Psychotherapy Works Over The Telephone

Psychotherapy delivered over the telephone reduces symptoms of depression in patients with physical impairments due to multiple sclerosis, investigators report.

"The biggest advantage of 'telemental health' is that it overcomes barriers," Dr. David C. Mohr, of the University of California at San Francisco stated. "Even in urban areas where mental health is available, there are a lot of barriers, such as physical disabilities, time constraints, transportation problems, or not being able to get away from home because of child care or elder care duties."

In many rural areas, he added, mental health care is not even available.

Mohr's group recruited 127 patients with depression and functional impairments due to multiple sclerosis who agreed to psychotherapy delivered over the telephone. They were randomly assigned to treatment with cognitive behavioral therapy or supportive emotion-focused therapy, both in 16 weekly 50-minute sessions.

According to the researchers' report in the Archives of General Psychiatry, there were significant improvements in both groups at the 16-week evaluations, but more so in the cognitive behavioral therapy group.

For example, the prevalence of major depression dropped from 73 percent to 13 percent in the cognitive behavioral therapy group and from 69 percent to 29 percent in the supportive emotion-focused group.

A further indication that treatment was effective was their "extraordinarily low attrition rate, with only about 5 percent who dropped out," Dr. Mohr noted. "Normally in most clinical trials of treatment for depression 15 percent to 60 percent drop out over 16 weeks."

Telephone-administered therapy works because patients "clearly appear to become very attached and very bonded to their therapists," the researcher said.

"Part of reason is that a lot of the nonverbal information about how people feel is carried through the voice," he explained. "There's a way in which the emotions people are feeling or the empathy that the therapist might be expressing comes through."

"Based on our results, we can say that it is possible to deliver quality care over the phone," he concluded. "But the question that is still outstanding is whether it is equivalent to face-to-face care."

SOURCE: Archives of General Psychiatry, September 2005.

Reference Source 89
September 12, 2005

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