In the 21st century, we have more ways to communicate and get information than ever before. News headlines and celebrity gossip reach millions of people in seconds on Twitter. We share our lives with friends and family on Facebook, post our pictures on Instagram, look for jobs on LinkedIn and share our passions on blogs and other social media outlets. When we want to talk to loved ones in far-flung locales, we no longer need to limit ourselves to the telephone — not when voice and video are just a Skype call away. But with so many ways to connect, why do we often feel so alone instead?

“One Is the Loneliest Number,” “Only the Lonely,” “Sgt. Pepper’s Lonely Hearts Club Band.” Popular culture is filled with the laments of the lonely. It has ever been thus: Loneliness is part of being human. The research on the prevalence of loneliness is mixed, but some experts believe that the number of lonely people is increasing, and some counselors report an increase in clients struggling with this issue. These professionals think that certain aspects of modern life, such as dramatic differences in the way we communicate, our overstretched schedules and our frenetic pace, can increase feelings of loneliness.

Whether or not loneliness is becoming more widespread, a 2010 AARP survey indicates that it is certainly a common issue in adults older than 45. Overall, 35 percent of survey respondents reported being lonely.

In a 2010 article in the Annals of Behavioral Medicine, “Loneliness Matters: A Theoretical and Empirical Review of Consequences and Mechanisms,” John T. Cacioppo, a psychologist who specializes in the study of loneliness, and his co-author, Louise C. Hawkley, published research indicating that loneliness is common in children and adolescents as well. Up to 80 percent of individuals younger than 18 reported feeling lonely at least sometimes.

The same study found that as many as 40 percent of those over age 65 report being lonely and that, in general, loneliness increases with advanced age. Researchers are concerned that as the population of older adults increases in the United States, loneliness will become a significant societal problem.

Psychiatrist Frieda Fromm-Reichmann is considered a pioneer in loneliness research. In her seminal article “Loneliness,” published in 1959 in Psychiatry: Journal for the Study of Interpersonal Processes, she asserted that loneliness (which she defined not as the state of being alone but rather as a lack of intimacy) played an integral role in mental health issues. She also posited that the lack of significant research into loneliness was due to people avoiding the topic because loneliness represented such a painful and frightening experience.

Since Fromm-Reichmann sounded the alarm on loneliness, however, a substantial amount of research has been conducted on the condition and its effects on the human body and psyche. It turns out that loneliness is not just emotionally painful — it can also lead to sickness and possibly even death.

As Fromm-Reichmann maintained, being alone is not the same as being lonely. The difference lies in perception. Someone can be surrounded by people yet feel totally disconnected. Conversely, a person who spends a significant amount of time alone might feel perfectly complete.

In addition, transient bouts of loneliness are not uncommon; almost everyone gets lonely from time to time. But problems arise when loneliness comes to stay. Research conducted over the past few decades has shown that chronic loneliness poses a huge health risk. In a 2010 PLOS Medicine study, researchers found that chronic loneliness is as dangerous or more dangerous than other established risks to mortality such as smoking and obesity.

The specific negative effects of loneliness on health are myriad. As Cacioppo and Hawkley noted in their Annals of Behavioral Medicine study, “Social isolation plays an important role in health and longevity, in part through its association with poor lifestyle behaviors such as lack of physical activity.”

They went on to write that loneliness can increase the risk of depression, high blood pressure, high cholesterol, cardiovascular problems, cognitive decline and Alzheimer’s disease. Loneliness also increases cortisol and systemic inflammation and causes sleep difficulties.

All of these risks are compounded by the effect of loneliness on physical activity. According to a 2009 Health Psychology study, “Loneliness Predicts Reduced Physical Activity: Cross-Sectional & Longitudinal Analyses,” loneliness in middle-aged and older adults is an independent risk factor for physical inactivity. Loneliness also increases the likelihood that people will continue to be inactive over time.

The question is, what is at the root of modern-day loneliness? A significant amount of discussion — and a growing body of research — has centered on whether the Internet and online activity might be an important factor. The answer is … maybe. It depends. A 2013 report from the National Bureau of Economic Research, “What Are We Not Doing When We’re Online?” found that online activity is partially crowding out other leisure activities. Part of most people’s online activity does include interacting with others, but on the whole, we’re probably having less real-life social contact.

However, a 2009 study in the journal CyberPsychology & Behavior, “Loneliness as the Cause and the Effect of Problematic Internet Use: The Relationship Between Internet Use and Psychological Well-Being,” found that Internet use did not have a significant effect on most people’s levels of loneliness except for with those who were already lonely.

