The role of interpersonal and social rhythm therapy in improving occupational functioning in patients with bipolar I disorder
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OBJECTIVE: Recent studies demonstrate the poor psychosocial outcomes associated with bipolar disorder. Occupational functioning, a key indicator of psychosocial disability, is often severely affected by the disorder. The authors describe the effect of acute treatment with interpersonal and social rhythm therapy on occupational functioning over a period of approximately 2.5 years. METHOD: Patients with bipolar I disorder were randomly assigned to receive either acute and maintenance interpersonal and social rhythm therapy, acute and maintenance intensive clinical management, acute interpersonal and social rhythm therapy and maintenance intensive clinical management, or acute intensive clinical management and maintenance interpersonal and social rhythm therapy, all with appropriate pharmacotherapy. Occupational functioning was measured with the UCLA Social Attainment Scale at baseline, at the end of acute treatment, and after 1 and 2 years of maintenance treatment. RESULTS: The main effect of treatment did not reach conventional levels of statistical significance; however, the authors observed a significant time by initial treatment interaction. Participants initially assigned to interpersonal and social rhythm therapy showed more rapid improvement in occupational functioning than those initially assigned to intensive clinical management, primarily accounted for by greater improvement in occupational functioning during the acute treatment phase. At the end of 2 years of maintenance treatment, there were no differences between the treatment groups. A gender effect was also observed, with women who initially received interpersonal and social rhythm therapy showing more marked and rapid improvement. There was no effect of maintenance treatment assignment on occupational functioning outcomes. CONCLUSIONS: In this study, interpersonal and social rhythm therapy, with its emphasis on amelioration of interpersonal and role functioning, improved occupational functioning significantly more rapidly than did a psychoeducational and supportive approach with no such emphasis on functional capacities.
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Stabilization of social routines is associated with significantly more rapid improvement in occupational functioning.
“and is associated with significantly more rapid improvement in occupational functioning (Frank et al., 2005; Frank et al., 2008; Miklowitz et al., 2007).”
From Biological rhythms, higher brain function, and behavior: Gaps, opportunities, and challenges (2009) · cites this paper as Frank et al., 2008
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- Authors
- 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.
- Affiliations
- University of Pittsburgh Medical Center (US)
- Venue
- American Journal of Psychiatry
- Published
- 2008-12
- Volume
- 165
- Issue
- 12
- Pages
- 1559-1565
- ISSN
- 0002-953X (ISSN-L)
- 1535-7228
- PMC
- PMC3308335
- OpenAlex
- W2159105931
- Cited by
- 168
- References
- 31
- Citations by year
- 2026: 2 · 2025: 4 · 2024: 8 · 2023: 5 · 2022: 3 · 2021: 5 · 2020: 5 · 2019: 21 · 2018: 5 · 2017: 8 · 2016: 15 · 2015: 18 · 2014: 9 · 2013: 14 · 2012: 14
- FWCI
- 7.48
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- American Journal of Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Use Siena air (University of Siena) (submittedVersion)
- Funders
- National Institute of Mental Health (R01MH081003)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
- Keywords
- interpersonal and social rhythm therapy, bipolar I disorder, occupational functioning, psychosocial disability, psychoeducation, gender differences, maintenance therapy, acute treatment
- MeSH terms
- Adolescent, Adult, Circadian Rhythm, Demography, Female, Humans, Interpersonal Relations, Male, Middle Aged, Psychotherapy, Group, Surveys and Questionnaires, Social Behavior, Treatment Outcome
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