Parkinsonʼs disease: the emotional impact
Healthcare Counselling and Psychotherapy Journal, January 2026

When we imagine Parkinson’s disease (PD), we probably picture tremors, rigidity and a shuffling gait. But for the person living with PD – and the clinician alongside them – the emotional effects are as important as the motor symptoms.

As one person with Parkinson’s said: ‘After I was diagnosed, I went on a rollercoaster of emotions, from the initial shock to disbelief, despair, sadness, anger and resignation, until I finally became more resilient and positive.’¹ 

If we are to deliver truly holistic care to people with PD, I believe we need to understand the neuropsychiatric aspects of the disease. We also need to understand that PD is as much a psychiatric as a motor condition. 

Neurological disorders involve the central and peripheral nervous systems, affecting the brain, spinal cord and nerves. More than three billion people worldwide live with some form of neurological condition, ranging from migraine, epilepsy and stroke to Alzheimer’s, multiple sclerosis and rarer genetic or autoimmune disorders.² 

Many of these conditions share common characteristics, including motor dysfunction, cognitive decline, fatigue, mood disturbances and loss of autonomy, all of which reshape identity, social role and subjective inner life. 

Parkinson’s disease is the second most common neurodegenerative disorder, affecting more than 10 million people globally.³ It is classically characterised by three motor symptoms: tremor, rigidity and bradykinesia (slowness of movement). But this triad represents only a part of the story – and not all people present with Parkinson’s in the same way. 

Non-motor symptoms – mood disturbance, anxiety, depression, apathy, sleep disorders and cognitive decline – are now recognised as core to PD. In fact, depression and anxiety can precede motor diagnoses. Recognition of PD as a neuropsychiatric condition has shifted how we approach both research and treatment. 

Brain circuits 

Neurological damage rarely respects functional silos. Key brain circuits involved in movement, such as the basal ganglia, frontal cortex and limbic structures, also serve emotional and cognitive regulation. 

The basal ganglia, which are central to PD pathology, have dense connections to limbic circuits, influencing motivation, reward and affective switching. The prefrontal cortex, which governs decision-making, impulse control and mood regulation, is also frequently affected by neurodegenerative disease. In addition, the amygdala and hippocampus – critical for emotional memory, fear conditioning and stress responses – are vulnerable to dysfunction in PD. The overlap is built into the neural architecture. A client’s tremor, fatigue or motor ‘off-periods’ might trigger anxiety, but underlying the anxiety might be direct neural disruption. Many clients with PD describe emotional changes as more disabling than physical ones.

Mood and anxiety disorders 

Depression and anxiety are not marginal footnotes in PD; they are leading non-motor challenges. Epidemiological studies report that about 50% of PD patients experience clinically significant depression, with some estimates ranging from 20% to 55%.⁵ 

The prevalence of anxiety is similarly high: a metaanalysis found that 40% of PD patients experience anxiety; generalised anxiety disorder (14.1%) and social phobia (13.8%) are especially common. It has been suggested that nine types of anxiety can be observed in PD patients.⁶ 

Anxiety can be linked to a number of factors, including body sensations, fear of disease progression, social identity and coping strategies.⁷ Moreover, anxiety often co-exists with depression; about a third of patients meet criteria for two or more concurrent anxiety diagnoses. In advanced PD, depressive symptoms occur in up to 60% of patients.⁸ 

Cognitive impairment is another core dimension of PD. As many as 80% of patients can develop cognitive decline or dementia over time. Dopaminergic treatments, while alleviating motor symptoms, can provoke psychosis, hallucinations or impulse-control disorders. The latter can include compulsive gambling, online spending, hypersexuality and porn addiction, which can further complicate the therapeutic work.⁹ 

Knowledge and understanding of the psychological impact of PD allow us to carefully tailor the clinical work. When depression or anxiety is framed as a ‘side effect’, rather than as intrinsic to PD, clients can feel blamed or stigmatised. Therapists and their clients must see mood symptoms, not as weaknesses but as legitimate expressions of altered neurobiology, interacting with life stressors. 

