How can the science of loneliness help us to address this global social issue?
What does scientific research tell us about what loneliness means and the most effective ways to treat loneliness?
Despite the global rise of loneliness following the COVID-19 pandemic, loneliness and feeling lonely remains a difficult topic to talk about in everyday parlance. Yet, many notable people have been open about their personal experiences of loneliness. British polymath Bertrand Russell, (1967–1969) discussed loneliness in a poem to his wife, Edith, where he described it as the “solitary pain the gnaws at the heart.” The late actor and comedian, Robin Williams, also described loneliness, “I used to think the worst thing in life was to end up being alone. It’s not. The worst thing in life is to end up with people who make you feel all alone.”
Worldwide, levels of loneliness have been increasing in relation to the lock-down and the required isolation ushered in by effective responses to the pandemic. Longitudinal research has found that loneliness has been particularly high among the over 70s, following cocooning and a disruption to pre-COVID social interactions. Pre-pandemic, loneliness was an important and pressing social issue, particularly for older people. Keming Yang (2019) argues in his 2019 book that loneliness is not only a psychological or medical issue, it is a social issue, too. For older people, many strategies that were in place to combat loneliness, such as opportunities to eat together as a group, volunteering and work placements were abruptly suspended in measures to reduce the spread of the virus leading a return to isolation and feelings of loneliness (Weger & Morley, 2020). It is essential that research is conducted into loneliness, of a range of demographic groups, including the elderly. In Japan “kodokushi” or “lonely death” refers to the phenomenon of old people dying alone without anyone noticing. Clearly then, kodokushi is something to be avoided at all costs.
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Research into loneliness had long established the problematic effects on mental and physical health. For instance, a study by researchers Holt-Lunstad, Smith & Layton (2010) found that living alone, a lack of social connections and the feeling of loneliness can be as damaging for our health as smoking or obesity. The research found that people with stronger social relationships have a 50% increased likelihood of survival (Holt-Lunstad, Smith & Layton, 2010). A study by KFF and The Economist (2018) found that loneliness is not only about being alone, but links to “real life problems and circumstances. Across Japan, UK and America, people reporting loneliness are more likely to report being down and out physically, mentally, and financially.” The study found that loneliness can increase the likelihood of adopting bad habits, such as overeating, smoking or using alcohol and drugs to cope with feelings of loneliness (KFF, 2018).
In a review of the research on loneliness and isolation, when considering 128 peer reviewed scientific studies, researchers found that only two studies did not find an association between social isolation or loneliness and health (Wattanakit et al. 2005, Wilby 2011), most of the reviewed studies have found loneliness links with poor health outcomes.
Within these studies, a large amount of research has been conducted that suggests loneliness is linked with depression and cardiovascular diseases both in adults and older adults. There are also links with reduced cognitive function, diabetes, Alzheimer’s and mortality (Courtin & Knapp, 2017). A recent editorial published in The Lancet looked at the negative effects of isolation and found it was linked with lower mood, decreased cognitive ability, sleep issues, increased stress and changes in body weight.
The effects of loneliness on the brain are still being investigated. However, already, neuroscientists have found differences in the brains of people who were lonelier with those who had lower levels of loneliness. From a longitudinal study examining two regions of the brain related to cognition and emotion, researchers found genes associated with cancer, cardiovascular disease and inflammatory diseases expressed in those who were lonelier.
One way that loneliness may exert a negative effect on both the body and the brain is through increasing feelings of stress, that overwhelms the individuals physiological systems through an increase in stress hormones (catecholamines and glucocorticoids) which ramp up the load of stress (allostatic load) on the body and brain.
In early research, loneliness was equated with social isolation but they are not the same. Whilst the two may ideas may overlap, viewing loneliness as a lack of social connections is inaccurate. Loneliness is more complex and highly subjective, how a divorcee with learning difficulties experiences loneliness may be different from an elderly widow and again, different from an only child stuck at home during lock-down. Loneliness is not simply about a lack of connections, an individual can have a network of social connections and still feel lonely. Its the quality of social interactions, not the quantity of interactions that matters.
So, what is loneliness?
There is not one agreed upon definition of loneliness. However, a common definition of loneliness views it as a subjective feelings towards the perceived gap between a person’s desired levels of social contact and their actual level of social contact (Peplau & Perlman, 1982). Public Health England has defined it as follows:
Loneliness as an individual’s personal, subjective sense of lacking connection and contact with social interactions to the extent that they are wanted or needed (PHE, 2017)
Previously, loneliness was considered an aspect of depression and not considered an issue in its own right (Cacioppo et al., 2015). Later research established that loneliness is in fact a distinct construct from that of depression. The experience of loneliness can precipitate depression (Cacioppo et al., 2006; Heinrich & Gullone, 2006).
