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"Depression is common, with the 1-year prevalence rate ofmajor depressive disorder estimated at between 6.6 percent and 10.3percent in the general population and roughly 25 percent of allprimary care visits involving patients with clinically significantlevels of depression. Psychotherapy is effective at treatingdepression, and most primary care patients prefer psychotherapy toantidepressant medication. When referred for psychotherapy,however, only a small percentage of patients follow through.Attrition from psychotherapy in randomized controlled trials isoften 30 percent or greater and can exceed 50 percent in clinicalpractice," according to background information in the article.The discrepancy between patients' preference for psychotherapy andthe low rates of initiation and adherence is likely due to accessbarriers, such as time constraints, lack of available andaccessible services, transportation problems, and cost. "Thetelephone has been investigated as a treatment delivery medium toovercome access barriers, but little is known about its efficacycompared with face-to-face treatment delivery." David C. Mohr, Ph.D., of the Northwestern University FeinbergSchool of Medicine, Chicago, and colleagues compared face-to-facecognitive behavioral therapy vs. a telephone-administered cognitivebehavioral therapy for the treatment of depression in primary care.The trial included 325 patients with major depressive disorder,recruited from November 2007 to December 2010. Participants wererandomized to 18 sessions of T-CBT or face-to-face CBT. The primarymeasured outcome for the study was attrition (completion vs.non-completion) at post-treatment (week 18). Secondary outcomesincluded measures of depression. The researchers found that significantly fewer participantsdiscontinued T-CBT (n = 34; 20.9 percent) before session 18compared with face-to-face CBT (n = 53; 32.7 percent). Attritionbefore week 5 was significantly lower in T-CBT (n = 7; 4.3 percent)than in face-to-face CBT (n = 21; 13.0 percent), but there was nosignificant difference in attrition between sessions 5 and 18.T-CBT patients attended significantly more sessions than thosereceiving face-to-face CBT. "The effect of telephone administration on adherence appearsto occur during the initial engagement period. These effects may bedue to the capacity of telephone delivery to overcome barriers andpatient ambivalence toward treatment. Access barriers likely exerttheir effects early in treatment, and thus the effect of thetelephone on overcoming those barriers is most prominent in thefirst sessions," the authors write. In terms of changes in level of depression, the researchers foundthat T-CBT was not inferior to face to face CBT in reducingdepressive symptoms at posttreatment. However, face-to-face CBT wassignificantly superior to T-CBT during the 6-month follow-upperiod. By 6-month follow-up, 19 percent of T-CBT vs. 32 percent offace-to-face CBT participants were fully remitted. "The findings of this study suggest that telephone-deliveredcare has both advantages and disadvantages. The acceptability ofdelivering care over the telephone is growing, increasing thepotential for individuals to continue with treatment," theauthors write. "The telephone offers the opportunity to extendcare to populations that are difficult to reach, such as ruralpopulations, patients with chronic illnesses and disabilities, andindividuals who otherwise have barriers to treatment. …"However, the increased risk of posttreatment deterioration intelephone-delivered treatment relative to face-to-face treatmentunderscores the importance of continued monitoring of depressivesymptoms even after successful treatment.". I am an expert from swimmingpool-cleaner.com, while we provides the quality product, such as China Flexible Plastic Bucket , China Floor Cleaning Mops, Swimming Pool Cleaner,and more.
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