Therapy with clients who have PD is inevitably intertwined with existential, identity and emotional work. A PD diagnosis often ruptures a life narrative. Grief, shame, anger and existential questioning can follow. Therapists can help by: 

• providing a safe container: clients need space to weep, rage or ‘numb out’, without judgment
• translating medical language: making sense of neurological jargon and prognosis
• normalising uncertainty: validating that shifting feelings – from denial to acceptance – are common. 

The following quote helps to illustrate this dynamic: ‘My wife is severely depressed. Although she can get out of bed with help, she would rather stay in bed and do nothing.’¹⁰ The quote hints at the interplay of mood, fatigue and meaning. Therapists must help clients to distinguish neurological fatigue from demoralisation, grief from clinical depression. 

Acceptance in chronic illness is rarely linear. It is an ongoing negotiation between holding loss and activating adaptation. Therapists should bear in mind the following principles: 

• self-compassion: physiology and neurology matter. ‘I’m angry at myself’ often masks brain changes
• normalisation of emotional flux: reminding clients that ambivalence is healthy
• strength-based reframing: focusing on what capacities remain and what new ways of expression might emerge, supporting individuals to develop their own coping strategies. 

The client might also need support in re-crafting their identity, so they can move from: ‘I used to be…’ to ‘I am… despite PD.’ 

Coping strategies 

Coping in PD involves relaxation, as well as problemfocused and emotion-focused strategies, with a tone of compassion. Therapists can support clients in: 

• calming the sympathetic nervous system
• building social support: facilitating family communication, engaging peer support
• energy conservation: helping clients pace activity, reduce stimulus overload, identify ‘zones of calm’
• mindfulness or acceptance-based practices: promoting moment-to-moment awareness
• cognitive reframing: balancing realistic appraisal with hopeful narrative, when the client is calm enough to work on cognitive reframing.

However, therapists must also watch for maladaptive coping, such as avoidance, denial or overdependence, which can exacerbate emotional distress. 

Clinical trials 

Clinical trials are limited, but some therapeutic approaches appear promising. In a recent systematic review, adapted cognitive behavioural therapy (CBT) was shown to be effective for reducing depression and anxiety in PD cohorts.¹¹ However, CBT can only be used when the client is in a relaxed state, not in a fight, flight or freeze zone. 

Acceptance and commitment therapy (ACT) can foster flexibility around declining abilities. For example, if someone is feeling more tired than they would have felt previously, it can be beneficial if they can accept that the disease is slowing them down.

Behavioural activation therapy (BAT) can help someone who is suffering from anxiety, by encouraging engagement in rewarding activities with others. Over time, it can increase the tolerance for socialising and lessen isolation. 

Expressive therapies, such as art therapy, can support people to manage anxiety, by providing a non-verbal outlet for their emotions. Some people also find comfort in meaning centred work, such as becoming active in support groups for other people with Parkinson’s disease. Therapists should, however, tailor interventions to suit neural fatigue, cognitive changes and fluctuating motor states. 

Therapeutic environment 

Therapy begins before the client walks into the room. So, it’s important to think about accessibility and sensory factors. I would suggest that therapists: 

• consider wide doorways, an open layout and comfortable seating that preferably meets occupational therapy standards
• avoid patterns on your clothes, the floor and the walls
• provide quiet or low-stimulus spaces, with soft lighting and minimal clutter
• use a consistent session format, to reduce cognitive load and develop routine. 

It’s a good idea to begin sessions with a check-in, acknowledging how the client’s physical state might affect mood or cognition. I generally keep sessions to between 35 and 40 minutes, to reduce the possibility of overload. I also build breathers into the session: short pauses to rest or re-orient. Transparent pacing can be helpful. So, don’t be afraid to explicitly ask clients how they’re tolerating cognitive and emotional load.

Inclusion of caregivers 

Given the relational impact of PD, engaging family or caregivers can be critical. Therapists can: 

• offer parallel sessions or psychoeducation to caregivers, spouses, partners and family members
• coach communication strategies
• monitor and support caregiver burnout. 

