Interpersonal Psychotherapy for
Depression:
A little bit of what you want to know
Dr Roslyn Law
Chair IPTUK
National Lead for IPT and IPT-A in IAPT
1
Weissman MM (2006) A Brief History of Interpersonal Psychotherapy. Psychiatric Annals,
2
36: 8, 552-557
Translate depressive symptoms into the interpersonal context
Depression
Interpersonal
3
IPT two main objectives
To resolve
interpersonal
problems linked to
the onset and
continuing symptoms
To reduce
symptomatic distress
4
What is IPT?
www.ucl.ac.uk/clinical-psychology/CORE/IPT_framework.htm
Depression
Interpersonal
Context
Social
Support
5
6
IPT: What does it do?
o IPT focuses on the relationship difficulties that
are often very important to people experiencing
depression and that are frequently identified as
key features of their depression stories
o IPT is primarily interested in the current conflicts,
role changes, losses and difficulties in establishing
and maintaining independent and satisfying
relationships that so often trigger and maintain
episodes of depression
7
TRAJECTORY
Initial sessions 1-4
Middle sessions 5-2
Chosen focal area:
• Grief
• Interpersonal Disputes
• Role Transitions
• Interpersonal Sensitivity/Deficits
PROCESS
Diagnosis
Interpersonal Inventory
Interpersonal formulation
Contract
Monitoring symptoms
Interpersonal work
Specific Techniques
Conclusions of acute treatment
Sessions 12-16
Separation responses
Review of progress
Resilience planning
Contingency planning
Maintenance (6mo-3years)
Maintenance contract
Prevention of relapse
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Symptoms
Interpersonal
Inventory
Focus
Selection
Contract
Clear statement
of focus, goals
and
expectations
Prepare for
future sessions
and
predictable
challenges
Psychoeducation
Populate
timeline of
depression
Inform
formulation
Guide to
symptom
discussion
Weekly
symptom
review
Patient
as expert
Review of
current
resources
Review of
current
difficulties
Guide to
interpersonal
discussion
Timeline
Decision re
a/d meds
& review
schedule
Social
model of
depression
Clarify moodinterpersonal
link
Clarify moodinterpersonal
link
History of
depression
and
treatment
Initial
symptom
relief
Mobilize
available
resources
Assist focus
selection
Clarify
treatment
targets/goals
Assist
focus
selection
Sick role
Diagnosis
Work on
ending
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Role Transition
Role Disputes
Grief
Sensitivities
Weekly symptom review
Weekly symptom review
Weekly symptom review
Weekly symptom
review
Link symptoms to focal
area
Link symptoms to focal
area
Link symptoms to focal
area
Link symptoms to
focal area
Review +/- of old and
new roles
Clarify communication
problems
Reconstruct and evaluate
lost relationship
Clarify recurring
interpersonal
problems
Explore process of
changes and affect
Identify key issues and
expectations
Review and evaluate
social support then and
now
Use therapeutic
relationship as a
model
Develop current
relationships and skills
Explore parallels across
relationships
Develop involvement
with current network
Develop new
satisfying
relationships
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Explicit discussion of ending
Explore feelings about ending and
potential loss
Review progress and highlight
competence
Evaluate therapy
Maintenance plan
Relapse prevention plan
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Mechanisms of change in IPT
Lipsitz & Markowitz (2013)
o Enhancing social support
o Develop resources and context to be soothed, contained and find meaning
o Decreasing interpersonal stress
o Target key interpersonal stressors and ameliorate negative contextual
influences
o Facilitating emotional processing
o Development capacity for emotional awareness and regulation as a means of
engaging interpersonal resources
o Improving interpersonal skills
o improving or adapting interpersonal skills essential to successful resolution of
the current crisis or predicament.
Training in Evidence Based Practice
+
Research evidence
Patient + values +
preferences
+
Clinician observations
Quantifiable results
Utility for clinicians
Acceptable to recipients
Frueh et al (2012) Evidence-Based Practice in Adult Mental Health. Handbook of Evidence-Based Practice in Clinical Psychology. Published
=
online.
