Interpersonal Social Rhythm Therapy Research Articles

Adjuvant Psychotherapies to Prevent Relapse in Bipolar Disorder

Several psychotherapy protocols have been evaluated as adjuncts to pharmacotherapy for patients with bipolar disorder (BD). Little is known about their comparative effectiveness. To compare the effectiveness of 2 types of group psychotherapy, skill-oriented, material-based cognitive behavioral therapy (SEKT) and supportive, patient-centered, emotion-focused therapy (FEST), to prevent relapse in patients with euthymic BD. This was a large, observer-blind, randomized clinical trial conducted over 18 months (posttreatment after 6 months; follow-up at 12 and 18 months). In addition to psychiatric care as usual (including mood-stabilizing medication), each participant at 9 clinical outpatient units in Germany received 24 hours of group psychotherapy over 4, full-day sessions spread over 5 months. Patients with euthymic BD type 1 (BD 1) or BD type 2 (BD 2) between the ages of 18 and 50 years were randomly assigned to 1 of 2 forms of psychotherapy, SEKT or FEST. Independent clinicians blinded to patient grouping performed assessments using structured interviews (Structured Clinical Interview for DSM Disorders and Longitudinal Interval Follow-Up Evaluation) and self-rating and clinician rating for inclusion criteria and outcome. Kaplan-Meier survival curves were calculated for time to relapse. Cox proportional hazards statistics and propensity score matching were calculated for the multivariate analysis. Study data were analyzed from March 2020 to September 2022. SEKT intervention is a structured cognitive behavioral therapy integrating elements of interpersonal social rhythm therapy, and of mindfulness-based cognitive therapy. FEST psychotherapy has its roots in emotion-focused, supportive, and nondirective therapy. Recurrence of a new affective episode assessed by blinded interviewer with the LIFE interview. In addition, self-rating and clinician rating of depressive and mania symptoms as well as level of social functioning were assessed. Of 348 screened referrals, 305 patients (median [IQR] age, 34 [18-50] years; 162 male [53%]) with euthymic BD 1 or BD 2 were included in the study. A total of 207 patients (68%) had BD 1, 98 (32%) had BD 2, and 278 (91%) received psychiatric care. Both therapies were equally effective in preventing recurrence of a new episode. Outcome (higher rate of new episodes) was not predicted by kind of treatment (SEKT: 69 [49%] relapse; FEST: 63 [46%] relapse) but was predicted by BD 2, comorbidity, attending all sessions, and the interaction of type of treatment by BD 1 or 2. Patients with BD 2 had the highest rate of relapse (60 [61%] relapse), in particular, when treated by SEKT (39 [70%] relapse). Results of this randomized clinical trial revealed that a structured, skill-oriented, material-based cognitive behavioral therapy (SEKT) and a supportive, patient-centered, emotion-focused therapy (FEST) were equally effective in preventing relapse of affective episodes when delivered in a new, intensive group format. Additionally, there were baseline factors, in particular BD 2, that influenced outcomes. ClinicalTrials.gov Identifier: NCT02506322.

Effectiveness of interpersonal social rhythm therapy applied to individuals with bipolar disorder: A systematic review

Effectiveness of interpersonal social rhythm therapy applied to individuals with bipolar disorder: A systematic review

Relationship between baseline cognition and 18-month treatment response in bipolar disorder

