IPT - Integrated Psychological Therapy
IPT corresponds to a cognitive-behavioral group therapy approach, was developed in our lab more than 4 decades ago and is now considered one of the pioneering approaches in the psychotherapeutic treatment of schizophrenia. IPT is based on empirical findings from various psychological and empirical fields, which were incorporated into an integrative therapy approach and, following initial studies, led to the first therapy manual as early as 1988. Over the years, new research findings have always been taken into account and incorporated into updated editions of the manual. The 7th edition of the manual is currently available in German language.
The outstanding feature of IPT to this day is the integration of goals that focus on improving deficits and optimizing resources in the areas of neurocognition, social cognition and social competence consisting of communication, social skills and interpersonal problem solving. All these areas of intervention are integrated into a uniform therapy concept, which shifts the level of challenge from rather cognitively simple and affectively non-stressful to cognitively complex and affectively demanding content and exercises. The areas of intervention described are divided into 5 sub-programs, which are structured and coordinated in such a way that they can be worked on one after the other as a bottom-up and simultaneously as a top-down approach. It should also be mentioned here that a 6th subprogram was added in the so-called Quebec version of IPT by integrating the Emotion Management Training (EMT, Hodel & Brenner 1996), also developed in our lab, as the 5th of a total of 6 subprograms (Briand et al. 2006). IPT clearly promotes strategy learning of patients (compensation strategies) instead of the usual drill and practice approach to ensure the sustainability of the learning. Empirical findings also support the maintenance of therapy effects in follow-up measurements.
The IPT groups are conducted with 4-8 patients by 2 trained therapists. Another characteristic of IPT is certainly the fact that IPT technology still does not use PC-supported exercises. Instead, the group exercises are carried out using standardized, described materials, cardboard cards with various characteristics and pictures with photographs as stimuli. In other words, the group participants are able to touch therapy materials with their hands and exchange them with each other, which generally promotes interaction and group cohesion per se. However, this requires flexible, structured and sometimes even highly structured group management by the therapist team using the group dynamics between the participants.
Another, more clinical and research-related characteristic of IPT is its worldwide distribution. The manual has been translated into near 20 languages. To date, this has led to 47 independent empirical studies with a total of 2177 patients in 15 countries. The study results have been empirically summarized in various meta-analyses. The significant effects in the cognitive and social functioning areas can be maintained in the follow-up phase and appear to be robust with regard to the treatment setting (inpatients, outpatients), disease phase (stabilized, post-acute) and site conditions (university hospitals, non-university centers). These favorable results led to IPT being designated as a “state of the art” intervention by the APA (APA/CAPP TFSMI 2009) and, for example, being included in the current German recommendation guidelines of both psychologists (DGPs 2019) and psychiatrists (DGPPN).
Additionally, IPT is just as effective with elderly patients, which seems all the more important as this population showed absolutely no changes under standard conditions (TAU), whereas younger adult patients did! IPT is also used with adolescent patients and ultra-high-risk patients (UHR), but to date there is only one RCT from Norway with adolescents (Ueland & Rund 2004). Clinical experience and initial individual case studies also indicate successful treatment results in the forensic setting. Finally, a reduction in negative symptoms was also demonstrated. IPT is now regarded as one of the most extensively evaluated psychotherapy approaches in the world.
Is IPT right for me?
IPT promotes neurocognitive functions (e.g. attention, working memory, problem solving), social cognitive functions (e.g. social and emotion perception, theory of mind) and social competence (e.g. communication skills, social skills, interpersonal problem-solving skills) in a group setting. IPT groups usually take place 1-2 times a week. Sessions last 45-90 minutes, in the first cognitive sub-programs rather 45 minutes, in the last two sub-programs rather 90 minutes depending on the patient's performance. In the post-acute area, the sessions are therefore reduced to 20-30 minutes. Clinicians often ask the question, what is the minimum number of sessions with inpatients needed before treatment effects can be expected? A recent study showed that just 3 sessions of IPT (and Integrated Neurocognitive Therapy INT, a further development of the two cognitive sub-programs of IPT) produce measurable changes (Redlich Bossy et al. in prep.). The duration of therapy varies between 15 and 30 sessions depending on the performance level of the participants. The groups are led by 2 specially trained therapists. The standardized, easy-to-use and highly varied therapy materials are used exclusively in group interactions. The exercises described in the therapy manual are used according to errorless-learning principles with graduated levels of difficulty: initially cognitively simple and affectively neutral standardized exercises are followed by increasingly cognitively complex and affectively stressful tasks.
What does an IPT session involve?
During a brief intake interview, newly assigned patients receive information on the content, aims and procedure of the group. In addition, fears and anxieties about group participation are addressed and attempts are made to reduce them (group rules such as no compulsion to speak, mistakes are allowed, confidentiality and mutual support). Detailed information (e.g. definitions of terms, discussion of the current course of therapy, etc.) is kept brief so as not to overwhelm the patients and cause them to become confused or distract them from the group exercises introduced in a playful manner. At the beginning, the therapists structure the promoted interactions more strongly and always pay great attention to the motivation of the participants in group exercises.
The main part focuses on the cooperative processing of the 5 sub-programs on neurocognition, social cognition (1 sub-program each) and social competence (3 sub-programs). Each sub-program lasts 3-6 sessions, with parts of the previous sub-programs being repeated, not least so that newcomers to the group can orient themselves better, but also so that the participants get to know the course of therapy and the therapy concept through practical experience. All exercises have been standardized and are described in detail with many examples in the therapy manual. It is important that the therapists take the needs and performance level of the individual participants into account when selecting the materials contained in the manual. The level of difficulty and standardization values of the norm population (e.g. Which emotion is depicted in this picture? How intense is the emotion? What is the degree of complexity of the picture?) are included in the manual in tabular form and serve as decision-making aids for therapists when selecting individually suitable materials for individual patients. Through the structured guidance of the therapists and linking the experiences of the participants, at the end of each exercise the focus is placed on the strategies used in processing the stimuli presented in the exercises. IPT consistently pursues the promotion of strategy learning.
What are the qualifications of IPT therapists?
As a rule, at least the main IPT therapist has completed postgraduate cognitive-behavioral therapy training. In addition, both therapists have completed practical IPT training courses of 2-3 days, where they have learned the didactics and IPT technology from experienced instructors. Supervision for therapists by the founders of IPT or experienced instructors is often offered afterwards.
How can I provide IPT to my clients?
The IPT manual has been translated into near 20 languages. The trained IPT therapists use this manual as a guide when leading groups. Information to professional referrers and interested clients has so far generally been organized regionally through information flyers and published contact options. Further information is available from the founders of IPT by e-mail or in the detailed manual.
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À propos du Cognitive Remediation Experts Workshop (CREW)
Nous sommes un réseau international de professionnels dédiés à l'avancement de la remédiation cognitive. Notre expertise porte sur la remédiation cognitive pour les troubles du spectre de la schizophrénie et d'autres troubles mentaux graves. Par la recherche, la formation et la collaboration, nous visons à améliorer la qualité des thérapies de remédiation cognitive et à les rendre accessibles.