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Patients with depression are more likely to stick with cognitive behavioural therapy when it's given over the phone, compared to traditional, face-to-face settings, according to a new study.
"This is very encouraging and suggests that the telephone can be an effective medium to communicate with clients during (cognitive behavioural therapy)," said Dr Stefan Hofmann, a psychologist at Boston University, who was not involved in this study.
On the other hand, while people might be less likely to drop out of telephone-based therapy, this approach may be slightly less helpful than office-based treatments. "Apparently, there is an advantage of doing therapy face-to-face, but the reason is not clear," Dr Hofmann added.
Cognitive behavioural therapy is an approach to psychotherapy that tries to change the thoughts and attitudes leading to a person's condition.
People dropout at face to face therapy
Lead author Dr David Mohr from Northwestern University Feinberg School of Medicine in Chicago said, "One of the things we've found over the years is that it's very difficult for people with depression to access psychotherapy."
In addition to the expense, if health insurance doesn't cover it completely, therapy requires a time commitment – sometimes an hour or more a week for months – that is a challenge for people to meet.
To see whether having therapy sessions over the phone might make it easier for people to stick to their treatment plan, Dr Mohr and his colleagues asked 325 people with depression to undergo 18 weeks of treatment.
Half of the patients received therapy over the phone, and the other half in-person.
More people dropped out of the face-to-face therapy than those in the telephone-based group (32.7% vs 20.9%, p=0.02).
Group feel less depressed
By the end of the study, patients in both groups felt significantly less depressed than at baseline.
But six months after the study ended, the patients who met their therapists’ in-person felt less depressed than those who had their sessions over the phone.
The in-person group scored about three points lower on a 52-point scale of depression. Dr Mohr said a three point difference on the depression scale "is of questionable clinical significance" – meaning that a three-point reduction is the minimum change by which people could actually feel better.
He said he suspects that the difference between the groups isn't because in-person therapy works better, but because the more difficult-to-treat patients were more likely to drop out of the in-person group.
Dr Mohr said he and his colleagues, who published their results online in the Journal of the American Medical Association, are doing more follow up work to determine whether this is the case, or if in-person psychotherapy is actually more effective in the long term.
Dr Hofmann said that perhaps patients could benefit from a combination of telephone and in-person therapy – starting with telephone-based sessions and following up with face-to-face sessions.
"This strategy might lead to lower attrition (than) face-to-face (cognitive behavioural therapy) but greater efficacy than (telephone-based cognitive behavioural therapy) over the long-term," he said.
Dr Mohr said he would recommend phone-based therapy for those patients who want it.
"At this point these finding do suggest that psychotherapy for depression can be administered both safely and effectively over the phone. Providers can be comfortable doing that and insurers and payers should feel comfortable" reimbursing for it, he told Reuters Health.
(Kerry Grens, Reuters Health, June 2012)
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