BackgroundTo date, few studies have examined baseline cognitive function as a predictor of clinical outcome following treatment in bipolar disorder (BD). The aim of this analysis was therefore to examine the relationship between baseline cognitive function and treatment outcome in a sample of young adults with BD receiving Interpersonal Social Rhythm Therapy (IPSRT) or Specialist Supportive Care (SSC) with adjunctive pharmacotherapy. MethodsEighty-six BD patients underwent baseline cognitive testing and completed 18 months of IPSRT or SCC. Univariate analyses examined the relationship between baseline cognitive function (global and individual cognitive domains) and change in mood symptom burden, and psychosocial functioning, from baseline to treatment-end. ResultsBaseline global cognition was not predictive of change in mood symptom burden over 18 months of treatment. However, poorer baseline psychomotor speed performance was associated with less improvement in mood symptom burden at treatment-end. Neither baseline global cognition nor individual cognitive domain scores were associated with change in psychosocial functioning. LimitationsDue to the exploratory nature of the study, correction was not made for multiple comparisons. Data was obtained from a relatively small sample and has been the subject of prior analysis, thereby increasing the likelihood of chance findings. ConclusionAlthough global cognition was not associated with outcome, when examining individual domains, poorer baseline psychomotor speed predicted less change in mood symptom burden following 18-months of psychotherapy and pharmacotherapy. This suggests that pre-treatment measures of psychomotor speed may help to identify those who require additional, and more targeted, intervention. Further large-scale research is required.

Functional and Mood Outcomes in Bipolar Disorder Patients With and Without Substance Use Disorders Undergoing Psychotherapy.

Objectives: Research suggests that patients with co-morbid bipolar disorder (BD) and substance use disorder (SUD) have a poorer illness course and clinical outcome. The evidence is limited as SUD patients are often excluded from BD studies. In particular, evidence regarding long term outcomes from studies using psychotherapies as an adjunctive treatment is limited. We therefore examined data from two studies of Interpersonal Social Rhythm Therapy (IPSRT) for BD to determine whether lifetime or current SUD affected outcomes.Methods: Data were analyzed from two previous clinical trials of IPSRT for BD patients. Change in scores on the Social Adjustment Scale (SAS) from 0 to 78 weeks and cumulative mood scores from 0 to 78 weeks, measured using the Life Interval Follow-Up Evaluation (LIFE), were analyzed.Results: Of 122 patients (non-SUD n = 67, lifetime SUD but no current n = 43, current SUD n = 12), 79 received IPSRT and 43 received a comparison therapy—specialist supportive care—over 18 months. Lifetime SUD had a significant negative effect on change in SAS score but not LIFE score. There was no effect of current SUD on either change in score. Secondary analysis showed no correlation between symptom count and change in SAS total score or LIFE score.Conclusion: Current SUD has no impact on mood or functional outcomes, however, current SUD numbers were small, limiting conclusions. Lifetime SUD appears to be associated with impaired functional outcomes from psychotherapy. There is limited research on co-morbid BD and SUD patients undergoing psychotherapy.

The chronotherapeutic treatment of bipolar disorders: A systematic review and practice recommendations from the ISBD task force on chronotherapy and chronobiology.

To systematically review the literature on the efficacy and tolerability of the major chronotherapeutic treatments of bipolar disorders (BD)-bright light therapy (LT), dark therapy (DT), treatments utilizing sleep deprivation (SD), melatonergic agonists (MA), interpersonal social rhythm therapy (IPSRT), and cognitive behavioral therapy adapted for BD (CBTI-BP)-and propose treatment recommendations based on a synthesis of the evidence. PRISMA-based systematic review of the literature. The acute antidepressant (AD) efficacy of LT was supported by several open-label studies, three randomized controlled trials (RCTs), and one pseudorandomized controlled trial. SD showed rapid, acute AD response rates of 43.9%, 59.3%, and 59.4% in eight case series, 11 uncontrolled, studies, and one RCT, respectively. Adjunctive DT obtained significant, rapid anti-manic results in one RCT and one controlled study. The seven studies on MA yielded very limited data on acute antidepressant activity, conflicting evidence of both antimanic and maintenance efficacy, and support from two case series of improved sleep in both acute and euthymic states. IPSRT monotherapy for bipolar II depression had acute response rates of 41%, 67%, and 67.4% in two open studies and one RCT, respectively; as adjunctive therapy for bipolar depression in one RCT, and efficacy in reducing relapse in two RCTs. Among euthymic BD subjects with insomnia, a single RCT found CBTI-BP effective in delaying manic relapse and improving sleep. Chronotherapies were generally safe and well-tolerated. The outcome literature on the adjunctive use of chronotherapeutic treatments for BP is variable, with evidence bases that differ in size, study quality, level of evidence, and non-standardized treatment protocols. Evidence-informed practice recommendations are offered.

