INTERPERSONAL PSYCHOTHERAPY

PRESENTER : DR. DAVIN C/P : MS. NEETHI 11/02/2012

INTRODUCTION
Time-limited, interpersonally focused, psycho dynamically informed psychotherapy Goals :

Symptom relief Improving interpersonal functioning

Interpersonal Contextthe relational factors that predispose, precipitate and perpetuate the patients distress.

INTRODUCTION
Interpersonal relationships :- Focus of therapeutic attention as the means to bring about change. Aims :

Helping to improve pts interpersonal relationships Change their expectations about them Assist patients to improve their social support network

INTRODUCTION
Multiple types : Long-term, insight-oriented, theoretically based, interpretive, and open-ended IPTs More-modern, short-term, time-limited, no interpretive approaches - avoid theory & insight Common belief Interpersonal relationships of a patient, have a role in etiology of his/her psychopathology & its treatment.

INTRODUCTION
Spectrum of approaches + Open-ended : Emphasize participant role of therapist and interpersonal relationship of patient & therapistlonger, more interpretive. Time-limited : Emphasis is on patient and his /her current interpersonal relationships in real life. - 1 or 2 current relationships targeted.

HISTORY
Roots in Psychodynamic Theory Primary instincts of sex and aggression involve relating to others Relationships with others contribute to personality development Psychological Problems due to deficits in early relations

Transference and countertransference are interpersonal

HISTORY

Object-Relations influence Object is human being Relations are internal, external, fantasized or real interactions with others Early parent-child relations are internalized as expectations for future relationships Identity/personality derived from pattern of early relationship experiences Expectations of others impacts quality of current interpersonal relationships and mood

HISTORY
Biopsychosocial

model Attachment Theory (Bowlby)

Relationships are primary Attachment is a biological drive Attachment is a cybernetic system Capacity to form flexible attachment is principal feature of mental health Styles Secure , Anxious Ambivalent , Anxious Avoidant

Patterns of attachment : develop early & tend to persist, but are not fixed persist within relationships persist across relationships

Less secure attachment - more prone to psychiatric symptoms Disruption of attachment increases vulnerability to psychiatric symptoms

Dysfunction results from

An acute crisis, attachment disruption, inadequate social support

IMPLICATIONS: Focus on attachment i.e. interpersonal relationships Resolution of here-and-now problems should result in symptom relief Fundamental personality change is unlikely in short-term treatment

HISTORY

American psychiatrist Harry Stack Sullivan (18921949) - Father of Interpersonal Psychotherapy. Alternative formulation to classic psychoanalytical theory 2 basic drives:
(Physical) satisfaction (i.e., food, warmth shelter, sex) (Interpersonal) security

HISTORY

Security : sense that one is an adequate human being

having a healthy self-esteem feeling confident to handle stress being comfortable among others being interpersonally competent being relatively anxiety-free

HISTORY

We learn :
How to separate fantasy from reality develop a sense of self and self-esteem (or lack) develop strategies for coping with anxiety

Social stages of child development :Enduring patterns of thinking and behaving Dont develop much because of inner conflicts, as an attempt to deal with human environment of one's family, school & community. Ultimately maladaptive mental illness.

Therapist is not & cannot be a passive observer Identify patterns of behavior & thinking from the patient's history Support self-esteem of patient and reinforce it appropriately Address positive aspects of patient & his/her successes

The story of interpersonal therapy (IPT) began in 1969 at Yale University. Dr. Gerald Klerman was joined by Dr. Eugene Paykel(London) to design a study to test the relative efficacy of a tricyclic antidepressant(TCA) alone and that with psychotherapy as maintenance treatment of nonbipolar depression.

Evidence for efficacy of TCAs for reducing the acute symptoms of depression was strong, yet the main treatment for depression at the time was psychodynamic psychotherapy. It was clear that many patients with acute depression relapsed after termination of TCA treatment.

Unclear how long psychopharmacologic treatment should continue? Whether psychotherapy had a role in the prevention of relapse? Some psychotherapists thought medication would make patients less interested in psychotherapy. Some psychopharmacologists felt psychotherapy would undo the positive effects of medication by having patients talk about upsetting material.

