Improve Parkinson’s Disease Psychological Symptoms with Mindfulness

Improve Parkinson’s Disease Psychological Symptoms with Mindfulness


By John M. de Castro, Ph.D.


“[Parkinson’s Disease] patients experience greater levels of stress than controls, and that stress worsens both motor and non-motor symptoms. Mindfulness may improve [Parkinson’s Disease] symptom severity, with the strongest effects on anxiety and depressed mood.” – Anouk van der Heide


Parkinson’s Disease (PD) is an incurable progressive degenerative disease of the central nervous system. The condition is caused by the death of nerve cells in the brain that produce the neurotransmitter dopamine. There are around seven million people worldwide and one million people in the U.S. living with PD and about 60,000 people are diagnosed with PD every year. PD is associated with aging as the vast majority of patients are diagnosed after age 50. In fact, it has been speculated that everyone would eventually develop PD if they lived long enough.


Its physical symptoms include resting tremor, slow movements, muscle rigidity, problems with posture and balance, loss of automatic movements, and slurring of speech. PD itself is not fatal but is often associated with related complications which can reduce life expectancy, such as falls, choking, and cardiovascular problems. PD also has psychological effects, especially cognitive decline, anxiety, and depression. Balance is a particular problem as it effects mobility and increases the likelihood of falls, restricting activity and reducing quality of life.


There are no cures for Parkinson’s Disease (PD) or even treatments to slow its progression. There are only treatments that can produce symptomatic relief. So, there is a need to discover new and different treatments. Mindfulness training has been found to improve the psychological symptoms and the quality of life with PD patients. PD patients often develop an unawareness of their motor symptoms. It is not known if mindfulness training may help make the patients more aware of their symptoms.


In today’s Research News article “Pilot Study of Mindfulness Training on the Self-Awareness of Motor Symptoms in Parkinson’s Disease – A Randomized Controlled Trial.” (See summary below or view the full text of the study at: ) Buchwitz and colleagues recruited otherwise healthy patients diagnosed with Parkinson’s Disease (average 64 years) and randomly assigned them to either a wait-list control condition or to receive 8 weekly 2-hour sessions of mindfulness training tailored for Parkinson’s Disease patients. Before and after training and 8 weeks later they were measured for awareness of their motor symptoms, cognitive ability, and Parkinson’s Disease symptoms.


They found that there was no improvement in general cognitive ability, motor performance, or awareness of motor symptoms by either group. But the mindfulness trained group had significant improvement in mindfulness, sleep quality, attentional ability, and language performance and reductions in anxiety, apathy, and impulsivity of eating behavior.


The findings are similar to those of others that mindfulness training improves the psychological well-being of patients diagnosed with Parkinson’s Disease. But it did not improve motor symptoms or the awareness of those motor symptoms. This suggests that mindfulness training should be incorporated into the routine treatment program for Parkinson’s Disease patients.


So, improve Parkinson’s Disease psychological symptoms with mindfulness



mindfulness training for people with [Parkinson’s Disease] found significant reductions in anxiety, depression and distress about symptoms, along with improvements in memory and verbal fluency.” – Emily Delzell



CMCS – Center for Mindfulness and Contemplative Studies


This and other Contemplative Studies posts are available on Twitter @MindfulResearch


Study Summary


Buchwitz TM, Maier F, Greuel A, Thieken F, Steidel K, Jakobs V and Eggers C (2021) Pilot Study of Mindfulness Training on the Self-Awareness of Motor Symptoms in Parkinson’s Disease – A Randomized Controlled Trial. Front. Psychol. 12:763350. doi: 10.3389/fpsyg.2021.763350



Objective: This study aims to evaluate feasibility and effects of a newly developed mindfulness intervention tailored to specific needs of patients with Parkinson’s disease (PD).

Background: The phenomenon of impaired self-awareness of motor symptoms (ISAm) in PD might be reduced by increasing patients’ mindfulness. A PD-specific mindfulness intervention has been developed and evaluated as a potential treatment option: IPSUM (“Insight into Parkinson’s Disease Symptoms by using Mindfulness”).

