Ires Ghielen

182 Appendix Chapters 2,3, and 4 focused on the associations between motor, anxiety, and other symptoms, not taking into account their temporal relationships. As symptom intensity may vary over time, we investigated the longitudinal associations between anxiety, fear of falling, and freezing of gait in 153 PD patients in chapter 5 . Across four measurements, with three weeks between each measurement, all associations were significant, with the strongest association between fear of falling and freezing of gait. Adjustments for disease characteristics (such as disease duration, depressive and cognitive symptoms) and adverse effects of medication (such as response fluctuations) diminished all associations, which confirms the complex interactions between motor and anxiety symptoms. After a description of the phenomenology of anxiety, and its cross-sectional and longitudinal associations with motor and other non-motor symptoms, part 2 of this PhD thesis focuses on the treatment of these complex symptom interactions in PD patients. In chapter 6 , we describe two meta-analyses on the effects of cognitive behavioral therapy and mindfulness-based therapies on psychological distress in patients with neurodegenerative disorders. The included studies were divided into those comparing the treatment of interest with an active control condition and those with a treatment as usual or waitlist control condition. The results showed that psychological interventions have a small to moderate effect on reducing psychological distress in patients with PD and Multiple Sclerosis (MS). The overall quality of the included studies was low and showed considerable heterogeneity, which pleads for more studies with better quality. Chapters 7 and 8 present the study protocol and results of a pilot randomized controlled trial (RCT) in which we described and investigated a newly developed multidisciplinary group treatment for wearing-off related anxiety in PD named BEWARE . BEWARE is a body awareness group training in which we combine elements from acceptance and commitment therapy (ACT) with physical therapy. We compared the BEWARE training with group physical therapy. In chapter 8 we describe the results of this pilot RCT. Patients that participated in the BEWARE training showed no significant improvement in the primary outcome measure, self- efficacy, as compared to the control condition. However, this group did show a more improved emotional wellbeing as well as standing balance, both at post-treatment and follow-up. Feelings of social stigmatization decreased as well, however, the difference with the control group was not statistically significant. The BEWARE training was the first attempt in improving body awareness and in addressing the