Psychoeducation is central to neurological work. It empowers clients, families and therapists alike. Clients and caregivers often focus on tremors or rigidity, overlooking mood, apathy and anxiety. Educating all parties about non-motor manifestations serves to normalise the emotional side of the illness. 

For example, explaining that emotional distress is often a neurological symptom, not a moral failing, can relieve guilt, shame and misattribution. Similarly, it’s perhaps helpful to know that depression in PD can emerge as a result of disrupted dopamine, serotonin and norepinephrine circuits.⁵ 

Burnout and compassion fatigue 

PD is a relentless and progressive condition. So, it’s perhaps no surprise that burnout is a frequent and well-documented phenomenon, not only among individuals living with PD but also among their carers and the professionals who support them.¹² Consequently, psychoeducation should encompass both the emotional impact of PD and the development of sustainable strategies for long-term wellbeing. 

For clients and families, psychoeducational interventions might address the following: 

• self-care planning and the establishment of realistic expectations
• the incorporation of respite and shared-care strategies
• recognition of early indicators of emotional exhaustion or compassion fatigue
• identification of sensory triggers within daily environments, such as noise, crowding, visual complexity
• development of energy conservation approaches, pacing routines and structured rest periods
• creation of low-stimulation zones to mitigate overwhelm and enhance recovery. 

For therapists, engagement with progressive neurological conditions necessitates sustained emotional and professional resilience. Preventing burnout requires both personal and systemic supports, including: 

• regular clinical supervision, with attention to countertransference dynamics
• opportunities for emotional processing through journaling, reflective practice or personal therapy
• maintenance of professional boundaries regarding caseload, availability and session structure
• cultivation of resilience-enhancing activities, such as movement, creative expression or time in nature
• ongoing engagement with emerging PD research to maintain clinical efficacy and a sense of purpose. 

Attending to the wellbeing of the therapist is not optional; it is an ethical imperative. Sustaining the health and resilience of both clients and practitioners safeguards therapeutic effectiveness and preserves the compassion, which is central to long-term care in PD. 

Integration with medical teams 

Psychotherapy for PD does not exist in isolation. Close collaboration with neurologists, movement-disorder specialists, occupational therapists, neuropsychiatrists and rehabilitation professionals is vital to ensure continuity of care and information. 

Collaborative care planning becomes particularly important when cognitive decline necessitates the adaptation of treatment goals or therapeutic approaches. Clear referral pathways for neuropsychological assessment, psychopharmacological consultation or advanced care planning further strengthen the support network surrounding the client. 

Therapists should remain hopeful. Advances in neuroscience, neurorehabilitation and psychotherapeutic approaches can deepen our understanding and efficacy. For example, deep-learning models are being explored to detect depressive symptoms through facial analysis in PD.¹³ 

Non-pharmacological interventions, such as tailored movement (including adapted boxing or paddling) are also showing promise in improving mood.¹³ Personalised medicine might soon help us match interventions (behavioural, pharmacological, neuromodulation) to each client’s neural profile. 

Science advances slowly, but therapists are already positioned to make a difference. By combining neural awareness, emotional regulation, psychoeducation and systemic sensitivity, we can accompany clients with PD into meaningful adaptation and acceptance, so they can live life as well as they can. 

Parkinson’s disease is more than a movement disorder; it is a neuropsychiatric journey that reshapes cognition, affect, identity and interpersonal life. For the psychotherapist, working with PD clients means navigating the overlap of neural disruption and emotional dynamics. 

We must help clients reassemble their ‘self’ in relation to the disease, manage grief and fear, as well as maintain agency in the face of decline. We must build therapeutic spaces that respect fatigue, cognitive fluctuation and emotional vulnerability. Psychoeducation is central to reducing shame, aligning expectations and cultivating resilience. 

Above all, therapists must attend to their own wellbeing, guarding against compassion fatigue and staying connected to hope. In doing so, we deliver not just clinical interventions, but human presence grounded in respect, curiosity and recognition that people with Parkinson’s are full beings, not symptoms to manage.