Phone therapy effective against depression

[Altostrata]

Perhaps "depressed" people just want someone to talk to?

 

http://www.medpagetoday.com/Psychiatry/Depression/33083

 

Therapy by Phone Good Against Depression

By Kristina Fiore, Staff Writer, MedPage Today June 05, 2012

 

Receiving cognitive behavioral therapy (CBT) over the phone is just as effective in primary care patients as when counseling is done face-to-face, and phone CBT may keep patients in treatment longer, researchers found.

 

Patients had significant improvement in depression scores with both means of treatment (P<0.001), but significantly fewer stopped telephone-based therapy (P=0.02), David Mohr, PhD, of Northwestern University in Chicago, and colleagues reported in the June 6 issue of the Journal of the American Medical Association.

 

But they noted that patients were more likely to maintain improvements in depression 6 months after sessions stopped if they received face-to-face treatment.

 

....

Roughly 25% of all primary care visits involve patients with clinically significant levels of depression, the authors pointed out.

 

Studies have shown that while CBT is an effective treatment for depression, only a small percentage of patients follow through because of barriers to access such as time constraints, transportation problems, and cost.

 

Yet some work has shown that giving CBT over the phone may help increase compliance.

 

So Mohr and colleagues conducted a randomized trial of 325 primary care patients in the Chicago area who had major depressive disorder from November 2007 to December 2010.

 

All patients had 18 sessions of CBT, either over the phone or face-to-face. All sessions were 45 minutes long, with two sessions a week for the first 2 weeks, followed by 12 weekly sessions, with two final booster sessions over 4 weeks.

 

The primary outcome was attrition at week 18, and secondary outcomes included interviewer- and self-reported depression scores.

 

The researchers found that significantly fewer patients discontinued telephone-based therapy compared with in-person therapy before week 18 (20.9% versus 32.7%, P=0.02).

 

Differences in attrition were apparent as early as week 5, with significantly fewer drop-outs in the telephone group (4.3% versus 13%, P=0.006), suggesting the effects of phone-base CBT on adherence "appear to occur during the initial engagement period," likely because barriers to access most often occur early in treatment, the researchers wrote.

 

Both treatments significantly improved depression (P<0.001) and there were no between-group differences at 18 weeks in terms of physician- or self-reported depression scores.

 

Also, calculated effect sizes revealed that telephone-based therapy wasn't inferior to face-to-face treatment.

 

Participants remained significantly less depressed 6 months after the intervention compared with baseline (P<0.001), but those who had face-to-face treatment were significantly less depressed than those in the phone intervention group in terms of both physician- and self-reported scores (P<0.001 and P=0.004, respectively).

 

Meeting face-to-face may be therapeutic in a way that promotes the maintenance of improvements in some patients, the researcher said, or the physical presence of the therapist may have some beneficial effects that last.

 

"If the finding that face-to-face treatment produces better maintenance of gains after treatment cessation is not an artifact, it suggests that longer-term follow-up is critical in research examining the effects of tele-mental health intervention and telemedicine more broadly," they wrote.

 

The study was limited in its generalizability because the sample was fairly well educated, the researchers cautioned, and because it wasn't possible to mask patients to the treatment arm.

 

Still, they concluded that telephone CBT "can overcome barriers to adhering to face-to-face treatment."

 

The study was supported by a grant from the National Institute of Mental Health.

 

....

 

Primary source: Journal of the American Medical Association

Source reference:

Mohr DC, et al "Effect of telephone-administered versus face-to-face cognitive behavioral therapy on adherence to therapy and depression outcomes among primary care patients" JAMA 2012; 307: 2278-2285.

[Skyler]

Perhaps "depressed" people just want someone to talk to?

 

That sounds about right. And on the phone is less effective than video Skype, and RL is best for therapy. I probably edited this down too much, but I get so very tired of studies that compare apples to grapes, and then generalize findings. ~S

[Barbarannamated]

Perhaps people are depressed because they are lonely and just need someone to chat with.

[Skyler]

Perhaps people are depressed because they are lonely and just need someone to chat with.

