How important are social connections to our overall health? Our host, Dr. Mo Alsuwaidan, is digging into loneliness and isolation, and what they could mean for us long-term.
How important are social connections to our overall health? Our host, Dr. Mo Alsuwaidan, is digging into loneliness and isolation, and what they could mean for us long-term. He chats with experts Dr. Julianne Holt-Lunstad, a professor of psychology and neuroscience at Brigham Young University, and Cathy Comber, CEO of Loneliness New Zealand, about how our social lives can help determine our health. They discuss how loneliness is associated with negative health outcomes – even the risk of earlier death. While that may sound scary, the conversation shows how much stronger the impact of social connection is on the positive side of the scale, and how critical it is to prioritize your friends and family.
Disclaimer: This podcast is provided for educational purposes and is not intended to replace discussions with your healthcare provider. All decisions regarding your care must be made with a healthcare professional, considering the unique characteristics of your personal situation. The opinions expressed are the opinions of the individuals recorded and not the opinions of Viatris. Individuals featured in this podcast may have participated in the past as or may be current members of an advisory group for Viatris.
Dr. Mo:
Welcome back to Listen Well. If you've been struggling with feelings of loneliness and isolation, especially over the last year and a half, you're not alone. Among all the other changes to our daily lives, many of us have faced a level of social isolation that we'd never experienced before. With the major shift towards working at home, a lack of social gatherings, and the inabilityto travel, our families and friends have felt further away than ever. On today's episode, we're unpacking the consequences that this kind of isolation can have on our health, both mental and physical, and how important it is to take care of our social health. We're bringing in Dr. Julianne Holt-Lunstad, a Professor of Psychology and Neuroscience at Brigham Young University, and Cathy Comber, the Founding Trustee and CEO of Loneliness New Zealand. Our experts will talk about the effects of loneliness and isolation, what the pandemic has meant for us all socially, and how we can move forward.
Dr. Mo:
I'm so glad that you're here and hope you're ready to listen well.
Dr. Mo:
It's a pleasure to have with us, Dr. Julian Holt-Lunstad. Welcome to the show, Julianne.
Dr. Julianne Holt-Lunstad :
Thank you for having me. And it's such a pleasure to be here with you.
Dr. Mo:
So, I wanted to start with a big overarching question. Why is social connection so important?
Dr. Julianne Holt-Lunstad:
Well, of course, humans are fundamentally a social species. Throughout human history we have needed to rely on others for survival. And so, it shouldn't be surprising that our relationships are critically important, not only for our survival, but for our wellbeing.
Dr. Mo:
And a lot of your work is about loneliness. How would you define loneliness and how does it differ or relate to social isolation?
Dr. Julianne Holt-Lunstad:
That's a great question because people use the terms social isolation and loneliness interchangeably. And of course, these can go hand in hand, but not always, and can be experienced independently. So, it's important to know the differences. So, isolation is thought to be more objective, it's having few relationships or infrequent social contact. Whereas loneliness is thought to be more subjective, a distressing feeling that's associated with the discrepancy between one's actual and desired level of social connection. And so of course, being isolated can increase your risk for feeling lonely, but you can be isolated and not feel lonely. You might actually enjoy being alone and conversely, you can be lonely, but not isolated. You might be- People have said use the phrase lonely in a crowd or felt lonely at a party and so you could be surrounded by others and yet still feel profoundly lonely. if the people that are around you aren't fulfilling one's needs or desires.
Dr. Mo:
That's an interesting paradox. And maybe we'll get to the modern world, whether that's increased or not. I wanted to ask you about the links between loneliness and mental health. Is there a link and how does loneliness affect mental health?
Dr. Julianne Holt-Lunstad:
Yeah. So first of all, it's important to recognize that these are actually different concepts. And you know I recently had a physician contactme and ask, if I just screen for depression, does that capture it? And these are actually different concepts. And so, depression is different from loneliness, but isolation and loneliness and mental health are correlated. And there seems to be a somewhat of a bidirectional effect. So, being isolated or lonely can increase your risk of poor mental health. And conversely, poor mental health can increase your risk of becoming isolated or lonely. And so, there are studies that have shown both of these directions.
Dr. Mo:
Are there specific mental health issues that are more correlated with loneliness? Depression for example, or other things?
