{"id":6793,"date":"2023-07-14T21:34:54","date_gmt":"2023-07-14T21:34:54","guid":{"rendered":"https:\/\/www.ronniestanglermd.com\/?p=6793"},"modified":"2023-07-14T21:59:39","modified_gmt":"2023-07-14T21:59:39","slug":"can-loneliness-be-treated","status":"publish","type":"post","link":"https:\/\/www.ronniestanglermd.com\/index.php\/2023\/07\/14\/can-loneliness-be-treated\/","title":{"rendered":"Can Loneliness Be “Treated”?"},"content":{"rendered":"\n

n.b. This is an elegant essay on a complex issue designated by Surgeon General Vivek Murthy as an epidemic<\/strong>. This is simultaneously a communal issue, reflecting on a society we have created. Solutions require both external interventions and individual action. Especially intriguing is how behaviors related to loneliness inadvertently become neurologically “wired” and self-reinforcing. But “loneliness doesn\u2019t have to be a permanent state. With the right support and a lot of determination, the brain can learn to connect again.” <\/em>rss<\/strong><\/p>\n\n\n\n

excerpted from guest editorial by Eleanor Cummins and Andrew Zaleski, “If Loneliness Is an Epidemic, How Do We Treat It?<\/a>“, published in the New York Times, 14, July, 2023<\/em><\/p>\n\n\n\n

\n\n\n\n

Stephanie Cacioppo thought she would be single forever. \u201cI was an only child,\u201d says Dr. Cacioppo. \u201cI always thought that was my fate to be alone.\u201d<\/p>\n\n\n\n

Despite that, Dr. Cacioppo, a behavioral neuroscientist, dedicated herself to studying the science of romance. In 2011, when least expecting it, she met the love of her life. His name was John Cacioppo, a twice-divorced neuroscientist and one of the world\u2019s leading researchers on loneliness.<\/p>\n\n\n\n

After they married, in a joyfully spontaneous ceremony in Paris, they were hardly ever apart and even conducted research together at the University of Chicago. They were known among their academic peers by complementary monikers: She was Dr. Love; he was Dr. Loneliness. But in 2018, at age 66, he died, very likely from complications of salivary gland cancer. She was only 43. \u201cThey not only shared the same office (the sign on the door said \u2018The Cacioppos\u2019),\u201d his New York Times obituary<\/a> read, \u201cbut also the same desk.\u201d<\/p>\n\n\n\n

In the wake of her husband\u2019s death, she experienced a crushing loneliness. So she decided to apply the couple\u2019s research to her life while using herself as a case study for further research into solutions. She reached out to friends, ran six miles a day and picked up doubles tennis, all of which she chronicled in her 2022 memoir, \u201cWired for Love<\/a>.\u201d <\/em>It\u2019s <\/em>an effort that Dr. Cacioppo, now an adjunct assistant professor of behavioral neuroscience at the University of Oregon, is still undertaking, with the goal of studying how to prevent loneliness and restore strong connections.<\/p>\n\n\n\n

More than one-fifth<\/a> of Americans over 18 say they often or always feel lonely or socially isolated. Among older adults, social isolation has been linked to various adverse physical and psychological effects, including increased risk of dementia and heart disease. \u201cAddressing the crisis of loneliness and isolation is one of our generation\u2019s greatest challenges,\u201d wrote Surgeon General Vivek Murthy in The Times in April<\/a>, discussing a national framework for rebuilding social connection to combat what he called an \u201cepidemic\u201d of loneliness.<\/p>\n\n\n\n

If loneliness is an epidemic, how do you treat it? Given its myriad health consequences, some experts argue it\u2019s time to consider new remedies. This calls to mind a trip to the pharmacy to pick up a bottle of pills, but treating loneliness the same way doctors treat high cholesterol isn\u2019t exactly the idea here. As a growing body of research indicates, loneliness is a biological phenomenon with far-reaching consequences. Neuroscientists have found that brain signals that should trigger someone to seek social connection are the same ones that, under different circumstances, can turn people defensive and vigilant – more apt to hunker down instead of reach out. Under this rubric, loneliness isn\u2019t simply a symptom of societal failure to foster deep relationships but rather a wariness that takes root, steadily snowballs and reshapes the brain. Loneliness may be a communal problem, but healing begins with the individual.<\/p>\n\n\n\n

