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David C. Mohr, PhD; Stacey L. Hart, PhD; Laura Julian, PhD; Claudine Catledge, MA; Lara Honos-Webb, PhD; Lea Vella, MPH; Edwin T. Tasch, MD

Arch Gen Psychiatry. 2005;62:1007-1014.

Background  Several studies have shown that telephone-administered cognitive-behavioral therapy (T-CBT) is superior to forms of no treatment controls. No study has examined if the skills-training component to T-CBT provides any benefit beyond that provided by nonspecific factors.

Objective  To test the efficacy of a 16-week T-CBT against a strong control for attention and nonspecific therapy effects.

Design  Randomized controlled trial including 12-month follow-up.

Setting  Telephone administration of psychotherapy with patients in their homes.

Participants  Participants had depression and functional impairments due to multiple sclerosis.

Interventions  A 16-week T-CBT program was compared with 16 weeks of telephone-administered supportive emotion-focused therapy.

Main Outcome Measures  Hamilton Depression Rating Scale score, Structured Clinical Interview for DSM-IV diagnosis of major depressive disorder, Beck Depression Inventory score, and Positive Affect scale score of the Positive and Negative Affect Scale.

Results  Of the 127 participants randomized, 7 (5.5%) dropped out of treatment. There were significant improvement during treatment on all outcome measures (P<.01 for all) and an increase in Positive Affect Scale score. Improvements over 16 weeks of treatment were significantly greater for T-CBT, compared with telephone-administered supportive emotion-focused therapy, for major depressive disorder frequency (P = .02), Hamilton Depression Rating Scale score (P = .02), and Positive Affect Scale score (P = .008), but not for the Beck Depression Inventory score (P = .29). Treatment gains were maintained during 12-month follow-up; however, differences across treatments were no longer evident (P > .16 for all).

Conclusions  Patients showed significant improvements in depression and positive affect during the 16 weeks of telephone-administered treatment. The specific cognitive-behavioral components of T-CBT produced improvements above and beyond the nonspecific effects of telephone-administered supportive emotion-focused therapy on evaluator-rated measures of depression and self-reported positive affect. Attrition was low.

Author Affiliations: Veterans Administration Medical Center, University of California, San Francisco (Drs Mohr, Hart, Julian, and Honos-Webb and Mss Catledge and Vella); and Kaiser Permanente Medical Care Group of Northern California, Santa Clara (Dr Tasch).

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