used to treat the disruption in circadian rhythms that is related to bipolar disorder. ISRT provides a biopsychosocial model for bipolar disorder and recognizes that the illness cannot be fully treated with medication alone, although it is biologically based. It postulates that stressful events, disruptions in circadian rhythms and personal relationships, and conflicts arising out of difficulty in social adjustment often lead to relapses.
Basically, it aims to establish regular daily routines for everyday life in response to the notion that people with bipolar disorder are just not as good at regulating ourselves as most folks. In combination with medications, ISRT can help reduce symptoms to at least some extent. It’s shown to be effective at extending time between mood episodes, and I imagine it would also improve one’s internal sense of order during states of emotional disorder as well. It also had substantial beneficial effects for teenagers with bipolar in another study.
As therapeutic paradigms go, it’s a relatively new therapy approach, extending Interpersonal Therapy (IPT) for Depression, and is documented in a book (Treating Bipolar Disorder: A Clinician’s Guide to Interpersonal and Social Rhythm Therapy). For those with the inclination, there’s also an excellent and very readable article: Interpersonal and Social Rhythm Therapy: Managing the Chaos of Bipolar Disorder, by Ellen Frank, Holly A. Swartz, and David J. Kupfer (Google will provide a PDF).
The overall goal of IPSRT is to reduce the frequency of bipolar episode recurrence, and to extend the interval between episodes. This is accomplished by: 1) gaining insight into the bidirectional relationship between mood and interpersonal events, 2) using IPT techniques to improve interpersonal functioning in one of the problem areas, 3) stabilizing daily routines and sleep-wake cycles, and 4) improving medication adherence (Frank 2005; Frank et al., 2000)
As far as I can tell, without really delving into stuff I haven’t had time to dig into lately, is that the early stage of IPSRT involves a lot of tracking and recording things, like what time of day you do things like have meals, and how much you do alone versus in the company of others. Later on, you get to doing some analysis and planning based on those records. There are also a few specific areas for therapeutic focus, but if you want that much detail, go find the PDF of the article.
The long and short of it is that IPSRT will help identify triggering situations, and also ways to build more supportive routines. The downside that is implied by the importance of social rhythms is that the entire approach is fundamentally based on accomplishing a level of stability that many bipolars can’t seem to achieve in any part of their lives. But there is a lot of logical appeal, and it makes a ton of horse sense to me.
When I dug around a bit, I didn’t find a whole lot of Internet-based resources for IPSRT. There were a couple of worksheets, but not even much of that. Eventually I customized my own to take a shot at tracking daily rhythms. Somehow that got sidetracked, so I don’t know how well it would have worked for me. Obviously, it’s the kind of thing that will work better if you’re answerable to a therapist.
IPSRT is also clearly something that would work well in combination with other treatments. This addresses some of the behavioral aspects of stabilizing mood disorders, but doesn’t cover the full spectrum of treatment needed for most people. I’d like to add it to my personal arsenal of tools, but I have a feeling it would really take some work to develop more stable and consistent social rhythms, and I’m not sure that I’m up for that kind of work just now.
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