Interpersonal and social rhythm therapy techniques

Interpersonal and social rhythm therapy (ISRT) helps people learn to regulate their mood using their natural biological and social routines.

Social rhythm therapy is based on the idea that changes in routine can trigger mood episodes in people who are medically vulnerable, such as those with bipolar disorder.

Your daily routine and habits are called your social rhythms. When the timing of your routine changes, this can disrupt your circadian rhythm (the biological clock that changes how you feel and act during 24 hours).

The stress of interpersonal problems, like relationship conflict, can also impact how stable your mood is throughout the days and weeks.

What is interpersonal and social rhythm therapy?

IPSRT is an add-on therapy for treating bipolar disorder and other mood disorders.

The therapy aims to minimize disruptions to your daily routines and rhythms since these changes can lead to disrupted sleep and an unstable mood in some people.

IPSRT can help to minimize the impact of stress from relationship conflict. During sessions, your therapist will also examine the impacts of stressful, role-changing life events, such as:

• marriage or divorce
• getting a new job, or losing a job
• having a child

Sleep disruption and stress can both increase the chance of hypomania or mania. Since IPSRT can reduce sleep irregularities and ease stress, it can be an effective treatment for bipolar disorder.

It’s important to note that IPSRT is not meant to replace medication for bipolar disorder. Instead, it helps by regulating your schedule to make medication compliance easier. If you’re currently taking medication that your doctor has prescribed, it’s best to continue as directed.

How does IPSRT work? 

IPSRT assumes that external triggers can activate symptoms in people who have them. For example, if you have allergies and encounter your trigger, you’ll have an allergic reaction.

People prone to mood disruption might notice mood changes from certain triggers, such as:

• changes to your regular schedule
• interrupted sleep
• stress

IPSRT involves regular meetings with a therapist, face to face or via telephone.

There are several stages:

Initial stage

During the initial stage, your therapist will work with you to:

• help you understand that your mood changes are not your fault, and that there is a medical component
• identify your current and previous mood patterns
• examine how certain relationships and behaviors are connected with your mood changes
• agree on a primary interpersonal area (such as a relationship or communication style) that you want to improve

The initial stage usually lasts for several sessions.

Intermediate stage

This is the stage in which you:

• use a social rhythm metric tracking form to log your social rhythm regularity
• review your form with your therapist each week
• apply feedback from your therapist

Maintenance stage

During the maintenance stage, you work on the skills your therapist has helped you learn. As you build your confidence, you apply these skills to manage disruptions, such as work schedule changes.

At this stage, your therapist visits aren’t as frequent. For example, they may decrease from weekly to bimonthly or monthly until therapy is finished.

What is the social rhythm metric?

IPSRT therapists use the social rhythm metric (SRM) to help you track your daily routine. To use this metric, you log daily event times with the goal of developing a consistent schedule.

SRMs can be detailed or basic. It’s easier to maintain a log when you have fewer items to record, so your therapist might suggest a simplified version that includes events relating to sleep patterns and mealtimes.

Examples of social rhythm metrics include:

• the time you get out of bed (not just awakening, but physically up from bed)
• the time of your first contact with another person (interaction matters, so reading a text doesn’t count, but having a text conversation does)
• the time you start your main activity, such as work, school, or family care
• the time you eat dinner
• the time you go to bed

Depending on your circumstance, your therapist might suggest other events to add to the list.

Your SRM is scored based on how many events occur at the same or close to the same time each day. For example, if you wake up at 7 a.m. each day, this counts toward your score.

According to research from 2014, a higher SRM score is associated with:

• better sleep
• increased morning alertness
• fewer depressive symptoms

What is the social zeitgeber theory?

An important part of IPSRT is social zeitgeber theory. Zeitgeber is German for “time giver” and refers to any environmental cue influencing your circadian system.

The most well-known zeitgeber is changing daylight brought about by sunrise and sunset. Other zeitgebers include:

• meals
• physical activity
• social encounters

“Zeitstörer” means time disrupter and covers such circadian interrupters as time zone travel and nighttime screen use.

Who can IPSRT help? 

IPSRT can benefit people living with conditions like mood disorders. It can help with:

• medication adherence
• learning and using coping strategies for managing stressful events
• minimizing social rhythm disruptions

A 2020 study involving people with bipolar disorder found that participants who received IPSRT experienced improvements to:

• anxious, depressive, and manic symptoms
• global functioning
• response to mood stabilizers

IPSRT may also be an effective strategy for preventing new-onset bipolar disorder in young people with a parent who has bipolar disorder, as demonstrated in a 2018 study.

Although it was originally designed to treat bipolar disorder, studies are assessing IPSRT as a possible therapy for other conditions, such as:

• major depressive disorder
• post-traumatic stress disorder (PTSD)
• bereavement in senior adults

Let’s recap

IPSRT is a therapy designed to help people with mood disorders. It helps to regulate sleep and circadian schedules and teaches coping skills that reduce the impact of stressful life events.

It was originally developed by Ellen Frank, PhD, to treat people with bipolar disorder. This therapy aims to promote consistent daily routines to stabilize circadian timing.

IPSRT isn’t meant to replace medication but instead to add on additional support.

You can visit IPSRT.org for more information and learn about tips and current research.

Interpersonal and Social Rhythm Therapy (IPSRT) is designed to help people improve their moods by understanding and working with their biological and social rhythms. Originally developed as a form of psychotherapy for a single clinician and a single patient, the program has since been adapted to work in several different kinds of settings, including inpatient and outpatient groups. IPSRT is 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.

A major goal of the IPSRT team is to expand the program’s use and the resources available to clinicians wishing to learn the IPSRT model, as well as to provide additional support to clinicians already trained in IPSRT.

Learn more >

What Is Interpersonal and Social Rhythm Therapy?

Interpersonal and Social Rhythm Therapy

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.

“IPSRT focuses on stabilizing the person’s lifestyle. The ‘interpersonal’ part focuses on building safe, healthy relationships and the ‘social rhythms’ part focuses on building a consistent daily routine,” says Aimee Daramus, PsyD, a licensed clinical psychologist and author of “Understanding Bipolar Disorder.”

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.

Aimee Daramus, PsyD

IPRST essentially helps regulate basic habits, which is not the same as fixing the overall problem.

— Aimee Daramus, PsyD

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.