Telephone Cognitive Behavioral Therapy Research Articles

Effects of combined pharmacotherapy and psychotherapy for improving work functioning in major depressive disorder

Major depressive disorder is associated with significant impairment in occupational functioning and reduced productivity, which represents a large part of the overall burden of depression. To examine symptom-based and work functioning outcomes with combined pharmacotherapy and psychotherapy treatment of major depressive disorder. Employed patients with a DSM-IV diagnosis of major depressive disorder were treated with escitalopram 10-20 mg/day and randomised to: (a) telephone-administered cognitive-behavioural therapy (telephone CBT) (n = 48); or (b) adherence-reminder telephone calls (n = 51). Outcomes included the Montgomery-Åsberg Depression Rating Scale (MADRS), administered by masked evaluators via telephone, and self-rated work functioning scales completed online. (Registered at clinicaltrials.gov: NCT00702598.) After 12 weeks, there were no significant between-group differences in change in MADRS score or in response/remission rates. However, participants in the telephone-CBT group had significantly greater improvement on some measures of work functioning than the escitalopram-alone group. Combined treatment with escitalopram and telephone-administered CBT significantly improved some self-reported work functioning outcomes, but not symptom-based outcomes, compared with escitalopram alone.

Evaluation of an Australian primary care telephone cognitive behavioural therapy pilot

A telephone-based cognitive behavioural therapy pilot project was trialled from July 2008 to June 2010, via an Australian Government-funded primary mental health care program. A web-based minimum dataset was used to examine level of uptake, sociodemographic and clinical profile of consumers, precise nature of services delivered, and consumer outcomes. Key informant interviews with 22 project officers and 10 mental health professionals elicited lessons learnt from the implementation of the pilot. Overall, 548 general practitioners referred 908 consumers, who received 6607 sessions (33% via telephone). The sessions were delivered by 180 mental health professionals. Consumers were mainly females with an average age of 37 years and had a diagnosis of depressive and/or anxiety disorders. A combination of telephone and face-to-face sessions of 1h in duration were conducted, delivering behavioural and cognitive interventions, usually with no cost to consumers. Several implementation issues were identified by project officers and mental health professionals. Although face-to-face treatment is preferred by providers and consumers, the option of the telephone modality is valued, particularly for consumers who would not otherwise access psychological services. Evidence in the form of positive consumer outcomes supports the practice of multimodal service delivery.

Telephone-based, cognitive-behavioral therapy for African American dementia caregivers with depression: Initial findings.

Discuss initial findings of a randomized clinical trial comparing the effects of telephone-based and face-to-face (f-to-f) cognitive-behavioral therapy (CBT) on changes in caregiver (CG) burden, assistance support, depression, and health status for African American (AA) CGs with depression. Pilot study using a prepost, two-group design with 14 enrolled and randomized participants. Subjective Burden subscale of the Caregiver Appraisal Inventory, Assistance Support subscale of the Interpersonal Support Evaluation List, Physical Symptoms subscale of the Caregiver Health and Health Behavior Inventory and the Center for Epidemiologic Studies Depression Scale. Prepost improvements were found on 11 completers across all measures for both telephone and f-to-f CBT. Moderate and similar effects sizes for CG subjective burden and assistance support were found for both the telephone and f-to-f groups. Effect sizes for physical symptoms and depression varied from low to moderate, respectively, with a trend toward smaller improvements in f-to-f CBT than in telephone CBT. Qualitative analysis highlighted CGs' perceptions of the active ingredients of treatment and provided indirect support for similar gains in emotional and psychosocial functioning across the two treatment modalities. Both telephone-based and f-to-f CBT showed improvements in depression, subjective burden, and assistance support in dementia AA CGs. Replication with a larger sample size (N = 106) is currently in progress. Study limitations and future directions for research are also addressed.

Building a community-academic partnership: implementing a community-based trial of telephone cognitive behavioral therapy for rural latinos.

