Interpersonal psychotherapy: recent indications beyond major depression

Objectives Interpersonal psychotherapy was proposed in 1984 by Klerman and colleagues. It is a time-limited psychotherapy (12-16 sessions/a week), diagnosis-focused, based on a medical model, according to which the patient has a treatable illness that is not his/her fault. Psychiatric symptoms develop in an interpersonal context, acting on which it is possible to induce remission and prevent subsequent relapses. IPT seeks the resolution of the interpersonal crisis improving social functioning and psychiatric symptoms, too. At first it was aimed to treat major depression, not psychotic or bipolar. Later IPT has been applied to a growing number of psychiatric disorders, because of their frequent and predominant interpersonal dimension. However, specific adaptations of IPT have been required to consider the different clinical characteristics of the disorders and to satisfy patient’s needs. This review will present and comment the results of the available studies of IPT adapted to mental disorders different from major depressive disorder. Methods Open-label and controlled studies concerning the use of IPT in Axis I and II disorders different from major depression were systematically searched for and commented. Results Chronic depressions, as dysthymic disorder, have usually been considered more difficult to treat with IPT, because their symptoms are more commonly egosyntonic and it is not possible to identify a life event at the onset of the current episode. The IPT-D, a model of IPT structured in at least 24 sessions, was so developed to treat dysthymia. It proposes a iatrogenic role transition as a recent interpersonal problem to work on with. The close correlation among life events, regularity of circadian rhythms and mood regulation, particularly in bipolar patients, has contributed to the development of the interpersonal and social rhythms psychotherapy (IPSRT). IPSRT is an interpersonal and psycho-educational intervention that considers these three factors and prevents pathological mood shifts first of all by the stabilization of patients’ social rhythms. The frequent comorbidity between substance abuse and mood disorders has also encouraged the use of IPT in the treatment of addictions. In particular, IPT has been used in subjects with alcohol, cocaine, and opiates dependence. The IPT has also found a promising field of application in eating disorders, particularly bulimia and binge-eating-disorder. It doesn’t directly address the pathological eating behavior, but it focuses on the interpersonal problematic areas. These problems are related to a difficult managing of emotions, that triggers binges. The IPT aims to stop the use of food as a coping strategy that is called “emotional eating”. Because of the interpersonal nature of their symptoms, also anxiety disorders are potential indications for IPT. In the treatment of social phobia, modified IPT (IPT-SP) focuses on the most problematic interpersonal area in these patients: the role transition. Preliminary data on the application of this therapy in panic disorder are now available. Finally, the IPT has been tested in post-traumatic stress disorder (IPT-PTSD). The IPT-PTSD first addresses, in a flexible way, relational and social consequences of the trauma and aims to reinforce the patient’s social network. Secondary, a well developed social support helps to understand and deal with the trauma. To date, among Axis II disorders, only borderline personality disorder (BPD) has been a focus of IPT. The frequent comorbidity with mood disorders and the relational problems due to BPD core symptoms are the main reasons for the proposal of an adapted model of IPT: the IPT-BPD. This is an intervention of longer duration than traditional IPT (34 sessions in 8 months), adding to the problematic areas “the image of the self”. It’s designed to take into account the chronicity of BPD and the poor therapeutic alliance and high risk of suicide of these patients. Conclusions Both classical model of IPT and several specific adaptations have been recently used to treat an increasing number of Axis I and II disorders. Initial results are overally promising, but only limited data are available for each indication. At the moment, a slightly larger number of studies has been performed for bipolar disorders and eating disorders, but replication of results in well-designed investigations is generally required.