Interpersonal and social rhythm therapy: managing the chaos of bipolar disorder
Abstract
Interpersonal and social rhythm therapy is an individual psychotherapy designed specifically for the treatment for bipolar disorder. Interpersonal and social rhythm therapy grew from a chronobiological model of bipolar disorder postulating that individuals with bipolar disorder have a genetic predisposition to circadian rhythm and sleep-wake cycle abnormalities that may be responsible, in part, for the symptomatic manifestations of the illness. In our model, life events (both negative and positive) may cause disruptions in patients' social rhythms that, in turn, perturb circadian rhythms and sleep-wake cycles and lead to the development of bipolar symptoms. Administered in concert with medications, interpersonal and social rhythm therapy combines the basic principles of interpersonal psychotherapy with behavioral techniques to help patients regularize their daily routines, diminish interpersonal problems, and adhere to medication regimens. It modulates both biological and psychosocial factors to mitigate patients' circadian and sleep-wake cycle vulnerabilities, improve overall functioning, and better manage the potential chaos of bipolar disorder symptomatology.
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Treatments to amplify, phase advance or delay circadian rhythms have been developed for potential use in psychiatric disorders in adults.
“Treatments to amplify, phase advance or delay circadian rhythms have been developed for potential use in psychiatric disorders in adults.”
From Rhythms of life: circadian disruption and brain disorders across the lifespan (2019) · cites this paper as [189]
Circadian disruptions can precipitate mood and psychotic episodes in individuals who already have psychiatric disorders.
“circadian disruptions can precipitate mood and psychotic episodes in individuals who already have psychiatric disorders189–191”
From Rhythms of life: circadian disruption and brain disorders across the lifespan (2019) · cites this paper as [189]
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BackgroundDevelopment and use of a biological rhythm interview
Giglio, L. M. F., Magalhães, P. V. D. S., Andreazza, A. C., Walz, J. C., Jakobson, L., Rucci, P., Rosa, A. R., Hidalgo, M. P. L., Vieta, E., & Kapczinski, F. P. (2009) · Journal of Affective Disorders · doi:10.1016/j.jad.2009.01.018 · Cited by 175 · see citing works
Mármol, F. (2008) · Progress in Neuro-Psychopharmacology and Biological Psychiatry · doi:10.1016/j.pnpbp.2008.08.012 · Cited by 174 · see citing works
“induced by bipolar illness episodes (Frank et al., 2000; Hlastala et al., 2000).”
McIntyre, R. S., Alda, M., Baldessarini, R. J., Bauer, M., Berk, M., Correll, C. U., Fagiolini, A., Fountoulakis, K., Frye, M. A., Grunze, H., et al. (2022) · World Psychiatry · doi:10.1002/wps.20997 · Cited by 171 · see citing works
Semi-Automated Tracking: A Balanced Approach for Self-Monitoring Applications
Choe, E. K., Abdullah, S., Rabbi, M., Thomaz, E., Epstein, D. A., Cordeiro, F., Kay, M., Abowd, G. D., Choudhury, T., Fogarty, J. A., et al. (2017) · IEEE Pervasive Computing · doi:10.1109/mprv.2017.18 · Cited by 171 · see citing works
Frank, E., Soreca, I., Swartz, H. A., Fagiolini, A. M., Mallinger, A. G., Thase, M. E., Grochocinski, V. J., Houck, P. R., & Kupfer, D. J. (2008) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2008.07121953 · Cited by 168 · see citing works
“Interpersonal and social rhythm therapy is a modular, manualbased treatment aimed at helping patients stabilize their daily routines and sleep/wake cycles in the hopes of stabilizing endogenous circadian rhythms, gaining insight into the bidirectional relationship between mood and interpersonal events, and resolving i…”
Bonsall, M. B., Wallace-Hadrill, S. M. A., Geddes, J. R., Goodwin, G. M., & Holmes, E. A. (2011) · Proceedings of the Royal Society B Biological Sciences · doi:10.1098/rspb.2011.1246 · Cited by 167 · see citing works
Expressed emotion as a predictor of outcome among bipolar patients undergoing family therapy
Kim, E. (2004) · Journal of Affective Disorders · doi:10.1016/j.jad.2004.02.004 · Cited by 164 · see citing works
“The IFIT protocol combined FFT with individual sessions of interpersonal and social rhythm therapy (Frank et al., 2000).”
