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Interpersonal Psychotherapy for Depression Bob Hill, Ph.D. Appalachian State University Boone, NC 28608

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Presentation on theme: "Interpersonal Psychotherapy for Depression Bob Hill, Ph.D. Appalachian State University Boone, NC 28608"— Presentation transcript:

1 Interpersonal Psychotherapy for Depression Bob Hill, Ph.D. Appalachian State University Boone, NC 28608 Email: hillrw@appstate.edu

2 Overview Depression Depression Theoretical Sources for IPT Theoretical Sources for IPT Prominent Features of IPT Prominent Features of IPT Outline of IPT Outline of IPT Phases of IPT Treatment Phases of IPT Treatment Clinical Examples Clinical Examples Empirical Support Empirical Support

3 Depression IPT clearly effective for treating Depression IPT clearly effective for treating Depression Diagnostic Criteria for Depression: Diagnostic Criteria for Depression: A.Five (or more) of the following symptoms have been present during the same 2-week period; at least one of the symptoms is either 1.depressed mood most of the day, nearly every day, as indicated by either subjective report or observation made by others. Note in children, can be irritable mood. 2. anhedonia: markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day

4 Depression Criteria continued (2+ needed): 3.significant weight loss when not dieting or weight gain or decrease or increase in appetite.. 4.insomnia or hypersomnia nearly every day 5.psychomotor agitation or retardation observable by others 6.fatigue or loss of energy nearly every day 7.feelings of worthlessness or excessive or inappropriate guilt 8.diminished ability to think or concentrate, or indecisiveness 9.recurrent thoughts of death, recurrent suicidal ideation with or without a specific plan, or suicidal intent.

5 Reasons to consider Medication Client too depressed to participate in treatment Client too depressed to participate in treatment Client not psychological, resistant to talking tx Client not psychological, resistant to talking tx Client who is at risk for suicide Client who is at risk for suicide Client with recurrent Depressive episodes, with symptoms of Melancholic Features Client with recurrent Depressive episodes, with symptoms of Melancholic Features  May respond more quickly with medication and IPT combined

6 Depression with Melancholic Features 1) anhedonia 1) anhedonia 2) lack of reactivity to usually pleasant stimuli 2) lack of reactivity to usually pleasant stimuli 3) Three or more of: 3) Three or more of:  Distinct quality of depressed mood  Depression is worse in a.m.  Early morning awakening (at least 2 hrs)  Marked psychomotor agitation or retardation  Significant anorexia or weight loss  Excessive or inappropriate guilt  Psychotic symptoms  Suicide risk

7 Prevalence of Depression Dysthymia DepressionDisorderTotalMalesFemales 6.4 % 6.4 % 4.8 % 4.8 % 8.0 % 8.0 % 17.1 % 12.7 % 21.3 % National Comorbidity Survey (1994)

8 Historical Influences of IPT Psychoanalysis Psychoanalysis Harry Stack Sullivan Harry Stack Sullivan Object Relations Therapy Object Relations Therapy Interpersonal Theory (Leary, Kiesler) Interpersonal Theory (Leary, Kiesler)

9 IPT: Roots in Psychodynamic Theory Primary instincts of sex and aggression involve relating to others Relationships with others contribute to personality development Psychological Problems due to deficits in early relations   Transference and counter-transference are interpersonal

10 Object Relations Influence “Object” is human being “Object” is human being “Relations” are internal, external, fantasied or real interactions with others “Relations” are internal, external, fantasied or real interactions with others Early parent-child relations are internalized as expectations for future relationships Early parent-child relations are internalized as expectations for future relationships Identity/personality derived from pattern of early relationship experiences Identity/personality derived from pattern of early relationship experiences Expectations of others impacts quality of current interpersonal relationships and mood Expectations of others impacts quality of current interpersonal relationships and mood

11 Manualized Interpersonal Therapy Klerman, G. (1984). Interpersonal Psychotherapy for Depression. Klerman, G. (1984). Interpersonal Psychotherapy for Depression. Weissman, M. (2002). Comprehensive Guide to Interpersonal Psychotherapy. Weissman, M. (2002). Comprehensive Guide to Interpersonal Psychotherapy.