Effect of interpersonal and social rhythm therapy combined drugs on sleep quality and quality of life in patients with insomnia

Objective To explore the effect of interpersonal and social rhythm therapy combined drugs on sleep quality and quality of life in patients with insomnia. Methods A total of 100 patients with insomnia treated in hospital from January 2016 to October 2017 were selected as subjects.The patients were divided into experimental group (n=50) and control group (n=50) according to the random number table.The control group was given conventional drug only, and the experimental group was combined with interpersonal and social rhythm therapy on the basis of the drugs treatment.The clinical efficacy was compared between the two groups.Pittsburgh Sleep Quality Index (PSQI) and Sleeping Personal Beliefs and Attitudes (DBAS) were used to assess the recent sleep quality of the two groups. The WHO Quality of Life Measurement Profile (WHOQOL-BREF) was used to compare of the quality of life between two groups. Results The clinical effective rate was 94.0% in the experimental group and 80.0% in the control group.There was significant difference between the two groups (χ2=4.332, P 0.05) and DBAS((80.96±10.11) vs (80.87±11.03), t=0.02, P>0.05) scores between experimental group and control group.After treatment, DBAS score((125.74±21.53) vs (104.22±20.97), t=4.93, P 0.05). After the treatment, all the scores in the four fields of the two groups were significantly increased (P<0.05), and the scores in the experimental group were significantly higher than those in the control group (P<0.05). Conclusion Interpersonal and social rhythm therapy combined with drugs can effectively improve sleep quality and the quality of life. Key words: Interpersonal and social rhythm; Insomnia; Sleep quality; Quality of life

Calculating the Social Rhythm Metric (SRM) and Examining Its Use in Interpersonal Social Rhythm Therapy (IPSRT) in a Healthy Population Study.

In psychiatry, the social zeitgeber theory argues that social life provides important social cues that entrain circadian rhythms. Disturbance of these social cues might lead do dis-entrainment of circadian rhythms and evoke somatic symptoms that increase the risk of mood disorders. In preventing and treating patients with bipolar disorders, the Interpersonal and Social Rhythm Therapy (IPSRT) relies on the Social Rhythm Metric (SRM) to (re)establish patients’ social cues and an re-entrain circadian rhythms. Since the SRM quantifies social rhythms that are derived from a patient’s interaction with a social environment, this contribution (a) calculates the SRM of the social environment of a representative healthy population study (n = 1249), (b) evaluates the robustness of the SRM as a quantifier of social rhythms by matching the scores of the pilot study, revealing the near absence of variance across population characteristics and investigation months—circadian rhythms need to be entrained for every month and for everyone—and (c) examines its use in IPSRT by relating high SRM-scores to lower psychological distress (p = 0.004) and low SRM-scores to higher social and emotional dysfunction (p = 0.018).

A Meta-Study of Qualitative Research Into the Experience of ‘Symptoms’ and ‘Having a Diagnosis’ for People Who Have Been Given a Diagnosis of Bipolar Disorder

