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What is Interpersonal and Social Rhythm Therapy?
Interpersonal and social rhythm therapy is not surprisingly an integration of interpersonal therapy (IP) and social rhythm therapy (SRM). Interpersonal social rhythm therapy (IPSRT) is unique, though, in that it was actually developed for the treatment of bipolar disorder. This makes it unusual indeed.
What Interpersonal and Social Rhythm Therapy is Based On
And what’s more, IPSRT is based on, what I consider to be, fairly sound ideas. IPSRT recognizes that biology plays the primary role in bipolar disorder, being particularly interested in “the genetic defect in manic depressive illness involves the circadian pacemaker or systems that modulate it,” which in 2013, we know plays an important role in bipolar disorder.
IPSRT, though, goes on to note that psychosocial factors can contribute to the disruption of bipolar disorder, possibly through changes to a person’s daily and circadian rhythms. The probable psychosocial factors that lead to bipolar reoccurrence include:
- Stressful life events
- Disruptions in social rhythms
- Medication non-adherence (also known as noncompliance)
IPSRT, then, is designed to address and prevent these disruptions.
Focus of Interpersonal and Social Rhythm Therapy
IPSRT is focused on:
- The link between mood and life events
- The importance of maintaining a daily rhythm
- The identification and management of potential precipitants of rhythm dysregulation with special attention to interpersonal triggers
- Mourning of the lost healthy self
- Identification and management of affective symptoms
Certainly, some of these components can be found in other therapies such as cognitive behavioral therapy and, in fact, cognitive behavioral therapy techniques are indeed used to facilitate IPSRT.
Phases of Interpersonal and Social Rhythm Therapy
IPSRT has three phases: the initial phase, the intermediate phase, and the preventative phase. (Each phase is more complex than can be summarized here, but this should give you some idea.)
The initial phase of IPSRT can be started at any time, whether the patient is symptomatic or not, and like most therapies it involves learning about the client’s history, life, interpersonal issues, relationships, and daily activities. The initial phase of IPSRT also contains psychoeducation which educates the patient about their illness and treatment. The patient is also asked to fill in “social rhythm metric” charts, which aim to measure daily activities and stimulation levels, understanding that greatly stimulating activities are most likely to lead to mood disruption.
The intermediate phase of IPSRT focuses on developing strategies to manage affective symptoms, regulate daily patterns, and solve interpersonal issues. And, I believe uniquely, this phase also works to facilitate grieving of the loss of the “healthy self” and the loss of the “highs” of the illness.
Behavioral approaches are used to regulate behavior in an attempt to regulate daily rhythms. For example, if a patient has an irregular bedtime, this phase of the therapy would work on strategies for maintaining a standard bedtime and on how that affects stability. The intermediate phase of IPSRT also works to look for other possible mood dysregulation triggers. This might be things like travel or shift-work. IPSRT then looks to prevent or mitigate these triggers.
The preventative phase of IPSRT may last for two years of monthly treatments as the number one goal of IPSRT is to prevent future episodes while improving everyday functioning. The patient becomes more confident in their own ability to apply IPSRT techniques outside of therapy during this phase.
But Does Interpersonal and Social Rhythm Therapy Work?
But the question is, does all this hard work pay off in the end? Tune in to my next article for the discussion of that important question.
Interpersonal and Social Rhythm Therapy: Managing the Chaos of Bipolar Disorder by Ellen Frank, Holly A. Swartz, and David J. Kupfer