Interpersonal and Social Rhythm Therapy Explained

In the intricate landscape of mental health, understanding mood disorders such as bipolar disorder requires a nuanced exploration of both genetic vulnerability and environmental stressors. Interpersonal and Social Rhythm Therapy (IPSRT) treats bipolar and other mood diorders through several techniques aimed to minimize environmental disruptions.

Genetic predispositions can set the stage for these conditions, but it is often the fluctuations in daily life—the chaotic nature of social interactions and unexpected life events—that trigger mood episodes. This interplay underscores the significance of establishing stable routines; by focusing on consistent daily patterns, individuals can create a buffer against these external pressures. The concept of social rhythms emerges as a critical component in this process, emphasizing how regularity in everyday activities helps regulate emotional states and mitigate the risk of relapse.

Moreover, interpersonal relationships play an essential role in shaping our social rhythms and overall well-being. Supportive connections with family, friends, and peers not only provide emotional sustenance but also reinforce healthy routines that contribute to mood stability. Engaging with others through structured social interactions fosters a sense of belonging while promoting accountability in maintaining those vital daily habits.

In treating mood disorders like bipolar disorder, harnessing the power of routine—alongside addressing interpersonal dynamics—becomes paramount for achieving long-term wellness and reducing symptom recurrence. By nurturing both individual routines and relational ties, IPSRT helps individuals cultivate resilience against the challenges posed by their genetic vulnerabilities and unavoidable environmental stressors.

Key Definition:

Interpersonal and Social Rhythm Therapy (IPSRT) is an evidence‑based psychotherapy developed for mood disorders—especially bipolar disorder—that aims to stabilize a person’s daily routines (social rhythms) and improve interpersonal relationships. It combines principles of interpersonal therapy. It uses strategies to regulate biological rhythms like sleep, activity, and social interaction. This approach is based on the idea that disruptions in these patterns can trigger mood episodes. By fostering regular routines and addressing relationship stressors, IPSRT helps reduce mood fluctuations and support long‑term stability.

Introduction: An Evidence-Based Approach to Mood Disorders

Interpersonal and Social Rhythm Therapy (IPSRT) is a comprehensive, evidence-based psychotherapy developed to address mood disorders, particularly bipolar disorder. This innovative approach integrates principles of interpersonal therapy (IPT) with a unique focus on stabilizing daily routines, known as social rhythms. The goal of IPSRT is to reduce mood episodes by targeting both social and biological factors that influence emotional stability. The therapy has garnered significant attention in clinical research and practice due to its effectiveness in decreasing relapse rates and improving overall functioning in individuals diagnosed with mood disorders (Frank et al., 2005).

The core strategy for regulating mood and achieving stability in IPSRT involves systematically coaching the patient. The goal is to make these social rhythms highly regular. Key activities should vary by no more than one hour each day. This increased rhythm regularity strengthens the vulnerable circadian system and is directly associated with a reduced likelihood of symptomatic recurrence (preventing both depression and mania) (Frank et al., 2006).

Additionally, IPSRT tackles interpersonal stress and life events—like addressing unresolved grief, handling conflicts (role disputes), or managing major life changes (role transitions)—because these issues can disrupt social rhythms and trigger mood instability through increased arousal. By stabilizing routines while simultaneously reducing interpersonal chaos, IPSRT equips patients with the skills to maintain a steady mood state and achieve long-term functional wellness (Frank et al., 2007).

Theoretical Background

Interpersonal and Social Rhythm Therapy (IPSRT) is built upon an integrative theoretical foundation primarily stemming from the social zeitgeber hypothesis of mood disorders and interpersonal psychotherapy (IPT).

The theoretical background of IPSRT can be broken down into these core components:

