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Depression Treatment by Phone
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Phone Psychotherapy for Depression Works, Gets Treatment to More Patients
By Daniel J. DeNoon
Reviewed by Laura J. Martin, MD
Psychotherapy is an effective treatment for depression. Patient surveys show most would prefer psychotherapy to antidepressant drugs. Yet only a small fraction of patients referred to psychotherapy actually show up for sessions.
Would more depressed patients get psychotherapy if it were offered by phone? Would phone therapy be as effective as face-to-face therapy? Yes, say David C. Mohr, PhD, Joyce Ho, PhD, and colleagues.
The researchers randomly assigned 225 adults diagnosed with major depressive disorder to receive 18 weekly psychotherapy sessions either by phone or face to face. The treatment was cognitive behavioral therapy (CBT) for depression. Patients work with a therapist to learn to manage their moods and to focus on activities that increase feelings of pleasure and accomplishment.
"Telephone therapy was able to reduce dropout. 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 tells WebMD.
Most of the dropouts in the face-to-face group were in the first few weeks of treatment. This suggests that phone sessions overcome some of the barriers to psychotherapy. These may include transportation, time constraints, and the sheer effort that it takes for a depressed person to get dressed, get out of the house, and go to a therapist's office.
Phone Therapy for Depression Effective
But does phone therapy work as well as face-to-face therapy?
"After 18 weeks of treatment, the depression declines were equivalent in the two groups," Ho, a clinical psychologist, tells WebMD.
Six months after completing therapy, patients who received face-to-face treatment were less depressed than those who got phone therapy. That could be because something about face-to-face therapy makes it more effective. Or it could be that more of the patients who were not doing quite as well with the treatment dropped out of face-to-face therapy.
What do therapists think? Gary Kennedy, MD, is director of geriatric psychiatry at New York's Montefiore Medical Center. He was not involved in the phone therapy trial, but earlier led a study showing that phone follow-up worked to screen patients for symptoms of depression.
Kennedy says most therapists feel that nonverbal communications such as body language are important to psychotherapy. But he says quibbling about whether phone therapy is every bit as effective as face-to-face therapy misses the point.
"The point of this study is that people do stick with telephone therapy," Kennedy says. "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."
Phone Therapy for Depression: Who Pays?
Ho and Kennedy note that Medicare and many private insurers do not pay for phone therapy.
"We hope studies like this will encourage insurers and Medicare to cover phone sessions," Ho says. "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."
"Few patients with depression actually get to effective psychotherapy," he says. "Phone sessions make a qualified and effective therapist available to people who would not otherwise have access to one. ... This has tremendous promise."
A report on the Mohr/Ho study appears in the June 5 issue of JAMA.
SOURCES: Mohr, D.C. JAMA, June 5, 2012. Joyce Ho, PhD, research assistant professor, Northwestern University, Chicago. Gary Kennedy, MD, director of geriatric psychiatry at Montefiore Medical Center, New York. Kennedy, G.J. Primary Psychiatry, May 2008.