June 6, 2012
Phone Therapy More Popular Than Face-To-Face For Depression
Patients suffering from depression are more likely to get therapy when it is offered over the phone, compared to traditional therapies, according to a new study from Northwestern University researchers.
And while therapy by telephone may be more appealing to many depressed people, face-to-face therapy is seen as slightly more effective, according to the study published in the Journal of the American Medical Association.
Psychotherapy is an effective treatment for depression and patient surveys show that most people would prefer that treatment over use of antidepressants. Even so, only a small percentage of patients referred to psychotherapy actually show up for sessions.
For their study, Mohr, Ho and colleagues randomly selected 325 patients with depression and gave them 18 weekly sessions of cognitive behavioral therapy, a type of psychotherapy used to treat depression, either by phone or in person.
First, the researchers found that patients were more likely to stick with the phone sessions.
“Four out of five who got therapy over the phone could complete 18 weeks of treatment, while only two out of three assigned to face-to-face therapy could complete treatment,” Ho told WebMD´s Daniel DeNoon.
For those who completed the study, the researchers found both forms of therapy significantly reduced depression symptoms 18 weeks out. However, in a follow-up after 6 months, the team found that those who received in-person therapy were less depressed than those who received over-the-phone therapy.
A vital part of cognitive behavioral therapy is assessing the actions of the patient during a session. With over-the-phone therapy it is often more difficult for therapists to do this because visual cues are lost, said Mohr, director of behavioral technology at Northwestern University´s Feinberg School of Medicine.
“One of the things we´ve found over the years is that it´s very difficult for people with depression to access psychotherapy,” said Mohr.
Today, about 85 percent of psychologists deliver some of their services over the phone for reasons that include a patient´s lack of transportation, time constraints, and often the sheer effort it takes for a depressed person to get ready, leave the house and make it to the therapist´s office.
The slight worsening seen in the telephone therapy group six months post-sessions may be because patients who had more mental health difficulties and who would have dropped out of in-person therapy were retained in telephone therapy, noted Mohr. Therefore, he said, the findings could be misleading.
“But we can´t rule out the possibility that it may be true and there is something about face-to-face treatment that creates better results for some people,” he said. “The physical presence of the therapist may be therapeutic in a way that helps some patients maintain their improvement in mood. There may be a unique quality about the human contact that increases resilience and maintains the skills learned to manage depression after treatment has ended.”
Gary Kennedy, MD, director of geriatric psychiatry at New York´s Montefiore Medical Center, said most therapists feel that nonverbal communication such as body language are important. But, he adds, quibbling about whether phone therapy is every bit as effective as face-to-face therapy misses the point.
Kennedy, who was not involved in the phone therapy study, but led his own showing that telephone follow-up worked to screen patients for symptoms of depression, said the point of the new study “is that people do stick with telephone therapy.”
“Depression, especially depression later in life, may be associated with conditions that make it impossible to come into psychotherapy on a regular basis. You don´t want to skip a session of therapy any more than you want to skip a dose of medication,” Kennedy told WebMD.
This study “suggests that the telephone can be an effective medium to communicate with clients during (cognitive behavior therapy),” said Stefan Hofmann, a psychology professor at Boston University, who was not part of the study. “Apparently there is an advantage of doing therapy face-to-face, but the reason is not clear,” he added.
Perhaps patients could benefit from a combination, starting with telephone-based sessions and following up with face-to-face sessions, Hoffman told Kerry Grens at Reuters Health. “This strategy might lead to lower attrition (than) face-to-face but greater efficacy than (telephone-based cognitive behavioral therapy) over the long-term,” he added.
Mohr noted that many insurance plans, including Medicare, currently do not pay for telephone therapy.
“There is good reason to reimburse these sessions,” Mohr said. “Many people can´t get to a therapist´s office, but they want to talk to someone. Telephone therapy is highly effective and offers a solution to people with depression who otherwise would be left out.”
“We hope studies like this will encourage insurers to cover phone sessions,” added Ho. “Patients a lot of times tell us they prefer this. And it could be especially attractive for people in rural areas or those with physical disability.”