Some Evidence for Efficacy of Interpersonal Psychotherapy and References
(Compiled by Bob Hill, Ph.D., Psychology, Appalachian State University)
Treatment and Prevention of Depression
in Psychological Science in the Public Interest
(Hollon, Thase & Markowitz, 2002)
This article reviews evidence for the efficacy of antidepressants, cognitive behavioral
psychotherapy (CBT) and interpersonal psychotherapy (IPT) in treating depression. CBT
and IPT are comparable to antidepressants in treatment response and have some
advantages over medications. A well written review printed in a special issue of
Psychological Science in the Public Interest (Treatment and Prevention of Depression),
available on line at:
http://www.psychologicalscience.org/journals/pspi/pdf/pspi31101.pdf
An excerpt about IPT from the abstract: "Although it is still unclear weather traditional
psychodynamic approaches are effective in treating depression, IPT has fared well in
controlled comparisons with medications and other psychotherapies. It also appears to
have a delayed effect that improves the quality of social relationships and interpersonal
skills. It has been shown to reduce acute distress and to prevent relapse and recurrence so
long as it is continued or maintained. Treatment combining IPT with medication retains
the quick results of pharmacotherapy and the greater interpersonal breadth of IPT, as well
as boosting response in patients who are otherwise more difficult to treat. The main
problem is that IPT has only more recently entered clinical practice and is not widely
available to those in need."
De Mello, M.F., Mari, J.J., Bacaltchuk, J., Verdeli, H., & Neugebauer, R. (2005). A
systematic review of research findings on the efficacy of interpersonal therapy for
depressive disorders. Eur Arch Psychiatry Clin Neurosci, 255, 75-82.
Findings from several individual trials strengthen the evidence for the efficacy of IPT in
depressive disorders. IPT was more effective than a placebo. However, IPT plus
medication proved to be no more helpful than either IPT or medication alone, contrasting
beliefs about the necessity for their combination. An important finding of this review is
the comparison of IPT to CBT, from which evidence can be made regarding the higher
efficacy of IPT. Review authors argue that the increased efficacy of IPT over CBT is
related to its format, which emphasized linking the patient’s own awareness of symptoms
to awareness of an interpersonal problem. Additional replication needed to efficiently
claim higher efficacy for IPT over CBT due to the limited number of trials reviewed in
this article.
Ryan, N.D. (2005). Treatmentof depression in children and adolescents. Lancet,
336, 933-940.
Another review emphasizing the efficacy of both IPT and CBT for the treatment of
depression for children and adolescents.
1
David-Ferdon, C. & Kaslow, N. (2008). Evidence-Based Psychosocial Treatments for
Child and Adolescent Depression. Journal of Clinical Child & Adolescent Psychology,
37(1), 62–104.
The evidence-base of psychosocial treatment outcome studies for depressed youth
conducted since 1998 is examined. For adolescents, two modalities are well-established
(CBT adolescent only group, IPT individual. For adolescent depression, both CBT and
IPT have well-established efficacy. Future research directions and best practices are
offered.
Lipsitz, J.D. et al. (2008). A randomized trial of interpersonal therapy versus supportive
therapy for social anxiety disorder. Depression and Anxiety, 25, 542-553.
This study randomly assigned patients with Social Anxiety Disorder into treatment
groups utilizing either IPT or ST. Patients in both of these groups reported significant
improvement in symptom experience, showing no superior effectiveness of one treatment
over the other.
Blanco, C. et al. (2006). Homework in interpersonal psychotherapy (IPT): Rationale and
practice. Journal of Psychotherapy Integration, 16, 201-218.
Good summary article, describing IPT and talking about its benefits and efficacy in a
variety of areas. Provides a number of examples describing use of Homework to
supplement treatment.
Finn-Magnus et al. (2008). Residential cognitive therapy versus residential interpersonal
therapy for social phobia: A randomized clinical trial. Journal of Anxiety
Disorders, 22, 991-1010.
