This small trial adds to the evidence that regulating daily routines helps prevent bipolar episodes — and shows how nurses can lead the way
STUDY: Aktaş Y et al, Archives of Psychiatric Nursing 2026;60:152047, PMID: 41864720
STUDY TYPE: Randomized controlled trial
FUNDING: Independent
Background
Disruptions in circadian rhythms — sleep, meals, activity, social contact — are both a trigger and a consequence of bipolar episodes. In the 1990’s, Ellen Frank showed that people with bipolar disorder could prevent new episodes by establishing daily routines at regular times through Interpersonal and Social Rhythm Therapy (IPSRT). The therapy also addresses the effects bipolar has on relationships, identity, and loss. This study tested IPSRT lead by nurses at a community mental health center in Turkey.
The Study
This randomized controlled trial enrolled 34 adults with bipolar disorder (both type I and II) in various stages of the illness to either IPSRT (10–12 individual sessions delivered twice weekly) or usual care. Assessments were taken at baseline, post-intervention, and at one- and three-month follow-up using four scales: a mania scale (YMRS), a depression scale (HDRS), a biological rhythm measure (BRIAN), and an interpersonal competence measure (ICS).
All outcome measures improved in the treatment group compared to the controls.
Limitations: Small (34 participants at baseline, with 27 completing the study). The control group was not a fair comparison.
Hildegard Peplau (1909 – 1999) was an American nurse and psychoanalyst
Fun Fact
The authors blended IPSRT with theories from Hildegard Peplau, a nurse and psychoanalyst who developed and experiential theory of nurse-client relationships. Rather than seeing it as a passive relationship in which the client receives treatment, she saw the healing process as a shared experience where the nurse helps the client take an active role in recovery.
Practice Implications
- Though the study has limitations, it builds on a consistent body of evidence supporting IPSRT in bipolar.
- IPSRT also has evidence in major depression and other psychiatric disorders. That makes sense — no one feels good if they wake at irregular times and don’t have any routines. Neurologists have a diagnosis for that: Social Jet Lag.
- Here’s a basic guide to IPSRT.
—Chris Aiken, MD
Director, Psych Partners
Editor in Chief, Carlat Psychiatry Report
What’s Your Take? Share in Comments
- How do you motivate clients to take better care of their circadian rhythms?
