In part one, we talked about the core beliefs of Interpersonal Psychotherapy—or IPT—how it uses the medical model, and other key points for this treatment approach. If you haven’t reviewed that, you’ll want to start there. Now, we’re picking up where we left off, which was talking about different diagnoses and adaptations for IPT.
We’ll start with the most common use, which is its use in treating depression. This is the area where IPT has been the most well-studied. Weissman and colleagues explain that the IPT view is that “Depression is not a failure, a punishment for past misconduct, or even a deliberate act. It is not something the patient has willed.” (p. 34) They go on to lay out some key points about the IPT view of depression, which are that “depression is a treatable medical illness; depression is not the patient’s fault; no one wants or tries to be depressed” (p. 34).
From an IPT point of view, depression is seen as having three parts, which are the symptoms, interpersonal aspects, and patient personality. Let’s quickly cover these, starting with the symptoms. As we know, depression can have a range of symptoms, such as a depressed mood. But, it may also cause an increase in anxiety, difficulty with concentration, result in the loss of interest in important things in life, indecisiveness, a more negative view, and so on.
The second part of depression according to IPT is related to the patient’s interpersonal or social life. As the name suggests (and as you have probably noticed up to this point) IPT puts a large emphasis on the relationships patients have in life. IPT views social connections as generally protective from depression, but also recognizes that social difficulties can bring about or worsen depression.
The third part of IPT’s view of depression is the patient’s personality. IPT recognizes that people have patterns in how they interact with the world and life generally, which is their personality. These patterns can make it more likely for someone to struggle with depression. In The Guide to Interpersonal Psychotherapy, they state that “Depressed individuals frequently describe longstanding passivity, avoidance of confrontations, and general social risk avoidance” (p. 23)
All that said, IPT often leads back to increasing interpersonal interactions, and goes about helping patients do this in multiple ways. As I mentioned, the belief is that by increasing social interactions, this will help improve the patient’s mood. As their mood increases, this will help to improve their interpersonal functioning, which will then improve their mood further. Treatment then hopes to help patients continue this cycle of positive interactions between mood and interpersonal functioning.
Being that depression is a low mood, it seems reasonable to try to use IPT for patients who have a Bipolar Disorder diagnosis since this involves both a depressed mood that alternates with an elevated, manic mood. For Bipolar Disorders, Interpersonal Psychotherapy has been adapted and combined with other approaches to increase the effectiveness. This combined approach is called Interpersonal and Social Rhythm Therapy—or IPSRT. This approach uses aspects of IPT and adds in behavioral components as well. Generally, the IPT approaches are applied to the treatment of the depressive episodes, and the behavioral aspects are incorporated to help monitor and manage manic episodes.
In IPSRT, common behavioral additions include managing sleep, stabilizing day-to-day behaviors, and addressing other environmental factors. It is important to also note that this approach should be used in combination with the use of medication, which is often a critical part of managing bipolar disorders.
IPSRT for Bipolar I Disorder has had multiple randomized controlled trials show that it is a superior approach to control conditions. IPSRT for Bipolar II Disorder has not been studied as much, but is showing positive results.
For anxiety disorders, results are finding that IPT may be an effective treatment option. Although there are not an abundance of studies at this point, what studies there are pointing in the direction of IPT being as effective as Cognitive Behavioral Therapy (CBT) in treating anxiety disorders. That said, the effectiveness of IPT for anxiety disorders will likely vary by the specific anxiety disorder in question.
Since patients with depression can often struggle with anxiety as well, it makes sense that using IPT may be effective. Actually, using IPT for anxiety disorders does not require much adaptation. The most notable change is that rather than helping patients make connections between life events and their mood (which is the goal in standard IPT), with anxiety disorders, the life events are instead linked to the patient’s experiences with anxiety.
The next adaptation for IPT is related to trauma- and stressor-related disorders. With this category of diagnoses, I should mention that IPT incorporates the use of the diathesis-stress model, which is especially relevant with trauma- and stressor-related disorders.
The Diathesis-Stress Model
The diathesis-stress model states that people have a level of vulnerability to mental health diagnoses that is based on their genetics, the chemical make-up of their body, their brain structure, and other biological factors. Some people have a low level of vulnerability while others have a higher level. Then, based on the stress a person is put under, this may result in the development of a mental health disorder. Based on their biological vulnerability and the level of stress they experience, the level of psychopathology may vary, ranging anywhere from a low to a high level of mental illness.
The diathesis-stress model is obviously relevant for trauma- and stressor-related disorders because it can help explain how people develop these diagnoses. According to this model, anyone can develop a mental health disorder, depending on the stress they experience.
Using IPT for trauma- and stressor-related disorders is not entirely surprising when you think about it. After all, it is not uncommon for somebody with a trauma-related diagnosis to experience disruptions in their interpersonal functioning, such as becoming more socially withdrawn or struggling to trust others.
Adapting IPT for trauma involves helping patients tolerate and manage the strong emotions they might experience as a result of the traumatic event, especially those that interfere with interpersonal interactions. The therapist helps patients verbalize and recognize their emotional experiences. The treatment also normalizes these emotions for the patient.
Using IPT for Posttraumatic Stress Disorder has been found to be effective in at least one randomized controlled trial.
For those with Borderline Personality Disorder, they often struggle with interpersonal relationships, and this disorder can make life very difficult for them. Because this diagnosis is strongly linked to interpersonal relationships, IPT seems like it could be a useful approach. Adaptations are being made to IPT for use with Borderline Personality Disorder, and so far, the evidence is looking positive. But there are very few studies on the effectiveness of IPT for Borderline Personality Disorder, and what studies there are have had a smaller number of participants. Therefore, more information is needed here.
Discussing the use of IPT with eating disorders, Weissman and colleagues say that “the assumption for testing IPT with eating disorders is that they occur in response to distress at poor social and interpersonal functioning and consequent negative mood, to which the patient responds with maladaptive eating behaviors” (p. 179). There are multiple diagnoses in the category of feeding and eating disorders in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, text revision. IPT has had differing results when used for eating disorders.
Bulimia Nervosa & Binge Eating Disorder
Using IPT for Bulimia Nervosa and Binge Eating Disorder has been found effective by multiple randomized controlled trials, and this approach can be used in an individual or group setting. In fact, many countries recommend IPT for Bulimia Nervosa and Binge Eating Disorder, including the UK, Australia, Canada, and the United States.
Anorexia Nervosa
Using IPT for Anorexia Nervosa is not recommended. At this time, the research has not found meaningful results with this approach with those struggling with Anorexia Nervosa.
If you want to learn more about IPT for patients with Bulimia Nervosa and Binge Eating Disorder, I recommend The Guide to Interpersonal Psychotherapy for more information.
Finally, the last adaptation of IPT we’ll review is for substance-related and addictive disorders. This review is pretty quick as IPT is not recommended for these patients as it has not been found effective with these populations.
These aren’t the only uses for IPT though. There are also specific adaptations that can be made to IPT in general, including for use in a group setting. There are also adjustments that can be made when working with peripartum depression, as well as depressed individuals in various age groups, such as children, adolescents, and older adults.
As we’re getting toward the end of our overview of IPT, I want to share this quote as I feel it is a pretty concise summary of this approach. “IPT works to help the patient recognize the connection between emotions and life circumstances and to develop skills to express those feelings in interpersonal circumstances in order to make life go better.” (p. 85)
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