In this study 80 patients were randomly assigned to 10 weeks of either cognitive or
interpersonal therapy for social phobia. Assessments were made before intervention, in
middle of treatment, post-treatment, and one year after cessation of treatment. Both
groups demonstrated significant improvement in symptoms, yet no significant different
was found between the two treatment groups. However, cognitive therapy in this trial
showed fewer beneficial effects than it has in previous studies.
Zaretsky, A.E., Rizvi, S., & Parikh, S.V. (2007). How well do psychosocial interventions
work in bipolar disorder? Review of Canadian Psychiatry, 52, 14-21.
This review focused on psychosocial interventions, IPT being one, and the treatment of
Bipolar disorder. Findings show that IPT and CBT are superior in treating the longlasting depressive symptoms that remain even after major symptoms have subsided.
“Clinical Implications
2
• Manualized psychosocial interventions for bipolar disorder should be disseminated more
widely to psychiatrists and psychiatry residents.
• CBT and IPT may offer additional benefit over PE by reducing residual depressive symptoms
in bipolar illness and by being antidepressant medication-sparing.
Limitations
• Effect sizes for acute phase treatment, compared with maintenance phase adjunctive treatment,
were not calculated.
• Psychosocial treatment approaches for conditions cooccuring with bipolar illness, such as
chronic insomnia, suicidality, and substance use, need to be further developed and tested.
• Treatment approaches for special bipolar disorder populations, such as adolescents with
bipolar disorder or bipolar disorder II, need to be fiirther developed and empirically tested.”
(p.14)
Boston- New Haven Study
(DiMascio et al., 1979; Weissmann et al., 1979)
This study marks the first test of IPT efficacy as an acute antidepressant treatment
in a four-cell, sixteen week randomized trial of IPT, amitriptyline, their combination, and
non-scheduled control treatment for 81 outpatients with major depression. Each active
treatment was shown to more effectively reduce symptom level compared with nonscheduled control group treatment. The combination of IPT and amitriptyline was more
effective than either active monotherapy. No significant differences were found between
IPT and amitriptyline in symptom reduction at the end of treatment; amitriptyline
demonstrated more immediate symptom relief. IPT was shown to mainly address
symptoms of mood, apathy, suicidal ideation, work, and interest. Amitriptyline was
shown to address neurovegetative symptoms of depression.
A one-year follow up revealed IPT patients demonstrated sustained benefits from
treatment, including the development of significantly better psychosocial functioning
during the twelve months following treatment. This development was not apparent in
IPT groups prior to the end of treatment and was not present in the group receiving only
amitriptyline.
NIMH Treatment of Depression Collaborative Research Program
(Elkin et al., 1989)
This multi-site study consisted of the random assignment of 250 depressed
outpatients to sixteen weeks of imipramine and clinical management, IPT, cognitivebehavioral therapy, or a placebo condition and clinical management. This marks the first
head-to-head comparison of IPT and CBT as antidepressant treatments.
Most patients completed at least 15 weeks or 12 treatment sessions. The group
with the lowest attrition rate among treatments was IPT. Less symptomatic patients
(Ham-D< 19) improved in all treatment conditions, and therefore no difference was
found among treatments for this group. More severely depressed patients (Ham-D>20)
showed more significant differences in intergroup comparison. The imipramine-CM
group showed the most rapid response that was consistently superior to placebo. IPT was
comparable to imipramine-CM on several outcome measures, showing a mean outcome
superior to placebo. CBT demonstrated an intermediate level of improvement but was
3
not superior to the placebo condition.
Klein and Ross (1993) developed the following continuum with their reanalysis of
the NIMH TDCRP data: “medication superior to psychotherapy, [and] psychotherapies
somewhat superior to placebo (p. 241).”
An eighteen-month follow up by Shea et al. (1992) yielded the following results:
no significant differences in recovery were found among remitters in each of the four
groups:
30% recovered with CBT (of these 36% relapsed)
26% recovered with IPT (of these 33% relapsed)
19% recovered with imipramine-CM (of these 50% relapsed)
20% recovered with placebo (of these 33% relapsed).