The purpose of this study is to review the current state of the literature reporting qualitative studies that depict the experiences of ‘symptoms’ and ‘having a diagnosis’ for people who have been given a diagnosis of bipolar disorder. The method attempted to combine empirical and discursive approaches and was strongly influenced by guidance from Paterson, Thorne, Canam, and Jillings (2001) on conducting a meta-review. Meta-data analysis was used to compare the studies and, subsequently, nine common themes emerged: ‘struggles with identity’, ‘loss of control’, ‘disruption, uncertainty and instability’, ‘negative impact of symptoms across life and the experience of loss’, ‘negative view of self’, ‘positive or desirable aspects of mania’, ‘struggling with the meaning of diagnosis’, ‘stigma’, and ‘acceptance and hope’. The meta-method explored and evaluated the qualitative methods that have been used to study this phenomenon, and the meta-theory considered the theoretical underpinnings and contributions of this research. The review concludes that an awareness of these themes could support clinical work with service-users and inform the development of relevant interventions such as interpersonal social rhythm therapy, cognitive behavioural therapy and mindfulness-based cognitive therapy. Further qualitative research is recommended to extend this literature base and include a greater representation of men and people living in non-westernised countries. Note This is a newer version of an article published in EJOP, Vol. 9 Issue 2 (2013) . In the following publication some section headings were added which had been lost during document production.

Bipolar Phenomenology: Have We Learned All We Can Learn?

Bipolar Phenomenology: Have We Learned All We Can Learn?

A review of empirically supported psychological therapies for mood disorders in adults.

The mood disorders are prevalent and problematic. We review randomized controlled psychotherapy trials to find those that are empirically supported with respect to acute symptom reduction and the prevention of subsequent relapse and recurrence. We searched the PsycINFO and PubMed databases and the reference sections of chapters and journal articles to identify appropriate articles. One hundred twenty-five studies were found evaluating treatment efficacy for the various mood disorders. With respect to the treatment of major depressive disorder (MDD), interpersonal psychotherapy (IPT), cognitive behavior therapy (CBT), and behavior therapy (BT) are efficacious and specific and brief dynamic therapy (BDT) and emotion-focused therapy (EFT) are possibly efficacious. CBT is efficacious and specific, mindfulness-based cognitive therapy (MBCT) efficacious, and BDT and EFT possibly efficacious in the prevention of relapse/recurrence following treatment termination and IPT and CBT are each possibly efficacious in the prevention of relapse/recurrence if continued or maintained. IPT is possibly efficacious in the treatment of dysthymic disorder. With respect to bipolar disorder (BD), CBT and family-focused therapy (FFT) are efficacious and interpersonal social rhythm therapy (IPSRT) possibly efficacious as adjuncts to medication in the treatment of depression. Psychoeducation (PE) is efficacious in the prevention of mania/hypomania (and possibly depression) and FFT is efficacious and IPSRT and CBT possibly efficacious in preventing bipolar episodes. The newer psychological interventions are as efficacious as and more enduring than medications in the treatment of MDD and may enhance the efficacy of medications in the treatment of BD.

Psychosocial interventions for bipolar disorder

Aim:To provide a selected overview of the literature on psychosocial treatments for bipolar disorderMethod:Selective literature reviewResults:Randomised controlled trials of psychosocial interventions in bipolar disorder fall largely into five categories, namely: psychoeducation, integrated treatments, family based therapy, cognitive behavioural therapy and interpersonal social rhythm therapy. Most studies have shown some benefit in terms of relapse prevention, but have tended to be effective for either the depressed or the manic pole, and not both. Broader outcome parameters such as quality of life have not been reported consistently. The mechanisms whereby treatments might exert their effects have not been clearly delineated. Many studies have excluded patients with bipolar II and other variants, and those with psychiatric and substance use comorbidities, reducing their generalisability.Discussion:Whilst psychosocial treatments show promise in the area of bipolar disorder, more work is required to delineate the effective elements of such interventions, and to ensure generalisability to individuals with bipolar II and other forms of bipolar disorder, as well as those with psychiatric and substance use comorbidities. Other forms of delivery, such as via the internet, deserve further exploration.

