , Volume 50 , Issue 1 , January 2022 , pp. 57 - 73
Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of the British Association for Behavioural and Cognitive Psychotherapies

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

APA (2013). Diagnostic and Statistical Manual of Mental Disorders (5th edn). Washington, DC, USA.Google Scholar
Barrera, T. L., & Norton, P. J. (2009). Quality of life impairment in generalized anxiety disorder, social phobia, and panic disorder. Journal of Anxiety Disorders, 23, 1086–1090. doi: 10.1016/j.janxdis.2009.07.011 CrossRefGoogle ScholarPubMed
Beck, A. T., & Steer, R. A. (1993). Beck Anxiety Inventory Manual. San Antonio, TX, USA: Psychological Corporation.Google Scholar
Bolluk, B., Ozel-Kizil, E. T., Akbostanci, M. C., & Atbasoglu, E. C. (2010). Social anxiety in patients with Parkinson’s disease. Journal of Neuropsychiatry and Clinical Neuroscience, 22, 390–394. doi: 10.1176/jnp.2010.22.4.390 CrossRefGoogle ScholarPubMed
Broen, M. P., Narayen, N. E., Kuijf, M. L., Dissanayaka, N. N., & Leentjens, A. F. (2016). Prevalence of anxiety in Parkinson’s disease: a systematic review and meta-analysis. Movement Disorders, 31, 1125–1133. doi: 10.1002/mds.26643 CrossRefGoogle ScholarPubMed
Brown, R. G., & Fernie, B. A. (2015). Metacognitions, anxiety, and distress related to motor fluctuations in Parkinson’s disease. Journal of Psychosomatic Research, 78, 143–148. doi: https://doi.org/10.1016/j.jpsychores.2014.09.021 CrossRefGoogle ScholarPubMed
Calvete, E., Orue, I., & Hankin, B. (2013). Early maladaptive schemas and social anxiety in adolescents: the mediating role of anxious automatic thoughts. Journal of Anxiety Disorders, 27, 278–288. doi: 10.1016/j.janxdis.2013.02.011 CrossRefGoogle ScholarPubMed
Cardaciotto, L., & Herbert, J. D. (2004). Cognitive behavior therapy for social anxiety disorder in the context of Asperger’s syndrome: a single-subject report. Cognitive and Behavioral Practice, 11, 75–81. doi: https://doi.org/10.1016/S1077-7229(04)80009-9 CrossRefGoogle Scholar
Chaudhuri, K. R., Healy, D. G., & Schapira, A. H. V. (2006). Non-motor symptoms of Parkinson’s disease: diagnosis and management. The Lancet Neurology, 5, 235–245. doi: https://doi.org/10.1016/S1474-4422(06)70373-8 CrossRefGoogle ScholarPubMed
Chen, J. J., & Marsh, L. (2014). Anxiety in Parkinson’s disease: identification and management. Therapeutic Advances in Neurological Disorders, 7, 52–59. doi: 10.1177/1756285613495723 CrossRefGoogle ScholarPubMed
Clark, D. (2005). Three Questionnaires for Measuring Central Constructs in the Cognitive Model of Social Anxiety: Preliminary Analysis. Unpublished.Google Scholar
Clark, D. M., & Wells, A. (1995). A cognitive model of social phobia. In Heimberg, R. G. Liebowitz, M. R. Hope, D. A. & Schneier, F. R. (eds), Social Phobia: Diagnosis, Assessment, and Treatment (pp. 69–93). Guilford Press.Google Scholar
Clark, D., Wells, A., Salkovskis, P., & Hackmann, A. (1995). The Social Behaviours Questionnaire . Unpublished manuscript. Department of Psychiatry, Oxford University, Oxford, UK.Google Scholar
Connor, K. M., Davidson, J. R., Churchill, L. E., Sherwood, A., Foa, E., & Weisler, R. H. (2000). Psychometric properties of the Social Phobia Inventory (SPIN). New self-rating scale. British Journal of Psychiatry, 176, 379–386.10.1192/bjp.176.4.379CrossRefGoogle ScholarPubMed
Deane, K. H. O., Flaherty, H., Daley, D. J., Pascoe, R., Penhale, B., Clarke, C. E., Sackley, C., & Storey, S. (2014). Priority setting partnership to identify the top 10 research priorities for the management of Parkinson’s disease. BMJ Open, 4, e006434. doi: 10.1136/bmjopen-2014-006434 CrossRefGoogle ScholarPubMed
