By Melissa Healy, Los Angeles Times/For the Booster Shots Blog
7:25 PM EDT, June 5, 2012
We pay our bills by phone. We order our groceries by phone. Some of us even have sex by phone. A new study suggests that, for the depressed, getting psychotherapy by phone might make sense too.
The study, published in the Journal of the American Medical Assn., found that teletherapy encourages more depressed patients to get help for their mental affliction, and a course of 18 sessions was just as effective at improving symptoms as seeing a therapist for the same number of sessions in his or her office.
But six months after the phone calls stopped, the study found that patients who got their psychotherapy in person were doing better at keeping depressive symptoms at bay than were those who got teletherapy.
The study suggests that teletherapy -- little studied but already widely practiced -- may be a viable solution for certain depressed patients: those for whom a trip to the therapist is either infeasible, logistically challenging or so daunting a prospect that it's not going to happen.
Among the study's 163 depressed subjects who were to receive 18 sessions of cognitive behavioral therapy by phone, significantly fewer dropped out than was the case among the 162 who were to get therapy face-to-face in a psychologist's office. In all, 53 in the face-to-face therapy group stopped coming to sessions, while 34 in the teletherapy group discontinued their participation before 18 sessions were complete.
In particular, the heavy attrition that psychotherapists tend to observe early in treatment was relatively rare in the group that got its therapy by phone: 21 people dropped out of face-to-face treatment in the first two weeks, while only seven of those getting teletherapy did.
"These effects may be due to the capacity of telephone delivery to overcome barriers and patient ambivalence toward treatment," wrote the study's authors, from Northwestern University's Feinberg School of Medicine and the Beck Institute for Cognitive Behavior Therapy in Pennsylvania.
The authors appeared to downplay the poorer mental states of teletherapy subjects at six months. Though those who got to face-to-face appointments might have been "more motivated" patients, sicker patients who are "at greater risk for post-treatment deterioration" may be the ones who are most likely to stick with teletherapy.
Clinical psychologist Mary Alvord of Bethesda, Md., is not so sure.
"The relationship matters," said Alvord. In an office a therapist not only responds to her patient's nonverbal cues--a strained voice, a sudden lapse in hygeine, an inability to make eye contact-- she said. The therapist also communicates empathy and support in ways that may be hard to convey over the phone.
The result is the vaunted "therapeutic alliance" that is widely thought to be central to a patient's ability to recast negative thinking and try out new responses to interpretations of life's challenges.
"You need to have a strong relationship so that people can face their fears," said Alvord, especially with patients who suffer from anxiety.
Alvord hailed teletherapy as a promising means to expand access to psychological care for patients who have considered it out of their reach. At the same time, she said, she would prefer to have "an established relationship with a person and then use telephone sessions to spread out" the duration of therapy.
But if psychotherapy-by-phone--still not permitted by many states' licensing boards--is to become routine on the American healthcare landscape, what should it be called? Psycho-teletherapy or Tele-psychotherapy?