How Interpersonal and Social Rhythm Therapy Can Help Treat Bipolar Disorder
If you’ve never heard of interpersonal and social rhythm therapy (IPSRT), it may just sound like a bunch of vaguely psychological words strung together. In reality, IPSRT can be incredibly helpful for some people with bipolar disorder. Here are the ins and outs of how IPSRT can ease bipolar disorder symptoms.
Bipolar disorder causes extreme shifts in mood and energy that can disrupt a person’s life.
There are two major subcategories of the disorder: bipolar I and bipolar II, according to the National Institute of Mental Health (NIMH).
Bipolar I involves prolonged and possibly dangerous manic episodes, which is when a person experiences an extremely elevated mood and energized behavior, the NIMH explains. Symptoms can include increased activity, trouble sleeping, being agitated or irritable, talking very quickly (or feeling like their thoughts are moving very quickly), thinking they can accomplish anything, and engaging in risky behavior like unprotected sex or impulsive spending. Someone with bipolar I can also experience episodes of hypomania that involve the heightened mood and energy of mania but on a less severe scale, depressive episodes lasting at least two weeks, or episodes combining symptoms of mania and depression. Bipolar II only involves episodes of hypomania and depression, the NIMH explains.
There are also some related conditions that describe having symptoms of hypomania and depression to a lesser extent (cyclothymia) or having symptoms that don’t neatly fit into any of the previous categories (Other Specified and Unspecified Bipolar and Related Disorders).
IPSRT is designed to teach someone with bipolar disorder how to prevent or better manage these shifts in mood and behavior.
This form of therapy focuses on stabilizing a person’s daily rhythms, like sleeping, waking up, and eating meals, according to the Mayo Clinic. If you take a look at its pretty jargon-y name, you can better understand why it does this.
The “interpersonal” aspect of IPSRT stresses the link between how a person’s mood affects their life, according to the Substance Abuse and Mental Health Services Administration (SAMHSA). “It is about how one relates to others in the world,” Nassir Ghaemi, M.D., M.P.H., professor of psychiatry at Tufts University School of Medicine, tells SELF. For instance, your therapist might ask you about recent or significant times your bipolar disorder has affected your friendships, love life, work relationships, and more. This can help a person with bipolar disorder examine how their condition influences their experiences so they’re more committed to living with it in the healthiest way possible. Your therapist may also ask you questions to identify how your routine (like when you sleep) affects your symptoms on a day-to-day basis, because committing to a lifestyle routine is an essential part of this therapy.
The “social rhythm” part of IPSRT centers around creating a daily routine a person can stick to long-term. “People with bipolar disorder tend to live less regimented lives,” Michael Thase, M.D., professor of psychiatry and director of the Mood and Anxiety Program at the University of Pennsylvania Perelman School of Medicine, tells SELF. “They may not go to bed at a good time, they may eat irregularly…adding normal times and a schedule to these things can help them take control of the irregularity.”
This type of set routine impacts your circadian rhythm (the collection of physiological processes timed to light and darkness that you go through over the course of 24 hours). This interplay is important because your circadian rhythm influences so many aspects of how your mind and body function, including the release of hormones that can influence your mood. (Research shows people’s circadian rhythms can affect their mood disorders.)
This is also why getting regular sleep is an especially crucial part of IPSRT, Dr. Ghaemi says. Since your circadian rhythm and sleep habits are inextricably intertwined, it’s no surprise that poor sleep can trigger manic and depressive episodes in some people with bipolar disorder.
If you’re going to get IPSRT, there are four phases of treatment to expect.
Here they are, per the SAMHSA:
- The initial phase is all about you and the therapist exploring how disruptions in your routine have led to bipolar episodes in the past.
- The intermediate phase involves laying out a new structure for your social rhythms (like when you wake up and go to sleep). You’ll typically start charting things like your mood, sleeping, eating, and exercise habits to pick up on how they’re connected, Dr. Ghaemi says.
- The maintenance phase is meant to help you reinforce these social rhythms so you trust that you can stick to them.
- The final phase is about reducing how often you need IPSRT.
As the SAMHSA explains, IPSRT treatment is meant to be weekly at first, then become monthly, then, ideally, you’d no longer need regular therapy sessions centered around this technique. Most people will undergo about 16 weeks of IPSRT, Dr. Ghaemi says. However, you can discuss continuing the sessions for as long as you find them valuable, Dr. Thase says.
Not every therapist is trained in IPSRT, so you’ll want to do your research before finding a practitioner.
When you’re searching for a therapist, you can use free consultations to ask how much practice your potential provider has in treating bipolar disorder, especially with this method. (Or you can ask the administrative office to find out for you if the therapist doesn’t offer free consultations.)
Even if they don’t have a ton of practice with IPSRT, a dedicated therapist may still be able to help. “The interpersonal component of this therapy is based on the traditional [psychotherapy] approach,” Dr. Ghaemi says. There are also free training tools available to experts looking to get a better handle on the social rhythm portion.
What if you’re interested in IPSRT but you’re already doing another form of therapy, like the cognitive behavioral variety? Ideally, you wrap that up before starting IPSRT, Dr. Ghaemi says, so you don’t interrupt your progress. “One could follow another,” he adds. However, that’s a decision you can make with your therapist. If they determine IPSRT would be more beneficial to you in the short-term than another form of therapy, it might make sense to dive right in.
Finally, let’s talk money, since therapy can be wildly expensive. IPSRT is typically covered by insurance at the same rate as any psychotherapy, Dr. Ghaemi says. If you have insurance, you can try using services like Psychology Today to find therapists who accept your plan and specialize in treating bipolar disorder. If you don’t have insurance, see whether any of the therapists who look promising to you accept patients on sliding scales based on income.
IPSRT can be excellent, but it’s not supposed to replace medication for bipolar disorder.
IPSRT should be used with certain medications to help treat this condition. “It does not work by itself,” Dr. Ghaemi says.
Medications to treat bipolar disorder can include mood stabilizers (to control manic or hypomanic episodes), antipsychotics (to help with symptoms of depression or mania that persist despite treatment with other medications), antidepressants (to treat the downcast mood), an antidepressant-antipsychotic (which works as a depression treatment and mood stabilizer), and anti-anxiety medications (to help with agitation and improve sleep), according to the Mayo Clinic.
You may need to take a variety of medications for your bipolar disorder symptoms, but combined with therapy like IPSRT, they can give you a good chance of feeling more in control of your life.