September 12, 2005

Psychotherapy works over the telephone

By Karla Gale

NEW YORK (Reuters Health) - Psychotherapy delivered over
the telephone reduces symptoms of depression in patients with
physical impairments due to multiple sclerosis, investigators

"The biggest advantage of 'telemental health' is that it
overcomes barriers," Dr. David C. Mohr, of the University of
California at San Francisco, told Reuters Health. "Even in
urban areas where mental health is available, there are a lot
of barriers, such as physical disabilities, time constraints,
transportation problems, or not being able to get away from
home because of child care or elder care duties."

In many rural areas, he added, mental health care is not
even available.

Mohr's group recruited 127 patients with depression and
functional impairments due to multiple sclerosis who agreed to
psychotherapy delivered over the telephone. They were randomly
assigned to treatment with cognitive behavioral therapy or
supportive emotion-focused therapy, both in 16 weekly 50-minute

According to the researchers' report in the Archives of
General Psychiatry, there were significant improvements in both
groups at the 16-week evaluations, but more so in the cognitive
behavioral therapy group.

For example, the prevalence of major depression dropped
from 73 percent to 13 percent in the cognitive behavioral
therapy group and from 69 percent to 29 percent in the
supportive emotion-focused group.

A further indication that treatment was effective was their
"extraordinarily low attrition rate, with only about 5 percent
who dropped out," Dr. Mohr noted. "Normally in most clinical
trials of treatment for depression 15 percent to 60 percent
drop out over 16 weeks."

Telephone-administered therapy works because patients
"clearly appear to become very attached and very bonded to
their therapists," the researcher said.

"Part of reason is that a lot of the nonverbal information
about how people feel is carried through the voice," he
explained. "There's a way in which the emotions people are
feeling or the empathy that the therapist might be expressing
comes through."

"Based on our results, we can say that it is possible to
deliver quality care over the phone," he concluded. "But the
question that is still outstanding is whether it is equivalent
to face-to-face care."

SOURCE: Archives of General Psychiatry, September 2005.