Tag Archives: loneliness

Life after traumatic brain injury: Lessons from a support group

By Judy A. Schmidt October 8, 2018

Support groups are wonderful opportunities for people with similar life experiences to meet each other, share their stories and encourage one another. Group members benefit from learning coping strategies and everyday tips for dealing with various experiences. For people with traumatic brain injury (TBI), support groups offer informal opportunities for understanding a shared experience that greatly changed their lives, often within a few seconds’ or minutes’ time. They are left with physical, cognitive and emotional outcomes that impact their relationships, work and independence, often leading to loneliness and isolation.

As noted by the Brain Injury Association of America, more than 2.5 million adults and children experience a TBI in the United States each year, and support groups play a vital role in their continued recovery and re-entry to everyday life. A TBI dramatically interrupts life for these individuals and their families. Extended hospitalizations for physical recovery and long-term cognitive training for rewiring the brain alter all aspects of life, with treatment continuing for up to a year after the incident.

 

Effects of TBI

The effects of TBI are varied and highly individualized. The extent of the physical and psychosocial impacts depends on the type of injury (closed, open or acquired) and the severity of the injury. Thus, depending on the area of injury, people with TBI may deal with deficits in memory, executive functioning issues and poor judgment.

Frontal lobe injuries may lead to changes in mood and personality, difficulty making decisions and difficulty with expressive language, all of which are executive functions.

Injuries to the parietal lobe, which helps with perceptual abilities, may lead to difficulties naming words (anomia), finding words (agraphia) or reading (alexia), as well as problems with perceptual abilities that integrate sensory information. The ability to distinguish right from left may also be affected.

Damage to the temporal lobe may involve hearing loss, Wernicke’s aphasia (difficulty grasping the meaning of spoken language), problems categorizing information such as objects and short-term memory problems.

Brain injuries to the occipital lobe, which controls our vision, may lead to visual field problems, distorted perception and difficulty with reading, writing and word recognition.

Injury to the base of the skull at the site of the cerebellum creates difficulties with balance, equilibrium and coordination, as well as slurred speech.

Acute and long-term rehabilitation from TBI involves physical, occupational and speech therapy, as well as cognitive neuropsychological evaluations. As individuals recover from the physical damage, it is important for counselors to be a part of the rehabilitation team to manage adjustment to the physical injuries, acute stress and cognitive disability. In addition, the psychosocial aspects of TBI are very disruptive. They can be long-lasting as these individuals and their families begin to adapt to everyday life. Counselors are needed to provide individual and family counseling, as well as psychoeducation about TBI and recovery.

 

Psychosocial aspects of TBI

The psychosocial aspects of TBI are also related to the area of brain damage. People with frontal lobe damage may have difficulty making decisions, maintaining attention to tasks and controlling impulsive behaviors.

When the parietal lobe is damaged, difficulties occur with eye-hand coordination, reading, math and writing.

Temporal lobe damage interferes with communication skills, learning and memory. Learning difficulties due to recognition and visual field problems may result from occipital lobe damage.

In assisting people with TBI and their families, it is important to understand how psychosocial areas of life are affected and how these areas impact the potential return to daily living. For example, an individual may not return to his or her pre-injury abilities and can experience problems returning to work or school. Difficulties with problem-solving, understanding others’ emotions and social cues, or just being able to carry on a conversation may isolate the person with the TBI and increase his or her feelings of loss. Other areas of life that may be affected include the ability to drive, participate in sports and exercise, which can create deficits in the person’s social life. Problems with executive functioning can lead to challenges making sound decisions. Because safety is a major concern, the individual with a TBI may need to be monitored consistently by family, which can lead to tensions and other problems.

These are all skills that most of us take for granted or complete without much planning and forethought. But for individuals with TBI, family and personal relationships can grow strained, and the ability to build new relationships is impacted. The person’s independence and self-esteem suffer greatly.

 

Lessons learned

As a rehabilitation counselor for an acute inpatient rehabilitation program, I work with individuals who have TBIs, as well as their families, to provide counseling for stabilization, adjustment to disability and assistance with developing coping strategies. Providing support to these patients and their families as they begin realizing the extent of the brain damage and start dealing with feelings of loss is a crucial part of recovery.

