June 5, 2012 -- Telephone therapy may be just as good as in-person therapy for treating depression symptoms, at least for the short term, according to a study published Tuesday in the Journal of the American Medical Association.
In the study, 325 participants with depression received 18 weekly sessions of cognitive behavioral therapy, a form of psychotherapy commonly used to treat depression, either in person or by phone.
The study found that more patients were likely to stick with telephone sessions compared to in-person therapy.
Both forms of therapy significantly reduced depression symptoms in the patients after the 18 sessions. However, a follow-up of the patients after six months found those who received face-to-face therapy were less depressed than those who received therapy over the phone.
Depression has been on the rise in the U.S., now affecting an estimated 1 in 10 adults, according to the U.S. Centers for Disease Control and Prevention.
An integral part of cognitive behavioral therapy is assessing the actions of the patient during the session. Therapy done over the phone is often less effective because patient and therapist cannot pick up each other's visual cues, according to David Mohr, director of the Center of behavioral technology at Northwestern University Feinberg School of Medicine, who was the author of the study.
"You can't smile at people, can't make eye contact, you can't watch behavioral changes in your patient," said Jenna Duffecy, a research assistant in preventive medicine at Northwestern University Feinberg School of Medicine, who served as a therapist in the trial.
But administering telephone therapy, she said, taught her to look for different cues like changes in tone and hesitancy in the voice.
"I was surprised at how well I connected with the patients," said Duffecy. "It's certainly not an inferior treatment but does require the therapist to change their style."
A majority of patients with depression find barriers that keep them from coming to in-person therapy sessions, said Mohr.
"Depression is a disease where the cardinal symptom is loss of motivation, so that accentuates the barrier," said Mohr.
Transportation, time constraints, or even lack of access to care may keep many patients away from in-person therapy, said Duffecy.
But Mohr said for some, talking about problems over the telephone may be more comfortable than in person.
"For a growing number of patients this is becoming acceptable and even desirable," said Mohr, adding that therapists should also see telephone-based therapy as a legitimate form of treatment.
Eighty-five percent of psychologists offer some form of care by phone, according to the American Psychological Association.
Although the study found that the in-person therapy group seemed to have fared better after three months, the findings may not necessarily mean that in-person therapy is better, Mohr said. According to Mohr, the telephone therapy group may have had more severe depression to begin with, and "had difficulty organizing and motivating themselves."
"The phone helped them with [the symptoms], but once treatment is done, it may lead to more stress and more difficulties," said Mohr. "[The findings] highlight the importance of following up with people after treatment."