Interpersonal Therapy for Social Anxiety Disorder

Interpersonal therapy (IPT) is a 12- to 16-week treatment program originally developed for depression. IPT was created by Gerald Klerman and Myrna Weissman in the 1980's. The treatment is very structured and focuses on the social context of disorders and improving interpersonal functioning.

Interpersonal therapy has been shown effective in the treatment of eating disorders and bipolar disorder. Given that one-third of patients with social anxiety disorder (SAD) do not respond to medication or cognitive-behavioral therapy (CBT), and because of the interpersonal nature of SAD, interpersonal therapy is now being considered as a potential treatment alternative.

IPT generally progresses through three phases consisting of weekly treatment sessions.

• Phase 1: (Sessions 1 - 3) During phase 1, your therapist will identify the interpersonal areas in your life that need attention. This includes taking an inventory of all the key relationships in your life, and the main areas of interpersonal difficulties, such as being socially avoidant or non-assertive.
• Phase 2: (Sessions 4 - 14) Your therapist will address the problems in your relationships.
• Phase 3: (Sessions 15 - 16) In the final phase, your therapist will discuss and review your progress and prepare you for the end of therapy.

In the interpersonal therapy model of depression, four areas are usually addressed during treatment: interpersonal disputes, role transitions, grief, and interpersonal deficits. Below are the key aspects of each area.

• Interpersonal Disputes: Your therapist will identify problems with communication and teach you problem-solving strategies for your relationships.
• Role Transitions: Your therapist will help you find solutions to deal with problems in adapting to new circumstances.
• Grief: If grief over a death or another loss has played a role in your difficulties, it will be explored.
• Interpersonal Deficits: Your therapist will help you to identify problems in the way that you relate to others. If you are lacking interpersonal relationships in your life, your therapist will use the relationship between you and him/her as a basis for exploring difficulties, and will help you learn how to develop new relationships.

Many IPT techniques are adopted from other therapies, such as psychoanalytic psychotherapy and CBT. Some of the techniques used by an interpersonal therapist are listed below.

Clarification: Your therapist will help you figure out how your own misconceptions or biases are playing a role in your relationships, or how your thought or behavior patterns influence your interactions.

Supportive listening: Your therapist will listen in a supportive way, without being judgmental or critical, to help you feel more comfortable and open up.

Role playing: You and your therapist will role play interpersonal situations so that you can see them in a different way and also get practice. For example, you might role play what happens when you try to make conversation with strangers.

Communication analysis: This technique involves your therapist having you remember in detail a social interaction that you had that caused you emotional pain. In doing so, you and your therapist will identify any unhealthy patterns that are reinforcing your social anxiety.

Encouragement of affect: Your therapist will help you express and manage your emotions to make changes in your life.

Research into the use of interpersonal therapy with SAD is still in its infancy. In one small study of 9 patients with SAD, 78% were rated as having much or very much improved symptoms after treatment with IPT. Patients also gave concrete examples of positive changes after therapy, such as finding a new job, returning to school, or dating. 

In a critical review, interpersonal therapy was found to show better outcomes for SAD than psychodynamic psychotherapy, but lesser outcomes compared to cognitive-behavioral therapy (CBT).

IPT for SAD has even been delivered through mobile devices (mIPT); however, findings show that interpersonal therapy delivered in this type of self-help format is less effective compared to mCBT.

Although IPT appears promising as a treatment for SAD, much more research is needed. In particular, researchers have noted that interpersonal therapy may require further modification to make it applicable to anxiety disorders.

Are you receiving IPT for social anxiety? Overall, it can't hurt and may even help. However, it seems that if offered the choice between CBT or interpersonal therapy, given the present research evidence, you would be best to go the route of CBT.

Interpersonal therapy for social anxiety disorder is still in the early stages of being evaluated in terms of its effectiveness. However, this may be a promising form of treatment for you, particularly if you struggle with interpersonal conflict in addition to social anxiety disorder.