For three years, I facilitated a monthly outpatient support group for people with TBI and found the experience fascinating. Hearing stories of people having car accidents, motorcycle accidents, work accidents, anoxia (deprivation of oxygen) and other unexpected accidents was difficult and often heart-wrenching. Yet these shared experiences forged a bond among group members that was undeniable and very moving.

They shared what it was like to not remember exactly what had happened to cause their brain injury. They shared what it was like to lose track of time and details and to have to trust the information told to them by health care providers, family members and friends. The fact that they each had “lost a period of time” from their lives and hadn’t been the same since seemed to build a sense of trust and caring among the group.

I soon learned that as a rehabilitation counselor, I could understand the medical, cognitive, vocational and emotional results of their injuries, but I couldn’t fully appreciate the daily psychosocial impact that their injuries had taken and continued to take on their lives.

The time since being injured varied among the support group members — anywhere from two years to 18 years. Regardless, the psychosocial effects they experienced were extensive. They talked about their school and work being interrupted, about having to settle for less challenging options or not being able to pursue their goals at all. Some shared tales of broken marriages and relationships, of losing custody of their children.

Others talked about losing their sense of independence because they had to rely on their families for almost everything. Some could no longer live at home due to the need for constant supervision, so they had to learn to live in group homes. Pursuing sports or other recreation choices was hard because of physical limitations. Another significant loss was no longer being able to drive and depending on others for transportation. The lack of money for “extras” was particularly difficult for those group members with children.

Holidays posed another challenge for these support group members because of sensory issues with noise, lights and too many people talking at once. Others discussed experiencing the stigma of having a TBI and being considered “different now” by family members and friends. This was felt particularly strongly at social gatherings, where family and friends made infrequent contact with them. Isolation and loneliness were prevalent themes in their stories. Depression, anxiety and low self-esteem made daily life a struggle.

Research conducted by Jesse Fann and colleagues in 2009 and by Annemieke Scholten and colleagues in 2016 and subsequently published in the Journal of Neurotrauma shows that the rate of depression during the first year after a TBI is 50 percent. The rate is close to 60 percent within seven years after the TBI. So, it is crucial for counselors to have this awareness of serious mental health issues in people with TBI to properly assist them and their families in seeking appropriate treatment.

Members of the support group I facilitated discussed that being on medication was difficult due to the side effects and to the cost of the medication if they had little or no insurance. They felt that cognitive retraining programs and daily psychosocial programs modeled after those for people with serious and persistent mental illness helped tremendously. The aspects of these programs that they reported helping most were receiving cognitive behavior therapy and continuing to learn more about TBI. The psychosocial programs were highly regarded because of the increase in social activities, access to vocational rehabilitation and supported employment services, and integration back into the community.

At times, the support group was difficult to manage because of the cognitive and emotional deficits with which the individuals dealt. However, the members had their unique ways of helping each other and redirecting the conversations. It was very clear that they respected one another.

Our time together as a support group transformed us into a unique family, particularly because the group remained fairly constant in its membership. The members trusted each other and understood the struggles being discussed. However, they also felt safe in correcting each other and being bluntly honest (which people with TBI are). We did have some new members join along the way. They were welcomed with open arms, and veteran members exhibited an unabashed eagerness to help. It was always interesting to hear about the creative accommodations that our members developed to live life each day and how the professionals in their lives assisted them.

As the group grew stronger, the members felt it was important for me to record what they wanted others to know about TBI and people with TBI. Their primary messages were:

  • “Conversation and expressing one’s self can be difficult.”
  • “People with TBI may not like the same things as they previously did, so don’t force us.”
  • “Tasks may take longer for people with TBI, so wait for us.”
  • “Social situations can overload people with TBI.”
  • “TBI affects everyone around the person.”
  • “Those with TBI are still the same people they were before.”

During my time with the support group, I learned many lessons. First of all, I learned that life after a TBI requires constant adjustments that must be made each day to be productive and involved. I also came to understand that time does offer healing when abundant respect and empathy are present. But most important, I learned about living life as it happens from a wonderful group of resilient individuals.

 

 

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Judy A. Schmidt is a clinical assistant professor in the clinical rehabilitation and mental health counseling program in the Department of Allied Health Sciences, and an adjunct clinical assistant professor in the Department of Physical Medicine and Rehabilitation, School of Medicine, at the University of North Carolina (UNC) at Chapel Hill. She is the rehabilitation counselor for the acute inpatient rehabilitation unit for UNC Hospital, where she provides counseling services to patients and their families after traumatic brain injury, stroke, spinal cord injury and other neurological trauma. Contact her at judy_schmidt@med.unc.edu.

