Interpersonal psychotherapy

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Interpersonal psychotherapy (IPT) is a brief, attachment-focused psychotherapy that centers on resolving interpersonal problems and symptomatic recovery. It is an empirically supported treatment (EST) that follows a highly structured and time-limited approach and is intended to be completed within 12–16 weeks. IPT is based on the principle that relationships and life events impact mood and that the reverse is also true. [1] [2] It was developed by Gerald Klerman and Myrna Weissman for major depression in the 1970s and has since been adapted for other mental disorders. [3] IPT is an empirically validated intervention for depressive disorders, and is more effective when used in combination with psychiatric medications. [4] Along with cognitive behavioral therapy (CBT), IPT is recommended in treatment guidelines as a psychosocial treatment of choice for depression. [5] [6]

Contents

History

Originally named "high contact" therapy, IPT was first developed in 1969 at Yale University as part of a study designed by Gerald Klerman, Myrna Weissman and colleagues to test the efficacy of an antidepressant with and without psychotherapy as maintenance treatment of depression. [7] [8] IPT has been studied in many research protocols since its development. [9] [10] NIMH-TDCRP demonstrated the efficacy of IPT as a maintenance treatment and delineated some contributing factors. [11]

Foundations

IPT was influenced by CBT as well as psychodynamic approaches. It takes its structure from CBT in that it is time-limited, employs structured interviews and assessment tools. [12] In general, however, IPT focuses directly on affects, or feelings, whereas CBT focuses on cognitions with strong associated affects. Unlike CBT, IPT makes no attempt to uncover distorted thoughts systematically by giving homework or other assignments, nor does it help the patient develop alternative thought patterns through prescribed practice. Rather, as evidence arises during the course of therapy, the therapist calls attention to distorted thinking in relation to significant others. The goal is to change the relationship pattern rather than associated depressive cognitions, which are acknowledged as depressive symptoms. [13]

The content of IPT's therapy was inspired by Attachment theory and Harry Stack Sullivan's Interpersonal psychoanalysis. Social theory is also influenced in a lesser role to emphasis on qualitative impact of social support networks for recovery. [14] Unlike psychodynamic approaches, IPT does not include a personality theory or attempt to conceptualize or treat personality but focuses on humanistic applications of interpersonal sensitivity. [15] [16]

The aim of IPT is to help the patient to improve interpersonal and intrapersonal communication skills within relationships and to develop social support network with realistic expectations to deal with the crises precipitated in distress and to weather 'interpersonal storms'.

Clinical applications

It has been demonstrated to be an effective treatment for depression and has been modified to treat other psychiatric disorders such as substance use disorders and eating disorders. It is incumbent upon the therapist in the treatment to quickly establish a therapeutic alliance with positive countertransference of warmth, empathy, affective attunement and positive regard for encouraging a positive transferential relationship, from which the patient is able to seek help from the therapist despite resistance. It is primarily used as a short-term therapy completed in 12–16 weeks, but it has also been used as a maintenance therapy for patients with recurrent depression. [20] A shorter, 6-week therapy suited to primary care settings called Interpersonal counselling (IPC) has been derived from IPT. [21]

Interpersonal psychotherapy has been found to be an effective treatment for the following: [22]

Adolescents

Although originally developed as an individual therapy for adults, IPT has been modified for use with adolescents and older adults. [22]

IPT for children is based on the premise that depression occurs in the context of an individual's relationships regardless of its origins in biology or genetics. More specifically, depression affects people's relationships and these relationships further affect our mood. The IPT model identifies four general areas in which a person may be having relationship difficulties:

  1. grief after the loss of a loved one;
  2. conflict in significant relationships, including a client's relationship with his or her own self; [25]
  3. difficulties adapting to changes in relationships or life circumstances; and
  4. difficulties stemming from social isolation. [22]

The IPT therapist helps identify areas in need of skill-building to improve the client's relationships and decrease the depressive symptoms. Over time, the client learns to link changes in mood to events occurring in his/her relationships, communicate feelings and expectations for the relationships, and problem-solve solutions to difficulties in the relationships. [26]

IPT has been adapted for the treatment of depressed adolescents (IPT-A) to address developmental issues most common to teenagers such as separation from parents, development of romantic relationships, and initial experience with death of a relative or friend. [26] IPT-A helps the adolescent identify and develop more adaptive methods for dealing with the interpersonal issues associated with the onset or maintenance of their depression. IPT-A is typically a 12- to 16-week treatment. Although the treatment involves primarily individual sessions with the teenager, parents are asked to participate in a few sessions to receive education about depression, to address any relationship difficulties that may be occurring between the adolescent and his/her parents, and to help support the adolescent's treatment. [27]

