Publication year
2011
Citation Title
Telephone-administered cognitive behavioral therapy for veterans served by community-based outpatient clinics.
Journal Name
Journal of Consulting and Clinical Psychology
Journal Volume
79
Issue Number
2
Page Numbers
261-265
DOI
10.1037/a0022395
Summary
The effectiveness of telephone-administered cognitive behavioral therapy (T-CBT) was examined for U.S. Veterans who screened positive for depression and were served by community-based outpatient clinics. A randomized controlled trial was used to determine differences between Veterans who received telephone-administered cognitive behavioral therapy and those who received treatment as usual (i.e., care through community-based outpatient clinics, but not formalized intervention or therapeutic plan).
Key Findings
Among veterans who received treatment, telephone-administered cognitive behavioral therapy did not result in significantly lower depressive symptoms over time.
Veterans in the control group received little psychological care compared to the Veterans in the treatment group.
There were no difference in the depressive symptoms of Veterans in the control group and those who received telephone-administered cognitive behavioral therapy.
Implications for Program Leaders
Enhance education, activities, and curriculum related to coping behaviors and dealing with depressive symptoms
Disseminate information regarding possible symptoms of mental health problems Service members may face after deployment and where individuals and families can find help for those problems
Consider validated tele-health services and resources to reach Service members and their families who live far from installations or traditional resources (e.g., hospitals or clinics)
Implications for Policy Makers
Continue to support innovative research on interventions that are effective at treating depression among Service members and their families
Promote reintegration programs that include attention to assisting Service members’ family in adjusting to the Service member’s return
Recommend training for community providers to educate them about unique factors that contribute to depression for military couples
Methods
Veterans were recruited from community-based outpatient clinics through Veterans Affairs (VA) hospitals.
Veterans who screened positive for depression were randomly assigned to receive telephone-administered cognitive behavioral therapy versus treatment as usual.
Veterans were assessed at baseline, 12 weeks, and 20 weeks (end of treatment).
Participants
Eighty-five Veterans (41 in telephone-administered cognitive behavioral therapy and 44 in comparison group) with a mean age of 55.9 years participated in the study.
The majority of participants were White (79%) and male (91%).
Most participants were married or co-habitating (52%) and the average education level was 14.37 years (SD = 2.90 years).
Limitations
Participants who chose to participate may differ in meaningful ways from those participants who did not participate, and this potential difference was not accounted for in the analyses.
The small sample size limits the generalizability of the findings.
The methodology included random assignment; while the researchers assessed differences between groups, this may not fully account for the possible effect of other factors such as co-morbidity (other than PTSD) and behavioral health history.
Avenues for Future Research
Replicate this study with a more diverse patient sample, including more women and racial/ethnic minorities
Explore if telephone-administered cognitive behavioral therapy is effective among younger Service members and/or those serving in the current conflicts
Examine factors that may contribute to Service members being less responsive to telephone-administered cognitive behavioral therapy compared to other populations
Focus
Multiple Branches
Target Population
Population Focus
Military Branch
Military Component
Abstract
Objective: Multiple trials have found telephone-administered cognitive behavioral therapy (T-CBT) to be effective for the treatment of depression. The aim of this study was to evaluate T-CBT for the treatment of depression among veterans served by community-based outpatient clinics (CBOCs) outside of major urban areas. Method: Eighty-five veterans meeting Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994) criteria for major depressive disorder were randomized to receive 16 sessions of T-CBT over 20 weeks or treatment as usual through the CBOC. Veterans were assessed at baseline, 12 weeks, 20 weeks (posttreatment), and 6-month follow-up using the Hamilton Depression Rating Scale (Hamilton, 1960), the Patient Health Questionnaire–9 (Kroenke, Spitzer, & Williams, 2001), and a standardized psychiatric interview. Results: There were no significant Time × Treatment effects (ps > .20). Patients were compliant, with 38 (92.7%) completing at least 12 sessions, and 32 (78.0%) having no missed sessions whatsoever. Ratings of audiotaped sessions showed the therapists to be highly competent. Conclusions: This trial yielded negative results for an intervention that has been shown to be effective under other circumstances. We speculate that veterans served within the Veterans Affairs system are more refractory to treatment than other populations, and they may require a more rigorous intervention.
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