Dr. Julianne Holt-Lunstad:
Well so, much of the research has focused on depression and anxiety. There is some evidence to suggest some other mental health issues as well, but those are some of the strongest evidence is among depression and anxiety.
Dr. Mo:
What about physical health? Does loneliness actually affect your bodies or other aspects of the physical health?
Dr. Julianne Holt-Lunstad:
That's actually the area where my research has focused on primarily. And interestingly, my research started really looking at some of the biological effects that might explain some of the associations that exist with physical health. And so, I spent much of my early career looking at psychophysiology and some of the biomarkers that might explain that. But, we do have good evidence that our relationships and various aspects of relationships that being more socially connected is protective for physical health, whereas isolation and loneliness is associated with greater risk.
Dr. Julianne Holt-Lunstad:
And this has been shown across a variety of sources of physical health outcomes or morbidities. But, most of the evidence is with in terms of illness is cardiovascular outcomes. Although, there is evidence of other kinds of outcomes, but cardiovascular outcomes we have more evidence of, but the strongest evidence comes from risk for all-cause mortality. And so, in some of my research, I've conducted a couple of meta-analyses and the first showed that those who are more socially connected have significantly increased odds of survival, compared to those who are less socially connected.
Narration (Dr. Mo):
Meta-analysis, if you’re unfamiliar, is when we examine data from multiple independent studies about the same topic. Doing this can help us determine overall trends about a particular subject.
Dr. Mo :
So, just living longer in general?
Dr. Julianne Holt-Lunstad:
Uh-huh, yeah. And then the second looked specifically at social deficits of isolation, loneliness, and living alone. And what that one found was that being lonely is associated with increased risk of earlier death by 26%, isolation by 29% and living alone by 32%.
Dr. Mo:
Wow. Those aren't small numbers.
Dr. Julianne Holt-Lunstad:
No, and what's interesting though is that the increased odds of survival of being socially connected, that was a 50% increase odd. So, the effect, the magnitude of that effect is actually stronger on the positive side than on the negative side. So, we shouldn't discount how protective our relationships can be.
Dr. Mo :
You used an interesting term, psychophysiology that your work has been in psychophysiology. So, can you define that for listeners?
Dr. Julianne Holt-Lunstad:
Yeah, yeah. It's looking at how social and psychological factors influence our physiology. And so, in some of these studies, we would bring individuals into a lab and connect them to monitors that would look for instance at cardiovascular functioning. And we would put them in various situations and measure how that might affect their physiology. And so, for instance, in some early studies, we put people in stressful situations and what we found was that people who had social networks that were filled with more supportive kinds of relationships were far less reactive physiologically to stress than those who had fewer supportive people in their network. We also did studies where we would bring people, have someone bring in a friend, either who was quite supportive or someone that they had mixed feelings towards. And they were much more reactive in these situations physiologically when they were interacting with someone that they had mixed feelings towards than someone that was very supportive. And so, our relationships do affect our physiology, which if sustained over time and experienced chronically, can potentially put us at risk for cardiovascular kinds of outcomes that ultimately might explain some of these health outcomes.
Dr. Mo:
That's really fascinating. So, I mean, I think everyone would agree that we live in an age where people are hyper connected virtually through technology. In your view, how has that affected real social connections, especially in younger people?
Dr. Julian Holt-Lunstad:
So, first in terms of what the science says on that is it’s really complicated. And part of that is because there are so many ways to… well first of all so many different types of technologies and so many different ways of using those technologies. And so, you know the big question initially was, is this just some shift, like you know the introduction of the telephone, just another way of us being able to communicate to others. Or is this something that is somehow different that might in some way either help or hinder relationships. And I don't know that we necessarily have any kind of definitive answers to that question yet, simply because, like I said, that the evidence is so diverse. And so, there's a whole body of evidence that’s looking, for instance, specifically at social media.
Dr. Julianne Holt-Lunstad :
So for instance, there have been a few studies that have shown that social media use has been linked to loneliness, but what's not clear with a correlational study is, is it that use of social media is leading to loneliness or is it that people who are lonely are more likely to use social media to connect?
Dr. Mo:
Yeah. And so I guess the Jury's still out then the knife can cut both ways. I was wondering what you thought about COVID's effects on social isolation and loneliness. Are we in fact in a loneliness pandemic?
Dr. Julianne Holt-Lunstad:
Yeah. So there have been a number of studies that have been conducted during the pandemic to try and understand to what extent this is increasing loneliness. So, like I mentioned, isolation and loneliness are different and you know it could have been possible that people are resilient and are engaging in behaviors and coping mechanisms that might protect one from loneliness. So, it is important to study and identify whether or not people have become more lonely or not. And so, a number of studies conducted were cross sectional, again, just you know asking people at one point in time, something along the lines of, do you feel lonelier now or than you did pre-pandemic. And so, in some ways is, you know, retrospective recollection or their perception of how that's changed. And I can think of one study that showed some stability, but most of them showed increases in loneliness. But interestingly, there were several studies that were longitudinal.
Narration (Dr. Mo):
A longitudinal study is where researchers follow and observe the same subjects over a period of time that sometimes lasts many years.
Dr. Julianne Holt-Lunstad:
And what these 32 studies showed was overall, there was an increase in severity of loneliness. So, within individuals, they on average got lonelier as well as an increase in prevalence of loneliness. So, more people reported severe loneliness during the pandemic compared to before. So, this evidence suggests that broadly, loneliness did increase in severity and prevalence.
Dr. Mo:
We hope you’re enjoying this episode of Listen Well. We’re so pleased to be working on this podcast to help encourage discussions about important health topics.
Andrew Enrietti:
Hello, my name is Andrew Enrietti. I am head of Global Human Relations at Viatris. While we’re talking about the impact of social isolation and loneliness on health in today’s episode, I wanted to share more about our commitment to mental health.We’ve always made the well-being of colleagues a priority, and the pandemic created even more of a “people first” mindset. We have employees in countries around the world who have been in various stages of the lockdown due to the pandemic. Working parents. Employees caring for elderly parents. Employees who are starting their first job ever. We’ve provided access to employee assistance programs around the world, which include counselors and other types of support. In some countries, we are also providing counseling via telemedicine, and we’ve seen an increase in usage. We’ve also provided our managers with training on coaching and how to adapt to managing teams virtually. And in some extreme cases, we have gone to great lengths to take care of colleagues who are isolated and literally don’t have support at home. People are at the intersection with this pandemic in different ways. You never know what people are going through and it calls for patience and empathy. Creating safe opportunities – both in groups and one-on-one settings – for people to feel comfortable is very important.
Dr. Mo:
So, Julianne, as you know, the global vaccination campaign is progressing rapidly in the developing world. And is there a way to use the experiences we learned in lockdown to improve our social connections moving forward? Especially, I get questions from patients and family members, friends about how do you deal with so-called re-entry phenomenon into socializing again?
Dr. Julianne Holt-Lunstad:
Yeah- oh gosh. There's so many lessons we could learn from this. And one of the things that I think is hopeful is that there is more of awareness around the importance of our relationships and being socially connected, as well as the potential risks around isolation and loneliness. And so, my hope is that this will also reduce some of the stigma around isolation and loneliness, so that there's more openness about talking about it and that people may be more open to reaching out for help, because there is a lot of stigma around that, which can be a barrier to identifying those who might be isolated or lonely. And so in terms of re-entry, you know it's interesting because I know one point in time, at least here in the US, you know we had a two week lockdown and then we thought it was going to be over. And then, things extended.
Dr. Mo:
And I think that was happening all over the world.
Dr. Julianne Holt-Lunstad:
And so, we need to find ways to connect to each other in ways that also don't put each other at risk for infection, because ultimately, our health and wellbeing is the goal. And I've always wanted to make sure that no one ever saw it as somehow competing goals and, in any way, ever took my research as evidence to somehow ignore any kind of safety recommendations around COVID safety. So yeah, it's part of that is going to be in terms of just some practical things that people can do, depending on what level of openness there is in one's community, is a few things that they can do is to think about how to nurture and maintain existing relationships.
Dr. Julianne Holt-Lunstad:
How to really look out for others as well, and to think about how one thinks about their relationship. So, those three components have been ways in which have been identified in the research to help reduce isolation and loneliness. And so, those three ways are to nurture and maintain existing relationships, to establish new relationships and to modify your thinking about relationships.
Narration (Dr. Mo):
We know that while loneliness is most commonly noted in younger people with lower incomes and chronic health conditions, loneliness really knows no bounds. It is pervasive across age categories, income levels, living situations, and gender.Anyone you know or see can be struggling with feelings of loneliness and isolation. It’s important to note that individual factors, community factors, and societal factors may all separately contribute to social isolation and loneliness, so each one of those things needs to be considered and targeted when we look at helping reduce those feelings.
Dr. Mo:
Okay. So I mean, that brings me to, if you want to help someone you love someone you know, someone who's suffering from loneliness or social isolation. I don't want to use them interchangeably, I know they're different, but if you want to help them, is that the advice we would give them, how would we go about kind of helping someone we love who's suffering loneliness?
Dr. Julianne Holt-Lunstad:
Yeah. So, I mean, first off is to try and understand what might be the underlying cause of it. And that I think is perhaps one of the biggest keys is because there may not be one solution that will help everybody or a one size fits all. And so, different individuals might have become isolated or lonely for different reasons. And if we're not responsive to their needs and what is going on in their lives, even though we might be very well intended, it might be misguided and may not be as helpful. And so, the first step is really understanding that individual and being responsive to those needs.
Dr. Mo:
Welcome to the show, Cathy, and can you tell us briefly about yourself and your organization, Loneliness New Zealand Charitable Trust?
Cathy Combers:
Yes. Thank you for having me on the show. I'm currently the CEO of Loneliness NewZealand, and one of the trustees. We started Loneliness New Zealand about three years ago, and that came about when I had been with Lifeline for about seven years, and I had many calls from people who were lonely. But because it's not a crisis situation, for somebody to be lonely, We gave them about 10 minutes of our time. And I noticed that people would phone regularly just to connect with someone. So when I came to look at setting up a charitable trust, I considered what else is there that helps people who are lonely, that stops them feeling that they need to be addicted- I actually had this feeling - that they were addicted to the telephone help lines.
Cathy Combers:
So, there wasn't anything in New Zealand and so I started looking internationally. And that's when I recognized the global issues that were happening with loneliness. When I saw at the time, the UK had, just, appointed a minister for loneliness.
Cathy Combers:
So with, with understanding that sort of more holistic picture, I realized, actually, loneliness is not something to leave by chance. It has critical, effects on peoples' health. And so, we set up the trust. We're a small trust with high impact. That's how we look at ourselves.
Cathy Combers:
We also seek to upscale people, to prevent themselves and others becoming lonely. People can help themselves and each other by better understanding loneliness. This podcast is the type of example of that. And we give New Zealand a focus on conquering loneliness. Much of our attention has been on advocating that our government do more, around loneliness and connections. And more recently we've, um, become involved with the Global Initiative on Loneliness and Connection, we're part of the founding members of that, and that's helping contribute to us furthering these goals in New Zealand and of course, helping internationally.
Dr. Mo:
That's super interesting. In your experience, what situations do you find loneliness affects people the most?
Cathy Combers:
Well, loneliness is a subject or feeling that relates to expectations and perceptions. So, situations that affect one person to be lonely might not affect others in the same way. So- And I think COVID lockdowns have really highlighted this.
Dr. Mo:
Right.
Cathy Combers:
Two people in the same household could have been experiencing both quite differently. You know, one of the people in the household could actually be lonelier than someone living alone.
Dr. Mo:
Mm-hmm (affirmative).
Cathy Combers:
So, I'm talking to the New Zealand experience, um, but before COVID and lockdowns, there are some situations where more people experience loneliness, and we found that through our surveys, they consistently show loneliness to be higher in our already vulnerable groups.
Cathy Combers:
So, the greatest prevalence of loneliness is in the people who do not identify as heterosexual.
Dr. Mo:
Mm-hmm (affirmative).
Cathy Combers:
Their situation might be that they don't understand themselves and it makes it harder for them to form relationships. Many don't have a sense of - Well, they have a sense of not belonging. Sometimes they're accepted for who they are amongst thems- you know, their own group, but often their very own families are excluding them.
Dr. Mo:
Right, right.
Cathy Combers:
So that's a... You know, they've got real challenges with loneliness. And then people with disabilities and, an example is those hard of hearing.
Dr. Mo:
Mm-hmm (affirmative).
Cathy Combers:
They might have lost their ability to actually have meaningful conversations with those people around them. Others are housebound and they can't get to activities and be amongst people that they used to be around. And I think one of the things with disability is that sometimes, instead of being able to have a reciprocal relationship, which is actually quite key in, meaningful relationships, which is the antidote to loneliness, they feel that they can't contribute to others and they're ending up relying entirely on others and that sort of, you know, makes it so it's how they think. And, poverty is linked with loneliness.
Dr. Mo:
Mm-hmm (affirmative).
Cathy Combers:
So, while we say money can't buy happiness, unemployment and low income can bring people to have lower self-worth and feelings of shame. And practically, socializing does require money in many of our cultures, and that money just isn't available. You know, whether we want to pay a group membership fee or to go on a coffee date, they- it transports. And, lastly in our New Zealand group of people who've experience higher than the average loneliness are single parents-
Dr. Mo:
Mm-hmm (affirmative).
Cathy Combers:
It can bring really great loneliness, you know, from losing relationships that they valued, no longer being part of a couple. Some of it also relates to those practicalities around not having help.You know, there's no reprieve from the responsibility of childcare. And in some cultures, being a single parent is still seen as a stigma, so they're also not readily accepted in their community.
Dr. Mo:
You know, as you described that, it sounds to me like a common thread is feeling marginalized.
Cathy:
So when choosing people to be with, we really do want to avoid those people to manipulate us or exploit our feelings. We can't have good social connectedness with toxic people. You know, say this, some people particularly with low self-esteem are prepared to put up with far too much to avoid the pain of loneliness. Their over eagerness to please is potentially assigned to their overlook, the harmful aspects of their relationship. You know, they'll put up with, those comments that marginalize them. So, when you're in a relationship, valuing yourself is as important as valuing the other. So, I think that is about that discrimination and marginalization.
Dr. Mo:
You started off broadly with describing some of the main areas your organization works in. How does your organization or advocate and what does the organization do for people who are feeling socially isolated and lonely?
Cathy Combers:
Okay, well, we've got a slogan "Know yourself, know others, know your landscape". And what we mean by that is overcoming loneliness is not just about yourself or how others treat you or what situation or culture you're living in. Understanding how these interconnect is what gives you the best shot at overcoming loneliness. So, there's, there's a lot in it. It's not just simply going to find a friend. Quite a lot of people ask me, you know, what should you do?
And so, I created an acronym, alone, A L O N E, to help remember some of the pointers that I give, which is just broad as a reminder, there's lots that goes into getting there.
Cathy Combers:
So the A is for accept your situation. And what I mean by that is, to stop having expectations that cause you to feel envy for others. The L is for love yourself, Love.Genuinely appreciate yourself and love others for their humanness. It's hard to expect others to value you when you don't value yourself. And it's hard to form friendships with others when we don't generally value them.
Cathy Combers:
So the O is for one focus at a time. What typically happens is people start getting anxiety and stress, then pessimism sets in with loneliness.
Cathy Combers:
And, we're really getting to find you to get your mind under control, to help you enjoy what you have in the moment.
Dr. Mo:
Being in the moment.
Cathy Combers:
Yeah, Being in the moment.
Dr. Mo:
Mm-hmm (affirmative)
Cathy Combers:
N is for neighborliness. And by that I mean, more than being friendly with your actual home neighbors. We want that.
Dr. Mo:
Mm-hmm (affirmative)
Cathy Combers:
But be friendly with a neighbor sitting next to you on the bus or at an event.
Dr. Mo:
Mm-hmm (affirmative).
Cathy Combers:
So, the E that I've put is to energize yourself. People get energized in different ways and looking for ways that you can do that by yourself without having a partner or friend involved is important. This helps increase your ability to enjoy solitude and takes pressure off your special people.
Dr. Mo:
Mm-hmm (affirmative).
Dr. Mo:
I love that acronym. So, if we can summarize it. The A was accept, right?
Cathy Combers:
Accept your situation.
Dr. Mo:
Accept the situation. The L was?
Cathy Combers:
Love humans.
Dr. Mo:
Love, yeah and love yourself.
Cathy Combers:
but it is about humans, yes.
Dr. Mo:
Right.