Elderly

IPT has been used as a psychotherapy for depressed elderly, with its emphasis on addressing interpersonally relevant problems. IPT appears especially well suited to the life changes that many people experience in their later years. [28]

Related Research Articles

<span class="mw-page-title-main">Cognitive behavioral therapy</span> Type of therapy to improve mental health

Cognitive behavioral therapy (CBT) is a psycho-social intervention that aims to reduce symptoms of various mental health conditions, primarily depression and anxiety disorders. Cognitive behavioral therapy is one of the most effective means of treatment for substance abuse and co-occurring mental health disorders. CBT focuses on challenging and changing cognitive distortions and their associated behaviors to improve emotional regulation and develop personal coping strategies that target solving current problems. Though it was originally designed to treat depression, its uses have been expanded to include many issues and the treatment of many mental health conditions, including anxiety, substance use disorders, marital problems, ADHD, and eating disorders. CBT includes a number of cognitive or behavioral psychotherapies that treat defined psychopathologies using evidence-based techniques and strategies.

<span class="mw-page-title-main">Major depressive disorder</span> Mental disorder involving persistent low mood, low self-esteem, and loss of interest

Major depressive disorder (MDD), also known as clinical depression, is a mental disorder characterized by at least two weeks of pervasive low mood, low self-esteem, and loss of interest or pleasure in normally enjoyable activities. Introduced by a group of US clinicians in the mid-1970s, the term was adopted by the American Psychiatric Association for this symptom cluster under mood disorders in the 1980 version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III), and has become widely used since.

Group psychotherapy or group therapy is a form of psychotherapy in which one or more therapists treat a small group of clients together as a group. The term can legitimately refer to any form of psychotherapy when delivered in a group format, including art therapy, cognitive behavioral therapy or interpersonal therapy, but it is usually applied to psychodynamic group therapy where the group context and group process is explicitly utilized as a mechanism of change by developing, exploring and examining interpersonal relationships within the group.

Dysthymia, also known as persistent depressive disorder (PDD), is a mental and behavioral disorder, specifically a disorder primarily of mood, consisting of similar cognitive and physical problems as major depressive disorder, but with longer-lasting symptoms. The concept was used by Robert Spitzer as a replacement for the term "depressive personality" in the late 1970s.

Psychodynamic psychotherapy and psychoanalytic psychotherapy are two categories of psychological therapies. Their main purpose is revealing the unconscious content of a client's psyche in an effort to alleviate psychic tension, which is inner conflict within the mind that was created in a situation of extreme stress or emotional hardship, often in the state of distress. The terms "psychoanalytic psychotherapy" and "psychodynamic psychotherapy" are often used interchangeably, but a distinction can be made in practice: though psychodynamic psychotherapy largely relies on psychoanalytical theory, it employs substantially shorter treatment periods than traditional psychoanalytical therapies. Psychodynamic psychotherapy is evidence-based; the effectiveness of psychoanalysis and its relationship to facts is disputed.

John C. Markowitz is an American physician, a Professor of Clinical Psychiatry at the Columbia University College of Physicians & Surgeons and a Research Psychiatrist at the New York State Psychiatric Institute. For several decades he has conducted research on psychotherapies and medications as treatments for mood disorders, anxiety disorders, and personality disorders, and more recently posttraumatic stress disorder (PTSD). He is most widely published in the area of interpersonal psychotherapy or IPT, a manualized form of treatment, in which he was trained by the late Gerald L. Klerman, M.D. Dr. Markowitz is a graduate of Columbia University and Columbia University College of Physicians and Surgeons and received his psychiatric residency training at the Payne Whitney Psychiatric Clinic of Cornell University Medical School/New York-Presbyterian Hospital.

<span class="mw-page-title-main">Psychotic depression</span> Medical condition

Psychotic depression, also known as depressive psychosis, is a major depressive episode that is accompanied by psychotic symptoms. It can occur in the context of bipolar disorder or major depressive disorder. It can be difficult to distinguish from schizoaffective disorder, a diagnosis that requires the presence of psychotic symptoms for at least two weeks without any mood symptoms present. Unipolar psychotic depression requires that psychotic symptoms occur during severe depressive episodes, although residual psychotic symptoms may also be present in between episodes. Diagnosis using the DSM-5 involves meeting the criteria for a major depressive episode, along with the criteria for "mood-congruent or mood-incongruent psychotic features" specifier.

