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Lower Attrition from Telephone Therapy for Depression

02 Jul

Researchers from Northwestern University’s Feinberg School of Medicine in Chicago examined using the telephone as a treatment delivery medium for seriously depressed patients with access barriers to face-to-face treatment [Ed. note. We assume this refers to it being hard to get out of bed, get out of the house, get to the therapist’s office, etc, when depressed.]

They compared telephone-administered cognitive behavioral therapy (T-CBT) to face-to-face CBT for reducing attrition (drop out rate) in depressed primary care patients.
A randomized controlled trial was conducted with 325 Chicago-area primary care patients with major depressive disorder. They were randomly assigned to 18 sessions of either phone CBT or face-to-face CBT.

The primary outcome studied was attrition (completion vs non-completion of the 18 sessions) at post-treatment (week 18).  Secondary outcomes included interviewer-ratings of depression with the Hamilton Depression Rating Scale (Ham-D) and self-reported depression with the Patient Health Questionnaire-9 (PHQ-9).

This study found that significantly fewer participants discontinued phone CBT (n = 34 or 20.9%) as compared to face-to-face CBT (n = 53 or 32.7% - p = .02).
Patients showed significant improvement in depression across both types of treatment (p < .001). There were no significant treatment differences at post-treatment between phone CBT and face-to-face CBT on the Ham-D (P = .22) or the PHQ-9 (P = .89).

Although participants remained significantly less depressed at 6-month follow-up relative to baseline (P < .001), participants receiving face-to-face CBT were significantly less depressed than those receiving phone CBT on the Ham-D (difference, 2.91; 95% CI, 1.20-4.63; P < .001) and the PHQ-9 (difference, 2.12; 95% CI, 0.68-3.56; P = .004).

The investigators conclude that among primary care patients with depression, providing CBT over the telephone compared with face-to-face resulted in lower attrition and close to equivalent improvement in depression at post-treatment. At 6-month follow-up, patients remained less depressed relative to baseline; however, those receiving face-to-face CBT were less depressed than those receiving phone CBT.
These results indicate that phone CBT improves adherence compared with face-to-face delivery, but at the cost of some increased risk of poorer maintenance of gains after treatment cessation.

Citation: Mohr DC, Ho J, Duffecy J, Reifler D, Sokol L, Burns MN, Jin L, Siddique J. Effect of telephone-administered vs face-to-face cognitive behavioral therapy on adherence to therapy and depression outcomes among primary care patients: a randomized trial. JAMA. 2012 Jun 6;307 (21):pages 2278-85. This email address is being protected from spambots. You need JavaScript enabled to view it.

Belleruth Naparstek

Psychotherapist, author and guided imagery pioneer Belleruth Naparstek is the creator of the popular Health Journeys guided imagery audio series. Her latest book on imagery and posttraumatic stress, Invisible Heroes: Survivors of Trauma and How They Heal (Bantam Dell), won the Spirituality & Health Top 50 Books Award