Cathy Combers:(laughs).
Dr. Mo:
And O was?
Cathy Combers:
One focus.
Dr. Mo:
One focus. And the N was being neighborly or neighborliness.
Cathy Combers:
Yes, neighborliness.
Dr. Mo:
Yeah, yeah.
Cathy Combers:
And E-
Dr. Mo:
And the E's energize.
Cathy Combers:
Energize yourself, yeah.
Dr. Mo:
Okay.
Cathy Combers:
Yes.
Dr. Mo:
That's fantastic. So, I work in the field of mental health and I know how much stigma can affect people, which brings me to my next question. You know, I imagine there's a lot of stigma about starting a conversation about overcoming social isolation and loneliness. So, what advice can we give people to start those conversations, especially people who are struggling?
Cathy Combers:
Yes, um, you're absolutely right about the stigma. People who are lonely do not know who to trust and people who are not lonely misunderstand loneliness and therefore misunderstand what's happening with a lonely person. So, just like getting over the stigma of other social issues like depression I suggest we treat people experiencing loneliness with empathy and communicate with integrity.
Dr. Mo:
Mm- hmm (affirmative).
Cathy Combers:
Simply talk and listen to them. When you've built up enough trust ask with compassion how they're managing each day. You don't have to use the word loneliness. That broad, that open question helps invite them to talk about their world. So, if you try and understand what the world is like for them without rushing to fix their situation you'll actually understand what's going on for them more.
Dr. Mo:
Mm-hmm (affirmative).
Cathy Combers:
If you're the person who is lonely and you're struggling to make progress and you're not into, being able to talk about your, um, loneliness then perhaps that's time to consider getting help.
Dr. Mo:
Mm-hmm (affirmative).
Cathy Combers:
If you feel no one in your world understands you then a counselor might just be one person that you can start that connection with and feel heard and, place where you can be yourself. So, that's what I would say at this point. You know, it's about really also just never making assumptions and you don't have to use the word loneliness.
Dr. Mo:
Thank you so much for your time. It's been a fantastic discussion. Do you have some key take home messages that you want our listeners to remember from this discussion?
Cathy Combers:
Well, I think, really, it is about everyone taking responsibility for loneliness. That it's not just about an individual person being lonely. People who are lonely to get help if you're struggling, and take opportunities where you can. And for everybody else to really just stop their judging. Stop the criticalness about what people should or shouldn't be and be far more accepting.
Narration (Dr. Mo):
And now, since we’ve heard Cathy’s recommendations, I’d like to ask the same question to Dr. Holt-Lunstad. What are your key take-home points for our listeners?
Dr. Mo:
What are your key take-home points for our listeners?
Dr. Julianne Holt-Lunstad:
A couple things. One is that I hope individuals realize just how critically important our social wellbeing is to our physical wellbeing. Our social relationships, we have very good evidence of the long-term health effects of being socially connected and that we need to take our relationships just as seriously for our health as we do other kinds of lifestyle factors. And then lastly, that there is something that everyone can do and that this applies to everyone. So, we're all somewhere on the risk continuum. And everyone can take little steps to reach out to someone else and in fact, research shows that by supporting others that actually reduces one's own loneliness and is quite effective. So, one of the best ways to help yourself is to help others.
Dr. Mo:
That's -I think- a great thought to end the episode on. Thank you so much.
Cathy Combers:
Thank you for having us.
Dr. Julianne Holt-Lunstad:
Thank you. My pleasure.
Dr. Mo:
And that's a wrap. We hope this discussion has been helpful in understanding the complexities of loneliness and social isolation and has offered some important strategies that may allow you to feel more connected to those around you. As we begin to resume a more normal social schedule, it's important to consider your social needs and motivations. Remember that social connection is good for your health, but that everyone needs a little alone time to rest and recharge as well. Sometimes our social needs can feel a little like a balancing act, but you're not alone. Others around you are probably feeling the same way.
I'd like to give a big thank you to our guests on this episode, Dr. Julianne Holt-Lunstad and Cathy Comber for offering their excellent insights and expertise on this topic.
If you're looking for more information or resources about the topics covered in this or other episodes, you can visit www.listenwellpodcast.com. I’m Dr. Mo Alsuwaidan. Thanks for listening.
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