 

Hi Barb, IMHO, depends. People who get depressed because of lonesomeness often have problems related to unresolved early loss and or an incomplete attachment. The feelings then get tripped by by the emergence of new issues and play out again in the present. Of course, with enough stress, anyone can get depressed.

[compsports]

Sorry if I am missing something obvious but why would phone therapy be more effective than meeting someone face to face?

 

Schuyler, great point about the studies.

 

CS

[Skyler]

Sorry if I am missing something obvious but why would phone therapy be more effective than meeting someone face to face?

 

Schuyler, great point about the studies.

 

CS

 

Hi Compos.. In real life we can see people's faces. I'll take the impact of a visit with someone anytime, whether with a friend or professional. There really was no question about this until computers came along, but the truth remains.. in person beats facbeook, beats texting, beats phone. I work on Skype.. and in person is still better. We miss facial expressions, body cues, or just plain vibes when people are not physically present.

 

Much of the drive to put services online is driven by health corps, yet another way they can cut costs and undercut quality for all of us.

 

Thanks for the positive feedback.~S

[compsports]

 

 

Hi Compos.. In real life we can see people's faces. I'll take the impact of a visit with someone anytime, whether with a friend or professional. There really was no question about this until computers came along, but the truth remains.. in person beats facbeook, beats texting, beats phone. I work on Skype.. and in person is still better. We miss facial expressions, body cues, or just plain vibes when people are not physically present.

 

Much of the drive to put services online is driven by health corps, yet another way they can cut costs and undercut quality for all of us.

 

Thanks for the positive feedback.~S

 

Thanks for letting me know I wasn't going crazy,

 

It just proves that drugs studies aren't the only ones that are bogus.

 

CS

[Barbarannamated]

Good discussion.

 

Absolutely, in person trumps other interaction via electronics. There's something about interpersonal energy/EMF/(choose preferred term).

 

RE: unresolved issues. Definitely a factor that has come in focus in past year.

My interest is in people who find themselves, by circumstance, without the "built-in" social supports or interactions such as employment, family, friends secondary to employment and family. I am, by nature, very outgoing and have created a purpose/activity/interaction for myself over last decade without employment or family/kids/grandkids. I'm comfortable going places on my own and enjoy meeting people at ballgames, concerts, etc. I suspect that with the increased rate of disability/unemployment and lower birth rate due to psych drugs, there will be a crisis of aloneness in younger age group similar to what is known to exist in geriatrics who have no family. There are social supports for geriatrics, but the issue is not yet addressed in younger age group. I've found only 1 person who has fewer relatives than i do (no children, nieces/nephews or cousins). She is employed. There are online groups of people (mostly women) who connect for this reason. They have no family or plan for care for future (limited retirement). Most were/are professionals but have lost their livelihood and retirement. They watch out for one another via internet. I haven't joined, but found a little comfort knowing my situation is not as extreme as others. Some of these people have gone as far as to have a plan to end their lives if they find themselves completely without resources. They are not depressed, but very pragmatic, though I admit it was shocking to read that on a HuffPost blog.

"The cat lady syndrome" Example- Recently, someone I kw of in my hometown was found deceased in his home after 5 days. Age 52. I think this will become more common and not isolated to elderly because more people do not have the daily "mandatory" interactions as more are unemployed and have no family and are dying at younger ages. Excuse the morbid story!

Also, I think that social media complicates this in some ways. I used to be very active on Facebook with daily interaction in several groups including my high school class (ie. Not anonymous presence). I decided about a year ago that FB was having a negative impacting on me and stayed off. The response was fascinating. The absence was not noticed until I returned or "my light was on". Then, I got a flood of messages along the lines of "You're BACK! How ARE you?!" Messages always thru Facebook messaging, as if people no longer thought to use private email. I was hacked a few times on FB and told people I don't communicate via FB messaging. Still, few thought to use email. Some call or text. I am back on FB now although using it cautiously. I play with it, sometimes dropping away for awhile, going back and get same response "You're BACK!" Bizarre - as if one only "exists" now if they are present on FB.

This is tangential, but all contributing to the disconnectedness of our society. My situation is unusual, thoug not unique. There are more and more people without daily "interactions of necessity". I have plenty of friends who I could spend time with either online or (fewer) in person. It's a constant "job" to stay occupied, connected and purposeful.