Methods: IPSUM’s effectiveness is evaluated by comparing an intervention with a waitlist-control group. Applying a pre-post design, patients were assessed before, directly after and 8weeks after treatment. The primary outcome was the change in a quantitative ISAm score from baseline to post-assessment. Secondary outcome measures were PD-related affective changes and neuropsychological test performance. Feasibility was evaluated via feedback forms.

Results: In total, 30 non-depressed and non-demented PD patients were included (intervention: n=14, waitlist-control: n=16). ISAm score did not change significantly, but the training group showed greater performance in sustained attention and language tasks over time. Additional changes included greater mindfulness as well as less sleeping problems and anxiety. Cognitive disturbances, apathy, and sleeping problems worsened only in the waitlist-control group. Patients’ feedback regarding the training concept and material was excellent.

Conclusion: Insight into Parkinson’s Disease Symptoms by using Mindfulness has not been capable of reducing ISAm in PD patients but appears to be a feasible and effective concept to, among others, support mental health in the mid-term. It has to be noted though that the study was stopped beforehand because of the SARS CoV-2 pandemic. The lack of findings might therefore be caused by a lack of statistical power. The need for further research to better understand the mechanisms of ISAm and its connection to mindfulness in PD is highlighted.


Concepts are not the solution. They’re the problem


“The words printed here are concepts. You must go through the experiences.” – Saint Augustine


Human beings rely on thinking. It’s responsible for human race’s ability to create the tools that have allowed us to dominate our planet and reshape it to suit our wants and needs. Much of thinking is conceptual. It is a mental manipulation of ideas and thoughts represented by concepts which are represented by words. We are reliant on our concepts to process information. This is and effective but very limited strategy.


We need these concepts because our minds are not capable of working with large amounts of information at the same time, as computers can. In fact, it’s been estimated that we are only able to work with about seven pieces of information at a time. That doesn’t give us much to work with unless we can somehow compress the information. In psychology this compressed information are called chunks. Words and concepts are examples of chunks.


There are many varieties of these chunks from the concrete, like ‘car’ to the abstract variety like ‘justice’. The word ‘chair’ is a concept, a chunk. It represents a wide range of different entities that have a common purpose to allow humans to sit comfortably. They range from solid wood hardback chairs, to patio chairs, to reclining chairs, etc. If we wish to think about chairs we are not capable of holding all the different kinds of chairs in our mind at once, so the concept chair is used instead and only comprises one piece of information. This frees the mind to consider other pieces in information along with the chair in processing information.


The use of these concepts has worked wonderfully for our everyday and scientific purposes. But, unfortunately they are interpreted as real, rather than the useful tools that they are. Concepts have no reality unto themselves. They are simply symbols. In fact they are always inherently incorrect. There are many, many, different objects that we call chairs, but the concept chair doesn’t really accurately describe any of them fully. There are many, many, different forms of actions or outcomes that we call justice, but the concept justice doesn’t really accurately describe any of them fully. So, the concept, although convenient, is never truly accurate or comprehensive.


These concepts can prove obstacles for creative thinking as they so compartmentalize things as to make it difficult to see them as something else, or reconfigure the concept to include or exclude various objects. The concepts themselves tend to separate things and thereby make it more difficult to see a wooden chair in the same category as a wood boat even though they are both objects created out of wood. We were once on a camping trip and ran out of gas. We had lots of camp stove fuel, but were unable for over an hour to realize that it was gasoline and could be used to fuel the vehicle. Once we broke through our conceptual fixatedness we filled the tank with camp stove fuel and drove off.


Concepts also freeze things in time which does not accurately portray the actual nature of the thing. This is most obvious with perishable items, like fruits and vegetables, although actually true for all things, they are impermanent and every changing. So, a lemon is soil and water, it’s a seed, it’s a tree, it’s a bud, it’s an unripe fruit, it falls from the tree, it is a ripe fruit, it begins to rot, it transforms back for simple chemicals, soil and water. The lemon is all of these things at some point or another. But the concept neglects the dynamic ever changing nature of the lemon and its connection to all other soil and water derived things.


