|Year : 2021 | Volume
| Issue : 4 | Page : 155-156
Importance and application of interpersonal psychotherapy during the COVID-19 pandemic
Holly A Swartz
Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
|Date of Submission||22-Aug-2021|
|Date of Acceptance||30-Sep-2021|
|Date of Web Publication||30-Nov-2021|
Prof. Holly A Swartz
Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Swartz HA. Importance and application of interpersonal psychotherapy during the COVID-19 pandemic. Heart Mind 2021;5:155-6
I read with great enthusiasm Zheng et al.'s article, Interpersonal psychotherapy knowledge dissemination in China. Using a careful, stepwise approach to training local experts, they have created Chinese language IPT materials, adapted IPT to Chinese culture, and laid the groundwork for disseminating IPT widely in China. Their vision, which includes incorporation of IPT into residency training curriculum and IPT research, will make China a global leader in IPT adoption and implementation. This important work comes not a moment too soon because, as countries grapple with the enormous mental health consequences associated with the COVID-19 pandemic,, IPT is proving to be an exceptionally good option for managing pandemic-related mental health problems. Thus, the work of Zheng et al. has the additional advantage of bringing IPT to China at a time when IPT is perhaps most needed.
Beginning in early 2020, SARS-CoV-2 spread across cities and nations until the virus that causes COVID-19 was found on every continent. Lockdowns, curfews, and state emergencies followed, leading to a host of pandemic-related psychosocial stressors including unemployment, familial stress, death of loved ones, and fragmented social networks. Even as the pandemic subsides in some places, continuing challenges such as new viral variants, uncertainty about return-to-school protocols, and global inequities in vaccine availability contribute to persistent pandemic-related worries. These stressors, in turn, contribute to high rates of mental health problems,, which some have labeled a secondary mental health pandemic., IPT is well equipped to manage mental health problems that are triggered by a clear set of taxing external environmental stressors such as those seen in the aftermath of the pandemic.
IPT, an evidence-based psychotherapy for psychiatric disorders, is based on a stress-diathesis model of illness. IPT posits that biologically vulnerable individuals develop psychiatric illnesses (depression, posttraumatic stress disorder, and anxiety) when triggered by interpersonally salient environmental events such as those arising from COVID-19. IPT provides therapists with an evidence-based framework for identifying a specific focal interpersonal problem area (grief, role transition, role dispute, or interpersonal deficits) and offers strategies to help patients better manage each of these problem areas. Therapists connect changes in psychiatric symptoms to changes in the focal interpersonal problem area, noting that (presumably) improved symptoms relate to adaptive changes that are made over the course of IPT in problematic relationships or circumstances. Patients understand that, as their interpersonal problems improve, symptoms improve, and that as symptoms improve, they will more easily manage their interpersonal difficulties. Thus, IPT is a natural fit for treating mental health problems that arise in the context of large social changes caused by the COVID-19 pandemic.
