A new study finds that individuals and therapists using telephone therapy improves access and compliance and has comparable outcomes to office-based care.
The ubiquity of cell phones and smartphones like the iPhone and Droid allows an individual to receive counseling in whatever setting they choose. A new Northwestern Medicine research study discovered patients who had therapy sessions provided over the phone were more likely to complete 18 weeks of treatment than those who had face-to-face sessions.
The study, published in the Journal of the American Medical Association, is the first large trial to compare the benefits of face-to-face and telephone therapy. Previous research has shown the effectiveness of telephone-based therapy.
Phone therapy is a rapidly growing trend among therapists. About 85 percent of psychologists now deliver some of their services over the phone because competing demands, transportation time and other problems make it difficult for many patients to get to their offices.
“Now therapists can make house calls,” said David Mohr, Ph.D., the lead author and a professor of preventive medicine at Northwestern University Feinberg School of Medicine.
“Our study found psychotherapy conveniently provided by telephone to patients wherever they are is effective and reduces dropout. This suggests these services now should be covered by insurance.”
While telephone therapy was as effective as face-to-face sessions in reducing depression during treatment, the lasting effect of the intervention was reduced from face-to-face therapy after six months.
In the randomized control trial, researchers followed 325 primary care patients with major depressive disorder.
The number of people who quit therapy before it was completed was significantly different between the two groups. Investigators discovered nearly 21 percent of patients who had cognitive-behavioral therapy over the phone dropped out compared to 32.7 percent for face-to-face therapy.
Patients in both therapies showed equally good improvement in their depression when treatment ended. Six months after treatment ended, all patients remained much improved. However, patients who had the telephone therapy scored three points higher on a depression scale than those who had face-to-face sessions.
“The three point difference is of questionable clinical significance but it raises the question whether some individuals are at risk of worsening after treatment with telephone therapy compared to face-to-face,” Mohr said.
It may be that the slight worsening seen in the telephone therapy after the end of treatment was because patients who had more mental health difficulties and who would have dropped out of face-to-face sessions were retained in telephone therapy, Mohr noted. Thus, this may not be a real finding.
“But we can’t rule out the possibility that it may be true and there is something about face-to-face treatment that creates better results for some people,” Mohr said.
“The physical presence of the therapist may be therapeutic in a way that helps some patients maintain their improvement in mood. There may be a unique quality about the human contact that increases resilience and maintains the skills learned to manage depression after treatment has ended.”
Mohr said he hopes the study results will encourage insurance providers including Medicare to reimburse telephone therapy sessions, which many companies currently don’t cover.
“There is good reason to reimburse these sessions,” Mohr said.
“Many people can’t get to a therapist’s office, but they want to talk to someone. Telephone therapy is highly effective and offers a solution to people with depression who otherwise would be left out.” This is particularly true for disabled people or those who live where care is unavailable, such as in rural areas, he noted.
Emerging research suggests people prefer talk therapy to antidepressant medication. However, problems with access often prevent them from receiving care from an office-based therapist.
With the emergence of mobile phones, obstacles that have prevented individuals from obtaining office-based therapy may now be overcome.
Source: Northwestern University