 

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

The age of isolation: How Instagram memes describe a lonely generation

By Adriana V. Cornell July 26, 2018

Instagram tells millions of stories. Many exhibit our personal daily moments, and, from a wider lens, others describe entire populations and social movements. With 800 million users, Instagram is one of the biggest and richest collections of societal data on the planet. We can learn a lot by noticing what these users choose to showcase personally and which accounts and posts they choose to follow. Lately, I’ve been paying attention to the latter.

Of course, Instagram has grown since its conception, from personal accounts to brand accounts. It seems every business, school, group, dog and fetish now has an Instagram account. “Celebrities” — foodies, beauty experts, daredevils, singers, comedians and more — are born on Instagram.

In the past year, I’ve been following a few comedic accounts that display almost exclusively memes. A “meme” comes from the concept of memetic theory, championed by Richard Dawkins in his 1976 book The Selfish Gene. Just as genetics connote characteristics passed from generation to generation, memetics refer to cultural ideas transferred from person to person. A meme spreads quickly because it can reproduce itself, jumping from mind to mind and therefore driving cultural influences across the globe. According to the theory, genetics and memetics are similarly affected by Darwinian rules of evolution: Their success is subject to their contribution to the effectiveness of the person carrying them.

Memes can concern any content, but the “units of culture” I have been focusing on seem to be targeting people in their mid- to late 20s who are still navigating the transition from youth to adulthood. I’ve noticed a trend in these memes that seems both disturbing and completely normal.

Here are a few that have been featured and reproduced on multiple accounts:

 

 

 

Posts of this kind receive an immense “ovation” of likes, comments and shares. More than 250,000 people liked the first meme, and more than 14,000 commented. Most comments “at” (or link) a friend’s account, inviting him or her to view the same post, and they remark together on the accuracy and truth of the message. These comments include:

“haha, us literally.”

“Lol my life story.”

“So accurate.”

“Us every day, all day.”
“Literally EVERY f*cking time, without fail…! Millennials & bad drivers make being an agoraphobe so much easier nowadays!”

 

Most memes display simply black Arial font on a white background; they seem to rely entirely on the words that compose them. Others feature text accompanied by graphics, pictures or GIFs, such as this one:

 

But even as memes become flashier and more complex with recycled photos or videos, the rule of Darwinian evolution remains critical: The success of memes depends on the effectiveness of the person carrying them — in this case, the account holder. The popularity of a meme, evidenced in the comments section, seems to multiply if the account holder’s caption provides funny, insightful, witty commentary on the meme: in essence, a meme upon a meme.

For example, in the third meme, an account holder captioned the image with: “I’m At Lunch Not Talking To The Person I’m With, But Instead Looking At A Facebook Photo Of The Lunch Belonging To A Girl I Haven’t Seen Since […] 2007.”

This caption — using a relatable, all-too-real anecdote — brings new life and humor to a recycled post. It successfully reproduces the memetic, refueling the cultural influence and giving it new shape before it is passed on.

Users react accordingly, many of them employing the “Face with Tears of Joy” emoji as they comment specifically on the caption:

“Hahaha omg ur caption”

“the caption!!!”

“what if ur sitting with a really boring person at lunch”

“hahaha the caption tho”

 

I simultaneously find myself laughing about and relating deeply to these memes and their captions. Even if my feelings don’t agree in the moment, many of the messages tap into emotions, reactions or thoughts that I’ve certainly had. I have wished that plans would fall through. I have spent too much time scrolling through Facebook. And I have used emojis and exclamations in text that I would never say or emote in real life.

Meanwhile, I can’t help but feel disturbed by these messages and the amount of praise and endorsement they receive. They are all deeply sad and negative in tone and content because they seem to connote a total lack of feeling, social inclination and zest for life, yet at the same time, the need to be liked, included and embraced.

For this reason, I started saving memes of this kind to a “collection” — an optional, user-controlled repository for images on Instagram — that I titled “Oxymoron.” The contradiction of craving and simultaneously rejecting social interaction became an apparent theme that puzzled me. I started asking myself and lots of other (mostly 20-something) people: What’s going on here?

