What is interpersonal and social rhythm therapy for bipolar disorder – and how does it work? Mental health professional, Liz Taylor from M1 Psychology, explains …
Bipolar is a mood disorder that is characterised by mood swings.
What happens in bipolar disorder is that the individual experiences high, elated moods coupled with low, depressive episodes – ups, and downs.
Of course people with bipolar will have ‘normal’ moods also.
Bipolar is a life long condition, however with the right medication, support and therapy, people with bipolar can live their lives in the same way, as those who don’t have the condition.
Two Elements of Bipolar Disorder
The symptoms of bipolar are split into two areas – depressive (the downs) and manic (the ups).
Manic symptoms include: an elevated mood, irritable mood, feeling able to achieve anything, euphoria, focused on one or more projects to the point of obsession, more talkative, possible lack of concern for one’s safety eg promiscuity or substance misuse, unable to sleep, inflated ego, rushed speech, racing thoughts, poor attention span and generally chaotic.
People who experience this episode describe it as being wonderful and they can achieve anything and feel invincible. However this type of episode is just as concerning as a depressive episode. It can cause people to take risks.
And eventually what goes up has to come down.
Depressive episode symptoms include: low mood, isolation, refusal to engage in daily activities, neglecting personal care, thoughts/intent/plans to self-harm or suicidal tendencies, sleeping for long periods, losing interests in all activities and in life itself, appetite and sleep changes.
Types of Bipolar Disorder
There are different types of bipolar disorder:
- Bipolar I Disorder—manic episodes that last at least 7 days, or by manic symptoms that are so severe that the person needs immediate hospital care. Usually, depressive episodes occur as well, typically lasting at least 2 weeks. Episodes of depression with mixed features (having depression and manic symptoms at the same time) are also possible.
- Bipolar II Disorder—similar to Bipolar I, but not the full-blown manic episodes described above.
- Cyclothymic Disorder (also called cyclothymia)—numerous periods of hypomanic symptoms as well as numerous periods of depressive symptoms lasting for at least 2 years (1 year in children and adolescents). However, the symptoms are not severe enough to meet the diagnostic requirements for a hypomanic episode and a depressive episode.
- Other Specified and Unspecified Bipolar and Related Disorders—bipolar disorder symptoms that do not match these categories.
Treating bipolar usually involves a multi-disciplinary approach drawing on the skills of various health professionals, to help to get you feeling well and in control of your life.
What is Interpersonal and Social Rhythm Therapy?
One therapy which has proved extremely successful in treating and helping people with bipolar is Interpersonal and Social Rhythm Therapy (IPSRT), which is described as ‘a compelling adjunctive therapy for people with mood disorders, and it emphasizes techniques to improve medication adherence, manage stressful life events, and reduce disruptions in social rhythms. IPSRT teaches patients skills that let them protect themselves against the development of future episodes.’
The process of IPSRT involves the following three stages:
Initial Stage: Usually over the course of a few sessions, your therapist will gather information about your current mood state and prior mood episodes, and explore the behaviours and relationships associated with changes in mood state over time. Together you and your therapist agree on a primary interpersonal problem area as the main focus for the interpersonal part of the treatment.
Intermediate Stage: You will be asked to complete a form to track social rhythm regularity every week, which you will review with your therapist. This helps you and your therapist regulate your social rhythms, particularly in your selected interpersonal area.
Later, as your confidence and skills build, you will be asked to put into practice some of the strategies you have been learning, to manage changes in routine such as holidays or a change of job. Weekly sessions may be reduced to monthly or bimonthly at this time.
Final Stage: As you become more skilled at managing your social and interpersonal rhythms, you and your therapist will gradually reduce or put an end to your sessions.
So what is it like to have bipolar? I will let those who truly know, answer this question:
“… Sleeping for 18 hours and haven’t had a shower in a week and a half. It’s not even recognizing who you are sometimes. It’s looking in the mirror and seeing someone else. It’s hiding behind silence so you no one will call you ‘crazy.’ It’s every emotion rolled into a ball and you wait to see which ‘you’ comes out first.” — Ashley S.
“Imagine feeling extremely happy and on top of the world but not able to truly appreciate the happiness because you know that soon (could be seconds, minutes, hours or days later) the happiness will be replaced with complete sadness. It’s only a matter of time before you are back to square one with the one demon that’s never gone and is always around the corner: depression.” — Hannah C.
“One day I have to miss work because I can’t get out of bed, and I spend the whole day wanting to die (even though I know I won’t, the thought is always there). The next day I’m staying up 24 hours taking on two jobs and spending more money than I have, running errands, loving life. It’s unpredictable and difficult because it’s not the kind of illness people understand. People look at it as a really bad illness and they don’t want to talk about it at all.” — Cailey C.
Therapy is essential in recovering from bipolar and at times it can feel like you are in danger as paranoid thoughts can consume you. This is why care plans and a crisis plan is imperative in your recovery, and to help you gain back control of your life.
Author: Liz Taylor, BA (Hons).
Liz Taylor is a social worker with over ten years’ experience in helping people with personality disorders and other mental health issues. Liz’s counselling strategies are drawn from the Relapse Prevention Model, Cognitive Behaviour Therapy (CBT), and Dialectical Behaviour Therapy (DBT). She is passionate about enabling her clients to function and feel a sense of control in their lives, and to achieve the goals and outcomes that they wish.