 focused on the definition, prevalence, timeframe, and consequences of chronic loneliness. This portion will focus on the proposed mechanisms by which loneliness may compromise health and various strategies to combat loneliness.

HOW EXACTLY DOES LONELINESS IMPACT HEALTH?

The response to this question is lengthy; it describes the 

 by which loneliness impairs health. Humans are designed to be social creatures. Cavemen and women were intended to be a part of a group, because being amongst others was protective against threats, such as marauding mastodons. As a result, when an individual perceives loneliness, the fight or flight response is initiated: respiration, blood pressure, heart rate increase, blood sugar elevates, intestinal muscles relax, pupils dilate, and blood flow is diverted to muscles. These changes enable an individual to fight or flee a threat, which is helpful when facing a short-term threat, but when this heightened state of arousal becomes chronic, deleterious changes may take place. Chronic hyperarousal results in hypertension, which in turn may lead to cardiovascular changes, eventually raising the risk of cardiovascular disease and stroke.

 Also, chronic hyperarousal may lead to activation of the HPA axis, resulting in increased inflammation and compromised immune functioning. This process may increase the expression of hormones, which may in turn lead to the creation of an environment that promotes tumor growth and progression.

WHICH STRATEGIES MAY DECREASE LONELINESS?

Several types of interaction have been explored in the effort to reduce levels of chronic loneliness. The results of a meta-analysis conducted in 2011

 documented that programs to increase opportunities for social contact or to improve social skills were ineffective in reducing levels of chronic loneliness. Programs focusing on enhancing social support (through mentoring or conference calls, for example) produced a small but significant reduction in chronic loneliness. 

The most effective interventions were programs designed to address maladaptive social cognitions. This approach has been referred to as social cognitive behavioral therapy (CBT).

Therapy focuses on changing maladaptive social perceptions and cognitions. Individuals are taught to identify automatic negative thoughts about both other people and social interactions in general, and how to examine the accuracy of the thoughts. Once the automatic negative thoughts are replaced with more accurate cognitions, the individual is more able to benefit from social interactions, reducing their level of loneliness.

John Cacioppo, a leading researcher in this field, has created a program based on social cognitive retraining to reduce chronic loneliness. The four-step program is known by the acronym EASE

. Push yourself to connect with other people, even if you are hesitant to do so. Start small and go slowly, such as volunteering at a shelter or becoming an assistant coach for a kids’ sports team.

. Don’t wait for the invitations to come in. Look at your calendar and be proactive in scheduling in social events.

 When it comes to reducing chronic loneliness, it is the quality, not quantity, of relationships that matters. Create connections that are meaningful in your life. Look for people that share your values. Join organizations that promote values that are important to you, such as a political action group, book club, or church choir.

. As explained above, lonely people tend to have maladaptive automatic thoughts regarding social interactions, and may be hypervigilant in detecting social slights. Work at identifying and changing those thoughts! Approach social interactions with hope and positive expectations. Try to be understanding and forgiving of perceived slights and view the relationship as a whole.

Read the first part of this bill by Susan Krigel here.

Valtorta NK, Kanaan M, Gilbody S, et al: Loneliness and social isolation as risk factors for coronary heart disease and stroke:  systemic review and meta-analysis of longitudinal observational studies.  

Lutgendorf SK, Sood AK: Biobehavioral factors and cancer progression:  physiological pathways and mechanisms. 

Masi CM, Chen HY, Hawkley LC, Cacioppo JT: A meta-analysis of interventions to reduce loneliness. 

Cacioppo S, Grippo AJ, London S, Goossens L,  Cacioppo JT: Loneliness:  clinical import and interventions. 

Cacioppo JT: Easing your way out of loneliness. 

https://www.psychologytoday.com/blog/connections/200812/easing-your-way-out-loneliness

Articles

This second installment of this blog on loneliness focuses on how loneliness may compromise health and can be combatted against.

Loneliness: The New Smoking, Part 2

“Social relationships, or the relative lack thereof, constitute a major risk factor for health—rivaling the effect of well-established health risk factors such as cigarette smoking, blood pressure, blood lipids, obesity and physical activity.”

Although this quote was from a meta-analysis published about 28 years ago, only in recent years has chronic loneliness or social isolation come to the fore as a risk factor for significant health consequences. In contrast to my other blogs, the current blog does not focus on patients with cancer: rather, I believe the topic is both important and relevant to all humans, including patients, providers, and caregivers. Part One of the blog will cover the distinction between loneliness and social isolation, the prevalence and timeline of loneliness, and the physical, cognitive, and psychological consequences of loneliness. Part Two will cover the proposed mechanisms by which chronic loneliness impacts health and provide suggestions to help individuals build stronger social connections.

HOW DO YOU DEFINE LONELINESS? WHAT IF SOMEONE JUST ENJOYS BEING ALONE?