MethodKaplan, K. A., Talbot, L. S., Gruber, J., & Harvey, A. G. (2012) · Bipolar Disorders · doi:10.1111/bdi.12021 · Cited by 162 · see citing works
Mansour, H. A., Talkowski, M. E., Wood, J., Chowdari, K. V., McClain, L., Prasad, K., Montrose, D., Fagiolini, A., Friedman, E. S., Allen, M. H., et al. (2009) · Bipolar Disorders · doi:10.1111/j.1399-5618.2009.00756.x · Cited by 161 · see citing works
“Disruption in circadian and social rhythms may precede the onset of manic episodes (20, 21).”
BackgroundSelf-citationAdolescent Neurodevelopment and Vulnerability to Psychosis
Patel, P. K., Leathem, L. D., Currin, D. L., & Karlsgodt, K. H. (2021) · Biological Psychiatry · doi:10.1016/j.biopsych.2020.06.028 · Cited by 152 · see citing works
Social rhythm regularity and the onset of affective episodes in bipolar spectrum individuals
Shen, G. H. C., Alloy, L. B., Abramson, L. Y., & Sylvia, L. G. (2008) · Bipolar Disorders · doi:10.1111/j.1399-5618.2008.00583.x · Cited by 149 · see citing works
“Interpersonal and social rhythm therapy (IPSRT) was developed based on the circadian rhythm theory of bipolar disorder, recognizing the impact of social zeitgebers on these biological rhythms (40).”
Neuropathology of bipolar disorder
Vawter, M. P., Freed, W. J., & Kleinman, J. E. (2000) · Biological Psychiatry · doi:10.1016/s0006-3223(00)00978-1 · Cited by 149 · see citing works
Jones, S. H., Tai, S., Evershed, K., Knowles, R. J., & Bentall, R. P. (2006) · Bipolar Disorders · doi:10.1111/j.1399-5618.2006.00329.x · Cited by 147 · see citing works
Bipolar depression: pharmacotherapy and related therapeutic strategies
Thase, M. E., & Sachs, G. S. (2000) · Biological Psychiatry · doi:10.1016/s0006-3223(00)00980-x · Cited by 145 · see citing works
Circadian genes and bipolar disorder
Mansour, H., Monk, T. H., & Nimgaonkar, V. L. (2005) · Annals of Medicine · doi:10.1080/07853890510007377 · Cited by 142 · see citing works
Bosetti, F., Rintala, J., Seemann, R., Rosenberger, T. A., Contreras, M. A., Рапопорт, С. И., & Chang, M. (2002) · Molecular Psychiatry · doi:10.1038/sj.mp.4001111 · Cited by 137 · see citing works
“While PGE 2 is not the only prostaglandin present in brain, it does represent a major product of the cyclooxygenase reaction and plays a key role in sleep regulation, which is altered in bipolar disorder”
BackgroundKlei, L., Reitz, P., Miller, M., Wood, J. A., Maendel, S., Gross, D., Waldner, T., Eaton, J. W., Monk, T. H., & Nimgaonkar, V. L. (2005) · Chronobiology International · doi:10.1080/07420520500397959 · Cited by 136 · see citing works
“The latter are clearly preferable, but were not feasible here (Frank et al., 2000; Monk et al., 1990, 2002, 2003, 2004).”
BackgroundAnimal models of bipolar mania: The past, present and future
Logan, R. W., & McClung, C. A. (2016) · Neuroscience · doi:10.1016/j.neuroscience.2015.08.041 · Cited by 136 · see citing works
McCarthy, M. J., Gottlieb, J. F., Gonzalez, R., McClung, C. A., Alloy, L. B., Cain, S., Dulcis, D., Etain, B., Frey, B. N., Garbazza, C., et al. (2022) · Bipolar Disorders · doi:10.1111/bdi.13165 · Cited by 136 · see citing works
Self-citationMindfulness‐Based Cognitive Therapy for Nonremitted Patients with Bipolar Disorder
Deckersbach, T., Hölzel, B. K., Eisner, L. R., Stange, J. P., Peckham, A., Dougherty, D. D., Rauch, S. L., Lazar, S. W., & Nierenberg, A. A. (2011) · CNS Neuroscience & Therapeutics · doi:10.1111/j.1755-5949.2011.00236.x · Cited by 131 · see citing works
“These include: (1) interpersonal and social rhythm therapy (IPSRT), which focuses on stabilization of social rhythms, and interpersonal problems such as grief, role transitions, role disputes, and interpersonal difficulties [18], (2) family therapy (e.”
