Interpersonal and Social Rhythm Therapy

Interpersonal and Social Rhythm Therapy (IPSRT) was developed as a treatment for mood disorders, particularly bipolar disorder. It incorporates techniques from Interpersonal Psychotherapy (IPT), which is a therapy that explores the bi-directional relationship between mood and life events – life events may trigger mood symptoms, and mood symptoms may lead to certain life events - with social rhythms, or daily routines and habits. The social rhythm elements of IPSRT developed out of clinical experience and research that showed changes in routines can trigger mood episodes in people who are vulnerable, such as those with bipolar disorder. A 2020 study indicated that participants with bipolar disorder who received IPSRT experienced improvements in anxious, depressive, and manic symptoms, global functioning, and response to psychotropic medications.

IPSRT focuses on providing skills for managing mood symptoms and improving interpersonal relationships, which can be a key factor in mood. For example, an ongoing conflict in one’s relationships can worsen mood and solid social support can improve mood. Therapy explores how a client’s behaviors and relationships may contribute to their mood, and if there is a primary interpersonal problem area that would be helpful to focus on in therapy. For example, perhaps a client is having consistent arguments with their partner or just went through a life transition such as getting a new job. Relationship skills discussed in therapy may include effective communication skills and boundary setting.

Therapy also provides strategies for regulating social rhythms, such as creating a sleep schedule and planning consistent meal times, and increasing socialization. For example, a handout used in IPSRT is called the social rhythm metric (SRM) handout, which asks clients to track 5 daily metrics:

• Time out of bed in the morning

• Time of first contact with another person

• Time started work, school, volunteering, family care, etc.

• Time of dinner

• Time went to bed

Research has suggested that when these metrics occur at the same, or close to the same, time each day, people experience better sleep, increased morning alertness, and fewer depressive symptoms. Sleep is an important focus of therapy as sleep disruption can increase the chance of experiencing a mood disturbance. So, IPSRT includes learning and practicing helpful sleep behaviors. Examples of these behaviors include:

• Get up at the same time each day.

• Don’t spend too much time in bed. The time spent in bed should nearly match the amount of time sleeping.

• If unable to sleep, get out of bed. Return to bed when sleepy.

• Use the bed for sleep and sexual activity only. Do not do other things in bed such as read, eat, watch TV, or use the phone.

• Make the bedroom comfortable. Keep room temperature moderate and limit disturbing noise and light.

This Psychology Today article generally discusses how sticking with a consistent sleep schedule benefits mood.

While having a schedule is important, shifts in routine are a part of life, and therapy aims to help clients build confidence in managing inevitable changes in routine while maintaining consistent habits overall. To learn more about IPSRT, please contact us at CBTDenver.