Social Rhythms: A New Way to Improve Mental Health

Ever heard of the term “social rhythm” before? Read on to learn about this concept!

Long before humans made the first clock, dwellers on Earth have come up with timekeepers to adapt to the continuously changing environment. Known as the biological clocks, they are ticking in most living creatures, ranging from tiny cyanobacteria to giant plants and from slimy fungi to brainy animals.

The biological clock is encoded in our DNA. It’s a delicate molecular machine, oscillating through the rise and fall of gene expressions with a period of about 24 hours. It serves to anticipate rhythmic environmental changes produced by Earth’s rotation, such as light and dark, and to prepare the organism for what is coming.

The resultant pattern of biological processes guided by the biological clock is called the circadian (“about a day”) rhythm. If a healthy person got locked in a dark room without any clue to know the time, they would still know when to eat and when to sleep following the lead of their circadian rhythm.

But reality doesn’t always meet expectations. Exposure to bright blue light at midnight, for example, confuses one’s biological clock, which expects darkness at the time, and disturbs the ongoing circadian rhythm.

Apart from light, other external factors can also affect our circadian rhythm. Interestingly, some elements of our social relationships, social demands, and social tasks also exert an impact on circadian rhythm regulation. Researchers refer to the pattern of these social elements as social rhythm.

Studies on college students have shown that a more regular social rhythm is associated with better emotional well-being ^1,2. A more irregular one, on the other hand, denotes more mental health problems, including symptoms of anxiety and depression, in the future.

The link between social rhythm and mental health probably sits right in the biological clock. For one thing, disruptions to the circadian rhythm are common among people with mental illnesses such as depression and bipolar disorder. In the late 1980s, researchers proposed that erratic social rhythm can cause circadian rhythm disturbance, which may further play a part in triggering mood episodes in vulnerable populations³.

People with bipolar disorder (BD), for instance, are found to undergo more social disruptions when encountering life changes such as losing a job or having a baby. They are, therefore, more vulnerable to disruptions in circadian rhythm and mood.

To promote mood stability in BD patients, Professor Ellen Frank at the University of Pittsburgh developed a therapy called Interpersonal and Social Rhythm Therapy (IPSRT). IPSRT focuses on reducing irregularity in patients’ circadian rhythms via social rhythm regulation⁴.

Frank’s team devised an instrument called the Social Rhythm Metric (SRM) to characterize social rhythm, originally inspecting 17 daily event categories⁵. Going through optimization in the early 2000s, the current version of SRM has only five items. The SRM-5 records the time and social interaction involved when the patient 1) gets out of bed, 2) makes their first contact with another person, 3) starts work, school, volunteer activities, or family care, 4) has dinner, and 5) goes to bed⁶. Using SRM, patients can recognize the interaction between the instability of their social rhythm and the fluctuation of their mood. As the four-phase IPSRT treatment proceeds, patients develop strategies to stabilize their social rhythm and resolve interpersonal problems with the help of their therapist.

 

 

Figure 2: Example of SRM [Source: Matthews et al. Assessment (2016)]

Since its development, IPSRT has been used in many studies and clinical trials as an adjunctive treatment for bipolar disorder. Previous results have suggested that IPSRT helps patients with bipolar depression acquire higher regularity of social rhythm and achieve longer periods without mood episodes⁷.

Although evidence from more randomized controlled trials is needed, a 2019 meta-analysis showed that IPSRT was effective in improving overall functioning for patients with bipolar disorders⁸. Another recent analysis suggested that IPSRT may also benefit patients with major depressive disorder⁹. 

While IPSRT is designed for individuals with bipolar disorder, its core concepts and techniques can be applied outside of bipolar disorder treatment. Research has begun to explore the importance of social rhythm regularity in individuals with other mental health problems such as anxiety. 

During the COVID-19 pandemic, many people have had to confront various stressful circumstances and different levels of social rhythm disturbances due to the home confinement situation. Sleep and emotional problems are becoming more prevalent. Could we adopt the rationale of IPSRT and address such issues through proactively regulating our social rhythm?

For years, the SRM-5 instrument in IPSRT has been highly paper-based. But all parameters it records, from sleep-wake activities to social interactions, can now be reported through a smartphone application conveniently¹⁰. 

By integrating its functions of self-planning and tracking daily activities with a newly developed social feature called #MyMoai, Owaves can serve as a useful app for self-monitoring social routines, which could be beneficial to users who are experiencing social and biological rhythm disruptions at the moment.

 

Figure 3: MyMoai

For future studies on mental health, Owaves can also act as a helpful research tool. On the one hand, it plays the role of a convenient platform for promoting psychoeducation about the interplay among circadian rhythm, social rhythm, and mental health. On the other hand, it’s a suitable application for validating the effect of social rhythm therapies in a digital setting.

References

1. Cai D, Zhu M, Lin M, Zhang XC, Margraf J. The bidirectional relationship between positive mental health and social rhythm in college students: a three-year longitudinal study. Frontiers in Psychology. 2017 Jun 30;8:1119.
2. Velten J, Bieda A, Scholten S, Wannemüller A, Margraf J. Lifestyle choices and mental health: a longitudinal survey with German and Chinese students. BMC Public Health. 2018 Dec 1;18(1):632
3. Ehlers CL, Frank E, Kupfer DJ. Social zeitgebers and biological rhythms: a unified approach to understanding the etiology of depression. Archives of general psychiatry. 1988 Oct 1;45(10):948-52.
4. Frank E, Swartz HA, Kupfer DJ. Interpersonal and social rhythm therapy: managing the chaos of bipolar disorder. Biological psychiatry. 2000 Sep 15;48(6):593-604.
5. Monk TH, Kupfer DJ, Frank E, Ritenour AM. The social rhythm metric (SRM): measuring daily social rhythms over 12 weeks. Psychiatry research. 1991 Feb 1;36(2):195-207.
6. Monk TH, Frank E, Potts JM, Kupfer DJ. A simple way to measure daily lifestyle regularity. Journal of sleep research. 2002 Sep;11(3):183-90.
7. Frank E, Kupfer DJ, Thase ME, Mallinger AG, Swartz HA, Fagiolini AM, Grochocinski V, Houck P, Scott J, Thompson W, Monk T. Two-year outcomes for interpersonal and social rhythm therapy in individuals with bipolar I disorder. Archives of general psychiatry
8. Lam C, Chung MH. A Meta-Analysis of the Effect of Interpersonal and Social Rhythm Therapy on Symptom and Functioning Improvement in Patients with Bipolar Disorders. Applied Research in Quality of Life. 2019 Aug 3:1-3.
9. Crowe M, Inder M, Douglas K, Carlyle D, Wells H, Jordan J, Lacey C, Mulder R, Beaglehole B, Porter R. Interpersonal and social rhythm therapy for patients with major depressive disorder. American Journal of Psychotherapy. 2020 Mar 1;73(1):29-34.
10. Matthews M, Abdullah S, Murnane E, Voida S, Choudhury T, Gay G, Frank E. Development and evaluation of a smartphone-based measure of social rhythms for bipolar disorder. Assessment. 2016 Aug;23(4):472-83.