認識人際心理治療
IPT的起源是什麽？
IPT於1970年代由美國精神科醫生Gerald L. Klerman 醫學博士、Myrna M. Weissman 博士及其同事共同開發，原本設計為一項隨機對照研究的研究工具，比較藥物治療、人際心理治療、和安慰劑對嚴重抑鬱症患者的治療成效。他們發現：
1. 許多人的情緒問題與人際關係的挑戰有關。
2. IPT 的效果優於安慰劑。
3. IPT 與藥物聯合治療的效果優於單獨使用任一種治療。
4. 一年後的數據顯示，IPT 幫助患者提升了社交技能，而藥物治療則無法達到這一效果。
經過多年研究，IPT已被證實有效於治療抑鬱症，並擴展應用於其他心理問題，如焦慮症、燥狂抑鬱症、飲食失調和創傷後壓力症候群（PTSD）。至今全球已發表超過250項隨機對照研究，證實了IPT的成效。
IPT是一種以人際關係為核心的心理治療，幫助您處理因人際關係問題而引發的情緒困擾。它認為心理問題（如抑鬱症）與人際關係的困難密切相關——人際關係的問題會影響心理健康，而抑鬱徵狀也會令病人的社交更加困難。
IPT透過實質的治療策略，幫助病人改善這些關係，緩解情緒問題。
IPT was developed by Dr Gerald L. Klerman and Dr Myrna M. Weissman.
In 1970 in Yale University, Dr Gerald Klerman was to design a study to test the efficacy of amitriptyline, with and without psychotherapy. Dr Myrna Weissman was tasked to design the psychotherapy. Influenced by the work of Harry Stack Sullivan, Adolf Meyer and John Bowlby, a psychotherapy manual was created, which later become known as interpersonal psychotherapy (IPT). The basic assumption was the onset and recurrence of a depressive episode were related to the patient’s social and interpersonal relationships. Early result showed that IPT was useful in the acute treatment of depression, particularly when combined with antidepressant.
The first IPT manual was published in 1984, after the efficacy of IPT had been independently demonstrated by other research group. After the publication of the first manual, many studies and adaptations of IPT followed, including IPT for adolescents, the elderly, pregnant and postpartum women, women after miscarriage, medical patients, and as part of maintenance therapy for recurrent depression and bipolar disorder, eating disorders, anxiety disorders, posttraumatic stress disorder, and depression in developing countries. The IPT manual has been translated into 10 languages.
Dr Klerman died in 1992, and Dr John Markowitz, one of Dr Klerman’s last trainees, joined Dr Weissman in updating the IPT manual over the years. The earliest gatherings of IPT professionals were held in conjunction with meetings of the American Psychiatric Association in the late 1990’s, organised by Dr John Markowitz.
In 2002, the International Society of Interpersonal Psychotherapy (ISIPT) was formally incorporated in Australia under the leadership of Rebecca Reay and Dr Michael Robertson. The organisation moved to the United States in 2010 under the leadership of Dr Scott Stuart. ISIPT’s first formal elections were held in 2015 and Dr Holly Swartz was ISIPT’s first elected President.
As of today, the ISIPT has been at the forefront in supporting IPT research and training. It serves at a pivotal role in supporting the professional development of IPT practitioners from around the world. The ISIPT holds a bi-annual conference to allow global IPT therapists and trainers to gather together, share their expertise, and to advance the development of IPT.
MM Weissman. Interpersonal Psychotherapy: History and Future. Am J Psychiatry Published Online: 22 Nov 2019.
IPT的治療有什麽特色？
- 時限性：IPT 最初設計為每周一次 50 分鐘的個人治療，爲期 12 至 16 周。在臨床實踐中，治療師可以根據患者需求調整療程長度，但從一開始就應設定明確的治療時限，令治療師和患者雙方都有清晰的目標和動力進行治療，在有限時間內集中精力解決核心問題。
- 簡單而結構化：IPT 有明確的治療手冊和步驟，避免治療的效果因爲治療師的不同而出現偏差。
- 針對性治療：IPT 針對處理患者現時面對跟抑鬱徵狀相關的人際問題，較少處理患者的童年創傷、固有思維模式等其他方面的心理狀況，令治療重點和脈絡清晰明確。
IPT的治療重點是甚麼？
IPT專注於四個主要的人際心理範疇：
- 人際紛爭（Interpersonal Disputes）：與他人（如家人、朋友或伴侶）的爭執或誤解。
- 角色改變（Role Transitions）：生活中的重大變化，如結婚、生子、失業或退休。
- 失去與哀傷（Grief and Loss）：因失去親人或重要關係而感到悲傷。
- 人際缺陷（Interpersonal Deficits）：當患者長期缺乏良好的人際關係時，治療會集中於改善社交能力和建立關係。
治療師會與病人一起找出最影響病人情緒的心理範疇，並制定計劃來應對這些挑戰。
IPT的治療分哪些階段？
IPT通常是短期治療，持續12至16週，每週一次，每次約50分鐘。IPT的治療過程分為三個主要階段：
- 初期（第1-3週）：治療師會與病人建立信任關係，了解病人的背景和現時面對的問題。他們會評估患者的情緒狀況，透過不同的工具（詳見附錄）形象化地呈現患者現時的人際關係，梳理各項影響情緒的因素。雙方會共同選定一個顯示最主要影響病人情緒的人際心理範疇，並設定接下來治療目標。
- 中期（第4-12週）：這是治療的核心階段，治療師會幫助患者專注於選定的人際問題，使用具體的策略來改善其關係和情緒。
- 末期（第13-16週）：治療師會與患者回顧進展，討論如何將學到的技巧應用於未來，並準備結束治療。這個階段也會處理病人對於結束治療而產生的情緒。
每個階段都以清晰的目標和步驟推進，確保治療有條理且有效。然而，治療的長度和階段也有相當的彈性，可以因應病人的病情進展而作出微調。
IPT有哪些關鍵策略？
IPT使用多種策略來幫助病人改善人際關係和情緒健康，例如：
- 情緒探索（Facilitation of Affect）：治療師會幫助患者解自己的感受，並將其與人際關係聯繫起來。治療師會鼓勵患者表達和理解自己的情緒，例如在失去親人時的悲傷或衝突中的憤怒。
- 溝通分析（Communication Analysis）：治療師會和患者詳細回顧最近一次與他人的對話，就像“電影劇本”一樣，分析對話的細節。在治療過程中，治療師和病人會一起分析並找出當中的誤解或無效的溝通模式，思考如何能更清晰直接地表達您的需要。
- 角色扮演（Role Playing）：透過模擬真實情境，幫助病人換位思考，瞭解對方在溝通時的感受。在扮演中治療師和病人會練習新的溝通技巧，檢視與他人解決衝突的更好方式。
- 問題解決（Decision Analysis）：治療師會引導病人一起制定實際的解決方案，例如如何處理工作中的衝突或適應新的生活角色。
