Wilfley, in, 2001Interpersonal psychotherapy (IPT) is a brief, time-limited treatment for major depression that was developed in the 1970s by Klerman and colleagues and in 1984 specified in a treatment manual by Klerman, Weissman, Rounsaville, and Chevron. IPT is derived from theories in which interpersonal function is recognized as a critical factor in psychological adjustment and well-being. IPT is also based on empirical research connecting change in the social environment to the onset and maintenance of depression. Although the initial goal of IPT is to reduce symptoms of depression, the major goal is to improve the quality of the patient's current interpersonal relations and social functioning. IPT moves through three defined phases, each of which is associated with specific strategies and tasks for the therapist and patient.

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Its well-defined and unique treatment strategies are aimed at resolving problems within four social domains: grief, interpersonal role disputes, role transitions, and interpersonal deficits. IPT has been found efficacious for major depression and has also been successfully adapted to treat other types of mood and nonmood disorders. In this review, IPTs development, treatment phases and strategies, therapeutic stance, and outcome research are described. In addition, areas in need of further research are delineated.

Interpersonal therapy (IPT) is a method of treating depression. IPT is a form of psychotherapy that focuses on you and your relationships with other people.

Frances Connan, Rahul Bhattacharya, in, 2012 Interpersonal psychotherapyInterpersonal psychotherapy (IPT) was first evaluated in the treatment of BN as a control condition for CBT. ED symptoms are not specifically addressed.

The interpersonal context of the ED is investigated to identify interpersonal problems in one of 4 areas: interpersonal disputes, role transitions, grief or interpersonal deficits. Therapy then aims to facilitate change in the identified problem area and to develop skills with which to manage future interpersonal problems. It is now a well replicated finding that IPT is as effective as CBT, although much slower to take effect ( Agras et al 2000). IPT is therefore the leading alternative to CBT for BN. It remains to be seen whether developments in CBT, such as CBT-E, improve efficacy against IPT.

IPT was less effective than the specialist supportive clinical management in an RCT of psychological treatment for AN ( McIntosh et al 2005).One treatment trial has compared group IPT for BED with group CBT. As for BN, there was no difference in effectiveness at follow-up, but the effect of IPT was slower ( Brownley et al 2007). Kissane, Matthew Doolittle, in, 2011 Interpersonal psychotherapyInterpersonal psychotherapy (IPT) focuses on improving patients' relationships, supporting their grief, and helping them to cope better through examination of life and its role transitions, any disrupted or contentious relationships, and any tendency to be overly sensitive. 33 In general, these latter vulnerabilities are addressed through a confident alliance with the therapist, and by coming to a detailed understanding of the role of trusting relationships and disrupted trust in the patient's biography. An interpersonal exploration of expectations and patterns of communication in both satisfactory and unsatisfactory relationships may be helpful as patients strive to mend relationships. Role playing may be helpful both in bringing patterns to light and in modeling alternative behaviors, often in anticipation of joint sessions, when the patient is able to engage in interpersonal work directly.The focus on role transitions involves identifying and reframing negative attitudes toward the anticipated role, and supporting self-esteem and mastery, with an emphasis on moving away from one thing and moving toward another. In the setting of palliative care, role transitions often involve loss of cherished aspects of identity and health, and the goal is to assist the patient in accepting some of the limitations of illness while not exaggerating the negative aspects of the new role or feeling helpless in the transition.

This focused exploration using IPT is manageable in the setting of acute medical illness. IPT proved better than placebo in 8 of 13 studies.

Rottenberg, in, 2001 5 Interpersonal Treatments for DepressionInterpersonal psychotherapies were developed from broad interpersonal theories of psychopathology, such as those formulated by Adolph Meyer, Harry Stack Sullivan, and John Bowlby. These theories posited that the quality of current interpersonal relationships was critical in contributing to the development and persistence of many forms of psychopathology. From this perspective, therefore, the therapist's primary goal is to change the patient's patterns of self-defeating interpersonal interactions. The most systematic and widely used therapy in this area is Interpersonal Psychotherapy (IPT), developed by Gerald Klerman and Myrna Weissman for the treatment of depression (Weissman et al.

2000) (see Cognitive and Interpersonal Therapy: Psychiatric Aspects. Like cognitive therapy, IPT is conducted most frequently as a short-term therapy (approximately 16 weekly sessions), but it has also been modified for use as a ‘maintenance therapy’ for the longer-term treatment of patients with recurrent or chronic depression.

A major goal of IPT is to improve the patient's interpersonal functioning by encouraging more effective expression of emotions, clearer communication with significant members of their entourage, and increased understanding of the patient's behavior in interpersonal interactions. The rationale underlying the use of IPT is that by solving interpersonal problems in therapy, the patient will improve their life situation and simultaneously decrease the number and intensity of depressive symptoms.IPT for depression is divided into three phases. In the initial phase of treatment (the first 3 sessions), the therapist conducts a diagnostic evaluation for depression, educates the patient about depression, and evaluates the patient's current interpersonal relationships. The therapist then establishes which of four interpersonal problem areas are most closely related to the patient's current depressive episode: grief, interpersonal role disputes, role transitions, or interpersonal deficits. In the middle phase of treatment (sessions 4–13), the therapist uses specific techniques (outlined explicitly in a treatment manual) that are designed to address these four problem areas.

Although these techniques may involve changing the patient's cognitions or having the patient engage in new behaviors, there is a clear and strong tie to the patient's current interpersonal relationships. The final phase of treatment (sessions 14–16) focuses on consolidating the changes that the patient has made through therapy and helping the patient recognize and counter depressive symptoms should they arise again in the future.In the 1980s and 1990s, IPT has been carefully evaluated in numerous research protocols and has been demonstrated to be effective in treating depression in a variety of populations, including adolescents, postpartum depressed women, married spouses, the elderly, and patients in primary medical care facilities. In fact, IPT was one of two forms of psychotherapy (the other was cognitive therapy) tested against antidepressant medication in a large-scale treatment study of 250 depressed patients (Elkin et al. The results of this study indicate that IPT is more effective than placebo, and as effective as medication and cognitive therapy in reducing depressive symptoms.

In addition, IPT was found to be more effective than cognitive therapy in treating more severely depressed patients (Elkin et al. Importantly, IPT has been shown to prevent or delay the onset of relapse episodes of depression, demonstrating its utility as a maintenance therapy. CBT involves several well-delineated steps (and may take several months): 1)Education about the disorder, treatment, prognosis, etc.

2)Training in symptom management, e.g., relaxation techniques. 3)Cognitive restructuring, mostly eliminating negative thoughts and anticipations, e.g., a noise on the roof is more likely a bird or squirrel, not a burglar.

4)Desensitization by gradual exposure techniques, e.g., fear of driving on freeway is initiated in very small steps, not during rush hour. 5)Relapse prevention planning.

Clarkin, in, 1998 3.09.5.1 IPT: An Early ManualOne of the earliest and most influential manuals is Interpersonal psychotherapy of depression by Klerman et al. This manual was written as a time-limited, outpatient treatment for depressed individuals. The treatment focuses on the current rather than on past interpersonal situations and difficulties. While making no assumption about the origin of the symptoms, the authors connect the onset of depression with current grief, role disputes and/or transitions, and interpersonal deficits.This brief intervention has three treatment phases which are described clearly in the manual. The first is an evaluation phase during which the patient and therapist review depressive symptoms, give the syndrome of depression a name, and induce the patient into a sick role. (Interestingly, the role of the therapist is not described explicitly.) The patient and therapist discuss and, hopefully, agree upon a treatment focus limited to four possibilities: grief, role disputes, role transitions, or interpersonal deficits. The middle phase of treatment involves work between therapist and patient on the defined area of focus.

