What Is Interpersonal and Social Rhythm Therapy (IPSRT)?

Interpersonal and Social Rhythm Therapy (IPSRT) helps people improve their mood and overall mental health by building a regular routine and improving their interpersonal relationships.

Ellen Frank, PhD, a professor of psychology and psychiatry at the University of Pittsburgh School of Medicine is credited with founding this form of therapy. Dr. Frank’s theory was that relationship conflicts or disruptions in one’s daily routine can trigger mood episodes in people with mental health conditions.

For instance, you may have noticed that not getting enough sleep affects your ability to concentrate and makes you feel tired and irritable.

Similarly, having a conflict with someone in your life can be destabilizing and affect your mood. Dr. Frank notes that most people recover from these disruptions fairly quickly; however, people who are vulnerable to mood disorders may not be able to cope so easily.

This article explores the techniques and benefits of IPSRT, as well as some steps to help you get started with this form of therapy.

IPSRT Techniques

IPSRT can be performed in different settings:

• Individual basis: One patient working with one healthcare provider
• Group setting: Multiple patients working with one or more healthcare providers
• Remote setting: Over the phone or internet

IPSRT can be broadly categorized into three stages, which are outlined below.

Initial Stage

The healthcare provider works with the patient to understand their current mood state, any previous mood episodes they have experienced, and how their behaviors and relationships have changed with each episode. 

Together, the patient and healthcare provider narrow down an interpersonal problem area that will be the area of focus for treatment.

This stage encompasses the first several sessions of treatment and may involve multiple sessions per week. 

Intermediate Stage

The patient maintains a chart on which they track all their daily rhythms, or social metrics, such as:

• The time they get out of bed
• The time of their first in-person interaction with someone else
• The time they start their primary activity (school, work, or family care, for instance)
• The time they eat their meals
• The time they go to bed

The healthcare provider reviews this chart with the patient at every weekly visit, with an aim toward building consistency and regularity. The healthcare provider may suggest more metrics to add to this list. This stage also focuses on developing coping skills to manage changes or disruptions to the daily rhythms, due to factors such as vacations.

Additionally, the patient and healthcare provider work on the interpersonal problem as well as building confidence and improving relationship skills.

Initially, the therapy sessions are conducted weekly, but they gradually taper off to once every two weeks or once a month during the latter stages.

Final Stage

In the final stage, the patient and healthcare provider work toward terminating therapy or reducing the number of sessions even further.

What IPSRT Can Help With

IPSRT helps people whose habits or symptoms are causing disruptions in relationships or in basic self-care, says Dr. Daramus.

It was initially developed to help with the mood episodes associated with bipolar disorder; however, it is now also used to help with other mental health conditions such as depression, anxiety, and schizophrenia.

Additionally, IPSRT can be adapted for any problem in which the person may benefit from improving their relationships and daily rhythms in order to live a more stable lifestyle, according to Dr. Daramus.

Benefits of IPSRT

These are some of the things IPSRT can help with, according to Dr. Daramus:

• Building confidence and improving relationship skills
• Replacing toxic relationships with healthier, more supportive ones
• Helping people remember basic life tasks that need to be done every day
• Teaching people techniques for better sleep and daily living
• Increasing adherence to medication and treatment
• Improving mood and creating an overall sense of stability

Effectiveness of IPSRT

Research shows that IPSRT can be helpful with mental health conditions such as:

• Bipolar disorder: A 2020 study found that IPSRT can help reduce depressive and manic symptoms in patients with bipolar disorder, improve their day-to-day functioning, increase adherence to medication, and improve their response to mood-stabilizing medication. Another study found that it may also be helpful in preventing or delaying the onset of bipolar disorder in at-risk adolescents.
• Depression and anxiety: A 2016 study notes that IPSRT and other social rhythm therapies (SRTs) can also be beneficial to people with mood disorders such as depression and anxiety, as they may be less likely to have consistent daily rhythms but simultaneously have heightened sensitivity to disruptions and irregularities.
• Schizophrenia: A 2021 study notes that IPSRT can help with the depressive symptoms people with schizophrenia may experience.

Things to Consider About IPSRT

Dr. Daramus says that while IPSRT can be a big help, it is most often used with another form of therapy, such as cognitive-behavioral therapy (CBT) or dialectical-behavior therapy (DBT), rather than by itself. 

“IPSRT doesn't usually directly treat a disorder, such as bipolar disorder, but it helps create a solid basis for medications and other types of therapy to work,” Dr. Daramus explains.

Needing two forms of therapy may mean working with two different therapists. It also means spending double the time and money on therapy.

How to Get Started With IPSRT

Dr. Daramus suggests some steps that can help you get started with IPSRT:

• Search for a specialist: If you’re looking for a therapist who specializes in IPSRT, it can be helpful to look up a therapist directory. Most directories will let you search by specialty and location, so you can find a therapist near you.
• Ask for a recommendation: If you’re seeing a healthcare provider who suggests IPSRT for you, it can be helpful to ask them for a recommendation to a specialist. 
• Learn about the treatment: There are some very good books and videos that can help you learn more about IPSRT, so you understand how it works and what to expect.

A Word From Verywell

IPSRT is a form of therapy that focuses on improving relationships and daily routines, in order to improve mood, stability, and mental health. It can be especially helpful to people who have mental health conditions that make them prone to mood episodes, as they may be particularly vulnerable to the destabilizing effects of stressors, disruptions to their routine, and relationship conflicts.