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Does Interpersonal and Social Rhythm Therapy Work in Bipolar Disorder?
Last week I talked about the basics of interpersonal and social rhythm therapy (IPSRT). This therapy combines psychotherapeutic techniques along with behavioral elements to help get and keep bipolar disorder on track and in studies this approach does appear to work.
Interpersonal and Social Rhythm Therapy in the Treatment of Bipolar Disorder
In a two-year study of 175 patients with bipolar I disorder, researchers found that those who were given IPSRT during their acute phase of treatment (versus pretty standard medication management) did not stabilize more quickly, but they did have a greater time to recurrence. Additionally, greater social rhythm regulation during the acute treatment phase predicted lower risk of recurrence during the maintenance phase of treatment. From this study it appears that IPSRM lowers the risk of relapse and reoccurrence of both mania and depression.
Additionally, in the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) study, IPSRT was superior to “abbreviated collaborative care” (a brief psychoeducational program of three sessions across six weeks) in depressed, medicated bipolar (I or II) patients both in time to recovery and proportion of patients recovered. This may indicate that IPSRT is effective in acute bipolar depression treatment.
A small, open study is also suggestive that a version of IPSRT is effective in treating teens with bipolar disorder as well. (In this case, the IPSRT was modified to ensure relevance to adolescents.) Participants experienced improvements in manic, depressive and general psychiatric symptoms over 20 weeks of treatment. Global functioning also increased.
It’s important to note that the above studies all use IPSRT in conjunction with medication and this may be critical as in this small study, neither IPSRT monotherapy nor quetiapine monotherapy appeared very successful at treating bipolar depression.
Psychosocial Interventions for Bipolar Disorder
Other of the newer psychosocial interventions that appear effective in the treatment of bipolar disorder include: family-focused therapy, psychoeducation and cognitive behavioral therapy. It’s worth noting that all these therapies focus on maintaining regulated schedules and reducing interpersonal conflict.
Conclusions about Interpersonal and Social Rhythm Therapy
In conclusion, I think IPSRT is a reason for hope in bipolar disorder. It appears to be another tool in the belt of those of us fighting bipolar disorder. I think the data from the last eight years is very promising. Unlike some psychotherapeutic techniques, IPSRT consistently shows usefulness when combined with medication treatment. There isn’t enough research to say anything unequivocal, but in my opinion, it is a treatment that anyone with bipolar disorder can benefit from, even if the only learning is that routine and schedules are critical in the treatment of bipolar disorder.