Long Term Depression Eased By Phone-Based
Therapy
Article Date: 28 Mar 2007 - 8:00 PDT
When people receive brief telephone-based psychotherapy
soon after starting on antidepressant medication, strong positive effects may
continue 18 months after their first session. So concludes a Group Health study
in the April Journal of Consulting and Clinical Psychology.
This paper describes one more year of follow-up since a 2004 Journal of the
American Medical Association (JAMA) report on the same random sample of
Group Health patients.
"With close to 400 patients, this is the largest study yet of
psychotherapy delivered over the telephone," said Evette
J. Ludman, PhD, senior research associate,
Long-term positive effects of initially adding phone-based therapy included
improvements in patients' symptoms of depression and satisfaction with their
care, said Ludman. At 18 months, 77 percent of those
who got phone-based therapy (but only 63 percent of those receiving regular
care) reported their depression was "much" or "very much"
improved. Those who received phone-based therapy were slightly better at taking
their antidepressant medication as recommended, but that did not account for
most of their improvement. And effects were stronger for patients with moderate
to severe depression than for those with mild depression.
"We were surprised at how well the positive effects were maintained over
time," said Ludman. "As with weight
control, maintaining improvement is the hardest part of treating
depression."
As is usual in clinical practice, the patients' primary care doctors diagnosed
their depression and prescribed their antidepressants. Half of the patients
also received eight sessions of telephone psychotherapy during the first six
months, then two to four "booster" sessions in the second six months
as well as medication follow-up and support from masters-level therapists.
The patients and therapists never met face to face, only over the phone, said Ludman. Patients weren't always easy to reach by phone, and
the therapists worked hard to reach them all. Therapists followed a structured
protocol for psychotherapy. They encouraged the patients to identify and
counter their negative thoughts (cognitive behavioral therapy), pursue
activities they had enjoyed in the past (behavioral activation), and develop a
plan to care for themselves.
"The patients participated more fully in psychotherapy and completed more
sessions than do most depressed people in the community," said Ludman. Nationally, only about half of insured patients
receiving depression treatment make any psychotherapy visit, and less than a
third make four or more visits. By contrast, in this study, three in four
patients completed at least six phone therapy sessions. This is striking, she
added, because the study did not include people who were already in counseling
or planning to be.
"Giving psychotherapy to people with depression who were not seeking
therapy may help them significantly," said Ludman.
Depression symptoms, including feeling discouraged and avoiding other people,
can prevent people from seeking help. One in four depressed people who make
appointments for in-person therapy are no-shows. "They slip through the
cracks," she added.
Few of the patients who received phone-based therapy - even fewer than those
who did not receive it - sought in-person therapy. "This suggests the
phone-based therapy met their needs, without whetting their appetite for
more," said Ludman. Phone-based therapy is more
convenient and acceptable to patients than in-person psychotherapy, she said.
Next, Ludman said, the researchers plan to explore
the combination treatment's cost-effectiveness and impact on work and home
life. They also want to compare the effectiveness of phone-based treatment with
that of in-person visits.
The National Institute of Mental Health funded the study. The other authors are
Greg E. Simon, MD, MPH, and Michael Von Korff, ScD,
senior investigators at
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Article adapted by Medical News Today from original press release.
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Contact: Joan DeClaire