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Lower attrition rate in telephone CBT, but at cost of poorer maintenance

Over-the-phone cognitive-behavioral therapy resulted in lower attrition and comparable improvement in depression among primary care patients compared with face-to-face sessions, but also resulted in poorer maintenance of gains, according to new data.

“Depression is common and often disabling, affecting up to 10% of Americans each year,” study researcher David C. Mohr, PhD, told Healio.com. “While most people with depression want psychotherapy to learn to manage the difficulties in their lives that contribute to their depression, more than 75% report barriers that prevent them from being able to access care.  Using the telephone can overcome these barriers.”

Mohr, a professor and director of the Northwestern University Center for Behavioral Intervention Technologies, and colleagues performed a randomized controlled trial of 325 Chicago-area primary care patients with major depressive disorder. Participants were assigned 18 weekly sessions of either telephone-administered cognitive behavioral therapy (T-CBT) or face-to-face CBT.

The researchers measured the primary outcome of attrition — completion vs. non-completion — at week 18. Depression severity was determined by the results of masked interviews using the Hamilton Depression Rating Scale (HDRS) and participants’ self-reports in the Patient Health Questionnaire (PHQ-9).

Significantly fewer participants discontinued T-CBT compared with CBT (20.9% vs. 32.7%). There were no significant treatment differences after week 18 between the two groups on the HDRS (P=.22) and the PHQ-9 (P=.89). HDRS (90% CI, –0.05 to 0.33) and PHQ-9 (90% CI, –0.2 to 0.17) results showed that the post-treatment effect size was within the inferiority margin, “indicating that T-CBT was not inferior to face-to-face CBT,” according to the researchers.

Although both groups were significantly less depressed at the 6-month follow-up relative to the baseline, the researchers found that participants receiving CBT were significantly less depressed than those in the T-CBT arm, measured on the HDRS (difference, 2.91; 95% CI, 1.2-4.63) and the PHQ-9 (difference, 2.12; 95% CI, 0.68-3.56).

“This study demonstrates that telephone psychotherapy is safe, effective and is not a second rate option,” Mohr said. “Clinicians can feel comfortable delivering care over the phone, patients can feel comfortable receiving care via telephone, and there is no reason why such care should not be reimbursable by payers.”

Disclosure: The researchers report no relevant financial disclosures.