Concerns about the appropriate use of EBP with ethnic minority clients and the ability of community agencies to implement and sustain EBP persist and emphasize the need for community-academic research partnerships that can be used to develop, adapt, and test culturally responsive EBP in community settings. In this paper, we describe the processes of developing a community-academic partnership that implemented and pilot tested an evidence-based telephone cognitive behavioral therapy program. Originally demonstrated to be effective for urban, middle-income, English-speaking primary care patients with major depression, the program was adapted and pilot tested for use with rural, uninsured, low-income, Latino (primarily Spanish-speaking) primary care patients with major depressive disorder in a primary care site in a community health center in rural Eastern Washington. The values of community-based participatory research and community-partnered participatory research informed each phase of this randomized clinical trial and the development of a community-academic partnership. Information regarding this partnership may guide future community practice, research, implementation, and workforce development efforts to address mental health disparities by implementing culturally tailored EBP in underserved communities.

Self-help therapy and recovery in psychosis: methodological considerations and service user involvement in a partially randomised preference trial

A new Recovery Guide for people with experience of psychosis has been developed (Barrowclough et al, 2009), drawing on existing cognitive behavioural interventions and founded on collaborations between service users, psychologists, researchers and healthcare professionals. This poster showcases the involvement of ‘experts by experience’ in the design, delivery and evaluation of this Recovery Guide, and the therapeutic structure that supports its use. The project has input from service users by various methods, including service user researchers, a service user reference group and service user consultants. Previous work has highlighted the strong and rational preferences that people experiencing psychosis hold about their potential treatment options (Gerrard et al, 2009); service users were presented with detailed information about the Recovery Guide and about different levels of therapeutic intervention to support it (low support= telephone cognitive behavioural therapy; high support= as low support, plus group sessions facilitated by a cognitive behavioural therapist and service user researcher). Findings revealed that most would be willing to take part in a trial of psychological treatments, whether as participants receiving extra therapeutic support or receiving treatment as usual only and assisting with the progress of the research. Participants also held strong feelings about which option they would prefer to receive. Participant preferences of this kind have not been taken into account in previous psychological treatment trials for psychosis. The poster describes the trial currently being implemented to evaluate the Recovery Guide; STAR-T (Self-help Therapy and Recovery-Trial), is an NIHR-funded preference trial in which participants can elect to join their treatment option of choice, or be randomly allocated to a condition. The trial emphasises the value of choice for people experiencing psychosis, and the poster will also discuss the methodological considerations necessary to support such a preference trial. The trial also benefits from the involvement of two service user researchers, who have personal experience of psychosis, and a panel of service user consultants. The ways in which this input has helped shape the design, implementation and evaluation of the trial will be outlined.

Cognitive Behaviour Therapy for Chronic Fatigue Syndrome in Adults: Face to Face versus Telephone Treatment - A Randomized Controlled Trial

Previous research has shown that face to face cognitive behaviour therapy (CBT) is an effective treatment for chronic fatigue syndrome (CFS)/Myalgic Encephalomyelitis (ME). However, some patients are unable to travel to the hospital for a number of reasons. The aim of this study was to assess whether face to face CBT was more effective than telephone CBT (with face to face assessment and discharge appointment) for patients with CFS. Patients aged 18-65 were recruited from consecutive referrals to the Chronic Fatigue Syndrome (CFS) Research and Treatment Unit at The South London and Maudsley NHS Trust in London. Participants were randomly allocated to either face to face CBT or telephone CBT by a departmental administrator. Blinding of participants and care givers was inappropriate for this trial. A parallel-groups randomised controlled trial was used to compare the two treatments. The primary outcomes were physical functioning and fatigue. Significant improvements in the primary outcomes of physical functioning and fatigue occurred and were maintained to one year follow-up after discharge from treatment. Improvements in social adjustment and global outcome were noted and patient satisfaction was similar in both groups. Results from this study indicate that telephone CBT with two face to face appointments is a mild to moderately effective treatment for CFS and may be offered to patients where face to face treatment is not a viable option. Despite these encouraging conclusions, dropout was relatively high and therapists should be aware of this potential problem.

