Loneliness is bad for your health. The work of John Cacioppo and others has proven this connection repeatedly over the last decade, finding links between loneliness and blood pressure, sleep quality, dementia, gene expression, and many other medical measures. The evidence has built to the point that loneliness could be considered a serious risk factor for poor health, joining more established factors such as obesity or smoking.
But for those risk factors, there are established treatments. These may not be easy for patients, but there are methods supported by science to help a person stop smoking or reduce their weight, thereby decreasing their risk of disease. However, the correct strategy for reducing a person’s loneliness is not so obvious. Is it simply a matter of surrounding a lonely person with people, giving them more opportunities to socialize? Do they need help developing social skills? Or does a lonely person need a sort of cognitive tune-up, a realignment to break out of the cycle of negative social thoughts and perceptions?
“If we know that loneliness is involved in health problems, the next question is what can we do to mitigate it,” Cacioppo, a professor of psychology at the University of Chicago, said.
Looking to build a better intervention for loneliness, Cacioppo teamed up with Christopher Masi, assistant professor of medicine at the University of Chicago Medical Center, for what’s called a meta-analysis, a wide review of the existing body of research on reducing loneliness. Essentially, the researchers looked at every study published between 1970 and 2009 that tested an intervention designed to directly target loneliness. The search brought in studies of all different types and sizes, and much of the work involved finding a way to boil their diverse study designs and results into numbers that would allow for comparison.
“Over the years there have been some qualitative reviews, not looking at the numbers quantitatively, but getting a gestalt for what seems to work and what doesn’t seem to work,” Masi said. “We thought that while that’s helpful, a quantitative meta-analysis would be more helpful and more reliable.”
In social science as well as medicine, not all studies are created equal. Some interventions were tried on a single group, with the amount of loneliness assessed before and after the treatment. Others compared a group receiving an intervention to a control group. But the gold standard was studies which compared randomized groups, minimizing any sample biases that could distort results.
Though there were only 20 such studies amidst the hundreds that the researchers uncovered, pooling their results yielded interesting findings. Previous qualitative meta-analyses concluded that group interventions were more effective than one-on-one interventions, but crunching the numbers revealed no difference between the two. Yet when all the studies were combined, the average effect on loneliness was significant, providing evidence that loneliness is indeed sensitive to treatment.
“We rigorously focused on the best studies and we still found a significant effect,” Masi said.
But the size of the averaged effect was small, prompting the researchers to break down each study according to intervention strategy to look for clues on how to build the optimal intervention for loneliness. Studies that sought to improve subjects’ social skills, social support, or increase their opportunities to socialize produced only subtle reductions in loneliness, if any. However, when the four studies that addressed what the authors call “maladaptive social cognition” were isolated, each produced strong positive results.
“That’s not that surprising, because bringing a bunch of lonely people together really is not expected to work if you know much about loneliness,” Masi said. “Several studies have shown that lonely people have incorrect assumptions about themselves and about how other people perceive them. If you bring them all together, it’s like bringing people with abnormal perceptions together, and they’re not necessarily going to click.”
Addressing those incorrect assumptions first would likely be the best way to reduce loneliness, the analysis suggested. With tools such as cognitive-behavioral therapy, interventions using exercises designed to break unhealthy thought patterns can help lonely people approach social situations with a more positive attitude. Such a strategy makes sense in light of Cacioppo’s theory of loneliness as a natural urge gone awry, akin to the relationship between hunger and an eating disorder.
For the next step, Cacioppo and Masi hope to apply what they learned from the meta-analysis toward designing a new ways of measuring and treating loneliness, methods that might be useful for both psychologists and primary care physicians. Different interventions can also be designed for people with minor or severe loneliness, Cacioppo suggested. But all such designs would do well to focus on social cognition above other tools to reduce the health hazard of loneliness.
“Effective interventions are not so much about providing others with whom people can interact, providing social support, or teaching social skills as it is about changing how people who feel lonely perceive, think about, and act toward other people,” Cacioppo said.
Masi CM, Chen HY, Hawkley LC, & Cacioppo JT (2010). A Meta-Analysis of Interventions to Reduce Loneliness. Personality and social psychology review : an official journal of the Society for Personality and Social Psychology, Inc PMID: 20716644