Social Factors Biological Factors

Genetics Substance Use Medical Illnesses Medical Treatments Intimate Relationships Social Support

Psychological Factors
Attachment Style Temperament Cognitive Style Coping Mechanisms

Unique Individual

Interpersonal Crises
Grief and Loss Interpersonal Disputes Role Transitions Interpersonal Sensitivity

Interpersonal Distress

OPEN ENDED IPT

Therapist :
Is a participant Cant be entirely objective Cant avoid being target of patient's stereotypical behaviour

Ability of therapist to:

Read his/her reactions to patient objectively, Reflect them therapeutically.

OPEN ENDED IPT

Kiesler Dyadic:-Therapist is a participant observer Impact messages: Feelings, thoughts & behaviours of therapist in response to patient
Direct feelings Action tendencies Cognitive attributions Fantasies

Therapist's active monitoring of his/her feelings & reactions- Strategy to understand

OPEN ENDED IPT

Categories of reply:
Simply respond to the manifest content of the statement Ignore it and change the subject Interpret statement as an unconscious message of patient to himself /patient to therapist Share either his personal reflection on or his reaction to patient's statement.

OPEN ENDED IPT

4 phases : (1) engaging :Attempt by therapist to make himself a significant person in the pt's life, both to get work done efficiently & to prevent premature termination (2) uncovering (3) resolving (4) terminating

TIME-LIMITED IPT

Our original intent was not to develop a new psychotherapy, but to describe what we believed was reasonable and current practice with depressed patients who might be considered for inclusion under the rubric of short term supportive psychotherapy. Weissman & Klerman, (1993)

TIME-LIMITED IPT
Noninterpretive, time-limited psychotherapy Gerald Klerman and colleagues Treatment of nonbipolar, non psychotically depressed outpatients. No assumptions about causes of psychiatric illness Onset, response to treatment, and outcomes are influenced by interpersonal relations between the patient and significant others.

TIME-LIMITED IPT
Set number of sessions Transference may be ignored/undermined Workbook may be used

Focus is specifically on the pt's interpersonal relationships. Advantage : IPT can be researched. Goal :- Reduce and/or eliminate psychiatric symptoms by improving quality of pt's current interpersonal relations & social functioning.

TIME-LIMITED IPT
Defined phases : Specific strategies and tasks for therapist and patient. Resolving problems within 4 social domains: Grief, interpersonal role disputes, role transitions, and interpersonal deficits. Efficacious for major depression Adapted to treat other types of mood and nonmood disorders.

TIME-LIMITED IPT
A persons behavior is viewed as influencing the reactions of people around them The persons typical interpersonal style may influence negative feedback from others, social isolation, relationship difficulties, etc. These situational factors may lead the individual to become depressed

Coynes Interpersonal Model of Depression

People who are depressed can be difficult to spend time with (e.g., they complain, they express negativity, they are less interested in participating in pleasurable activities) Because of this, non-depressed people tend to decrease the amount of time spent with the depressed person

Coynes Interpersonal Model of Depression

The depressed person experiences a lack of social support and a reduction in social interaction This can lead the person to become more depressed which in turn makes them even less desirable to be around

 Interpersonal

therapy helps patient to improve functioning, particularly in current relationships, in order to break the depressive cycle Sessions focus on interpersonal style and interpersonal relationships Interpersonal therapists focus on the functional role of depression rather than on its etiology or cause They look at the ways in which problematic interactions develop when a person becomes depressed

DIFFERENCES FROM OTHER PSYCHOTHERAPIES

Time-limited- outcome studies document efficacy of short-term (12-16 weeks) treatment Not designed for personality change Focused on current interpersonal disputes, anxieties, frustrations Addresses 1-2 problem areas in interpersonal functioning

DIFFERENCES FROM CBT

Goal is to change feelings, thoughts, actions in problematic relationships Negative/irrational cognitions are addressed only in interpersonal function IPT attends to distorted thinking in relation to significant others Goal is to change relationship pattern rather than depressive cognitions

DIFFERENCES FROM CBT

Focus on affect & expression of emotions Explores avoidance & resistance behavior Identification of patterns in clients behavior, thinking, feeling and relationships Attention to past experiences Focus on interpersonal experience Emphasis on the therapeutic relationship

IPT and Personality Change

IPT does not target alteration of personality Personality pathology may limit IPT outcome IPT may help patient recognize maladaptive personality features IPT may improve social skills and thus ameliorate maladaptive personality traits

Role of IPT Therapist

Therapist is patient advocate, not neutral Expresses unconditional positive regard Intentionally cultivates positive expectations of treatment

Optimistic, positive, reassuring

Therapist is active in keeping interpersonal problem areas to focus

4 SOCIAL DOMAINS
1.

2.