Most people I know are pulled in many different directions with job, family, etc. I have absolutely no obligations or place to be indefinitely.

I see a future need for ways to keep this segment of the population engaged in productive, purposeful ways (ie. Not TV watching, bar hanging). In my hometown, the unemployment and disability are EXTREMELY high. Very sad that a large percentage of people spend afternoons in bars in order to socialize. I HOPE that the city is an anomaly. It had the highest unemployment rate in the nation when I was growing up (steel mills, coal mining major industry).

Sorry to go off-topic! Along the lines of Whitaker's work, I see this as a consequence of masses on disability at young age. Ive looked into communal/sustainable living and other group situations that do not reinforce the "disability" mentality.

 

In conclusion... I think you have job security, Schuyler!

[Skyler]

Good discussion.

 

Absolutely, in person trumps other interaction via electronics. There's something about interpersonal energy/EMF/(choose preferred term).

 

RE: unresolved issues. Definitely a factor that has come in focus in past year.

My interest is in people who find themselves, by circumstance, without the "built-in" social supports or interactions such as employment, family, friends secondary to employment and family. I am, by nature, very outgoing and have created a purpose/activity/interaction for myself over last decade without employment or family/kids/grandkids. I'm comfortable going places on my own and enjoy meeting people at ballgames, concerts, etc. I suspect that with the increased rate of disability/unemployment and lower birth rate due to psych drugs, there will be a crisis of aloneness in younger age group similar to what is known to exist in geriatrics who have no family. There are social supports for geriatrics, but the issue is not yet addressed in younger age group. I've found only 1 person who has fewer relatives than i do (no children, nieces/nephews or cousins). She is employed. There are online groups of people (mostly women) who connect for this reason. They have no family or plan for care for future (limited retirement). Most were/are professionals but have lost their livelihood and retirement. They watch out for one another via internet. I haven't joined, but found a little comfort knowing my situation is not as extreme as others. Some of these people have gone as far as to have a plan to end their lives if they find themselves completely without resources. They are not depressed, but very pragmatic, though I admit it was shocking to read that on a HuffPost blog.

"The cat lady syndrome" Example- Recently, someone I kw of in my hometown was found deceased in his home after 5 days. Age 52. I think this will become more common and not isolated to elderly because more people do not have the daily "mandatory" interactions as more are unemployed and have no family and are dying at younger ages. Excuse the morbid story!

Also, I think that social media complicates this in some ways. I used to be very active on Facebook with daily interaction in several groups including my high school class (ie. Not anonymous presence). I decided about a year ago that FB was having a negative impacting on me and stayed off. The response was fascinating. The absence was not noticed until I returned or "my light was on". Then, I got a flood of messages along the lines of "You're BACK! How ARE you?!" Messages always thru Facebook messaging, as if people no longer thought to use private email. I was hacked a few times on FB and told people I don't communicate via FB messaging. Still, few thought to use email. Some call or text. I am back on FB now although using it cautiously. I play with it, sometimes dropping away for awhile, going back and get same response "You're BACK!" Bizarre - as if one only "exists" now if they are present on FB.

This is tangential, but all contributing to the disconnectedness of our society. My situation is unusual, thoug not unique. There are more and more people without daily "interactions of necessity". I have plenty of friends who I could spend time with either online or (fewer) in person. It's a constant "job" to stay occupied, connected and purposeful.

Most people I know are pulled in many different directions with job, family, etc. I have absolutely no obligations or place to be indefinitely.

I see a future need for ways to keep this segment of the population engaged in productive, purposeful ways (ie. Not TV watching, bar hanging). In my hometown, the unemployment and disability are EXTREMELY high. Very sad that a large percentage of people spend afternoons in bars in order to socialize. I HOPE that the city is an anomaly. It had the highest unemployment rate in the nation when I was growing up (steel mills, coal mining major industry).

Sorry to go off-topic! Along the lines of Whitaker's work, I see this as a consequence of masses on disability at young age. Ive looked into communal/sustainable living and other group situations that do not reinforce the "disability" mentality.

 

In conclusion... I think you have job security, Schuyler!

 

Barb, can you use more definitive paragraph breaks.. hard to follow. Thanks! ~S