Both the TDCRP and the Boston-New Haven study determined that treatment
could induce remission of symptoms but not guarantee maintenance of symptom
remission, and subsequent recovery from depression.
Dutch Studies and Neuroimaging
The effectiveness of IPT has been demonstrated in open trials for mood disorders
in the Netherlands (Blom et al., 1996), as well as in United Kingdom-based neuroimaging
studies of DSM-IV major depression patients with minimal Hamilton Depression scale
scores of 18.
Group Interpersonal Psychotherapy for Patients with Major Depression Disorder
Levkovitz, Y. et al. (2000)
This study involved twenty-five individuals who responded to antidepressant
medication and were being treated on an outpatient basis in an acute phase of major
depressive disorder with the use of antidepressant medication. The patients were divided
into two groups: one group (controls) received continued antidepressant medication and
follow up visits for a major depressive disorder; the other group entered into group
interpersonal psychotherapy (IPT-G) and also continued their antidepressant medication.
The IPT-G group showed significantly greater improvement in depressive symptoms than
the control group. This was found both during therapy and during a six month follow-up
period. The individuals in the IPT-G group also reported that the IPT-G group helped
with working through interpersonal loss as well as increasing social functioning.
Interpersonal Psychotherapy for Anorexia Nervosa
McIntosh, et al. (2000)
This article explores the rationale for using interpersonal psychotherapy to treat
anorexia nervosa. Interpersonal and family dysfunction are put forth as possible
etiologies of anorexia nervosa. Evidence for this etiological theory rests in the findings
that both families of patients who are diagnosed with anorexia nervosa and the patients
themselves report family dysfunction at some level. Individuals who are diagnosed with
anorexia nervosa experience difficulties with social functioning specifically social
anxiety. Because interpersonal psychotherapy endeavors to improve interpersonal
4
relations and thereby reduce symptomology, it follows that (accepting this etiological
theory), IPT would be an effective treatment for anorexia nervosa.
Efficacy of Interpersonal Psychotherapy for Depressed Adolescents
Mufson, L. et al. (1999)
This study involved an open clinical trial of interpersonal psychotherapy for
depressed adolescents (IPT-A) and clinical monitoring for depressed adolescents on a
wait list. Each of the subjects scored at least a fifteen on a Hamilton Depression Rating
Scale (HRSD) at intake. The IPT-A group was seen weekly for twelve weeks. The
clinical monitoring group was assigned a therapist who they saw once a month for thirty
minutes. Depression was assessed at baseline and termination using the HRSD and Beck
Depression Inventory (BDI). The IPT-A group reported a significantly greater decrease in
depressive symptoms and increase in social functioning compared to the clinical
monitoring group. See book:
Interpersonal Psychotherapy for Depressed Adolescents, Second Edition
Mufson, L. Dorta, Moreau, Weissman (2004)
Efficacy of Interpersonal Psychotherapy for Postpartum Depression
O’Hara et al. (2000)
This study evaluated the effectiveness of twelve weeks of interpersonal
psychotherapy treatment (IPT) compared with a waiting list condition. The subjects were
one hundred twenty women who met the criteria for a major depressive episode with
postpartum onset. Each of the subjects had a HRSD score of at least twelve and were
randomly assigned to a group. Significant improvements in depressive symptoms were
found in the IPT group compared to the waiting list condition group.
Interpersonal Psychotherapy for Depression: Overview, Clinical Efficacy
and Future Directions
Frank, E. et al. (1995)
This article reviews interpersonal psychotherapy, its history, empirical
foundation, supportive studies, successes (specifically in the treatment and prevention of
major depression and depressive episodes) and suggestions for future work.
Interpersonal Psychotherapy and Antidepressant Medication: Evaluation of a
Sequential Treatment Strategy in Women with Recurrent Major Depression
Frank, E. et al. (2000)
This study compared two groups of women with recurrent major depressive
disorder. One group initially received Interpersonal Psychotherapy (IPT) and
pharmacotherapy. The other group received IPT only for the first four weeks, if the
major depressive disorder was not in remission after the four weeks, pharmacotherapy
was implemented in addition to IPT (a sequential treatment strategy). The group who
initially received IPT and pharmacotherapy had a 66%remission rate. The sequential
treatment group had a 79% remission rate. These findings suggest that this sequential
5
treatment strategy can be highly effective. Additionally, these findings might be of
interest to women in the child bearing years who might find it favorable to avoid
antidepressant medication.
