YAbout IPT

(IPT) Interpersonal Psychotherapy

Interpersonal Psychotherapy (IPT) is an empirically validated treatment for a variety of psychiatric disorders.  The evidence for IPT supports its use for a variety of affective disorders, anxiety disorders, and eating disorders, and for a wide range of patients from children and adolescents to the elderly.  The evidence base for IPT supports its use from age 9 to 99+. 

IPT is recognized as an efficacious psychotherapy by the American Psychiatric Association, the American Psychological Association, and the National Institute for Health and Clinical Excellence in the UK.  There are now over 250 empirical studies supporting the efficacy and effectiveness of IPT.  Detailed descriptions of IPT can be found in the textbooks listed below.

IPT is a time-limited psychotherapy that focuses on interpersonal issues, which are understood to be a factor in the genesis and maintenance of psychological distress.  The targets of IPT are symptom resolution, improved interpersonal functioning, and increased social support.  Typical courses of IPT range from 6-20 sessions with provision for maintenance treatment as necessary.  The Defining Elements of IPT can best be understood by describing framework for its delivery.  This framework can be divided into the theories supporting IPT; the targets of IPT; the tactics of IPT (i.e., the concepts applied in the treatment); and the techniques of IPT (i.e., what the therapist says or does in the treatment).  Though individual elements in each of these categories may be shared with other psychotherapeutic approaches, their unique combination defines IPT (Table 1).

Table 1: The Defining Elements of IPT

Theory:  Attachment Theory, Communication Theory

Targets:  Psychiatric Symptoms, Interpersonal Relationships, Social Support

Tactics:

  • Interpersonal Triad
  • Biopsychosocial/Cultural/Spiritual Model
  • Interpersonal Inventory
  • Interpersonal Problem Areas
  • Interpersonal Formulation
  • IPT Structure
  • Non-Transferential Focus of Interventions
  • Present Focus
  • Collaboration & Goal Consensus
  • Positive Regard for the Patient

Techniques:

  • Interpersonal Incidents
  • Communication Analysis
  • Use of Content and Process Affect
  • Role Playing
  • “Common” Techniques

 The Interpersonal Triad: A Model for Psychological Distress

IPT is explicitly based on a Biopsychosocial/Cultural/Spiritual Model.  IPT works from the premise that interpersonal distress is connected with psychological symptoms.  An acute interpersonal crisis (stressor) begins the process.  The ability of the patient to manage the crisis psychologically and biologically is heavily influenced by the patient’s Biopsychosocial/Cultural/Spiritual vulnerabilities (diatheses) and strengths, such as genetic vulnerability to illness, temperament, attachment style, and personality, which may modulate or exacerbate the crisis.   Social factors such as a patient’s current significant relationships and general social support provide the context in which the stress-diathesis interaction occurs, and further modify the individual’s ability to cope with his or her distress.  Together, these elements form the Interpersonal Triad (Figure 1), which models the basic IPT conceptualization of the development of psychological distress.

Figure 1: The Interpersonal Triad

1- IPT Introduction and theory 2015-10-28

A History of IPT 

by Myrna Weissman, PhD, Columbia University

IPT was developed in the 1970’s at Yale University when Gerald Klerman, Myrna Weissman, and Eugene Paykel investigated the relative efficacy of a tricyclic antidepressant alone and in combination with psychotherapy as a maintenance treatment for unipolar depression [1].  At that time, the evidence for the efficacy of tricyclic antidepressants for reducing the acute symptoms of depression was strong.  However, though it was clear that many patients with depression relapsed after termination of acute tricyclic antidepressant treatment, there was no data regarding how long psychopharmacologic treatment should continue.  Moreover, though the treatment most commonly provided for both acute and maintenance treatment of depression was psychodynamic psychotherapy, there was a dearth of data about its efficacy in general, much less data regarding the role of psychotherapy in the prevention of relapse.

The studies of psychotherapy at that time were largely limited to behavioral treatments, though there were several large scale psychodynamic studies which had been published.  Few of these studies, however, used the contemporary diagnostic criteria for depression or standardized outcome measures.  Most were also limited in scope and sample size.  This led to a movement in the early 1970’s to develop standardized and manualized psychotherapeutic treatments for acute depression that could be tested and reliably replicated, such as Beck’s Cognitive-Behavioral Therapy (CBT) [2] among others.

The initial studies of IPT were designed to reflect clinical practice as closely as possible, both with respect to medication and psychotherapy.  Because many patients received both psychotherapy and drugs, either together or in sequence, Klerman and Weissman and colleagues elected to include a standardized psychotherapy in the maintenance treatment trial.  There was not an assumption that psychotherapy would be efficacious, but that psychotherapy should be subjected to testing in a clinical trial.

