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Depressed patients stick with phone CBT

Telephone CBT as effective in many respects as face-to-face treatment

Louise Prime

Wednesday, 06 June 2012

Cognitive behavioural therapy administered by telephone was as effective, in terms of improvement in symptoms, as CBT delivered face to face, US research has found. The study, published today in JAMA, also showed that patients were less likely to discontinue telephone CBT than face-to-face CBT. But six months later, people who had had face-to-face therapy were less depressed than those who had had CBT administered by phone.

Researchers in Chicago recruited 325 people who were being treated in primary care for a major depressive disorder, and randomised them to 18 sessions of either telephone-administered CBT, or face-to-face CBT.

Attrition rates were significantly lower for telephone CBT, both at week 5 and at the end of the 18-week treatment period – although not between these points – and people assigned to telephone CBT also attended significantly more sessions. By week 18, 20.9% of people in the telephone group had discontinued treatment, compared with 32.7% in the face-to-face group; the authors point out that the usual attrition rate in randomised controlled trials of psychotherapy is often at least 30%, and in clinical practice can be 50% or more.

They commented: “The effect of telephone administration on adherence appears to occur during the initial engagement period. These effects may be due to the capacity of telephone delivery to overcome barriers and patient ambivalence toward treatment.”

Telephone CBT was not inferior to face-to-face CBT in terms of reducing symptoms of depression by the end of treatment. However, by six months’ follow up, only 19% of people from the telephone group had full remission of their symptoms, compared with 32% of the those in the face-to-face group.

The study’s authors concluded: “The findings of this study suggest that telephone-delivered care has both advantages and disadvantages. The acceptability of delivering care over the telephone is growing, increasing the potential for individuals to continue with treatment.

“The telephone offers the opportunity to extend care to populations that are difficult to reach, such as rural populations, patients with chronic illnesses and disabilities, and individuals who otherwise have barriers to treatment … However, the increased risk of post-treatment deterioration in telephone-delivered treatment relative to face-to-face treatment underscores the importance of continued monitoring of depressive symptoms even after successful treatment.”

Meanwhile, UK general practice-based research published today on bmj.com found that facilitated physical activity, in addition to usual care, neither improved outcome nor reduced antidepressant use in 361 adults with an initial Beck depression inventory score of 14 or more. However, the intervention did increase patients’ self-reported physical activity levels compared with usual care, which was sustained for 12 months.

The authors said: “Clinicians and policy makers should alert people with depression that advice to increase physical activity will not increase their chances of recovery from depression.”

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