Interpersonal and social rhythm therapy (IPSRT) is an intervention for people with bipolar disorder (BD). Its primary focus is stabilizing the circadian rhythm disruptions that are common among people with bipolar disorder (BD). IPSRT draws upon principles from interpersonal psychotherapy, an evidence-based treatment for depression and emphasizes the importance of daily routine (rhythm).

<span class="mw-page-title-main">Psychological intervention</span>

In applied psychology, interventions are actions performed to bring about change in people. A wide range of intervention strategies exist and they are directed towards various types of issues. Most generally, it means any activities used to modify behavior, emotional state, or feelings. Psychological interventions have many different applications and the most common use is for the treatment of mental disorders, most commonly using psychotherapy. The ultimate goal behind these interventions is not only to alleviate symptoms but also to target the root cause of mental disorders.

Mentalization-based treatment (MBT) is an integrative form of psychotherapy, bringing together aspects of psychodynamic, cognitive-behavioral, systemic and ecological approaches. MBT was developed and manualised by Peter Fonagy and Anthony Bateman, designed for individuals with borderline personality disorder (BPD). Some of these individuals suffer from disorganized attachment and failed to develop a robust mentalization capacity. Fonagy and Bateman define mentalization as the process by which we implicitly and explicitly interpret the actions of oneself and others as meaningful on the basis of intentional mental states. The object of treatment is that patients with BPD increase their mentalization capacity, which should improve affect regulation, thereby reducing suicidality and self-harm, as well as strengthening interpersonal relationships.

Management of depression is the treatment of depression that may involve a number of different therapies: medications, behavior therapy, psychotherapy, and medical devices.

<span class="mw-page-title-main">Depression in childhood and adolescence</span> Pediatric depressive disorders

Major depressive disorder, often simply referred to as depression, is a mental disorder characterized by prolonged unhappiness or irritability. It is accompanied by a constellation of somatic and cognitive signs and symptoms such as fatigue, apathy, sleep problems, loss of appetite, loss of engagement, low self-regard/worthlessness, difficulty concentrating or indecisiveness, or recurrent thoughts of death or suicide.

Late-life depression refers to depression occurring in older adults and has diverse presentations, including as a recurrence of early-onset depression, a new diagnosis of late-onset depression, and a mood disorder resulting from a separate medical condition, substance use, or medication regimen. Research regarding late-life depression often focuses on late-onset depression, which is defined as a major depressive episode occurring for the first time in an older person.

The mainstay of management of borderline personality disorder is various forms of psychotherapy with medications being found to be of little use.

<span class="mw-page-title-main">Melancholic depression</span> Medical condition

Melancholic depression, or depression with melancholic features, is a DSM-IV and DSM-5 specifier of depressive disorders. The specifier is used to distinguish clinically relevant subsets of causes and symptoms that have the potential to influence treatment.

Gerald L. Klerman was an American psychiatrist and researcher whose work included the development of interpersonal psychotherapy, a short-term treatment for depression. He was chief of the US national mental health agency from 1977 to 1980.

Cognitive behavioral therapy (CBT) is derived from both the cognitive and behavioral schools of psychology and focuses on the alteration of thoughts and actions with the goal of treating various disorders. The cognitive behavioral treatment of eating disorders emphasizes on the minimization of negative thoughts about body image and the act of eating, and attempts to alter negative and harmful behaviors that are involved in and perpetuate eating disorders. It also encourages the ability to tolerate negative thoughts and feelings as well as the ability to think about food and body perception in a multi-dimensional way. The emphasis is not only placed on altering cognition, but also on tangible practices like making goals and being rewarded for meeting those goals. CBT is a "time-limited and focused approach" which means that it is important for the patients of this type of therapy to have particular issues that they want to address when they begin treatment. CBT has also proven to be one of the most effective treatments for eating disorders.

Hilary Patricia Blumberg is a medical doctor and the inaugural John and Hope Furth Professor of Psychiatry at the Yale School of Medicine. She is also a professor of Radiology and Biomedical Imaging, and works in the Child Study Center at Yale where she has been a faculty member since 1998. She attended Harvard University as an undergraduate, and completed medical school at Cornell University Medical College (1990). She completed her medical internship and psychiatry residency at Cornell University Medical College/New York Hospital, and her neuroimaging fellowship training at Cornell University, Weill Medical College. She has received the 2006 National Alliance for Research in Schizophrenia and Depression (NARSAD) and the Gerald L. Klerman Award for Clinical Research. Blumberg has authored a number of scientific articles that focus on bipolar disorder, neuroimaging, and effects of specific genetic variations, developmental trajectories and structure-function relationships.