12 Prominent Features of IPT IPT designed for symptom reduction and improved interpersonal relationships IPT designed for symptom reduction and improved interpersonal relationships Focus on current disputes, frustrations, anxieties in the interpersonal context which impact mood and self esteem Focus on current disputes, frustrations, anxieties in the interpersonal context which impact mood and self esteem

13 IPT Compared to Other Therapies Time-limited- outcome studies document efficacy of short-term (12-16 weeks) tx Time-limited- outcome studies document efficacy of short-term (12-16 weeks) tx  Not designed for personality change Focused on current interpersonal disputes, anxieties, frustrations Focused on current interpersonal disputes, anxieties, frustrations  Addresses 1-2 problem areas in interpersonal functioning

14 IPT Compared to Other Therapies Interpersonal, not intrapsychic Interpersonal, not intrapsychic Interpersonal, not Cognitive Behavioral Interpersonal, not Cognitive Behavioral  Goal is to change feelings, thoughts, actions in problematic relationships  Negative/irrational cognitions are addressed only in interpersonal function  IPT attends to distorted thinking in relation to significant others  Goal is to change relationship pattern rather than depressive cognitions

15 IPT Compared to CBT Focus on affect and expression of emotions Focus on affect and expression of emotions Explores avoidance and resistance behavior Explores avoidance and resistance behavior Identification of patterns in client’s behavior, thinking, feeling and relationships Identification of patterns in client’s behavior, thinking, feeling and relationships Attention to past experiences Attention to past experiences Focus on interpersonal experience Focus on interpersonal experience Emphasis on the therapeutic relationship Emphasis on the therapeutic relationship Exploration of client’s wishes, dreams, fantasies Exploration of client’s wishes, dreams, fantasies Blagys & Hilsenroth, 2000

16 IPT and Personality Change IPT does not target alteration of personality IPT does not target alteration of personality Personality pathology may limit IPT outcome Personality pathology may limit IPT outcome IPT may help patient recognize maladaptive personality features IPT may help patient recognize maladaptive personality features IPT may improve social skills and thus ameliorate maladaptive personality traits IPT may improve social skills and thus ameliorate maladaptive personality traits

17 Role of IPT Therapist Therapist is patient advocate, not neutral Therapist is patient advocate, not neutral Expresses unconditional positive regard Expresses unconditional positive regard Intentionally cultivates positive expectations of treatment Intentionally cultivates positive expectations of treatment  Optimistic, positive, reassuring Therapist is active in keeping interpersonal problem areas to focus Therapist is active in keeping interpersonal problem areas to focus

18 Outline of IPT Intervention Initial Sessions (Overview) Assess Depressive symptoms Assess Depressive symptoms Complete Interpersonal Assessment Complete Interpersonal Assessment Identify Major Interpersonal Problem Area Identify Major Interpersonal Problem Area Explain IPT and make treatment contract Explain IPT and make treatment contract

19 Initial Sessions (“Sick Role”) Review Sxs, Dx of depression to communicate “sick role” Review Sxs, Dx of depression to communicate “sick role” Functions of “Sick Role” Functions of “Sick Role”  Sick person exempt from responsibilities  Sick person in need of help  Sick is undesirable and needs to be improved  Sick person obliged to cooperate with Tx  Sick role shifts blame from client to illness  Mitigates self blame

20 Relate Depression to Interpersonal Context What interpersonal events related to depression? Review current & past interpersonal relationships Who does client interact with? Who does client interact with? Frequency of contact, activities shared? Frequency of contact, activities shared? Assess quality and themes of relationships Assess quality and themes of relationships Assess expectations of client (and other) in relationships Assess expectations of client (and other) in relationships Assess satisfying and unsatisfying aspects of relationships Assess satisfying and unsatisfying aspects of relationships Discuss changes client wants in relationships Discuss changes client wants in relationships

