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

描述(申请人提供)：严重抑郁障碍(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，表面上也是可取的，但启动和维持心理治疗存在各种障碍。在所有接受心理治疗的患者中，只有大约20%的人曾进行过随访。在那些确实开始心理治疗的人中，近一半在治疗完成前就退出了。通过电话进行心理治疗可能会克服许多障碍，这些障碍与未能启动治疗和治疗过程中的磨擦有关。最近的一些研究表明，电话治疗在减少抑郁方面是有效的，被患者很好地接受，能够将治疗扩展到经历重大障碍的患者，包括残疾。此外，与面对面提供的治疗相比，电话管理的心理治疗可能与低磨损率相关。这项研究将比较为期16周的电话管理认知行为疗法(T-CBT)干预和16周面对面CBT(FTF-CBT)干预。假设1)T-CBT将比FTF-CBT产生更低的磨损率，2)意向治疗分析将显示，在开始治疗的样本中，T-CBT比FTF-CBT显著更大地减少抑郁症，以及3)与T-CBT相关的更大程度的抑郁症的减少将完全由磨耗调节。这项研究有可能产生一种机械化的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.