BackgroundColom, F., & Vieta, E. (2004) · Bipolar Disorders · doi:10.1111/j.1399-5618.2004.00136.x · Cited by 129 · see citing works
Jones, S. H. (2001) · Clinical Psychology Review · doi:10.1016/s0272-7358(01)00111-8 · Cited by 126 · see citing works
Hlastala, S. A., Kotler, J. S., McClellan, J., & McCauley, E. (2010) · Depression and Anxiety · doi:10.1002/da.20668 · Cited by 122 · see citing works
“These theoretical models identify three interrelated pathways to symptom exacerbation and/or relapse in bipolar patients (1) medication nonadherence, (2) disruptions to the circadian system (through sleep and social routines), and (3) psychosocial stressors.([31]) Thus, IPSRT attempts to intervene in each pathway to i…”
BackgroundInsomnia before and after treatment for anxiety and depression
Mason, E. C., & Harvey, A. G. (2014) · Journal of Affective Disorders · doi:10.1016/j.jad.2014.07.020 · Cited by 124 · see citing works
Adrenal Clocks and the Role of Adrenal Hormones in the Regulation of Circadian Physiology
Leliavski, A., Dumbell, R., Ott, V., & Oster, H. (2014) · Journal of Biological Rhythms · doi:10.1177/0748730414553971 · Cited by 119 · see citing works
“On the other hand, patients with mood disorders benefit from daily routines that include adherence to a strict bedtime (Frank et al., 2000).”
BackgroundMichalak, E. E., Yatham, L. N., Wan, D. D. C., & Lam, R. W. M. (2005) · The Canadian Journal of Psychiatry · doi:10.1177/070674370505000204 · Cited by 116 · see citing works
“Several multimodal psychotherapeutic interventions have been developed for BD, such as family-focused treatment (FFT) (12,13), interpersonal and social rhythm therapy (14), and cognitive-behavioural therapy (CBT) (15).”
Circadian preference in bipolar disorder
Giglio, L. M. F., Magalhães, P. V. D. S., Andersen, M. L., Walz, J. C., Jakobson, L., & Kapczinski, F. P. (2009) · Sleep And Breathing · doi:10.1007/s11325-009-0301-3 · Cited by 115 · see citing works
“There is a frequent clinical observation of a reversal in the sleep/wake cycle in bipolar disorder [ 20 ].”
BackgroundBehavioral Treatment of Insomnia in Bipolar Disorder
Kaplan, K. A., & Harvey, A. G. (2013) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2013.12050708 · Cited by 115 · see citing works
“Accruing evidence suggests that bipolar disorder is characterized by significant schedule variability (10, 11), along with hypothesized sensitivity to schedule disruption and circadian changes (30), and schedule regularity is an established form of treatment in bipolar disorder (31).”
BackgroundLeibenluft, E., & Rich, B. A. (2008) · Annual Review of Clinical Psychology · doi:10.1146/annurev.clinpsy.4.022007.141216 · Cited by 114 · see citing works
Bender, R. E., & Alloy, L. B. (2011) · Clinical Psychology Review · doi:10.1016/j.cpr.2011.01.004 · Cited by 106 · see citing works
“For example, based on the SRD theory, Frank, Swartz, and Kupfer (2000, 2005) designed Interpersonal and Social Rhythm Therapy (IPSRT).”