Grief : Problem area when onset of the patients symptoms is associated with loss of a person or a relationship, either recent or past. Interpersonal role disputes: Conflicts with a significant other (e.g., a partner, other family member, coworker/ close friend) that emerge from differences in expectations about the relationship.

4 SOCIAL DOMAINS
3.

4.

Role transitions : difficulties associated with a change in life status (e.g., graduation, leaving a job, moving, marriage/divorce, retirement, change in health status) Interpersonal deficits : Apply to those patients who are socially isolated or are in chronically unfulfilling relationships.

TECHNIQUES

Essential IPT techniques include:

discuss feelings (both positive & negative) about interpersonal experience take action to change interpersonal experience

Other IPT techniques common to other psychotherapies

TECHNIQUES
Explorative techniques Non-directive exploration Begin sessions with: How have things been since we last met? Use open-ended questions Encourage clients sense of responsibility Direct questioning

necessary to review depressive symptoms necessary to review interpersonal relationships

TECHNIQUES
Encourage the Affect Learning in psychotherapy is emotional learning Eliciting affect informs client remeaningful goals Facilitate acceptance of painful affect

encourage clear expression of painful, suppressed or unacknowledged feelings inquire into sensitive areas

TECHNIQUES
Use emotions in relationships Assist client to negotiate painful affect in significant relationships Client may change relationship behavior (self or other) to eliminate painful affect Client may learn new ways to cope with anger or anxiety Client may eliminate irrational thinking and emotional sequelae

TECHNIQUES

Help clients with suppressed emotions For clients who may be emotionally constricted or unassertive Client may lack awareness or confidence to express Some clients distressed by strong emotions (e.g. trauma history) may need help suppressing overwhelming emotions
may be counter-productive to encourage emotional display

TECHNIQUES
Clarification Communication techniques to review content, clarify feelings, promote awareness

repeating, rephrasing statements calling attention to logical implications of statements raising contradictions or contrasts

Alert client to false, irrational or pervasive beliefs regarding interpersonal relationships

TECHNIQUES
Communication analysis Identify communication failures to improve relationship satisfaction Frequently review important conversations or arguments Illuminate common communication difficulties

TECHNIQUES
Use of Therapeutic relationship Clients feelings toward therapist and therapy are helpful focus may reflect characteristic ways of feeling and behaving in other relationships Therapist instructs client to express complaints, fears, that arise about therapist model genuine negotiation with such feeling therapist can correct distortions and acknowledge genuine deficiencies

TECHNIQUES

Directive techniques Include educating, advising, modeling Initially open to practical help: depressed clients may need case management Provide suggestions if client unable to make successful decisions independently Modeling may involve informing client how therapist might handle similar situation Use directive techniques sparingly use early, w/o undermining clients autonomy

TECHNIQUES

Decision analysis :
Help patient integrate communication analysis, wishes & options & constraints of situation Decide specific course of action

Role playing :
Help rehearse course of action before implementing in real life

TIMELINE OF TREATMENT

Typical course lasts 12 to 20 sessions over a 4- to 5-month period. 3 phases : Initial phase : Dedicated to identifying the problem area that will be the target for treatment. Intermediate phase : Devoted to working on the target problem area(s) Termination phase : Focused on consolidating gains made during treatment & preparing the patients for future work on their own

Initial phase: Sessions 15

Give the syndrome a name; provide information about the prevalence and characteristics of the disorder Describe the rationale and nature of the therapy Conduct the interpersonal inventory to identify the current interpersonal problem area(s) associated with the onset or maintenance of the psychiatric symptoms.

