The idea of a psycho-social model of loneliness is not new.   In the 1980’s Perlman and Peplau developed the discrepancy theory of loneliness which defines loneliness as  – “… the unpleasant experience that occurs when a person’s network of social relations is deficient in some important way, either quantitatively or qualitatively..” (Perlman and Peplau, 1981,p31). 

The key distinguishing feature of Perlman and Peplau’s work is that loneliness is understood to be a function of the individual’s perception. Whilst external / objective social conditions may have some influence, ultimately loneliness is a function of a perceived discrepancy between the type of relationships they have and what they want.  Loneliness is not automatically caused by a trigger event (e.g. retirement or bereavement), or by a set of social circumstances (e.g  living alone or being over 80); rather it is how a person understands and judges these things that determines whether a feeling of loneliness is experienced. There are internal cognitive processes, unique to the individual, which come into play to influence whether loneliness is the outcome.  

 “… the discrepancy between the desired and achieved social relations is typically perceived by the individual and labelled as loneliness.  But, according to a cognitive perspective, this discrepancy does not lead directly and inevitably to loneliness.  Several factors may affect the self labelling process and the intensity of the person’s reactions to their situation, and cognitive processes play a central role in modulating the loneliness experience.” (Perlman and Peplau, 1981 , p45)

These and other elements will be analysed for their psychological content throughout the rest of this paper.

Personality Traits

Personality traits or characteristics have been found to have a significant influence on the incidence and experience of loneliness (Long and Marin, 2000, Wang and Dong, 2018a, Mund and Neyer, 2015, Abdellaoui et al., 2018, Fees et al., 1999, Hensley et al., 2012, Chang and Dong, 2014, Cacioppo et al., 2006, de Jong-Gierveld, 1987, Schermer and Martin, 2019, L. Flett et al., 2016, Ernst and Cacioppo, 1999, Long and Martin, 2000).  Particular personality types have been found to be linked to loneliness:-

• Increase risk of loneliness
  • Neuroticism: the tendency to be prone to psychological stress and to experience unpleasant emotions easily i.e. low emotional stability.  People who score high on neuroticism are much more likely to experience loneliness, indeed some research(Wang and Dong, 2018b) found that people with high levels of neuroticism were 3.59 times more likely to feel lonely. 
• Protect against risk of loneliness
  • Conscientiousness: the tendency to be organised and dependable, show self discipline and prefer planned rather than spontaneous behaviour.  People with a high conscientiousness score had a 24% decreased risk of loneliness (Wang and Dong, 2018b).
  • Extraversion: the tendency to be energetic, assertive and to seek stimulation in the company of others.  People who score high on extraversion have a decreased risk of loneliness 

Interestingly, not only does research show that personality can affect the likelihood of becoming lonely, there is also evidence to suggest that being lonely in earlier life stages can shape evolving personality as one ages, potentially setting up a vicious cycle of isolation(Jarrett, 2015, Mund and Neyer, 2016).  Specifically, greater loneliness in youth appears to go hand in hand with slower decreases in neuroticism with age, and slower increases in conscientiousness (Mund and Neyer, 2016).  In other words, feeling lonely when young appears to shape the course of personality development in a way which increases the risk of loneliness in later life.  Other research also indicates that loneliness is ‘moderately heritable’ (Distel et al., 2010, Cacioppo et al., 2009)

Whilst it is important to consider the links between personality traits and loneliness, it must however be remembered that traits are not predictions; i.e. there is no evidence of a ‘psychological determinism’ whereby particular personality types will inevitably become lonely.  Personality type is one of many risk factors.  Whilst personality traits can be difficult to change, research (Hudson and Fraley, 2015, Hudson et al 2019) has shown that where people are motivated to do so, it is possible.  It also has to be remembered that most people can be helped to find ways to moderate or cope with particular negative outcomes associated with any particular type.

Cultural values and norms

One of the predisposing factors which is commonly neglected in discussions about loneliness is the impact of cultural values and stereotypes.   This refers to the way in which larger societal narratives can have a noticeable impact on individuals’ thoughts and feelings which in turn can affect cognitive processing and attribution.