1. The Instability Model of Bipolar Disorder: The underlying premise acknowledges that “instability is the fundamental dysfunction in manic-depressive illness.” Bipolar disorder is characterized by frequent recurrences, often with incomplete recovery and poor functioning between episodes (Frank et al., 2006).
2. The Social Zeitgeber Hypothesis: This is a central theoretical pillar of IPSRT.
   • Zeitgebers (“Time Givers”): Environmental cues that synchronize the body’s circadian clock are known as zeitgebers. While the primary physical zeitgeber is the daily cycle of the sun, social factors such as the consistent timing of work, meals, social contacts, and other daily routines are critically important in modern society for establishing and maintaining circadian rhythms (Frank et al., 2006).
   • Rhythm Disruption and Mood Episodes: The hypothesis posits that in individuals vulnerable to mood disorders (those with a mood disorder diathesis or a biological/familial predisposition), disruptions or significant changes in these social time cues—or the presence of “zeitstörer” (active disrupters like major life events)—can destabilize biological rhythms (including sleep/wake cycles, appetite, energy, and alertness). Even changes in routines that seem benign or non-stressful can still place considerable stress on the body. This affects the body’s attempt to maintain these synchronized rhythms. This disruption can lead to a “pathological entrainment of circadian rhythms,” manifesting as syndromal episodes of depression or mania (Frank et al., 2007).
   • Empirical Basis: Research by Ehlers, Frank, and Kupfer, along with studies by Malkoff-Schwartz et al., has demonstrated a strong association between life events that disrupt social rhythms and the onset of manic episodes, and a more modest association with depressive onsets, in individuals with bipolar I disorder (Goldstein et al., 2014b). IPSRT was specifically developed by Frank’s research group due to their sustained interest in this connection between the circadian system and mood disorders (Franks et al., 2006).
3. Interpersonal Psychotherapy (IPT): IPSRT integrates social rhythm theories within the established framework of IPT, originally developed by Klerman and colleagues for unipolar depression (Klerman, 1984). IPT focuses on the reciprocal relationship between mood symptoms and interpersonal difficulties, addressing these through four main problem areas:
   • Grief: This includes processing loss and, specifically for bipolar disorder, “grief for the lost healthy self” – mourning the life the patient might have had without the illness.
   • Role Transitions: Managing changes in life roles, such as starting a new job, ending a relationship, or becoming a single parent (Frank et al., 2006).
   • Role Disputes: Resolving conflicts in significant interpersonal relationships (Frank et al., 2006).
   • Interpersonal Deficits: Addressing difficulties in initiating or maintaining satisfactory relationships. The IPT component of IPSRT aims to reduce interpersonal stress, facilitate emotional processing, improve communication and interpersonal skills, and enhance social support, as these factors are recognized as vital for maintaining wellness and can directly impact circadian stability and daily routines (Moot et al., 2022).

---

In essence, IPSRT combines behavioral strategies to enhance the regularity of daily routines. It also helps stabilize sleep/wake cycles, which supports the inherently vulnerable circadian system. Psychotherapeutic work focuses on interpersonal issues to reduce stressors. This approach improves relationships and facilitates acceptance of the illness. As a result, it prevents symptomatic recurrence and promotes overall functional recovery in individuals with bipolar disorder. IPSRT directly targets the three primary pathways to recurrence in bipolar disorder: medication nonadherence, stressful life events, and disruptions in social rhythms.

Development and History of IPSRT

IPSRT was initially developed in the 1990s by Ellen Frank and colleagues at the University of Pittsburgh as an adaptation of IPT for use with patients with bipolar disorder. Their research demonstrated that individuals with bipolar disorder often experience social rhythm disruptions prior to the onset of mood episodes (Frank et al., 1997). This observation led to the hypothesis that teaching patients to maintain regular daily routines could help prevent relapses.

Principles and Structure of IPSRT

IPSRT is a structured therapy, typically delivered over 20 to 24 sessions spanning 6 to 12 months. The approach is divided into four phases:

• Initial Phase: The therapist conducts a thorough assessment of the patient’s psychiatric history, daily routines, and interpersonal relationships. The patient is educated about the relationship between social rhythms and mood episodes.
• Intermediate Phase: The patient begins tracking their daily activities using a Social Rhythm Metric (SRM), which allows for the identification of irregularities. The therapist collaborates with the patient to set goals for stabilizing sleep, meal times, and social activities.
• Maintenance Phase: The patient practices maintaining regular routines and addresses ongoing interpersonal problems. Therapeutic interventions might include conflict resolution, strengthening support networks, and adapting routines during periods of stress.
• Termination Phase: The therapy concludes with a review of progress, relapse prevention strategies, and planning for future support should symptoms recur (Frank et al., 2005).

