Interpersonal and social rhythm therapy for adolescents with bipolar disorder: Treatment development and results from an open trial
Department of Psychiatry and Behavioral Sciences, University of Washington Medical Center, Seattle, Washington, USA. Depression and Anxiety
(Impact Factor: 4.41).
05/2010; 27(5):457-64. DOI: 10.1002/da.20668
In adolescents and adults, bipolar disorder (BD) is associated with significant morbidity, mortality, and impairment in psychosocial and occupational functioning. IPSRT is an empirically supported adjunctive psychotherapy for adults with bipolar disorder, which has been shown to help delay relapse, speed recovery from a bipolar depressive episode, and increase occupational and psychosocial functioning in adults with BD. This study is designed to describe the adolescent-specific developmental adaptations made to IPSRT (i.e., IPSRT-A) and to report the results from an open trial of IPSRT-A with 12 adolescents with a bipolar spectrum disorder.
Interpersonal and Social Rhythm Therapy was adapted to be developmentally relevant to adolescents with bipolar disorder. Twelve adolescents (mean age 16.5+/-1.3 years) diagnosed with a bipolar spectrum disorder participated in 16-18 sessions of adjunctive IPSRT-A over 20 weeks. Manic, depressive, and general symptoms and global functioning were measured at baseline, monthly during treatment, and at post-treatment. Adolescent satisfaction with treatment was also measured.
Feasibility and acceptability of IPSRT-A were high; 11/12 participants completed treatment, 97% of sessions were attended, and adolescent-rated satisfaction scores were high. IPSRT-A participants experienced significant decreases in manic, depressive, and general psychiatric symptoms over the 20 weeks of treatment. Participants' global functioning increased significantly as well. Effect sizes ranged from medium-large to large.
IPSRT-A appears to be a promising adjunctive treatment for adolescents with bipolar disorder. A current randomized controlled trial is underway to examine effects of adjunctive IPSRT-A on psychiatric symptoms and psychosocial functioning.
Figures in this publication
Available from: Susan L Rossell
- "Certainly, these kinds of investigations would inform the development of psychological treatments that may be effective in improving psychosocial outcome in the disorder. Current psychological treatments for BD include cognitive behavioural therapy (CBT) and interpersonal social rhythm therapy (ISRT); these techniques show small effects on the reduction of symptoms and improvement in psychosocial functioning (Costa et al., 2011; Gregory, 2010; Hlastala et al., 2010; Hollon and Ponniah, 2010). However, these treatments provide intervention after neurocognitive, social cognitive or emotion regulation abnormalities are established . "
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Neurocognitive ability and mood have often been discussed as contributing mechanisms to the severe psychosocial dysfunction experienced in bipolar disorder (BD). In contrast, there has been little discussion on the contribution of social cognition or emotion regulation. This paper aims to assert a potential role for these constructs in psychosocial functioning in BD, with an overarching goal to highlight the necessary importance of considering them in future research examining psychosocial outcomes in the disorder.
This paper provides a theoretical synthesis of available and indirect evidence for an influence of (1) social cognition and (2) emotion regulation on psychosocial functioning; it acknowledges important clinical questions that need addressing, and discusses how current research might be translated to improve the treatment of psychosocial dysfunction in BD.
Given their assumed roles in facilitating social interactions and modulating behaviours, it is certainly plausible that abnormalities in social cognition and emotion regulation are detrimental to psychosocial functioning. Currently, there is only minimal direct evidence examining their influence, although existing BD studies are preliminarily supportive of relationships between these constructs.
There are reasonable theoretical grounds, supported by indirect and preliminary evidence, to suggest that social cognition and emotion regulation may be important in the prediction of psychosocial outcome in BD. However, this proposition is limited by the paucity of empirical research directly examining this matter.
Australian and New Zealand Journal of Psychiatry 10/2013; 48(1). DOI:10.1177/0004867413508452 · 3.41 Impact Factor
Available from: PubMed Central
- "Support groups and psychotherapy offer a context in which people can experience acceptance, appreciation and meaningful interpersonal connections. Some interventions such as interpersonal and social rhythm therapy (IPSRT) may also enhance psychosocial competence in BD . At the same time, these efforts may not be powerful enough to override a misfit between genetic vulnerability to stress and psychosocial demand. "
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ABSTRACT: Previous research on functional outcome in bipolar disorder (BD) has uncovered various factors that exacerbate psychosocial disability over the course of illness, including genetics, illness severity, stress, anxiety, and cognitive impairment. This paper presents an integrated view of these findings that accounts for the precipitous decline in psychosocial functioning after illness onset. The proposed model highlights a number of reciprocal pathways among previously studied factors that trap people in a powerful cycle of ailing forces. The paper discusses implications to patient care as well as the larger social changes required for shifting the functional trajectory of people with BD from psychosocial decline to growth.
Depression research and treatment 01/2012; 2012(2090-1321):949248. DOI:10.1155/2012/949248
Available from: ncbi.nlm.nih.gov
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ABSTRACT: AIM: To review the diagnosis and the pharmacologic and psychosocial interventions for pediatric bipolar disorder (PBD). METHODS: A comprehensive literature review of studies discussing the diagnosis and treatment of PBD was conducted. RESULTS: A context for understanding controversies and difficulties in the diagnosis of PBD is provided. An evidence-based assessment protocol for PBD is reviewed. The evidence for the following three categories of pharmacologic interventions are reviewed: Lithium, antiepileptics, and second generation antipsychotics. Algorithms for medication decisions are briefly reviewed. Existing psychosocial treatments and the evidence for those treatments are also reviewed. CONCLUSION: Despite recent developments in understanding the phenomenology of PBD and in identifying pharmacologic and psychosocial interventions, critical gaps remain.
Minerva psichiatrica 03/2011; 52(1):21-35.
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