Depression improved during telephone therapy in multiple sclerosis patients

Patients with multiple sclerosis showed significant improvement in their depression during 16 weeks of telephone-administered psychotherapy treatment, according to an article in the September issue of Archives of General Psychiatry, one of the JAMA/Archives journals.

Although two-thirds of depressed patients prefer psychotherapy over antidepressants, only 10 to 45 percent ever make a first appointment and nearly half will drop out before the end of treatment, background information in the article states. Barriers to receiving psychotherapy include physical impairments, transportation problems, proximity of services and lack of time or financial resources. In the 1990s, the use of telephone psychotherapy increased in part due to the advent of 1-900 number counseling services and the increased use of telephone support services by insurance and medical groups.

David C. Mohr, Ph.D., from the University of California, San Francisco, and colleagues tested the efficacy of telephone-administered psychotherapy for depression in patients with multiple sclerosis (MS). One hundred twenty-seven patients were randomized into one of two 16-week psychotherapies: telephone-administered cognitive-behavioral therapy (T-CBT) or telephone-administered supportive emotion-focused therapy (T-SEFT). The two therapies differ in that the goal of T-CBT is to "teach skills that help participants manage cognitions and behaviors that contribute to depression and improve skills in managing stressful life events and interpersonal difficulties," while T-SEFT has the goal of "increasing participants' level of experience of their internal world." All patients spoke with a psychologist on the phone for 50 minutes each week and were followed-up for 12 months.

The researchers found that over 16 weeks, improvements were significantly greater for T-CBT compared with T-SEFT for major depressive disorder frequency, and on some depression ratings scales. Treatment gains were retained during the 12-month follow-up, however, differences across treatments were no longer evident.

"This sample of MS patients had impairments that affected their ability to engage in social roles, as evidenced by the assessed functional impairment and the fact that 74 percent of the sample was not in the workforce. The use of telephone-administered therapies may also overcome various other barriers in the general population arising from transportation problems, lack of services in the area, child care problems, lack of time, and stigma," the authors write.

The authors concluded: "To facilitate decisions about the benefits, risks, and utility of telephone-administered psychotherapies, it will be important to examine if the outcomes of telephone-administered therapies are equivalent to face-to-face interventions and if the apparent reductions in attrition associated with telephone administration of psychotherapy can be confirmed in such a comparative trial."