\u201cThinking of loneliness as a clinical problem – I actually think that\u2019s an appropriate way to think about the issue,\u201d says Daniel Russell, a professor in the department of human development and family studies at Iowa State University. It was Dr. Russell who, in the 1970s, helped develop the U.C.L.A. Loneliness Scale, a 20-item questionnaire still commonly used in research to measure how lonely a person is.<\/p>\n\n\n\n

It\u2019s not entirely obvious what the medical system can or should do with loneliness. Proposals range from the simple (adding loneliness scales to annual checkups) to the medically far-fetched (a pill for loneliness) and are sure to come with side effects and controversies. Even Dr. Cacioppo, who has dedicated her life to studying human connection, including pharmaceutical solutions for loneliness, questions the value of medicalizing it. (Can you imagine the insurance premiums?) But experts hope to help millions of struggling Americans find their way back to one another. \u201cWe are each other\u2019s key to a long life and healthy life,\u201d she says. \u201cWe need to be accountable for the well-being of our friends and teammates and others.\u201d<\/p>\n\n\n\n

Declaring loneliness an epidemic<\/strong> first requires an understanding of what loneliness is and how it works in the brain. Only when the latest insights into the lonely mind are considered can Americans begin to hope for a solution. Folk wisdom has dictated the terms for too long, but hard science is available.<\/p>\n\n\n\n

While sometimes mistaken for social isolation, loneliness is different. Social isolation is an objective state: Are you interacting regularly with other people or not? Loneliness, by contrast, is a paradoxical puzzle – an entirely subjective experience of distress at one\u2019s perceived lack of social connection. That can be true whether you\u2019re alone most of the time or at the center of a dance floor.<\/p>\n\n\n\n

\u201cYou\u2019re lonely because the set of relationships you have, your social network, is not meeting your expectations,\u201d says Dr. Russell.<\/p>\n\n\n\n

People feel lonely for many reasons: relocating for school or work, grieving a spouse, struggling with counterproductive coping mechanisms or even having a natural disposition toward gloom. If these are the causes, then there are at least known remedies to try. Nonetheless, experts feel as if they\u2019re banging their heads against a wall. How many times can you give someone the same tired advice to join a club, call a friend or make small talk with a stranger?<\/p>\n\n\n\n

Many lonely people not only feel sad; they also feel endangered. Social situations are perceived as a threat, not an invitation. Over the past decade, those who study loneliness have begun to better understand why. Although loneliness is usually understood as an experience of mental anguish, in reality it is \u201ca whole-body affliction,\u201d as the historian Fay Bound Alberti writes in \u201cA Biography of Loneliness<\/a>.\u201d Research suggests chronic loneliness is related to a range of physical and neurological problems, including increased susceptibility to infections and cognitive decline.<\/p>\n\n\n\n

In other words, loneliness is more than just a mental struggle. Dr. Cacioppo explains it as a \u201cbiological signal that tells us that there is something wrong in our social environment.\u201d Compounded over months and years, loneliness can gradually become a self-fulfilling prophecy. And when the emergency sirens are already blaring, it can be difficult to make the changes necessary for a more fulfilling life.<\/p>\n\n\n\n

Neuroscience has plumbed the depths of the lonely mind for decades. In 1992, John Cacioppo helped coin the term \u201csocial neuroscience.\u201d He later co-founded the University of Chicago\u2019s Center for Cognitive and Social Neuroscience, where he documented the dangers of loneliness. A steady stream of research has since demonstrated just how much loneliness is manifested in the brain.<\/p>\n\n\n\n

