Telephone Versus Face-to-Face Administration of CBT for Depression

描述（由申请人提供）：重度抑郁症（MOD）很常见，12个月的患病率估计在6.6- 10.3%之间。大量文献表明，抑郁症可以通过药物治疗和/或心理治疗得到有效治疗。几项研究发现，如果可以选择，大约三分之二的抑郁症患者更喜欢心理治疗或咨询，而不是抗抑郁药物。虽然心理治疗既有效又令人满意，但在开始和维持心理治疗方面存在各种障碍。在所有接受心理治疗的患者中，只有大约20%的人进行了随访。在那些接受心理治疗的人中，将近一半的人在治疗完成之前就退出了。通过电话进行心理治疗可以克服许多与治疗失败和治疗损耗有关的障碍。最近的一些研究表明，电话治疗在减少抑郁症方面是有效的，为患者所接受，能够将治疗扩展到经历包括残疾在内的重大障碍的患者。此外，与面对面的治疗相比，电话进行的心理治疗可能与低流失率有关。这项研究将比较16周的电话认知行为治疗（T-CBT）干预和16周的面对面认知行为治疗（FtF-CBT）。假设1)与FtF-CBT相比，T-CBT会产生更低的损耗率；2)意向治疗分析将显示，在开始治疗的样本中，T-CBT比FtF-CBT更显著地减少抑郁；3)与T-CBT相关的抑郁的更大减少将完全由损耗率介导。这项研究有可能产生一个手动的T-CBT计划，可以将治疗扩展到许多目前无法获得护理的人群。

DESCRIPTION (provided by applicant): Major depressive disorder (MOD) is common, with 12-month prevalence rates estimated at between 6.6- 10.3%. A large literature has established that depression can be effectively treated using pharmacotherapy and/or psychotherapy. Several studies have found that given a choice, about two-thirds of depressed patients prefer psychotherapy or counseling over antidepressant medication. While psychotherapy is both effective and ostensibly desirable, a variety of barriers exist both to initiating and maintaining psychotherapy. Only about 20% of all patients referred for psychotherapy ever follow-up. Of those who do initiate psychotherapy, nearly half drop out prior to completion of treatment. Administering psychotherapy over the telephone may overcome many barriers associated with failure to initiate treatment and attrition from treatment. A number of recent studies have shown that telephone- administered treatments are effective at reducing depression, well accepted by patients, able to extend treatment to patients who experience significant barriers including disabilities. Furthermore, telephone administered psychotherapies are likely associated with low rates of attrition, compared to treatments delivered face-to-face. This study will compare a 16-week telephone-administered cognitive behavioral therapy (T-CBT) intervention to 16 weeks of face-to-face CBT (FtF-CBT). It is hypothesized that 1)T-CBT will produce lower rates of attrition compared to FtF-CBT, 2) intent-to-treat analyses will show T-CBT to produce significantly greater reductions in depression compared to FtF-CBT, in the sample initiating treatment and 3) the greater reductions in depression associated with T-CBT will be fully mediated by attrition. This research has the potential to produce a manualized T-CBT program that could extend treatment to many populations who are currently unable to access care.