Core Techniques in IPSRT

IPSRT employs several core techniques, including:

• Social Rhythm Metric (SRM): The SRM is a self-monitoring tool that tracks the timing of daily activities. Patients record wake and bed times, meal times, physical activity, and social interactions. This tool helps both clinician and patient identify patterns of instability that may precipitate mood changes (Frank et al., 2000).
• Psychoeducation: Patients learn about the biological mechanisms that link circadian rhythms to mood, and how lifestyle choices can affect their vulnerability to mood episodes.
• Interpersonal Problem-Solving: Borrowing from IPT, IPSRT helps patients navigate relationship difficulties, role transitions, grief, and interpersonal disputes, all of which can destabilize social rhythms.
• Relapse Prevention: Patients develop personalized strategies for coping with stress and life events that might otherwise disrupt their routines.

Clinical Applications and Evidence

IPSRT is primarily used in the treatment of bipolar disorder, but its scope has expanded to include recurrent major depressive disorder and other mood disorders. Clinical trials have demonstrated that IPSRT is effective in prolonging periods of wellness, reducing the frequency and severity of mood episodes, and improving overall quality of life (Frank et al., 2005).

One randomized controlled trial found that patients with bipolar disorder who received IPSRT had significantly longer time to recurrence of mood episodes compared to those who received intensive clinical management alone (Frank et al., 2005).

IPSRT in Youth and Diverse Populations

Interpersonal and Social Rhythm Therapy (IPSRT) has been intentionally adapted and explored for use with specific populations, particularly adolescents at high risk for Bipolar Disorder (BD) and individuals in culturally diverse settings, necessitating tailored modifications to the established adult treatment model.

Adaptation of IPSRT for Adolescents and High-Risk Youth

The developmental stage of adolescence is considered optimal for early intervention. This period is critical for the onset of BP illness. It is marked by physiological changes that disrupt sleep and circadian patterns. A pilot study examining IPSRT for adolescents at-risk for BD (due to a first-degree family history of the illness) aimed to modify the treatment manual to this high-risk population and gather preliminary data on feasibility and acceptability (Goldstein et al., 2014a).

Key modifications to the treatment structure include:

• Duration and Structure: The treatment length was decreased from 18 sessions to 12 sessions delivered over six months. The visit schedule was flexible to accommodate youth and their families.
• Psychoeducation: Psychoeducation materials were modified to target youth who were at-risk rather than those already diagnosed. Psychoeducation about the risk for BP and the biopsychosocial model of the illness was conducted conjointly with parents and adolescents.
• Social Rhythm Metric for Adolescents (SRM-A): The mechanism for assessing and stabilizing routines utilized the SRM-A, where adolescents recorded seven routine daily activities, in addition to mood and energy. The aim was to stabilize problematic sleep habits. It also aimed to stabilize social routines, such as large discrepancies (more than two hours) between weekday and weekend sleep patterns. Preliminary data from the pilot trial indicated that IPSRT resulted in significant changes in select sleep/circadian patterns, specifically showing less weekend “sleeping in” and less oversleeping.
• Unique Interpersonal Focus: The most significant adaptation involved prioritizing the adolescent’s feelings. It also focused on stress related to having a parent or sibling with BD as the core interpersonal problem area. This focus allows the adolescent to discuss their experiences, cope with the stigma of having a mentally ill family member, and mourn the “parent or sibling who might have been able to fulfill his/her familial role in a different or more satisfying way” (an adaptation of the “grief for the lost healthy self” module in adult IPSRT).
• Feasibility and Stigma: IPSRT proved to be feasible and acceptable to families, who reported high satisfaction. Clinician ratings reflected minimal improvement in overall psychiatric illness. However, engagement challenges arose because many adolescents felt “nothing wrong” with them and viewed therapy as stigmatizing. Targeting the IPSRT focus on sleep and circadian rhythms helped minimize this stigma and facilitate engagement in the at-risk group. Attendance was moderately high (mean of 7.7 sessions attended), though missed sessions were often attributed to the severity of the parental BP illness itself, highlighting familial stress as a continued challenge (Goldstein et al., 2014b).

Application in Diverse and Cross-Cultural Contexts

IPSRT’s central tenets, focusing on the regulation of daily routines and interpersonal relationships, require sensitivity when applied across diverse contexts because social rhythms are inherently tied to cultural norms and family dynamics (Swartz & Swanson, 2014).

