People with depression often fail to attend regular psychotherapy sessions; reasons for this failure are thought to be linked to barriers to access, such as time constraints, transportation difficulties, cost, and the availability of services. The authors of a recent study sought to determine whether cognitive behavioral therapy (CBT) administered over the telephone was as effective as CBT provided in person. Three hundred twenty-five patients receiving primary care who met the criteria for major depressive disorder were enrolled in the study.

The same nine PhD-level therapists provided both face-to-face CBT and telephone CBT and used the same protocol for both routes of administration. Patients were randomly assigned to one of the modes of administration. Treatment involved 18 45-minute sessions, and all participants received a workbook outlining CBT concepts.

Of the 162 patients in the face-to-face group, 21 discontinued treatment before week 5, compared with seven of 163 patients in the telephone group. However, attrition rates were similar for both groups from sessions five to 18, with 32 patients in the face-to-face group discontinuing and 27 in the telephone group doing so. After 18 treatment sessions, patients in the two groups showed comparable decreases in depressive symptoms from baseline, with no significant differences between them. At the six-month follow-up, however, there were significantly lower rates of major depressive disorder in the face-to-face group (26% versus 29%), and a higher percentage of patients in the face-to-face group met the criteria for full remission (32% versus 19%).

The authors conclude that CBT delivered over the telephone results in lower attrition rates than in-person therapy during the first few weeks of treatment but that, although telephone therapy effectively improves depression, the effects of face-to-face treatment last longer after the end of treatment. They hypothesize that this is because physically attending sessions promotes maintenance or that human contact contributes to sustained gains. Telephone-administered therapy, they write, can increase access to treatment for depression, but the increased risk of posttreatment deterioration associated with it in this study "underscores the importance of continued monitoring of depressive symptoms even after successful treatment."

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