People with depression may not need to physically go see a doctor to get effective treatment.
A new study suggests that patients who participate in over-the-phone counseling are more likely to stick with their treatment than those who go in face-to-face and experience similar overall improvements.
The findings, researchers said, are good news for people who can't make regular in-person appointments because of limited access, money or crammed schedules that just can't accommodate an appointment.
"A lot of therapists say, 'If I don't look you in the eye, how can we form a bond?'" said Joyce Ho, assistant research professor of preventive medicine at Northwestern University Feinberg School of Medicine and one of the study's authors. "Cognitive behavioral therapy is a very concrete type of work that we've found translates to multiple mediums."
In the new study, published in the Journal of the American Medical Association on Tuesday, more than 300 Chicago-area primary care patients were assigned to receive cognitive behavioral therapy either in-person or over the phone. Cognitive behavioral therapy is a type of mental health counseling that can help people identify negative patterns of thinking and behavior and develop more helpful ones. Although methods can differ, both groups in the new study received exactly the same treatment.
One of the main ways researchers gauged efficacy was attrition or drop-out, which was lower in the phone group.
Overall, about 20 percent of patients engaged in telephone therapy stopped treatment, versus more than 30 percent of patients attending in-person sessions.
"I think that's a very encouraging finding," said Suzette Glasner-Edwards, a research psychologist and researcher at UCLA's Semel Institute for Neuroscience and Behavior, who was not involved with the study. "With mental health and substance abuse treatment, we see people who for various reasons are unable to comply with treatment, and that's one of our major challenges."
In some places, good treatment options might just be too far away to be realistic, she said, but even in areas where people have good access, day-to-day challenges such childcare and work schedules can be obstacles.
"If [speaking on the] telephone can do a better job at retaining people in the treatment process, that's very important," Glasner-Edwards said.
Another benefit of the telephone is that it may help combat what the authors call "patient ambivalence" about treatment, particularly in the earlier sessions when people who are wary of therapy are more likely to stop.
But while the findings suggest that overall, telephone and face-to-face therapy are equally effective in reducing depressive symptoms, there were longer-term differences.
Following-up six months later, the researchers found that people in both groups were still significantly less depressed, but those in the face-to-face group saw the biggest mood gains.
That could simply be an "artifact," or a result of the fact that more patients with substantial mental health problems stuck with the phone therapy, swaying the overall results.
But it could well be a "real" finding. The authors hypothesize that there may be something about having to leave the house and physically attend treatment that is therapeutic. Or it may be that the physical presence of a therapist somehow helps with mood maintenance long term.
"It could have something to do with the type of connection, or what we call 'therapeutic alliance','' said Glasner-Edwards, referring to the collaborative connection between patient and physician.
Ho said that future research will probe such questions, which could become increasingly important as people consider the possibility of video therapy.
"Convenience is the big thing," said Ho. "The telephone is something that almost everybody has. It's easy to pick up the phone."
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