So perhaps technology’s loneliness effect is dependent on how someone uses that technology. Still, some counselors think that technology is actually changing the way we communicate, leading to a general social disconnect that increases loneliness.

All the lonely people

“I think modern society itself can cause certain kinds of disconnection,” says Everett Painter, an American Counseling Association member and college counselor at Walters State Community College in Morristown, Tennessee. The breadth and volume of information people receive from so many different sources can be overwhelming, notes Painter, who presented a session at the 2014 ACA Conference that examined the effect that social media and technology have on personal relationships.

His view is that processing this surfeit of communication requires substantial energy — energy we might otherwise spend engaging with friends and relatives and cementing the personal bonds that allow us to feel connected. While smartphones and social media outlets allow people to communicate on multiple platforms, many of those connections are virtual rather than face to face, and not always in real time. Online activity can also eat up a substantial portion of our workdays and leisure time, which may mean time away from the important relationships in our lives, Painter notes.

“For some people, online communication can replace face-to-face communication, and I think that we need that human connection for our health,” he says.

Gerald Opthof, an ACA member and licensed professional counselor (LPC) in the Morristown, New Jersey, area, agrees. Opthof, who specializes in addiction issues but also sees couples and individuals for a variety of other reasons, says that he has noticed a significant amount of loneliness in his client base. Like Painter, Opthof believes much of the loneliness he is seeing is related to the isolation and disconnection that online communication can cause.

“With social media, smartphones, the Internet, we are more in touch with what is occurring with others,” Opthof says. “However, we are not [really] connected to individuals. We don’t sit and talk. How many times are we at a restaurant and we see people at the same table all looking at their phones?”

Socializing online just feels easier and emotionally safer for some people. However, online activity can also function as a way to hide.

“When a client engages with people via social media forums such as Facebook, Twitter, Instagram, Snapchat and others, it keeps an emotionally protective barrier in place,” says Amy Lasseter, an ACA member and LPC in Athens, Georgia.

Lasseter says that loneliness has been “popping up” more and more frequently in her practice. In some cases, she says, social media use seems to cause clients to unintentionally start the cognitive process of comparing their lives to the lives of others. “This comparison can lead to an increase in feelings of failure and reinforce emotional distance, which may lead to greater emotional isolation,” she says. “It can become a dangerous cycle.”

For certain people, social media has also turned the idea of making friends and connections into a numbers game, complete with “winners” and “losers.”

“The Internet and social media have made it possible to connect with more people, which may have increased the expectation for some people that they should be connected to more people,” observes ACA member James Huber, a licensed marriage and family therapist in Reading, Pennsylvania, and an associate professor of counseling psychology at Holy Family University in Philadelphia. This can create pressure for relationship quantity over relationship quality, and if a person’s numbers are “low,” it might lead the person to feel lonely, Huber says.

This feeling of needing to measure up can extend to other parts of life. Lasseter, for one, thinks that excessive self-expectations are becoming more common in today’s clients. “[I’m] seeing an increase in the need for perfection and the fear of failure,” she says. “These things have formed a continuum, with perfection on one end and failure on the opposite end. As a society, we’ve forgotten that our species learns by doing and that we rarely get something ‘right’ the first time.”

As with the social media “life comparisons” that Lasseter notices clients engaging in, this fear of failure and need for perfection can lead to low self-esteem and isolation, which often lead to loneliness.

Of course, social media and technology-enabled communication are not the only causes or contributors to loneliness. But all causes seem to share a unifying theme: the lack of connection.

“We are always on the run,” Opthof laments. “People are working more trying to provide for their families, and there isn’t enough time to get things done and be everywhere we have to be. This keeps us isolated.”

Opthof notes that throughout life, people go through transitions such as graduating and leaving behind their social circles, experiencing the breakup of relationships and enduring the deaths of loved ones. These transitions can fragment old relationships and require forging new connections.

Making connections

The counselors interviewed for this article agree that the principal antidote for loneliness is connection — both with oneself and with others. Research supports this. In a 2011 meta-analysis published in Personality and Social Psychology Review, Cacioppo and colleagues identified four primary intervention strategies for loneliness: improving social skills, enhancing social support, increasing opportunities for social contact and addressing maladaptive social cognition.

To encourage clients to reengage and connect, Lasseter requests that they create a bucket list containing activities they’ve enjoyed in the past as well as other activities they’d like to try for the first time. The list might include anything from traveling to taking a pottery class to learning a new language.

