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Degree Name

Doctor of Philosophy



First Advisor

Jo Lynne Robins



Anxiety is recognized as a predominant nonmotor symptom of Parkinson’s disease (PD) which greatly diminishes quality of life. Current treatment is largely pharmacologic and is recognized as rife with undesirable and unsafe side effects. Reviews commissioned by The Movement Disorder Society Task Force on Evidence-Based Medicine and the American Academy of Neurology revealed there was insufficient evidence to make recommendations for the treatment of anxiety. A review of the literature confirmed anxiety in PD is underdiagnosed, undertreated, and under studied. A common element in many of the non-pharmacologic self-managed interventions used by the studies included in the review was the use of focused breath. This randomized clinical trial used a mixed methods design to determine the feasibility and acceptability of focused breath as a self-managed intervention for anxiety in PD. 28 participants were recruited and 25 completed the six week study. Quantitative data were analyzed using a mixed effects linear model to determine the value of the intervention for group, visit, and group by visit. The least squares (LS) mean at each time point was generated from the model to map a line between each variable (anxiety, depression, self-efficacy, sleep, and quality of life) and the response to the intervention. Model parameters were fixed effects for group (focused breathing and waitlist control) and time (Visit 1 and Visit 2) and random effects for participant. Despite statistically insignificant quantitative results, themes resulting from qualitative analysis revealed both feasibility and acceptability for focused breathing as a self-managed strategy to manage anxiety in PD. This study provides preliminary evidence suggested that focused breathing, which presents with minimal barriers for patients and is easily taught, can be used to self-manage anxiety. Further research is warranted using larger sample sizes, prescreening to anxiety meeting DSM-IV diagnostic criteria for anxiety, and a longer follow-up period.


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Available for download on Monday, May 19, 2025