Bridging the Rural Mental Health Gap: Telehealth Delivery of Specialized CBT and MBCT for Veterans With Parkinson's Disease

PURPOSE: The Veteran Affairs (VA) New Jersey Parkinson's Disease (PD) Telepsychotherapy Hub (PD Telepsych Hub) delivers virtual mental health treatments to underserved rural Veterans in partnership with VA Parkinson's Disease Research, Education, and Clinical Centers (PADRECCs). This manuscript outlines the PD Telepsych Hub's hybrid type 2 implementation-effectiveness framework then presents the clinical and demographic characteristics of Enrolled Veterans along with mental health outcomes for Treatment Engagers receiving individual Cognitive Behavioral Therapy (CBT-PD) or group Mindfulness-Based Cognitive Therapy (MBCT-PD) over the first 5 years of operation (10/2020 to 09/2025). METHODS: Underserved rural Veterans with PD were primarily directly outreached by the PD Telepsych Hub (64%) or referred by VA clinicians. Veterans who met screening criteria and completed a psychiatric consult were enrolled and offered CBT-PD or MBCT-PD via telehealth according to preferences and needs. Enrolled Veterans completed baseline questionnaires assessing demographics and health characteristics. Treatment Engagers completed pre-and-post measures of mood, anxiety, loneliness, functional change, and treatment satisfaction. RESULTS: Enrolled Veterans (N = 522 across 31 states) were rural (72%), 6% Hispanic, 8% people of color, and on average 71-years-old. They reported an average of 7 years since PD diagnosis. Although most met criteria for a mood disorder (86%) and 43% had psychiatric comorbidities, only 9% were receiving psychotherapy at time of program enrollment. CBT-PD (n = 202) significantly reduced depression and anxiety, while MCBT-PD (n = 38) reduced depression. Treatment Engagers (n = 240) overall reported high treatment satisfaction (94%). CONCLUSION: At baseline, the mismatch between care access and clinical need was striking. Results highlight a growing foundation for real-world effectiveness in delivering empirically supported, PD-adapted interventions via telehealth to the highest-need, lowest-access populations.