The etiology of loneliness and its consequences are complex

The etiology of loneliness and its consequences are complex

When the 1978 Task Panel report to the US President’s Commission on Mental Health emphasized the importance of improving health care and easing the pain of those suffering from loneliness, few would have thought that their recommendation would be even more relevant and important today. With increasing evidence that loneliness is a risk factor for mental and physical health problems, attention has begun to turn to interventions for addressing chronic loneliness.

As a first step, there is a need for increased public awareness – and awareness among healthcare providers – that loneliness is a condition that, like chronic pain, can become an affliction for almost anyone. Even popular and high status individuals can find themselves feeling lonely, and the stigma of loneliness further complicates assessment and treatment. Despite the fact that loneliness is a common emotional distress syndrome with a high risk factor for early mortality and a broad variety of physical health and psychiatric issues, it still gets little attention in medical training or in healthcare more generally.

In Masi et al.’s meta-analysis (2011), we identified a need for well-controlled randomized studies focusing on the rehabilitation of the underlying maladaptive social cognition. With the advances made over the past 5 years in the identification of the psychobiological and pharmaceutical mechanisms associated with loneliness and maladaptive social cognition, it may soon be possible to combine (social) cognitive behavioral interventions with short-term adjunctive pharmacological treatments in order to reduce the prevalence of loneliness and its harmful consequences.


Preparation of this article was supported by the Department of the Army, Defense Medical Research and Development Program Grant No. W81XWH-11-2-0114.

A main challenge for physicians and mental health clinicians has been, therefore, to become sufficiently informed about the scientific definition of loneliness so that other mental disorders were not mistakenly diagnosed and treated when loneliness was either the primary presenting problem or the cause of the depression for which treatment was sought (Booth, 2000). For instance, because loneliness and depression share some characteristics and a correlation ranging from .38 to .71 (cf., Booth, 2000; J. T. Cacioppo et al., 2006), many clinicians believed, for decades, that loneliness was simply an aspect of depression with no distinct concept worthy of study (cf. Young, 1982). There is now considerable evidence showing that loneliness and depression are separable and that loneliness increases the risk for depression (J. T. Cacioppo et al., 2006; Heinrich & Mocospace sign in Gullone, 2006). In 1980, for instance, Weeks et al. administered loneliness and depression scales to undergraduate college students. Using data from 333 subjects, they concluded that loneliness and depression, though correlated with each other, were “clearly different constructs.” These results have been replicated and extended in recent longitudinal research (J. T. Cacioppo et al., 2010; VanderWeele et al., 2011), and reinforced Ostrov and Offer’s (1978) clinical observation that a potential difference between loneliness and depression was that while both are filled with helplessness and pain, loneliness is characterized by the hope that all would be perfect if only the lonely person could be united with another longed for person.

The second dimension is relational loneliness, or what Weiss (1973) termed social loneliness. It refers to the perceived presence/absence of quality friendships or family connections, that is, connections from the “sympathy group” (Buys & Larson, 1979; Dunbar, 2014) within one’s relational space. According to Dunbar the “sympathy group” can include among 15 and 50 people and comprises core social partners whom we see regularly and from whom we can obtain high-cost instrumental support (e.g. loans, help with projects, child care; Dunbar, 2014).

Interventions to Reduce Loneliness

Contrary to the conclusion of previous narrative reviews carried out since the 1980s, Masi et al.’s (2011) quantitative literature review revealed little evidence for better efficacy of one-to-one individual therapies compared to group therapies. Type of intervention program was a significant moderator, however. Twenty studies met the criteria for randomized group comparison design, and all four primary types of interventions known to reduce loneliness were present in this group. These four pris were (a) those that increased opportunities for social contact (e.g., social recreation intervention), (b) those that enhanced social support (e.g., through mentoring programs, Buddy-care program, conference calls), (c) those that focused on social skills (e.g., speaking on the phone, giving and receiving compliments, enhancing nonverbal communication skills), and (d) those that addressed maladaptive social cognition (e.g., cognitive behavioral therapy). Among these four types, interventions designed to address maladaptive social cognition were associated with the largest effect size (mean effect size = ?.598).

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