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Patients stay with phone psychotherapy longer than office visits

September 22, 2008

CHICAGO -- The problem with psychotherapy has long been that nearly half the patients quit going after a few sessions. Therapy can't work if patients stop coming to the therapist's office.

But a new meta-analysis has found that when patients receive psychotherapy for depression over the phone, most of them continue with the therapy.

Researchers from Northwestern University's Feinberg School of Medicine have taken the first "snapshot" of telephone-administered therapy studies around the country. Telephone therapy is becoming more widely used by health care providers and employee-assistance programs.

The new study found that the average attrition rate in the telephone therapy was only 7.6 percent compared to nearly 50 percent in face-to-face therapy. The telephone therapy also was effective in reducing depressive symptoms with results that appear to be similar to face-to-face treatment.

"The problem with face-to-face treatment has always been very few people who can benefit from it actually receive it because of emotional and structural barriers," said David Mohr, professor of preventive medicine at the Feinberg School and lead author of the study, published in the September issue of Clinical Psychology: Science and Practice. "The telephone is a tool that allows the therapists to reach out to patients, rather than requiring that patients reach out to therapists."

Mohr said that of the patients who say they want psychotherapy, only 20 percent actually show up for a referral and half later drop out of treatment.

"One of the symptoms of depression is people lose motivation," Mohr said. "It's hard for them to do the things they are supposed to do. Showing up for appointments is one of those things."

Patients also may not have the transportation or time to travel back and forth to a therapist's office. It may be hard to squeeze an appointment into days already crammed with work, caring for kids or elderly parents or other family obligations.

Telephone therapy seems to transcend all these barriers. Mohr began using telephone-administered therapy because he was working with patients who had multiple sclerosis who could not get to a therapist's office.

Mohr said what's needed is a definitive study with a randomly selected population of patients that directly compares therapy delivered in the traditional face-to-face manner to therapy delivered over the phone. He has already launched such a study in subjects who receive their primary care from Northwestern's Medical Faculty Foundation. He expects to have results in two to three years.

Northwestern University