Social Rhythm Therapy

DeeDee newInterpersonal and social rhythm therapy (ISRT) is a type of behavioral therapy designed specifically for bipolar disorder. As Wikipedia tells us, it’s:

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).

According to Frank’s own website,

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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7 thoughts on “Social Rhythm Therapy

  1. This makes a lot of sense, in one way…but in another, it increases my despair at never seeming to know what “normal” is. Yes, it does seem reasonable that one could build an external framework and stick to it…and on the other hand, what happens if the bodymind just won’t “go”?

    • I know the confusion – what “should” I be doing, given that I know I can’t judge it adequately?

      I find that using routines and imposed quotas and limits helps remove some of the choices that I tend to make poorly and makes me a bit more critical about what I choose to do with what’s left. I do better on the overall if I try to stick to an external schedule. It might not be easy or what I feel like my body/brain wants, but it eliminates my baseless excuses as well. I’m finding it most helpful for sleep hygiene, but also being conscious of how much time I spend alone, which is probably more than it should be.

      • Yeah, I hear what you’re saying. I haven’t been so good at managing myself lately, despite setting alarms for everything I’m supposed to do. I think maybe it’s a one-two punch of ADD and depression. Ugh.

  2. I’ve always found this approach very interesting. Would like to try it myself even if I am not bipolar per se. It’s funny… OK, it’s not funny but I am wondering… When I took psychiatry, there was a school of thought that said that depressive disorders were bipolar in essence. Only that some people never expressed manic episodes, only hypomanic ones that were small enough to pass as quirks and therefore considered “normal” behaviour in our society. As such, the only really noticeable symptoms were those of depression thus the believe of a separate condition

    I wonder where that theory went.

    • I think this kind of approach would be useful for all kinds of mental health needs. At the heart of it, we really all do need connectedness, structure enough for whatever level of stability we require, etc.

      I don’t know where that theory went, but I don’t think I agree with it. There have been studies showing distinctive differences in neurophysiology (cause or effect – who knows? but that kind of thing tends to be self-reinforcing) and in creativity, of all things. Apparently schizophrenics and bipolars have higher rates of working in creative fields, but depressives no more than average. To me, that suggests that they are distinct conditions, but again – who knows?

      • well, since creativity happens mostly during the manic episodes it would make sense that schizophrenics and bipolars have higher rates of working in creative fields. But I stopped studying neurophysiology about a decade ago so I don’t know

  3. omg thank you so much for doing this blog. I really would love more resources on this new therapy, I’ve been having trouble in social situations since as a teenager and today in my love life. I don’t want to miss judge social situations all the time but with bipolar you do this over and over again. I wanted to also find infomration online, even looked into finding an application, but none. I just got a routine planner app and now seeing my doctor tomorrow to talk about this new therapy. Keep us posted please and thanks again for this!

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