In Depression

The Benefits of Interpersonal Therapy

Interpersonal therapy definition: It involves the treatment of patients with depression. It focuses on past and present social roles within the realm of interactions. The therapist bases the area of treatment on one or two patient problem areas. Some examples would be disputes between family, friends, and co-workers. The areas of grief and loss are also included. And life role transitions like divorce or retirement are also examined.

|SEE ALSO: Common Signs of Depression in Teens|

The Two Types of Interpersonal Therapy

You may ask what does interpersonal mean? The interpersonal definition is described as of or relating to the interactions between individuals.

There are two categories of interpersonal therapy for depression. The first is short-term treatment related to a depressive episode. In this case, weekly sessions with a therapist occur for two to four months. Once the symptoms subside, the treatment ends.

The second form of interpersonal psychotherapy involves long-term maintenance. The idea is to prevent or reduce future episodes of depression. Monthly sessions may take place for a period of two to three years.

Four Basic Problem Areas

* Unresolved grief occurs when the effects last longer than normal bereavement. The grieving can also be delayed or take on forms other than emotion.

* When the patient and important people in his or her life have different expectations concerning their relationship, it is called a role dispute.

* Role transition problems happen when major changes occur within a person’s life and they have difficulty coping with them.

* When a patient has problems forming and maintaining good relationships with others, it is termed interpersonal deficits.

History of IPT

What is interpersonal therapy? Interpersonal therapy (IPT) originated in 1969 at Yale University. Dr. Gerald Kierman teamed with Dr. Eugene Paykel. They developed a test designed to measure the effects of an antidepressant as an ongoing treatment of ambulatory non-bipolar depression. This was done with or without psychotherapy.

IPT’s structure takes a cue from cognitive behavioral therapy (CBT), which is a structured means of psychotherapy that wants to alter problem behavior by replacing negative inaccurate thoughts with positive reinforcements and behavioral rewards.

For the last 20 years, IPT has been the subject of various studies. It has been proven to successfully treat patients battling depression. In fact, the process had been modified to combat other psychiatric disorders like substance abuse, dysthymia, and bulimia.

A 1989 study by the National Institute of Mental Health found that interpersonal therapy was very effective in treating depression during the first six to eight weeks of treatment. In addition, one could expect improvement in psychosocial function after 16 weeks.

IPT has been proven to be effective in treating patients with the following disorders:

Bipolar Disorder

The typical symptoms of bipolar disorder are elevated mood, sometimes followed by periods of depression. The elevated mood is called mania, and it often results in a feeling of over-the-top happiness, extra energy, or being irritable. During this time, the subject will be prone to making ill-advised decisions that can result in dire consequences. Their outlook on life can be taken over by negativity. Suicidal behavior can also be a problem. They can additionally be inclined to abuse drugs.

Treatment for bipolar disorder can involve psychotherapy, including IPT, and mood stabilizer or antipsychotic medications. Mood stabilizers used in treatment include lithium and anticonvulsants.

At times, persons in treatment may require hospitalization against their will, due to their extreme antisocial behavior and a refusal to willingly seek treatment.

When a patient has severe behavioral problems, short-term benzodiazepines or antipsychotics can be helpful in managing the disorder.

When a patient is a prisoner of the disorder, they can have social, financial, or work-related problems. Also, the risk of death from natural causes are twice as high for those with bipolar disorder.

Bulimia

People who suffer from bulimia, which is an eating disorder, binge eat and then follow this by purging the food from their systems either by inducing vomiting or by taking a laxative or stimulant. They are obsessed with keeping their body weight down.

Bulimia sufferers may engage in fasting over a long period of time. The disorder can lead to potassium loss, health hazards, and bouts of depression as well as the potential for suicidal behavior. Many people who suffer from bulimia also have psychiatric disorders that can be treated with IPT methods. They include anxiety, impulse control, and substance misuse. Other associations can be impulse behaviors like overspending, excessive sexual behavior, and alcohol and substance abuse.

Women constitute 80 to 90 percent of the people who suffer from bulimia. Adolescents are most at-risk. A survey of 496 teenage girls found that 12 percent had some form of an eating disorder by the time they reached the age of 20.

Postpartum Depression

Postpartum depression (PPD) is a type of clinical depression that women suffer from after childbirth. The symptoms involved include sadness, fatigue, altered sleeping and eating habits, lack of interest in sex, crying, plus anxiety and irritability.

The exact cause of PPD is still unknown. Many women are able to recover after participating in support groups or counseling sessions.