Ageist attitudes and stereotypes are prevalent in mainstream cultural narratives and have been shown to be damaging to a number of aspects of older people’s health and psychological wellbeing (Robertson, 2017).   They have been shown to have a significant impact on the incidence of loneliness as well.  Research (Pikhartova et al., 2016) looked specifically at the role of ageist beliefs in the incidence of loneliness in later life. It demonstrated that those holding negative stereotypes about later life (i.e. expectations about it being a time of loneliness) were found to have an increased range of between 2.3-2.8 increased likelihood of experiencing loneliness.  Other research by (Menkin et al., 2016) demonstrated the counterfactual position.  In their research, participants with more positive expectations of ageing at baseline made more new friends 2 years later and had greater overall perceived support available 12mths later.  These (and related) research findings (Coudin and Alexopoulos, 2010, Shiovitz-Ezra et al., 2018)  suggest that there is a need to address ageism as part of any strategy to reduce loneliness.  As Pikhartova and colleagues concluded:-

To date our repertoire of interventions of how to prevent/reduce loneliness (including services such as befriending or group based activities) have been largely unsuccessful. The linking of loneliness with individuals beliefs and expectations of what old age will be like suggests that, potentially, ‘mass campaigns’ to change these may be more effective in combating loneliness than the types of services currently offered. (Pikhartova et al., 2016, p548)

What this has shown is that cultural values (i.e. ageist attitudes in wider society) can impact on individual cognitive processes that compromise or undermine older people’s ability or motivation to make meaningful connections with others – thereby increasing the risk of loneliness.  The evidence suggests that ageist cultural values need to begin to be addressed in psycho-social initiatives to address loneliness.  

Life Transitions

Whilst the exact proportions are unknown, it is clear that the majority of older people who experience loneliness have begun to do so in later life as a result of some change in their circumstances, principally one or more of the major life events and transitions commonly experienced in later life (e.g. retirement, moving home, becoming a care, ill health, bereavement etc).  Of all of these, bereavement is by far the most common trigger.

Whist these major life events and transitions have a tendency to disrupt relationship networks, they tend to bring this about through their impact on psychological and emotional processes. As outlined by Robertson (2016), another framework drawn from the field of humanistic psychology (Dilts, 1990) is helpful in conceptualising this.  The elements outlined below are each likely to be impacted in different ways by major life events and the effect is likely to be felt at an emotional/psychological level:-  

• Sense of purpose – impact on people’s motivation and meaning in life
• Identity – impact on how people feel about their role and place in society
• Beliefs – impact on what people believe to be true or important
• Capabilities – how people’s talents and abilities are affected, which in turn affects a sense of self efficacy
• Behaviour – what changes might be required in the actions the person takes in their day to day life – which can challenge people’s self confidence
• Environment – what changes may be required in their living arrangements or where they carry out their day to day activities

The framework is useful in unpacking the breadth of psychological change that a transition in later life might occasion (for detailed outline of the internal dynamics of each major life event using this framework see Robertson, 2016).  

Sense of Purpose warrants special attention in relation to loneliness.  It has a unique power to motivate people towards involving themselves in the social realm and thereby generate or maintain social connections.  Research supports the notion that a sense of purpose is particularly connected with general wellbeing and protection against loneliness (Creecy et al., 1985, Stillman et al., 2009, Neville et al., 2018, Schaefer et al., 2013, Irving et al., 2017, Nygren et al., 2005, Bondevik and Skogstad, 2000, Tam and Chan, 2019). The lack of a strong sense of purpose can feed the (self)exclusion of older people from many forms of social engagement.  Without a purpose in life it is very difficult to have the motivation and self confidence to engage with others, and this deficit can therefore precipitate and sustain a negative cycle of isolation.

Multi dimensionality of loneliness

Much of the discussion of loneliness treats it almost as one single phenomenon.  This is not the case. Loneliness is not a uni-dimensional experience; in reality it has many dimensions and contexts which affect the emotional and psychological experience.  There are two key dimensions which require special attention– intensity of emotional distress and duration of the experience.

Intensity of emotional distress relates to the fact that there is a big difference between, on the one hand losing an intimate life long partner through bereavement, and on the other hand wishing that one had more acquaintances to engage with.  The difference is generally reflected in the distinction between ‘social’ and ‘emotional’ loneliness, first proposed by Wiess (1973) and supported by subsequent research (Dykstra and Fokkema, 2007, Russell et al., 1984, de Jong-Gierveld, 1987).  The experiences of each kind of loneliness are different and consequently the interventions similarly need to be tailored to address the different psychological and emotional characteristics (Dahlberg and McKee, 2014).  Whilst the literature refers to two categories it is perhaps more helpful to consider this aspect of loneliness along a continuum from low to high intensity ((Aiden, 2016).

Duration is another key consideration.  Experiencing loneliness most or all of the time is clearly much more damaging and will have different psychological and emotional dimensions than experiencing it occasionally.  Indeed, experiencing loneliness occasionally has been seen as an inevitable and positive phenomenon by some (Cacioppo and Patrick, 2008).  They propose that in the same way that hunger propels us to eat, so loneliness compels us to connect with others.  It could be argued that occasional loneliness is therefore only of relevance to public policy in so far as it sometimes develops into more frequent experiences, which then could develop into more serious chronic loneliness.  Duration is particularly relevant to understanding the psychological drivers of loneliness by virtue of its tendency to elicit a degree of ‘perceptual distortion’ in people experiencing loneliness (see below).

