Overview of Brief IPT

Holly A. Swartz, M.D.

 

Brief interpersonal psychotherapy (IPT-B) was originally developed to address the treatment needs of overwhelmed patients who were unlikely to adhere to longer courses of treatment.  The direct impetus to develop a shorter form IPT of came from the observation that even when 16 sessions of psychotherapy (the standard course of IPT) was offered in a location convenient for women, the average number of sessions attended by those who “completed” treatment was 8 (1).  This led us to formulate a shorter version of IPT that could be administered over 8 sessions instead of 12-16 sessions (2).  Thus, 8-session IPT-B was developed to meet the needs of women in the community who suffer from depression but had difficulty attending 16 sessions of treatment.

In most cases, IPT-B is used with patient populations who have difficulties engaging in and/or adhering to treatment.  Therefore, we typically administer IPT-B in conjunction with a single-session pre-treatment engagement intervention designed to address potential barriers to treatment seeking.  This engagement intervention is based on the principles and techniques of motivational interviewing (3).  In most of the clinical trials conducted to date, IPT-B has been tested as 9-session intervention (one engagement session followed by 8 sessions of IPT-B) (4-7).

IPT-B retains the structure of standard IPT but employs a series of strategies to distill its most important ingredients and hasten its time course.  The initial phase of treatment is limited to 2 (rather than 3) sessions.  The goals of the initial phase, however, remain the same as standard IPT. Efforts are made to pick a “manageable” interpersonal problem area as a treatment focus.  IPT-B is a strength-based (rather than deficit-based) model. The selected problem area, whenever possible, should build on the patient’s existing capacities and natural inclinations rather than explore an extremely complex interpersonal dilemma.  For instance, the therapist may avoid a highly contentious role disputes that threatens to destabilize the patient’s entire social support network in favor of focusing on a role transition back into the workforce (when both are temporally linked to the onset of the depression).  The interpersonal deficits category is generally avoided in IPT-B because of time constraints.  Although this is a category of “last resort” in standard IPT as well, we are skeptical about the therapist’s capacity to effect change in 8 weeks using interpersonal deficits strategies.

In the middle phase of treatment, IPT-B uses specific strategies to activate patients and hasten the change process: 1) borrowing from cognitive therapy, the therapist inquires about the impact of depression on participation in pleasurable activities and explores potential avenues to help the patient re-engage (behavioral activation)(8),  2) interpersonally-focused homework is assigned each week and reviewed at follow-up sessions, and 3) therapists leverage patients’ strengths, focusing on and underscoring capacity for self-efficacy (9).  Although maintaining focus is always important in IPT, this is especially salient in IPT-B where it is impossible to accomplish the work of the middle phase in 5 sessions unless the therapist remains on task.  Termination is relegated to a single session in IPT-B.

To date, IPT-B has been used to treat depression in mothers of children with psychiatric illnesses (2,6), in low income antepartum women receiving care in an urban obstetrics clinic (4,5), and in women with comorbid pain (10).  An unpublished treatment manual is available from the authors upon request (11).

For more information, contact Holly Swartz at SwartzHA@upmc.edu

Bibliography

1.       Swartz HA, Shear MK, Frank E, Cherry CR, Scholle SH, Kupfer DJ. A pilot study of community mental health care for depression in a supermarket setting. Psychiatric Services. 2002;53:1132-7.

2.       Swartz HA, Frank E, Shear MK, Thase ME, Fleming MAD, Scott J. A pilot study of brief interpersonal psychotherapy for depression in women. Psychiatric Services. 2004;55:448-50.

3.       Swartz HA, Zuckoff A, Grote NK, Spielvogle H, Bledsoe SE, Shear MK, et al. Engaging depressed patients in psychotherapy: Integrating techniques from motivational interviewing and ethnographic interviewing to improve treatment participation. Professional Psychology: Research and Practice. 2007;38(4):430-9.

4.       Grote NK, Bledsoe SE, Swartz HA, Frank E. Feasibility of providing culturally relevant, brief interpersonal psychotherapy for antenatal depression in an obstetrics clinic: a pilot study. Research on Social Work Practice. 2004;14(6):397-407.

5.       Grote NK, Swartz HA, Geibel SL, Zuckoff A, Houck PR, Frank E. A randomized controlled trial of culturally relevant, brief interpersonal psychotherapy for perinatal depression. Psychiatric Services. 2009;60(3):313-21.

6.       Swartz HA, Frank E, Zuckoff A, Cyranowski JM, Houck PR, Cheng Y, et al. Brief interpersonal psychotherapy for depressed mothers whose children are receiving psychiatric treatment. American Journal of Psychiatry. 2008;165(9):1155-62.

7.       Swartz HA, Zuckoff A, Frank E, Spielvogle H, Shear MK, Fleming MAD, et al. An open-label trial of enhanced brief interpersonal psychotherapy in depressed mothers whose children are receiving psychiatric treatment. Depression and Anxiety. 2006;23:398-404.

8.       Jacobson NS, Martell CR, Dimidjian S. Behavioral activation treatment for depression: Returning to contextual roots. Clinical Psychology-Science & Practice. 2001;8(3):255-70.

9.       Bandura A. Social cognitive theory of personality. In: Pervin LA, John OP, editors. Handbook of peronsality: Theory and research. Second ed. New York: Guilford Press; 1999. p. 154-96.

10.      Poleshuck EL, Talbot NE, Zlotnick C, Gamble SA, Liu X, Tu X, et al. Interpersonal psychotherapy for women with comorbid depression and chronic pain. J Nerv Ment Dis. 2010;198(8):597-600.

11.      Swartz HA, Grote N, Frank E, Bledsoe SE, Fleming MAD, Shear MK. Brief Interpersonal Psychotherapy (IPT-B) Treatment Manual. unpublished 2004.