\u201cThere\u2019s lots and lots of evidence\u201d for it, says Dr. Danilo Bzdok, an associate professor in McGill University\u2019s department of biomedical engineering. During the first year of the Covid-19 pandemic, he and several colleagues carried out the largest studies to date looking for loneliness markers in the brain \u2014 studies they conducted in response to the social isolation people were experiencing. Their work demonstrated that the default network was larger in the brains of lonely people. This network is an area seated deep within the brain that lights up when we think about others, especially with respect to how we interpret their intentions.<\/p>\n\n\n\n

Research has shown that a lonely brain is transformed. Neurotransmitters important for bonding and social connection go haywire. The hypothalamic-pituitary-adrenal axis, responsible for modulating stress, is hyperactive. The amygdala, which triggers our fight-or-flight response and helps process emotional reactions, is in overdrive: In previous studies, Dr. Cacioppo found that lonely people detect negative or threatening pictures and words in under 400 milliseconds. This might explain not only the sadness that accompanies loneliness but also the palpable sense of danger.<\/p>\n\n\n\n

Such changes in the brain may help to explain why lonely individuals perceive their social environment as threatening. \u201cWe cannot perceive the world for what it is,\u201d Dr. Bzdok says.<\/p>\n\n\n\n

Depression, grief, social anxiety – a full-body cascade of what might be termed symptoms of a lonely life -can follow. Dr. Alberti calls loneliness an \u201cemotion \u2018cluster,\u2019\u201d in which feelings ranging from \u201canger, resentment and sorrow to jealousy, shame and self-pity\u201d can take hold. For some people, loneliness becomes a self-perpetuating feedback loop and turns chronic. The neuroplastic nature of the brain, its ability to create different structural pathways, can reinforce these changes. But what\u2019s important to know is that the brain can also snap back.<\/p>\n\n\n\n

Dr. Cacioppo has experienced both ends of this spectrum. \u201cI really wore my solitude as a badge of honor,\u201d she says of her early life.<\/p>\n\n\n\n

After her husband\u2019s death, Dr. Cacioppo continued the couple\u2019s research into a pharmaceutical intervention for loneliness in the form of the hormone pregnenolone. It has been shown to reduce stress by calming the amygdala as well as the insula, another area of the brain, which, if dysfunctional, can contribute to a lonely person\u2019s hypervigilance to social threats. While it couldn\u2019t treat loneliness directly, the hormone, the Cacioppos theorized, might ease symptoms and help people connect again.<\/p>\n\n\n\n

From 2017 to 2019, Dr. Cacioppo conducted a trial on the effects of an oral dose of pregnenolone in lonely individuals. She says the preliminary results indicated that self-reported loneliness declined. In other words, the pill was working as intended. But after processing her grief through exercising in the outdoors, she felt the possible side effects of a pill – which might range from worsened sleep quality to cardiovascular problems – could no longer be justified.<\/p>\n\n\n\n

\u201cI personally stopped the clinical trial because I think that we could boost pregnenolone and social connections naturally,\u201d Dr. Cacioppo says. Walking, meditation, time spent in nature – all of these activities have been shown to produce similar changes to her pill, with none of the downsides. So if a pill for loneliness is not the right approach, at least for now, what is?<\/p>\n\n\n\n

Dr. Cacioppo\u2019s experience<\/strong> suggests a lonely mind might be healed with help from the body. A clinical conception of chronic loneliness, then, most likely takes shape by combining natural remedies as the ones she employed with medical interventions already available to us.<\/p>\n\n\n\n

The simplest is what Dr. Murthy wrote about<\/a> in The Times: Go to the doctor. A recent essay<\/a> in The New England Journal of Medicine argued that clinicians should see themselves as part of the front line in reconnecting Americans. A report<\/a> on loneliness in America published by Harvard University\u2019s Graduate School of Education two years ago has a similar starting point. Doctors \u201cshould be asking patients if they are lonely as part of annual physicals,\u201d the authors wrote.<\/p>\n\n\n\n

