Interventions targeting social cognition most effective in mitigating loneliness

Changing how a person perceives and thinks about others was the most effective intervention for loneliness, a sweeping analysis of previous research has determined. The findings may help physicians and psychologists develop better treatments for loneliness, a known risk factor for heart disease and other health problems.

Recently, researchers have characterized the negative influence of loneliness upon blood pressure, sleep quality, dementia, and other health measures. Those effects suggest that loneliness is a health risk factor, similar to obesity or smoking, which can be targeted to improve patients' health in several dimensions.

"People are becoming more isolated, and this health problem is likely to grow," said John Cacioppo, PhD, Professor of Psychology at the University of Chicago. "If we know that loneliness is involved in health problems, the next question is what we can do to mitigate it."

To determine the most effective method for reducing loneliness, Cacioppo and a team of researchers from the University of Chicago examined the long history of research on the topic. Published in the journal Personality and Social Psychology Review, their quantitative review found that the best interventions targeted social cognition rather than social skills or opportunities for social interaction.

The team's review, called a meta-analysis, analyzed the methods and results from dozens of papers that tested loneliness interventions. Strategies fell into four categories: improving social skills, increasing social support, creating opportunities for social interaction, and addressing social cognition.

When the researchers pooled the 20 studies that employed the most rigorous study design of randomized, controlled trials, they found a small, but significant effect on reducing loneliness. Sub-dividing the studies by their strategy revealed that interventions targeting social cognition - a person's thoughts about themselves and others - were far more effective than the other strategies.

"We're getting a better understanding of loneliness, that it's more of a cognitive issue and is subject to change," said Christopher Masi, MD, Assistant Professor of Medicine at the University of Chicago Medical Center and lead author of the study.

Specifically, the four interventions that helped people break the cycle of negative thoughts about self-worth and how people perceive them were the most effective at reducing loneliness. Studies that used cognitive-behavioral therapy, a technique also used for treating depression, eating disorders and other problems, were found to be particularly effective, the authors reported.

"Effective interventions are not so much about providing others with whom people can interact, providing social support, or teaching social skills as they are about changing how people who feel lonely perceive, think about, and act toward other people," Cacioppo said.

The quantitative analysis also examined whether group interventions were more effective than individual-based therapies for loneliness. Despite previous findings from qualitative reviews that favored group formats, the current review found no advantage for either group or individual interventions.

"That's not that surprising, because bringing a bunch of lonely people together is not expected to work if you understand the root causes of 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."

Cacioppo, Masi, and colleagues next hope to apply what they learned from their review toward designing new ways of measuring and treating loneliness. Interventions of various intensity can also be designed for use by psychologists and primary care physicians on people with minor or severe loneliness. But all such designs would do well to focus on social cognition above other tools to reduce the health hazard of loneliness.

"I think loneliness is increasingly recognized as an important problem in medicine - and certainly the demographic trends in society will likely exacerbate this problem," Masi said. "We found a type of intervention which seems to be effective and we are looking forward to testing a new intervention based on these findings."