Clinical complexity and the effectiveness of an intervention for depressed diabetes patients

In a trial completed in 2010, US patients with diabetes and depression were randomized to usual care or telephone cognitive behavioural therapy that emphasized physical activity. Twelve-month intervention effects were observed for blood pressure, depression, and pedometer-measured step-counts. This study examined variation in intervention effects across patient subgroups defined by a measure of clinical complexity. Three groups of patients were identified at baseline using the Vector Model of Complexity that recognizes socioeconomic, biological, behavioural, and other determinants of treatment response. Complexity-by-intervention interactions were examined using regression models. Intervention effects for blood pressure, depression, and step-counts differed across complexity levels (each p < 0.01). Effects on Beck Depression Inventory scores were greater in the low-complexity group (-8.8) than in the medium- (-3.2) or high-complexity groups (-2.7). Physical activity effects also were greatest in the low-complexity group (increase of 1498 steps per day). In contrast, systolic blood pressure effects were greater among intervention patients with high complexity (-8.5 mmHg). This intervention had varying impacts on physical and mental health depending on patients' clinical complexity. Physical activity and depressive symptom gains may be more likely among less complex patients, although more complex patients may achieve cardiovascular benefits through decreased blood pressures.

A Randomized Trial of Telephonic Counseling Plus Walking for Depressed Diabetes Patients

Patients with diabetes and depression often have self-management needs that require between-visit support. This study evaluated the impact of telephone-delivered cognitive behavioral therapy (CBT) targeting patients' management of depressive symptoms, physical activity levels, and diabetes-related outcomes. Two hundred ninety-one patients with type 2 diabetes and significant depressive symptoms (Beck Depression Inventory scores ≥ 14) were recruited from a community-based, university-based, and Veterans Affairs health care systems. A manualized telephone CBT program was delivered weekly by nurses for 12 weeks, followed by 9 monthly booster sessions. Sessions initially focused exclusively on patients' depression management and then added a pedometer-based walking program. The primary outcome was hemoglobin A1c levels measured at 12 months. Blood pressure was a secondary outcome; levels of physical activity were determined by pedometer readings; depression, coping, and health-related quality of life were measured using standardized scales. Baseline A1c levels were relatively good and there was no difference in A1c at follow-up. Intervention patients experienced a 4.26 mm Hg decrease in systolic blood pressure relative to controls (P=0.05). Intervention patients had significantly greater increases in step counts (mean difference, 1131 steps/d; P=0.0002) and greater reductions in depressive symptoms (58% remitted at 12 mo vs. 39%; P=0.002). Intervention patients also experienced relative improvements in coping and health-related quality of life. This program of telephone-delivered CBT combined with a pedometer-based walking program did not improve A1c values, but significantly decreased patients' blood pressure, increased physical activity, and decreased depressive symptoms. The intervention also improved patients' functioning and quality of life.

Telephone-delivered cognitive behavioural therapy: a systematic review and meta-analysis

Telephone-delivered cognitive behavioural therapy (CBT) is an increasingly popular mode of delivering care. We conducted a systematic review which focused on physical health outcomes. Literature searches were conducted to identify randomized controlled trials (RCTs) comparing telephone-delivered CBT for improving physical health with any other therapy or routine care in patients with chronic illness. Eight RCTs (1093 patients) met the eligibility criteria and were included in the review. Six of the eight RCTs compared the telephone intervention with routine care, one trial employed symptom monitoring as the control condition and the final trial compared telephone CBT to telephone supportive emotion-focused therapy. Meta-analysis found that telephone-delivered CBT significantly improved physical health in people with chronic illness (d = 0.225, 95% CI = 0.105, 0.344). Moderator analyses found that less therapist contact was associated with better outcomes, and telephone-delivered CBT was more effective for chronic illnesses that are not immediately life-threatening. The results of the meta-analysis support the use of telephone-delivered CBT as a tool for improving health in people with chronic illness. There is a need for future trials to evaluate cost-effectiveness.