治療過程以病人為中心，治療師會以溫柔引導的態度支持病人做出改變。
Adaptations of interpersonal psychotherapy
人際心理治療的延伸版本
IPT for perinatal women
Up to 20% of women suffer from mood and anxiety disorders during pregnancy, and around 10 to 15% of women develop postpartum depression.
Research show that IPT results in substantial improvement in the mood and social support of women suffering from postpartum depression. Local research also show that couple-based IPT reduce depressive symptoms at 6 weeks and 6 months postpartum for both first-time mothers and fathers.
Becoming a mother is a time of big change for most women. They need to face changes in self-image, social role, marital and extended family relationship, as well as changes in the body and in job requirement. Statistics compiled in the Comprehensive Child Development Service in Hong Kong revealed perinatal women receiving government psychiatric service commonly experience challenges in the areas of marital relationship, in-law relationship, role transition of being a mother, baby care, as well as finance and housing.
The IPT problem areas of interpersonal disputes and role transition match the common difficulties faced by perinatal women. The non-cognitive and flexible nature of IPT allow therapists to help perinatal women manage their mood without the feeling of being judged, and give rooms for the mother to talk about her new and challenging experience in marriage, at work, and in caring for her newborn child.
IPT can be conducted in individual or group format during the perinatal period. Each session usually lasts for 45 minutes. Individual therapy usually consist of 8-12 sessions.
The ROSE program (Reach Out, Stay Strong, Essentials for mothers of newborns) is an evidence-based program that has been shown to reduce cases of postpartum depression by half among low-income women in a series of randomised control trials. It is based on IPT principles and includes 4 or 8 prenatal sessions and one postnatal booster session.
IPT-B is a briefer, 8 sessions version of IPT used in the treatment of perinatal depression.
- X Wang, Q Qiu, Z Shen, S Yang, X Shen. A systematic review of interpersonal psychotherapy for postpartum depression. Journal of Affective Disorders Vol 339, 15 Oct 2023; 823-831.
- FW Ngai, LL Gao. Effect of couple-based interpersonal psychotherapy on postpartum depressive symptoms: A randomised controlled trial. Asian J Psychiatr 2022 Dec:78:103274.
- JPY Chung. Interpersonal Psychotherapy for Postnatal Anxiety Disorder. East Asian Archives of Psychiatry 2015; 25:88-94.
- JE Johnson, S Wiltsey-Stirman, S Sikorsky, T Miller, A King, JL Blume et. al. Protocol for the ROSE sustainment (ROSES) study, a sequential multiple assignment randomized trial to determine the minimum necessary intervention to maintain a postpartum depression prevention program in prenatal clinics serving low-income women. Implement Sci 2018 Aug 22;13(1):115.
- HA Swartz, NK Grote, P Graham. Brief Interpersonal Psychotherapy (IPT-B): Overview and Review of Evidence. Am J Psychother. 2014; 68(4): 443–462.
Interpersonal and Social Rhythm Therapy (IPSRT) for bipolar affective disorder
Interpersonal and Social Rhythm Therapy (IPSRT) is an evidence-based psychological treatment for bipolar disorder. It is one of the few psychological treatments available in preventing relapse in bipolar disorder.
IPSRT is derived from IPT. It uses conventional IPT techniques to help bipolar patients deal with interpersonal and social stresses. It also uses the social rhythm metric (SRM) to help bipolar patients understand and regulate their biological and social rhythm. IPSRT teaches bipolar patients skills to protect them against future episodes of manic or depressive relapses.
In the randomised controlled trial of psychosocial treatments for bipolar depression in the STEP-BD study, IPSRT, CBT and family-focused therapy (FFT) were found to have higher recovery rates and shorter times to recovery than collaborative care.
IPSRT online training can be found in the IPSRT website.
DJ Milklowitz, MW Otto, E Frank. Psychosocial Treatments for Bipolar Depression: A 1-Year Randomized Trial From the Systematic Treatment Enhancement Program. Arch Gen Psychiatry. 2007;64(4):419-426.
Interpersonal Psychotherapy in Hong Kong | 人際心理治療 | 香港 