 Review significant relationships, past and present Identify interpersonal precipitants of episodes of psychiatric symptoms Select and reach consensus about the interpersonal problem area(s) and treatment plan with patient

Intermediate phase: Sessions 615

Implement strategies specific to the identified problem area(s) Encourage and review work on goals specific to the problem area Illuminate connections between symptoms and interpersonal events during the week Work with the patient to identify and manage negative or painful affects associated with his or her interpersonal problem area

Termination phase: Sessions 1620

Discuss termination explicitly Educate the patient about the end of treatment as a potential time of grieving; encourage the patient to identify associated emotions Review progress to foster feelings of accomplishment and competence Outline goals for remaining work; identify areas and warning signs of anticipated future difficulty Formulate specific plans for continued work

INITIAL PHASE
Assessing the patient's current psychiatric symptoms and obtaining a history of these symptoms, the therapist gives the patient a formal diagnosis (DSM,ICD) Discuss diagnosis, as well as what might be expected from treatment. Assignment of the sick role Dual function

Grant patient both permission & responsibility to recover

Conducts an interpersonal inventory with the patient and develops an interpersonal formulation determine precise focus of treatment

Thorough psychiatric interview Assigning the sick role : Purposes are both theoretical and practical. Reinforces the idea that patient has a known condition that can be treated Explicitly identifies the patient as being in need of help Temporarily exempt the individual from other responsibilitiesdevote full attention to recovery

DIAGNOSIS AND ASSESSMENT OF A SICK ROLE

Sick is undesirable and needs to be improved Person obliged to cooperate with treatment Shifts blame from client to illnessmitigate self blame Symptom relief starts with helping the patient to understand that his/her psychiatric symptoms are part of a known syndrome that responds to several treatments.

REVIEWING DEPRESSIVE SYMPTOMS

What interpersonal events related to depression? Review current & past interpersonal relationships Who does client interact with? Frequency of contact, activities shared? Assess quality and themes of relationships Assess expectations of client (and other) in relationships Assess satisfying and unsatisfying aspects of relationships

THE INTERPERSONAL INVENTORY

Structure for elucidating social & interpersonal context of the onset and maintenance of psychiatric symptoms & delineates the focus of treatment. Concerns changes in relationships proximal to the onset of symptoms Obtain chronological history of
significant life events fluctuations in mood and self-esteem interpersonal relationships psychiatric symptoms

Make connection between certain life experiences and psychiatric symptoms Thorough interpersonal inventory :

optimal treatment plan key to success in therapy

ESTABLISH RELEVANT PROBLEM AREAS

Develop an individualized interpersonal formulation Link patient's symptoms to one of the 4 interpersonal problem areas Patient needs to concur with the problem area proposed & agree to work on it in treatment. Time-limited nature of treatment necessitates a focused approach. Assign 1 or, at most, 2 problem area(s).

Problem area that seems most likely to be responsive to treatment is addressed first Patient's morale and overall sense of competence enhances when progress is made

COLLABORATIVELY DEVELOP TREATMENT GOALS

Formulate a treatment plan with specified goals Guide the day-to-day work Identify specific steps the patient will take to improve relationships and socialization Summary should include reference to specific individuals, events, & interpersonal themes to help ensure that they are as personally meaningful to the patient as possible. Written summary Treatment contract

INTERMEDIATE PHASE
8-10 sessions work of the therapy Strengthen the connections patient makes between the changes he/she is making in his/her interpersonal life and the changes in his/her psychiatric symptoms Treatment strategies implemented specific to identified problem area

IMPORTANT TASKS : Help client discuss topics pertinent to problem area Attend to clients affective state Assist client in discussing therapeutic relationship Prevent client from sabotaging treatment

GRIEF AREA FOCUS

Normal Grief involves:

Symptoms including sadness, disturbed sleep, agitation, impairment, etc. Symptoms usually resolve in 2 4 weeks without treatment

ABNORMAL GRIEF EVIDENCE

Inadequate grief in bereavement period Multiple losses Avoidance behavior (re funeral, grave, talk) Symptoms around significant anniversary Preserving environment of deceased Fear of illness that caused death Absence of social support during bereavement

GRIEF - GOALS
Facilitate the mourning process Help client re-establish interests and relationships to substitute for what has been lost

