Telephone therapy benefits depression

Imagine a treatment that was so powerful and useful, it could even be delivered by the telephone.

That treatment? Good old psychotherapy.

I’ve previously written about the benefits of using web-based self-help programs for depression based upon proven cognitive-behavioral therapy techniques. And I’ve also noted previous studies that showed the benefits of telephone therapy for depression. But this new 600-person study is the largest to date of psychotherapy by phone — and one of the largest studies of psychotherapy ever.

Subjects in the study were randomly assigned to one of three groups — treatment as usual, telephone care management, and telephone care management + psychotherapy.

People in the treatment as usual group continued to receive any treatments normally available, such as follow-up visits with their primary care doctor, and referrals to mental health professionals (but not psychotherapy). The telephone care management group received up to 5 brief telephone calls or personalized mailings intended to monitor and improve antidepressant adherence and to support follow-up in primary care. People in the care management plus psychotherapy group received up to 12 calls, including both care management and a structured cognitive behavioral psychotherapy program delivered by telephone.

The best part about the study’s findings if that it was inexpensive to administer and resulted in far more depression-free days than the other treatment methods:

Over two years, phone psychotherapy plus care management led to a gain of 46 depression-free days, with only a $397 increase in outpatient health care costs. The incremental net benefit of phone psychotherapy plus care management was positive, even if a day free of depression was valued as low as $9.

One of the benefits of this study is that it also directly measures and discusses costs associated with the various treatment groups, so those who are focused on such measures (hello insurance companies) can see the benefits of ensuring people have access to this kind of treatment. The telephone psychotherapy group resulted in the most effective treatment method out of the three, at the lowest possible cost (since nobody’s actual work day is measured as low as $9). People free of depression are more focused, can concentrate better, and are generally more productive than those who feel depressed.

According to the researchers, few of the patients who received phone-based therapy sought in-person therapy. They went on to suggest that phone-based therapy is more convenient and acceptable to patients than in-person psychotherapy. The same could be said of web-based interventions as well.

Telephone-based psychotherapy also has a much smaller drop-out rate compared with face-to-face psychotherapy. A study last year found an attrition rate of only 7.6 percent for those in telephone therapy, versus nearly 50 percent for those in face-to-face therapy. It’s cheaper to provide, is more convenient and acceptable for the client, and has a significantly smaller attrition rate.

Will this finally be the study that convinces people, providers, and insurance companies that telephone therapy is a legitimate and useful alternative to face-to-face psychotherapy? I hope so, as it’s pretty clear that at least for depression — one of the most common mental health concerns — it’s of great benefit.

The study was published earlier this month in the Journal of the American Medical Association (JAMA).

John Grohol Psy.D. Bio

Dr. Grohol researches and writes about mental health, psychology and technology issues.

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