Interpersonal and social rhythm therapy for adolescents with bipolar disorder: treatment development and results from an open trial

Abstract

Background In adolescents and adults, bipolar disorder (BD) is associated with significant morbidity, mortality, and impairment in psychosocial and occupational functioning. IPSRT is an empirically-supported adjunctive psychotherapy for adults with bipolar disorder which has been shown to help delay relapse, speed recovery from a bipolar depressive episode, and increase occupational and psychosocial functioning in adults with BD. The current study is designed to describe the adolescent-specific developmental adaptations made to IPSRT (i.e., IPSRT-A) and to report the results from an open trial of IPSRT-A with 12 adolescents with a bipolar spectrum disorder. Method Interpersonal and Social Rhythm Therapy was adapted to be developmentally-relevant to adolescents with bipolar disorder. Twelve adolescents (mean age 16.5 ± 1.3 years) diagnosed with a bipolar spectrum disorder participated in 16–18 sessions of adjunctive IPSRT-A over 20 weeks. Manic, depressive, and general symptoms and global functioning were measured at baseline, monthly during treatment, and at post-treatment. Adolescent satisfaction with treatment was also measured. Results Feasibility and acceptability of IPSRT-A were high; 11/12 participants completed treatment, 97% of sessions were attended, and adolescent-rated satisfaction scores were high. IPSRT-A participants experienced significant decreases in manic, depressive and general psychiatric symptoms over the 20 weeks of treatment. Participants’ global functioning increased significantly as well. Effect sizes ranged from medium-large to large. Conclusions IPSRT-A appears to be a promising adjunctive treatment for adolescents with bipolar disorder. A current randomized controlled trial is underway to examine effects of adjunctive IPSRT-A on psychiatric symptoms and psychosocial functioning.

Dialectical Behavior Therapy for Adolescents with Bipolar Disorder: Results from a Pilot Randomized Trial

“…Among adolescents with BP, Miklowitz and colleagues demonstrated improvement in depression, but not mania, symptoms with FFT-A (Miklowitz et al 2008). Hlastala and colleagues documented improvement in both depression and mania symptoms among adolescents with BP in an open trial of IPSRT (Hlastala et al 2010).…”

“…Hlastala and Frank (2006) modified Interpersonal and Social Rhythm Therapy (IPSRT) (Frank 2005), a treatment focused on regularizing circadian and social rhythms with demonstrated efficacy in adults, for adolescents with BP. In a small open trial (n = 12), they documented improvement in manic and depressive severity from pre-to posttreatment (Hlastala et al 2010). For school-age children with both unipolar and bipolar mood disorders, Fristad and colleagues demonstrated the efficacy of a multifamily psychoeducational program (MF-PEP) in improving mood symptoms (Fristad et al 2009), while Pavuluri and colleagues developed a cognitive behavioral intervention for children with mood spectrum disorders (Child and Family-Focused Cognitive-Behavioral Therapy [CFF-CBT]) (Pavuluri et al 2004;West et al 2009).…”

The International Society for Bipolar Disorders Task Force report on pediatric bipolar disorder: Knowledge to date and directions for future research

“…175 The category of family psychoeducation plus skill building can be considered as a well-established treatment, meaning that two or more research groups have, via independent RCTs, demonstrated efficacy. 176 Dialectical behavior therapy 171 can be considered possibly efficacious , based on a single RCT or multiple studies by the same group, while interpersonal and social rhythm therapy 177 remains experimental in youths at this time. Effectiveness trials suggest that family psychoeducation plus skill-building approaches have excellent acceptability and sustainability in community settings.…”

Management of Bipolar Disorder in Children and Adolescents

“…Hlastala and colleagues developed an adapted version of interpersonal and social rhythm therapy for adolescents (IPSRT-A) with bipolar disorder (101). IPSRT-A consists of 16-18 sessions delivered over 20 weeks, mostly with the adolescent alone.…”