Some friends, while acknowledging that we’re naturally social animals, offered a simple answer. “After working a 12-hour day, that desire to socialize becomes secondary to my need for sleep,” Kelly, 28, explained. “I’m so happy if plans fall through because I feel exhausted by the idea of devoting any more energy to anything in my day.” Others echoed similar ideas and sentiments.

But this explanation didn’t seem to capture the full picture, and it seemed even my busy friends agreed. As our email exchanges developed, so did our ideas about other possible contributors to what seems like an age of isolation, neediness and sadness. After all, depression rates for teens and young adults are higher than ever (12.7 percent as of 2015, according to Psychological Medicine). The chief perpetrators, we concluded: social media and smartphones.

 

Socializing without the authentic self

Comedy is successful when it shamelessly and nakedly brings to light the truest feelings we all possess but don’t readily admit to or talk about. It can be an immensely satisfying relief to hear our private thoughts, habits and emotions exposed and articulated in an anonymous way that lets us know we’re not the only ones experiencing them — that we’re not alone.

And we will do anything to avoid feeling lonely. We will maintain friendships that we don’t enjoy. We will agree to plans that we don’t look forward to. We will stay in relationships that make us unhappy. We will join gangs, extremist groups and cults. In studying our basic human needs, Abraham Maslow determined that we will even sacrifice our safety for the sake of belonging, as evidenced, for example, by children who cling to abusive parents.

Loneliness is deadly. According to research conducted by Julianne Holt-Lunstad, professor of psychology at Brigham Young University, loneliness has the same effects on our health as smoking 15 cigarettes a day. It is more fatal than obesity.

Conveniently, smartphones have given us a tool to dismiss and evade feelings of loneliness quickly and with little effort. Texting, of course, provides the sense of company and togetherness in any and every moment. But even scrolling feeds on Facebook or Instagram can make us feel invited into the lives of friends whom we might not readily meet up with or call.

“We know that engagement with social media and our cell phones releases a chemical called dopamine,” noted Simon Sinek in a 2016 interview on Inside Quest. “That’s why when you get a text, it feels good. It’s why we text 10 friends when we’re feeling a bit lonely, a bit sad. … It’s why we count the ‘likes’ on our Instagram.” And we can do all of this without getting off the couch, without putting on fresh clothes and — best of all — without actually speaking to anyone.

Because socializing in person, face-to-face, is hard. We’re required — in real time — not only to process and listen to what others are saying, but then also to compose (witty, sensible, empathetic, affirming, interesting) comments in reply, sensitive to the situation, conversation and environment. All the while, we must align our facial expressions to the context and content, some of which changes by the second. If live conversation can be described, as it often is, as “dancing,” then texting or using social media might be described as a card game. Both require thought and strategy, but in-person communication demands spontaneity. It commands us to be our authentic selves.

But that can be complicated and challenging. What if we don’t like who we are? What if we don’t know who we are?

The pressure to be perfect has never been more intense. In his 2015 bestseller Sapiens: A Brief History of Humankind, Yuval Noah Harari wrote, “If you are a teenager today, you are a lot more likely to feel inadequate. … Even if the other guys at school are an ugly lot, you don’t measure yourself against them, but against the movie stars, athletes, and supermodels you see all day on television, Facebook and giant billboards.”

Social media allows us to craft, edit, filter and recraft ourselves so that we can come closer to this ideal. We can even consult friends before we reply to a text or post a photo, giving us the ability to depict the (airbrushed) story we wish to tell. But allowing real-time spontaneity to eventually and inevitably reveal who we really are can feel risky and terrifying.

Brené Brown boils this down to a deep aversion to vulnerability. Because we are social animals, we need to feel connected and a sense of belonging in order to survive. “Connection is why we’re here,” Brown said in her 2010 TED Talk. “It’s what gives purpose and meaning to our lives.”

And it is the fear of disconnection, Brown asserts, that often makes us feel the most challenging feelings, like vulnerability and shame.

 

A downward spiral of loneliness

The memes I have observed and collected are popular because they send the message that putting ourselves out there is not worth the risk. No one else is going out; why should you? Why let yourself feel judged, offended or not good enough?

But “for connection to happen,” Brown continues, “we have to allow ourselves to be seen. Really seen. …When we numb vulnerability, we numb joy, gratitude, happiness.” We must accept who we are and embrace vulnerability. People who are most connected, Brown found, “were willing to let go of who they thought they should be in order to be who they were. You have to do that for connection.”