GRIEF - STRATEGIES

Explore Events & Elicitation of Feelings

Discuss events prior to, during and after the death

Reconstruction of Relationship
Use photos and stories to discuss relationship Use belongings and memories to evoke painful feelings client has avoided What were the ups and downs in relationship? (normalize negative features)-- Facilitate Expression of Affect

GRIEF - STRATEGIES

Behavior change:
Plan and discuss development of new social relationships (e.g. organizations, church, work, dating) Support client as they learn to fill empty space

ROLE TRANSITIONS
Role transitions are varied in their nature. Examples according to Stuart and Robertson (2003) include: situational role transitions, e.g., job loss, promotion, graduation, migration. relationship role transitions, e.g., marriage, divorce, stepparenthood.

 illness related role transition, e.g., diagnosis of chronic illness, adaptation to pain or physical limitations. post-event role transition, e.g., posttraumatic symptoms, refugee status.

ROLE TRANSITIONS
Diagnosis Assess: How did life change? What people in your life changed or left? Goals :

mourning & accepting the loss of old role recognizing the positive & negative aspects of both old and new roles restoring the patient's self-esteem

ROLE TRANSITIONS STRATEGIES

Facilitate evaluation of lost role

Tell me about the old ___. What were the good, and bad, things? What has changed?

Encourage expression of affect

How did it feel to give up ___?

Identify positive aspects of new role

Are there potential benefits?

ROLE TRANSITIONS STRATEGIES

Develop Social Skills needed for new role What is required in new role? Are assumptions of role demands accurate? Role play or rehearse difficult situations Assist with managing performance anxiety Establish new relationships and social support Facilitate discovery of new opportunities for social support

INTERPERSONAL ROLE DISPUTES

Diagnosis : Current Overt / Covert disputes with a significant other Client and other have non-reciprocal expectations Dispute related to onset or perpetuation of depression Client demoralized about relationship

Poor patterns of communication Irreconcilable differences

IP ROLE DISPUTES GOALS

Identify the dispute Make choices about a plan of action Modify communication patterns / Reassess Expectations Consider satisfying needs outside relationship

ISSUES
Differences in expectations/values between client and other? Clients wishes in relationship? Other wishes? What are the clients options? How have they resolved disagreements in past? Strengths and weaknesses in relationship? What changes are realistically possible?

IP ROLE DISPUTESSTRATEGIES
Assess stage of Role Dispute: Impasse- discussion stopped, low-level resentment exists treatment may initially increase disharmony Renegotiation- aware of differences, actively trying to change Treatment may require calming parties to facilitate resolution Dissolution- implies the relationship is irretrievably disrupted Treatment may resemble grief therapy

IP ROLE DISPUTESSTRATEGIES
Find Parallels in previous relationships What does client gain by the behavior? What are unspoken assumptions that lie behind behavior? Optimistic tone: lets figure out what went wrong here so we can decide how to help you make it better Often communication problems are revealed- Treatment involves improving skills

IP ROLE DISPUTESSTRATEGIES
Help identify mixed feelings e.g. anger, fear, sadness Devise strategies for managing feelings e.g. direct communications, reducing irrational suspicions Role Play Rehearse expressing feelings and wishes Anticipate communication problems Consider Conjoint sessions with significant other

INTERPERSONAL DEFICITS
DIAGNOSIS: History of social impoverishment, chronic inadequate or unsustained relationships Consider Dysthymia (or Double Depression)

IPT adaptation for dysthymia

Long standing or temporary deficits in social skills yields low self-esteem, withdrawal

IP DEFICITS - GOALS
Reduce Clients social isolation Enable:

close relationships with intimates or family members satisfying relationships with friends adequate relationships in work role

IP DEFICITS - STRATEGIES
Review past significant relationships including childhood relationships with family members depressed patients minimize or forget positive experiences explore repetitive or parallel problems in past relationships define interpersonal situations that lead to difficulties

IP DEFICITS - STRATEGIES

Use therapist-client relationship

explore clients positive and negative feelings toward therapist discuss distorted or unrealistic thoughts or feelings toward therapist model resolution of relationship tension by open and genuine communication

IP DEFICITS - STRATEGIES

Encourage patient to increase social interactions

review attempts in treatment to identify deficits identify deficits in communication skills look for assumptions client makes about others thoughts and feelings