These two dimensions, intensity and duration, can usefully be combined in order to provide a framework for assessing the varying psychological aspects and what sort of interventions are required.   

People experiencing the sort of loneliness associated with section A for example are likely to require the most significant psychological assistance; whereas those in section D are unlikely to require any.  It is arguable that a lot of current social group type interventions tend to be  focussed on people in section C.  What is often missing are interventions supporting people in sections A & B.

Perceptual Distortion

As indicated above, it is very important to note that people who have experienced sustained feelings of loneliness have been found to commonly develop harmful and self defeating internal narratives which then distort and undermine their ability to interact with others.  Psychological research into loneliness has found that such people tend to exhibit maladaptive and unhelpful thoughts and feelings about themselves (Cacioppo and Hawkley, 2009), other people, and (importantly) the perceived risks and threats arising from engaging in social interactions (Masi et al., 2011), particularly those involving groups of people.  Lonely people commonly exhibit a form of ‘perceptual distortion’ such that they are more likely to view relationships and social encounters negatively and pessimistically. 

” (Loneliness) produces an oversensitivity to minimal cues and a tendency to misinterpret or to exaggerate the hostile intent of others.”(Weiss, 1973)

This can set in train a powerful negative feedback loop whereby lonely people tend to withdraw even further from the very people who could alleviate their loneliness. They tend to assume that others aren’t interested in their company and that they will be rejected (Goll and al., 2014). As a result people can end up taking little initiative to instigate social connection and instead tend to find excuses to turn down social invitations they are offered.  Research (Masi et al., 2011, Jones et al., 1981, Anderson et al., 1983, Perlman and Peplau, 1981, Duck et al., 1994) indicates that lonely people tend to:-

• approach social encounters with greater cynicism and interpersonal mistrust, 
• rate other people and themselves more negatively
• are more likely to expect others to reject them
• have lower feelings of self worth
• tend to blame themselves for social failures
• hold more negative social expectations

…all of which results in them adopting behaviours that increase, rather than decrease, their likelihood of rejection (Cacioppo et al., 2009).  In essence, when people feel lonely for any length of time, they tend to think and act differently than people who do not feel lonely.  They develop ‘maladaptive social cognitions’ which influence behaviours, social interactions and feelings in a way which exacerbate feelings of sadness and loneliness (Masi et al., 2011). 

Social Exclusion 

The individually generated self-fulfilling prophecy outlined above can also feed into a group initiated process of social exclusion. There is evidence to suggest that social groups can tend to exclude lonely people – “While there are exceptions to the rule, by and large the general population tends to avoid lonely people and to marginalize them on society’s periphery”.  It has been found that lonely people tend to be connected with others who also suffer from loneliness.  Cacioppo et al (2009) set out an explanation for how social groups play their part in excacerbating  the individual’s experience of loneliness. “The phenomenon is described as a process of induction occurring within social networks.  Individuals who feel lonely become marginalised through a type of ‘social quarantine’ or exclusion, rather than seeking out and forming connections with other people by their own volition.  This implies that loneliness is perceived as being contagious, aversive, and something to be avoided, like emotional tuberculosis.  From this perspective, marginalized connections found among lonely individuals may be a result of attempts by the larger social network to preserve its structure.  Such attempts create barriers that limit the lonely individual’s interpersonal resources due to disconnection from primary support systems.”

Depression and Bereavement

There are two psychological/emotional states prevalent in later life which warrant special attention in any discussion about loneliness. 

Depression is worthy of special mention because it is commonly seen as ‘a gateway into loneliness’.  It is the most common mental disorder in older people, affecting about 20% of people over 65. There is a well evidenced strong association between loneliness and depression (Mann, 2018, Domènech-Abella et al., 2019).  Loneliness is both a predisposing factor for, and an outcome of, depression, and people with depression who have weak social networks have poorer recovery rates (Wang and Mann, 2018).  Depression has also been found to influence cognitive processes such that judgements about the adequacy of social interactions are interfered with (Burholt and Scharf, 2014). Unfortunately, depression is under-detected in older people, with only one in six older people with depression discussing their symptoms with their GP, and less than half of these receiving adequate treatment (Graham et al., 2011).  There is a strong case for depression to feature much more in discussions about loneliness and how to treat it,

