Treating Bipolar Disorder. Ellen Frank, Ph.D., Guilford Press, 2005

Though almost 5 years old, Treating Bipolar Disorder, by Ellen Frank is still one of the first and most frequent reading recommendations that I make for newly diagnosed patients. Written in plain, easy to understand English, this little gem asserts that affective relapse in bipolar disorder follows from disruptions in social and circadian rhythms. This theory led to the development of a disorder-specific therapy, Interpersonal Social Rhythm Therapy (IPSRT) whose case-based description is the mainstay of this book.

Frank starts with a review of existing theories and empirically-validated treatments of bipolar disorder, In so doing, both this book and her treatment model include a healthy serving of psychoeducational information about this illness. Given that this is one of the most potent and, perhaps, a common element of all psychotherapies for bipolar conditions, this inclusion makes good sense.

The model of IPSRT is presented next. In formulating this model, Frank essentially connects two different research areas into a single causal pathway of affective relapse: the association of interpersonal conflicts with unipolar depression and the literature emphasizing circadian disruption in affective relapse of bipolar disorder. Rather than viewing these as separate contributory factors, she proposes that changes in social routine lead to altered biological rhythms (especially sleep) which form the final common pathway to the onset of new mood episodes. Using this model of relapse, IPSRT intervenes both at the level of social discord and circadian disruption to stabilize disordered rhythms.

The remainder of the book details these two fundamental components of IPSRT.

Beginning with a history-taking that seeks to demonstrate the relationship between social and biological rhythm havoc and episode onset, Frank walks the reader through the treatment process and its different modules. The IP component identifies and then addresses the most salient relationship problems the individual is experiencing. The SRT module, however, is what’s new and most interesting here.

Using a standardized tool, the Social Rhythm Metric, patients are asked to note and record the time of a host of daily activities such as sleep onset, awakening, meals, when one leaves home, physical exercise, exposure to sunlight, level of socializing, etc With the initial data as a baseline, therapists and patients work together to increasingly standardize fluctuations in these behavioral indices. Research studies are presented documenting the effectiveness of this approach in reducing relapse in patients with Bipolar Disorder Type I.

This book is readable, engaging and encouraging. The IPSRT model gives patients a new perspective and sense of empowerment in confronting their illness. No longer a disease which strikes randomly and without warning, IPSRT provides patients with a strategy to monitor, anticipate and modify social and biobehavioral rhythms and thereby exert better control over their lives. Not a bad thing.

Postscript: An article from February, 2009, published in the Journal, Bipolar Disorders, by Holly Swartz, Ellen Frank and colleagues at the University of

Pittsburgh, examined the efficacy of IPSRT as a monotherapy for Bipolar II depression. Yes, monotherapy, meaning only IPSRT and no psychoactive medications. Though the study was small, had a high number of drop-outs and no control group, about 40% of the treatment cohort experienced significant improvement.  Is it possible that a subset of bipolar patients can be managed through biologically-stabilizing psychotherapeutic interventions alone??? Stay tuned.