Interpersonal therapy Flashcards
Underlying Theory
- Once patients become depressed, symptoms of the illness compromise their interpersonal functioning, and bad events follow. - Whether life events follow or precede mood changes, the patient’s task in therapy is to resolve the disturbing life event(s), building social skills and helping to organize his or her life. - If the patient can solve the life problem, depressive symptoms should resolve as well. - This coupled effect has been borne out in clinical trials demonstrating the efficacy of IPT for major depression.
Practice Context
- IPT is a time-limited and structured psychotherapy for Moderate to Severe Depression.- A central idea in IPT is that psychological symptoms, such as depressed mood, can be understood as a response to current difficulties in our everyday interactions with others. - In turn, the depressed mood can also affect the quality of our relationships.- The main focus of IPT is on difficulties in relating to others and helping the person to identify how they are feeling and behaving in their relationships. When a person is able to interact more effectively, their psychological symptoms often improve.
Techniques and Strategies
• Identification of Emotion — Helping the person identify what their emotion is and where it is coming from.• Example — Roger is upset and fighting with his wife. Careful analysis in therapy reveals that he has begun to feel neglected and unimportant since his wife started working outside the home. Knowing that the relevant emotion is hurt and not anger, Roger can begin to address the problem.• Expression of Emotion — This involves helping the person express their emotions in a healthy way.• Example — When Roger feels neglected by his wife he responds with anger and sarcasm. This in turn leads his wife to react negatively. By expressing his hurt and his anxiety at no longer being important in her life in a calm manner, Roger can now make it easier for his wife to react with nurturance and reassurance.• Dealing With Emotional Baggage — Often, people bring unresolved issues from past relationships to their present relationships. By looking at how these past relationships affect their present mood and behavior, they are in a better position to be objective in their present relationships.• Example — Growing up, Roger’s mother was not a nurturing woman. She was very involved in community affairs and often put Roger’s needs on the back burner. When choosing a wife, Roger subconsciously chose a woman who was very attentive and nurturing. While he agreed that the family needed the increased income, he did not anticipate how his relationship with his own mother would affect his reaction to his wife working outside the home.
Historical Development - Dates and Key Figures
- Interpersonal therapy began in 1969 at Yale University, where Dr. Gerald Klerman was joined by Dr. Eugene Paykel from London to design a study to test the relative efficacy of an antidepressant alone and both with and without psychotherapy as maintenance treatment of ambulatory nonbipolar depression. - IPT takes structure from contemporary Cognitive Behavioral Therapy (CBT) approaches in that it is time-limited and employs homework, structured interviews, and assessment tools. - Yet the content of therapy was inspired by Harry Stack Sullivan’s psychodynamic Interpersonal Theory (Sullivan, 1953, Interpersonal Theory of Psychiatry). - IPT focuses on a specific vulnerability to social stressors, such as differing role expectations in a dyadic relationship (Weissman, et al, 2007), but does not include a personality theory or attempt to conceptualize or treat personality (Prochaska, 1984, Systems of Psychotherapy: A Transtheoretical Analysis). - This makes IPT quite distinct from its psychodynamic influence, which is fundamentally a personality theory. However, other theorists have developed contemporary Interpersonal psychotherapies that remain true to the psychodynamic origin. - Over the past 20 years, IPT has been carefully studied in many research protocols, has been demonstrated to successfully treat patients with depression, and has been modified to treat other psychiatric disorders (substance abuse, dysthymia, bulimia) and patient populations (adolescents, late-life, primary medical care).- From the beginning, IPT has been tested in various clinical trials and found to be effective in treating acute episodes of depression and preventing or delaying the onset of subsequent episodes. - A large multicenter collaborative study was conducted by the National Institute of Mental Health (NIMH), comparing IPT, CBT, imipramine and placebo.
Applications
Interpersonal Psychotherapy (IPT) is a structured therapy for people with moderate to severe depression.
IPT can typically focuses on the following relationship areas: • Conflict with another person
• Life changes that affect how you feel about yourself and others
• Grief and loss
• Difficulty in starting or keeping relationships going
Interpersonal psychotherapy has been proven as an effective treatment for the following:
• Bipolar disorder (Weissmann & Markowitz, 1998)
• Bulimia nervosa (Weissmann & Markowitz, 1998)
• post-partum depression (Weissmann & Markowitz, 1998)
• family therapy (Weissmann & Markowitz, 1998
• Major depressive disorder (Joiner, Brown & Kistner, 2006)
• Cyclothymia
• Various other disorders (Markowitz, 1990)
Evidence Base
- Fairburn (1997) patients with bulimia prefer IPT to CBT- Paley et al (2008) found no difference in efficacy of CBT and IPT- RObinson, Berman and Neimeyer (1990) both CBT and IPT showed tendency for symptoms to recur
Stregnths of IPT
- IPT’s minimal use of jargon and format allows psychotherapist to become quickly competent- Approach easily modified for a range of conditions- Likely to be applicable to a wide range of patient disorders
An undeniable strength of IPT is the evidence supporting its efficacy. Positive expectations predict better therapy outcomes, and IPT research shows encouraging results. As clinicians, we can confidently recommend IPT for treatment of major depressive disorder.
IPT for depression
Most randomized controlled trials of IPT focus on its efficacy as a treatment for depression. Research focusing on its effectiveness and applicability to other psychiatric conditions is still in its infancy, as is research examining the mechanisms underlying this approach. For a comprehensive review of IPT research, the reader is directed to Weissman, Markowitz and Klerman (4) or Stuart and Robertson (5).
