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,
36: 8, 552-557 2
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 Social
Context 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 PROCESS
Diagnosis
Initial sessions 1-4 Interpersonal Inventory
Interpersonal formulation
Contract
Middle sessions 5-2
Chosen focal area: Monitoring symptoms
• Grief Interpersonal work
• Interpersonal Disputes Specific Techniques
• Role Transitions
• Interpersonal Sensitivity/Deficits
Separation responses
Conclusions of acute treatment Review of progress
Sessions 12-16 Resilience planning
Contingency planning
Maintenance contract
Maintenance (6mo-3years)
Prevention of relapse
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Interpersonal Focus
Symptoms Contract
Inventory Selection
Guide to Clear statement
Psycho- Populate
Diagnosis Inform symptom of focus, goals
education timeline of and
formulation discussion
depression expectations
Prepare for
Weekly Review of Review of Guide to future sessions
Patient interpersonal
symptom current current and
review as expert discussion predictable
resources difficulties
challenges
Decision re
a/d meds Social Clarify mood- Clarify mood-
Timeline interpersonal Work on
& review model of interpersonal
link link ending
schedule depression
History of Initial
depression
symptom Mobilize Clarify
and
relief Assist focus treatment
treatment available
selection targets/goals
resources
Assist
focus Sick role
selection
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Role Transition Role Disputes Grief Sensitivities
Weekly symptom review Weekly symptom review Weekly symptom
Weekly symptom review
review
Link symptoms to focal Link symptoms to focal Link symptoms to focal Link symptoms to
area area area focal area
Clarify recurring
Review +/- of old and Clarify communication Reconstruct and evaluate interpersonal
new roles problems lost relationship problems
Review and evaluate Use therapeutic
Explore process of Identify key issues and relationship as a
social support then and
changes and affect expectations model
now
Develop new
Develop current Explore parallels across Develop involvement
satisfying
relationships and skills relationships with current network
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 + Clinician observations
preferences
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
70 67.8
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
60 57.7 57.7 55.2
50 48
40 34
29.5 29.7
30 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 Combined recovery Combined response Combined response
recovery8 16 8 16
20
Mean Pre, Mid & Post Scores on PHQ-
9, GAD-7 & WSAS
25 23.7
20 18.8
16.2
14.7
15 13 13.5
12.4
10.7
10 9.3
8.3 7.9
7.4
0
PHQ GAD WSAS
Baseline Session 8 Session 16 End
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Grief: Mean Pre, Mid & Post Scores on
PHQ-9, GAD-7 & WSAS
30
27
25
21.4 21 20.2
20
16.6 16.8
14.5
15 12.5 12.5 11.7
11.2 10.4
10
0
PHQ GAD WSAS
Baseline Session 8 Session 16 End of Treatment
22
Sensitivity: Mean Pre, Mid & Post
Scores on PHQ-9, GAD-7 & WSAS
30
24.5
25
19.9
20 17.7 18
15.2
15 13.2
10.6 10.1
10 7.9 8.2 7.7 7.3
5
0
PHQ GAD WSAS
Baseline Session 8 Session 16 End of Treatment
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RD: Mean Pre, Mid & Post Scores on
PHQ-9, GAD-7 & WSAS
25 23.8
20 17.8
14.4 14.9
15
10 9 8.8 9.1
8.1
6.2 5.5
5.2 5.3
5
0
PHQ GAD WSAS
Baseline Session 8 Session 16 End of Treatment
24
RT: Mean Pre, Mid & Post Scores on
PHQ-9, GAD-7 & WSAS
25
20 19.2
17.9
15 13.9
12.9
12 12.7
10.3
10 9 8.9 8.5
7.3 7
5
0
PHQ GAD WSAS
Baseline Session 8 Session 16 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
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Mean Pre/Post Scores PHQ-9 & GAD-7
Baseline End
25
20
15
10
0
PHQ GAD
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% Recovery & Response (50% reduction)
90
80
70
60
50
40
30
20
10
0
PHQ PHQ GAD GAD Combined Combined
recovery response recovery response recovery response
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IPT in IAPT
Evidence based
Routine
Collaborative IAPT outcome
monitoring
Case
management
and supervision
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NICE Guidelines
recommended
Explicitly Weekly
collaborative in symptom
session and
between
IPT-A review and
Interpersonal
agencies 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
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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
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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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