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We review assessments of loneliness and build on this meta-analysis to discuss the efficacy of various treatments for loneliness

We review assessments of loneliness and build on this meta-analysis to discuss the efficacy of various treatments for loneliness


In 1978, when the Task Panel report to the US President’s Commission on Mental Health emphasized the importance of improving health care and easing the pain of those suffering from emotional distress syndromes including loneliness, few anticipated that this issue would still need to be addressed 40 years later. A meta-analysis (Masi et al., 2011) on the efficacy of treatments to reduce loneliness identified a need for well-controlled randomized clinical trials focusing on the rehabilitation of maladaptive social cognition. With the advances made over the past 5 years in the identification of the psychobiological and pharmaceutical mechanisms associated with loneliness and maladaptive social cognition, there is increasing evidence for the potential efficacy of integrated interventions that combine (social) cognitive behavioral therapy with short-term adjunctive pharmacological treatments.

Life in America in the 21 st century is unlike any period in human history. People are living longer than ever before, and the rise in the Internet has transformed how Americans work, play, search, shop, study, communicate, and relate to one another. People are increasingly connected digitally, but the prevalence of loneliness (perceived social isolation) also appears to be rising. From a prevalence estimated to be 11–17% in the 1970s (Peplau, Russell, & Heim, 1979), loneliness has increased to over 40% in middle aged and older adults 1 (Edmondson, 2010; Perissinotto, Cenzer, & Covinsky, 2012). Over the past 40 years, loneliness has also become more widespread overseas (e.g., Victor, Scambler, Bowling, & Bond, 2005; Randall, 2012; Victor & Yang, 2012; Stickley et al., 2013). For instance, a 2010 survey from Statistics New Zealand shows that 33% of individuals aged 15 and above experienced loneliness in the four weeks preceding the survey. In the U.K., prevalence of loneliness is estimated between 5%–6% (for individuals reporting feeling “often” lonely), 21%–31% (for individuals reporting feeling “sometimes” lonely; Victor et al., 2005; Victor & Yang, 2012), and prevalence rates as high as 45% have been reported throughout the U.K. according to an online survey that took place in ). As the prevalence of loneliness rises, evidence accrues that loneliness is a major risk factor for poor physical and mental health outcomes.

Definition of Loneliness

Psychiatrist Fromm-Reichmann (1959) raised awareness of loneliness and noted the need for a rigorous, scientific definition of loneliness. In the decades that followed, loneliness as a psychological condition was characterized, and measures for quantifying individual differences were introduced (e.g., Lynch & Convey, 1979; Peplau, Russell, & Heim, 1979; Russell, Peplau, & Cutrona, 1980; Weiss, 1973). Loneliness corresponds to a discrepancy between an individual’s preferred and actual social relations (Peplau & Perlman, 1982). This discrepancy then leads to the negative experience of feeling alone and/or the distress and dysphoria of feeling socially isolated even when among family or friends (Weiss, 1973). This definition underscores the fact that feeling alone or lonely does not necessarily mean being alone nor does being alone necessarily mean feeling alone (see J. T. Cacioppo et al., this issue). One can feel lonely in the crowd or in a marriage. Reciprocally, one may enjoy being alone (a pleasant state defined as solitude; Tillich, 1959) at times in order to reach personal growth experiences (such as those achieved through solitary meditation or mindfulness exercises) or to simply take a temporary break from dealing with the demands of modern life.

Loneliness emphasizes the fact that social species require not simply the presence of others but also the presence of significant others whom they can trust, who give them a goal in life, with whom they can plan, interact, and work together to survive and prosper (J. T. Cacioppo & Patrick, 2008). Moreover, the physical presence of significant others in one’s social environment is not a sufficient condition. One needs to feel connected to significant others to not feel lonely. Accordingly, one can be temporarily alone and not feel lonely as they feel highly connected with their spouse, family, and/or friends – even at a distance. Subjectivity and perception of the friendly or hostile nature of one’s social environment is, thus, a characteristic of loneliness. As comedian Robin Williams said: “I used to think the worst thing in life was to end up all alone. It’s not. The worst thing in life is to end up with people who make you feel all alone” (2009). Although this crucial component of loneliness helps better differentiate subjective social isolation (loneliness) from objective social isolation, it has led occasionally to a conflation of loneliness and other dysphoric states (e.g., social anxiety, depression) in which a person’s subjective experiencing of their social environment plays also a crucial role.

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