MethodIntegrated Family and Individual Therapy for Bipolar Disorder
Miklowitz, D. J., Richards, J. A., George, E. L., Frank, E., Suddath, R. L., Powell, K. B., & Sacher, J. A. (2003) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.v64n0211 · Cited by 109 · see citing works
Self-citationRucci, P., Frank, E., Kostelnik, B., Fagiolini, A. M., Mallinger, A. G., Swartz, H. A., Thase, M. E., Siegel, L., Wilson, D., & Kupfer, D. J. (2002) · American Journal of Psychiatry · doi:10.1176/appi.ajp.159.7.1160 · Cited by 109 · see citing works
Self-citationSubthreshold bipolarity: diagnostic issues and challenges
Nusslock, R., & Frank, E. (2011) · Bipolar Disorders · doi:10.1111/j.1399-5618.2011.00957.x · Cited by 109 · see citing works
“Drawing from IPSRT, individuals could be taught strategies for maintaining consistent social and circadian rhythms and educated on the role that disruptions to these rhythms can have on the course of bipolar disorder (120).”
Self-citationAnimal models for bipolar disorder: from bedside to the cage
Beyer, D. K. E., & Freund, N. (2017) · International Journal of Bipolar Disorders · doi:10.1186/s40345-017-0104-6 · Cited by 110 · see citing works
Bosetti, F., Weerasinghe, G. R., Rosenberger, T. A., & Rapoport, S. I. (2003) · Journal of Neurochemistry · doi:10.1046/j.1471-4159.2003.01701.x · Cited by 108 · see citing works
“Prostaglandin D2 and PGE2 play a key role in sleep–wake regulation and may be disturbed in patients with bipolar disorder, who usually show an abnormal circadian rhythm and sleep–wake cycle (Hayaishi 1999; Frank et al. 2000).”
BackgroundSocial Rhythm and Mental Health: A Cross-Cultural Comparison
Margraf, J., Lavallee, K. L., Zhang, X.-C., & Schneider, S. (2016) · PLoS ONE · doi:10.1371/journal.pone.0150312 · Cited by 107 · see citing works
“Additional support in favor of the link between rhythmicity and mental health comes from therapy research, which indicates that therapy to increase rhythmicity is effective in treating bipolar disorder [14,15,16,17,18].”
BackgroundÉtain, B., Dumaine, A., Bellivier, F., Pagan, C., Francelle, L., Goubran‐Botros, H., Moreno, S., Deshommes, J., Moustafa, K., Dudal, K. L., et al. (2012) · Human Molecular Genetics · doi:10.1093/hmg/dds227 · Cited by 105 · see citing works
Bernert, R., Luckenbaugh, D., Duncan, W., Iwata, N. G., Ballard, E., & Zarate, C. (2016) · Journal of Affective Disorders · doi:10.1016/j.jad.2016.08.050 · Cited by 76 · see citing works
‘Stealing Me from Myself’: Identity and Recovery in Personal Accounts of Mental Illness
Wisdom, J., Bruce, K., Saedi, G. A., Weis, T. R., & Green, C. (2008) · Australian and New Zealand journal of psychiatry (Print) · doi:10.1080/00048670802050579 · Cited by 121 · see citing works
“Current efforts are under way to develop therapies to assist individuals and families as they navigate these tasks, and such efforts would benefit from additional attention [35].”
BackgroundCircadian Rhythms, Melatonin and Depression
A. Quera Salva, M., Hartley, S., Barbot, F., C. Alvarez, J., Lofaso, F., & Guilleminault, C. (2011) · Current Pharmaceutical Design · doi:10.2174/138161211796197188 · Cited by 100 · see citing works
Psychotherapy of bipolar disorder: a review
Jones, S. H. (2003) · Journal of Affective Disorders · doi:10.1016/s0165-0327(03)00111-3 · Cited by 99 · see citing works
GOLDBERG, J., & Garno, J. L. (2005) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2004.11.002 · Cited by 96 · see citing works
Chronobiological theories of mood disorder
Zaki, N. F. W., Spence, D. W., BaHammam, A. S., Pandi-Perumal, S. R., Cardinali, D. P., & Brown, G. M. (2017) · European Archives of Psychiatry and Clinical Neuroscience · doi:10.1007/s00406-017-0835-5 · Cited by 95 · see citing works
“[60] developed interpersonal and social rhythm therapy (IPSRT), an intervention program to repair and merge social rhythm regularity as a protective strategy against relapse into depressed states.”
