Interpersonal Psychotherapy (IPT) for depressed adults: Specific interventions and techniques
- Holly A Swartz, MD
Holly A Swartz, MD
- Professor of Psychiatry
- University of Pittsburgh School of Medicine
Interpersonal Psychotherapy (IPT) is a time-limited psychotherapy for treating depression [1,2]. The therapy focuses upon improving problematic interpersonal relationships or circumstances that are directly related to the current depressive episode. Interpersonal relationships and depressive symptoms appear to affect each other in a reciprocal manner [3-7]. Improvement of interpersonal functioning reduces symptoms, which leads to additional spontaneous improvement of interpersonal functioning, which in turn reduces depressive symptoms further.
IPT was developed in the 1970s as a treatment for depression and for many years was used only by investigators in clinical trials . Demonstrated success in multiple studies eventually led clinicians to discover that IPT is a practical, user-friendly treatment for many different types of depressed patients, including pregnant, postpartum, or primary care patients .
Neuroimaging studies using sequential single photon emission computed tomography (SPECT) and positron emission tomography (PET) suggest that successful treatment of major depression with IPT leads to changes in brain function [10,11]. Many of these changes overlap with changes in brain function seen in patients treated with an antidepressant, including regional brain metabolic abnormalities that tended to normalize with treatment.
Clinical guidelines suggest IPT monotherapy for treatment of mild to moderate depression [9,12,13]. In addition, IPT is used to treat other psychiatric illnesses, including bipolar disorder, eating disorders, and anxiety disorders .
This topic will review specific IPT interventions and techniques for treating depressed adults. The indications, theoretical foundation, general concepts, and efficacy of IPT are discussed separately, as are other treatments of depression. See (See "Interpersonal Psychotherapy (IPT) for depressed adults: Indications, theoretical foundation, general concepts, and efficacy" and "Unipolar major depression in adults: Choosing initial treatment" and "Unipolar depression in adults: Treatment of resistant depression".)
- Klerman, GL, Weissman, MM, Rounsaville, BJ, Chevron, ES. Interpersonal Psychotherapy of Depression, Basic Books, New York 1984.
- Weissman, MM, Markowitz, JC, Klerman, GL. Comprehensive Guide to Interpersonal Psychotherapy, Basic Books, New York 2000.
- Brown GW, Harris TO, Peto J. Life events and psychiatric disorders. 2. Nature of causal link. Psychol Med 1973; 3:159.
- Coyne JC. Depression and the response of others. J Abnorm Psychol 1976; 85:186.
- Brown, GW, Harris, T. Social origins of depression: A study of psychiatric disorders in women, Free Press, New York 1978.
- Henderson S, Byrne G, Duncan-Jones P, et al. Social relationships, adversity and neurosis: a study of associations in a general population sample. Br J Psychiatry 1980; 136:574.
- Weissman MM, Klerman GL, Paykel ES, et al. Treatment effects on the social adjustment of depressed patients. Arch Gen Psychiatry 1974; 30:771.
- Markowitz, JC, Weissman, MM. Applications of individual interpersonal psychotherapy to specific disorders: Efficacy and indications. In: Textbook of Psychotherapeutic Treatments, Gabbard, GO (Eds), American Psychiatric Publishing, Inc, Washington, DC 2009. p.339.
- Practice Guideline for the Treatment of Patients with Major Depressive Disorder, Third Edition www.psych.org/guidelines/mdd2010.
- Brody AL, Saxena S, Stoessel P, et al. Regional brain metabolic changes in patients with major depression treated with either paroxetine or interpersonal therapy: preliminary findings. Arch Gen Psychiatry 2001; 58:631.
- Martin SD, Martin E, Rai SS, et al. Brain blood flow changes in depressed patients treated with interpersonal psychotherapy or venlafaxine hydrochloride: preliminary findings. Arch Gen Psychiatry 2001; 58:641.
- Depression: the treatment and management of depression in adults (update). www.NICE.org.UK/CG90 (Accessed on October 12, 2010).
- American Psychiatric Association. Practice Guideline for the Treatment of Patients with Major Depressive Disorder, third edition. Am J Psychiatry 2010; 167 (supplement):1.
- Swartz, HA, Markowitz, JC. Techniques of individual interpersonal psychotherapy. In: Textbook of Psychotherapeutice Treatments, Gabbard, GO (Eds), American Psychiatric Publishing, Inc., Washington, DC 2009. p.309.
- Markowitz, JC. Interpersonal psychotherapy. In: The American Psychiatric Publishing Textbook of Psychiatry, Fifth Edition, Hales, RE, Yudofsky, SC, Gabbard, GO (Eds), American Psychiatric Publishing, Washington, DC 2008. p.1191.
- Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med 2001; 16:606.
- Kroenke, K, Spitzer, RL. The PHQ-9: a new depression and diagnostic severity measure. Psychiatric Annals 2002; 32:509.
- Zimmerman M, Chelminski I, McGlinchey JB, Posternak MA. A clinically useful depression outcome scale. Compr Psychiatry 2008; 49:131.
- Zimmerman M, Posternak MA, Chelminski I. Using a self-report depression scale to identify remission in depressed outpatients. Am J Psychiatry 2004; 161:1911.