From there, doctors can help patients single out components of chronic loneliness and line up appropriate treatment. People struggling with post-traumatic stress disorder, which can manifest as prolonged periods of intense loneliness, need a different type of attention from people whose anxiety makes them feel reluctant to go to a social gathering.<\/p>\n\n\n\n

Whatever the root source of loneliness, given what we know about the brain\u2019s capacity to rewire itself, coaching social interaction through mindfulness therapy or cognitive interventions can make up elements of a clinical response.<\/p>\n\n\n\n

Dr. Bzdok says that training people on \u201cprocessing emotional cues or social interactions on a regular basis\u201d can lead to adaptations in regions of the brain that govern social interaction. He notes that activities that reinforce social bonds, such as exercising together and eating together, while not an answer in and of themselves, are \u201cpossible parts of a response.\u201d<\/p>\n\n\n\n

There is a risk involved in assessing chronic loneliness on clinical grounds. Medicalization can reduce individual suffering, says Gary Greenberg, a practicing psychotherapist and the author of \u201cThe Book of Woe: The DSM and the Unmaking of Psychiatry<\/a>.\u201d But it might also lead people to believe that loneliness, by all accounts a crisis on a societal scale, is nothing more than an unfortunate series of individual failings. This, in turn, \u201cmight distract attention from the question of: Why in the world are we so isolated? And what should we do about that?\u201d he says.<\/p>\n\n\n\n

Clinical assessment of loneliness faces more practical barriers, too. As Dr. Russell points out, health care providers have yet to come up with criteria that describe when a person is sufficiently lonely to the point that physicians should do something about it. Some medical organizations, he adds, use a shortened form of the U.C.L.A. Loneliness Scale as a screening tool, but absent criteria for diagnosing loneliness, there\u2019s no research that has been done to evaluate the scale\u2019s diagnostic ability. Also, objective measures, like hitting a score based on the scale, might be imperfect or incomplete.<\/p>\n\n\n\n

\u201cAn important distinction is between individuals who may be lonely now but that may not last very long, versus individuals who become lonely and remain lonely and may have always been lonely,\u201d Dr. Russell says.<\/p>\n\n\n\n

Unlike depression or anxiety, loneliness is not a mental health disorder. The American Psychiatric Association has developed clear diagnostic criteria for those other conditions, contained in the Diagnostic and Statistical Manual of Mental Disorders, or D.S.M. Such standards do not exist for chronic loneliness. Though the goal is not to pathologize loneliness or to add it to the D.S.M., health care workers will need clear guidelines for identifying loneliness and triaging care.<\/p>\n\n\n\n

Even if a pill for loneliness were to become widely available, the goal should not be to get rid of these emotions that make up loneliness or the insights that a short period of loneliness can provide. Rather, it\u2019s to make sure that people can move forward – that their loneliness can work as an effective alarm, calling out their need for connection, rather than becoming the soundtrack of their life.<\/p>\n\n\n\n

\u201cWe don\u2019t want to just adjust that or, you know, moderate that feeling,\u201d says Julianne Holt-Lunstad, a professor of psychology and neuroscience at Brigham Young University, an author of the New England Journal of Medicine paper and the lead scientist on the surgeon general\u2019s advisory on rebuilding connection. \u201cWe also want to make sure that those objective needs are actually being met.\u201d<\/p>\n\n\n\n

Loneliness will never<\/strong> be cured<\/strong>. But it probably can be treated. Medicine will play an important role in recovery, and social reform is essential to prevent future generations from succumbing to chronic loneliness. But the most important source of change are the lonely people themselves.<\/p>\n\n\n\n

In his social connection advisory, Dr. Murthy recommended<\/a> a number of potential societal-scale interventions, including investing in shared infrastructure like public transportation and parks and beefing up community organizations that bring neighbors together. Dr. Cacioppo recommends reframing our relationship with social media platforms that can be a source of disconnection, especially among young people. There\u2019s nothing like a glamorous Instagram post to make people more attuned to whether their life is falling short of expectations.<\/p>\n\n\n\n