Enders, C. K. (2003). Using the expectation maximization algorithm to estimate coefficient alpha for scales with item-level missing data. Psychological Methods, 8, 322–337. doi: 10.1037/1082-989X.8.3.322 CrossRefGoogle ScholarPubMed
Fernie, B. A., Spada, M. M., Ray Chaudhuri, K., Klingelhoefer, L., & Brown, R. G. (2015). Thinking about motor fluctuations: an examination of metacognitions in Parkinson’s disease. Journal of Psychosomatic Research, 79, 669–673. doi: 10.1016/j.jpsychores.2015.05.001 CrossRefGoogle ScholarPubMed
Ferrans, C. E., & Powers, M. J. (1985). Quality of life index: development and psychometric properties. Advances in Nursing Science, 8, 15–24.10.1097/00012272-198510000-00005CrossRefGoogle ScholarPubMed
Ferrans, C. E., & Powers, M. J. (1992). Psychometric assessment of the Quality of Life Index. Research in Nursing & Health, 15, 29–38.10.1002/nur.4770150106CrossRefGoogle ScholarPubMed
Field, A. (2013). Discovering Statistics Using IBM SPSS Statistics: And Sex and Drugs and Rock “n” Roll, 4th edn. Sage: Los Angeles, London, New Delhi.Google Scholar
Fresco, D. M., Coles, M. E., Heimberg, R. G., Liebowitz, M. R., Hami, S., Stein, M. B., & Goetz, D. (2001). The Liebowitz Social Anxiety Scale: a comparison of the psychometric properties of self-report and clinician-administered formats. Psychological Medicine, 31, 1025–1035.CrossRefGoogle ScholarPubMed
Goddard, J. (2014). An Exploration into the Experiences of Parkinson’s Disease and its Relationship with Emotional Well-Being (Doctorate in Clinical Psychology). University of Leicester,Google Scholar
Goetz, C. Luo, S., & Stebbins, G. (2019). Modeling the effect of patient’s perception of non-motor and mptor function on Parkinson’s disease severity [abstract]. Movement Disorders, 34.Google Scholar
Goetz, C., Luo, S., Wang, L., Tilley, B. C., LaPelle, N. R., & Stebbins, G. T. (2015). Handling missing values in the MDS-UPDRS. Movement Disorders, 30, 1632–1638. doi: 10.1002/mds.26153 CrossRefGoogle ScholarPubMed
Goetz, C. G., Tilley, B. C., Shaftman, S. R., Stebbins, G. T., Fahn, S., Martinez-Martin, P., … & Movement Disorder Society UPDRS Revision Task Force (2008). Movement Disorder Society-sponsored revision of the Unified Parkinson’s Disease Rating Scale (MDS-UPDRS): scale presentation and clinimetric testing results. Movement Disorders, 23, 2129–2170. doi: 10.1002/mds.22340 CrossRefGoogle ScholarPubMed
Gultekin, B. K., Ozdilek, B., & Bestepe, E. E. (2014). Social phobia in Parkinson’s disease: prevalence and risk factors. Neuropsychiatric Disease and Treatment, 10, 829–834. doi: 10.2147/NDT.S62942 Google ScholarPubMed
Heimberg, R. C., Brozovich, F. A., & Rapee, R. M. (2010). A cognitive behavioral model of social anxiety disorder: Update and extension. In Hofmann, S. G. & DiBartolo, P. M. (eds), Social Anxiety: Clinical, Developmental, and Social Perspectives (pp. 395–422). Elsevier Academic Press. https://doi.org/10.1016/B978-0-12-375096-9.00015-8 CrossRefGoogle Scholar
Heimberg, R. G., Hofmann, S. G., Liebowitz, M. R., Schneier, F. R., Smits, J. A., Stein, M. B., … & Craske, M. G. (2014). Social anxiety disorder in DSM-5. Depression and Anxiety, 31, 472–479. doi: 10.1002/da.22231 CrossRefGoogle ScholarPubMed
Heimberg, R. G., Liebowitz, M. R., Hope, D. A., & Schneier, F. R. (1995). Social Phobia: Diagnosis, Assessment, and Treatment. Guilford Press.Google Scholar