Development and Evaluation of a Smartphone-Based Measure of Social Rhythms for Bipolar Disorder
Matthews, M. L., Abdullah, S., Murnane, E. L., Voida, S., Choudhury, T., Gay, G. K., & Frank, E. (2016) · Assessment · doi:10.1177/1073191116656794 · Cited by 93 · see citing works
“Therapists particularly focus on educating patients about the disorder including information about symptoms, medications, and the possible role of social and circadian disruptions (Frank, Swartz, & Kupfer, 2000).”
BackgroundSelf-citationA Transdiagnostic Intervention for Youth Sleep and Circadian Problems
Harvey, A. G. (2015) · Cognitive and Behavioral Practice · doi:10.1016/j.cbpra.2015.06.001 · Cited by 94 · see citing works
Chronobiology and mood disorders
Wirz-Justice, A. (2003) · Dialogues in Clinical Neuroscience · doi:10.31887/dcns.2003.5.4/awirzjustice · Cited by 91 · see citing works
Biological rhythms and chronotherapeutics in depression
Geoffroy, P. A., & Palagini, L. (2021) · Progress in Neuro-Psychopharmacology and Biological Psychiatry · doi:10.1016/j.pnpbp.2020.110158 · Cited by 127 · see citing works
When brain clocks lose track of time: cause or consequence of neuropsychiatric disorders
Menet, J. S., & Rosbash, M. (2011) · Current Opinion in Neurobiology · doi:10.1016/j.conb.2011.06.008 · Cited by 91 · see citing works
“It is also noteworthy that treatments of mice [31] and human [32] aimed at reinforcing biological rhythms reduce the neuropathological symptoms associated with some psychotic disorders.”
BackgroundSleep and circadian rhythms in children and adolescents with bipolar disorder
HARVEY, A. G., MULLIN, B. C., & HINSHAW, S. P. (2006) · Development and Psychopathology · doi:10.1017/s095457940606055x · Cited by 88 · see citing works
“IPSRT includes instruction in be- havioral techniques designed to regularize routines and reduce social rhythm disruption ~e.g., Frank et al., 2000!. Cognitive behavior therapy administered individually ~e.g., Lam et al., 2003! or in groups ~e.g., Patelis-Siotis et al., 2001! provides education…”
BackgroundMindfulness-Based Cognitive Therapy for Bipolar Disorder
Stange, J. P., Eisner, L. R., Hölzel, B. K., Peckham, A., Dougherty, D. D., Rauch, S. L., Nierenberg, A. A., Lazar, S. W., & Deckersbach, T. (2011) · Journal of Psychiatric Practice · doi:10.1097/01.pra.0000407964.34604.03 · Cited by 88 · see citing works
Circadian Clocks and Mood-Related Behaviors
Albrecht, U. (2013) · Handbook of experimental pharmacology · doi:10.1007/978-3-642-25950-0_9 · Cited by 86 · see citing works
“Interestingly, nearly all individuals that suffer from mood disorders benefit from strict daily routines including strictly followed bedtime and rise in the morning (Frank et al. 2000).”
BackgroundSocial Rhythm Therapies for Mood Disorders: an Update
Haynes, P. L., Gengler, D. N., & Kelly, M. R. (2016) · Current Psychiatry Reports · doi:10.1007/s11920-016-0712-3 · Cited by 89 · see citing works
“2 Department of Psychology, University of Arizona, 1503 E. University Blvd., P.O. Box 210068, Tucson, AZ 85721, USA Curr Psychiatry Rep (2016) 18: 75”
InfluentialBehavioural sensitization to repeated sleep deprivation in a mice model of mania
BENEDETTI, F., FRESI, F., MACCIONI, P., & SMERALDI, E. (2008) · Behavioural Brain Research · doi:10.1016/j.bbr.2007.09.012 · Cited by 85 · see citing works
Circadian biomarkers, circadian genes and bipolar disorders
Milhiet, V., Étain, B., Boudebesse, C., & Bellivier, F. (2011) · Journal of Physiology-Paris · doi:10.1016/j.jphysparis.2011.07.002 · Cited by 87 · see citing works
“Non pharmacological treatments might also be effective in bipolar disorders such as interpersonal and social rhythm therapy (IPSRT) (Frank et al., 2000), light therapy or sleep deprivation (Wirz-Justice et al.”
