Adults with major depression were significantly less likely to discontinue treatment when they received telephone-administered cognitive behavioral therapy, compared with patients who received face-to-face CBT. However, at 6-months, those who received in-person therapy were comparatively less depressed, according to the findings of a randomized, controlled trial. The results were published June 6 in JAMA.
"The discrepancy between patients’ preference for psychotherapy and the low rates of initiation and adherence is likely due to access barriers," said David C. Mohr, Ph.D., of Northwestern University, Chicago, and colleagues. Telephone therapy has been tested as a tool to overcome barriers, but not for its effectiveness compared with face-to-face therapy, the researchers noted.
In this study, 325 adults with major depressive disorder who were being treated in primary care settings were randomized to 18 weekly sessions of telephone cognitive behavior therapy (T-CBT) or in-person CBT (JAMA 2012;307:2278-85).
Significantly fewer T-CBT patients discontinued therapy before the end of the study, compared with in-person CBT patients (21% vs. 33%). Early attrition (prior to 5 weeks) was significantly lower in the T-CBT patients compared with the in-person CBT patients (4% vs. 13%), but attrition rates were not significantly different between the two groups from 5 weeks to 18 weeks.
"The discrepancy between patients’ preference for psychotherapy and the low rates of initiation and adherence is likely due to access barriers," said David C. Mohr, Ph.D.
At study completion, there was no significant difference in the number of patients who met the key response-to-treatment criterion – a 50% decrease in scores on the Hamilton Depression Rating scale – between the T-CBT and in-person CBT groups (44% and 49%, respectively).
Although improvement in depressive symptoms compared with baseline was similar between the groups at the end of the treatment period, significantly more patients who received in-person therapy were fully remitted after 6 months (19% vs. 32%).
No significant adverse events – including suicide completions, suicide attempts, or psychiatric hospitalizations – were reported in either group.
The results were limited by the narrow focus on CBT for depression, which prevents generalization to other therapies and other mental health problems, the researchers noted.
There are pros and cons of telephone therapy, they said. Telephone therapy allows health care providers to reach more patients. "However, the increased adherence associated with T-CBT may come at the cost of some increased risk of poorer outcomes after treatment cessation," they added.
Dr. Mohr reported having no financial conflicts of interest. The study was funded by the National Institute of Mental Health.