Addiction A-Z

Interpersonal and social rhythm therapy for bipolar disorder

Interpersonal and social rhythm therapy (IPSRT) was developed by Ellen Frank.  Designed to treat individuals diagnosed with bipolar disorder, this therapy is based on the chronobiological model of bipolar disorder.  This theory suggests that disrupted circadian rhythms – the internal clock that regulates our sleep-wake cycle – play at least a partial if not major role in bipolar symptoms.

Chronobiology is a specialized area of biology that focuses on the biological rhythms or cycles of all living organisms, and how the sun and moon influence these cycles.  When your sleep schedule and normal routine is erratic or frequently interrupted by other things going on in your life, the negative impact on your mood, concentration, and overall functioning can be quite noticeable.

If you’ve ever been up all night attending to a fussy infant or sick child, or kept awake by noisy neighbors who were partying all night, you know how awful it can make you feel the next day.  Even a relatively minor amount of sleep deprivation makes many people more irritable and tense.   Minor annoyances suddenly become major ordeals when fatigue causes your normally excellent coping skills to scurry into hiding like frightened mice.   Disrupted sleep isn’t good for anyone, but the consequences are often much more problematic if you’re suffering from bipolar disorder.

Your sleep schedule is part of your overall social rhythm, which is comprised of your day to day routine of eating, sleeping, exercising, going to work, and so on.

The interpersonal component of social rhythm therapy utilizes the principles of traditional interpersonal therapy to address the impact that relationship issues and problems have on your life.  When you’re having a conflict with your spouse, boss, best friend, or anyone else in your life, can cause anxiety and heighten your stress.  This kind of stress can severely disrupt your normal routine.  Working on improving and resolving these issues in therapy helps bipolar individuals minimize the stress in their lives – which is important, as stress can trigger mood episodes – and make it easier for them to adhere to a healthy routine.

Interpersonal and social rhythm therapy was initially designed to treat individuals.  However, it’s been adapted to use effectively as a form of group therapy as well.  This therapeutic approach is typically used in conjunction with medication, which is often necessary for anyone with bipolar disorder.  Cognitive behavioral techniques are also utilized to help patients develop and stick with a workable routine that minimizes stress and helps keep their mood stable.

The medications used most often in the treatment of bipolar disorder include mood stabilizers, such as lithium and valproic acid (Depakote), and antipsychotics, such as aripiprazole (Abilify), quetiapine (Seroquel), and risperidone (Risperdal).

Bipolar Disorder Symptoms and Patterns

Interpersonal and social rhythm therapy addresses both the psychosocial and biological aspects of bipolar disorder.  While any mental illness can and usually does cause some degree of chaos in a person’s life, a manic, hypomanic, or depressed episode can really turn a person’s life upside down.

Although there are different types and variations of bipolar disorder, the primary symptom is the presence of significant mood episodes – mania, hypomania, and depression – that can seriously alter a person’s life.

Manic episodes are comprised of an elevated, irritable, or “expansive” mood that typically includes unusually high energy levels, a decreased need for sleep, and / or highly goal-oriented behavior.  The episode must last at least a week, unless the symptoms are severe enough to require hospitalization.

Other symptoms often include:

  • Rapid, pressured speech and a noticeable increase in talkativeness
  • Racing thoughts
  • Grandiosity
  • Distractibility
  • Impulsivity
  • Behavior that often leads to bad consequences, like running up credit cards on a major shopping spree or sleeping with multiple partners in a short period of time
  • Psychotic symptoms, such as delusions or hallucinations, may also occur

The mood disturbance is severe enough to cause significant problems at work or school, in relationships, and / or in other important areas of the person’s life.

The symptoms of a hypomanic episode are very similar but less severe and less disruptive to the person’s life, there is no psychosis, and the timeframe is typically shorter (4 days minimum).

Major depressive episodes last at least two weeks and are comprised of a either a depressed mood or loss of pleasure during the bulk of that time.  Other symptoms may include:

  • Changes in appetite
  • Changes in sleep
  • Suicidal thoughts or behaviors, or frequent thoughts of death
  • Low energy and fatigue
  • Feelings of worthlessness
  • Feelings of hopelessness
  • Excessive or inappropriate guilt
  • Frequent tearfulness
  • Apathy or low motivation
  • Irritability
  • Restlessness or noticeably slow behavior
  • Poor concentration

Individuals with bipolar disorder may also experience “mixed episodes”, which include both manic and depressive symptoms.  Mood episodes must not be caused by a medical condition or substance (including medication).

Many individuals with bipolar disorder alternate between periods of mania or hypomania and depression.  They may have long periods of times between mood episodes, lasting weeks, months, or even longer.  But some individuals experience “rapid cycling”, which means more frequent mood episodes (at least 4 per year, but some experience many more than that).

While major depression, just by itself – i.e., without the bipolar component – is one of the most common mental health disorders, manic episodes are less common and occur primarily in individuals with bipolar I disorder, which is the most severe form of the illness.  In fact, a manic episode without any history of depression is usually enough for a diagnosis of bipolar I disorder.  (The exception would be someone with schizoaffective disorder, which is a psychotic disorder very similar to schizophrenia but with the addition of significant mood episodes that may include mania.)

