Interpersonal & Social Rhythm Therapy (ISRPT): Origin And Application

Interpersonal & Social Rhythm Therapy (ISRPT) is a mental health intervention that focuses on an individual’s daily routine, ongoing stressful events, and the quality of relationships to understand their struggles with mental health. It was originally developed by Ellen Frank for patients of Bipolar Disorder (Haynes et al., 2016) but now is also used for the treatment of other mental health disorders like depression and anxiety.

The ISRPT Model proposes that the episodes of mood disorders (e.g., depression & bipolar disorder) are caused when individuals experience major changes in their lives that disturb their daily routine. For example, a person who has received a low score on a test may experience stress and anxiety related to their performance.

These changes disrupt circadian rhythm – the body’s internal “clock” which regulates essential physiological activities like appetite and sleep. Due to irregular schedules caused by stressful life events for long periods, these disruptions in the circadian rhythm may cause stress in our mind and body, invariably affecting our mental health.

Interpersonal & Social Rhythm Therapy focuses on the stabilization of daily behaviors by developing an active and consistent lifestyle. According to the ISRPT model, a daily routine can help to restore the circadian rhythm which leads to improved mood and level of functioning (Haynes et al., 2016).

While the nature of stress may vary from person to person, the ISRPT model proposes four key themes (Markowitz & Weissman, 2004) that make an individual more likely to experience these disruptions:

1.Grief

The grief is caused by the loss of something important to us.

The loss can be of a relationship (e.g., death of a loved one), a valued object (e.g., financial loss), or a role (e.g., unexpected termination from a job).

2.Role Transition

A person may experience stress due to transitioning into a new role in their personal or professional lives. Some examples include transitioning into the role of spouse after marriage, switching jobs, etc.

While these transitions may or may not be favorable for the individual, they may cause stress due to the demands of the new role (e.g., co-sharing a space with a partner after marriage, dealing with an unsupportive work environment, etc.)

3.Role Disputes

Whilst transitioning into a new role, a lack of clarity about the responsibilities can cause conflicts with others. If an individual does not have skills for dealing with conflicts and/or feels unsupported in the process, it naturally takes a toll on the body and mind, disrupting the circadian rhythm.

4.Interpersonal Skill Gap

When there is no clear stressor about what might be causing stress, the ISRPT model proposes to check if the individual is struggling with an interpersonal skill gap, i.e., a possible lack of social skills (e.g., effective communication, boundary setting, etc.) that might be causing stress.

A person may lack social skills because of a myriad of reasons – lack of soft skills training, differences in communication style with respect to the social circle, etc. The good news is that social skills can always be learned – working with a therapist or a coach who specializes in soft skills training can be immensely helpful!

The Interpersonal and Social Rhythm Therapy occurs in four phases. The ISRPT treatment is usually conducted in a structured manner and requires about 10 – 12 sessions (Frank et al., 2007).

Stage 1: Assessment

In Stage 1, the client and the therapist collaborate to see what events have been occurring in the client’s life that may be contributing to the present distress. A detailed case history is conducted where factors like health, interpersonal relationships, level of social support, etc. are assessed to make an overall assessment.

Once a case history is completed, a possible diagnosis (e.g., depression) is explored via assessment, observation, and discussion with the client. While a diagnosis is not always necessary, it can support the client to frame the source of distress outside them – it helps them to understand that something is not wrong with them, rather they are struggling with a mental health condition.

The client and the therapist mutually decide what factors within the ISRPT model are the source(s) of distress to the clients. These concerns are framed as goals for ISRPT therapeutic intervention.

Stage 2: Intervention

In stage 2, the client and the therapist focus on building a stable social routine to restore circadian rhythm functioning. Due to extreme stress, it is possible that the client’s regular biological functioning (e.g., eating habits, personal hygiene, level of movement) has significantly deviated from the baseline.

Hence, taking small and consistent steps is an important part of this treatment phase. The client may decide to work on a single goal at a time and slowly move it towards their baseline (e.g., eating lunch around 1 pm daily).

At the same time, the client and the therapist start working on building the client’s interpersonal skills so that they are effectively able to manage the stressors at hand. For example, a client overwhelmed by additional tasks assigned to them at work may benefit from learning the skill of strategic communication.

Stage 3: Continuation Or Maintenance

In Stage 3, the client and the therapist explore the strategies that can help the client maintain their social routine and keep the interpersonal stress at bay. They strategize how the client can implement the skills they’ve learned in the therapy in their lives.

This stage of ISRPT Treatment also involves analyzing any challenges that a client may experience in implementation. The client may rehearse how to implement these strategies with the therapist by preparing scripts or doing roleplays.

Stage 4: Termination

When the client starts feeling better and is able to independently practice the tools learned in therapy, the termination of the therapy process can be considered. It is recommended to gradually phase out of the treatment by reducing the frequency of the sessions (e.g., bimonthly instead of weekly).

The client can occasionally come for “booster sessions” with the therapist to maintain progress. At any point after termination, if there is a need to resume therapy, one should not hesitate to contact their therapist. Ebbs and flows in our mental health are normal – and we highly encourage you to seek help!

The research studies suggest that Interpersonal and Social Rhythm Therapy is highly effective as an adjunct treatment for mental health disorders. The ISRPT protocol can be used alongside the existing therapy procedure for the management of daily functioning and improving the quality of interpersonal relationships.

Multiple research studies demonstrate the effectiveness of Interpersonal and Social Rhythm Therapy in the treatment of mood disorders like depression, bipolar, and anxiety.

It enables an individual to make sense of ongoing stressful events, learn skills to deal with them, and reorganize their lives to better deal with their mental health condition (Markowitz & Weissman, 2004).

The focus of the ISRPT model on generating insight and skill-building can help the client prevent or manage the intensity of future episodes.

Dealing with life’s challenges can be overwhelming and stressful and talking to a mental health professional helps a lot! If you are looking for mental health support check out Mave Health’s Therapy Club! – India’s largest mental health platform that makes good mental health a priority.

Find a professional on Mave Health who can meet your needs and start your mental health journey today.

REFERENCES: