Interpersonal therapy

Carroll et al. (2004) conducted another study examining psychotherapy and disulfiram treatment for cocaine dependence. In this randomi2ed, doubleblind, placebo-controlled study, patients (iV=121) were assigned to one of four conditions 1) disulfiram plus CBT 2) disulfiram plus interpersonal therapy (IPT), which addressed adherence to a medical model of psychiatric problems, interpersonal functioning, and supportive therapeutic exploration 3) placebo plus CBT or 4) placebo plus IPT. The patients who received disulfiram reduced their cocaine use, relative to those who received placebo, and the patients who received CBT reduced their cocaine use, relative to those who received IPT. Cocaine abstinence among the patients who received CBT plus placebo was not statistically different from that of the patients who re-... 

Various forms of psychotherapy are regarded as effective interventions in mild to moderate depression, but studies comparing the economics of psychotherapy and pharmacotherapy are few (Rosenbaum and Hylan, 1999). One study found that the total health-care costs for patients who received psychotherapy were no different from those for patients who received an antidepressant. However, no efficacy measure was used (Edgell and Hylan, 1997). A randomized, prospective study which evaluated the treatment of depression with nortriptyline, interpersonal therapy or treatment as usual, with outcomes expressed in quality-adjusted life years, found that nortriptyline but not interpersonal therapy was a cost-effective alternative to treatment as usual (Lave et al, 1998). 

Interpersonal therapy and cognitive behavioral therapy are types of psychotherapy that have well-documented efficacy for the treatment of MDD. Psychotherapy alone is an initial treatment option for mild to moderate cases of depression, and it may be useful when combined with pharmacotherapy in the treatment of more severe cases of depression. In fact, the combination of psychotherapy and pharmacotherapy can be more effective than either treatment modality alone in cases of severe or recurrent MDD. Psychotherapy can be especially helpful for patients with significant psychosocial stressors, interpersonal difficulties, or comorbid personality disorders.16... 

Psychotherapy (e.g., individual, group, and family), interpersonal therapy, and/or cognitive behavioral therapy / Stress reduction techniques, relaxation therapy, massage, yoga, etc. 

Fairburn, C., Jones, R., Peveler, R., and Hope R. (1993) Psychotherapy and bulimia nervosa longer-term effects of interpersonal therapy, behavior therapy and cognitive behavioral therapy. Arch Gen Psychiatry 50 419 28. 

The techniques of interpersonal therapy (IPT) developed by Klerman, Weissman and other authors are based on the concept that depressions have their origin in the area of interpersonal relationships and that they also run their course in that area (see Klerman et al., 1984). The purpose of IPT is to restore the patients within a short time to a position in which they can better understand their interpersonal problems and are able to change their unsatisfactory behavior towards others that leads to conflicts and frustrations. An early IPT study is presented in Box 8.5. 

Box 8.5 Interpersonal Therapy, Drug Treatment and their Combination... 

During all phases of treatment, education, supportive therapy, and, at times, more specific types of psychotherapy are essential for a satisfactory outcome. For example, interpersonal therapy can complement adequate maintenance antidepressant treatment, possibly diminishing the frequency of episodes (see the section Role of Psychosocial Therapies in Chapter 7), and cognitive-behavioral techniques in combination with antiobsessive agents (e.g., clomipramine) can improve the quality of life for patients with obsessive-compulsive disorder, minimizing time spent on disabling rituals (see the section Obsessive-Compulsive Disorder in Chapter 13). 

Despite the diagnostic challenges that remain in trying to understand the nature of MDD in children and adolescents, advances in its treatment has progressed considerably since the last edition of this textbook. Over this interval, selective serotonin reuptake inhibitors (SSRIs) have superseded TCAs as the treatment of first choice based both on efficacy and safety considerations. As in adults, specific psychotherapies (cognitive therapy, cognitive-behavioral therapy, and interpersonal therapy) may be as effective as antidepressant medication, at least in mild to moderate depression in children and adolescents ( 111, 112). Also, evidence indicates that depression in children and adolescents may be more influenced than is depression in adults by psychosocial variables such as peers and family, as well as other environmental factors (113). 

I. We want this book to be theory-neutral. Each model and every therapist makes unique contributions to the therapeutic process. You might be an expert in cognitive-behavioral therapy, family systems theory, interpersonal therapy, or another model your expertise is a critical component of healing. However, because we assume that you already have expertise in some type of psychotherapy, that is not the focus of this book. 

Taking depression as an example, an extensive evidence base exists for the efficacy of several forms of psychotherapy. These include cognitive therapy (in which individuals identify faulty views and negative automatic thoughts and attempt to replace them with ways of thinking less likely to lead to depression), interpersonal therapy (which focuses on relationships, roles and losses), brief dynamic psychotherapy (a time-limited version of traditional psychoanalysis) and cognitive analytical therapy (another well structured time-limited therapy which combines the best points of cognihve therapy and traditional analysis). 

As mentioned in chapter 2, individuals particular personality style and unique psychodynamics will often dramatically influence how they respond to pharmacotherapy. Robert Michaels (1992) has commented that in general clinical practice two-thirds of patients with Axis I disorders appear to respond quite well either to medication treatment or to brief, targeted psychological interventions, such as cognitive-behavioral or interpersonal therapy. However, a significant minority of patients with clear-cut Axis I disorders don t respond well to such treatments, primarily due to serious co-morbid character pathology. In treating these people, at the very least the clinician must be alert to how personality factors influence treatment outcome often medication treatment must be accompanied by more intensive psychotherapy that addresses the personality disorder. 

Psychotherapy is not only possible but can be very productive with the bipolar patient. Miklowitz (1996), in addressing combined psyAotherapy and medication treatment for bipolar disorder, offers a comprehensive and detailed description of two approaches, family psychoeducation and individual therapy. The latter incorporates elements of interpersonal therapy for affective disorders with strategies to stabilize social rhythms. However, the therapist must be skilled at identifying symptoms of hypomania, mania, and depression, and the necessity for medication adjustment referrals. The therapist can be tested especially by the effects of medication noncompliance, when symptoms return and judgment and insight diminish. 

I Psychotherapeutic interventions, particularly cognitive behavioural therapy (CBT) and interpersonal therapy (IPT) are effective in the treatment of many children and adolescents with depressive symptoms and mild-to-moderate depressive episodes and should probably be considered first-line treatment. 

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