One of the most frustrating and heartbreaking facts about bipolar disorder is that many individuals are misdiagnosed and treated for other disorders long before (often several years) a medical or mental health professional makes the accurate diagnosis of bipolar disorder.  Once an accurate diagnosis is made, proper treatment protocols, with usually include both medication and therapy such as IPSRT, can be put in place.

Managing Social Rhythms with IPSRT

In IPSRT, one of the primary goals of therapy is to help therapy clients develop a healthy and consistent daily routine.  This is often difficult for individuals who don’t have a psychiatric disorder, so it can present quite a challenge for someone who’s grappling with the challenges of bipolar disorder.  Many experts believe that the lack of a routine and an irregular sleep schedule can trigger or worsen bipolar symptoms.

In therapy, clients are educated about the role of circadian rhythms, as well as the importance of living life on a fairly strict schedule.  Eating, going to bed, getting up in the morning, and other routine daily tasks need to be done at approximately the same times every day.  Clients learn to keep a very close, detailed track of their moods each day.  Fluctuations in mood or an increase in mood symptoms provide valuable information that helps clients establish a routine that works well for them.

Once established, clients are instructed to follow the routine as closely as possible.  When problems arise, they are discussed in therapy to determine solutions or areas that may need to be tweaked.  It usually takes at least 3 weeks to develop a habit, so clients need to understand that it will get easier to follow the routine as it becomes more ingrained with practice and time.

During therapy, relationship problems that may interrupt the routine are discussed.  This part of therapy involves helping clients improve their social skills and develop healthier relationships with those closes to them.  Improved relationships not only results in few disruptions to the routine, but also helps clients feel more content, more fulfilled, more relaxed, and more supported – that latter is especially important when challenges arise of symptoms begin to appear or worsen.  Healthy, supportive relationships can also help clients through depressive episodes, as isolation and a sense of worthlessness are very common during depression.

Another primary focus of IPST is helping clients learn to effectively manage stressful situations and events.  Although establishing and adhering to a strict schedule, improving interpersonal skills, and taking medications as prescribed will help reduce stress to some degree, stressful events will inevitably occur from time to time.  Teaching clients effective coping skills will help offset the impact of unexpected or unavoidable stressors when they arise.

Interpersonal and social rhythm therapy helps individuals with bipolar disorder:

  • Identify and effectively manage their symptoms
  • Come to terms with the impact of being diagnosed with a serious and typically lifelong psychiatric disorder
  • Understand the connection between their mood and what’s happening in their life
  • Identify potential mood triggers (e.g. spending a weekend with difficult in-laws) and find healthy and effective ways to offset their impact as much as possible
  • Fully understand just how vital sticking with a routine and adhering to treatment (e.g. taking their medication) is to their mental health and overall wellbeing
  • Improve their interpersonal skills and ability to effectively handle conflicts
  • Identify and resolve relationship problems and issues that are causing stress and disrupting their social rhythm
  • Manage painful role transitions (e.g. a divorce or breakup)
  • Manage unresolved grief
  • Identify and decrease interpersonal deficits ( an example of an interpersonal deficit would be a lack of quality, supportive friends)

Benefits of Interpersonal and Social Rhythm Therapy

There are numerous potential benefits for individuals who go participate in interpersonal and social rhythm therapy.  Following are just a few:

  • More fulfilling and positive relationships with others
  • Fewer mood episodes and symptoms / longer periods of time between mood episodes
  • Significant reduction in overall stress as a result of developing a consistent schedule, improving stress management skills, and adhering to a daily routine
  • Better communication skills
  • Improved problem-solving skills
  • Increased self-awareness
  • Much greater understanding of bipolar disorder and how to manage it effectively

Finding an Interpersonal and Social Rhythm Therapist or Therapy Group

If you’ve been diagnosed with bipolar disorder and thing IPSRT might help you learn to manage it, or manage it better than you currently are, it’s important to work with a psychologist or other mental health professional who has the proper training and experience in using this form of therapy.  It’s also important to find a therapist who has a fair amount of experience treating bipolar disorder, and understand the complexity of the disorder as well as the unique challenges that bipolar individuals frequently face.

One of the best ways to find a therapist in your area is to do an online search for IPSRT followed by your city or interpersonal and social rhythm therapy [you city].  That should get you started with at least a few potential professionals or programs to contact.  You might also try searching for treatment for bipolar disorder, bipolar therapy, and similar terms followed by your city.  Once you find a two or three potential therapists (or at least one), call them to briefly discuss any treatment questions and concerns.  Talking to a therapist briefly over the phone may also give you an initial sense of the therapist’s personality, which can be a deciding factor in terms of who you choose to work with.

Living with bipolar disorder can be challenging.  However, many individuals learn to manage it effectively and live happy, fulfilling lives.  Considering all the benefits of improving your relationships and establishing a consistent sleep and daily activity schedule, IPSRT has the potential to help you manage your disorder in the most effective way possible.

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