You are absolutely right, there is a difference between being alone and loneliness. Loneliness is defined as the 

 Loneliness can also be described as the “dissatisfaction with the discrepancy between desired and actual social relationships.

 In other words, one can lead a fairly solitary existence and not feel lonely, or one may be among people all day and not feel connected. The defining factor is the level of satisfaction with the quality of one’s social relationships.

HOW PREVALENT IS LONELINESS? DOES LONELINESS VARY OVER THE LIFETIME?

It is believed that loneliness is increasing due to the decline of both the quality and quantity of social relationships. (I call this the “Starbucks” phenomenon, referring to the fact that even though we may be among people, often we are immersed in our own world, looking at our phones or computer screens, rather than interacting with each other.  Next time you are at Starbucks, look around and count how many people are actually talking to each other).  Statistically (and more objectively), it is believed that at any one time about 15-30% of the population is experiencing chronic loneliness.

 Rates of loneliness may vary throughout the lifetime, with about 80% of individuals under 18 and 40% of adults over the age of 65 reporting being lonely. Satisfaction with the quality of social relationships rises during middle age, but then decreases among individuals 70 or older.

 It is speculated that by 2030 the prevalence of loneliness may be at epidemic proportions.

WHAT ARE THE CONSEQUENCES OF CHRONIC LONELINESS?

Loneliness increases the risk of death as much as smoking and more than obesity or physical inactivity!  Chronic loneliness may impact individuals in the following domains:

Physical: Chronic loneliness has been documented to be associated with changes in the cardiovascular, immune, and nervous systems, and raises the risk of cardiovascular disease and stroke.

Cognitive: Perceived social isolation has been found to be a risk factor for accelerated cognitive decline, poorer executive function, and lower overall cognitive functioning.

Psychological: Chronic loneliness is correlated with lower self-esteem, lower self-efficacy, less frequent use of active coping skills, more depression, and hypersensitivity to perceived social slights.

House JS, Landis KR, Umberson D: Social relationships and health. 

Holt-Lunstad J, Smith TB, Baker M, et al: Loneliness and social isolation as risk factors for mortality: a meta-analytic review. Persp Psych Science 10:227-237, 2015

Peplau LA, Perlman D (Eds): Loneliness:  a sourcebook of current theory, research, and therapy. New York, NY: Wiley, 1982

Heinrich LM, Gullone E: The clinical significance of loneliness:  a literature review.  Clin Psychol Rev 26:695-718, 2006

Pinquart M, Sorensen S: Influences on loneliness in older adults:  a meta-analysis. Basic App Soc Psych 23:245-266, 2001

Valtorta NK, Kanaan M, Gilbody S, et al: Loneliness and social isolation as risk factors for coronary heart disease and stroke:  systematic review and meta-analysis of longitudinal observational studies. Heart 102:1009-1016, 2016

Cacioppo JT, Hawkley LC: Perceived social isolation and cognition. Trends Cogn Sci 13:447-454, 2009

Exploring loneliness and its effect on health. Part 1 of 2.

Loneliness: The New Smoking

Susan Krigel, PhD, psychologist at Midwest Cancer Alliance, the outreach arm of The University of Kansas Cancer Center, discusses fear of recurrence among cancer survivors.

Ninety-seven percent of cancer survivors experience fear of recurrence, which can persist for several years. Fear of recurrence typically remains steady at low to moderate levels until a spike is caused by a trigger, such as an upcoming appointment, an anniversary, hearing of another person’s diagnosis, or experiencing a new symptom.

Krigel also says that high levels of fear of recurrence can impair people in different domains of their life, including socially, cognitively, emotionally, and physically.

Susan Krigel, PhD, psychologist at Midwest Cancer Alliance, the outreach arm of The University of Kansas Cancer Center, discusses fear of recurrence among cancer survivors. 

Susan Krigel on Fear of Recurrence  Among Cancer Survivors

Susan Krigel, PhD, psychologist at Midwest Cancer Alliance, the outreach arm of The University of Kansas Cancer Center, discusses factors that are closely associated with fear of recurrence among patients with cancer.

Research shows that psychological and sociodemographic factors including anxiety, depression, poor coping skills, identifying oneself as a cancer patient, being young, or having young children are linked to higher levels of fear of recurrence.

Susan Krigel Discusses Factors Associated with Patient's Fear of Recurrence

Susan Krigel, PhD, is a licensed clinical psychologist with the Midwest Cancer Alliance. Her cancer-related career has spanned 10 years, and began when she worked as a Cancer Information Specialist for the National Cancer Institute. In her role at the Midwest Cancer Alliance, she utilizes her clinical and research skills to create and conduct programs with cancer patients across Kansas and western Missouri, focusing on improving the quality of life during survivorship. Programs are delivered both in person and via telemedicine. She also participates in professional development programs for healthcare providers.