TELEPHONE THERAPY FOR DEPRESSION IS NO JOKE - IT REALLY HELPS

Although treatment for major depression significantly raises the odds for recovery and speeds recovery time, less than half of all people suffering from major depression get treatment. If their reasoning is that their case of the blues will go away on its own, they’re mistaken. Left untreated depression can worsen and even become chronic with devastating effects on one’s relationships and one’s employment. The longer an episode of depression lasts the higher the toll exacted on your brain and body by elevated stress hormone levels. Untreated depression can cause brain shrinkage in healthy people. It produces worse outcomes in heart patients and cancer patients. It is associated with higher risk of dementia and higher rates of mortality from suicide and accidents in the elderly.

So why don’t more people seek treatment for their depressive episode? Conventional treatment consists of in-person visits to a psychotherapist and anti-depressant medication. According to psychologist Steve Tutty, Ph.D. and his colleagues at Brigham Young University, conventional treatment puts up certain barriers which discourage some patients from getting treated. These barriers are: the lost time, financial costs, schedule disruption and inconvenience associated with traveling from one’s job or home to the appointment and back; the stigma from having to disclose one’s illness to people who ask where you’re going and why; fear of medications and problems with medication side effects. Because of this less than half of all patients receive the required level of anti-depressant medication or even follow through on their first patient appointment.

A generation ago different psychologists counseling patients with major depression were using different methods. Some were using a behavior change model in which the goal was to encourage healthy, adaptive behaviors and discourage unhealthy, maladaptive behaviors. Behavior change therapists talked to patients about the feelings they experienced in connection with certain behaviors. This sort of therapy relied somewhat heavily on the establishment of a positive, trusting, personal relationship between the patient and his therapist.

Other therapists were using cognitive-behavioral therapy (CBT) in which the focus of treatment was to change the patient’s thinking to help him unlearn unwanted reactions to life’s events. CBT is based on the premise that our thoughts cause our feelings and behaviors. The goal is to get patients to spot and defuse defeatist thinking which renders them helpless and increases depression, while increasing the use of realistic thinking which enables them to tolerate life’s frustrations and disappointments without becoming depressed.

CBT is built on an educational model and is highly instructive in nature. The therapist provides the patient with a workbook and gives him homework assignments. CBT is not open-ended. There is a typically a set number of sessions. The therapist has specific concepts and techniques to teach the patient at each session. The total time for a course of CBT is rather brief compared to other therapies. Because it relies on teaching and learning CBT is more portable than other therapies, and is much better suited for the telephone. Prior to 2009 some researchers had published studies showing that teletherapy with CBT was valuable as an adjunct to treatment with anti-depressant medications, but there had not been a study demonstrating the effectiveness of teletherapy using CBT as a stand-alone treatment.

In 2009 Dr. Tutty and his colleagues at BYU (Diane L. Spangler, Ph.D. and Landon E. Poppleton, Ph.D.) undertook a study funded by the National Institute of Mental Health to ascertain the effectiveness of telephone therapy using a pure CBT approach to treating major depression, see Evaluation the Effectiveness of Cognitive-Behavioral Teletherapy in Depressed Adults, Behavior Therapy 41 (2010) 229-236. For the study they recruited thirty adults with major depression who had presented at a local, out-patient mental health clinic and who expressed a willingness to try stand-alone telephone therapy using CBT after the clinic therapist explained all the treatment options. These people were intrigued by the idea of trying a low cost alternative to traditional treatment that they could utilize without leaving their home or office at times convenient to them.

The patients ranged in age from 18-65. None were psychotic, bi-polar or suicidal. None had taken anti-depressant medication within the past six months. Each patient was diagnosed with major depression at baseline by the clinic therapist using a Structured Clinical Interview for the DSM-IV and by a twenty item checklist for depressive symptoms. The patients were evaluated again using the same methods at three months and six months after the initial baseline assessment. Each participant received eight 30 minute core sessions of CBT over the phone delivered weekly followed by two 30 minute booster sessions delivered at thirty day intervals thereafter. Phone sessions cost $40 each which is a good bit lower than the $92 average cost of an in-person visit to a therapist in Utah.

At the end of the study six months after it began 42% of the patients were recovered, 69% of the participants said they were “very satisfied” with the treatment they had received, and 88% showed a clinically significant reduction in symptoms (i.e. a reduction of symptoms greater than 50%).While prior studies showed a 50% recovery rate for in-person CBT a 42% rate for teletherapy was rather good, considering that teletherapy may increase the participation rate of depressed people who might not otherwise seek care. Although there is always a risk of relapse for any patient who achieved full symptom remission after treatment, Dr. Spangler says CBT is significantly more effective at reducing relapse of depression than other therapies.

The BYU research team felt the study had demonstrated many pluses for stand-alone teletherapy using CBT for adults with major depression. It showed a good recovery rate (close to that achieved by in-person CBT). It preserved the patient’s privacy. It gave patients convenience by allowing them to get treated over the phone at flexible times including evenings and weekends. Phone treatment gave them direct access to their therapist. They did not have to travel across town or wait in a waiting room. Most of the patients liked the structured approach in which they got to use a workbook at home.

Why Teletherapy May be Useful for Lawyers with Major Depression

Lawyers are notorious grinds who get stuck in their offices. They are constantly postponing or cancelling appointments with other people for fun things like lunch, golf, tennis, a movie or attending a baseball game. They do the same thing when it comes to self-care whether it’s seeing the dentist for a teeth cleaning, getting a colonoscopy when they hit fifty, getting a prostate exam (for men) or a mammogram (for women) or even seeing their accountant to bring some order to their messy finances. The press of business (signing up new clients, cranking out briefs and motions, getting ready for trials and the like) is too strong. It’s like a powerful undertow at the beach. They even work nights and weekends when they would be better off spending time with their spouses and kids.

When lawyers get depressed they don’t like the feeling of feeling weak, of admitting they feel weak to a living soul, of having other people know they’re depressed and damaging their reputation for toughness or of having to rely on the help of another person to feel better. This set of discomforts makes it all too easy to justify not seeking treatment because there’s so much work to do at the office and so many pressing deadlines to meet. That way they never have to drive to a therapist’s office, find a place to park and then sit in a waiting room where, God forbid, someone they know might walk in.

Given the situation, the idea of doing teletherapy from the privacy of one’s own office during the workday at a flexible time that doesn’t interfere with your work seems like a very good one. Core sessions of CBT take only 30 minutes and can be extended, if need be, if there are questions. This technique promises effective, low cost care with the added benefits of privacy, convenience and minimal disruption of your schedule. The authors of the study are not saying that stand-alone teletherapy should replace or will replace in-person psychotherapy which creates a personal relationship between therapist and patient. What they are saying is that for people who find it too stigmatizing, too inconvenient or too costly to see a therapist in person, it’s far, far better to do phone therapy than go without treating your major depression.

Are you one of those lawyers who has tried to conceal his symptoms of major depression and who has made all kinds of excuses to avoid getting treatment? Are you telling yourself and your spouse that you’re just too busy at the office to see a shrink? Please compare the potential treatment benefits of teletherapy to the likely harms of doing nothing to treat your major depression. Isn’t it a no-brainer that you’re better off seeking out teletherapy? Please don’t put it off. Your health, your career, your marriage, your relationship with your kids, and more, all depend on you getting treatment as soon as possible. Don’t let the punitive, self-critical voice of depression coerce you to avoid care and keep suffering. Start taking good care of yourself today. You will be ever so glad you did, and so will your family and your law colleagues. You’re worth it.