The psychotherapy developed and manualized for this original treatment trial was modeled after what was considered high quality supportive psychotherapy as it might be delivered by social workers.  Initially, IPT was described as “high contact” to denote the weekly application of the treatment.  When their maintenance study [1] demonstrated the efficacy of “high contact” counseling, the treatment was more fully developed and was subsequently renamed Interpersonal Psychotherapy (IPT).   A 3-way comparison acute treatment trial using antidepressants and IPT was then conducted [3-4].  Efficacy results were positive, and the combination of medication and psychotherapy was found to be the most efficacious treatment for depression.

The results of these initial studies of IPT led to its inclusion in the NIMH Treatment of Depression Collaborative Research Program [5-6], which compared IPT to imipramine, placebo, and CBT for acute treatment of depression.  The original IPT manual, Interpersonal Psychotherapy for Depression [7], was published in 1984 as a manual for this research project.

Since that time, IPT has been tested for a variety of affective disorders with different populations of patients.  A sampling of these studies include depressed adolescents [8], the elderly [9-10], perinatal women [11-14], and dysthymia [15-16].  Frank and Kupfer have also demonstrated that IPT is an effective maintenance treatment for depression [17-19].  IPT has also been utilized with patients with eating disorders (bulimia [20], anorexia [21], binge eating disorder [22]), and social phobia [23].  It has been tested in many different cultural and international settings, and by using different methods of delivery, such as phone-delivered IPT [24], in brief form in community settings [25], and with couples [26] and in groups [27-29].

Comprehensive IPT References

IPT manuals for specific disorders:

Stuart S, Robertson M: Interpersonal Psychotherapy: A Clinician’s Guide, 2nd Edition . London, Edward Arnold (Oxford University Press), 2012.

Frank E. Treating Bipolar Disorder: A Clinician’s Guide to Interpersonal and Social Rhythm Therapy. New York: Guilford, 2005.

Frank E, Levenson JC. Interpersonal Psychotherapy. Washington DC, American Psychological Association, 2010.

Hinrichsen, G.A., & Clougherty, K.F. Interpersonal psychotherapy for depressed older adults. Washington, DC: American Psychological Association, 2006.

Miller M. Clinician’s Guide to Interpersonal Psychotherapy in Late Life. New York, Oxford University Press, 2009.

Mufson L, Dorta KP, Moreau D, Weissman MM. Interpersonal Psychotherapy for Depressed Adolescents, second edition. New York: Guilford, 2004.

Weissman MM, Markowitz JC, Klerman GL: Comprehensive Guide to Interpersonal Psychotherapy. New York: Basic Books, 2000.

Weissman MM, Markowitz JC, Klerman GL: Clinician’s Quick Guideto Interpersonal Psychotherapy. New York: Oxford University Press, 2007.

Wilfley, DE, Mackenzie KR, Welch RR, Ayres VE, Weissman MM: Interpersonal Psychotherapy for Group. New York, NY: Basic Books, 2000.

References

1. Klerman, G.L., et al., Treatment of depression by drugs and psychotherapy. American Journal of Psychiatry, 1974. 131: 186-191.

2. Beck, A.T., Rush, A.J, Shaw, B.F, Emery, G., Cognitive Therapy of Depression, 1979, New York:Guilford Press.

3. DiMascio, A., M.M. Weissman, and B.A. Prusoff, Differential symptom reduction by drugs and psychotherapy in acute depression. Archives of General Psychiatry, 1979. 36: p. 1450-1456.

4. Weissman, M.M., Prusoff, B.A., Dimascio, A., Neu, C., Goklaney, M., Klerman, G.L., The efficacy of drugs and psychotherapy in the treatment of acute depressive episodes. American Journal of Psychiatry, 1979. 136(4B): p. 555-558.

5. Elkin, I., Parloff, M.B., Hadley, S.W., Autry, J.H., NIMH Treatment of Depression Collaborative Research Program.  Background and research plan. Archives of General Psychiatry, 1985. 42(3): p. 305-316.

6. Elkin, I., et al., NIMH Treatment of Depression Collaborative Research Program: I. General effectiveness of treatments.  Archives of General Psychiatry, 1989. 46: p. 971-982.

7. Klerman, G.L., Weissman, M.M., Rounsaville, B., Chevron, E.S. , Interpersonal Psychotherapy of Depression, 1984, New York:Basic Books.

