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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    • "The SRT component postulates that disordered circadian biology contributes to the development and maintenance of psychiatric symptoms and that helping patients to develop more regular routines and social patterns will facilitate stabilization of underlying circadian abnormalities, thereby reducing symptoms and improving outcomes. Previous work demonstrates that improved regularity of daily routine mediates improved outcomes in patients treated with IPSRT (Frank et al. 2005b), and SRT has been used as a stand-alone intervention in routine practice setting (Swartz et al. 2011). IPSRT typically lasts from 12-26 sessions (Miklowitz et al. 2007, Swartz et al. 2012). "
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    ABSTRACT: Background: Telephone-administered psychotherapies (T-P) provided as an adjunct to antidepressant medication may improve response rates in major depressive disorder (MDD). The goal of this study was to compare telephone-administered social rhythm therapy (T-SRT) and telephone-administered intensive clinical management (T-ICM) as adjuncts to antidepressant medication for MDD. A secondary goal was to compare T-P with Treatment as Usual (TAU) as adjunctive treatment to medication for MDD. METHODS: 221 adult out-patients with MDD, currently depressed, were randomly assigned to 8 sessions of weekly T-SRT (n=110) or T-ICM (n=111), administered as an adjunct to agomelatine. Both psychotherapies were administered entirely by telephone, by trained psychologists who were blind to other aspects of treatment. The 221 patients were a posteriori matched with 221 depressed outpatients receiving TAU (controls). The primary outcome measure was the percentage of responders at 8 weeks post-treatment. RESULTS: No significant differences were found between T-SRT and T-ICM. But T-P was associated with higher response rates (65.4% vs 54.8%, p=0.02) and a trend toward higher remission rates (33.2% vs 25.1%; p=0.06) compared to TAU. LIMITATIONS: Short term study. CONCLUSIONS: This study is the first assessing the short-term effects of an add-on, brief, telephone-administered psychotherapy in depressed patients treated with antidepressant medication. Eight sessions of weekly telephone-delivered psychotherapy as an adjunct to antidepressant medication resulted in improved response rates relative to medication alone.
    Journal of Affective Disorders 10/2015; 190:6-11. DOI:10.1016/j.jad.2015.07.052 · 3.38 Impact Factor
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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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    ABSTRACT: Most of the literature on the alliance-outcome association is based exclusively on differences between patient reports on alliance. Much less is known about the unique contribution of the therapist's report to this association across treatment, that is, the association between therapist-reported alliance and outcome over the course of treatment, after controlling for the patient's contribution. The present study is the first to examine the unique contribution of the therapist-reported alliance to outcome, accounting for reverse causation (symptomatic levels predicting alliance), at several time points in the course of treatment. Of 156 patients randomized to dynamic supportive-expressive psychotherapy, antidepressant medication with clinical management, and placebo with clinical management, 149 were included in the present study. Alliance was assessed from the perspective of both the patient and the therapist. Outcome measures included the patients' self-reported and diagnostician-rated depressive symptoms. Overall, the findings demonstrate that the therapists' contribution to the alliance-outcome association was explained mainly by prior symptomatic levels. However, when a time lag of several sessions was introduced between alliance and symptoms, a positive association emerged between alliance at 1 time point and symptomatic distress assessed several sessions later in the treatment, controlling for previous symptomatic level. The findings were similar whether or not we controlled for the patient's perspective on the alliance. Taken together, the findings attest to the importance of improving therapists' ability to detect deterioration in the alliance. (PsycINFO Database Record (c) 2015 APA, all rights reserved).
    Journal of Counseling Psychology 08/2015; DOI:10.1037/cou0000106 · 3.23 Impact Factor
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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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    ABSTRACT: To evaluate the effect of cognitive therapy on biological rhythm and depressive and anxious symptoms in a twelve-month follow-up period. In addition, correlations between the reduction of depression and anxiety symptoms and the regulation of biological rhythm were observed. This was a randomized clinical trial with young adults from 18 to 29 years of age who were diagnosed with depression. Two models of psychotherapy were used: Cognitive Behavioral Therapy (CBT) and Narrative Cognitive Therapy (NCT). Biological rhythm was assessed with the Biological Rhythm Interview of Assessment in Neuropsychiatry (BRIAN). Severity of depressive and anxious symptoms was assessed by the Hamilton Depression Rating Scale (HDRS) and the Hamilton Anxiety Rating Scale (HARS), respectively. The sample included 97 patients who were divided within the protocols of psychotherapy. There was a significant reduction in depressive and anxious symptoms (p<0.001) and an increase on regulation of biological rhythm (p<0.05) at the twelve-month follow-up. Moreover, we showed a positive correlation between the reduction of depressive symptoms and regulation of biological rhythm (r=0.638; p<0.001) and between the reduction of anxious symptoms and regulation of biological rhythm (r=0.438; p<0.001). Both models showed that cognitive therapy was effective on the reduction of depressive and anxious symptoms and on the regulation of biological rhythm at a twelve-month follow-up evaluation. This study highlights the association between biological rhythm and symptoms of depression and anxiety. We did not assess genetic, hormonal or neurochemical factors and we did not include patients under pharmaceutical treatment or those with severe symptomatology. Copyright © 2015 Elsevier B.V. All rights reserved.
    Journal of Affective Disorders 08/2015; 187:1-9. DOI:10.1016/j.jad.2015.08.014 · 3.38 Impact Factor
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