For example, with current role disputes the therapist explores with the patient the nature of the disputes and options for resolution. The final phase of treatment involves reviewing and consolidating therapeutic gains. A recent addition is the publication of a client workbook ( Weissman, 1995) and client assessment forms.IPT has been used in many clinical trials, the first of which was in 1974 ( Klerman, DiMascio, Weissman, Prusoff, & Paykel, 1974). In addition to the IPT manual, a training videotape has been produced and an IPT training program is being developed ( Weissman & Markowitz, 1994).IPT provides a generic framework guiding patient and therapist to discuss current difficulties and this framework has been applied to symptom conditions other than depression. For example, the format has been applied to patients with bipolar disorder ( Ehlers, Frank, & Kupfer, 1988), drug abuse ( Carroll, Rounsaville, & Gawin, 1991; Rounsaville, Glazer, Wilber, Weissman, & Kleber, 1983), and bulimia ( Fairburn et al., 1991). In addition to its initial use of treating depression in ambulatory adult patients, it has now been utilized as an acute treatment, as a continuation and maintenance treatment ( Frank et al., 1990), and has been used for geriatric ( Reynolds et al., 1992) and adolescent patients ( Mufson, Moreau, Weissman, & Klerman, 1993) and in various settings such as primary care and hospitalized elderly.

The success of IPT seems to be the articulation of a rather straightforward approach to discussion between patient and therapist, of current situations without the use of more complicated procedures such as transference interpretation.The IPT manual was one of the first in the field, and its straightforward description of a common-sense approach to patients with depression is readily adopted by many clinicians. However, the process of treatment development and amplification is also relevant to this, one of the earliest and best treatment manuals. It is now clear that depression is often only partially responsive to brief treatments, such as IPT, and that many patients relapse. It would appear that maintenance treatment with IPT may be useful ( Frank et al., 1991), and the IPT manual must therefore be amplified for this purpose.

Furthermore, it has become clear that depressed individuals with personality disorders respond to treatment less thoroughly and more slowly than depressed individuals without personality disorders ( Clarkin & Abrams, 1998). This would suggest that IPT may need modification for those with personality disorders, either in terms of how to manage the personality disorder during treatment, or to include treatment of relevant parts of the personality disorder to the depression.In order to place IPT in perspective, one could compare it to the cognitive therapy of depression in its earliest articulation ( Beck, Rush, Shaw, & Emery, 1979) and with more recent additions ( Beck, 1995). ROCK, WALTER H.

KAYE, in, 2001 2. PSYCHOLOGICAL, MEDICAL, AND NUTRITIONAL MANAGEMENT OF BINGE EATING DISORDERSimilar to bulimia nervosa, cognitive-behavioral therapy, interpersonal psychotherapy, and pharmacologic treatments have all been shown to have utility in the treatment of binge eating disorder 102. Psychotherapy has been shown to be effective in reducing the frequency of binge eating in patients with binge eating disorder, but cognitive behavior therapy (adapted from protocols used in the treatment of bulimia nervosa) and interpersonal therapy are the approaches most often utilized 12, 101, 102. Nutritional Management.In the adaptation of cognitive-behavioral therapy to the treatment of binge eating disorder, the goal is reduced frequency of binge eating and also a pattern of overall moderation of food intake. Although a framework or meal plan for regular meals may be useful for many patients, strict food rules and rigid diet plans are discouraged.

The goal is to promote a healthy overall pattern of eating and exercise, and achieving that goal is accomplished by planning and by identifying and modifying maladaptive thoughts and beliefs that lead to overeating and binge eating. Nutritional guidance emphasizes three planned meals and two to three planned snacks each day, no more than a 3-hour interval between meals or snacks, a varied and balanced diet, and food servings that are of average portion size.

Many patients with binge eating disorder benefit from basic nutrition education on the components of a healthy diet and discussion to dispel common myths about diet and nutrition.An important issue in the nutritional management of patients with binge eating disorder is whether weight loss should be a goal of the intervention, in addition to normalized eating patterns. For the vast majority of these patients, obesity is the major health risk resulting from the disorder. Efforts that are focused solely on eliminating binge eating have not been shown to result in weight loss in the majority of patients with binge eating disorder 110–114. Also, studies suggest that guidance toward energy restriction through the application of behavioral weight control strategies does not appear to exacerbate binge eating in these patients 101, 102, 111.