Heinrichs, N., Hoffman, E., & Hoffman, S. (2001). Cognitive-behavioral treatment for social phobia in Parkinson’s disease: a single-case study. Cognitive Behavioural Practice, 8, 328–335.CrossRefGoogle ScholarPubMed
Hodson, K., McMannus, F., Clark, D., & Doll, H. (2008). Can Clark and Wells’ (1995) cognitive model of social phobia be applied to young people? Behavioural and Cognitive Psychotherapy, 36, 449–461.CrossRefGoogle Scholar
Hodson, K. J., McManus, F. V., Clark, D. M., & Doll, H. (2008). Can Clark and Wells*#x2019; (1995) cognitive model of social phobia be applied to young people. Behavioural and Cognitive Psychotherapy, 36, 449–461. https://doi.org/10.1017/S1352465808004487 CrossRefGoogle Scholar
Ishihara, L., & Brayne, C. (2006). A systematic review of depression and mental illness preceding Parkinson’s disease. Acta Neurologica Scandinavica, 113, 211–220. doi: 10.1111/j.1600-0404.2006.00579.x CrossRefGoogle ScholarPubMed
Jordan, S., Watkins, A., Storey, M., Allen, S. J., Brooks, C. J., Garaiova, I., … & Morgan, G. (2013). Volunteer bias in recruitment, retention, and blood sample donation in a randomised controlled trial involving mothers and their children at six months and two years: a longitudinal analysis. PLoS One, 8, e67912. doi: 10.1371/journal.pone.0067912 CrossRefGoogle Scholar
Kleve, L., Rumsey, N., Wyn-Williams, M., & White, P. (2002). The effectiveness of cognitive-behavioural interventions provided at Outlook: a disfigurement support unit. Journal of Evaluation in Clinical Practice, 8, 387–395. doi: 10.1046/j.1365-2753.2002.00348.x CrossRefGoogle ScholarPubMed
Klingelhoefer, L., & Reichmann, H. (2017). Parkinson’s disease as a multisystem disorder. Journal of Neural Transmission, 124, 709–713. doi: 10.1007/s00702-017-1692-0 CrossRefGoogle ScholarPubMed
Kummer, A., Cardoso, F., & Teixeira, A. L. (2008). Frequency of social phobia and psychometric properties of the Liebowitz social anxiety scale in Parkinson’s disease. Movement Disorders, 23, 1739–1743. doi: 10.1002/mds.22221 CrossRefGoogle ScholarPubMed
Liebowitz, M. R. (1987). Social phobia. Modern Problems of Pharmacopsychiatry, 22, 141–173. doi: 10.1159/000414022 CrossRefGoogle ScholarPubMed
Marinus, J., Leentjens, A. F., Visser, M., Stiggelbout, A. M., & van Hilten, J. J. (2002). Evaluation of the hospital anxiety and depression scale in patients with Parkinson’s disease. Clinical Neuropharmacology, 25, 318–324.CrossRefGoogle ScholarPubMed
Martínez-Martín, P., Rodríguez-Blázquez, C., Mario, A., Arakaki, T., Arillo, V. C., Chaná, P., … & Merello, M. (2015). Parkinson’s disease severity levels and MDS-Unified Parkinson’s Disease Rating Scale. Parkinsonism & Related Disorders, 21, 50–54. doi: https://doi.org/10.1016/j.parkreldis.2014.10.026 CrossRefGoogle ScholarPubMed
Mattick, R. P., & Clarke, J. C. (1998). Development and validation of measures of social phobia scrutiny fear and social interaction anxiety. Behaviour Research and Therapy, 36, 455–470. doi: 10.1016/S0005-7967(97)10031-6 CrossRefGoogle ScholarPubMed
McManus, F., Sacadura, C., & Clark, D. M. (2008). Why social anxiety persists: an experimental investigation of the role of safety behaviours as a maintaining factor. Journal of Behavior Therapy and Experimental Psychiatry, 39, 147–161. doi: https://doi.org/10.1016/j.jbtep.2006.12.002 CrossRefGoogle ScholarPubMed
Moriyama, T. S., Felicio, A. C., Chagas, M. H., Tardelli, V. S., Ferraz, H. B., Tumas, V., … & Bressan, R. A. (2011). Increased dopamine transporter density in Parkinson’s disease patients with Social Anxiety Disorder. Journal of the Neurological Sciences, 310, 53–57. doi: 10.1016/j.jns.2011.06.056 CrossRefGoogle ScholarPubMed