The Edinburg Postnatal Depression Scale is a 10-item questionnaire that is used to identify women who have postpartum depression. Items and symptoms compiled in the list include feelings of guilt, sleep disturbance, low energy, and suicidal thoughts. The higher the score, the greater the likelihood the patient has PPD.

Major Depressive Disorder

Major depressive disorder is an ailment that features persistent and pervasive low mood combined with low self-esteem and a loss of interest in normally enjoyable activities. A major characteristic of major depressive disorder is a disabling condition that has an affect on the subject’s family, work or social life, sleeping and eating habits, and health in general.

According to U.S. statistics, 3.4 percent of people with major depression disorder commit suicide. And about 60 percent of people who commit suicide suffer from depression or a mental disorder.

The basis of major depressive disorder diagnosis relies on factors that include the patient’s reported experiences, family members or friends doing the same, or in some cases a mental status examination. There is no lab test for major depression. The time for the disorder to most likely occur is in the ages between 20 or 30 years old, with a later peak at 30 or 40 years old.

For the majority of people with major depressive disorder, treatment can involve antidepressant medication and forms of counseling, like cognitive behavioral therapy or IPT. When self-neglect or harmful behavior is involved, hospitalization may be necessary. A minority of patients may be treated with electroconvulsive therapy, which is when electrically induced seizures are prompted to cause relief from psychiatric illnesses. Treatment is usually given two or three times a week until the patient is better.

The running time of the disorder varies. It could be one episode lasting a few weeks to a long-term or lifelong disorder with recurring major episodes.

Cyclothymia

Cyclothymia is a type of mood disorder that is considered to be a milder version of bipolar disorder. Typical symptoms are several mood disturbances and periods of hypomanic symptoms alternating with bouts of depression.

The diagnostic criteria for cyclothymia is that a patient must exhibit an alternating pattern of highs and lows for at least two years. For children and adolescents, the time period must be at least a year.

Cyclothymia is not nearly as common as bipolar disorder. The patient has to have the mood swings minus a highly depressive episode. If the patient has more episodes of progressive mood swings, their status could be upgraded to bipolar or bipolar II disorder.

There are similarities between bipolar II and cyclothymia in that signature hypomanic episodes occur. Due to hypomania being associated with creative, outgoing, and high-functioning behavior, the condition often goes undiagnosed. Usually, it is the depressive behavior that prompts treatment.

Family Therapy

Family therapy is a branch of psychotherapy that involves working with families and couples to bring about change and development within the family group. It stresses family relationships as being very important in terms of psychological health.

A consensus among family therapists is that identifying the cause of a problem and involving the family in the solution will benefit the patient. In therapy, the family commonly becomes involved in sessions.

In the early years of the process, family was defined in narrow terms. Now, it has been expanded to include long-term relationships among people who may or may not be related by blood or marriage.

In terms of family therapy, the number of sessions depends on the situation, but on average, there are between 5 and 20. Several members of the family meet with the therapist, and the focus is generally on the relationship patterns rather than early childhood traumas.

Family therapists are basically relationship-oriented. They are focused on what happens between individuals rather than within one or more individuals. Family therapists want to be involved with the maintenance and solving of problems as opposed to attempting to identify a cause. A circular method of problem solving is used over a linear route in the hopes of identifying patterns of behavior, causes of the behavior, and what can be done to rectify the situation.

Techniques of Interpersonal Therapy

*Case Study 1

Edward is constantly fighting with his wife. Therapy sessions reveal that he feels neglected since his wife has taken a job outside of the home. When he discovers the relevant emotion is hurt rather than anger, Edward can begin to examine the problem.

*Case Study 2

Edward is feeling neglected by his wife. His reaction is anger and sarcasm. His wife reacts negatively. In a calm way, using interpersonal therapy techniques, Edward expresses his anxiety and hurt at not being important in his wife’s world. Now it becomes easy for his wife to react with reassurance and a nurturing disposition.

Strengths and Limitations of IPT

IPT seems favorable for patients who find dynamic therapy mystifying or for those who find the homework demands of cognitive behavioral therapy daunting. Interpersonal therapy has been modified for adolescents who might find the methods of CBT too much like school work.

For general psychiatrists, a limitation of IPT seems to be that it has not been modified to include management of psychoses in the manner that CBT does. As a face-to-face therapy, it requires individuals to show up for pre-arranged therapy sessions. No homework tasks are involved with IPT, but re-enactment of past negative feelings and a danger of resulting emotional harm does exist.

Studies have concluded little difference in the effectiveness of CBT and IPT. Even when a placebo is introduced into the study, there is no significant difference in results.

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