If you follow this reasoning deeply you can begin to see that concepts and categories are artificial and, in essence, all things are the same thing. Not only is the lemon soil and water but so is the chair, and so is the car, etc. It is this problem with concepts that causes us to miss the oneness of all things. This is the cornerstone of enlightenment. Enlightenment experiences are highly varied, but they all have the common strain of an experience of the oneness of everything. Under normal conditions we miss this completely due to the operation of our compartmentalizing (dualistic) concepts.


The Buddha realized this and taught about it extensively. The “Diamond Sutra” is entirely concerned with how concepts can deceive and prevent you from attaining enlightenment. He stated that “the living beings to whom you refer are neither living beings nor not living beings. Why? Subhuti, all the different kinds of living beings the Buddha speaks of are not living beings. But they are referred to as living beings.” He is clearly recognizing that the concept ‘living beings’ can be seen in many different ways and just sticking to the actual concept itself is a deception or as he would say, a delusion.


To see the world as a Buddha you must fully understand a thing in all its glorious forms, varieties, and stages before the concept can be used appropriately. To see the world as a Buddha, concepts are the problem, not the solution.


“Thought can organize the world so well that you are no longer able to see it.”  ― Anthony de Mello


CMCS – Center for Mindfulness and Contemplative Studies


The Miracle of Language 3 – Thinking and Implicit Speech

In a prior post we discussed the miracle of speech production and comprehension.

Speech production involves intricate motor control by the nervous system of breathing, the larynx, mouth, and tongue producing sound pressure waves that can be detected by others. Speech comprehension involves the response of the auditory system to sound pressure waves produced by another, causing a neural response from the receptors in the cochlear and transmission of this information to the nervous system.

Production originates in the nervous system and comprehension occurs in the nervous system. Because all of the information processing occurs internally in the central nervous system it is reasonable to think that perhaps the nervous system could produce and comprehend language without the involvement of the vocal apparatus or the auditory system. This is indeed what appears to happen in what we call implicit speech.

In essence we talk to ourselves. We’ve been dong it most of our lives and as such we take it totally for granted. But, taking a much closer look we can see that this may be even more of a miracle than the production and reception of vocalized speech.

In meditation, we attempt to quiet the mind. What this means in essence is to turn off implicit speech, to cease the constant internal jabbering. But, it is very difficult to do this and veteran meditators have learned not to fight it, but to allow it to happen and observe it just as they would observing an odor rising up and falling away or the shadow of a cloud as it passes over us. As a friend of mine likes to say, let the thoughts come in, just don’t serve them tea. In other words, let them pass on through without undue attention.

As we meditatively observe the process of implicit speech we appear to “hear” an internal voice. In addition, the meaning of this speech is readily apparent as if it was produced outside. Somehow understanding is present but where or how or what that understanding is, is a complete miraculous mystery. As you become more sensitive to the whole process you begin to recognize that the important stuff happens in an awareness that isn’t the verbal mind that we thought it was, the awareness that is aware of the internal speech.

Although implicit speech is part of our thought processes. It is only a small part. But, nevertheless it can be very distracting. It is for the most part not terribly productive, frequently repetitive, with a thought or phrase repeating itself over and over again, sometimes even a song lyric. Problem solving and creativity seem to happen outside of this internal speech but when the solution becomes apparent, the implicit speech recognizes it, articulates and is often credited with the solution of which it had very little or any part.

We think of the implicit speech as our mind. But, it is as Suzuki Roshi used to call it our “little mind.” He called the actual, vital, creative, but mysterious entity our “Big Mind.” The reason we need to quiet the implicit speech in meditation is so that the “Big Mind” will not be hidden by the incessant noise of the “little mind.” Once it is quieted we can observe the core of our existence, the “Big Mind”, the consciousness, the awareness that is the essence of our being.

So, observe this process of internal speech and marvel at it, but quiet it and see what you really are.


The miracle of language 2 – Hearing – Understanding

In a prior post we discussed the miracle of speech production.

Hearing and understanding the speech produced by another is no less of a miracle. The combination of speech production with speech comprehension by another is the basis of all complex human interactions. It is the basis for human cooperation which is the foundation of society. Much more could be said, but, it should be clear how essential these processes are to our flourishing as a species.