A developmental approach to the treatment of bipolar disorder: IPSRT with an adolescent

This case study explains how a psychotherapy previously used with adults can be used with adolescents by focusing on the specific developmental issues associated with adolescence. Bipolar disorder is a damaging disorder to experience during the developmental phase of adolescence. Interpersonal social rhythm psychotherapy has been developed as an adjunct to medication for managing bipolar disorder and shows some promising outcomes in adults. This is a single case study design drawn from a larger randomised control trial of two psychotherapies for bipolar disorder. The case study addressed the question: How can Interpersonal social rhythm therapy be applied with adolescents who have bipolar disorder? This study used a purposeful sampling process by selecting the youngest adolescent participating in the randomised control trial. All the subject's sessions of Interpersonal social rhythm therapy were taped, transcribed and analysed. The analysis involved describing the process of psychotherapy as it occurred over time, mapping the process as a trajectory across the three phases of psychotherapy experience and focusing the analysis around the impact of bipolar disorder and IPSRT on adolescent developmental issues, specifically the issue of identity development. Interpersonal social rhythm therapy allowed the therapist to address developmental issues within its framework. As a result of participation in the psychotherapy the adolescent was able to manage her mood symptoms and develop a sense of identity that was age-appropriate. Interpersonal social rhythm therapy provided the adolescent in the case study the opportunity to consider what it meant to have bipolar disorder and to integrate this meaning into her sense of self. Bipolar disorder is a chronic and recurring disorder that can have a serious impact on development and functioning. Interpersonal social rhythm therapy provides an approach to nursing care that enables adolescents to improve social functioning.

What Can Interpersonal and Social Rhythm Therapy Do for Patients with Bipolar Disorder

Patients with bipolar disorder have notoriously poor vocational outcomes. In previous research, interpersonal and social rhythm therapy (IPSRT) in

Psychosocial Interventions: Empirically-Derived Treatments for Bipolar Disorder

Background: Over the past decade, a variety of psychosocial interventions have been reported to be beneficial for bipolar disorder. Acceptance of this literature has been slow in part because most studies have been small and lack rigorous methodology. Furthermore, skepticism about the potential efficacy of psychosocial treatments stems from recognition of the indisputable biological basis of the disorder. Well powered randomized trials are the standard by which pharmacologic strategies demonstrate efficacy. Thus, we review the randomized controlled trials of psychosocial interventions as an adjunct to medication in the treatment of bipolar disorder. Methods: We conducted a literature search to identify randomized controlled studies of Cognitive-Behavioral therapy (CBT), Psychoeducation (PE), Family-Focused Therapy (FFT), and interpersonal social rhythm therapy (IPSRT) for bipolar disorder. Only studies which randomized at least 80 individuals diagnosed with bipolar disorder were selected for review. Results: Nine studies met our inclusion criteria and of these, eight found that adding one of the above psychosocial interventions to pharmacotherapy improved treatment outcomes for individuals with bipolar disorder. None of the psychosocial interventions claims benefit for acute treatment of hypomania or mania; however, CBT, FFT, and IPSRT appear efficacious in treating depressive symptoms and preventing new episodes. PE appears helpful against the recurrence of hypomania or mania, but not depression. Conclusions: These findings support the use of psychosocial interventions in treating individuals with bipolar disorder.

Bipolar disorder: Causes, contexts, and treatments

Bipolar disorder is a chronic and often devastating illness that may go undiagnosed because of its complex and diverse presentation. Clinicians can provide psychological treatments, in conjunction with pharmacotherapy, that can reduce the frequency, severity, and duration of manic and depressive episodes. Because bipolar disorder is characterized by high degrees of comorbidity and high rates of medical complications, the clinician will frequently need to implement other treatments targeted to comorbid conditions, such as panic, generalized anxiety, substance abuse, and personality disorders. This article introduces the issue of Journal of Clinical Psychology: In Session devoted to the treatment of bipolar disorder. We describe the cognitive styles and personal vulnerabilities that pose greater risk for bipolar disorder. Three evidence-based psychological treatments (interpersonal social rhythm therapy, family-focused treatment, and cognitive-behavioral therapy) and current pharmacological treatments are examined and illustrated. Finally, we review the effectiveness and practice implications of a variety of treatments for this severe and underresearched disorder.