Telephone-Based, Clinician-Guided Self-Help Cognitive Behavioral Therapy for Depression in Parkinson's Disease (dPD): The Responder Cases of "Alice" and "Carl," and the Nonresponder Cases of "Ethan" and "Gary"

Abstract

Roseanne Dobkin and her colleagues (e.g., Dobkin, Interian, Durland, Gara, & Menza, 2018) have developed a 10-session, individual cognitive-behavioral treatment (CBT) program for treating depression in individuals with Parkinson’s disease (dPD). The program has been found to yield statistically and clinically significant success in both uncontrolled group trial designs and randomized clinical trials—originally in a face-to-face version, and then in a telehealth version, using telephone therapy sessions and guided self-help materials for patients.  This latter version is herein called "Teleheath Guided Self-Help for dPD," or "TH-GSH-dPD," for short. Applying Fishman, Messer, Edwards, and Dattilio’s (2017) "case studies within psychotherapy trials" methodological model, the present research was designed to complement the group research findings by my conducting systematic, pragmatic case studies (Fishman, 2013) with four patients representative of those in the telehealth studies, given the names of "Alice" (and her caregiver husband "Bob"); "Carl" (and his caregiver wife "Doris"); "Ethan" (and his caregiver wife, "Fay"); and "Gary" (and his caregiver mother, not named). Specifically, Alice and Carl were representative of those patients in the group studies with positive, responsive outcomes; and Ethan and Gary were representative of those patients in the group studies with negative, nonresponsive outcomes. Each case combines (a) quantitative data, comprised of demographic information, psychiatric diagnostic data, neurocognitive data, caregiver distress, and treatment outcome measures; and (b) qualitative data, consisting of recordings of the telephone therapy sessions, my treatment notes, my observations as the therapist, and systematic, post-treatment "Exit Interviews" I conducted with each of the patients and their caregivers about their therapy experience.  Each of the four case studies aims (a) to provide a detailed, thickly described portrait of the TH-GSH-dPD treatment process; and (b) to explore the presence and influence of barriers and facilitators of treatment in an idiographic context. Regarding point (b), the following variables that cut across the case studies are explored as appearing to be particularly impactful: patients’ worldviews, patients’ cognitive functioning, caregiver involvement, and homework adherence.