Ellen Frank is a psychologist and Distinguished Professor Emeritus of Psychiatry and Distinguished Professor of Psychology at the University of Pittsburgh. She is known in the field of Psychotherapy as one of the developers of Interpersonal and Social Rhythm Therapy, which aims to treat bipolar disorder by correcting disruptions in the circadian rhythm while promoting increased regularity of daily social routines. Frank is the co-founder and Chief Scientific Officer of HealthRhythms, a company that uses mobile technology to monitor the health and mental health of clients, facilitate the detection of changes in their status, and better manage mental health conditions.

<span class="mw-page-title-main">Myrna Weissman</span>

Myrna Milgram Weissman is Diane Goldman Kemper Family Professor of Epidemiology in Psychiatry at the Vagelos College of Physicians and Surgeons and Mailman School of Public Health, Columbia University, and Chief of the Division of Translational Epidemiology at the New York State Psychiatric Institute. She is an epidemiologist known for her research on the prevalence of psychiatric disorders and psychiatric epidemiology, as it pertains to rates and risks of anxiety and mood disorders across generations. Among her many influential works are longitudinal studies of the impact of parental depression on their children.

References

  1. ↑ Markowitz, JC; Svartberg, M; Swartz, HA (1998). "Is IPT time-limited psychodynamic psychotherapy?". The Journal of Psychotherapy Practice and Research. 7 (3): 185–95. PMC   3330506 . PMID   9631340.
  2. ↑ "Interpersonal Therapy (IPT)". Nightingale Hospital. Retrieved 26 April 2015.
  3. ↑ Cuijpers, Pim; Donker, Tara; Weissman, Myrna M.; Ravitz, Paula; Cristea, Ioana A. (2016). "Interpersonal Psychotherapy for Mental Health Problems: A Comprehensive Meta-Analysis". American Journal of Psychiatry. 173 (7): 680–7. doi: 10.1176/appi.ajp.2015.15091141 . hdl: 1871.1/e5f03ebe-ef61-42c8-af16-0a6e951d6d92 . PMID   27032627.
  4. ↑ Weissman, Myrna M.; Prusoff, Brigitte A.; Dimascio, Alberto; Neu, Carlos; Goklaney, Mahesh; Klerman, Gerald L. (1979-04-01). "The Efficacy of Drugs and Psychotherapy in the Treatment of Acute Depressive Episodes". American Journal of Psychiatry. 136 (4B): 555–558. doi:10.1176/ajp.1979.136.4b.555. ISSN   0002-953X.
  5. ↑ Cuijpers, Pim; Geraedts, Anna S.; van Oppen, Patricia; Andersson, Gerhard; Markowitz, John C.; van Straten, Annemieke (2011). "Interpersonal Psychotherapy for Depression: A Meta-Analysis". American Journal of Psychiatry. 168 (6): 581–92. doi:10.1176/appi.ajp.2010.10101411. PMC   3646065 . PMID   21362740.
  6. ↑ Tsai, Alexander C.; Barth, Jürgen; Munder, Thomas; Gerger, Heike; Nüesch, Eveline; Trelle, Sven; Znoj, Hansjörg; Jüni, Peter; Cuijpers, Pim (2013). "Comparative Efficacy of Seven Psychotherapeutic Interventions for Patients with Depression: A Network Meta-Analysis". PLOS Medicine. 10 (5): e1001454. doi: 10.1371/journal.pmed.1001454 . PMC   3665892 . PMID   23723742.
  7. ↑ Weissman, Myrna M. (August 2006). "A Brief History of Interpersonal Psychotherapy". Psychiatric Annals. 36 (8). doi:10.3928/00485713-20060801-03.
  8. ↑ Markowitz, John C.; Weissman, Myrna M. (2012). "Interpersonal Psychotherapy: Past, Present and Future". Clinical Psychology & Psychotherapy. 19 (2): 99–105. doi:10.1002/cpp.1774. PMC   3427027 . PMID   22331561.
  9. ↑ Klerman, Gerald L.; Dimascio, Alberto; Weissman, Myrna; Prusoff, Brigitte; Paykel, Eugene S. (1974). "Treatment of Depression by Drugs and Psychotherapy". American Journal of Psychiatry. 131 (2): 186–91. doi:10.1176/ajp.131.2.186. PMID   4587807.
