You already know that in-person therapy can help people who suffer from depression.
But getting to a therapist’s office isn’t always easy or convenient—and for some people, it’s overwhelmingly uncomfortable to look someone in the eye (or even be in the same room) and talk about personal difficulties.
So what about phone-based therapy, which doesn’t require travel or face-to-face interaction? Is that as effective?
An interesting new study compared the two types…
FACE-TO-FACE VS. OVER THE PHONE
This study used cognitive behavioral therapy, which helps people identify—and change—destructive thought patterns and behaviors that contribute to many cases of depression. In the study, people with depression were randomly divided into two groups. One group was assigned to 18 face-to-face therapy sessions, and the other was assigned to 18 telephone sessions. Before participants began treatment, their levels of depression were rated by trained evaluators using the standard Hamilton Depression Rating Scale (the higher the score, the more severe the depression).
Results: The therapies were equally effective in reducing depression symptoms after the 18 sessions…at that point, both groups’ scores dropped by about 10 pounts.
Six months later, the telephone-therapy group had lost a little ground, with its score edging back up by 1.5 points…while the face-to-face group’s score had actually improved by an additional 0.4 points.
So face-to-face therapy appeared to be slightly more effective six months after treatment. But that’s a very close one-two finish, when you consider that the telephone group’s depression symptoms were still much improved even six months after therapy had ended!
What’s important to note, however, is that there was a big difference between the two groups in terms of who was able to complete the therapy—participants in the phone-therapy group were more likely to finish all the sessions. By the end of the study, only 67% of the face-to-face group members remained in treatment, while 79% of the telephone group remained.
Knowing that those “dropouts” were included in the average Hamilton scores listed earlier, it makes me think that face-to-face therapy might be not just slightly more effective but perhaps much more effective when patients actually attend the sessions. But more research is needed before we can say for sure. Plus, this study looked at symptoms after only six months—the study’s researchers will be exploring longer-term follow-up data from these patients.
NOT IDLE CHATTER
To learn more, I called study coauthor Michelle Burns, PhD, a research assistant professor in the department of preventive medicine and at the Center for Behavioral Intervention Technologies (CBITs) at Northwestern University’s Feinberg School of Medicine in Chicago.
It’s unknown exactly why face-to-face therapy may have been more effective, but she has a few theories. For instance, depressed people often don’t want to leave the house, so simply visiting the therapist’s office might have been therapeutic…perhaps seeing a patient in-person—and noticing nonverbal cues, such as hygiene, wardrobe and body language—helped the therapist learn more about the patient, which in turn helped the therapist treat the patient more effectively…it could be that for a patient, seeing a therapist’s facial expressions is more helpful, because those visual cues may help the patient remember the skills learned in therapy.
More patients might have stuck with phone therapy, Dr. Burns said, because it’s less intimidating…because there are transportation, time and other logistic barriers that can make it challenging to attend face-to-face therapy…and perhaps also because the therapists initiated calls with the patients (whereas the therapists doing face-to-face sessions did not come to the patient’s home).
WHICH THERAPY IS BETTER?
This study suggests that face-to-face therapy may be more effective for reducing depression, but that phone therapy is also a surprisingly effective option. The researchers hope that this study will be a wake-up call to insurers, who mostly don’t cover phone therapy. Meanwhile, if you’re interested in phone therapy, many cognitive behavioral therapists are willing to work over the phone. Ask your medical doctor for the names of skilled therapists, or look for one in your area who treats depression by searching the therapist locator on the Web site for the American Psychological Association’s APA Practice Organization at http://locator.apa.org/.