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Help is a phone call away

Researchers find a helpful combo in drugs and psychotherapy sessions conducted as phone appointments.

By DAVID HOHN
The BALTIMORE SUN

In a study sure to please the telecommunications industry, researchers have found that psychotherapy via telephone can significantly help patients suffering from depression when used in conjunction with anti-depressant drugs.

Published in yesterday's issue of the Journal of the American Medical Association, the paper is the first large-scale look at the technique.

"Telephone therapy has a lot of potential, based on this study," said psychiatrist Deral Refier, director of research at the American Psychiatric Association. "It's a very clever approach."

The study by Seattle researchers looked at 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 medicine, along with three brief telephone check-ins over four months from a "care manager."

The third group received medicine, 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 who received eight sessions of psychotherapy reported that their depression was much improved after treatment, compared with 66 percent in the care management group and 55 percent in the medicine-only group.

The results show that telephone therapy can be effective, said the study's lead author, psychologist Gregory Simon, a researcher and clinician at Group Health Cooperative, a Seattle-based HMO that covers 500,000 people in the Pacific Northwest.

Regier praised the $1.4 million study for its rigor, saying it was "very carefully done." The research was funded by the National Institute of Mental Health.

The study could help popularize the tele-therapy approach, particularly for treating depression. Unable to rouse themselves from their gloom, depressed patients often miss therapy appointments and stop taking medicines. The phone method can overcome this problem through sheer persistence, the researchers said. If a patient missed a phone appointment, the therapist would simply call again later - sometimes, more than a dozen times.

About a quarter of the subjects in the tele-therapy group regularly required multiple calls.

"When you reached them. they invariably said, "I've been so overwhelmed, but I am glad you kept trying to reach me,'" Simon said.

This aggressive outreach goes against psychological convention. 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."

Some 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 at Stanford University.

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.

Simon, who thinks telephone therapy could eventually be used widely, said it would be particularly valuable for certain groups, including people who are embarrassed or ashamed about visiting a therapist, or rural patients who must travel long distances to see a clinician.

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