Improving health and productivity of depressed workers: a pilot randomized controlled trial of telephone cognitive behavioral therapy delivery in workplace settings

Objective To examine the feasibility of telephone-delivered cognitive behavioral therapy (T-CBT) in an occupational context, with reference to participant recruitment, treatment adherence, follow-up and effect. Method Eligible participants comprised all employees of a large communications company with authorized work absence due to mild/moderate mental health difficulties over a 10-month period. Fifty-three consenting participants were centrally randomized to 12 weeks T-CBT or usual care, with minimization on age, gender and illness severity. Primary (symptom severity) and secondary outcomes (self-rated work performance and productivity) were measured at baseline and 3-months via postal questionnaires. Intention-to-treat analysis comprised multiple regression modeling with adjustment for missing response predictors, minimization variables and baseline values. Results Twenty-three employees attended one or more T-CBT sessions. T-CBT was associated with medium–large effects sizes on clinical outcomes (0.63–0.77) and work productivity scores (0.75–0.88). Twenty-one patients failed to return 3-month primary outcome data. Non-respondents were more likely to be male and more severely ill. Conclusion Delivery of T-CBT in an occupational context is feasible with evidence of potential effect. Larger-scale trials are warranted. These studies demand assertive outreach or telephone-based assessment strategies in order to maximize participant recruitment and follow-up.

A Pilot Study of Telephone Cognitive-Behavioural Therapy for Obsessive-Compulsive Disorder in Young People

Cognitive-behaviour therapy (CBT) is the recommended psychological treatment for obsessive compulsive disorder (OCD) in young people. Access to CBT may be limited by a number of factors, including lack of trained therapists, and geographic or financial factors preventing access to a specialized service. Telephone delivery of CBT represents one way of overcoming some of these accessibility issues. This pilot study describes outcomes for a telephone-based cognitive-behavioural treatment for obsessive-compulsive disorder (OCD) in young people. Ten participants, aged 13 to 17 years, and their parents received up to 16 sessions of telephone CBT (TCBT). Measures of OCD symptoms were obtained using multiple informants and a repeated measures design. Assessments were conducted at pre-treatment, post-treatment, and at 6- and 12-month follow-up. Improvements were found for OCD symptoms across all informants. Family satisfaction with treatment over the telephone was high. The findings suggest that TCBT is a clinically effective, feasible and acceptable means of service delivery that offers the potential to make CBT a more accessible treatment for young people. TCBT requires further evaluation in randomized, controlled trials to compare effectiveness with face-to-face CBT, which currently represents the usual care model.

TELEPHONE COGNITIVE BEHAVIOUR THERAPY FOR CHRONIC FATIGUE SYNDROME IN SECONDARY CARE: A CASE SERIES

Four randomized controlled trials have shown out-patient cognitive behaviour therapy reduces fatigue and disability in people suffering from chronic fatigue syndrome (CFS). However, some patients referred to Kings College Hospital, London are unable to attend regular appointments. We therefore developed a self-help treatment manual using cognitive-behavioural principles for patients to use at home with telephone contact with a therapist. Nine consecutive patients with a diagnosis of CFS who were unable to attend regular out-patient appointments used this self-help treatment approach at home. The therapist (MB) carried out a face-to-face assessment at the hospital. Subsequently, patients had fortnightly telephone appointments to discuss their progress, plan and discuss their homework and any problems. Outcome was evaluated using measures of functional impairment, fatigue, mood and general health before and after treatment and at 3 and 6-month follow-up. Eight patients completed treatment. Functional impairment, fatigue and general health improved at discharge and gains were maintained at 6-month follow-up. Self-treatment at home guided by a manual with fortnightly telephone sessions was helpful in the treatment of patients with chronic fatigue syndrome. A randomized controlled trial is underway to compare telephone cognitive behaviour therapy with out-patient cognitive behaviour therapy. Patients with other conditions such as chronic pain who are unable to travel for regular appointments may benefit from a home-based treatment package involving therapist contact by phone.