• Cultural Adaptations: In clinical trial protocols developed in New Zealand, specific modifications ensured cultural relevance. These modifications included adapting the manual to reflect New Zealand English or te reo Maori. They also changed “real-life” tasks to situations more realistic in that country (Douglas, 2022).
• Interpersonal Dynamics and Culture: The core IPSRT strategy of managing interpersonal difficulties must account for how cultural values influence emotional socialization. For instance, studies show that in different subcultures in Nepal (Tamang vs. Brahman), cultural values play out in caregiving practices that result in different scripted emotional responses regarding anger and shame in children. IPSRT’s emphasis on family involvement, especially for youth, is critical because high levels of family conflict and a lack of household cohesion have been documented in households with a parent affected by BP, which contributes to irregular social rhythms in the offspring (Goldstein et al., 2014a).
• Functional Improvements: Research on IPSRT has demonstrated effects across functional domains. This may be important in various populations. It shows a positive impact on patients’ social and leisure activities. It also extends family relationships when compared to treatment as usual (TAU). This focus on social role functioning is highly relevant to individuals from diverse backgrounds whose well-being depends heavily on these social structures (Frank, 2007).

---

While IPSRT modifications for adolescents have demonstrated feasibility and positive preliminary outcomes related to rhythm stability, studies using rigorous controlled designs with long-term follow-up are still needed to definitively determine if early intervention using IPSRT can successfully delay or prevent the onset of BD in at-risk youth.

Strengths and Limitations

Strengths

Interpersonal and Social Rhythm Therapy (IPSRT) demonstrates several key strengths as an adjunctive psychosocial intervention for bipolar disorder:

Recurrence Prevention and Longer Stability:

• IPSRT is associated with a significantly reduced risk of recurrence of both depression and mania in individuals with Bipolar I disorder over a 2-year period (Frank et al., 2006).
• Participants who received acute IPSRT survived significantly longer without a new affective episode during the maintenance phase, irrespective of the type of maintenance treatment they received afterward (Frank, 2007).
• The protective effect of the treatment is directly related to the extent to which patients increased the regularity of their social rhythms (Frank et al., 2006).
• IPSRT targets the three major pathways to recurrence: medication nonadherence, stressful life events, and disruptions in social rhythms (Frank et al., 2007).

Acute Symptom Improvement:

• In comparison to collaborative care (CC), intensive psychotherapies (including IPSRT) led to significantly higher year-end recovery rates (64% versus 52%) and shorter times to recovery from depression (Swartz & Swanson, 2014).
• Acute IPSRT had a positive effect on time to remission of bipolar depression in one large multisite trial (STEP-BD) (Frank et al., 2005).
• It is associated with significant reduction in suicide attempts in a highly vulnerable population (Frank et al., 2008).
• IPSRT also shows promise as monotherapy for individuals with bipolar II depression of moderate symptom severity (Frank et al., 2007).

Functional and Psychosocial Gains:

• IPSRT demonstrated a significantly more rapid initial improvement in occupational functioning compared to intensive clinical management (ICM) during the acute treatment phase (Swartz & Swanson, 2014).
• The improvements in occupational functioning were largely sustained over a subsequent 2-year period (Frank et al., 2008).
• It resulted in positive impacts on specific domains of social adjustment compared to treatment as usual (TAU), specifically improving social and leisure activities and extended family relationships over 18 months (Moot et al., 2022).
• It showed significant improvement in the housework domain compared to baseline scores over 18 months (Moot et al., 2022).
• The therapy aims to enhance social and occupational functioning, manage stressors, and enhance the protective effects of social supports (Frank et al., 2006).
• It resulted in improved relational functioning when compared to collaborative care (Frank et al., 2007).

Mechanism and Compliance:

• IPSRT strengthens the vulnerable circadian system by increasing the regularity of daily routines (like sleep/wake cycles, meals, and social contact). (Frank et al., 2006).
• The interpersonal component helps patients accept the illness, facilitates the process of grieving for the “lost healthy self,” and thereby improves medication adherence (Frank et al., 2007).
• It provides a mechanism to reduce interpersonal and social role distress (Frank et al., 2007).
• It is one of the few evidence-based psychotherapies for bipolar disorder endorsed by international treatment guidelines (Swartz & Swanson, 2014).