21 Inventory of Interpersonal Problems 64 items assess diverse interpersonal problems: 64 items assess diverse interpersonal problems: Being too controlling or manipulative Being too controlling or manipulative Being self-centered and resentful Being self-centered and resentful Having minimal feelings of affection for, and little connection with, other people Having minimal feelings of affection for, and little connection with, other people Being socially avoidant Being socially avoidant Being nonassertive Being nonassertive Being gullible and easily taken advantage of Being gullible and easily taken advantage of Being excessively selfless, generous, trusting, Being excessively selfless, generous, trusting, Being too intrusive Being too intrusive

22 Interpersonal Problems Circumplex

23 IIP Circumplex Evan

24 IIP Scale Profile

25 Identification of Major Problem Area Assess interpersonal experience and depression to identify of one of Four Problem Areas: Interpersonal Role Dispute: with spouse, lover, family member, friends, co-worker Interpersonal Role Dispute: with spouse, lover, family member, friends, co-worker Role Transition: e.g. new job, relocation, divorce Role Transition: e.g. new job, relocation, divorce Interpersonal Deficits: evidenced by social impoverishment, loneliness, isolation Interpersonal Deficits: evidenced by social impoverishment, loneliness, isolation Grief: following death if abnormally severe, protracted or impairing Grief: following death if abnormally severe, protracted or impairing

26 Problem Area Focus Four problems areas are: Four problems areas are:  Not exhaustive, nor mutually exclusive  Not “deep” conceptual theory Communicate to client Problem area focus Communicate to client Problem area focus  Problem area ensures focus on recognized problem rather than personal weakness E.g. ‘try to discover what you want and need from others and help you learn how to get it’ E.g. ‘try to discover what you want and need from others and help you learn how to get it’

27 Explain Interpersonal Focus Tx focus will be interpersonal satisfaction, not intrapsychic exploration Tx focus will be interpersonal satisfaction, not intrapsychic exploration Educate about link between depressed mood and difficulty getting what we want/need from others Educate about link between depressed mood and difficulty getting what we want/need from others Therapist describes nature of clients interpersonal difficulty Therapist describes nature of clients interpersonal difficulty Agree on goal of improved interpersonal relations Agree on goal of improved interpersonal relations Set expectation: make changes btwn sessions Set expectation: make changes btwn sessions

28 Setting Treatment Contract Set 2 –3 treatment goals with client related to problem area focus Set 2 –3 treatment goals with client related to problem area focus Ask client what would be the: Ask client what would be the:  Best possible outcome  Most expectable outcome  Worst possible outcome Describe expected Duration and Frequency of treatment (12-16 weeks) Describe expected Duration and Frequency of treatment (12-16 weeks)

29 Teaching Client Their Role in IPT “Talk about things that affect you emotionally “Talk about things that affect you emotionally “Your responsibility to select topics that are most important to you” “Your responsibility to select topics that are most important to you” “No right or wrong thing to talk about” “No right or wrong thing to talk about” “When important feelings emerge, raise them” “When important feelings emerge, raise them”  “including feeling about me or the therapy”

30 Starting Intermediate Sessions Initial Assessment and Development of Treatment Contract Typically 2-3 Sessions Initial Assessment and Development of Treatment Contract Typically 2-3 Sessions Important tasks of Intermediate Sessions: Important tasks of Intermediate Sessions:  Help client discuss topics pertinent to problem area  Attend to clients affective state  Assist client in discussing therapeutic relationship  Prevent client from sabotaging treatment

