Q&A

Chronic Loneliness

How can clients reduce loneliness by building stronger social connections? Clinical psychologist Professor Roz Shafran explains how CBT can help.

Roz Shafran is Emeritus Professor of Translational Psychology at the UCL Great Ormond Street Institute of Child Health and a Fellow of the Academy of Medical Sciences. She founded the Charlie Waller Institute of Evidence-Based Psychological Treatment at the University of Reading, set up the Lucy Booth drop-in mental health service at Great Ormond Street Hospital and is an expert adviser to the National Institute for Health and Care Excellence. The British Psychological Society has recognised her distinguished contributions to psychology in practice.

Her more than 300 publications cover perfectionism, eating disorders and OCD. More recently she has helped develop a CBT model for chronic loneliness, tested in a 2021 trial of internet-based treatment. Her books include Overcoming Perfectionism and The CBT Handbook.

What are some key strategies to help clients reduce loneliness?

Cognitive behaviour therapy is one option to address loneliness. More information can be found here: Therapist Guided Internet Based Treatments for Loneliness

Other options are mindfulness: Mindfulness Training Reduces Loneliness and Increases Social Contact in a Randomized Controlled Trial

And community navigation interventions: The Community Navigator Study: Results from a feasibility randomised controlled trial of a programme to reduce loneliness for people with complex anxiety or depression

The strategies will depend on the different needs of the clients. For example, an elderly bereaved person who is lonely will need a different strategy from someone who has social anxiety, who again will be different from someone with autism. The principles will be the same, but the key strategies may differ.

I believe the root of human desire is to be understood. For me understanding comes from being accepted as I am. I know that I accept myself completely. But I don't feel like others do. I often get abandoned. This leaves me feeling unconnected. Help?

This is a difficult problem. I wonder if this book may be helpful? A Sense of Belonging: How To Find Your Place In A Fractured World

How much are social skills related to chronic loneliness? Is it an assumption to think that a key intervention for people experiencing loneliness is social skills training?

This speaks to the first point. For some people who have social skills deficits, social skills training may be helpful. For others, their primary difficulty will be more about their perception of the discrepancy between their perceived and desired social relationships.

Is the mindset that comes with loneliness similar to social anxiety and can this inform your formulation for CBT?

Again, there is a lot of individual variation. For some, social anxiety is central to social isolation and loneliness, but for others, it is less relevant.

Why is it harder to make connections as an adult? I feel like I will never make connections like people around me who have had friendships since college and school.

This is hard to answer. Some people don’t have any friendships since college and school, and their closest friends are those they make in adulthood (e.g., when becoming a parent or in the workplace).

Is there a particular approach that you take in helping clients who want to be able to tolerate being with themselves in solitude without feeling overwhelming loneliness? Where does the struggle to do this come from? This issue particularly seems to come up with new parents of infants who can feel overwhelmed with loneliness being alone with their infant.

This sounds like a complex situation. New parents are also exhausted and going through lots of other changes. Accessing support for new parents and helping people manage difficult emotions that become overwhelming when alone are important issues that may require interventions broader than just loneliness.

How can CBT help you feel connected to yourself?

It depends on what you mean by 'connected.' CBT for loneliness can help people address personal meanings, e.g., perceived lack of connectedness. Emotion regulation training may help give more insight into emotions and acceptance of them. These may be good resources.

Emotional Regulation In Psychotherapy: A Practitioner's Guide

Mindful self-compassion (MSC). In the "Handbook of mindfulness-based programmes" (see attached PDF).

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How do you help with the thought "I am all alone"?

It depends on whether it is a thought or a fact. If it is a fact, then increasing social contacts will be a priority. If it's a thought that is not based in reality, then understanding the meaning of that thought to the person would be a central part of helping to change it.