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.
- Expression of Emotion — This involves helping the person express their emotions in a healthy way.•
- 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.
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).
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)
Stregnths of IPT
- IPT is particularly accessible to patients who find dynamic approaches mystifying, or the ‘homework’ demands of Cognitive Behavioral Therapy (CBT) daunting.
- IPT has been specially modified for adolescents who may find CBT too much like school work, whereas IPT addresses relationships — a primary concern (Muston et al., 1993).
- IPT is abstemious in its use of technical jargon — a bonus for those who distrust ‘ psychobabble’. C.G. Fairburn, in a 1997 study, reported that both patients and therapists in his bulimia studies expressed a preference for IPT over CBT. This may have implications for compliance and therapist morale.
Limitations of IPT
- For general psychiatrists, a perceived limitation of IPT is it has not yet been modified for the management of psychoses ( although this limitation is true of many prominent psychotherapies).
- The CBT model requires such expertise for its use with this population that it would be considered risky for a trainee to attempt its use without expert training and support (Morris, 2002).
- As with any face-to-face therapy, it is demanding of the individual in that effort must be made to attend pre-arranged dates for the therapy sessions. Whereas substantive effort may not be needed for ‘homework’ tasks, the therapy involves the reenactment of past negative feelings which, as well as creating a danger of emotional harm, often requires more effort than that required in CBT sessions.
IPT for anxiety
Lipsitz, Marjowitz, Cherry & Fryer, 1999
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.
Stangier et al (2002)
RESULTS: Regarding response rates and Liebowitz Social Anxiety Scale scores, CT performed significantly better than did IPT, and both treatments were superior to WLC. At 1-year follow-up, the differences between CT and IPT were largely maintained, with significantly higher response rates in the CT vs the IPT group (68.4% vs 31.6%) and better outcomes on the Liebowitz Social Anxiety Scale.
CONCLUSIONS: Cognitive therapy and IPT led to considerable improvements that were maintained 1 year after treatment; CT was more efficacious than was IPT in reducing social phobia symptoms.
IPT for bi-polar disorder
Frank, Schwarz and Kupfer, 2000
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
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.
IPT for depression
- The literature on interpersonal psychotherapy initially focused on major depression in adults ( Cuijpers 2008),
- But it has expanded across the age range, with randomised controlled trials involving adults of working age ( Elkin 1985), adolescents ( Klomek 2006) and older adults ( Post 2008).
- The type of depressive disorder has also been explored, with treatment for acute episodes ( Luty 2007), recurrent depression ( Frank 2007), chronic depression ( Blanco 2001; Markowitz 2003; Schramm 2008), dysthymia ( Browne 2002; Markowitz 2008) and bipolar disorder ( Frank 2005) all having come under scrutiny.
- The context in which depressive symptoms are experienced has also drawn attention, particularly medical contexts such as the peri- and postnatal period ( Grote 2009), post-stroke ( Finkenzeller 2009), post-myocardial infarction ( Lesperance 2007), in patients with cancer and their partners ( Donnelly 2000) and in HIV-positive patients ( Markowitz 1998; Ransom 2008).
- The literature is also no longer limited to the treatment of depressive disorders. It addresses interpersonal psychotherapy for eating disorders ( Fairburn 1991, 1993) and for anxiety disorders, including social phobia ( Hoffart 2009), panic disorder ( Lipsitz 2006) and post-traumatic stress disorder (PTSD) ( Bleiberg 2005; Robertson 2007; Krupnick 2008).
- After depressive disorders, the evidence base for interpersonal psychotherapy is the most developed for eating disorders, and the intervention is recommended in NICE guidelines for eating disorders ( National Collaborating Centre for Mental Health 2004).
- Although most of the literature examines interpersonal psychotherapy as an individual intervention, it is by no means limited to that.
- A number of publications examine interpersonal psychotherapy delivered in a group format ( Bolton 2003; Verdeli 2008), across different cultural settings ( Bass 2006; Rossello 2008), delivered by telephone for patients who cannot easily attend sessions ( Miller 2002; Ransom 2008) and as a therapy for couples in disputes ( Klerman 1993).
