Academic journal article American Journal of Psychotherapy

Brief Interpersonal Psychotherapy (IPT-B): Overview and Review of Evidence

Academic journal article American Journal of Psychotherapy

Brief Interpersonal Psychotherapy (IPT-B): Overview and Review of Evidence

Article excerpt

INTRODUCTION

Depression is a prevalent illness, affecting 16% of individuals over their lifetime (Kessler et al., 2003). However, less than a third of individuals suffering from depression will receive treatment for the disorder (Kessler et al., 2005), and even fewer will receive adequate treatment. In the National Comorbidity replication study Survey (Wang et al., 2005), approximately 40% of respondents with a psychiatric disorder received behavioral health care over a 12-month period, but the number of visits was small: patients treated in the mental health specialty sector received approximately seven visits over the year. Time-limited psychotherapies for depression are typically administered over 12 to 20 sessions (Koss & Shiang, 1994) with the primary goal of symptom remission. Although brief by psychoanalytic standards, even these time-limited treatments may be impractical in routine practice settings where the fiscal constraints of public health care systems, limited availability of trained mental health providers, and low-reimbursement rates for psychotherapeutic services constrain delivery of longer term treatments (Clemens, 2009). Thus, shorter duration treatments, if effective, may better meet the needs of individuals unable to access more time-intensive services.

Little is known about optimal dosage of psychotherapy. A metaanalysis of a large sample of individuals (n = 2,431) pooled from numerous psychotherapy studies found that half of the patients studied achieved symptom relief within eight sessions of open-ended treatment (Howard, Kopta, Krause, & Orlinsky, 1986). Although most studies evaluated in this meta-analysis were naturalistic and included patients suffering from heterogeneous symptoms (diagnoses not specified), this finding raises the possibility that for many patients, eight sessions may be adequate. A randomized study from the United Kingdom compared eight and 16 sessions of two manual-based treatments for depression, cognitive behavior therapy and psychodynamic-interpersonal therapy (not to be confused with interpersonal psychotherapy or IPT), and found no long-term advantage of 16 sessions over eight sessions for either modality (Shapiro et al., 1994). For those who were more severely depressed, 16 sessions were initially associated with better outcomes than eight, but this advantage disappeared when patients were reassessed at one-year follow up (Shapiro et al., 1995).

Although it may seem counterintuitive to believe that patients could achieve the same degree of relief from eight and 16 sessions of therapy, investigations have shown that when the number of therapy sessions is limited from the outset, patients and therapists felt pressured to make more efficient use of psychotherapy. That is, patients who know a priori that a treatment will conclude in eight weeks behave differently over time-move faster-than those assigned to a psychotherapy that is expected to continue for 16 weeks (Barkham, Rees, Stiles, Hardy, & Shapiro, 2002; Reynolds, Stiles, Barkham, & Shapiro, 1996). Thus, the expectation of treatment brevity spurs both patients and therapists to work harder and faster.

RATIONALE FOR DEVELOPMENT OF BRIEF INTERPERSONAL PSYCHOTHERAPY (IPT-B)

Interpersonal psychotherapy (IPT) is an evidence-based psychotherapy for depression (Cuijpers et al., 2011) that, like many time-limited therapies, was originally designed to be administered as a 12-to-16 week intervention (Klerman, Weissman, Rounsaville, & Chevron, 1984). The rationale for developing a briefer form of IPT was two-fold. As outlined above, a paucity of empirical evidence linking increased therapy "dosage" to enhanced therapeutic effects raised the possibility of achieving favorable outcomes with a more limited number of psychotherapy sessions. Also, some depressed individuals are unable to attend 16 sessions of psychotherapy, even when it is offered free of charge and in a convenient location (Swartz et al. …

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