Ask an Expert: Courtney Doherty and Tricia Wallace Discuss Coping Strategies for Mental Health

Courtney Doherty, MCP, RCC, completed her Masters of Counselling Psychology at Adler University in Vancouver. She has been working as a Registered Clinical Counsellor (RCC) with the British Columbia Association of Clinical Counsellors for over 5 years, and has a part-time private practice. Her personal connection to PD brought her to PSBC 7 years ago. Courtney’s father was diagnosed with PD over 15 years ago, and successfully underwent Deep Brain Stimulation surgery. Believing that every individual has the potential to lead a happy and fulfilling life regardless of challenges faced, she brings a unique perspective and skill set to PSBC.

Tricia Wallace, MSN, MCP, has practiced as a registered nurse since 1988 in hospital and community settings, attaining a Bachelor of Science in Nursing (BSN) and a Master of Nursing (MSN) from the University of Victoria. She has recently completed a Master of Arts in Counselling Psychology (MACP) at Yorkville University. Tricia has extensive experience working with adults of all ages in the field of mental health, including those with neurodegenerative diseases. Tricia recognizes the importance of a strength-based, holistic approach to Parkinson’s disease that includes emotional support and skill building.

Courtney Doherty and Tricia Wallace are clinical counsellors with Parkinson Society British Columbia (PSBC). The Society offers free, short-term, confidential, and non-judgemental counselling services for people touched by Parkinson’s disease (PD). Counselling provides a safe and structured environment to discuss challenges, process emotions, and provide you with the extra support you and your loved ones may need. Our counsellors have experience working with people with Parkinson’s, and their carepartners and family members. They are able to help in dealing with a combination of issues, such as coping with a diagnosis, life transitions, grief and loss, depression, and anxiety.

What are some common mental health challenges faced by people with Parkinson’s?

The mental health challenges faced by people with Parkinson’s can vary widely, being influenced by the stage of disease progression, one’s support system, and personal histories affecting coping patterns. As clinical counsellors, some of the most common concerns we hear from people with PD have to do with changes in their relationships, questions about the future and disease progression, and grief and loss related to their sense of identity and purpose.

People living with PD face mental health challenges as they adapt to their diagnosis and the changes that it brings. Symptoms of depression, anxiety, and apathy/amotivation are common, and can be attributed to both psychological stressors and changes in brain function caused by the disease. Parkinson’s causes interruptions in nerve communication pathways, which affects not only movement, but sensation, motivation, sleep, and emotion regulation (Chaudhuri et al., 2011; Pfeiffer, 2015). Cell loss, changes in brain structure, and inflammation secondary to Parkinson’s are all thought to contribute to the development of mental health conditions (Xie, 2015).

What effects do mental health challenges have on people with Parkinson’s?

Mental health conditions can have a profound impact on quality of life, and can potentially decrease your ability to respond favourably to treatment. Left untreated, depression, anxiety, and apathy can make self-management difficult, and may keep you from socializing, exercising, and enjoying your usual hobbies.

Some people with PD may also experience impulse control problems as a medication side effect. These can have a serious and far-reaching impact. They may cause compulsive gambling and shopping, hypersexuality, binge eating, and addictions to the Internet or to other recreational activities (PSBC, 2016). If you are taking any medications associated with these side effects, speak with your doctor, and notify your carepartner or family members so they may be vigilant and prepared to support you in seeking help should you need it.

How do I know if I am experiencing mental health challenges?

Depression, anxiety, and apathy can be identified by examining changes in your day-to-day life. Start by asking yourself the following questions:

• Have my sleep patterns, appetite, energy levels, or sexual function changed recently?
• Am I more irritable and/or worried than I used to be?
• Am I having difficulty concentrating?
• Am I unmotivated to do things?

If the answer to even one of these questions is yes, you may be experiencing some mental health changes, and should speak with your doctor.

The primary symptoms of depression include sadness, hopelessness, irritability, and suicidal ideation. Anxiety disorders are associated with feeling nervous, overly worried, tense, fearful, and restless. Apathy is a lack of interest and motivation in things, but without sadness, hopelessness, and other symptoms associated with depression.

Do I need treatment for mental health changes?

In many cases, changes in mental health and other non-motor symptoms often precede the onset of motor symptoms, like tremor, rigidity, and slowness of movement (Chaudhuri et al., 2011; Pfeiffer, 2015). As motor symptoms progress, so can the mental health conditions associated with PD, therefore it is important to seek early diagnosis and treatment.

