Phone therapy: Call it helpful

Unable to rouse themselves from their gloom, depressed patients often miss therapy appointments and stop taking medications, thwarting their own recovery. Psychotherapy via telephone may be a solution.

In the first large-scale look at the technique, researchers in Seattle found that it significantly helped patients when used in conjunction with antidepressant drugs.

“Telephone therapy has a lot of potential, based on this study,” said psychiatrist Darrel Regier, director of research at the American Psychiatric Assn. “It’s a very clever approach.”

The study, published in the Aug. 25 issue of the Journal of the American Medical Assn., involved 600 patients in Washington state, most of whom were moderately depressed.

The patients were divided into three groups. One received antidepressant medication only. Another received medication along with three brief telephone check-ins over four months from a “care manager.” The third group received medication plus eight sessions of telephone psychotherapy over a period of two to four months. The sessions typically lasted 30 minutes to an hour. During the treatments, the therapist and patient didn’t meet in person.

Eighty percent of those in the psychotherapy group reported that their depression was much improved after treatment, compared with 66% in the care management group and 55% in the medicine-only group.

“With telephone therapy and antidepressants, patients clearly do better,” said the study’s lead author, psychologist Gregory Simon. The results show that telephone therapy can be effective, said Simon, a researcher and clinician at Group Health Cooperative, a Seattle-based HMO that covers 500,000 people in the Pacific Northwest.

The research was funded by the National Institutes of Mental Health, a branch of the National Institutes of Health.

Many therapists now use telephone therapy occasionally, with patients who are on vacation or moving to another area. Perhaps a handful of practitioners use it more extensively, but there are no statistics on the technique’s prevalence. The new study could help popularize the approach.

About a quarter of the subjects in the tele-therapy group regularly required multiple calls. But when the therapist finally made contact with elusive subjects, they were almost always happy to talk, the researchers said.

“When you reached them, they invariably said, ‘I’ve been so overwhelmed, but I’m so glad you kept trying to reach me,’ ” Simon said.

This aggressive outreach goes against psychological convention. Generally, patients with moderate mental illness are left to their own devices; therapists don’t pursue those who stop treatment.

But the standard approach allows too many depressives to fall by the wayside, Simon said. He pointed out that about a quarter of people who make an appointment at a mental health clinic never show up.

“If we’re going to help people who are depressed,” he said, “we’ll have to be more active about trying to reach them.”

Experts cautioned that telephone therapy lacked the immediacy and richness of the in-person approach.

“If there can be face-to-face therapy, there should be. That’s preferable,” said Dr. Thomas Nagy, adjunct assistant clinical professor of psychiatry at Stanford University. An expert on the ethics of psychological practice, He also said that therapists working over the phone might be more likely to skip key steps, such as taking a detailed patient history.

The Seattle researchers agreed that in-person therapy was likely more helpful, but they said the telephone approach would allow clinicians to reach many patients who would otherwise get little or no treatment.