The title of this article is a little bit misleading, although not
deliberately so. The study examined the question of whether
telephonic CBT – added to pharmacotherapy – was beneficial, in a
primary care population. Note that the primary care population is
NOT the population that psychiatrists typically see.
Consequently, it is not possible to extrapolate these results to most
typical psychiatrist’s practices. It also is not applicable to
the population of persons seen in many outpatient offices of other
mental health specialists.
Psychotherapy Effective, Efficient in Treatment of Depression
Medscape Medical News
Janis C. Kelly
October 16, 2009 — Depressed patients gain more
depression-free days if
they are treated with telephone care management plus telephone
psychotherapy than with care management alone.
In research published in the October issue of the Archives of General
Psychiatry, Gregory E. Simon, MD, MPH, from the Center for Health
Studies, Group Health Cooperative, Seattle, Washington, and colleagues
report that compared with usual care, the telephone care management
program added $676 to outpatient health care costs for a gain of 29
depression-free days, whereas the telephone care management plus
psychotherapy program added $397 to outpatient costs but produced an
additional 46 depression-free days.
Telephone care management plus psychotherapy was cost-effective if a
depression-free day was valued at $9; telephone care management alone
was cost-effective only if a depression-free day was valued at $20 or
“The care management plus psychotherapy program was a better bargain no
matter what value we attach to an additional day free of depression,”
Dr. Simon told Medscape Psychiatry…
Arch Gen Psychiatry. 2009;66:1081-1089. ( href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=19805698&dopt=Abstract">Link
There are plenty of people out there, who get better with a
prescription for an antidepressant alone, or with the addition of a
course of CBT. However, psychiatrists (those whom I know, anyway)
rarely treat persons represented in that population.
Really, it is more of a proof-of-concept study, showing that
it is reasonable to believe that therapy over the phone is not
that actual psychotherapy is more effective than chatting
with people. It
also reinforces something we already knew: medication management
psychotherapy is better than medication alone. The study
be used to conclude that telephonic psychotherapy is as effective as
psychotherapy, or that telephonic psychotherapy alone (without
management) is effective.
If the idea of telephonic therapy seems strange to you, how about
therapy done by a robot? There’s an article in The New Yorker
that may be of interest:
in technological therapy.
by Jerome Groopman
November 2, 2009
The article is about physical therapy and cognitive rehabilitation, not
psychotherapy, so I won’t comment at length. But
psychotherapy-by-robot may someday be possible. Although it seems
barely comprehensible today, one of my pet hypotheses is that as we get
a few more generations of persons who are are accustomed to electronic
communication, as opposed to face-to-face communication, it may seem