Interpersonal and Social Rhythm Therapy

In several clinical trials, Interpersonal and Social Rhythm Therapy (IPSRT) in conjunction with taking prescribed medications has been shown to significantly increase the time between episodes of both mania and depression for individuals with bipolar I disorder (Frank et al., 2005).  IPSRT can be used both as an acute treatment for individuals currently in the midst of a depressive or manic episode or as a preventative treatment for individuals currently between episodes and seeking to remain symptom free for as long as possible. 

IPSRT was developed by Ellen Frank Ph.D. from the University of Pittsburgh. IPSRT is based on the observation that disruptions of circadian rhythms and sleep deprivation can stimulate or aggravate bipolar disorder symptoms. It combines behavioral psychology techniques like self-monitoring and self-management, with interpersonal principles, to help people with bipolar disorder maintain systematic routines for sleeping, eating, and other daily activities. 

It is important to stabilize circadian and social rhythms because they are often out of sync in people with bipolar disorder. Therapists who practice IPSRT will work with their clients to help them observe and then regulate sleep-wake cycles, daily routines, and social relationships. Limiting disruptions to these social and bodily “rhythms” can help minimize bipolar episodes in many people.

In an initial therapy session, the client may discuss the times she goes to sleep and wakes, time of day she has meals, what times she typically has her interactions with other people, and whether those interactions are positive, negative, stress producing, stimulating, boring, or emotionally upsetting. I keep a daily journal. I record moods, food, important interactions, exercise, etc. I didn’t realize that I was doing IPSRT.

Monitoring social rhythms can help you identify the  habits and patterns that may be aggravating the disorder. Sleep disruptions are often one of the primary triggers for manic episodes. Highly stimulating events or stressful social interactions during the day can also worsen both mania and depression. I found that I spontaneously eliminated certain people and activities from my life as I began to recover from my 2009 manic episode. Eliminating those stimuli allowed my body and mind to start calming down so that I could return to my pre-manic state. I observed that if a triggering stimuli appeared, I could actually feel the manic energy well up in me, and then I’d have difficulty sleeping for several nights afterwards. Eliminating the stimuli that is contributing to or triggering an episode is essential for recovery.

Treating Bipolar Disorder: A Clinician’s Guide to Interpersonal and Social Rhythm Therapy. Ellen Frank. New York: Guilford Press (www.guilford.com). 2005.