31 Interpersonal Disputes: Diagnosis Current Overt or Covert disputes with a significant other Current Overt or Covert disputes with a significant other Client and other have non-reciprocal expectations Client and other have non-reciprocal expectations Dispute related to onset or perpetuation of depression Dispute related to onset or perpetuation of depression Client demoralized about relationship Client demoralized about relationship  Poor patterns of communication  or irreconcilable differences

32 Interpersonal Disputes: Goals Identify the dispute Identify the dispute Make choices about a plan of action Make choices about a plan of action Modify communication patterns or Modify communication patterns or Reassess Expectations Reassess Expectations Consider satisfying needs outside relationship Consider satisfying needs outside relationship

33 Interpersonal Disputes: Strategies Assess stage of Role Dispute: Assess stage of Role Dispute: Impasse- discussion stopped, low-level resentment exists Impasse- discussion stopped, low-level resentment exists  Tx may initially increase disharmony Renegotiation- aware of differences, actively trying to change Renegotiation- aware of differences, actively trying to change  Tx may require calming parties to facilitate resolution Dissolution- implies the relationship is irretrievably disrupted Dissolution- implies the relationship is irretrievably disrupted  Treatment may resemble grief therapy

34 Interpersonal Disputes: Issues Differences in expectations/values between client and other? Differences in expectations/values between client and other? Clients wishes in relationship? Other wishes? Clients wishes in relationship? Other wishes? What are the client’s options? What are the client’s options? How have they resolved disagreements in past? How have they resolved disagreements in past? Strengths and weaknesses in relationship? Strengths and weaknesses in relationship? What changes are realistically possible? What changes are realistically possible?

35 Interpersonal Disputes: Strategies Find Parallels in previous relationships Find Parallels in previous relationships What does client gain by the behavior? What does client gain by the behavior? What are unspoken assumptions that lie behind behavior? What are unspoken assumptions that lie behind behavior? Optimistic tone: “lets figure out what went wrong here so we can decide how to help you make it better” Optimistic tone: “lets figure out what went wrong here so we can decide how to help you make it better” Often communication problems are revealed- Tx involves improving skills Often communication problems are revealed- Tx involves improving skills

36 Interpersonal Disputes: Strategies Help identify “mixed feelings” e.g. anger, fear, sadness Help identify “mixed feelings” e.g. anger, fear, sadness Devise strategies for managing feelings e.g. direct communications, reducing irrational suspicions Devise strategies for managing feelings e.g. direct communications, reducing irrational suspicions Role Play Role Play  Rehearse expressing feelings and wishes  Anticipate communication problems Consider Conjoint sessions with significant other Consider Conjoint sessions with significant other

37 Problem Area: Role Transitions Diagnosis: Depression and interpersonal problems related to role changes Diagnosis: Depression and interpersonal problems related to role changes  e. g. separation/divorce, children left home, start/end job or school, retired, promoted, financial or health problems Assess: How did life change? What people in you life changed or left? Assess: How did life change? What people in you life changed or left?

38 Role Transition: Tx Strategies Facilitate evaluation of lost role Facilitate evaluation of lost role  “Tell me about the old ___. What were the good, and bad, things? What has changed? Encourage expression of affect Encourage expression of affect  How did it feel to give up ___? Identify positive aspects of new role Identify positive aspects of new role  Are there potential benefits?

39 Role Transition: Tx Strategies Develop Social Skills needed for new role Develop Social Skills needed for new role  What is required in new role?  Are assumptions of role demands accurate? Role play or rehearse difficult situations Role play or rehearse difficult situations  Assist with managing performance anxiety Establish new relationships and social support Establish new relationships and social support  Facilitate discovery of new opportunities for social support

40 Interpersonal Deficits: Diagnosis History of social impoverishment, chronic inadequate or unsustained relationships History of social impoverishment, chronic inadequate or unsustained relationships Consider Dysthymia (or Double Depression) Consider Dysthymia (or Double Depression)  IPT adaptation for dysthymia Long standing or temporary deficits in social skills yields low self-esteem, withdrawal Long standing or temporary deficits in social skills yields low self-esteem, withdrawal