The National Institute of Mental Health Treatment of Depression Collaborative Research Program (NIMH- TDCRP, 24), still regarded as the gold standard for psychotherapy efficacy research, catalyzed the development of IPT.
The NIMH-TDCRP compared IPT, CBT, imipramine and a placebo–clinical management arm for the treatment of patients with major depression. IPT was found to be superior to placebo and equal to CBT and imipramine for mild-to-moderate depression.
There was some evidence that IPT was superior to CBT for individuals with severe depression (25). IPT has since been found to be an effective treatment for depression patients from adolescence (26) to late life (27), for women with postpartum depression (28,29) and for patients with medical comorbidity (30,31).
As well, group IPT has recently been tested in a large randomized controlled trial for patients in Uganda with major depression or sub- syndromal depression and found to be highly efficacious (32). For patients with recurrent depression in the continuation and maintenance phases of treatment, “low-dose,” once-monthly maintenance IPT can reduce relapse rates and prolong periods between depressive episodes (23,33).
IPT for social anxiety
Lipsitz, Marjowitz, Cherry & Fryer, 1999
OBJECTIVE: Interpersonal psychotherapy is a time-limited treatment initially developed to treat depression. It has not been studied for the treatment of anxiety disorders.
METHOD: Interpersonal psychotherapy was modified and tested in a 14-week, open trial of nine patients with DSM-IV social phobia.
RESULTS: At termination, seven (78%) were independently rated as much or very much improved on overall social phobia symptoms. Nearly all clinician ratings and self-ratings of social phobia symptoms significantly improved. Changes approximated those of established treatments for social phobia.
CONCLUSIONS: Interpersonal psychotherapy may have efficacy for the treatment of social phobia. Further study in a comparison trial is warranted.
IPT for bi-polar disorder
Frank, Schwarz and Kupfer, 2000
OBJECTIVE: Interpersonal and social rhythm therapy is an individual psychotherapy designed specifically for the treatment for bipolar disorder. Interpersonal and social rhythm therapy grew from a chronobiological model of bipolar disorder postulating that individuals with bipolar disorder have a genetic predisposition to circadian rhythm and sleep-wake cycle abnormalities that may be responsible, in part, for the symptomatic manifestations of the illness. In our model, life events (both negative and positive) may cause disruptions in patients’ social rhythms that, in turn, perturb circadian rhythms and sleep-wake cycles and lead to the development of bipolar symptoms.
RESULTS: Administered in concert with medications, interpersonal and social rhythm therapy combines the basic principles of interpersonal psychotherapy with behavioral techniques to help patients regularize their daily routines, diminish interpersonal problems, and adhere to medication regimens. It modulates both biological and psychosocial factors to mitigate patients’ circadian and sleep-wake cycle vulnerabilities, improve overall functioning, and better manage the potential chaos of bipolar disorder symptomatology.
IPT for eating disorders
Wilfley et al. 2002
BACKGROUND:
Cognitive-behavioral therapy (CBT) has documented efficacy for the treatment of binge eating disorder (BED). Interpersonal psychotherapy (IPT) has been shown to reduce binge eating but its long-term impact and time course on other BED-related symptoms remain largely unknown. This study compares the effects of group CBT and group IPT across BED-related symptoms among overweight individuals with BED.
METHODS:
One hundred sixty-two overweight patients meeting DSM-IV criteria for BED were randomly assigned to 20 weekly sessions of either group CBT or group IPT. Assessments of binge eating and associated eating disorder psychopathology, general psychological functioning, and weight occurred before treatment, at posttreatment, and at 4-month intervals up to 12 months following treatment.
RESULTS:
Binge-eating recovery rates were equivalent for CBT and IPT at posttreatment (64 [79%] of 81 vs 59 [73%] of 81) and at 1-year follow-up (48 [59%] of 81 vs 50 [62%] of 81). Binge eating increased slightly through follow-up but remained significantly below pretreatment levels. Across treatments, patients had similar significant reductions in associated eating disorders and psychiatric symptoms and maintenance of gains through follow-up. Dietary restraint decreased more quickly in CBT but IPT had equivalent levels by later follow-ups. Patients’ relative weight decreased significantly but only slightly, with the greatest reduction among patients sustaining recovery from binge eating from posttreatment to 1-year follow-up.
CONCLUSIONS:
Group IPT is a viable alternative to group CBT for the treatment of overweight patients with BED. Although lacking a nonspecific control condition limits conclusions about treatment specificity, both treatments showed initial and long-term efficacy for the core and related symptoms of BED.
Fairburn et al, 1991
OBJECTIVE:
The specificity and magnitude of the effects of cognitive behavior therapy in the treatment of bulimia nervosa were evaluated.
METHOD:
Seventy-five patients who met strict diagnostic criteria were treated with either cognitive behavior therapy, a simplified behavioral version of this treatment, or interpersonal psychotherapy. Assessment was by interview and self-report questionnaire, and many aspects of functioning were evaluated.
RESULTS:
All three treatments resulted in an improvement in the measures of the psychopathology. Cognitive behavior therapy was more effective than interpersonal psychotherapy in modifying the disturbed attitudes to shape and weight, extreme attempts to diet, and self-induced vomiting. Cognitive behavior therapy was more effective than behavior therapy in modifying the disturbed attitudes to shape and weight and extreme dieting, but it was equivalent in other respects.
CONCLUSION:
The findings suggest that cognitive behavior therapy, when applied to patients with bulimia nervosa, operates through mechanisms specific to this treatment and is more effective than both interpersonal psychotherapy and a simplified behavioral version of cognitive behavior therapy.
