Loneliness: Research and Treatment Strategies

As a masters and early doctoral student, I recall many moments of sitting in my office hearing others in the hallway discussing what they did over the weekend, what tasks they had ahead of them, and laughter as they connected with one another. Sometimes I would feel the painful urge to go say hi and hope that they would indulge me in decreasing the loneliness that I felt. Other times, I would think that I should not burden them with my troubles. After all, no one just comes out and says, “Would you please talk to me? I feel really lonely.” I could tell, over a number of times, that this was not feeling sad, anxious, low in self-worth, or a number of other things; it was all those things wrapped into one—loneliness. After realizing what I had been experiencing, I wanted to know more and understand what exactly loneliness is.

Loneliness is a complicated and complex concept that can be split into three primary perspectives: 1) emotion-based types, 2) cognitively linked, and 3) a behavioral process. The emotion-based types were developed by Weiss (1973) and consisted of emotional and social types of loneliness. Each type represents a global presentation of thoughts, feelings, and experiences that result in a potent emotional experience. Emotional loneliness represents a lacking intimacy and connection to important others in an individual’s life, such as a family member, best friend, or romantic partner (Wiess, 1973). Social loneliness represents the absence of a social group that an individual belongs or associates with in a meaningful way (Weiss, 1973). Weiss’s development of these types also holds ties to attachment theory, separation anxiety, and self-esteem. The second perspective—cognitively linked—was developed by Peplau and Perlman (1982). Though loneliness is believed to be a mixture of thoughts, feelings, and behaviors, they stated that loneliness is the cognitive discrepancy between an individual’s actual relationships and desired relationships. Finally, Cacioppo, Hawkley and colleagues (2006) proposed the evolutionary theory of loneliness in which individuals feel the aversive presence of loneliness and begin a behavioral process to connect with others and alleviate the current feelings of loneliness. This perspective of loneliness generally sees individuals as having either successful or failed attempts at solving transient experiences of loneliness.

Other important perspectives have been presented to help understand loneliness across most age groups. Similar to Bronfenbrenner’s Ecological Systems Theory (1979), Beck and Young (1978) suggested that the concept of time and environment were crucial to taking on a holistic view of what loneliness means to people. They separated loneliness into three time-specific forms: 1) chronic, 2) situational, and 3) transient. Chronic loneliness is seen as most severe, as it lasts the longest and has more set-in schemas that disrupt individuals and their systems from optimal functioning. Situational and transient loneliness are seen as short-term and relating to what their names imply; situational loneliness is a reaction to a loss or change in one’s context like a family member passing away or a romantic relationship ending, whereas transient loneliness is fleeting and happens within moments of emptiness or aloneness (Beck & Young, 1978). According to a review on the clinical significance of loneliness, chronic and more stable forms of loneliness pose the greatest threat to mental health of adolescences to adults, however, the ability to address short term forms of loneliness in hopes of stopping chronic loneliness from forming was viewed as meaningful (Heinrich & Gullone, 2006).

Currently, loneliness has received attention for its prevalence in North American countries, as well as European and Asian countries (Bruce, Wu, Lustig, Russell, & Nemecek, 2019; Yang & Victor, 2011). Reviews of loneliness prevalence suggest that upwards of 80% of individuals will experience distressing loneliness and a smaller number will face clinically significant, even painful levels of loneliness (Qualter et al., 2015). A more recent nationally representative study in the United States found that 17.2% of adults between 18 to 70 years old have clinical levels of social-emotional loneliness (Hyland et al., 2018). The study also noted that emotional forms of loneliness, akin to Weiss’ (1973) loneliness types, were impactful on psychological well-being and distress tolerance. Well known evidence exists for the impact of loneliness on older adults and the correlation that social isolation (the objective sense of being alone) holds with loneliness (subjective sense of being alone; Holt-Lunstad, Smith, & Layton 2010). However, loneliness is not bleak when looking at how to manage it. Studies have suggested addressing needs of social support, physical exercise, and purposeful interactions with others (Bruce et al., 2019; Galambos, Barker, & Krahn, 2006). Considering loneliness is tied to a number of different struggles (i.e., low self-esteem, diminished life satisfaction, social anxiety; Peplau & Perlman, 1982), studies have suggested focused effort on those impacted outcomes and social obligation to connect with those who are struggling. MFTs are positioned to see the relational needs and how loneliness hurts our clients and ourselves.