Limitations

Interpersonal and Social Rhythm Therapy (IPSRT) has proven efficacy, but clinical trials and adaptations have highlighted several limitations:

Efficacy and Target Population Limitations

• Limited Acute Symptom Stabilization: IPSRT showed no difference between the treatment strategies in time to stabilization of the acute episode when compared to Intensive Clinical Management (ICM) in individuals with Bipolar I disorder. There is no evidence that psychotherapy facilitates recovery from mixed or pure manic states (Frank et al., 2005).
• Comorbidity Interaction: Individuals with a high level of medical burden or a history of anxiety disorders fared better when assigned to the ICM approach during the acute phase. They showed more improvement compared to those in IPSRT. Medically burdened and anxious participants assigned to IPSRT may find it difficult to set aside their somatic focus to engage in the interpersonal work required by IPSRT (Frank et al., 2005). .
• Sustainability of Functional Gains: While IPSRT leads to a rapid initial improvement in occupational functioning, this improvement difference compared to ICM was not sustained over a subsequent 2-year maintenance phase (Frank et al., 2008) .
• Challenge with Denial: IPSRT is relatively easy to implement in motivated patients who accept their illness, but patients who are still in partial denial about the severity or lifelong nature of bipolar disorder represent a greater challenge for the clinician (Frank, 2007).
• Statistical Power in Acute Depression: In one major trial (STEP-BD), the additive effect of IPSRT on time to remission for depressed subjects did not reach statistical significance, potentially due to inadequate power (e.g., only 50 depressed subjects per arm) (Frank et al., 2005).

Application to Adolescents and Digital Formats Limitations

• Poor Attendance in Youth: In a pilot study for at-risk adolescents, participants, on average, attended only about half of the scheduled sessions (mean 7.7 out of 12), with missed sessions often attributed to parental bipolar illness severity (incapacity and/or disorganization) (Goldstein et al., 2014a).
• Stigma and Engagement in Youth: Many adolescents declined participation because they felt there was “nothing wrong” with them or viewed therapy as stigmatizing, viewing it as a service only for those with severe mental illness (Goldstein et al., 2014a).
• Lack of Long-Term Outcome Data for Youth: Preliminary trials for high-risk youth are limited in scope and cannot determine whether IPSRT successfully delays or prevents the onset of bipolar disorder; controlled trials with long-term follow-up are needed (Goldstein et al., 2014a).
• Feasibility Challenges in Online Format (RAY): An internet-based version (RAY) was limited by its small sample size and the fact that it did not achieve expected recruitment goals (Swartz et al., 2021).
• Generalizability of Online Format: The online study’s exclusion criteria (e.g., substance use disorders, lack of broadband access) and the fact that many potential participants could not be reached limit the generalizability of the findings (Swartz et al., 2021).

Research Methodology and Measurement Limitations

• Inability to Isolate Effects: In some trials (e.g., the RAY pilot study), individuals were concurrently receiving care from specialty mental health services, making it difficult to isolate the effects of the active IPSRT intervention (Swartz et al., 2021)..
• Randomization Issues: In the original maintenance trial, randomization issues occurred because variables strongly related to outcome (such as marital status and medical burden) were not distributed equally among the treatment strategies, complicating interpretation (Frank et al., 2005).
• Measurement of Interpersonal Effects: There is a recognized need to develop better measures to test for the mediation of outcome by changes in the interpersonal realms to fully clarify the active ingredients of the treatment (Frank et al., 2005)..
• Functional Measure Limitations: When assessing functional outcomes using tools like the Social Adjustment Scale Self-Report (SAS-SR), statistically significant findings in domains such as work, marital status, children, and family unit were lacking, likely because participants did not respond to subscales that were not personally applicable to them, limiting the utility of the full scale across the study sample (Moot et al., 2022).

Future Directions

Future directions for IPSRT research focus on optimizing delivery methods. Researchers are integrating the therapy with other evidence-based interventions. They aim to expand its application to highly vulnerable populations. The ultimate goal is achieving comprehensive functional recovery. A primary focus is the development of digital and online interventions based on IPSRT principles. The “Rhythms And You” (RAY) program undergoes rigorous testing. Conducting adequately powered Randomized Controlled Trials (RCTs) is essential to formally evaluate its efficacy. These trials assess its role as an adjunctive treatment across primary and specialty care settings. These trials will also explore positioning the digital intervention within a collaborative care model and utilizing brief human support to enhance patient engagement and outcomes (Swartz et al., 2021).

