Book Review: Bipolar Disorder, Treating Bipolar Disorder: A Clinician's Guide to Interpersonal and Social Rhythm Therapy

Abstract

Bipolar Disorder Treating Bipolar Disorder: A Clinician's Guide to Interpersonal and Social Rhythm Therapy Ellen Frank. New York (NY): Guilford Press; 2005. 212 p. US$35.00. Reviewer Rating: Very good Many psychiatric books either look back or review the present, but Ellen Frank's reflects a trend evolving into the future. While, in the past, the treatment of bipolar disorder focused on mood stabilizers, recent years have seen the development of psychosocial enrichments. Over the past 16 years, Ellen Frank, a leading researcher in the field of mood disorders, has developed interpersonal and social rhythm therapy (IPSRT) and tested its effectiveness in bipolar disorders. The procedure, as Dr Frank conceived it, grew out of her impressive expertise in interpersonal and cognitive therapies. It skillfully combines interpersonal therapy (IPT) with social rhythm regulation into one treatment by enhancing IPT with a large behaviour modification component focused on the rhythms and routines of a patient's life. As we now know, mood regulation involves complex brain systems that are not only disrupted in many different ways but can also be influenced positively from a number of directions, several of which are included in IPSRT. In addition to medication, mood stabilization can be helped by building coping skills and satisfying relationships, improving medication adherence, supporting regular daily routines and rhythms, and resolving interpersonal conflicts. As far as I know, this is the first complete guide to this practical and useful therapeutic approach. Frank first illustrates her ideas and approach with 2 detailed case examples and then offers a comprehensive theoretical underpinning. She elegantly weaves biological and psychosocial factors together and proposes that episodes of bipolar disorder result from both domains, including, in particular, interpersonal stresses and disruptions of circadian rhythms. Unlike many theorists who remain trapped in biological or psychosocial sectors, Ellen Frank emphasizes a theoretical perspective that integrates such seemingly conflicting views of the illness. She feels that, for those subjects who are biologically vulnerable to mood disorders, the loss of social timekeepers and the emergence of social disrupters lead to new illness episodes. Consequently, the treatment and prevention of recurrences needs to be achieved by helping patients identify and resolve interpersonal problems and maintain regular daily rhythms; yet for most patients, this is achieved in conjunction with carefully chosen pharmacotherapy. Frank takes us step by step, through screening, assessment and case conceptualization, acute and maintenance treatment, and periodic booster sessions. …