Interpersonal and Social Rhythm Therapy for Bipolar Disorder (IPSRT)
Interpersonal psychotherapy for bipolar disorder (IPSRT) is conceptualized as a prophylactic intervention. Although it can be initiated either during the acute treatment of an episode or once stabilization has occurred, its primary goal is the prevention of subsequent episodes.
There are likely to be three paths to recurrence in bipolar patients maintained on lithium carbonate: 1) lithium noncompliance; 2) stressful life events; and 3) disruptions in social rhythms. IPSRT specifically addresses each of these potential pathways to new episodes of illness. By providing, in addition to standard medication compliance training, a forum in which the patient can explore his or her individual feelings about the disorder, grieve for the lost healthy self and come to terms with how the disorder has altered his or her life, IPSRT reduces denial and increases acceptance of the life-long nature of the illness and its never-to-be-underestimated propensity to recur.
By addressing interpersonal problem areas in the patient's life, IPSRT attempts to reduce the number and severity of interpersonally-based stressors the patient experiences. By paying careful attention to the regularity of daily routines (both the timing of events and the amount of stimulation they produce) and the extent to which both positive and negative life events may influence these daily routines (i.e., social rhythms), IPSRT increases the regularity of patients' lives and their vigilance with respect to maintaining that stability.
In contrast to both IPT and IPT-M, IPSRT places considerably more emphasis on the management of symptoms, and this emphasis persists throughout all phases of treatment. It does so through a focus on the patient's social rhythms and how these rhythms affect and are affected by the course of the bipolar patient's symptoms and his interpersonal stress. In addition, IPSRT broadens various aspects of grief work, interpersonal disputes, role transitions and interpersonal deficits to more directly meet the needs of the bipolar I patient. Finally, the therapy constantly explores the interaction among changes in the interpersonal realm, changes in social rhythms and symptomatic changes.
The primary difference between IPSRT and any of the forms of IPT used with unipolar patients (e.g. IPT, IPT-M, IPT-LLM) is in the manner in which affective symptoms are managed. Because of the episodic, recurring nature of bipolar illness, the therapist must remain constantly attentive to the symptom management aspects of the therapy, never assuming that the patient's social rhythms have been stabilized to the point where vigilance in this area is no longer required.
Therapists familiar with the use of IPT in either the acute or maintenance treatment of unipolar patients will find that many of the skills needed for conducting IPSRT are similar to the techniques outlined in the original IPT manual and in the Klerman et al., (1984) book. The four problem areas of IPT (grief, role transitions, role disputes and interpersonal deficits) remain as the focus of interpersonal work. While certain features of these problem areas differ in the lives of bipolar patients, the techniques and strategies which the therapist employs are essentially the same as those used with unipolar patients.