Interpersonal and Social Rhythm Therapy (IPSRT), based on Interpersonal Psychotherapy (IPT), is an evidence-based psychotherapy for individuals suffering from bipolar disorder. Developed by Ellen Frank, Ph.D. and colleagues at the University of Pittsburgh, this treatment combines a behavioral approach to increasing the regularity of daily routines (social rhythms) with an interpersonal approach to coping with the stresses of bipolar illness itself, with interpersonal life stress and with social role problems. Refinements and adaptations include IPSRT for bipolar II disorder (Swartz et al.), group IPSRT (Swartz et al.), IPSRT for youth with bipolar disorder (Hlastala et al.), IPSRT for high risk offspring of parents with bipolar disorder (Goldstein et al.), and an online version of IPSRT (Swartz et al.).
Origins of Interpersonal and Social Rhythm Therapy
An instability model of bipolar I disorder assumes that individuals with bipolar disorder are fundamentally (biologically) vulnerable to disruptions in circadian rhythms. It posits that for biologically at-risk individuals, recovery from even slight perturbations in schedules is difficult. While those who do not possess this vulnerability can relatively quickly “rebound” from external threats to their circadian integrity, individuals with mood disorders quickly move from mild circadian variations to maladaptive patterns which then potentially lead them from euthymia to mood episodes. For instance, when an individual misses a night of sleep because they are working late to complete a work deadline, they experience disturbances in their circadian integrity. In individuals without mood disorders, this disturbance is transient and easily corrected by a night or two of restorative sleep. In contrast, an individual with bipolar disorder is very sensitive to these changes and is likely to be unable to return to a regular pattern of sleep without considerable effort. After a several nights of disturbed sleep, this individual is at much higher risk for episode recurrence. A direct consequence of this model is the hypothesis that helping patients learn to lead more orderly lives should promote circadian integrity and thereby improve symptomatic outcomes. IPSRT was developed in response to this hypothesis.
IPSRT was built on the idea that helping patients to regulate social rhythms and to more effectively manage their interpersonal relationships will help vulnerable individuals reduce the risk of developing both depressive and (hypo)manic mood symptoms. IPSRT fuses three distinct strategies, interpersonal psychotherapy, psychoeducation, and social rhythm therapy, to accomplish these goals. The therapist moves seamlessly among the strategies, according to the particular needs of the patient at the time
Social Rhythm Metric
The backbone of Social Rhythm Therapy is the Social Rhythm Metric (SRM). The SRM is a pencil and paper assessment that patients complete each week to record the time at which they complete each of 5 daily activities: out of bed, first contact with another person, start regular daily activity (school, work, etc.), dinner, and in bed. An app version of the SRM is in development. Individuals are also asked to evaluate the degree of involvement of other people in these activities: “0” means that no one was present; “1” means that someone was present but not very involved; “2” means that someone was present and interacting with the individual to a moderately stimulating degree; and “3” means that someone was present and interacting on very stimulating level. In addition to recording the timing of daily activities and levels of stimulation, the patient also records average mood and energy levels on a scale of minus five to plus five. The SRM is used as both an outcome measure and a therapeutic tool. Improvement in scores has been associated with favorable outcomes with IPSRT. In individual sessions, the IPSRT therapist reviews SRMs to help the patient achieve more regular rhythms. In addition, the SRM is used to help the patient track the links among rhythm stability (or instability) and mood and energy states, ultimately coming to recognize that disruptions in schedule will likely lead to dysregulated mood and energy states and, conversely, that dyregulated mood and energy states may contribute to changes in daily rhythms. Identification of these patterns represents the first step in regulating them.
For more information about IPSRT, visit the online training website at www.ipsrt.org