Soreca, I., Fagiolini, A. M., Frank, E., Houck, P. R., Thompson, W. K., & Kupfer, D. J. (2008) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2007.10.009 · Cited by 86 · see citing works
“Furthermore, bipolar disorder is uniquely characterized by instability, fluctuations, course variability and unpredictability, ongoing symptoms and ongoing fluctuations during the remitted phase, disruption of circadian rhythms that may all be part of a common diathesis that leads to both psychiatric and medical disor…”
BackgroundSelf-citationMinutes, days and years: molecular interactions among different scales of biological timing
Golombek, D. A., Bussi, I. L., & Agostino, P. V. (2014) · Philosophical Transactions of the Royal Society B Biological Sciences · doi:10.1098/rstb.2012.0465 · Cited by 80 · see citing works
“Conversely, individuals that suffer from mood disorders benefit from predictable daily routines including strictly followed bed- and mealtime [96].”
Jones, S. H., Mansell, W., & Waller, L. (2006) · Journal of Affective Disorders · doi:10.1016/j.jad.2006.01.017 · Cited by 84 · see citing works
“Additionally Frank and colleagues have explored the relationships between social rhythm disruptions and bipolar symptomatology (Frank et al., 2000; MalkoffSchwartz et al., 1998, 2000).”
BackgroundEarly intervention in bipolar disorders: Clinical, biochemical and neuroimaging imperatives
Berk, M., Malhi, G. S., Hallam, K. T., Gama, C. S., Dodd, S., Andreazza, A. C., Frey, B. N., & Kapczinski, F. P. (2008) · Journal of Affective Disorders · doi:10.1016/j.jad.2008.08.011 · Cited by 80 · see citing works
“…thought to precipitate episodes of illness based on triggering innate biological and genetic vulnerabilities, (Kraepelin, 2002, Frank et al., 1997, Frank et al., 2000, Hammen and Gitlin, 1997) later stages are more likely to be associated with endogenous factors and less closely coupled to…”
BackgroundInterpersonal Psychotherapy for Depressed Adolescents (IPT-A)
Mufson, L. H., & Moreau, D. (1999) · Issues in clinical child psychology · doi:10.1007/978-1-4615-4755-6_13 · Cited by 82 · see citing works
Stressful life events in bipolar I and II disorder: Cause or consequence of mood symptoms?
Koenders, M. A., Giltay, E. J., Spijker, A. T., Hoencamp, E., Spinhoven, P., & Elzinga, B. M. (2014) · Journal of Affective Disorders · doi:10.1016/j.jad.2014.02.036 · Cited by 78 · see citing works
“, 2003) and specific psychotherapeutic treatments (Frank et al., 2000) already aim to diminish the impact and occurrence of life events and stress in BD patients to some extent.”
Background
- Authors
- Frank, E., Swartz, H. A., & Kupfer, D. J.
- Affiliations
- University of Pittsburgh (US)
- Corresponding author
- Frank, Ellen
- Venue
- Biological Psychiatry
- Publisher
- Elsevier BV
- Published
- 2000-09
- Volume
- 48
- Issue
- 6
- Pages
- 593-604
- ISSN
- 0006-3223 (ISSN-L)
- OpenAlex
- W2163455012
- Cited by
- 521
- References
- 47
- Citations by year
- 2026: 11 · 2025: 18 · 2024: 18 · 2023: 9 · 2022: 17 · 2021: 18 · 2020: 12 · 2019: 14 · 2018: 20 · 2017: 20 · 2016: 26 · 2015: 19 · 2014: 25 · 2013: 22 · 2012: 24
- FWCI
- 2.78
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Biological Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute of Mental Health (MH60473, MH 29618, R25MH060473, MH30915)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
- Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Keywords
- interpersonal and social rhythm therapy, bipolar disorder, circadian rhythm, sleep-wake cycle, social rhythms, chronobiology, interpersonal psychotherapy, life events, medication adherence, psychosocial interventions
- MeSH terms
- Affect, Behavior Therapy, Bipolar Disorder, Combined Modality Therapy, Humans, Interpersonal Relations, Life Change Events, Models, Psychological, Psychotherapy, Tranquilizing Agents, Randomized Controlled Trials as Topic, Sleep Disorders, Circadian Rhythm
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