Furthermore, there is significant interest in creating more comprehensive treatment packages, including an ongoing RCT testing the impact of adding group-based Cognitive Remediation (CR) to IPSRT for adults with mood disorders to simultaneously address cognitive impairment and mood stabilization (Douglas et al., 2021). For high-risk youth, controlled studies incorporating long-term follow-up are needed to determine if IPSRT effectively delays or prevents the onset of bipolar disorder (Goldstein et al., 2014a). Ultimately, the field is moving toward developing programs that focus not only on restoring functional outcomes but also on preventing functional decline and enhancing Quality of Life and well-being, advocating for future multicomponent therapies that target cognitive enhancement and healthy lifestyles (Bonnín et al., 2019).

Associated Concepts

• Convoy Theory: This theory examines the impact of a network of close relationships. It also considers more distant relationships that form a “convoy” of social support. This network includes family members, friends, colleagues, and other acquaintances who provide varying levels of support, guidance, and companionship.
• Social Support Theory: This concept involves the perception and actuality that one is cared for. It means having assistance available from other people. It also involves being part of a supportive social network.
• Homeostasis: This refers to the body’s ability to maintain stable internal conditions despite external changes. It involves a series of processes and mechanisms. These work together to keep the body’s internal environment within a narrow range of optimal conditions. These conditions include temperature, pH, and nutrient levels.
• Somatic Markers: Physiological or bodily reactions, associated with emotions, influence decision-making processes.
• Diathesis-Stress Model: This model is a psychological theory. It suggests that people have an underlying predisposition (diathesis) towards certain psychological conditions. The manifestation of these conditions is determined by the presence of stressors.
• Allostasis: This term refers to the body’s adaptive response to stressors, aiming to maintain stability through changes. Unlike homeostasis, which focuses on set points, allostasis considers dynamic adjustments to optimize functioning.

A Few Words by Psychology Fanatic

Interpersonal and Social Rhythm Therapy (IPSRT) stands as a beacon of hope for those navigating the tumultuous waters of mood disorders, particularly bipolar disorder. IPSRT intricately weaves the fabric of daily routines with interpersonal relationships. This provides a holistic approach. It addresses both the biological and social components influencing emotional stability.

This innovative therapy not only aids individuals in recognizing and regulating their social rhythms but also empowers them to confront underlying relational stressors that can exacerbate mood fluctuations. As evidenced by extensive research, IPSRT has demonstrated its efficacy in reducing relapse rates, enhancing functional outcomes, and fostering resilience among those affected by mood instability.

Looking forward, it is clear that IPSRT’s relevance will expand further as ongoing studies refine its methodologies and applications across diverse populations. The therapeutic principles rooted in stabilizing daily activities while nurturing interpersonal connections offer a roadmap for sustainable mental wellness. Advancements in technology are paving the way for more accessible treatment modalities. These include digital tools for rhythm tracking and remote therapy. As a result, IPSRT may soon reach even broader audiences seeking relief from mood disorders.

Ultimately, this integrative approach equips individuals with vital skills to navigate life’s complexities while cultivating enduring emotional well-being amidst their unique challenges.

Last Update: September 21, 2025

References:

Bonnín, C. D.; Reinares, M.; Martínez-Arán, A.; Jiménez, E.; Sánchez-Moreno, .J.; Solé, .B.; Montejo, L.; Vieta, E. (2019). Improving Functioning, Quality of Life, and Well-being in Patients With Bipolar Disorder. International Journal of Neuropsychopharmacology, 22(8), DOI: 10.1093/ijnp/pyz018
(Return to Main Text)

Douglas, K.; Inder, M.; Crowe, M.; Jordan, J.; Carlye, D.; Lacey, C.; Beaglehole, B.; Mulder, R.; Eggleston, K.; Donovan, K.; Frampton, C.; Bowie, C.; Porter, R. (2022). Randomised controlled trial of Interpersonal and Social Rhythm Therapy and group-based Cognitive Remediation versus Interpersonal and Social Rhythm Therapy alone for mood disorders: study protocol. BMC Psychiatry, 22(1), DOI: 10.1186/s12888-022-03747-z
(Return to Main Text)

Frank, Ellen (2007). Interpersonal and social rhythm therapy: A means of improving depression and preventing relapse in bipolar disorder. Journal of Clinical Psychology, 63(5), 463-473. DOI: 10.1002/jclp.20371
(Return to Main Text)

