Interpersonal & Social

Rhythm Therapy
Aastha Jain
M.Phil CP Ist yr
 MOVING TOWARDS A DEFINITION
IPSRT is an evidence based biopsychosocial intervention model for
Bipolar Affective Disorder.

It was designed primarily to address instability that is a major

accompaniment in BPAD.

It talks about how changes in social rhythms greatly disrupt circadian

rhythms which in turn increase the chance of relapse in BPAD patients.

Three elements of IPSRT:

a) Psychoeducation
b) Social Rhythm
c) Interpersonal relations
BASIC TENETS OF IPSRT
Its a biopsychosocial model. It is believed that BPAD cannot be
treated by medication alone.

Stressful life events & major life changes both disrupt daily
functioning, which in turn disrupts circadian rhythms which
often lead to relapses in patients with BPAD.

Primarily 3 factors are believed to play an active role in causing

relapse:
Medication non-adherence
Stressful life events
Disruption in social rhythms
 Social zeitgebers (timekeepers) are emphasized upon. It might
directly impact mood or indirectly impact mood by impacting
the daily routine.

The seemingly benign life events (eg new job) might impact
wake, appetite, sleep rhythms which are the hallmark of
euthymic state.

Individuals who are vulnerable to mood disorders are known

to have a more difficult time adapting to such changes.

IPSRT is likely to be adaptable to various cultural preferences

 Stressful
event=
autonomic
arousal

stressful stressful event=

event= Relapse changes in social
alteration in rhythm
mood eg loss of job

Significant
life events
 CONCEPTION OF IPSRT
It was developed by Ellen Frank

Primarily for late adolescent & adult patients with Bipolar I

disorder.

Combined Interpersonal therapy with Social rhythm

regulation treatment

The specific goals of IPSRT was to stabilize patients social

rhythms or routines while improving the quality of their
interpersonal relationships and satisfaction with social roles
 IPSRT STAGES: Initial Phase(4-5
sessions)
Detailed case history taking
Charting instances of impact of changes in social rhythms
on mood
Assessment of quality of interpersonal relationships
Initiating use of Social Rhythm Metric
Psychoeducating the patient & family member about the
pathology
 Intermediate Phase
Regularizing the social rhythms

Collaboratively selecting an Interpersonal focus. Any of

the following aspects is explored in therapy:

Grieving the loss of old healthy self & capacities

Role transitions

Role disputes
 Maintenance Phase

Establishing patients confidence is using the techniques

Helping patient accept the abilities lost due to the illness &

helping device compensatory roles possible now

Helping the patient to maintain functioning in face of

unavoidable social changes & new challenges

 Borrowing from other models

Sleep hygiene

Activity scheduling

Interpersonal therapy(developed by Klerman & Weissman for

unipolar depression)
 When to use & for whom

IPSRT can be used both as a preventive model (following

remission) and an acute intervention .
More effective to use with patients whose symptoms are
milder, or have subsided for IPSRT requires considerable
effort & willingness on patients part.
Can also be used with patients with anxiety disorder
Not amenable to use with patients with severe psychotic
symptoms
Research findings
Researchers have found that life events associated with disruptions in social rhythms (e.g.,
overseas travel, being fired from a full-time job, marital separation) were better predictors of
manic episodes than severe life events in general in a sample of patients with bipolar
disorder (Malkoff-Schwartz S, Frank E, Anderson B, Sherrill JT, Siegel L, Patterson D, Kupfer DJ
Arch Gen Psychiatry. 1998 Aug; 55(8):702-7.)

When IPSRT targets the three prominent pathways to new episodes, it is associated with
longer time to recurrence of both mania and depression in patients with bipolar I disorder
(Frank et al., 2005) and with shorter time to remission of depression in patients suffering
from bipolar I or bipolar II disorder and with improvement in their quality of long-term
remission (Miklowitz et al., in press).
References

Swartz, H. A., Frank, E., Spielvogle, H. N., & Kupfer, D. J. (n.d.). Interpersonal
and Social Rhythm Therapy. Mood Disorders, 275-293

Frank, E. (2007). Interpersonal and social rhythm therapy: A means of improving

depression and preventing relapse in bipolar disorder. Journal of Clinical Psychology

Nusslock, R., & Frank, E. (2012). Interpersonal Social Rhythm Therapy (IPSRT)
for Bipolar Disorder. Casebook of Interpersonal Psychotherapy