National Institute for Health and Care Excellence (NICE) (2020). Social Anxiety Disorder: Recognition, Assessment and Treatment [NICE Guideline N0. 159]. https://www.nice.org.uk/guidance/cg159 Google Scholar
National Institute for Health and Care Excellence (NICE) (2013). Social Anxiety Disorder: Recognition, Assessment and Treatment. https://www.nice.org.uk/guidance/cg159 Google Scholar
Nègre-Pagès, L., Grandjean, H., Lapeyre-Mestre, M., Montastruc, J. L., Fourrier, A., Lépine, J. P., … & DoPaMiP Study Group (2010). Anxious and depressive symptoms in Parkinson’s disease: the French cross-sectionnal DoPaMiP study. Movement Disorders, 25, 157–166. doi: 10.1002/mds.22760 CrossRefGoogle ScholarPubMed
Pachana, N. A., Egan, S. J., Laidlaw, K., Dissanayaka, N., Byrne, G. J., Brockman, S., … & Starkstein, S. (2013). Clinical issues in the treatment of anxiety and depression in older adults with Parkinson’s disease. Movement Disorders, 28, 1930–1934. doi: 10.1002/mds.25689 CrossRefGoogle ScholarPubMed
Pallant, J. (2010). SPSS Survival Manual: A Step by Step Guide to Data Analysis Using SPSS (4th edn). Maidenhead, UK: Open University Press/McGraw-Hill, 2010.Google Scholar
Poder, K., Ghatavi, K., Fisk, J. D., Campbell, T. L., Kisely, S., Sarty, I., … & Bhan, V. (2009). Social anxiety in a multiple sclerosis clinic population. Multiple Sclerosis, 15, 393–398. doi: 10.1177/1352458508099143 CrossRefGoogle Scholar
Postuma, R. B., Berg, D., Stern, M., Poewe, W., Olanow, C. W., Oertel, W., Obeso, J., Marek, K., Litvan, I., Lang, A. E., Halliday, G., Goetz, C. G., Gasser, T., Dubois, B., Chan, P., Bloem, B. R., Adler, C. H., & Deuschl, G. (2015). MDS clinical diagnostic criteria for Parkinson’s disease. Movement Disorders: Official Journal of the Movement Disorder Society, 30, 1591–1601. https://doi.org/10.1002/mds.26424 CrossRefGoogle ScholarPubMed
Ranta, K., Tuomisto, M. T., Kaltiala-Heino, R., Rantanen, P., & Marttunen, M. (2014). Cognition, imagery and coping among adolescents with social anxiety and phobia: testing the Clark and Wells model in the population. Clinical Psychology & Psychotherapy, 21, 252–263. doi: 10.1002/cpp.1833 CrossRefGoogle Scholar
Rapee, R. M., & Heimberg, R. G. (1997). A cognitive-behavioral model of anxiety in social phobia. Behaviour Research and Therapy, 35, 741–756. https://doi.org/10.1016/s0005-7967(97)00022-3 CrossRefGoogle ScholarPubMed
Reijnders, J. S., Ehrt, U., Weber, W. E., Aarsland, D., & Leentjens, A. F. (2008). A systematic review of prevalence studies of depression in Parkinson’s disease. Movement Disorders, 23, 183–189. https://doi.org/10.1002/mds.21803 CrossRefGoogle ScholarPubMed
Rodríguez-Blázquez, C., Alvarez, M., Arakaki, T., Campos Arillo, V., Chaná, P., Fernández, W., … & Martínez-Martín, P. (2017). Self-assessment of disability in Parkinson’s disease: the MDS-UPDRS Part II versus clinician-based ratings. Movement Disorders Clinical Practice, 4, 529–535. doi: 10.1002/mdc3.12462 CrossRefGoogle ScholarPubMed
Rumsey, N., Clarke, A., & White, P. (2003). Exploring the psychosocial concerns of outpatients with disfiguring conditions. Journal of Wound Care, 12, 247–252. doi: 10.12968/jowc.2003.12.7.26515 CrossRefGoogle ScholarPubMed
Safren, S. A., Heimberg, R. G., Brown, E. J., & Holle, C. (1996). Quality of life in social phobia. Depression and Anxiety, 4, 126–133. doi: 10.1002/(SICI)1520-6394(1996)4:3<126:AID-DA5>3.0.CO;2-E3.0.CO;2-E>CrossRefGoogle ScholarPubMed