Integration

As clinicians, the role of supporting clients through difficult times becomes about meeting the need where it exists and understanding the context within which those clients are living. Considering our current pandemic, clinicians need to know how to appropriately pair clients’ needs with a method for reaching them in their place of distress. This integration can appear as shown in the following.

One example might be a client dealing with the loss of social connections due to pandemic social distancing. A systemic therapist noting that type of social loneliness, while also making efforts to increase the client’s positive experiential moments, would inspire the integration of Weiss’ (1973) types of loneliness and an experiential treatment approach. This integration might end up looking like providing a humanistic approach and supporting the client to see the humanity of this pandemic while balancing the gratitude and positive outcomes from social relationships.   

Another example might be a client who has described a strain in making strong interpersonal connections over a long period of time. The therapist might note that the client is not only dealing with chronic forms of loneliness through failed interpersonal attempts, but also ineffective behavioral strategies at engaging those interpersonal relationships. This integration could be a pairing of the evolutionary theory of loneliness (Cacioppo et al., 2006) with a mindfulness approach to address present moment loneliness, while increasing self-directed behaviors during interpersonal interactions.

A final example may be clients who feel they are more lonely than anyone else they know, and any thoughts they have to say otherwise are washed away as soon as they have them. An MFT in this situation might understand that these clients are experiencing cognitively linked forms of loneliness, as well as having an embedded schema that they are lonely people. This integration might be a pairing of’ the cognitively-linked perspective of loneliness (Peplau & Perlman, 1982) with Rational Emotive Behavioral Therapy (REBT) to highlight actual, quality-oriented relationships that clients possesses in their daily lives.

Application

After having an understanding of loneliness and possible integrations that would best fit a client’s needs, MFTs need tangible ways to address that loneliness in the therapy room. To date, there are not many direct suggestions for how to approach loneliness. Recommended primary approaches have been cognitive behavioral in nature. One study highlighted how REBT processes supported the reduction of loneliness factors (Hyland et al., 2019), and another study addressed multiple types of loneliness clustering based on various combinations of cognitive, emotional, and behavioral symptoms (Young, 1982). Despite limited evidence for therapeutic models that specifically address loneliness, there are clues to what works for MFTs as systemic and progressive advocates of the mental health field during the current pandemic.

• Approach loneliness with strength and humility: Loneliness has a history of holding stigma, whether young or old, identified male or female. Understanding the impact that stigma has on systems and their processes allows MFTs to be informed about how loneliness might lurk in the shadows.
• Provide insight about loneliness and what that does to the client’s context: Clients are the experts of their lives, but loneliness has evidence of distorting the perception of intimacy, connectedness, and access to supports. Make it clear that the way loneliness works impacts the path to a solution.
• Promote purposeful action by the client to address loneliness: Clients who are autonomous and self-directed often find the grip of loneliness to be loose at worst. Evidence suggests that invested action is the second most powerful tool to address loneliness beyond social support (Bruce et al., 2019). Encouraging chosen virtual hangouts over forced video meetings holds substaintial power in addressing loneliness.

Using this APP (Approach loneliness, Provide insight, Promote purposeful action) may allow MFTs, and other clinicians, to ease the emotion of loneliness and decrease the distance between our clients’ reality and aspirations for connection.

Clients are the experts of their lives, but loneliness has evidence of distorting the perception of intimacy, connectedness, and access to supports.