IP DEFICITS COMMUNICATION ANALYSIS

Get detailed account of conversation or argument Identify communication difficulties ambiguous, indirect, & non-verbal as substitute for open confrontation incorrect assumptions re communication assuming that others know their feelings accompanied by anger, frustration, silence failing to make sure they are heard, understood

IP DEFICITS COMMUNICATION ANALYSIS

Incorrect interpretation of others statements perceive criticism where none intended Indirect verbal communication inhibited directly expressing expectations or criticism instead use hints and ambiguous messages prone to build resentments toward others who are unaware of offense silence - unaware of destructive impact

Use role playing

rehearse difficult interactions with client explore style of communicating with others practice new skills -- e.g. expressing anger or being assertive rehearsal with therapist increases clients interpersonal confidence

IP DEFICITS - PROGNOSIS
Treatment of interpersonal deficits often difficult Client often lacks relationships to practice and develop skills Treatment goals limited to making early gains interpersonally, not resolving interpersonal deficits.

TERMINATION PHASE
For time-limited treatment, important to keep initial contract for 12-16 weeks Termination Treatment issues explicit discussion of termination during last 3-4 sessions acknowledge ending may involve loss and grief normalize fear, anger, sadness may need to distinguish sadness from depression

TERMINATION ISSUES
Foster clients self-confidence in coping independently Deflect clients attribution of success to therapist Call attention to clients accomplishments Anticipate future difficulties with client

help plan for future problems rehearse explicit scenarios if helpful discuss possibility of relapse of

TERMINATION DIFFICULTIES
Failure for depression to resolve refer for other treatment, encourage hope Client wants to continue schedule 8 week waiting period impart to client self-confidence in ability to cope Maintenance IPT may be appropriate for: chronic or recurring depression clients with personality problems or interpersonal deficits

IPT IN GROUP FORMAT

20 sessions over a 5-month period Therapeutic Stance :warmth,support,empathy Pre group meeting :

Assignment of the sick role, Interpersonal inventory, Development of the problem area(s) Development of treatment goals

Occur in a structured 2-hour pre-group meeting

IPT IN GROUP FORMAT

Important interpersonal skills are learned while participating in a group (e.g., interpersonal confrontation, honest communication, expression of feelings)

IPT IN GROUP FORMAT

Initial phase : 5 sessions Cultivate positive group norms and group cohesion Emphasizing the commonality of symptoms among members and how they will be addressed in the group context. Encouraged to review their goals with the group Make some initial changes in their respective interpersonal problem areas

IPT IN GROUP FORMAT

Intermediate phase :6-15 Facilitate connections among members as they share the work on their goals with one another. Encourage group members to practice newly acquired interpersonal skills in & outside the group

IPT IN GROUP FORMAT

Midtreatment meeting : Detailed review of each group member's progress on his/her individual problems and to refine interpersonal goals Termination phase : Help members to consolidate their work & plan continued work Assist in grieving loss of group.

IPT IN GROUP FORMAT

Post treament meeting :

1 week after final group session Develop an individualized plan for each group member's continued work

Maintaining IP focus :
Use of group summaries/self help manuals Group stage development theory interventions - intensifies group cohesiveness, prevents premature dropouts

INDICATIONS
Major depressive disorder Bulimia nervosa IPSRT(IP social rhythms therapy) Bipolar disorder Anxiety disorders less evidence Substance use,dysthymic disorders no advantages

International society for IPT May 2000,Chicago Manuals different age groups, subpopulations , different lengths, formats including telephone adaptations Basic principles followed:

No fault definition of illness Excusing pt from blame Continued focus on relation b/w pts mood and life situations

Never indicated as monotherapy for psychotic depression or bipolar disorder. Complications : Straightforward therapy
Treatment nonresponders should be evaluated for possible prescription of an alternative, evidence-based treatment

Ethical issues : Require training and supervision to develop proficiency Specific IPT training guidelines(Weissman et al) Specific group training guidelines(Wilfley et al)

Research & Evaluation

Acute Treatment of major depression Boston-New Haven Study (1979) 4 Tx Groups (16 wks & 1yr follow-up): IPT, amitriptyline, both combined, control IPT and amitriptyline equally effective Combination IPT & Amitryptyline most effective IPT grp. Sustained improved psychosocial functioning 1 yr later (not in AMI grp alone)

