Interpersonal and social rhythm therapy (ISRT) helps people learn to regulate their mood using their natural biological and social routines.

Social rhythm therapy is based on the idea that changes in routine can trigger mood episodes in people who are medically vulnerable, such as those with bipolar disorder.

Your daily routine and habits are called your social rhythms. When the timing of your routine changes, this can disrupt your circadian rhythm (the biological clock that changes how you feel and act during 24 hours).

The stress of interpersonal problems, like relationship conflict, can also impact how stable your mood is throughout the days and weeks.

IPSRT is an add-on therapy for treating bipolar disorder and other mood disorders.

The therapy aims to minimize disruptions to your daily routines and rhythms since these changes can lead to disrupted sleep and an unstable mood in some people.

IPSRT can help to minimize the impact of stress from relationship conflict. During sessions, your therapist will also examine the impacts of stressful, role-changing life events, such as:

  • marriage or divorce
  • getting a new job, or losing a job
  • having a child

Sleep disruption and stress can both increase the chance of hypomania or mania. Since IPSRT can reduce sleep irregularities and ease stress, it can be an effective treatment for bipolar disorder.

It’s important to note that IPSRT is not meant to replace medication for bipolar disorder. Instead, it helps by regulating your schedule to make medication compliance easier. If you’re currently taking medication that your doctor has prescribed, it’s best to continue as directed.

IPSRT assumes that external triggers can activate symptoms in people who have them. For example, if you have allergies and encounter your trigger, you’ll have an allergic reaction.

People prone to mood disruption might notice mood changes from certain triggers, such as:

  • changes to your regular schedule
  • interrupted sleep
  • stress

IPSRT involves regular meetings with a therapist, face to face or via telephone.

There are several stages:

Initial stage

During the initial stage, your therapist will work with you to:

  • help you understand that your mood changes are not your fault, and that there is a medical component
  • identify your current and previous mood patterns
  • examine how certain relationships and behaviors are connected with your mood changes
  • agree on a primary interpersonal area (such as a relationship or communication style) that you want to improve

The initial stage usually lasts for several sessions.

Intermediate stage

This is the stage in which you:

  • use a social rhythm metric tracking form to log your social rhythm regularity
  • review your form with your therapist each week
  • apply feedback from your therapist

Maintenance stage

During the maintenance stage, you work on the skills your therapist has helped you learn. As you build your confidence, you apply these skills to manage disruptions, such as work schedule changes.

At this stage, your therapist visits aren’t as frequent. For example, they may decrease from weekly to bimonthly or monthly until therapy is finished.

IPSRT therapists use the social rhythm metric (SRM) to help you track your daily routine. To use this metric, you log daily event times with the goal of developing a consistent schedule.

SRMs can be detailed or basic. It’s easier to maintain a log when you have fewer items to record, so your therapist might suggest a simplified version that includes events relating to sleep patterns and mealtimes.

Examples of social rhythm metrics include:

  • the time you get out of bed (not just awakening, but physically up from bed)
  • the time of your first contact with another person (interaction matters, so reading a text doesn’t count, but having a text conversation does)
  • the time you start your main activity, such as work, school, or family care
  • the time you eat dinner
  • the time you go to bed

Depending on your circumstance, your therapist might suggest other events to add to the list.

Your SRM is scored based on how many events occur at the same or close to the same time each day. For example, if you wake up at 7 a.m. each day, this counts toward your score.

According to research from 2014, a higher SRM score is associated with:

An important part of IPSRT is social zeitgeber theory. Zeitgeber is German for “time giver” and refers to any environmental cue influencing your circadian system.

The most well-known zeitgeber is changing daylight brought about by sunrise and sunset. Other zeitgebers include:

  • meals
  • physical activity
  • social encounters

Zeitstörer” means time disrupter and covers such circadian interrupters as time zone travel and nighttime screen use.

IPSRT can benefit people living with conditions like mood disorders. It can help with:

  • medication adherence
  • learning and using coping strategies for managing stressful events
  • minimizing social rhythm disruptions

A 2020 study involving people with bipolar disorder found that participants who received IPSRT experienced improvements to:

  • anxious, depressive, and manic symptoms
  • global functioning
  • response to mood stabilizers

IPSRT may also be an effective strategy for preventing new-onset bipolar disorder in young people with a parent who has bipolar disorder, as demonstrated in a 2018 study.

Although it was originally designed to treat bipolar disorder, studies are assessing IPSRT as a possible therapy for other conditions, such as:

IPSRT is a therapy designed to help people with mood disorders. It helps to regulate sleep and circadian schedules and teaches coping skills that reduce the impact of stressful life events.

It was originally developed by Ellen Frank, PhD, to treat people with bipolar disorder. This therapy aims to promote consistent daily routines to stabilize circadian timing.

IPSRT isn’t meant to replace medication but instead to add on additional support.

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