Beyond motor improvement: The potential role of Mindfulness across the Deep Brain Stimulation pathway in Parkinson’s Disease

Deep brain stimulation (DBS) provides substantial and durable relief of levodopa-responsive motor symptoms and motor complications in people with advanced Parkinson's disease (PD), yet motor improvement does not invariably translate into satisfactory psychological, social, and quality-of-life outcomes. Anxiety, depression, apathy, cognitive vulnerability, unrealistic expectations, altered illness roles, and concerns about identity or authenticity may persist or emerge during the DBS pathway. Mindfulness-based interventions (MBIs), including mindfulness-based stress reduction and mindfulness-based cognitive therapy, have been investigated as adjunctive treatments in PD, whereas acceptance and commitment therapy (ACT) provides a related framework focused on psychological flexibility and values-guided action. This narrative review integrates the literature on MBIs in PD with evidence concerning cognition, expectations, placebo/nocebo responses, psychosocial adjustment, and identity after DBS. Small trials and meta-analyses suggest that MBIs are feasible and may improve anxiety, depressive symptoms, mindfulness skills, and some aspects of quality of life, while evidence for motor, cognitive, apathy, sleep, and caregiver outcomes remains inconsistent or preliminary. Direct trials of mindfulness in patients with PD undergoing DBS are essentially lacking. We propose that mindfulness is unlikely to enhance the neurostimulatory effect itself but may target modifiable mediators between motor capacity and lived outcome: stress reactivity, attentional control, symptom appraisal, expectation rigidity, experiential avoidance, and dyadic adjustment. A phase-specific framework is outlined for preoperative preparation, early postoperative programming, and long-term adaptation. Dedicated co-designed feasibility studies and adequately controlled trials are required before mindfulness can be recommended as a routine component of DBS care.