8. Mufson, L., Interpersonal Psychotherapy for Depressed Adolescents. 2nd ed, 2004, New York: The Guilford Press.

9. Reynolds, C.F., et al., Nortriptyline and interpersonal psychotherapy as maintenance therapies for recurrent major depression: a randomized controlled trial in patients older than fifty-nine years. Journal of the American MedicalAssociation, 1999. 281: p. 39-45.

10. Miller, M.D., et al., Interpersonal psychotherapy for late-life depression: past, present, and future. Journal of Psychotherapy Practice and Research, 2001. 10: p. 231-238.

11. O’Hara, M.W., et al., Efficacy of interpersonal psychotherapy for postpartum depression. Archives of General Psychiatry,2000. 57: p. 1039-1045.

12. Pearlstein, T.B., Zlotnick, C., Battle, C.L., Stuart, S., O’Hara, M.W., Price, A.B., Grause, M.A., Howard, M., Patient choice of  treatment for postpartum depression: a pilot study. Archives of Women’s Mental Health, 2006. 9(6): p. 303-308.

13. Grote, N.K., et al., A randomized controlled trial of culturally relevant, brief interpersonal psychotherapy for perinatal depression. Psychiatric Services, 2009. 60(3): p. 313-321.

14. Spinelli, M.G. and J. Endicott, Controlled clinical trial of Interpersonal Psychotherapy versus parenting education program for depressed pregnant women. American Journal of Psychiatry, 2003. 160(3): p. 555-562.

15. Markowitz, J., Interpersonal Psychotherapy for Dysthymic Disorder, 1998,Washington,DC: American Psychiatric Press.

16. Browne, G., et al., Sertraline and interpersonal psychotherapy, alone and combined, in the treatment of patients with dysthymic disorder in primary care: a 2 year comparison of effectiveness and cost. Journal of Affective Disorders, 2002.68: p. 317-330.

17. Frank, E., et al., Three-year outcomes for maintenance therapies in recurrent depression. Archives of General Psychiatry,1990. 47: p. 1093-1099.

18. Kupfer, D.J., Frank, E., Perel, J.M., Cornes, C., Mallinger, A.G., Thase, M.E., McEachran, A.B., Grochocinski, V.J., Five- year outcome for maintenance therapies in recurrent depression. Archives of General Psychiatry, 1992. 49(10): p. 769-773.

19. Frank, E., et al., Randomized Trial of Weekly, Twice-Monthly, and Monthly Interpersonal Psychotherapy as Maintenance Treatment for Women With Recurrent Depression. American Journal of Psychiatry, 2007. 164: p. 761-767.

20. Fairburn, C.G., R. Jones, and R.C. Peveler, Three psychological treatments for bulimia nervosa: a comparative trial.Archives of General Psychiatry, 1991. 48: p. 463-469.

21. McIntosh, V.V., et al., Interpersonal psychotherapy for anorexia nervosa. International Journal of Eating Disorders,2000. 27: p. 125-139.

22. Wilfley, D.E., et al., Adapting interpersonal psychotherapy to a group format (IPT-G) for binge eating disorder: toward a model for adapting empirically supported treatments. Psychotherapy Research, 1998. 8: p. 379-391.

23. Lipsitz, J.D., et al., Open trial of interpersonal psychotherapy for the treatment of social phobia. American Journal of Psychiatry, 1999. 156: p. 1814-1816.

24. Donnelly, J.M., et al., A pilot study of interpersonal psychotherapy by telephone with cancer patients and their partners.Psycho-oncology, 2000. 9: p. 44-56.

25. Swartz, H.A., et al., Brief interpersonal psychotherapy for depressed mothers whose children are receiving psychiatric treatment. American Journal of Psychiatry, 2008. 165(9): p. 1155-1162.

26. Foley, S.H., Rounsaville, B.J., Weissman, M.M., Individual versus Conjoint Interpersonal Psychotherapy for Depressed Patients with Marital Disputes. International Journal of Family Psychiatry, 1989. 10: p. 29-42.

27. Wilfley, D.E., et al., Interpersonal Psychotherapy for Group, 2000,New York: Basic Books.

28. Klier, C.M., et al., Interpersonal psychotherapy adapted for the group setting in the treatment of postpartum depression. Journal of Psychotherapy Practice and Research, 2001. 10: p. 124-131.

29. Mulcahy, R., et al., A randomised control trial for the effectiveness of group interpersonal psychotherapy for postnatal depression. Archives of Women’s Mental Health, 2010. 13(2): p. 125-139.