However, the long-term effects on weight management that may be achieved in these patients by behavioral intervention programs that incorporate energy restriction are unknown. Decades of research and long-term follow-up of participants in behavioral treatment programs aimed toward weight reduction suggest that few patients are likely to sustain the energy deficit necessary for continued weight loss and maintenance without considerable motivation and lifestyle modification (see Chapter 34). Thus, the cognitive-behavioral treatment programs for binge eating currently place the greatest emphasis on the goal of normalized eating patterns, clarifying with patients that simply eliminating the binge eating is unlikely to cause substantial weight loss. Pharmacologic Management.The use of antidepressants, such as the tricyclic antidepressants, in binge eating disorder has been suggested to have a possible role in the treatment of binge eating disorder, based on results from some studies 101. However, a role for pharmacotherapy has not been firmly established at this point, and more studies are needed. Neill H Anderson, Kirstie Woodburn, in, 2010 Psychological treatment of depressionThere appears to be no difference between younger and older adults in the efficacy of psychotherapy for depression ( Cuijpers et al 2009 ), and good evidence supports the use of cognitive–behavioural therapy and interpersonal psychotherapy in treating late-life depression ( Cuijpers et al 2006, Wilson et al 2008). The additive effects of antidepressant medication and psychotherapy may be superior to either treatment alone, especially in preventing relapse ( Hollon et al 2005).

Psychological treatment may be superior to antidepressant medication in depressions of lesser severity, and supportive counselling and a problem-solving approach may help in emotional difficulties associated with situational problems. In intractable depression ongoing support is vital, and discussing practical difficulties may bring some relief. D'Alli, in, 2009 Psychosocial and Combination TreatmentIn cases of mild to moderate depression, it is best to begin treatment with a psychosocial therapy. Multiple RCTs have demonstrated the efficacy of cognitive-behavioral psychotherapy ( Compton et al, 2004 ) and interpersonal psychotherapy ( Mufson et al, 2004) in treating adolescent depression. A groundbreaking, randomized, placebo-controlled study of moderately to severely depressed teenagers known as TADS (Treatment for Adolescents with Depression Study) examined the efficacy and cost-effectiveness of cognitive-behavioral therapy (CBT), the antidepressant fluoxetine, their combination, and placebo ( March et al, 2004). At 12 weeks, the response rate in the fluoxetine monotherapy group was comparable to that of prior exclusivity studies of fluoxetine in depressed youth, whereas the response rate of the CBT monotherapy group was surprisingly closer to the placebo response rate.

However, the synergy of simultaneous therapy with both CBT and fluoxetine (called combination treatment) resulted in a superior response on all outcome measures. At 12 weeks, fluoxetine monotherapy was more cost-effective than combination treatment, but both proved to be at least as cost-effective as routine primary care for adolescent depression ( Domino et al, 2008).

Interestingly, by 36 weeks, the difference in response rates among the active TADS conditions essentially disappeared; however, response was accelerated in the conditions in which fluoxetine was used, whereas CBT appeared to confer enhanced safety with greater reduction in suicidal ideation in the conditions in which it was used ( March et al, 2007). A British trial conducted with 208 moderately to severely depressed adolescents in which half were randomized to an SSRI (fluoxetine preferred) with routine care and half were randomized to an SSRI plus CBT and routine care showed neither a difference in outcome measures nor any protective effect of CBT at 12 weeks ( Goodyer et al, 2007). The Treatment of SSRI-Resistant Depression in Adolescents (TORDIA) addressed the problem of depressed youth who do not respond to an initial adequate trial of fluoxetine (or other SSRI) monotherapy. The TORDIA study randomized 334 depressed adolescents to monotherapy with an alternative SSRI, monotherapy with venlafaxine, combination CBT plus the alternative SSRI, or combination CBT plus venlafaxine. Switching to any condition resulted in a significant response rate with fewer adverse effects due to the alternative SSRI compared with venlafaxine, but a clearly superior response, consistent with the TADS findings, resulted when either combination treatment was used ( Brent et al, 2008).

