Print“Immediately after treatment, patients counseled by phone were less depressed relative to baseline measurements.”
Phone calls with a psychotherapist helped depressed patients improve their condition nearly as well as face-to-face consultations, according to a new study comparing the approaches. As many as 10 percent of Americans battle clinical depression, but access barriers, such as disability and distance, sometimes prevent them from engaging with and completing in-person treatment. Telephone-counseling appointments have been tried to overcome those barriers, but little was known about their efficacy compared with face-to-face treatments until now.
"Historically, psychotherapists have been very skeptical of delivering therapy over the phone." says David Mohr, a professor of preventive medicine and director of the Center for Behavioral Intervention Technologies at Northwestern University and author of the study, published in the June 6 issue of the Journal of the American Medical Association. He says therapists have worried they might miss non-verbal cues when talking to patients by phone, while payers have worried telephone-based treatment might not be as effective or safe as in-person sessions.
To take a measure of the differences between phone-based and in-person treatments, Mohr ran a trial of 325 Chicago-area primary care patients with major depressive disorder, recruited from November 2007 to December 2010. Although patients who received telephone-based therapy were more likely to stick with the treatment than those assigned to get in-person treatment—20 percent of patients quit phone-based treatments versus 33 percent assigned to in-person sessions—the phone patients didn't fare better.
Immediately after treatment, patients counseled by phone were less depressed relative to baseline measurements and showed about as much improvement as patients who received therapy in-person. But six months after therapy had ended, patients counseled in-person were less depressed than those counseled by phone, and the phone patients were found to be at slightly higher risk of losing ground.
It's not clear why people counseled face-to-face appeared to maintain their gains better after six months, says Mohr in an interview accompanying the study. He theorizes that it may be a result of telephone counseling better retaining people at risk of deterioration—people with greater levels of psychopathology and higher levels of baseline depression. But the difference may also show that face-to-face psychotherapy has more durability over time, a theory that will be examined as the data is analyzed in greater depth.
"This study should be reassuring to payers and insurance companies who are considering extending reimbursements for telephone-delivered services," says Mohr. "The treatment was effective. It was safe. And it allowed greater numbers of patients to receive effective care."
Next up, Mohr and his team plan to look at web-based and mobile technologies to deliver less intensive care, with the goal of extending treatments to larger groups of people. He hopes those technologies will ultimately support a stepped approach to care, offering help to people that can benefit from them while reserving more expensive, in-person psychotherapy for those who don’t respond to less resource-intensive interventions.
June 07, 2012
http://www.burrillreport.com/article-phone_appointments_effective_in_battling_depression.html
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