“I also try to help clients identify how their emotional boundaries have kept them safe in the past and how they are helping [or hurting] them now,” Lasseter says. She asks clients struggling with loneliness to identify ways that they struggle with confidence and then encourages them to push beyond their current boundaries. “The bucket list is great for this because it is filled with things they already want to do,” she notes.

Similarly, Myrtle Alvarez, an ACA member and LPC in Florence, South Carolina, suggests that clients explore groups and activities that might be enjoyable to them, noting that this could include joining a book club or church group, doing volunteer work or even just walking dogs at the local shelter.

“I encourage my clients to create a new narrative for themselves. Sometimes the things we tell ourselves become self-fulfilling prophecies,” says Alvarez, who has noticed loneliness becoming a prominent issue among clients. Rather than dwelling on their loneliness or critiquing themselves too harshly, Alvarez instructs these clients to “speak kindness and encouragement [to themselves]. Speak gain and not loss. Others will see this and, who knows, you may attract another lonely person and find healing between the two of you.”

Of course, there is no one antidote to loneliness for clients. Reaching out and connecting is a very personal process.

Huber was counseling a woman in her 30s who had recently divorced. In the process, she had lost the connection not only to her ex-husband, but also to some of their mutual friends. The client was self-aware and realized she needed to form some new relationships, but the strategy she was using wasn’t working.

“[She] was trying to meet new people and potential dating partners by going to the popular local bars,” Huber recounts. “She explained that she really didn’t like to drink, and the bar scene made her feel even more lonely.”

When Huber realized this tack wasn’t appropriate or comfortable for his client, he prescribed a different way for her to form connections organically. Huber gave her a kind of mantra that he has found to be particularly effective for clients who are struggling with feelings of loneliness: “Pursue interests, not individuals.”

“She liked singing, hiking and reading,” Huber says. “So over the next month, she joined her church choir, went on the monthly Saturday morning group hike with a local trail club and started to volunteer at a learn-to-read adult literacy program. She began to enjoy her post-divorce life more and found herself less lonely and more confident when she did meet eligible men.”

Huber believes counselors need to tailor their approaches and strategies for each individual client rather than trying to prescribe a one-size-fits-all solution for loneliness. For example, he recalls another success story with a client who was quite different from the 30-something woman who had gotten divorced. This client was “a 16-year-old popular athlete with lots of friends, but he found himself alone at home watching ESPN on weekend nights because he chose not to go to underage drinking parties or hang out with peers ‘just looking for trouble,’” Huber says. “As he put it, ‘It can be lonely doing the right thing.’ The approach with him involved affirming his decision-making and using his existing strengths to build contingency plans for weekends.”

“Since he played football, we used the concept of ‘calling an audible’” — changing the “play” — “when he needed to find meaningful options when friends were engaged in undesirable activities,” Huber says. “He felt connected to others [when doing] service projects, so he began to participate in a program that involved visiting older adults, to walk the neighbor’s dog or to referee basketball at a local youth center when he needed alternative social connections.”

Huber says counselors might also consider using other techniques he has found useful for clients dealing with loneliness:

• Reframe loneliness from being a “sign of a problem” to a “signal to change.” Huber validates the client’s feelings of loneliness but also encourages the client to use those feelings as the impetus to practice and utilize the skills he or she has learned in counseling rather than just giving up.
• Focus on the client’s strengths, interests and efforts early and often. Huber discusses the client’s feelings of loneliness but expands the discussion with a verbal and written inventory of the person’s strengths and interests. Huber asks the client to consider scenarios in which he or she might potentially develop or may already have connections. These scenarios include groups and environments such as work, school, recreation networks and religious communities.
• Describe therapy as an opportunity to practice relationship-building skills. “Practicing relationship skills in session involves identification, preparation and rehearsal of relevant skills in therapeutic role-playing,” Huber says. “For example, if the client is learning to initiate and maintain small talk when meeting new people, then we practice using these skills in a variety of typical social situations.” During these role-play scenarios, Huber and the client discuss behaviors that help people connect, such as showing interest, expressing care and respecting others. 
• Explore the “loneliness paradox”: Not everyone who is alone is lonely; not everyone who is lonely is alone. Huber and the client dissect the paradox by discussing the difference between being alone and being lonely.
• Define elements of “healthy solitude” versus default loneliness. “Healthy solitude is the choice to occasionally be alone [and] nourish mind, body and spirit,” Huber explains. “Loneliness is a feeling of being separated, isolated or disconnected from others without a choice.”
• Shift the focus of treatment away from chronic feelings of loneliness and toward cognitive choices. In other words, work with the client on changing maladaptive thinking that can perpetuate loneliness by shifting the client’s perception of self and others. Huber helps shift the client’s negative perception of self by targeting automatic negative thoughts such as “It’s no use trying” or “Nobody would want to be with me.” He and the client work together to edit these habitual thoughts to instead create a mindset conducive to overcoming loneliness. For example, instead of dwelling on all-or-nothing or self-limiting thinking, Huber encourages clients to make statements such as “I could try several things to meet more people; some might work, some may not” or “I have some qualities that people may enjoy.”
• Teach clients to rehearse and follow the three-step ACT mantra when they are feeling lonely:

Adjust your attitude. Instead of thinking, “Nothing will help,” try “Something may help with practice.”