Spotlight Article:

Frank, Ellen; Gonzalez, J.B.; Fagiolini, A. (2006). The Importance of Routine for Preventing Recurrence in Bipolar Disorder. American Journal of Psychiatry. DOI: 10.1176/ajp.2006.163.6.981
(Return to Main Text)

Frank, E.; Kupfer, D. J.; Thase, M. E.; Mallinger, A. G.; Swartz, H. A.; Fagiolini, A. M.; Grochocinski, V.; Houck, P.; Scott, J.; Thompson, W.; Monk, T. (2005). Two-year outcomes for interpersonal and social rhythm therapy in individuals with bipolar I disorder. Archives of general psychiatry, 62(9), 996–1004. DOI: 10.1001/archpsyc.62.9.996
(Return to Main Text)

Frank, E.; Swartz, H. A.; Kupfer, D. J. (2000). Interpersonal and social rhythm therapy: An intervention addressing the disruption in social rhythms associated with bipolar disorder. Psychiatric Annals, 30(6), 355-362. DOI: 10.31887/DCNS.2007.9.3
(Return to Main Text)

Frank, Ellen; Soreca, Isabella; Swartz, Holly; Fagiolini, Andrea; Mallinger, Alan; Thase, Michael; Grochocinski, Victoria; Houck, Patricia; Kupfer, David. (2008). The Role of Interpersonal and Social Rhythm Therapy in Improving Occupational Functioning in Patients With Bipolar I Disorder. The American journal of psychiatry. 165. 1559-65. DOI: 10.1176/appi.ajp.2008.07121953.
(Return to Main Text)

Frank, E.; Kupfer, D. J.; Ehlers, C. L.; Monk, T. H.; Cornes, C.; Matthews, A. (1997). The role of interpersonal and social rhythm therapy in the maintenance treatment of bipolar disorder. Journal of Affective Disorders, 44(1), 63-70. DOI: 10.1176/appi.ajp.2008.07121953
(Return to Main Text)

Spotlight Article:

Frank, E.; Swartz, H. A.; Boland, E. (2007). Interpersonal and social rhythm therapy: an intervention addressing rhythm dysregulation in bipolar disorder. American Journal of Psychiatry. DOI: 10.31887/DCNS.2007.9.3/efrank
(Return to Main Text)

Goldstein, T.; Fersch-Podrat, R.; Axelson, D.; Gilbert, A.; Hlastala, S.; Birmaher, B.; Frank, E. (2014a). Early Intervention for Adolescents at High Risk for the Development of Bipolar Disorder: Pilot Study of Interpersonal and Social Rhythm Therapy (IPSRT). Psychotherapy, 51(1), 180-189. DOI: 10.1037/a0034396
(Return to Main Text)

Goldstein, T. R.; Axelson, D. A.; Birmaher, B.; Brent, D. A. (2014b). Interpersonal and social rhythm therapy for youth with bipolar disorder: Case examples and clinical issues. Journal of Child and Adolescent Psychopharmacology, 24(5), 285-290. DOI: 10.1016/j.jad.2018.04.049
(Return to Main Text)

Klerman, Gerald L. (1984). Interpersonal Psychotherapy of Depression. Basic Books. ISBN: 9780465033966
(Return to Main Text)

Moot, W.: Crowe, M.: Inder, M.: Eggleston, K.: Frampton, C. ; Porter, R. (2022). Domain-Based Functional Improvements in Bipolar Disorder After Interpersonal and Social Rhythm Therapy. Frontiers in Psychiatry, 13, DOI: 10.3389/fpsyt.2022.767629
(Return to Main Text)

Swartz, Holly A.: Rollman, Bruce L.; Mohr, David C.; Sadow, Samuel: Frank, Ellen (2021). A randomized pilot study of Rhythms And You (RAY): An internet-based program for bipolar disorder administered with and without clinical helper support in primary care. Journal of Affective Disorders 295 (2021) 183–191. DOI: 10.1016/j.jad.2021.08.025
(Return to Main Text)

Swartz, Holly A.; Swanson, Josua. (2014). Psychotherapy for Bipolar Disorder in Adults: A Review of the Evidence. FOCUS. Summer 2014, Vol. XII, No. 3. DOI: 10.1176/appi.focus.12.3.251
(Return to Main Text)