We take it all for granted. But if we take some time to look deeply at what transpires as we listen to voiced sounds and understand what is being communicated, we will find a miraculous process in action.

When we process sounds we immediately and automatically pick out individual words from the continuous stream. We hear each word as separate and distinct, but they are not. We hear an apparent pause between each word, but there is not. It’s an automatic auditory perceptual process called segmentation. Our neural language processing system inserts the pauses even though they are not there. It simplifies language decoding for us automatically and without awareness. It’s one of many miracles of language.

Once the word has been segmented we hear it an immediately understand its meaning. But, what is that understanding? It is also without awareness how we obtain the meaning from a symbol, word. We just sense it and know it but there is no indication how we do this. Sometimes there’s a vivid sensory image produced but mostly the meaning emerges without any tangible image or sensation. It’s another of many miracles of language.

But the meaning of each word is not detected in isolation. It is extracted within the context of other words surrounding it. We are not aware of this but it is demonstrable that this occurs as many words with different meanings have share the same sound pattern, e.g. blue and blew and bleu. We contextualize the word to extract the meaning automatically. His is just another of the many miracles of language.

The nervous system appears to be programed to learn and implement language comprehension. During development language is learned too rapidly to be explained by simple learning processes. The brain appears to be preprogrammed to acquire language. There is an area in the parietal lobe of the human cortex that is crucial for understanding articulate language. It is on the same side of the brain as the frontal area responsible for speech, most frequently the left side of the brain. When that area is destroyed in adulthood, the individual will never again be able to understand articulate speech. So, much of the automatic processes of language comprehension results from nervous system mechanism that work without thought or awareness.

Contemplate and meditate deeply on understanding language. We believe that we are totally in control of it. But, we are not. Much of it is beyond awareness. Watch it and be fascinated and amazed by this uniquely human miraculous activity.


The miracle of language 1 – speech production

We take language for granted. But, we absolutely should not! There is nothing that we are capable of that has had a greater impact on the human race than language. It is the basis for our ability to work cooperatively. It is the basis for our ability to transmit learning from generation to generation. It is the basis for continuous improvement and development as we can read what others have accomplished and experienced and build upon it. It is the basis for science and technology. It is the reason that humans have become the dominant species of the planet.

Look deeply at the process of producing language and we can see a miraculous phenomenon. I find it useful to contemplate on the internal mental processes and the motor movements involved in the production of language. We take it so for granted. So, we need to really concentrate on it to view the inner workings of this miraculous process.

If we simply look closely at how we produce speech, its automaticity becomes obvious. We are only occasionally consciously thinking about what words to produce or how to combine them into sentences. There is an underlying idea that we have in mind to communicate, but the actual process of production appears to occur without thought. The words and sentences just seem to arise into consciousness without direction.

How does this happen? How do we interconnect and idea with the proper symbol, word, to represent it? There is no thinking involved, it just happens automatically. How do we apply proper syntax to our sentences? Normally, there’s no thought or even awareness of it happening. But it does, automatically and unconsciously.

There is now another fascinating automatic process engaged in the production of the actual sounds. If you look deeply at what happens you can become aware of the larynx vibrating as the sound pressure waves are being produced. I find this easiest to do while chanting so I don’t have to think about meaning and can instead focus on the physical process or producing the vibrations. Somehow, our brains have translated the intention to produce a particular word into motor movements in the larynx in coordination with breathing and mouth and tongue movements. Just watching it and recognizing what is actually transpiring is amazing.

The nervous system appears to be programed to learn and implement language production. During development language is learned too rapidly to be explained by simple learning processes. The brain appears to be preprogrammed to acquire language. There is an area in the frontal lobe of the human cortex that is crucial for speech. It is on the left side of the brain only in the vast majority of humans. When that area is destroyed in adulthood, the individual will never again be able to produce articulate speech. So, much of the automatic processes of speech production results from nervous system mechanism that work without thought or awareness.

Contemplate and meditate deeply on speech. We believe that we are totally in control of it. But, we are not. Much of it is beyond awareness. Watch it and be fascinated and amazed by this uniquely human miraculous activity.