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Cognitive therapy by phone helps depressed patients

Saturday June 9, 2012
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Patients with major depression who received telephone-administered cognitive behavioral therapy had lower rates of discontinuing treatment compared with patients who received face-to-face CBT, according to a study.

The study also found that telephone-administered treatment was not inferior to face-to-face treatment for improving symptoms by the end of treatment. However, at follow-up after six months, patients receiving face-to-face CBT were less depressed than those receiving telephone administered CBT.

In background information for the study, which appears in the June 6 issue of JAMA, researchers noted that "psychotherapy is effective at treating depression, and most primary care patients prefer psychotherapy to antidepressant medication. When referred for psychotherapy, however, only a small percentage of patients follow through. Attrition from psychotherapy in randomized controlled trials is often 30% or greater and can exceed 50% in clinical practice."

The discrepancy between patients’ preferences for psychotherapy and the low rates of initiation and adherence likely stems from access barriers, such as time constraints, lack of available and accessible services, transportation problems and cost, according to the researchers. "The telephone has been investigated as a treatment delivery medium to overcome access barriers, but little is known about its efficacy compared with face-to-face treatment delivery," the researchers wrote.

David C. Mohr, PhD, of the Northwestern University Feinberg School of Medicine in Chicago, and colleagues compared face-to-face cognitive behavioral therapy versus a telephone-administered cognitive behavioral therapy (T-CBT) for the treatment of depression in primary care. The trial included 325 patients with major depressive disorder, recruited from November 2007 to December 2010. Participants were randomized to 18 sessions of T-CBT or face-to-face CBT. The primary measured outcome for the study was attrition at post-treatment (week 18). Secondary outcomes included measures of depression.

The researchers found that significantly fewer participants discontinued T-CBT (20.9%) before session 18 compared with face-to-face CBT (32.7%). Attrition before week 5 was significantly lower in T-CBT (4.3%) than in face-to-face CBT (13%), but the researchers found no significant difference in attrition between sessions 5 and 18. T-CBT patients attended significantly more sessions than those receiving face-to-face CBT.

"The effect of telephone administration on adherence appears to occur during the initial engagement period," the researchers wrote. "These effects may be due to the capacity of telephone delivery to overcome barriers and patient ambivalence toward treatment. Access barriers likely exert their effects early in treatment, and thus the effect of the telephone on overcoming these barriers is most prominent in the first sessions."

Regarding changes in level of depression, the researchers found that T-CBT was not inferior to face-to-face CBT in reducing depressive symptoms at post-treatment. However, face-to-face CBT was significantly superior to T-CBT during the 6-month follow-up period. By six months, 19% of T-CBT vs. 32% of face-to-face CBT participants were fully remitted.

"The findings of this study suggest that telephone-delivered care has both advantages and disadvantages," the authors concluded. "The acceptability of delivering care over the telephone is growing, increasing the potential for individuals to continue with treatment. The telephone offers the opportunity to extend care to populations that are difficult to reach, such as rural populations, patients with chronic illnesses and disabilities, and individuals who otherwise have barriers to treatment.

"However, the increased risk of post-treatment deterioration in the telephone-delivered treatment relative to face-to-face treatment underscores the importance of continued monitoring of depressive symptoms even after successful treatment."

To read the study, visit http://bit.ly/KLXPJz.

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