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Therapy Done Over the Phone May Help Depressed Patients

Study found early drop-out rate significantly lower than during in-person treatment

TUESDAY, June 5, 2012 (HealthDay News) -- Many people drop out of depression therapy before it has a chance to help, but new research suggests that therapy done over the phone might keep more people in treatment.

The study found that about 21 percent of people receiving therapy via telephone dropped out, compared to 33 percent of those in face-to-face therapy.

"Psychotherapy can be delivered over the phone safely and effectively, and it should be considered as an option for treating depression," said study author David Mohr, a professor of preventive medicine at Northwestern University Feinberg School of Medicine in Chicago.

Results of the study appear in the June 6 issue of the Journal of the American Medical Association.

Depression is a significant problem in the United States, with an estimated prevalence as high as 10 percent in any given year, according to background information in the study. About one-quarter of all primary care visits involve people who have clinically significant levels of depression, the study authors noted. Yet, most people don't follow through when their physicians refer them to psychotherapy. And, when they do follow through, up to half of those who start therapy drop out, the study reported.

Access barriers, such as transportation problems, time constraints and availability of services, likely play a big role in the initiation and continuation of therapy sessions, the researchers pointed out.

To see if removing those access barriers by providing a telephone therapy option could help, Mohr and his colleagues recruited 325 people from the Chicago area who had been diagnosed with a major depressive disorder.

The volunteers were randomly assigned to receive 18 sessions of cognitive behavioral therapy, either by phone or in-person. Cognitive behavioral therapy is a type of treatment that focuses on a person's thoughts and beliefs in an effort to change negative thinking patterns.

Overall, the researchers found that just 21 percent of those getting telephone therapy dropped out compared to 33 percent of those receiving face-to-face therapy. The biggest difference occurred in the first few weeks of therapy. Before week 5, only 4.3 percent of those in telephone therapy dropped out compared to 13 percent of those receiving in-person treatment.

"Telephone therapy exerts its biggest effect in getting people to begin therapy. If there are barriers that will get in the way of treatment, like difficulty scheduling appointments, transportation issues or motivational issues, they will occur early in the treatment," explained Mohr.

During treatment and just after treatment ended, there was no significant difference in reduction in depressive symptoms between the two groups. Six months after treatment, the group that received face-to-face therapy reported less depression than the telephone-treated group.

However, Mohr said the difference was about three points on a depression test. Such a small difference, he said, might not make any clinical difference, which means it likely wouldn't make a significant difference in someone's life.

Mohr also said he suspected that the people they were able to retain in telephone treatment might have had more severe depression, and would've been more likely to drop out of standard therapy.

"I think what might be happening is that we were able to treat these people, but they have more characteristics that might make them harder to treat," said Mohr.

Commenting on the study, Dr. Gary Kennedy, director of geriatric psychiatry at Montefiore Medical Center in New York City, said: "Telephone therapy is accessible, and it works so well that insurance companies should be paying for this. It may not be a substitute for all face-to-face therapy, but it could be part of the continuum of depression treatment."

Kennedy pointed out that there are some drawbacks to phone therapy. Therapists prefer to be able to see their patients so they can read their body language as well. He also noted that telephone therapy lacks a factor called behavioral activation. Behavioral activation is making the decision to go to therapy, getting up and out of the house and then interacting with the therapist, explained Kennedy. "It's kind of pulling yourself up by your bootstraps," he said, and it's an important step in getting well.

Still, he added, phone therapy can be a valuable tool, especially in areas where access to care might be more limited, such as in rural areas.

Both experts said they also expected that therapy through computer videoconferencing would likely be a part of therapy options in the future. Mohr said that some insurance companies are already working on this, however, they need to set up secure channels to do the videoconferencing rather than use publicly available videoconferencing services, to ensure patient confidentiality.

More information

Learn more about cognitive behavioral therapy from the National Alliance on Mental Illness.

SOURCES: David C. Mohr, Ph.D., professor, preventive medicine, Northwestern University Feinberg School of Medicine, Chicago; Gary Kennedy, M.D., director, geriatric psychiatry, Montefiore Medical Center, New York City; June 6, 2012, Journal of the American Medical Association
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