Biopsychosocial rhythms

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What are they?

We all have rhythms and routines which are usually fairly regular and stable. These include the time we go to sleep, the time we wake, the times we eat, the number of people we interact with, plus work and play schedules.

These can become disrupted by life events (Zeitstörers) such as childbirth, a long haul flight, a change to shift work. In turn this life event disrupts the prompts in our environment (Zeitgebers) that keep our social rhythms stable.

The most important physical factor in our environment is sunlight/dark.

Disruption in these rhythms

Disruption in social rhythms changes our biological and hormonal rhythms and leads to mood symptoms which in some cases can be extreme. For example after an argument a partner may keep awake mulling over the event.

The disrupted sleep then leads to a drop in mood. Childbirth can lead to sleep loss and this, coupled with the tiring demands of breastfeeding, and change in the times of interaction with a partner, can lead to symptoms.

By paying careful attention to the regularity of daily routines and the extent to which both positive and negative life events can influence these daily routines, symptoms can be addressed and often prevented.

When an individual has bipolar disorder it is even more important to be aware of changes in social rhythms as disruptions can lead to depressive or manic symptoms or even full-blown episodes.

Targeting Biosocial Rhythm Changes

A simple way is as follows:

Find the most unstable rhythm. e.g. changes in sleep/wake cycle following childbirth can lead to not going to bed till 1am, and still being in bed or disorganised at 11am.
Set goals for change. e.g. always try to go to bed at 10pm or get out of bed by 8am (give or take an hour).
Set reasonable expectations for change. e.g. do it gradually over the next few weeks by shifting the time you go to bed or get out of bed by quarter of an hour per day.
Search for triggers to rhythm disruption. e.g. breastfeeding times can a partner give expressed milk by bottle while you sleep or get yourself organised.
Find and maintain the right balance - how much rest, activity, stimulation is ideal for you?
Adapt to changes in routine Planned e.g. travel with children vs. Unexpected for example illness in children

Interpersonal Social Rhythm Therapy (IPSRT)

IPSRT is a modification of IPT (interpersonal therapy) for bipolar disorder.

It combines IPT and the stabilisation of social rhythms and has been shown to greatly help the amount of depressive symptoms a person with bipolar disorder has.

By including medication taking as a regular routine social rhythm it may also be beneficial for preventing manic symptoms

IPT Talking Treatments Self-care