A key difference between loneliness and depression discovered in the late 1970s is that whilst both involve helplessness and emotional pain, people that are lonely anticipate that with the right person or right people that would be happy, which is not the case in depression (Cacioppo et al., 2015).
There are different types of loneliness. Emotional loneliness refers to a perceived lack of emotional connection in relationships, for example meeting with a group of friends that are all married and being on the only member of the group without children. Another, type of loneliness, social loneliness refers to the perceived lack of a social network, this overlaps with the definition of social isolation. Existential loneliness (EL), is often linked with life threatening situations, such as as near the end of life, it has been defined as,
“an intolerable emptiness, sadness, and longing, that results from the awareness of one’s fundamental separateness as a human being.”
Whilst there are many negative repercussions of loneliness and chronic loneliness, there are some benefits of being alone.
Some therapists have noted that loneliness can be a catalyst for emotional growth. There are number of skills that can be obtained from the effective management of loneliness (such as enjoying ones own company or working on a new hobby). From an evolutionary perspective, it’s increasingly understood that loneliness could serve to help individuals to become aware of social threats and return to the pack in order to survive (Cacioppo et al., 2006), akin to the ‘no man is an island’ idea.
Governments taking action on loneliness
Governments have recognised that loneliness is in fact a public health issue. The Campaign to End Loneliness created a network of national, regional and local organisations to work together to ensure that loneliness of older people remains a public health priority (Brooke, 2020).
In the UK, there has been a policy of encouraging doctors to prescribe patients activities within the community, such as yoga, sports or art classes, described as social prescribing. Such types of activities can be very helpful for lonely people. A government press release stipulated that, by 2023, English doctors “will be able to refer patients experiencing loneliness to community activities and voluntary services” .
In the context of Covid-19, national governments and charities have provided advice about how to manage loneliness linked to the pandemic. The NHS have published a number of strategies from phoning a friend to joining a choir.
What does research tell us about treating loneliness?
Within the scientific literature, 4 key approaches to managing loneliness have been identified: 1) improving social skills, 2) enhancing social support, 3) increasing opportunities for social contact, and 4) addressing ways of thinking that has negative consequences (maladaptive social cognition) (See Masi et al., 2011).
Of these approaches, fascinatingly, interventions that change how we think, social cognition, have been found to be more effective when compared with other types of programmes (they had a larger mean effect size compared to programmes that aimed to increase social support and social skills).
Why might changing the way we think be better than actually spending time with other people to treat loneliness?
This is worth digging into some more.
Researchers have proposed a model of a regulatory loop theory of loneliness (Cacioppo, & Hawkley, 2009). In this cycle, people who are lonely pay greater attention to negative social cues, and remember negative aspects of social events, and behave in ways that confirm suspicions that it was not worthwhile spending time with others. Researchers argue that this negative loop serves to push lonely people away from spending time with others. The resulting solitude then leads to other behaviours that place individuals at increased for depression and negative outcomes mentioned earlier.
Thus, cognitive behavioural therapy (CBT) or interventions that aim to support individuals to address negative thinking patterns regarding interacting with others can break this regulatory loop. This may involve breaking preconceptions about the negative effects of spending time with others and the feeling that one might not be understood or belong. In these settings, individuals can identify beliefs that are unrealistic and explore them, to experience more satisfaction with relationships. CBT can enable identification and correcting of faulty thinking patterns both with a therapist or through digital apps.
In addition to addressing faulty thinking patterns or negative preconceptions about social interactions, our environments can influence loneliness. Most people have at one point in their lives, walked into a particular space and felt feelings of belonging, such as a party or a busy office, versus walking into a space and feeling a sense of anomie and alienation. Human centred design that involves communities in planning and social policy can actively promote social connection. The Mayor of Vancouver introduced block parties as a strategy against loneliness and connecting communities.
Finally, it could be argued that the loneliness aspect of the pandemic could be seen as unprecedented territory, a new epidemic. From another perspective it was already an existing problematic issue for particular groups (such as older people, single people and single parents) that may now be experienced much more widely. Whilst we know that there are a number of strategies to combat loneliness, and that cognitive thinking patterns can be particularly effective, new knowledge is needed about what works and for whom. In my opinion, its important to be able to share feelings of loneliness and the sadness of separation from friends and family, without fear of shame or stigma. Perhaps we could all benefit from more dialogue about loneliness, what it means to each of us and our personal ways of coping.
We need not tackle loneliness alone, we need to tackle it together. Finally, I provide the full poem from Betrand Russell that to me shows both the experience of loneliness, and overcoming such feelings.
Through the long years
I sought peace,
I found ecstasy, I found anguish,
I found madness,
I found loneliness,
I found the solitary pain
that gnaws the heart,
But peace I did not find.
Now, old & near my end,
I have known you,
And, knowing you,
I have found both ecstasy & peace,
I know rest,
After so many lonely years.
I know what life & love may be.
Now, if I sleep,
I shall sleep fulfilled.”
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