Researchers from Northwestern University’s Feinberg School of Medicine in Chicago examined using the telephone as a treatment delivery medium for seriously depressed patients with access barriers to face-to-face treatment [Ed. note. We assume this refers to it being hard to get out of bed, get out of the house, get to the therapist’s office, etc, when depressed.]

They compared telephone-administered cognitive behavioral therapy (T-CBT) to face-to-face CBT for reducing attrition (drop out rate) in depressed primary care patients.
 
A randomized controlled trial was conducted with 325 Chicago-area primary care patients with major depressive disorder. They were randomly assigned to 18 sessions of either phone CBT or face-to-face CBT.

The primary outcome studied was attrition (completion vs non-completion of the 18 sessions) at post-treatment (week 18).  Secondary outcomes included interviewer-ratings of depression with the Hamilton Depression Rating Scale (Ham-D) and self-reported depression with the Patient Health Questionnaire-9 (PHQ-9).

This study found that significantly fewer participants discontinued phone CBT (n = 34 or 20.9%) as compared to face-to-face CBT (n = 53 or 32.7% - p = .02).
 
Patients showed significant improvement in depression across both types of treatment (p < .001). There were no significant treatment differences at post-treatment between phone CBT and face-to-face CBT on the Ham-D (P = .22) or the PHQ-9 (P = .89).

Although participants remained significantly less depressed at 6-month follow-up relative to baseline (P < .001), participants receiving face-to-face CBT were significantly less depressed than those receiving phone CBT on the Ham-D (difference, 2.91; 95% CI, 1.20-4.63; P < .001) and the PHQ-9 (difference, 2.12; 95% CI, 0.68-3.56; P = .004).

The investigators conclude that among primary care patients with depression, providing CBT over the telephone compared with face-to-face resulted in lower attrition and close to equivalent improvement in depression at post-treatment. At 6-month follow-up, patients remained less depressed relative to baseline; however, those receiving face-to-face CBT were less depressed than those receiving phone CBT.
 
These results indicate that phone CBT improves adherence compared with face-to-face delivery, but at the cost of some increased risk of poorer maintenance of gains after treatment cessation.

Citation: Mohr DC, Ho J, Duffecy J, Reifler D, Sokol L, Burns MN, Jin L, Siddique J. Effect of telephone-administered vs face-to-face cognitive behavioral therapy on adherence to therapy and depression outcomes among primary care patients: a randomized trial. JAMA. 2012 Jun 6;307 (21):pages 2278-85. [email protected]