Ludgate, in, 1998 6.11.3.1 DepressionA great deal of research has been conducted into the long-term outcome of depressive disorders (see also Chapters 3 and 16, this volume). The NIMH consensus panel ( NIMH, 1985) concluded that as many as 50% of patients with recurrent unipolar depressive disorder who recover from an episode of depression will have a recurrence within two years. Other reviewers in this field ( Belsher & Costello, 1988; Lavori, Keller, & Klerman, 1984) confirm these findings and additionally report a 20% relapse rate within two months and a 40% rate within a year. Approximately 70% of unipolar depressed patients respond to antidepressant medication in the short term but there is a considerable relapse rate with short-term pharmacotherapy ( Ludgate, 1991). There is now an emerging body of evidence demonstrating that the use of maintenance medication (antidepressants or lithium) reduces the probability of relapse. Prien and Kupfer (1986) concluded in a review of this field that the risk of relapse was approximately 20% in patients continuing to take lithium or antidepressant medication compared to 50% who were switched to a placebo. Thase (1990) suggests that maintenance pharmacotherapy reduces the risk of recurrence over a two to three year period from 80% to 50%.Behavioral approaches have shown some promise in producing positive long-term outcome and reducing relapse in depressed patients ( Gonzales, Lewinsohn, & Clarke, 1985; Thompson & Gallagher, 1984).

Social skills training has been found to be superior to both psychotherapy and tricyclic maintenance medication at six month follow-up ( Hersen, Bellack, Himmelhoch, & Thase, 1984). Behavioral therapy was found to have a better course than pharmacotherapy, relaxation therapy, and nondirective therapy in a two and a half year follow-up of depressed outpatients ( McLean & Hakistian, 1990).Encouraging results have also been found using interpersonal psychotherapy with depressed patients ( Weissman, 1994). Weisman, Klerman, Pruscoff, Shalomskas, and Padian (1981) found no difference between interpersonal psychotherapy and antidepressant medication at one year follow-up. (1990) used continuation interpersonal psychotherapy (on a monthly basis for 20 weeks) and antidepressant medication as a continuation treatment for unipolar depressed patients initially successfully treated with either interpersonal psychotherapy or medication. They found that maintenance medication had significant prophylactic effects and interpersonal psychotherapy had modest effects in reducing relapse risk.A number of reviews ( Hollon, Shelton, & Loosen, 1991; Ludgate, 1995; Wilson, 1992) have concluded that cognitive behavioral therapy has a prophylactic effect in the treatment of depression. It appears that patients treated with short-term antidepressant medication have roughly twice the relapse risk compared to patients receiving cognitive behavioral therapy (22–38% vs. In the NIMH study ( Shea et al., 1992), cognitive therapy, interpersonal psychotherapy, and short-term Imipramine were compared.

Relapse rates at 18-month follow-up were: 36% for cognitive therapy, 33% for interpersonal psychotherapy, 50% for Imipramine, and 33% for placebo. Return to treatment was significantly lower in the cognitive therapy group than in the other groups.

In the only studies that compared cognitive therapy to maintenance antidepressant medication ( Blackburn, Eunson, & Bishop, 1986; Evans et al, 1992), cognitive therapy still fared better in terms of relapse rates although the use of maintenance medication also resulted in relatively low rates of relapse. Wilson (1992b) concludes that cognitive therapy is at least as effective as maintenance medication properly maintained for one year. In all of the studies carried out on the long-term outcome of cognitive therapy for depression, no explicit relapse prevention or maintenance procedures are described. The therapy administered follows that described by Beck et al. (1979) and focuses on providing cognitive and behavioral strategies that aim to alleviate depressive symptomatology with the addition in some studies of booster sessions and some additional therapy ( Blackburn et al., 1986). Only one study ( Berlin, 1985) used an explicit relapse prevention focus and attempted to determine its effects.

Self-critical patients were randomly assigned to standard cognitive behavior therapy or to a specifically designed relapse prevention program.