Think back to the last time your daily routine suffered a significant interruption. (With the COVID-19 pandemic turning life upside down, most of us don’t have to reach too far back!) When the rhythm of everyday life is upended, most people naturally become more anxious and less focused. Predictable routines are an important part of what keeps us centered.
For people with mood disorders, keeping up with the routines of daily life and maintaining positive relationships can pose significant challenges. That’s where Interpersonal and Social Rhythm Therapy can help. IPSRT is a research-based intervention that’s designed to help people with mood disorders reduce their symptoms through stabilizing their life routines. In this post, we’ll examine the IPSRT framework to see how it works, look at some of the research behind it, and share how you can become an IPSRT-trained therapist.
What is Interpersonal and Social Rhythm Therapy?
Interpersonal and Social Rhythm Therapy is a form of therapy designed to help those with mood disorders like bipolar I and major depressive disorder to reduce the recurrence of acute symptoms. This form of therapy targets two main areas: the maintenance of consistent, everyday life routines and the cultivation of positive social relationships. The core tenet of IPSRT is that when disruptions to natural and social rhythms combine with sleep deprivation, a more frequent recurrence of acute symptoms can result. Although this form of therapy was originally developed for individual therapy sessions, it has since been broadened to include group sessions in inpatient and outpatient settings. IPSRT is commonly used in combination with a medication regime.
How IPSRT Works
When addressing the interpersonal component, the IPSRT-trained therapist encourages the client to identify how their mood has negatively impacted their work, family, or romantic relationships in the past. The therapist helps the client understand the importance of maintaining a more regimented daily routine by making a direct connection between past, poorly-regulated symptoms and difficulties with maintaining social connections. Moving forward, the therapist works with the client to help improve the health of their social support network and existing relationships.
When addressing the social rhythm component, the therapist and client discuss how daily disruptions in routine can negatively impact mood. People with mood disorders often live lives that are less structured, with wide variations in everyday life routines such as when they go to bed and wake up and when they choose to eat. To address this problem, the therapist works with the client to establish and maintain a regular routine. They also collaborate on how to effectively deal with circumstances that may interrupt the daily routine.
Stages of IPSRT
There are three distinct phases of IPSRT: the initial, intermediate, and final stages. Each focuses on an area where mood and life choices can impact quality of life.
Initial Stage — The focus of the initial stage is on interpersonal relationships. The therapist starts by gathering information about the client’s current and past mood episodes. Together, the therapist and client make between behaviors and relationships and the mood states that the client expressed at that time. They decide on one problematic interpersonal relationship as the focus of this phase of treatment. The initial stage of IPSRT typically lasts for several weeks.
Intermediate Stage — The intermediate stage begins with the client tracking their social rhythm for one week and then discussing the results with the therapist. During this second stage of therapy, the client and therapist collaborate on establishing and maintaining daily routines. They also work on improving the interpersonal relationship identified during the initial stage of therapy. The later sessions of the intermediate stage center on developing strategies for maintaining everyday routines in the midst of a disruptive life event like a job loss or a move. During the intermediate stage, the therapist works with the client to further develop a sense of self-confidence that they can rely on to remain consistent with their new life routines. As the intermediate stage draws to an end, sessions typically begin to transition from weekly to biweekly or monthly.
Final Stage — During the conclusion of therapy, the focus shifts to self-sufficiency as the frequency of the sessions is further reduced, eventually resulting in the termination of therapy.
IPSRT has been studied extensively, and results show that IPSRT appears to be effective at reducing symptoms for those diagnosed with major depressive disorder and bipolar disorder. Here are three revealing studies and their results.
A 2019 study published in The American Journal of Psychotherapy involved participants diagnosed with major depressive disorder. The research examined three areas: if those treated with IPSRT experienced any adverse effects, whether mood symptoms and functioning improved, and whether there was a signal of benefit. Preliminary results after 12 months showed improvements in both mean depressive and functioning scores with moderate to large effect sizes.
A 2020 study in the Annals of General Psychiatry compared two groups of individuals with bipolar disorder. One group received a standard treatment, and the other received an IPSRT intervention. When compared with the control group, those who were treated using IPSRT showed significant improvement in anxious depressive and manic symptoms, overall functioning, and response to mood stabilizers.
An older study published in JAMA Psychiatry compared the effects of treating acute episodes of bipolar disorder with IPSRT and intensive clinical management (ICM). Although there was no measurable difference in the amount of time it took to stabilize a patient after an acute episode, those who received IPSRT experienced a longer period of time between episodes and demonstrated a higher degree of regularity in social rhythms.
The Interpersonal and Social Rhythm Therapy website offers an 8-hour online training course that will provide you with the information you need to begin implementing this intervention with clients. The course includes video interviews with IPSRT experts, tracking tools, and other downloadable resources to help you get started.
IPSRT is a promising intervention for individuals with significant mood disorders. Its dual focus on setting and maintaining healthy routines and developing positive, stable social relationships addresses two areas of critical need for these clients. With research to prove it, this intervention can be effectively used to help individuals with mood disorders lessen the frequency of their acute symptoms.
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