Telephone-administered cognitive behavioral therapy for people with major depression has lower dropout rates compared to equivalent face-to-face therapies, researchers from Northwestern University reported in JAMA (Journal of the American Medical Association). The authors added that they believe telephone-therapy is just as good as face-to-face treatments as far as symptoms improvements at the end of treatments are concerned.
However, those receiving face-to-face cognitive behavioral therapy who completed their course had less depression than their telephone counterparts after a six-month follow-up.
The authors wrote, as background information in the report:
“Depression is common, with the 1-year prevalence rate of major depressive disorder estimated at between 6.6 percent and 10.3 percent in the general population and roughly 25 percent of all primary care visits involving patients with clinically significant levels of depression.
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 percent or greater and can exceed 50 percent in clinical practice.”
Although patients appear to welcome psychotherapy, initiation rates are low, as is compliance. This is probably because of lack of available accessible services, finding it hard to allocate the necessary time for therapy sessions, cost, and travel problems.
The authors wrote that “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.”
David C. Mohr, Ph.D., and team set out to determine how face-to-face behavioral therapy might compare to telephone-administered CBT (cognitive behavioral therapy) for depression treatment in primary care (general practice). The study involved 325 adults, all of them with major depressive disorder – they were recruited from November 2007 to December 2010.
The patients were randomly selected to receive 18 Telephone or face-to-face CBT sessions. Their main focus was on attrition – how many completed the course, and how many did not, at week 18. Secondary outcomes included a measurement of depression severity – i.e. did their depression improve, and if so, by how much?
The authors found that:
- 20.9% of the telephone patients dropped out
- 32.7% of the face-to-face patients dropped out
- Before week 5, the dropout rate among the telephone patients was 4.3%
- Before week 5, the dropout rate among the face-to-face patients was 13%
- The dropout rates between sessions 5 and 18 were not significantly different
- Overall, the telephone patients attended considerably more sessions than the face-to-face ones
The researchers wrote:
“The effect of telephone administration on adherence appears to occur during the initial engagement period. 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 those barriers is most prominent in the first sessions.”
Although telephone-CBT was found not to be inferior to face-to-face CBT when participants were assessed at the end of the 18 weeks, the authors noted that after a six-month post-treatment follow-up, the face-to-face patients had more reduced depressive symptoms.
Dr. Mohr wrote:
“The findings of this study suggest that telephone-delivered care has both advantages and disadvantages. 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 posttreatment deterioration in telephone-delivered treatment relative to face-to-face treatment underscores the importance of continued monitoring of depressive symptoms even after successful treatment.”
Written by Christian Nordqvist