Does Interpersonal Psychotherapy Protect Women from Depression in the Face of
Stressful Life Events?
Harkness, K.L. et al. (2002)
This study involved a pool of 83 women who suffered from recurrent major
depressive disorder. The women were acutely treated for a major depressive episode
using interpersonal psychotherapy. After the major depressive episode was in remission,
the women remained in maintenance interpersonal psychotherapy for two years. This
maintenance IPT was found to be effective at decreasing the recurrence of a major
depressive episode, even in the face of stressful life events.
Other Articles on IPT& References:
Blagys, M. D. & Hilsenroth, M. J. (2000). Distinctive features of short-term
psychodynamic interpersonal psychotherapy: A review of the comparative
psychotherapy process literature. Clinical Psychology, 7 (2), 167-188.
Blanco, C. et al. (2006). Homework in interpersonal psychotherapy (IPT): Rationale and
practice. Journal of Psychotherapy Integration, 16, 201-218.
Blanco,-Carlos; Lipsitz,-Joshua; Caligor,-Eve. (2001). Treatment of chronic depression
with a 12-week program of interpersonal psychotherapy. American Journal of
Psychiatry. Mar; Vol 158(3): 371-375
Brody, A. L. et al. (2001). Regional Brain Metabolic Changes in Patients With Major
Depression Treated With Either Paroxetine or Interpersonal Therapy. Archives of
General Psychiatry, 58:631-640.
Curry, J.F. (2001). Specific psychotherapies for childhood and adolescent depression.
Biological Psychiatry, 49 (12), 1091-1100.
David-Ferdon, C. & Kaslow, N. (2008). Evidence-Based Psychosocial Treatments for
Child and Adolescent Depression. Journal of Clinical Child & Adolescent
Psychology, 37(1), 62–104.
De Mello, M.F., Mari, J.J., Bacaltchuk, J., Verdeli, H., & Neugebauer, R. (2005). A
systematic review of research findings on the efficacy of interpersonal therapy for
depressive disorders. Eur Arch Psychiatry Clin Neurosci, 255, 75-82.
DiMascio, A. et al. (1979). Differential symptom reduction by drugs and psychotherapy
in acute depression. Archives of General Psychiatry, 36, 1450-1456.
Elkin, I. Et al. (1989). NIMH treatment of depression collaborative research program:
General effectiveness of treatments. Archives of General Psychiatry, 46, 971-982.
Finn-Magnus et al. (2008). Residential cognitive therapy versus residential interpersonal
therapy for social phobia: A randomized clinical trial. Journal of Anxiety
Disorders, 22, 991-1010.
Frank, E. et al. (2000). Interpersonal psychotherapy and antidepressant medication:
Evaluation of a sequential treatment strategy in women with recurrent major
6
depression. Journal of Clinical Psychiatry, 61(1), 51-57.
Frank, E., & Spanier, C. (1995). Interpersonal psychotherapy for depression: Overview,
clinical efficacy, and future directions. Clinical Psychology: Science and
Practice, 2 (4), 349-369.
Gillies, L. (2001). Interpersonal psychotherapy for depression and other disorders. In
Barlow, D. (Ed.), Clinical Handbook of Psychological Disorders, pp. 309-331.
NY: Guilford Press.
Guthrie, E. et al. (2001). Randomised control trial of brief psychological intervention
after deliberate self poisoning. British Medical Journal, 323 (7305).
Harkness, K.L., et al. (2002). Does interpersonal psychotherapy protect women from
depression in the face of stressful life events? Journal of Consulting and Clinical
Psychology, 70(4), 908-915.
