Overview
Interpersonal and Social Rhythm Therapy is an adaptation of Interpersonal Psychotherapy (IPT) for depression, a time-limited treatment that focuses on the bidirectional relationship between mood and life events. IPT also emphasizes strategies to improve social support and relationships. For more information about IPT, please visit the website of the International Society of Interpersonal Psychotherapy (ISIPT).
Social Rhythm Therapy (SRT) was added to IPT to form IPSRT. The SRT component came from clinical experience and research showing a connection between daily routines and mood. A growing body of evidence shows that disturbances in circadian rhythms, the approximately 24-hour biologic processes that control many aspects of physiology, contribute to risk for mood disorders. These intertwined research-based threads contributed to the evolution of IPSRT.
Originally developed as a form of psychotherapy for a single clinician and a single patient, the program has since been adapted to work in several kinds of settings, including inpatient and outpatient groups. In an individual format, IPSRT is commonly administered as weekly sessions lasting 45-60 minutes. Good candidates for IPRST include individuals with bipolar I, bipolar II, or another specified bipolar disorder or with a non-bipolar depressive disorder such as major depressive disorder. While IPSRT can be introduced at any stage of treatment, it is easiest to start the treatment with a patient who is experiencing at least some symptoms. Research implicates disruptions in rhythms in many other health conditions including obesity, cardiovascular disease, and cancer. Although IPSRT has not been tested for these conditions, individuals experiencing these conditions may also find IPSRT techniques to be helpful.
Treatment Implementation
IPSRT is typically administered in four stages. The acute phase of treatment lasts about 20 weeks, with an option for maintenance treatment afterwards. Throughout IPSRT, therapists use tracking tools to monitor and modify patients’ rhythms and relationships. These tracking tools include the Interpersonal Inventory and Social Rhythm Metric, which are available to registered site users.
The clinician gathers information about the patient’s current mood state and prior mood episodes. She explores the behaviors and relationships associated with changes in mood state over time, administers the interpersonal inventory to ascertain the nature and quality of interpersonal relationships, and provides psychoeducation about mood disorders. The clinician and patient agree on a primary interpersonal problem area as the focus of the interpersonal part of the treatment. During the initial phase, the patient is introduced to the Social Rhythm Metric (SRM) as a way to evaluate regularity of their routines. The initial stage work normally occurs over the first several (3-5) sessions of treatment.
During the middle phase of treatment, the clinician helps the patient regulate social rhythms and address the selected interpersonal problem area. The patient completes the SRM every week and reviews it with the clinician at the subsequent visit, developing goals to improve mood and rhythm regularity. Other topics addressed in the intermediate stage include understanding sources of rhythm disruption and exploring the impact that one’s illness has on self-identity (“grief for the lost healthy self”). During the later part of the intermediate phase, IPSRT focuses on building the patient’s confidence and developing skills to manage anticipated shifts in routine such as vacations or job changes.
Toward the end of treatment, the clinician and patient work toward terminating therapy, developing a relapse prevention plan and striving for a ‘good goodbye.’ Termination may occur at the end of acute treatment or be postponed until after the maintenance phase, if indicated.
In the maintenance phase, the patient practices the skills learned during the earlier phase of the program. Sessions change to bimonthly or monthly during the maintenance phase but can return to weekly sessions if needed.
Interpersonal and social rhythm therapy (IPSRT) was conceived in a single day; actually, in a single flash of recognition on July 14, 1990.