41 Interpersonal Deficits: Goals Reduce Client’s social isolation Reduce Client’s social isolation Enable: Enable:  close relationships with intimates or family members  satisfying relationships with friends  adequate relationships in work role

42 Interpersonal Deficits: Strategies Review past significant relationships Review past significant relationships  including childhood relationships with family members  depressed patients minimize or forget positive experiences explore repetitive or parallel problems in past relationships explore repetitive or parallel problems in past relationships  define interpersonal situations that lead to difficulties

43 Interpersonal Deficits: Strategies Use therapist-client relationship Use therapist-client relationship  explore client’s positive and negative feelings toward therapist  discuss distorted or unrealistic thoughts or feelings toward therapist  model resolution of relationship tension by open and genuine communication

44 Interpersonal Deficits: Strategies Encourage patient to increase social interactions Encourage patient to increase social interactions  review attempts in treatment to identify deficits  identify deficits in communication skills  look for assumptions client makes about others thoughts and feelings

45 Use Communication Analysis Get detailed account of conversation or argument Get detailed account of conversation or argument identify communication difficulties identify communication difficulties  ambiguous, indirect, & non-verbal as substitute for open confrontation  incorrect assumptions re communication  assuming that others know their feelings  accompanied by anger, frustration, silence  failing to make sure they are heard, understood

46 Use Communication Analysis Incorrect interpretation of others statements Incorrect interpretation of others statements  perceive criticism where none intended indirect verbal communication indirect verbal communication  inhibited directly expressing expectations or criticism  instead use hints and ambiguous messages  prone to build resentments toward others who are unaware of offense  silence - unaware of destructive impact

47 Use Communication Analysis Use role playing Use role playing  rehearse difficult interactions with client  explore style of communicating with others  practice new skills  e.g. expressing anger or being assertive  rehearsal with therapist increases client’s interpersonal confidence

48 Interpersonal Deficits: Prognosis Treatment of interpersonal deficits difficult Treatment of interpersonal deficits difficult client often lacks relationships to practice and develop skills client often lacks relationships to practice and develop skills treatment goals limited to making early gains interpersonally, not resolving interpersonal deficits treatment goals limited to making early gains interpersonally, not resolving interpersonal deficits

49 Grief Problem Area Focus Normal Grief involves: Normal Grief involves:  Symptoms including sadness, disturbed sleep, agitation, impairment, etc.  Symptoms usually resolve in 2 –4 weeks without treatment

50 Abnormal Grief Evidence Inadequate grief in bereavement period Inadequate grief in bereavement period Multiple losses Multiple losses Avoidance behavior (re funeral, grave, talk) Avoidance behavior (re funeral, grave, talk) Symptoms around significant anniversary Symptoms around significant anniversary Preserving environment of deceased Preserving environment of deceased Fear of illness that caused death Fear of illness that caused death Absence of social support during bereavement Absence of social support during bereavement

51 Abnormal Grief Treatment Goals Facilitate the mourning process Facilitate the mourning process Help client reestablish interests and relationships to substitute for what has been lost Help client reestablish interests and relationships to substitute for what has been lost

52 Grief Treatment Strategies Explore Events and Elicitation of Feelings Explore Events and Elicitation of Feelings  Discuss events prior to, during and after the death Reconstruction of Relationship Reconstruction of Relationship  Use photos and stories to discuss relationship  Use belongings and memories to evoke painful feelings client has avoided  What were the ups and downs in relationship? (normalize negative features) Facilitate Expression of Affect

53 Grief Treatment Strategies (cont.) Behavior change: Behavior change:  Plan and discuss development of new social relationships (e.g. organizations, church, work, dating)  Support client as they learn to fill “empty space”

