Managing the mental state may ease anxiety-related freezing of gait in Parkinson’s

Freezing of gait is one of the most disabling and distressing symptoms experienced by people living with Parkinson’s disease. Described by patients as feeling as though their feet are suddenly glued to the floor, these episodes can strike without warning, cutting short a step mid-stride and leaving the person stranded, sometimes in the middle of a doorway, a crowded street or a busy kitchen. Beyond the immediate risk of falls, freezing carries a heavy psychological toll, and a growing body of research suggests that the two are locked in a self-reinforcing loop. A randomized controlled trial published in npj Parkinson’s Disease now examines whether deliberately targeting the mental state — the anxiety that so often precedes and accompanies freezing — can help break that cycle.

The study, titled ‘Managing the mental state’ to tackle anxiety-related freezing of gait in people with Parkinson’s disease, set out to test a proposition that is increasingly supported by neuroscience but has rarely been evaluated in such a direct, trial-based fashion: that freezing of gait is not purely a motor problem, and that interventions aimed at the emotional and cognitive machinery of the brain may therefore yield measurable benefits for walking. The researchers framed their approach around the observation that anxiety and freezing tend to travel together, with anxious arousal narrowing attention, disrupting the automatic flow of movement and making episodes more likely at precisely the moments when people with Parkinson’s can least afford them.

Freezing of gait affects a substantial proportion of people with Parkinson’s as the disease progresses, and its mechanisms remain only partially understood. Contemporary models describe it as arising from a breakdown in the neural circuits that normally allow walking to proceed on autopilot. In healthy individuals, gait is largely controlled by subcortical loops that require little conscious attention. Parkinson’s disease damages these loops, forcing patients to rely more heavily on deliberate, effortful control of stepping. That compensation works reasonably well in calm, open environments, but it collapses under pressure. When cognitive resources are consumed by worry, when a doorway or a crowd demands rapid navigation, or when the fear of freezing itself takes hold, the fragile control system is overwhelmed and the gait pattern fragments into the characteristic stuttering, shuffling or complete arrest that patients know so well.

Anxiety enters this picture at several levels. There is the situational anxiety of approaching a feared trigger, such as turning in a tight space or crossing a busy road. There is the anticipatory anxiety that builds as people begin to organize their lives around avoiding situations in which freezing might occur, a pattern that can shrink confidence and mobility over time. And there is the physiological arousal that accompanies anxious states — elevated heart rate, muscle tension and heightened vigilance — all of which alter the way the brain allocates attention to movement. Researchers have argued that this arousal effectively competes with the already-strained motor control resources of the Parkinsonian brain, lowering the threshold at which freezing is triggered.

If anxiety is a genuine driver of freezing rather than a mere byproduct, the reasoning goes, then teaching patients to manage that anxiety should reduce the frequency or severity of episodes. This is the hypothesis the randomized controlled trial was designed to test. Rather than focusing on the mechanics of stepping, as many gait rehabilitation programs do, the intervention centered on strategies for regulating the mental state: recognizing the early signs of anxious arousal, applying techniques to calm and refocus attention, and reframing the fear of freezing that can itself precipitate an episode. Participants were randomly assigned to receive the mental-state intervention or a comparison condition, allowing the researchers to separate the specific effects of the anxiety-focused approach from the general benefits of attention, practice and clinical contact.

The randomized design matters. Freezing of gait fluctuates naturally from day to day and responds strongly to context, expectation and environment, which makes uncontrolled observations notoriously unreliable. A patient who believes a therapy will help may walk more confidently, freeze less and attribute the change to the treatment, regardless of the treatment’s specific content. By randomly allocating participants and including a comparator, the trial aimed to isolate the true effect of managing the mental state from placebo responses, regression to the mean and the natural course of the disease. Such rigor is essential if anxiety-focused approaches are to earn a place alongside medication, deep brain stimulation and cueing strategies in the standard toolkit for gait problems in Parkinson’s.

The broader significance of the trial lies in what it says about the nature of Parkinson’s disease itself. For much of the twentieth century, Parkinson’s was understood primarily as a disorder of movement, defined by tremor, rigidity, slowness and postural instability. Research over recent decades has progressively widened that picture, revealing profound non-motor dimensions — sleep disturbance, loss of smell, cognitive change, depression and anxiety — that often precede the motor symptoms by years and shape quality of life at least as much. The recognition that anxiety is not simply an understandable reaction to a difficult diagnosis but a modifiable factor with a direct bearing on motor function represents a meaningful shift. It reframes the psychological life of the patient as part of the disease mechanism, and therefore as a legitimate target of treatment.

The trial also speaks to a practical reality of clinical care. Pharmacological options for freezing of gait are limited; dopaminergic medications help some patients some of the time, but freezing frequently persists or even worsens as the disease advances, and no drug is approved specifically for the symptom. Physiotherapy and cueing techniques — rhythmic auditory signals, visual targets on the floor, laser attachments to walking frames — offer genuine benefit by providing external rhythm and attentional anchors, yet they do not address the internal state that can override them. An approach that equips patients to regulate anxiety in the moment could, in principle, be combined with these existing strategies, giving people a layered set of defenses: environmental cues for the feet, mental strategies for the mind.

For patients and families, the message embedded in this research is one of agency. Freezing of gait can feel arbitrary and humiliating, an unpredictable betrayal by one’s own body. The idea that the mental state — the breath, the attention, the fearful anticipation — is not just a victim of freezing but a participant in it offers a handle on the problem. It suggests that the moments before an episode, when the heart begins to race and the mind fills with dread, are not merely a prelude but an intervention point. Learning to notice that moment, and to act on it, may be as therapeutically important as any exercise performed in a clinic.

Much remains to be established. The mechanisms linking anxiety to freezing are still being mapped, the durability of mental-state interventions over months and years is an open question, and the optimal way to integrate such training with medication and physical therapy has yet to be defined. But the trial marks a clear step in a direction that many in the field consider overdue: treating the person with Parkinson’s as an integrated system in which emotion, cognition and movement are inseparable. If managing the mental state proves to loosen the grip of freezing, it will validate a simple but powerful idea — that in Parkinson’s disease, the mind is not a bystander to the gait, but part of the machinery that keeps it moving.

Subject of Research: A randomized controlled trial of mental-state management to reduce anxiety-related freezing of gait in Parkinson's disease.

Article Title: ‘Managing the mental state’ to tackle anxiety-related freezing of gait in people with Parkinson’s disease: a randomized controlled trial

Article References: Vissers, G., Tosserams, A., Duits, A. A., Helmich, R. C., Bloem, B. R., Young, W. R., & Nonnekes, J. (2026). ‘Managing the mental state’ to tackle anxiety-related freezing of gait in people with Parkinson’s disease: a randomized controlled trial. npj Parkinson's Disease. https://doi.org/10.1038/s41531-026-01571-w

Image Credits: AI Generated

DOI: 10.1038/s41531-026-01571-w

Keywords: Parkinson's disease, freezing of gait, anxiety, randomized controlled trial, gait rehabilitation, motor symptoms, mental state, npj Parkinson's Disease, neurodegeneration, clinical trial, movement disorders, anxiety management