13
Clinical evidence for IPT
Author
Number of participants
Number of sessions/duration
Elkin et al (1989)
239
16 weekly plus optional 4 extra sessions
Frank et al (1990)
128
12 weekly, 12 fortnightly, 3 years monthly
Weissman (1992)
35
6 sessions
Schulberg et al (1996)
276
16 weekly, 4 monthly continuation sessions
Reynolds et al (1999)
80
8 weekly, 16 fortnightly, 2 years monthly
Reynolds et al (1999b)
107
Treat to remission, 16 fortnightly, 3 years monthly
De Mello et al (2001)
35
16 weekly, 6 monthly
Freeman et al (2002)
124
16 sessions
Reynolds et al (2006)
165
2 years
Van Schain et al (2006)
143
5 months
Blom et Al (2007)
193
12 sessions
Luty et al (2007)
177
16 sessions
14
Outcome data sample
o PHQ-9 & GAD-7 data were gathered for a
intention to treat sample of IPT patients in IAPT
(London)
o 165 patients
o 18 therapists
o 10 services
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Cut off scores for Recovery
• PHQ-9 : below 10 is cut-off for recovery
• GAD-7 : below 8 is cut off for recovery
• WSAS:below 8 used as cut off for recovery
• Response: 50% reduction from baseline scores
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Attendance
90
80
80
67,8
70
60
50
40
30
20
13,7
10
0
M no session
% Completed
12 or more session
17
Focal Areas
70
63
60
50
40
40
29
30
20
14
10
0
Role Transition
Role Disputes
Grief
Sensitivities
18
% Recovery & Response (50% reduction) at
session 8 and 16
70
57,7
60
57,7
55,2
48
50
40
30
34
29,5
29,7
25,9
20
10
0
19
Combined PHQ and GAD % Response
and Recovery Rates
60
56,4
52
50
40
30
27
21
20
10
0
Combined
recovery8
Combined recovery Combined response Combined response
16
8
16
20
Mean Pre, Mid & Post Scores on PHQ9, GAD-7 & WSAS
23,7
25
20
15
10
18,8
16,2
14,7
13 13,5
12,4
8,3
9,3
10,7
7,4
7,9
5
0
PHQ
GAD
Baseline
Session 8
WSAS
Session 16
End
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Grief: Mean Pre, Mid & Post Scores on
PHQ-9, GAD-7 & WSAS
30
25
27
21,4
21 20,2
20
15
16,8
16,6
14,5
12,5
11,2
12,5 11,7
10,4
10
5
0
PHQ
Baseline
GAD
Session 8
Session 16
WSAS
End of Treatment
22
Sensitivity: Mean Pre, Mid & Post
Scores on PHQ-9, GAD-7 & WSAS
30
24,5
25
20
19,9
17,7
15
15,2
13,2
10,6
10
18
7,9
8,2
10,1
7,7
7,3
5
0
PHQ
Baseline
GAD
Session 8
Session 16
WSAS
End of Treatment
23
RD: Mean Pre, Mid & Post Scores on
PHQ-9, GAD-7 & WSAS
23,8
25
20
17,8
10
5
14,9
14,4
15
9
8,8
8,1
5,2
5,3
6,2
9,1
5,5
0
PHQ
Baseline
GAD
Session 8
Session 16
WSAS
End of Treatment
24
RT: Mean Pre, Mid & Post Scores on
PHQ-9, GAD-7 & WSAS
25
20
19,2
17,9
13,9
15
10
10,3
9
8,9
12,9
8,5
7,3
12 12,7
7
5
0
PHQ
Baseline
GAD
Session 8
Session 16
WSAS
End of Treatment
25
Outcome data sample
• PHQ-9 & GAD-7 data were gathered for a
intention to treat sample of IPT patients
• 48 patients
• 7 therapists
• 6 services
26
Mean Pre/Post Scores PHQ-9 & GAD-7
Baseline
End
25
20
15
10
5
0
PHQ
GAD
27
% Recovery & Response (50% reduction)
90
80
70
60
50
40
30
20
10
0
PHQ
recovery
PHQ
response
GAD
recovery
GAD
response
Combined
recovery
Combined
response
28
IPT in IAPT
Evidence based
Collaborative
IAPT
Routine
outcome
monitoring
Case
management
and supervision
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NICE Guidelines
recommended
Explicitly
collaborative in
session and
between
agencies
IPT-A
Weekly
symptom
review and
Interpersonal
goals
Collaborative practice
and supervision
protocol
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Training Figures 2013-2014
100
90
80
70
Durham
60
Yorkshire and North West
50
West Midlands
40
London
30
South East
20
Total
10
0
IPT Prac
IPT-A Prac
IPT Sup
31
Case management and supervision
o Supervision is a condition of practice
o Access to supervision is a condition of attending
training
o +ve: more than doubled the number of IPTUK
registered IPT trainees, practitioners and supervisors
during 3 years of IAPT
o Limited supervision capacity but growing. Remote
supervision (telephone/Skype) remains the norm
32
Case management and supervision
• For accreditation
– Four cases completed under supervision
– Must cover at least two focal areas
– All sessions are recorded and three complete sessions
are reviewed per case
– Self assessment throughout supervision
– 15 mins supervision per case per week
• Minimum of monthly IPT peer supervision
following accreditation
• Distance supervision (telephone, Skype) is the
norm
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Challenges of IAPT
• A practitioner does not make a service
– Where possible two trainees are recruited from
each partnership
• Service targets v evidence based practice
• Ensuring protected time to learn and
contribute to service transformation
• Baseline numbers of IPT practitioners and
supervisors in IAPT are very small
• Working across adult and CYP services
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IPT: In summary
• IPT is a time limited, evidence based treatment for depression in
adults and adolescents.
• It targets key interpersonal issues that trouble many people with
depression who seek treatment and collaboratively formulates a
treatment plan to focus on their primary relationship difficulties
• It monitors symptom reduction and progress towards interpersonal
goals on a weekly basis and has been shown to achieve outcomes
that are equivalent or superior to existing treatment approaches for
moderate to severe depression in people
• IPT combined with medication has repeatedly been should to
achieve better outcomes in adults than either therapy alone for
moderate to severe depression
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Questions and comments
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