54 Termination of Treatment For time-limited treatment, important to keep initial contract for 12-16 weeks For time-limited treatment, important to keep initial contract for 12-16 weeks Termination Treatment issues Termination Treatment issues  explicit discussion of termination during last 3- 4 sessions  acknowledge ending may involve loss and grief  normalize fear, anger, sadness  may need to distinguish sadness from depression

55 Termination Issues Foster client’s self-confidence in coping independently Foster client’s self-confidence in coping independently deflect client’s attribution of success to therapist deflect client’s attribution of success to therapist call attention to client’s accomplishments call attention to client’s accomplishments anticipate future difficulties with client anticipate future difficulties with client  help plan for future problems  rehearse explicit scenarios if helpful  discuss possibility of relapse of depression

56 Termination Difficulties Failure depression to resolve Failure depression to resolve  refer for other treatment, encourage hope client wants to continue client wants to continue  schedule 8 week waiting period  impart to client self-confidence in ability to cope maintenance IPT may be appropriate for: maintenance IPT may be appropriate for:  chronic or recurring depression  clients with personality problems or interpersonal deficits

57 Specific IPT Techniques Essential IPT techniques include: Essential IPT techniques include:  discuss feelings (both positive & negative) about interpersonal experience  take action to change interpersonal experience  Other IPT techniques common to other psychotherapies

58 Exploratory Techniques Non-directive exploration Non-directive exploration Begin sessions with: “How have things been since we last met?” Begin sessions with: “How have things been since we last met?” use open-ended questions use open-ended questions encourage clients sense of responsibility encourage clients sense of responsibility Direct questioning Direct questioning  necessary to review depressive symptoms  necessary to review interpersonal relationships

59 Encourage Affect Learning in psychotherapy is emotional learning Learning in psychotherapy is emotional learning eliciting affect informs client re meaningful goals eliciting affect informs client re meaningful goals facilitate acceptance of painful affect facilitate acceptance of painful affect  encourage clear expression of painful, suppressed or unacknowledged feelings  inquire into sensitive areas

60 Use emotions in relationships Assist client to negotiate painful affect in significant relationships Assist client to negotiate painful affect in significant relationships client may change relationship behavior (self or other) to eliminate painful affect client may change relationship behavior (self or other) to eliminate painful affect client may learn new ways to cope with anger or anxiety client may learn new ways to cope with anger or anxiety client may eliminate irrational thinking and emotional sequelae client may eliminate irrational thinking and emotional sequelae

61 Help Client with suppressed emotions For Clients who may be emotionally constricted or unassertive For Clients who may be emotionally constricted or unassertive client may lack awareness or confidence to express client may lack awareness or confidence to express some clients distressed by strong emotions (e.g. trauma history) may need help suppressing overwhelming emotions some clients distressed by strong emotions (e.g. trauma history) may need help suppressing overwhelming emotions  may be counter-productive to encourage emotional display

62 Clarification Communication techniques to review content, clarify feelings, promote awareness Communication techniques to review content, clarify feelings, promote awareness  repeating, rephrasing statements  calling attention to logical implications of statements  raising contradictions or contrasts Alert client to false, irrational or pervasive beliefs regarding interpersonal relationships Alert client to false, irrational or pervasive beliefs regarding interpersonal relationships

63 Communication Analysis Identify communication failures to improve relationship satisfaction Identify communication failures to improve relationship satisfaction Frequently review important conversations or arguments Frequently review important conversations or arguments Illuminate common communication difficulties Illuminate common communication difficulties

64 Use of Therapeutic Relationship Client’s feelings toward therapist and therapy are helpful focus Client’s feelings toward therapist and therapy are helpful focus  may reflect characteristic ways of feeling and behaving in other relationships Therapist instructs client to express complaints, fears, that arise about therapist Therapist instructs client to express complaints, fears, that arise about therapist  model genuine negotiation with such feeling  therapist can correct distortions and acknowledge genuine deficiencies