NIMH Treatment of Depression Collaborative Research Program (1989)

4 groups (16 wks, multi-site, N=250) IPT, CBT, Imipramine & clinical management (CM), placebo & CM IPT comparable to Imipramine & CM CBT showed somewhat less improvement IPT grp. had lowest attrition rate Results for mod.-severe depression

Special population settings

Depressed primary care patients :

70% receiving IPT / nortriptyline recovered in 8 mths

Depressed HIV + Patients

Randomized study-101 pts IPT+imipramine superior to CBT ,SPT

Peripartum depression : CCT IPT > didactic education

Conjoint IPT for depressed patients with marital disputes (IPT-CM)

Yale Univ. -18 pts -16 wks of IPT or IPTCM Better marital adjustment,affection,sexual relations

Depressed adolescents (IPT-A) 3 RCTs IPT > CBT self esteem and social adaptaion

Maintainence treatment(Pittsburgh):
128 pts IPT +imipramine for 4 mths Remitted pts randomly assigned : IMI+CM ,IMI+mthlyIPT,mthlyIPT , mthlyIPT+placebo, pla+CM Both IPT & Imipramine superior to placebo

Bipolar disorder :IPSRT

Hypothesis Disruption of social rhythms destabilize & trigger relapse

Dysthymic disorder : Reconceptualize lifelong character flaws ego-dystonic,chronic mood dependent symptoms 3 RCTs improvement in IPT + sertraline combination significant

Non mood disorders : Bulimia Fairburn modified IPT long term benefits,decreased binge eating Anxiety disorders Not yet tested Substance use no efficacy in 3 CTs

Predictors of response
Social Dysfunction(higher functionbetter) Cognitive dysfunction Expectation of improvement Therapeutic alliance Endogeneity of depression-better Double depression poorer outcome Personality traits poorer response Duration of current episode (longerworser) Prior social judgement good

Case study
22y Brendan Depressed mood,poor concentration,lethargy,reduced appetite,sleep disturbance,suicidal ideation since 3-4y,^since 3 mths Sertraline 100 mg mod. Improvement Carpenter by occupation ,had difficulties with the way supervisor talked to him .always quiet at work,enjoyed work

1 good friend since primary school Felt uncertain around girls Mother expired 2y back cancer Not much contact with dad and elder brother O/E cooperative,depressed mood ,restricted affect

IPT intervention Diagnosed MDD ,in partial remission IP context +

Supervisor diff IP dispute Mothers death grief Impoverished social network IP sensitivity

IP inventory attachment insecure avoidant Formulation IPT focus created Roles explained

Sessions 1-7-wkly,8-10-fortnightly,11-12 mthly Middle sessions 3 problem areas addressed pt was quite introverted Dispute with supervisor priority Affect elicited and therapeutic relationship established Communication analysis supervisors behaviour not personal Brainstorming scenarios & role play sessions-assertiveness

Next to grief Seq of events related to moms death recreate relationship Process affect elicited anger ,guilt Next to utilise existing social supports to develop new interests Sought to develop stronger relationship with a maternal aunt & family friend Socializing more with quieter men at work Began to relax during events at tavern secure base-looked for support & guidance from therapist

Termination phase discuss feelings to prevent symptom intensification Advised maintainence sessions if he relapsed

FUTURE DIRECTIONS
1.

Little is known about mechanisms by which interpersonal psychotherapy exerts its effects
Greater understanding would assist in further refinements and yield insights about nature of the psychiatric syndrome under investigation.

2.

Increased efforts to improve the effectiveness of interpersonal psychotherapy -altering the structure , identifying specific therapist behaviors

FUTURE DIRECTIONS
3. 4.

Refining the definitions of the target populations is advised Need to translate interpersonal psychotherapy efficacy data to effectiveness studies and appropriate clinical practice.

CONCLUSION
IPT stands, in contrast to other therapies through an emphasis on the effects of a persons external interpersonal environment upon their mental health Sufficient clinical trials conclude that IPT is an efficacious time limited treatment for a range of conditions,esp. depression and bulimia Manualised format makes it relatively easy to learn and apply.