Sagna, A., Gallo, J. J., & Pontone, G. M. (2014). Systematic review of factors associated with depression and anxiety disorders among older adults with Parkinson’s disease. Parkinsonism & Related Disorders, 20, 708–715. doi: 10.1016/j.parkreldis.2014.03.020 CrossRefGoogle ScholarPubMed
Salazar, R. D., Le, A. M., Neargarder, S., & Cronin-Golomb, A. (2017). The impact of motor symptoms on self-reported anxiety in Parkinson’s disease. Parkinsonism & Related Disorders, 38, 26–30. doi: 10.1016/j.parkreldis.2017.01.011 CrossRefGoogle ScholarPubMed
Salkovskis, P. M. (1991). The importance of behaviour in the maintenance of anxiety and panic: a cognitive account. Behavioural Psychotherapy, 19, 6–19. https://doi.org/10.1017/S0141347300011472 CrossRefGoogle Scholar
Schreiber, F., Höfling, V., Stangier, U., Bohn, C., & Steil, R. (2012). A cognitive model of social phobia: applicability in a large adolescent sample. International Journal of Cognitive Therapy, 5, 341–358. doi: 10.1521/ijct.2012.5.3.341 CrossRefGoogle Scholar
Spurr, J. M., & Stopa, L. (2002). Self-focused attention in social phobia and social anxiety. Clinical Psychology Review, 22, 947–975. doi: https://doi.org/10.1016/S0272-7358(02)00107-1 CrossRefGoogle ScholarPubMed
Stephens, E. J., Dysch, L., & Gregory, J. (2018). Diagnostic overshadowing of anxiety in Parkinson disease: psychosocial factors and a cognitive-behavioral model. Cognitive Behavioural Neurology, 31, 123–132. doi: 10.1097/WNN.0000000000000161 CrossRefGoogle Scholar
Stoker, T. B., & Greenland, J. C. (2018). Parkinson’s Disease: Pathogenesis and Clinical Aspects. doi: 10.15586/codonpublications.parkinsonsdisease.2018 CrossRefGoogle Scholar
Tanner, R. J., Stopa, L., & De Houwer, J. (2006). Implicit views of the self in social anxiety. Behaviour Research and Therapy, 44, 1397–1409. https://doi.org/10.1016/j.brat.2005.10.007 CrossRefGoogle ScholarPubMed
Weintraub, D., Moberg, P. J., Duda, J. E., Katz, I. R., & Stern, M. B. (2004). Effect of psychiatric and other nonmotor symptoms on disability in Parkinson’s disease. Journal of the American Geriatric Society, 52, 784–788. doi: 10.1111/j.1532-5415.2004.52219.x CrossRefGoogle ScholarPubMed
Weintraub, D., Newberg, A. B., Cary, M. S., Siderowf, A. D., Moberg, P. J., Kleiner-Fisman, G., … & Katz, I. R. (2005). Striatal dopamine transporter imaging correlates with anxiety and depression symptoms in Parkinson’s disease. Journal of Nuclear Medicine, 46, 227–232.Google ScholarPubMed
Wells, A., Stopa, L., & Clark, D. (1993). The Social Cognitions Questionnaire. Unpublished.Google Scholar
Wood, B., van der Mei, I. A., Ponsonby, A. L., Pittas, F., Quinn, S., Dwyer, T., … & Taylor, B. V. (2013). Prevalence and concurrence of anxiety, depression and fatigue over time in multiple sclerosis. Multiple Sclerosis, 19, 217–224. doi: 10.1177/1352458512450351 CrossRefGoogle ScholarPubMed
Woody, S. R. (1996). Effects of focus of attention on anxiety levels and social performance of individuals with social phobia. Journal of Abnormal Psychology, 105, 61–69. doi: 10.1037//0021-843x.105.1.61 CrossRefGoogle ScholarPubMed
Woody, S. R., Chambless, D. L., & Glass, C. R. (1997). Self-focused attention in the treatment of social phobia. Behaviour Research and Therapy, 35, 117–129. doi: https://doi.org/10.1016/S0005-7967(96)00084-8 CrossRefGoogle ScholarPubMed
Zigmond, A. S., & Snaith, R. P. (1983). The Hospital Anxiety and Depression Scale. Acta Psychiatrica Scandinavica, 67, 361–370. doi: 10.1111/j.1600-0447.1983.tb09716.x CrossRefGoogle ScholarPubMed
Submit a response

Comments

No Comments have been published for this article.