Two-Year Outcomes for Interpersonal and Social Rhythm Therapy in Individuals With Bipolar I Disorder

Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA.
Archives of General Psychiatry (Impact Factor: 14.48). 10/2005; 62(9):996-1004. DOI: 10.1001/archpsyc.62.9.996
Source: PubMed


Numerous studies have pointed to the failure of prophylaxis with pharmacotherapy alone in the treatment of bipolar I disorder. Recent investigations have demonstrated benefits from the addition of psychoeducation or psychotherapy to pharmacotherapy in this population.
To compare 2 psychosocial interventions: interpersonal and social rhythm therapy (IPSRT) and an intensive clinical management (ICM) approach in the treatment of bipolar I disorder.
Randomized controlled trial involving 4 treatment strategies: acute and maintenance IPSRT (IPSRT/IPSRT), acute and maintenance ICM (ICM/ICM), acute IPSRT followed by maintenance ICM (IPSRT/ICM), or acute ICM followed by maintenance IPSRT (ICM/IPSRT). The preventive maintenance phase lasted 2 years.
Research clinic in a university medical center.
One hundred seventy-five acutely ill individuals with bipolar I disorder recruited from inpatient and outpatient settings, clinical referral, public presentations about bipolar disorder, and other public information activities.
Interpersonal and social rhythm therapy, an adaptation of Klerman and Weissman's interpersonal psychotherapy to which a social rhythm regulation component has been added, and ICM.
Time to stabilization in the acute phase and time to recurrence in the maintenance phase.
We observed no difference between the treatment strategies in time to stabilization. After controlling for covariates of survival time, we found that participants assigned to IPSRT in the acute treatment phase survived longer without a new affective episode (P = .01), irrespective of maintenance treatment assignment. Participants in the IPSRT group had higher regularity of social rhythms at the end of acute treatment (P<.001). Ability to increase regularity of social rhythms during acute treatment was associated with reduced likelihood of recurrence during the maintenance phase (P = .05).
Interpersonal and social rhythm therapy appears to add to the clinical armamentarium for the management of bipolar I disorder, particularly with respect to prophylaxis of new episodes.

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    • "2012 ) . We failed to find significant differences between treatments in any of the analyses examining the alliance - outcome association . The lack of significant difference between treatments is consistent with previous studies that found no significant general differences between these treatments ( Barber et al . , 2012 ; Elkin et al . , 1989 ; Frank et al . , 2005 ; Imber et al . , 1990 ) and with studies in which alliance was identified as a common factor across different treat - ment orientations ( Horvath et al . , 2011 ) . The findings are also consistent with previous findings specifically demonstrating the important role of alliance for therapeutic change in case manage - ment ( Zilcha - Ma"
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    • "Literature remains scarce regarding the observation of biological rhythm as an improvement marker resulting from a psychotherapeutic intervention. Frank et al. (2005), in a study with Interpersonal and Social Rhythm Therapy (IPSRT), showed that psychotherapy improved social/circadian rhythms in patients with bipolar disorders. To our knowledge, there is no study showing whether psychotherapy positively affects biological rhythms regulation in depressed patients over a twelve-month follow-up period. "
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