\u201cIf people can use social media as a way station rather than as the destination, that could really help,\u201d Dr. Cacioppo says. \u201cSocial media can be a great tool to form connection. It all depends on how you use it.\u201d Limiting the amount of time spent online, the platforms visited or the accounts followed can help.<\/p>\n\n\n\n

Finding ways to help people reset their expectations, possibly through therapy, while coaching them on new ways to engage with the people around them could be helpful. As is helping people understand where their loneliness is coming from and why it keeps returning.<\/p>\n\n\n\n

Health care providers of all stripes can serve as a resource for those looking for a way back to connection, says Dr. Holt-Lunstad. In addition to offering support, doctors can connect their patients with organizations that can provide means to aid them on their journey, including exercise classes and support groups.<\/p>\n\n\n\n

Friends and family must also be proactive about engaging with lonely people on terms that work for them. Finding ways to support others gives lonely people a chance to connect – and can help them break out of a kind of self-centered thinking that loneliness can exacerbate.<\/p>\n\n\n\n

Most important, lonely people must remember that while they are not necessarily responsible for the conditions that plunged them into loneliness, they can take steps to pull themselves out of it. This may involve forcing themselves to connect – even when they don\u2019t feel like it. Dr. Murthy wrote<\/a> eloquently about this \u201cmedicine hiding in plain sight\u201d: \u201cIt could be spending 15 minutes each day to reach out to people we care about, introducing ourselves to our neighbors, checking on co-workers who may be having a hard time, sitting down with people with different views to get to know and understand them and seeking opportunities to serve others, recognizing that helping people is one of the most powerful antidotes to loneliness.\u201d<\/p>\n\n\n\n

Instead of investigating a pharmaceutical solution to loneliness, Dr. Cacioppo is now promoting the acronym GRACE, which stands for \u201cgratitude, reciprocity, altruism, choice and enjoyment.\u201d It\u2019s fairly self-explanatory: Be grateful for what you have, ask for and offer help to others and make time for fun. But one letter is more controversial than the others.<\/p>\n\n\n\n

\u201cIt\u2019s a choice to remain lonely or not lonely,\u201d Dr. Cacioppo says. Put another way: Loneliness doesn\u2019t have to be a permanent state. With the right support and a lot of determination, the brain can learn to connect again.<\/p>\n\n\n\n

\n
\n

previous<\/a><\/p>\n<\/div>\n\n\n\n

\n

next<\/a><\/p>\n<\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"

n.b. This is an elegant essay on a complex issue designated by Surgeon General Vivek Murthy as an epidemic. This is simultaneously a communal issue, reflecting on a society we have created. Solutions require both external interventions and individual action. Especially intriguing is how behaviors related to loneliness inadvertently become neurologically “wired” and self-reinforcing. But…<\/p>\n","protected":false},"author":1,"featured_media":6795,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[231],"tags":[],"class_list":["post-6793","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-good-reads"],"_links":{"self":[{"href":"https:\/\/www.ronniestanglermd.com\/index.php\/wp-json\/wp\/v2\/posts\/6793","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.ronniestanglermd.com\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.ronniestanglermd.com\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.ronniestanglermd.com\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.ronniestanglermd.com\/index.php\/wp-json\/wp\/v2\/comments?post=6793"}],"version-history":[{"count":9,"href":"https:\/\/www.ronniestanglermd.com\/index.php\/wp-json\/wp\/v2\/posts\/6793\/revisions"}],"predecessor-version":[{"id":6814,"href":"https:\/\/www.ronniestanglermd.com\/index.php\/wp-json\/wp\/v2\/posts\/6793\/revisions\/6814"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.ronniestanglermd.com\/index.php\/wp-json\/wp\/v2\/media\/6795"}],"wp:attachment":[{"href":"https:\/\/www.ronniestanglermd.com\/index.php\/wp-json\/wp\/v2\/media?parent=6793"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.ronniestanglermd.com\/index.php\/wp-json\/wp\/v2\/categories?post=6793"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.ronniestanglermd.com\/index.php\/wp-json\/wp\/v2\/tags?post=6793"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}