Experiences of Anxiety and Its Relationship to Freezing of Gait in Parkinson's Disease: A Qualitative Study.

Freezing of gait (FOG) is a disabling motor symptom in Parkinson's disease (PD) with substantial impact on mobility and quality of life. Anxiety is frequently implicated in triggering or worsening FOG, yet the lived experience of this interaction remains poorly understood. This study explored how individuals with PD reflect on the interaction between anxiety and FOG following an anxiety-focused intervention, aiming to better understand how and why this interaction develops and impacts daily life. A thematic analysis was conducted using semistructured interviews with 12 individuals with PD who reported daily FOG episodes influenced by anxiety or stress. Interviews were conducted during the final session of a behavioral intervention targeting anxiety related to FOG. Interviews were transcribed verbatim and analyzed iteratively to identify patterns of meaning. Five overarching themes emerged. First, participants described how anxiety was linked to a gradual loss of confidence in their walking abilities, driven by perceived loss of control, unpredictability of FOG, and feelings of vulnerability. Second, regaining control over walking was mentioned to reduce anxiety, either through having a compensatory strategy available in case of a freezing episode, or through contextual factors (e.g., being in the dopaminergic ON state). Third, anxiety typically developed gradually alongside the progression of FOG and the concomitant decline in confidence during walking, but could also intensify following negative events, such as falls. Fourth, anxiety was reported to divert attentional resources toward potential threats and make it more difficult to focus on strategies for managing FOG. Finally, many participants engaged in avoidance behaviors, causing negative downstream effects such as limiting social participation and physical activity. These findings highlight the importance of early recognition, as well as the potential for interventions that enhance confidence to help reduce anxiety surrounding FOG.