Cultivate a connection: “Reach out to at least one person for support when practicing new skills,” Huber urges his clients. “You don’t have to go it alone.”

Try something tangible: “Analysis can lead to paralysis,” Huber says. “Instead of wondering about going to a cooking class, go to a class. Instead of thinking about calling a classmate, make the call. Instead of hoping you will be invited to dinner, invite someone for a meal.”

Opthof uses rational emotive behavior therapy and cognitive behavior therapy to help clients struggling with loneliness to reframe. He works with clients to get them to rethink their situations and look at them from a more rational view. He also encourages clients to confront their loneliness by engaging in other pursuits. Opthof enhances this work by encouraging clients to consider pursuing a whole-person, mind-body approach.

“I often spend a session with them discussing their diet, making sure they are eating as healthily as possible and encouraging them to get moderate exercise such as just taking a walk around the block,” he says. “I also recommend they look into yoga or meditation.”

Opthof also encourages clients to cut back on activities that distract and isolate. “The major tip that I give my patients is to cut back on the disconnection items — turn the phone off 30 minutes before going to bed, shut the phone off in the car, read email only a few times a day,” he says. “I encourage my patients, lonely or not, to focus on the here and now, [to] be in the moment. Often clients report that they feel less lonely when they try a few simple steps.”

Addressing loneliness also requires clients to foster a connection with themselves, says Marie Holland, an ACA member and LPC in Nags Head, North Carolina. She helps clients to increase their self-understanding by being mindful of their emotions. Holland also encourages the therapeutic relationship through validation. She lets clients know they are being heard by asking them questions and making it clear that she is open to whatever they have to say.

Holland has found group therapy helpful for uncovering and exploring self-esteem issues with clients. Often, low self-esteem can be at the root of an individual’s isolation and feelings of loneliness. In group, she says, clients feel safe revealing esteem issues because they are surrounded by people struggling with the same problems. Therefore, they feel less likely to be judged.

Holland also addresses clients’ negative self-image by helping them examine the self-judgments they make. She also guides them away from focusing on thoughts and encourages them to be aware of what they are feeling through mindfulness and meditation. In addition, Holland uses progressive muscle relaxation and guided imagery with clients.

Holland also uses an active approach to help clients combat loneliness. “The practice of role-playing with assertive communication skills is extremely helpful because it allows for the individual to experience success and gain confidence in their new skills,” she says.

Finding community

Although relying solely on technological sources for a social life can be harmful, clients can use online tools — particularly social media — to make new connections and strengthen old bonds.

People may even be expanding their social networks through social media by finding old classmates and long-lost friends. A 2011 Pew Research survey on social media found that Facebook users are more likely to have a larger number of close social ties. With that survey population, at least, Facebook seemed to encourage the development of intimate personal ties. The survey also found that people are increasingly using social media to keep up with their close friends; 40 percent of users have “friended” their core confidants.

Although it’s true that social media can be used to maintain or even enhance a person’s circle of friends, Opthof, for one, thinks people need to regularly get offline and make it a priority to interact with the people around them. Community is an important source of connection — one he feels we too often ignore in today’s society.

“When I walk around my neighborhood, there’s no one sitting on the front stoop or porch. We’ve gotten away from that. Now we all have decks,” he laments.

Opthof says he once enjoyed waving to people as he walked around, but now there’s nobody to wave to. All his neighbors are inside or behind the backyard fence — on their decks.

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To contact the individuals interviewed for this article, email:

• Myrtle Alvarez at malvarezlpc@gmail.com
• Marie Holland at marie@mariehollandcounseling.com
• James Huber at jhuber@holyfamily.edu
• Amy Lasseter at amy@lassetertherapies.com
• Gerald Opthof at gerald@gaotherapy.com
• Everett Painter at epainter971@gmail.com 

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Laurie Meyers is the senior writer for Counseling Today. Contact her at lmeyers@counseling.org.

Letters to the editor: ct@counseling.org