It can be difficult to distinguish mental health changes from the changes seen in PD. Be sure to let your healthcare provider know about any changes you or your loved ones have noticed. While it is possible to effectively manage depression, anxiety, and apathy through behavioural changes, a professional can offer guidance, tools, and strategies specific to your situation.

How can people with Parkinson’s cope with mental health challenges?

Even with a diagnosis of Parkinson’s, and mental health challenges like depression, anxiety, or apathy, it is possible to live a full and happy life. Mental health challenges are not caused by a person’s weakness, or a lack of willpower, but are real medical conditions, and legitimate symptoms of Parkinson’s that can and should be treated.

Just like with PD, there are many treatment options available to support those with mental health challenges, and many different professionals who can offer various services for the specific symptoms associated with the condition you are experiencing. An outside perspective is important, so if your family, friends, or physician have noticed symptoms of depression, anxiety and/or apathy, be sure to take their concerns seriously, and seek help.

There are many types of medication for mental health conditions, so do not hesitate to ask about your options. If you do start taking these medications, remember that it may take several weeks before you feel better. Early side effects of these drugs usually disappear as your body gets used to them. If the first medication you try does not seem to be helping after some time, your doctor can help you find something that works better for you.

The support of friends and family is crucial, so it is important to be open and ask for help when you need it, even if just to set aside a time to talk to a loved one.

How can carepartners, friends, and family support people with mental health challenges?

Education is a major way that family and friends can support their loved ones with PD. Learning about the disease is essential to cultivating a supportive environment. Once a basic understanding of PD is established, it is important to listen to what is actually going on for the individual with Parkinson’s, rather than generalizing, ignoring, or minimizing their situation. When family and friends understand how the disease impacts their loved one, they are able to build greater empathy for that person, as well as offer more effective support. It is also important to recognize when challenges may be beyond one’s capacity, and to seek other sources of support, such as counselling or support groups. Attending a Parkinson’s support group can be very beneficial to recognize that no one is alone on their journey, and to learn what has helped others deal with similar challenges.

Increasing communication about mental health is another way to effectively support loved ones with depression, anxiety, and other challenges. Carepartners, relatives, and friends are often eager to “fix” the person with PD, and so find themselves helping with activities of daily living (e.g., putting on a coat or buttoning up a shirt). Sometimes, this is unnecessary and could hinder the individual with PD, who may not want this type of help. It is important for family and friends to ask the individual with PD what they need, and listen to them. Listening to others can be empowering to all parties involved, and can provide a foundation to move forward together.

Another way that friends and family can show their support is by exercising patience and empathy, both for their loved one with Parkinson’s and for themselves. This can also help prevent carepartner burnout, enabling them to provide support on a longterm basis. As counsellors, we see the difference in clients who choose to develop these capacities for their loved one and themselves. They are often more grateful, relaxed, and grounded.

While family carepartners, caregivers, relatives, and friends can act as valuable sources of support, it is important to recognize that they are not trained mental health professionals. Seeking professional help may be necessary in certain situations.

How can counselling help people with Parkinson’s?

Parkinson’s disease is a very complex condition; it has life-changing effects on the person diagnosed, as well as their carepartners, family, and friends. Access to counselling is important because it provides a safe space to explore challenges, establish a support network, and to gain coping strategies to move forward.

Parkinson Society BC offers short-term counselling services — up to 8 sessions — to tackle the most pertinent issues that an individual is facing. Depression, anxiety, and/or apathy are among some common challenges that individuals with PD seek counselling for. Other challenges that clients bring to counselling include grief and loss, relationship struggles, panic attacks, hallucinations, impulse control problems, and inadequate coping strategies.

Once 8 sessions have been completed, and where long-term counselling is identified as being beneficial, the individual(s) will be referred to other resources. Counselling is a very individualized process, and clients can expect a tailored approach. As counsellors, we always use evidenced-based approaches.

Sources

Chaudhuri, K. R., Martinez-Martin, P., Odin, P., & Antonini, A. (2011). Handbook of Non-Motor Symptoms in Parkinson’s Disease. London: Springer Healthcare.

Pfeiffer, R. F. (2016). Non-motor symptoms in Parkinson’s disease. Parkinsonism & related disorders, 22.

Xie, CL., Wang, XD., Chen, J. et al. (2015). A Systematic Review and Meta-Analysis of Cognitive Behavioral and Psychodynamic Therapy for Depression in Parkinson’s Disease Patients. Neurol Sci, 36.

This content was published in the Summer 2019 edition of our quarterly magazine, Viewpoints. The content was accurate as of this publication date.