65 Directive Techniques Include educating, advising, modeling Include educating, advising, modeling initially open to practical help: depressed clients may need “case management” initially open to practical help: depressed clients may need “case management” provide suggestions if client unable to make successful decisions independently provide suggestions if client unable to make successful decisions independently modeling may involve informing client how therapist might handle similar situation modeling may involve informing client how therapist might handle similar situation use directive techniques sparingly use directive techniques sparingly  use early, w/o undermining clients autonomy

66 Decision Analysis Depressed clients often have history of self- defeating decisions Depressed clients often have history of self- defeating decisions  because they fail to consider consequences  and fail to see alternatives Therapist helps with decision analysis to help client recognize range of options Therapist helps with decision analysis to help client recognize range of options  insist on delaying action until each option is explored  for interpersonal situations

67 Decision Analysis Involves Set goal for interpersonal situation: “What do you want to happen?” Set goal for interpersonal situation: “What do you want to happen?” Consider all useful alternatives Consider all useful alternatives  observe alternatives that client omits direct client to explore probable consequences of each line of behavior direct client to explore probable consequences of each line of behavior  clients often restrict range of alternatives or unrealistically assess consequences beware of premature decision analysis beware of premature decision analysis

68 Role Playing Useful to explore client’s feelings and style of communicating with others Useful to explore client’s feelings and style of communicating with others Rehearse new ways for client to communicate in safe setting Rehearse new ways for client to communicate in safe setting  e.g. practice more assertiveness or expressing affection Bolsters client’s self-confidence in communicating genuinely Bolsters client’s self-confidence in communicating genuinely

69 Evidence for IPT Efficacy Boston-New Haven Study (1979) Boston-New Haven Study (1979) 4 Tx Groups (16 wks & 1yr follow-up): 4 Tx Groups (16 wks & 1yr follow-up): IPT, amitriptyline, both combined, control IPT, amitriptyline, both combined, control IPT and amitriptyline equally effective IPT and amitriptyline equally effective Combination IPT & amitrip. most effective Combination IPT & amitrip. most effective IPT grp. Sustained improved psychosocial functioning 1 yr later (not amitrip. Grp) IPT grp. Sustained improved psychosocial functioning 1 yr later (not amitrip. Grp)

70 NIMH Tx Depression Research (1989) 4 Tx grps (16 wks, multi-site, N=250) 4 Tx grps (16 wks, multi-site, N=250) IPT, CBT, Imipramine & clinical management (CM), placebo & CM IPT, CBT, Imipramine & clinical management (CM), placebo & CM IPT comparable to Imipramine & CM IPT comparable to Imipramine & CM CBT showed somewhat less improvement CBT showed somewhat less improvement IPT grp. had lowest attrition rate IPT grp. had lowest attrition rate Results for mod.-severe depression Results for mod.-severe depression

71 Brain Activity Changes with either IPT or Antidepressant Tx Pet scans showed higher prefrontal and less temporal activity in depressed vs controls Pet scans showed higher prefrontal and less temporal activity in depressed vs controls Both IPT and Paxil resulted in normalized Pet scan activity and improved Dep. Sxs Both IPT and Paxil resulted in normalized Pet scan activity and improved Dep. Sxs Brody (2001); Martin (2001) Brody (2001); Martin (2001)

72 IPT Also Useful for Treating: Dysthymia (see chapter in Weissman (2000) Comprehensive Guide to IPT) Dysthymia (see chapter in Weissman (2000) Comprehensive Guide to IPT) Social Phobia (Lipsitz et al., 1999) Social Phobia (Lipsitz et al., 1999) Adolescent Depression (Muffson et al., 1999) Adolescent Depression (Muffson et al., 1999) Postpartum Depression ( Postpartum Depression (O’Hara et al., 2000) Bulimia (Wilson et al., 2002) Bulimia (Wilson et al., 2002) Late-Life Depression ( Late-Life Depression (Miller et al., 2001)

73 Bob Hill’s IPT Website: Click on link at: http://www.appstate.edu/~hillrw/


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