Individualizing Evidence-Based Treatment of Neuropsychiatrically Complex Patients: Process-Based Targets for Change in Parkinson’s Depression

Providing evidence-based treatment always requires responding in the moment to apparent gaps between the protocol and the patient’s presenting needs and preferences. In the treatment of depression in Parkinson’s disease (PD), research has shown that providing PD-specialized, empirically supported interventions is paramount. However, given PD’s highly heterogeneous symptom presentations, adapting and individualizing treatment to address each patient’s unique constellation of neuropsychiatric symptoms and PD-related physical challenges is equally important. This Commentary on the article by Dr. Logan Durland (2020) focuses on the importance of attending to process-based factors to inform protocol adaptations in the treatment of Parkinson’s depression, guided by the framework of functional analytic psychotherapy (FAP). The FAP approach applies behavioral principles to in-session processes as a means of highlighting and therapeutically targeting clinically relevant behaviors in real time. Seeking such opportunities to foster within-session change may be especially important when providing evidence-based treatment to individuals with co-occurring mental health issues and chronic, functionally limiting medical problems like PD. As these patients manage the interactions between the complex demands of illness self-management and the burden of mental health symptoms, they must respond adaptively to unpredictable daily challenges. Harnessing moments of clinically relevant struggle during sessions in order to support and reinforce new responses—including new ways of approaching the learning process itself—can help patients consolidate both the coping skills themselves and flexibility and confidence to apply them.