- Rush AJ, Trivedi MH, Ibrahim HM, et al. The 16-Item Quick Inventory of Depressive Symptomatology (QIDS), clinician rating (QIDS-C), and self-report (QIDS-SR): a psychometric evaluation in patients with chronic major depression. Biol Psychiatry 2003; 54:573.
- Trivedi MH, Rush AJ, Ibrahim HM, et al. The Inventory of Depressive Symptomatology, Clinician Rating (IDS-C) and Self-Report (IDS-SR), and the Quick Inventory of Depressive Symptomatology, Clinician Rating (QIDS-C) and Self-Report (QIDS-SR) in public sector patients with mood disorders: a psychometric evaluation. Psychol Med 2004; 34:73.
- Frank E, Kupfer DJ, Perel JM, et al. Three-year outcomes for maintenance therapies in recurrent depression. Arch Gen Psychiatry 1990; 47:1093.
- DiMascio A, Weissman MM, Prusoff BA, et al. Differential symptom reduction by drugs and psychotherapy in acute depression. Arch Gen Psychiatry 1979; 36:1450.
- Reynolds CF 3rd, Frank E, Perel JM, et al. Nortriptyline and interpersonal psychotherapy as maintenance therapies for recurrent major depression: a randomized controlled trial in patients older than 59 years. JAMA 1999; 281:39.
- Wilfley, DE, MacKenzie, RK, Welch, RR, et, al. Interpersonal Psychotherapy for Group, Basic Books, New York 2000.
- Donker T, Bennett K, Bennett A, et al. Internet-delivered interpersonal psychotherapy versus internet-delivered cognitive behavioral therapy for adults with depressive symptoms: randomized controlled noninferiority trial. J Med Internet Res 2013; 15:e82.
- Swartz HA, Frank E, Shear MK, et al. A pilot study of brief interpersonal psychotherapy for depression among women. Psychiatr Serv 2004; 55:448.
- Swartz HA, Frank E, Zuckoff A, et al. Brief interpersonal psychotherapy for depressed mothers whose children are receiving psychiatric treatment. Am J Psychiatry 2008; 165:1155.
- American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), American Psychiatric Association, Arlington 2013.
- The World Health Organization International Classification of Diseases, ICD-10 Online, Current Version (2007) http://www.who.int/classifications/icd/en/ (Accessed on October 22, 2010).
- PARSONS T. Illness and the role of the physician: a sociological perspective. Am J Orthopsychiatry 1951; 21:452.
- Joiner TE Jr, Cook JM, Hersen M, Gordon KH. Double depression in older adult psychiatric outpatients: hopelessness as a defining feature. J Affect Disord 2007; 101:235.
- Markowitz, JC, Swartz, HA. Case formulation in interpersonal psychotherapy of depression. In: Handbook of Psychotherapy Case Formulation, 2nd ed, Eels, TE (Eds), Gulford Press, New York 2007.
- Joiner TE Jr, Steer RA, Abramson LY, et al. Hopelessness depression as a distinct dimension of depressive symptoms among clinical and non-clinical samples. Behav Res Ther 2001; 39:523.
- Frank E, Kupfer DJ, Wagner EF, et al. Efficacy of interpersonal psychotherapy as a maintenance treatment of recurrent depression. Contributing factors. Arch Gen Psychiatry 1991; 48:1053.
- Markowitz JC. The future of interpersonal psychotherapy. J Psychother Pract Res 1997; 6:294.
- Foley, SH, Rounsaville, BJ, Weissman, MM, et, al. Individual versus conjoint interpersonal psychotherapy for depressed patients with marital disputes. Int J Fam Psychiatr 1989; 10:29.
- Kendler KS, Gatz M, Gardner CO, Pedersen NL. A Swedish national twin study of lifetime major depression. Am J Psychiatry 2006; 163:109.
- Jacobson, NS, Martell, CR, Dimidjian, S. Behavioral activation treatment for depression: Returning to contextual roots. Clin Psychol Sci Prac 2001; 8:255.
- Frank E, Kupfer DJ, Buysse DJ, et al. Randomized trial of weekly, twice-monthly, and monthly interpersonal psychotherapy as maintenance treatment for women with recurrent depression. Am J Psychiatry 2007; 164:761.
- Weissman, MM, Markowitz, JC, Klerman, GL. Clinician's Quick Guide to Interpersonal Psychotherapy, Oxford University Press, New York 2007.
- THERAPEUTIC STRATEGIES
- Principles of IPT
- Common therapeutic factors
- Combining IPT with pharmacotherapy
- DELIVERING INTERPERSONAL PSYCHOTHERAPY
- Individual versus group format
- Face to face versus online format
- Duration of therapy
- Stages of treatment
- - Initial phase
- Diagnose major depression
- Give the patient the sick role
- Take an interpersonal inventory
- Establish the depression timeline
- Select interpersonal problem area and formulate the case
- Provide hope
- Discuss treatment contract
- - Middle phase
- Interventions for each interpersonal problem area
- - Grief (bereavement)
- - Role dispute
- - Role transition
- - Interpersonal deficits
- Interventions for any interpersonal problem area
- - Termination
- OTHER RESOURCES
- SUMMARY AND RECOMMENDATIONS