  10. ↑ Weissman, MM; Prusoff, BA; Dimascio, A; Neu, C; Goklaney, M; Klerman, GL (1979). "The efficacy of drugs and psychotherapy in the treatment of acute depressive episodes". The American Journal of Psychiatry. 136 (4B): 555–558. doi:10.1176/ajp.1979.136.4b.555. PMID   371421.
  11. ↑ Elkin, Irene (1989). "National Institute of Mental Health Treatment of Depression Collaborative Research Program". Archives of General Psychiatry. 46 (11): 971–83. doi:10.1001/archpsyc.1989.01810110013002. PMID   2684085.
  12. ↑ Weissman, MM; Markowitz, JC; Klerman, GL (2007). Clinician's Quick Guide to Interpersonal Psychotherapy. New York: Oxford University Press.[ page needed ]
  13. ↑ Weissman, M. M., Markowitz, J. C., & Klerman, G. L. (2000). Comprehensive Guide to Interpersonal Psychotherapy. Basic Books.
  14. ↑ Brown, George William; Harris, Tirril O. (January 1989). Life Events and Illness. Guilford Press. ISBN   9780898627237.[ full citation needed ][ page needed ]
  15. ↑ Hall, Judith A.; Andrzejewski, Susan A. (2009). "Interpersonal Sensitivity". Encyclopedia of Human Relationships. doi:10.4135/9781412958479.n291. ISBN   9781412958462.
  16. ↑ Prochaska (1984). Systems of Psychotherapy: A Transtheoretical Analysis.[ page needed ]
  17. ↑ Bartholomew, Kim; Horowitz, Leonard M. (1991). "Attachment styles among young adults: A test of a four-category model". Journal of Personality and Social Psychology. 61 (2): 226–44. doi:10.1037/0022-3514.61.2.226. PMID   1920064.
  18. ↑ Kiesler, Donald J.; Watkins, Lucy M. (1989). "Interpersonal complementarity and the therapeutic alliance: A study of relationship in psychotherapy". Psychotherapy. 26 (2): 183–94. doi:10.1037/h0085418.
  19. ↑ Kiesler, DJ (1979). "An interpersonal communication analysis of relationship in psychotherapy". Psychiatry. 42 (4): 299–311. doi:10.1080/00332747.1979.11024034. PMID   504511.
  20. ↑ Cornes, CL; Frank, E (1994). "Interpersonal psychotherapy for depression". The Clinical Psychologist. 47 (3): 9–10.
  21. ↑ Judd, F.; Weissman, M.; Davis, J.; Hodgins, G.; Piterman, L. (2004). "Interpersonal counselling in general practice". Australian Family Physician. 33 (5): 332–337. PMID   15227863.
  22. 1 2 3 Weissman, Myrna M.; Markowitz, John C. (1998). "An Overview of Interpersonal Psychotherapy". In Markowitz, John C. (ed.). Interpersonal Psychotherapy. American Psychiatric Press. pp. 1–33. ISBN   978-0-88048-836-5.
  23. ↑ Joiner; et al. (2006). The interpersonal, cognitive, and social nature of depression. Mahwah, NJ: Lawrence Erlbaum Associates.[ page needed ]
  24. ↑ Zhou, Xinyu; Hetrick, Sarah E.; Cuijpers, Pim; Qin, Bin; Barth, Jürgen; Whittington, Craig J.; Cohen, David; Del Giovane, Cinzia; Liu, Yiyun; Michael, Kurt D.; Zhang, Yuqing; Weisz, John R.; Xie, Peng (2015). "Comparative efficacy and acceptability of psychotherapies for depression in children and adolescents: A systematic review and network meta-analysis". World Psychiatry. 14 (2): 207–22. doi:10.1002/wps.20217. PMC   4471978 . PMID   26043339.
  25. ↑ "The Trauma Response". StillPoint Counseling. Retrieved 13 December 2015.[ unreliable medical source? ]
  26. 1 2 Swartz, Holly A. (1999). "Interpersonal Psychotherapy". In Hersen, Michel; Bellack, Alan S. (eds.). Handbook of Comparative Interventions for Adult Disorders. Wiley. pp.  139–55. ISBN   978-0-471-16342-8.
  27. ↑ Mufson, L. (1999). "Efficacy of Interpersonal Psychotherapy for Depressed Adolescents". Archives of General Psychiatry. 56 (6): 573–9. doi:10.1001/archpsyc.56.6.573. PMID   10359475.
  28. ↑ Hinrichsen, Gregory A. (1999). "Treating older adults with interpersonal psychotherapy for depression". Journal of Clinical Psychology. 55 (8): 949–60. doi:10.1002/(SICI)1097-4679(199908)55:8<949::AID-JCLP4>3.0.CO;2-S.

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