Bereavement is also worthy of special mention.  There are over 603,000 deaths in the UK in 2015 (and 85% of these being people aged 65 and older), and yet death and bereavement barely feature in discussions about loneliness. This despite the fact that nearly 33% of bereaved people over 65 see themselves as very lonely, compared to just 5% of people of the same age who have not lost their partner(Seymour et al., 2018).Loneliness that comes from losing a life partner is generally experienced as a significant form of ‘emotional loneliness’ and it is questionable whether interventions promoting social connections begin to address the situation (Utz et al., 2013). In fact bereaved people often report lower levels of social isolation than others (Seymour et al., 2018), although there are indications that social support becomes more important in the longer term (Bennett and Victor, 2012, van Baarsen, 2002) .  Loss of a close partner can often result in ‘complicated grief’ for about 10-15% of bereaved people.  It can be a very powerful trigger into loneliness. It is noteworthy that older bereaved people are less likely to seek help than younger bereaved people and they are also less likely to be referred for bereavement support than younger people (Seymour et al., 2018).  This is particularly unfortunate given the evidence that bereavement support (one to one counselling or peer group support) can be effective in helping people address and move on from the trauma of losing someone who has been so emotionally important to them (Schut et al., 2001, Schut and Stroebe, 2005, Stewart et al., 2001, Arthur et al., 2010, Currier et al., 2010).  

Towards the development of psycho-social interventions

This examination of the psychological and emotional aspects of loneliness provides a number of important pointers as to how interventions to address loneliness could become more holistic.  It is important that these considerations are taken into account in the Government’s commitment to “support all health and care systems to implement social prescribing connector schemes across the whole country” by 2023, otherwise there is the risk that the psychological drivers of loneliness will remain unaddressed.  This paper does not set out the solutions, but it does highlight a number of key issues to be taken into account:-

• the importance of individual perception in determining whether a person experiences loneliness, and if so what form that loneliness will take. Social and demographic factors have some influence, but ultimately it is psychological / emotional / cognitive processes within the individual which determine the outcome.  Unhelpful internal narratives (i.e. maladaptive cognitions, perceptual distortion etc) require interventions which can work at this level.  Evidence based options include Cognitive Behavioural Therapy, Mindfulness and Positive Psychology – although work is required to develop delivery models which operate from whole population preventative initiatives right through to remedial work with individuals experiencing chronic loneliness
• personality traits play a significant role in determining whether loneliness is experienced.  That having been said, personality is a risk factor rather than an inevitable predictor of loneliness, and personality is also open to volitional change. Understanding how personality types are linked to loneliness will be key to establishing how best to work with people to alleviate or prevent loneliness
• Those working with people experiencing loneliness need to pay attention to how an individual attributes the causes of their loneliness – in order to help them generate the motivation and strategies to move forward
• the provision of information about the psychological and emotional basis of loneliness could empower people at risk of loneliness to take more control of their inner world and wellbeing outcomes.
• Highlighting and challenging ageist stereotypes could help some individuals to reset unhelpful internal narratives which increase the risk of loneliness
• It is crucial that interventions to address loneliness concentrate more on helping older people to enrich the emotional quality of the relationships they have rather than trying just to increase the number of social contacts.  Research suggests that focussing on the quantity of social interactions actually goes against the grain of what sort of relationships people generally want in later life.  For example, research by Laura Carstensen and conceptualised within her Socio Emotional Selectivity theory (Carstensen et al., 1999), explains that the contraction in older people’s social networks is generally a function of a positive psychological re-prioritisation of time and effort towards more meaningful and emotionally rewarding interactions. Older people generally want to spend time with people who are more emotionally meaningful to them, rather than with larger numbers of acquaintances with whom there is less emotional connection.  This, and evidence from others (Marangoni and Ickes, 1989, de Jong-Gierveld, 1987, Rook, 1987) suggests that enhancing the quality of relationships in later life is likely to be far more effective in addressing loneliness than just increasing the number of social contacts.
• Helping those at risk of loneliness to increase and strengthen their ‘sense of purpose’ and meaning in life is likely to be one of the most important psychological interventions.  People who have a strong sense of purpose are most likely to develop the sort of relationships they need in life.
• Loneliness has strong links with mental health problems and therefore strategies to address loneliness need to pay more attention to how mental health services can meet the needs of those at risk of loneliness.  At the same time there is a careful balance to be achieved such that loneliness doesn’t become further stigmatised by a simplistic ‘branding’ as a mental health problem.
• Staff working with people at risk of loneliness need to develop a better understanding of the emotional and psychological process which underpin loneliness.

Where possible it would seem most appropriate to integrate the psychological dimensions into some of the current socially based interventions rather than to develop a whole new raft of psychological interventions.

Guy Robertson
Director
Positive Ageing Associates
July 2020

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