Comparative Effectiveness of Cognitive Behavioral Therapy Delivery Formats on Anxiety, Depression, and Quality of Life in Parkinson's Disease: A Network Meta-Analysis.

BACKGROUND: Anxiety and depression are common in Parkinson's disease (PD), but the optimal cognitive behavioral therapy (CBT) delivery format remains unclear. We aimed to compare the relative effectiveness of CBT delivery formats for anxiety, depression, and quality of life. METHODS: We searched databases from inception to January 2026 and included randomized controlled trials (RCTs) of CBT for PD. Two reviewers independently conducted the study inclusion, data extraction, and risk of bias assessments. We conducted random-effects frequentist network meta-analyses to summarize the evidence and used the GRADE approach to rate the certainty of evidence. RESULTS: A total of 34 RCTs were included. At postintervention, face-to-face group CBT probably reduced anxiety (SMD -1.12, 95% CI -1.85 to -0.38, moderate certainty), whereas face-to-face individual CBT may improve depression (SMD -1.18, 95% CI -1.71 to -0.65, very low certainty) and quality of life (SMD -1.36, 95% CI -2.56 to -0.16, moderate certainty). At follow-up, face-to-face individual CBT probably reduced anxiety (SMD -0.81, 95% CI -1.16 to -0.46, moderate certainty), whereas remote individual CBT probably improved depression (SMD -1.09, 95% CI -1.63 to -0.56, moderate certainty) and quality of life (SMD -0.50, 95% CI -0.81 to -0.19, moderate certainty). CONCLUSION: Moderate certainty evidence suggests that face-to-face group CBT probably reduces short-term anxiety, face-to-face individual CBT probably improves quality of life and sustains a reduction in anxiety, and remote individual CBT probably improves long-term depression and quality of life. These findings may help clinicians consider CBT delivery formats according to specific therapeutic goals and the expected duration of benefit in PD care.