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Good release on CBT/anxiety missed on cost/comparison info

Telephone-Based Cognitive Behavioral Therapy for Anxiety in Rural Older Adults

Our Review Summary

Loneliness in old ageThe news release reports on the outcome of a randomized clinical trial testing how well telephone-based therapy can be used for older rural patients experiencing general anxiety disorder.  It’s an interesting and important topic.  The release would have been improved significantly with just a few more details.

 

Why This Matters

The research paper points out that generalized anxiety disorder “is one of the most common anxiety disorders in older adults” and is “associated with poor quality of life, increased health care utilization, impaired memory, and potentially increased morbidity and mortality.”  Those issues can be amplified by life in rural communities where psychological care can be scarce.  Older adults can be more prone to these issues based on their physical isolation.  So if therapy could be effectively delivered via telephone, adults facing these challenges might be more readily helped.

Criteria

Does the news release adequately discuss the costs of the intervention?

Not Satisfactory

At no point in the release was cost mentioned.  Psychotherapy and counseling can be costly, especially for the elderly on fixed incomes.  Readers would be well-served with some estimate of the costs of the services provided through this trial.  Also, a mention of a comparison between the costs of office visits for such therapy versus that delivered via telephone would be useful to give readers a fuller picture of the practical potential for this approach. Medicare requires in person contact for payment.  That’s why the cost issue is important in this case. We think news releases can and should address these matters.

Does the news release adequately quantify the benefits of the treatment/test/product/procedure?

Not Satisfactory

The release fails to give readers any indication of the degree of differences between the two approaches tested, and falls back on simply saying that X “was superior to” Y and “resulted in a greater reduction of symptoms.”  Without any numerical values being offered, readers can’t gauge for themselves the value of one approach over the other. It’s difficult to gauge the clinical effectiveness versus the statistical differences.  It would have been helpful to compare the degree of reduction of symptoms with office-based therapy, and drug treatment.  Journal news releases can help educate journalists and all readers by quantifying potential benefits – and by reinforcing the expectation in readers that such information should be provided

Does the news release adequately explain/quantify the harms of the intervention?

Not Applicable

The release mentioned no possible harms from this approach, although in fairness, supportive telephone conversations are unlikely to carry much risk.   However, we wonder about situations where the telephone therapy sessions may not detect some problems that might surface during a face-to-face consultation.

Does the news release seem to grasp the quality of the evidence?

Satisfactory

The study itself used accepted psychological assays to gauge participants’ degree of GAD, and relied on self-reports by participants to determine any improvements following therapies.  All of these are subjective by nature, rather than empirical and some reference to that would have been useful.  Rather than saying, “there was greater decline in worry severity,” the release more accurately could have said “participants reported” a greater decline to remind reads of the caveats to the findings.

The authors of the journal article also made the point that their results could be regression to the mean.

Nonetheless, we’ll rate this satisfactory because of the details that were provided.

 

Does the news release commit disease-mongering?

Satisfactory

The release does not demonstrate disease mongering.

Does the news release identify funding sources & disclose conflicts of interest?

Satisfactory

An end note points out that this study was funded by the National Institute of Mental Health.  There was no indication of any conflicts of interest.

Does the news release compare the new approach with existing alternatives?

Satisfactory

The release points out that the study focuses on older adults living in rural settings where psychotherapy may be unavailable.  It also points out that older adults may prefer psychotherapy over medications.  We wonder about other approaches to address loneliness in the elderly, especially in rural areas, that could improve a person’s quality of life.

 

Does the news release establish the availability of the treatment/test/product/procedure?

Satisfactory

Since the telephone is ubiquitous in modern life, one assumes that such a program as explained in this clinical trial could be available in short notice, assuming financial support for the project.

Does the news release establish the true novelty of the approach?

Satisfactory

Telephone-based support programs are not new and the release makes no claims that the approach is necessarily novel.  It specifically says that it “is one way to overcome some barriers to mental health treatment.”

Does the news release include unjustifiable, sensational language, including in the quotes of researchers?

Satisfactory

The release does not appear to use any unjustifiable language.

But, on a side note about language, the release never defined “non directive supportive therapy,” which is what the comparison group received.  Many journalists – and general public readers – might not know what that means and would benefit from a one line definition.

Total Score: 7 of 9 Satisfactory

Comments (1)

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LS

August 10, 2015 at 2:57 pm

Making phone contact with an older person suffering from anxiety (and possibly loneliness) is helpful in and of itself because any positive conversation interrupts their usual negative thought pattern. However, to help a client change the way they approach anxiety in the future (long term goal) there has to be mutual trust requiring the therapist practicing CBT and the client form a bond. It’s extremely difficult to assess mood or know when a good connection has been established without “being in the room” with the client. Working at a distance forces an abridged counseling structure on the participants. Not having the opportunity to notice a client’s shifting body language, a momentary change in facial affect or nervous habits is the limitation of phone counseling and has to be acknowledged as a reason that anxiety probably won’t be resolved entirely through phone conversations.

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