Hinrichsen, G.A., & Clougherty, K. F. (2006). Interpersonal psychotherapy for depressed
older adults. Washington, DC: American Psychological Association
http://www.apa.org/books/4317102.html
Hollon, S. D., Thase, M. E. & Markowitz, J. C. (2002). Treatment and Prevention of
Depression. Psychological Science in the Public Interest, 3(2).
Levokovitz, Y. et al. (2000). Group interpersonal psychotherapy for patients with major
depression disorder – pilot study. Journal of Affective Disorders, 60 (3), 191-195.
Lipsitz, J.D. et al. (2008). A randomized trial of interpersonal therapy versus supportive
therapy for social anxiety disorder. Depression and Anxiety, 25, 542-553.
Lipsitz,-Joshua-D; Markowitz,-John-C; Cherry,-Sabrina; Fyer,-Abby-J (1999).Open trial
of interpersonal psychotherapy for the treatment of social phobia. American
Journal of Psychiatry. Nov; Vol 156(11): 1814-1816
Martin, S. D. et al. (2001). Brain blood flow changes in depressed patients treated
with IPT or venlafaxine hydrocloride. Archives of General Psychiatry, 58:641648.
7
McIntosh, V.V., Bulik, C.M., McKenzie, J.M., Luty, S.E., Jordan, J. (2000).
Interpersonal psychotherapy for anorexia nervosa. Interpersonal Journal of
Eating Disorders, 27 (2), 125-139.
Miller, M.D. et al. (2001). Interpersonal psychotherapy for late-life depression: Past,
present, and future. Journal of Psychotherapy Practice and Research, 10 (4), 231238.
Mufson, L. Dorta, Moreau, Weissman (2004). Interpersonal Psychotherapy for Depressed
Adolescents (2nd Edition). Guilford Press.
Mufson, L., Weissman, M.M., Moreau, D., & Garfinkel, R. (1999). Efficacy of
interpersonal psychotherapy for depressed adolescents. Archives of General
Psychiatry, 56 (6), 573-579.
O’Hara, M.W., Stuart, S., Gorman, L.L., & Wenzel, A. (2000). Efficacy of interpersonal
psychotherapy for postpartum depression. Archives of General Psychiatry, 57
(11), 1039-1045.
Ryan, N.D. (2005). Treatmentof depression in children and adolescents. Lancet,
336, 933-940.
Santor, D.A., & Kusumakar, V. (2001). Open trial of interpersonal therapy in adolescents
with moderate to severe major depression: Effectiveness of novice IPT therapists.
Journal of the American Academy of Child and Adolescent Psychiatry, 40 (2),
236-240.
Shea, M. et al. (1992). Course of depressive symptoms over follow-up: Findings from the
NIMH treatment of depression collaborative research program.. Archives of
General Psychiatry, 49, 782-787.
Stuart,-Scott; O'Hara,-Michael-W (2002). Interpersonal psychotherapy. Reinecke, Mark
A. (Ed); Davison, Michael R. (Ed). Comparative treatments of depression.
Springer series on comparative treatments for psychological disorders. (pp. 317357). New York, NY, US: Springer Publishing Co. xv, 510 pp.
Teyber, E. (2006). Interpersonal Process in Psychotherapy (5th Ed). Wadsworth, Brooks
Cole.
Weissman MM, Markowitz JC, Klerman GL: A Clinician's Quick Guide to Interpersonal
Psychotherapy. New York: Oxford Press (2007).
Weissman, M., Markowitz, J. & Klerman, G. (2000). Comprehensive Guide to
Interpersonal Psychotherapy. Basic Books.
Wilson, G.T., Fairburn, C.C., Agras, W.S., Walsh, B.T., Kraemer, H. (2002). Cognitivebehavioral therapy for bulimia nervosa: Time course and mechanisms of change.
Journal of Consulting and Clinical Psychology, 70 (2), 267-274.
Zaretsky, A.E., Rizvi, S., & Parikh, S.V. (2007). How well do psychosocial interventions
work in bipolar disorder? Review of Canadian Psychiatry, 52, 14-21.
8