Mr. A. is an example of someone who developed depression in the setting of the COVID-19 pandemic and was successfully treated with IPT. Mr. A is a 47-year-old male with a clear biologic vulnerability to major depressive disorder. He suffered two prior depressive episodes, both in the context of major life changes, the first after leaving his rural home to move to the city for work and the second following the death of his father. However, Mr. A. had been doing well before the COVID-19 pandemic, working as a cook in a local restaurant, happily married to Mrs. A., and enjoying time with his 12-year-old daughter. When COVID-19 arrived, his city was placed in lockdown for several months. The restaurant where he was working closed, and he lost his job. Although he had some savings and was eligible for unemployment support from the government, he was very worried about his finances. His wife's parents, too anxious to live alone during difficult times, moved into Mr. A.'s two bedroom apartment, taking over their daughter's room and much of the common living space. Although he was close to and respected his in-laws, he resented their constant presence and interference in his household. A depressive episode ensued. He sought therapy over Zoom, hoping to obtain relief from his low mood, sleep problems, lack of interest in activities, weight loss, and low energy. Using IPT, the therapist linked his current depressive episode to social changes related to the COVID-19 pandemic. In IPT terms, the therapist pointed out that Mr. A. was experiencing a role transition or a change in social roles, i.e., moving from the roles of being head of a three-person household and employed outside of the home to someone who is unemployed, economically insecure, and forced to spend all of his time with his own family plus his in-laws in a small space and without an opportunity for going outside. The therapist not only normalized the patient's experiences (”many people are struggling with role transitions because of COVID-19”) but also suggested that his mood might improve if they could jointly find ways to better manage his difficulties. Mr. A. agreed to spend 12 weeks (45 minute, weekly Zoom sessions) using IPT to help him better managing his COVID-19-related role transition as a strategy for treating his current depressive episode. IPT initially focused on helping the patient understand and mourn what had been lost (independence associated with having a job and not having in-laws living with him) as well as considering some of the negative aspects of the old role (he felt that he was mistreated at the restaurant and had been looking for a new job when the pandemic hit). They also explored the positive and negative aspects of the new situation - including recognizing that his in-laws were very helpful with household chores, freeing Mr. and Mrs. A up to spend more time relaxing or helping their daughter with schoolwork. Mr. A also worked on skills to help him communicate more effectively with his wife and in-laws, role-playing conversations with his therapist to help him talk about his feelings more directly with his wife and make more constructive requests of his in-laws to help him feel more comfortable in his own home. He negotiated with his family to give him an hour a day to play online videogames, and he started playing on a virtual team with some old friends from his hometown. He chatted with them online and then continued the conversations even after the gaming ended, helping to build social support beyond his family. He also got a part-time job at a different restaurant that was serving only take-out food and therefore was less stressful than his old job. As he began to find creative solutions to his pandemic-related difficulties, Mr. A began to feel better. And, as his mood symptom lessened, he was better able to navigate COVID-19-related life challenges and stressors. Thus, over the course of a relatively brief treatment, IPT helped shift this patient into a mutually reinforcing, virtuous cycle of improvements in interpersonal difficulties and reductions in psychiatric symptoms.
As reported by Zheng et al., psychodynamic psychotherapy and cognitive behavioral therapy (CBT) have historically been the preferred psychotherapy modalities in China. Although these treatments are both well-regarded interventions, they may be less well suited than IPT to addressing the challenges associated with COVID-19. CBT focuses on correcting maladaptive negative cognitions and behaviors. As noted by Markowitz, CBT “benefits from the disparity between a relatively benign life situation and catastrophic thinking, whereas IPT works best in the setting of actual trouble.” Most would agree that the COVID-19 pandemic is “actual trouble;” it is, by definition, a life-changing event with far-reaching consequences. In midst of the AIDS epidemic, another infectious disease disaster, IPT performed better than CBT in a comparative randomized trial for depressive symptoms in HIV + individuals precisely because of the very real implications of contracting AIDS. CBT may be a less preferred than IPT for psychiatric disorders emerging in the context of the pandemic because therapists would be hard pressed to convince a rationale patient that they are overreacting to the terror and hardship associated with a worldwide lethal virus that evades vaccines and public health measures. Similarly, because of its emphasis on early childhood experiences and intrapsychic conflicts rather than recent stressors, psychodynamic psychotherapy may be less salient for patients struggling with the contemporary challenges of COVID-19. Given IPT's focus on the connection between current stressful life events and psychiatric disorders, it is not surprising that this approach is well suited to addressing mental health problems emerging in the aftermath of the pandemic.
Zheng's et al.'s report is a timely one. IPT's relevance in the face of the pandemic makes bringing IPT to China even more urgent. With its widespread dissemination to the second most populous country in the world, IPT's reach will be extended to many who may benefit from it, especially against the backdrop of the ongoing threat of COVID-19. I look forward to seeing many more groundbreaking reports on IPT from this productive and thoughtful group of colleagues.
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