CBT therapy: face-to-face or on the phone?

CBT therapy: face-to-face or on the phone?

By Liz Lockhart

Many therapists now offer treatment both in person and over the phone, but are both methods equally effective in the treatment of depression?

A study conducted by researchers from the Northwestern University Feinberg School of Medicine in Chicago compared the two methods of administering cognitive behavioural therapy (CBT).  They found that patients with major depression who received CBT via the telephone had considerable lower rates of discontinuing their treatment when compared to those who had face-to-face CBT.  They also found that by the end of the treatment, telephone CBT was in no way inferior to treatment administered face-to-face in terms of improvement of symptoms.

However, the patients who received face-to-face treatment were less depressed than those who had telephone CBT when a follow-up was done after 6 month. 

Background information in the published article, which appears in JAMA, states ‘Depression is common, with the 1-year prevalence rate of major depressive disorder estimated at between 6.6% and 10.3% in the general population and roughly 25% of all primary care visits involving patients with clinically significant levels of depression.  Psychotherapy is effective at treating depression, and most primary care patients prefer psychotherapy to antidepressant medication.  When referred for psychotherapy, however, only a small percentage of patients follow through.  Attrition from psychotherapy in randomised trials is often 30% of greater and can exceed 50% in clinical practice.’

Patients prefer to have telephone counselling which, the researchers suggest, is due to factors such as access barriers, time constraints, lack of available and accessible services, cost and transport problems.  ‘The telephone has been investigated as a treatment delivery medium to overcome access barriers, but little is known about its efficacy compared with face-to-face delivery,’ the article continues.

This study included 325 participants with major depressive disorder.  The participants were randomly given 18 sessions of either telephone or face-to-face CBT.  At the end of the 18 weeks it was found that the drop-out rate for telephone CBT was 20.9% whereas with face-to-face CBT it was 32.7%.  Drop-out rates before 5 weeks were 4.3% for telephone CBT and 13% for face-to-face CBT.

The study authors say ‘The effect of telephone administration on adherence appears to occur during the initial engagement period.  These effects may be due to the capacity of telephone delivery to overcome barriers and patient ambivalence toward treatment.  Access barriers likely exert their effects early in treatment and thus the effect of the telephone on overcoming those barriers is most prominent in the first sessions.’

Levels of depression were improved equally between the two methods of treatment at the end of the 18 weeks, however, when followed up after 6 months post-treatment, face-to-face CBT was significantly superior to telephone CBT.  32% of face-to-face CBT participants were in full remission from their depression compared to 19% of telephone CBT participants.

The authors conclude ‘The findings of this study suggest that telephone-delivered care has both advantages and disadvantages.  The acceptability of delivering care over the telephone is growing, increasing the potential for individuals to continue with treatment.  The telephone offers the opportunity to extend care to populations that are difficult to reach, such as rural populations, patients with chronic illnesses and disabilities, and individuals who otherwise have barriers to treatment.’

‘However, the increased risk of post-treatment deterioration in telephone-delivered treatment relative to face-to-face treatment underscores the importance of continued monitoring of depressive symptoms even after successful treatment.’

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