The concern that has nagged me over the past year is that these memes openly reject this kind of self-exposure and authenticity, essentially instructing us to give in to our fear of vulnerability. This not only prevents others from knowing us, it prevents us from knowing ourselves. We get stuck, therefore, in a developmental stage that looks and feels a lot like adolescence — afraid of judgment, lacking self-confidence and without a sense of true belonging.

Another distinct and crucial feature of face-to-face conversation is the opportunity for touch. A pat on the back, caress on the arm, stroke of the hair or hold of the hand is essential to our mental and physical well-being. “Being touched increases the number of natural killer cells, the frontline of the immune system,” says Tiffany Field, founder of the Touch Research Institute at Miami Medical School. “Serotonin increases. That’s the body’s natural antidepressant.”

Deprivation of the sensation of touch from another human often results in feelings of isolation, social exclusion and depression. What’s more, these feelings make people fearful and put them “into a kind of defensive state where the levels of cortisol [the hormone released by the brain in times of stress] are raised,” says Kellie Payne, researcher at the Campaign to End Loneliness. “Having had negative experiences, they anticipate that their connection with people will also be negative, which makes it hard to reinstate contact.”

In short, lonely people can get trapped in a downward spiral of loneliness. These memes tap into and perpetuate this vulnerability, actively discouraging ambition, social connection and productivity.

Fortunately, our brains are resourceful; they find alternative ways to satisfy our needs. For many, this compensation is happily found in communicating via text message and social media. That dose of dopamine can be the fix we need in sad or lonely moments so that, with the approval and company of tens of thousands, we can quickly wipe them away.

Returning to Maslow, these memes, therefore, allow us to reach the two highest orders of human need: esteem (being accepted and valued by others) and self-actualization (reaching our full potential; being all we can be).

The problem is that this solution is shallow, artificial and temporary. Because although it feels like we’re raising unspoken issues of loneliness and depression, and relating to others when we like or comment on these memes, we’re not actually facing our feelings or each other, or talking about them in a way that allows us to be honest, authentic or vulnerable. At the end of the day, the humor used in these memes is merely numbing and normalizing some of our deepest and truest emotions by providing a false sense of togetherness and belonging that inevitably lets us down.

But because “connecting” to others via social media has become so easy and satisfying, like any dopamine producer, it is highly addictive. We’re no longer willing to devote energy, time and effort to our relationships (or any project) because it is —comparatively — too hard.

In other words, social media has yet to find a way to produce serotonin: a far more gratifying, long-lasting and pleasure-inducing hormone. Serotonin provides a sense of relationship, allegiance and pride after dedicating time and effort to a project or task that transcends selfish motivations. But when a meme caption says: “If you do anything interesting or important today, you can go f**k yourself,” we’re excused from trying. Instant gratification has overtaken meaningful, lasting reward, and dopamine has overtaken serotonin.

And just as any addiction — drugs, food, sex — is, by definition, extremely satisfying in the first stages, it often loses appeal, allure and thrill as it becomes more intense and demanding. The craving or desire becomes a need or chore, and we in turn become a slave to our addiction. These memes and apps such as Instagram are designed not only to “rescue” us in times of loneliness or sadness, but to draw us in constantly, at all times of day and night.

“That itch to glance at our phone is a natural reaction to apps and websites engineered to get us scrolling as frequently as possible,” wrote Bianca Bosker in a 2016 edition of The Atlantic. “In short, we’ve lost control of our relationship with technology because technology has become better at controlling us.”

When we are or feel controlled, we lose our sense of self and self-worth — our ability to produce, invent and create. The majority of Instagram users are merely consumers of information; only a small percentage of users are actually creating the message, the humor and the trend. It requires far less thought and effort to simply “at” a friend or double tap to “like” a photo than it does to lean in and think about and interact with society so that we can create our own ideas — or even just talk to one another about them.

 

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Adriana V. Cornell has spent the past two years living in Nairobi, Kenya, working as a school counselor and college counselor at an international school. She has worked primarily with high school students and has focused her writing and research on students in transition and social media. She moved back to the United States with her husband in July. Contact her at adriana.v.cornell@gmail.com.

 

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

Confronting loneliness in an age of constant connection

By Laurie Meyers December 22, 2014

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 Branding-Box-Lonelywith 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:

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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