Interpersonal and social rhythm therapy is helpful to many people with bipolar disorder

Sep 12 2005

A treatment program that stresses maintaining a regular schedule of daily activities and stability in personal relationships is an effective therapy for bipolar disorder, report University of Pittsburgh School of Medicine researchers in September's Archives of General Psychiatry.

Interpersonal and Social Rhythm Therapy (IPSRT), a novel approach developed by the University of Pittsburgh researchers, was effective in preventing relapse over a two-year period, particularly in patients who don't have other chronic medical problems such as diabetes or heart disease.

IPSRT is based on the idea that disruptions in daily routines and problems in interpersonal relationships can cause recurrence of the manic and depressive episodes that characterize bipolar disorder. During the treatment, therapists help patients understand how changes in daily routines and the quality of their social relationships and their social roles, such as a parent, spouse or caregiver, for example, can affect their moods. After identifying situations that can trigger mania or depression, therapists teach the individuals how to better manage stressful events and better maintain positive relationships.

"Our study shows that this form of psychotherapy is helpful to many people with bipolar disorder," said Ellen Frank, Ph.D., professor of psychiatry at the University of Pittsburgh School of Medicine and Western Psychiatric Institute and Clinic, and principal investigator of the study. "Second, it shows that the type of psychotherapy we choose for a patient should depend on the individual's circumstances. Treatment for bipolar is not 'one-size-fits-all.' We have shown that IPSRT is a powerful tool in the prevention of illness recurrence."

More than 4 percent of adults in the United States suffer from a bipolar disorder or "sub-threshold" bipolar disorder. Bipolar disorder, commonly referred to as manic-depressive illness, is characterized by cycles of mania, depression or mixed states that often disrupt work, school, family and social life.

Conventional treatment approaches for the disorder include lithium and other mood stabilizers, which work well in the short-term but often have limited long-term success. Historically, psychotherapy has not been given much credence as a treatment option for the condition because of the disorder's strong biological basis. Only recently have researchers begun to investigate the effectiveness of psychotherapy for people with bipolar disorder, and studies like this one have shown that psychotherapy can have promising long-term benefits.

The University of Pittsburgh study involved 175 acutely ill individuals with bipolar I disorder, the more serious form of the illness involving full-blown episodes of mania and major depression, who were enrolled in the Maintenance Therapies in Bipolar Disorder trial. They were randomized to one of four treatment groups. One group received IPSRT during both the acute phase of their bipolar disorder, defined by a severe episode of mania, depression or mixed symptoms, and for two years after the episode, referred to as the maintenance phase. The second group received Intensive Clinical Management therapy (ICM), a form of psychotherapy that addresses the general causes, symptoms and treatments of bipolar disorder, during both the acute and maintenance phases. The remaining two groups received either IPSRT during the acute phase and ICM during the maintenance phase or ICM during the acute phase and IPSRT during the maintenance phase. Patients in all groups received standard medication therapy throughout the study.

After controlling for the effects of marital status, medical burden and anxiety, the researchers found that patients who received IPSRT during the acute treatment were more likely to remain well during the two-year maintenance phase. Furthermore, the strength of the effect was directly related to the extent to which patients increased the regularity of their social routines. Those who responded well to IPSRT were more likely to be those in somewhat better physical health.

Patients who had multiple medical problems in addition to bipolar disorder and those with anxiety responded better to the ICM therapy, possibly because of that therapy's focus on physical symptoms. Study authors hypothesized that these patients had a greater need to manage and cope with their medical symptoms and were less able to focus on controlling their social rhythms and relationships. Individuals with bipolar disorder are at an increased risk for a number of serious medical illnesses, including cardiovascular disease, diabetes and pulmonary problems.