Ires Ghielen

142 Chapter 8 related to a low level of dopamine [14]. In addition, treating anxiety symptoms with pharmaceutics, such as psychotropic medication, might interfere with DRT and result in increased tremor or rigidity, which is undesirable. Non-pharmaceutical approaches to treat wearing-off include exercise programs and physical therapy. These have been shown to improve motor problems, daily functioning and quality of life in PD patients [15-18]. While effective in improving mobility-related problems, current physical rehabilitation approaches typically do not offer tools to address the (interaction with) non-motor symptoms, such as WRA. Cognitive Behavior Therapy (CBT), mindfulness and Acceptance & Commitment- based therapies (ACT) are effective in reducing anxiety symptoms, distress and avoidance behavior and enhancing quality of life in patients with anxiety disorders and PD [19-23]. Therefore, tools from CBT and ACT might also be useful in the treatment of the debilitating effects of WRA in PD. However, the classical approach aims to reduce symptoms, whereas the inevitability of motor and non-motor fluctuations in PD demands a coping strategy on dealing with these fluctuations. In addition, cognitive rigidity becomes more prominent with disease progression and complicates a mono-disciplinary cognitive treatment approach. To address both the physical and the mental aspects of PD, Wahbeh et al. [24] reviewed mind-body interventions in the treatment of PD and showed that participating in tai chi classes improved the patients’ physical condition. Landsman- Dijkstra and colleagues [25] tested a highly structured and standardized 3-day body-awareness program in 14 participants who suffered from chronic non-specific psychosomatic symptoms. After the intervention body awareness, self-efficacy and quality of life had significantly improved. The main limitation of this study, apart from the small sample size, was the lack of a control group. In summary, mind-body interventions seem promising for the treatment of WRA in PD patients, but the therapeutic efficacy has yet not been investigated. We therefore developed an integrated body awareness training combining ACT with physical therapy for patients with PD, named BEWARE. We investigated the feasibility and the efficacy of this group intervention using a pilot randomized controlled study, with conventional group physical therapy as active control condition.