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 the experience of anxiety related to FOG in people with PD, aiming to better understand how and why anxiety surrounding FOG develops and how it impacts the lives of individuals with PD. A thematic analysis was conducted using semi-structured interviews with 12 individuals with PD who reported daily FOG episodes influenced by anxiety or stress. 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, promoting confidence 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.