Building Social Connections: Testing the Efficacy of Two Brief Cognitive-Behavioral Interventions to Reduce Loneliness Among Young Adults
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Date
February 20, 2019
Author(s)
LeBlanc, Nicole Jennifer
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Citation
LeBlanc, Nicole Jennifer. 2019. Building Social Connections: Testing the Efficacy of Two Brief Cognitive-Behavioral Interventions to Reduce Loneliness Among Young Adults. Doctoral dissertation, Harvard University, Graduate School of Arts & Sciences.
Abstract
Background: Loneliness is the negative emotional response that accompanies perceived social isolation. Researchers believe that it is an evolved mechanism for activating a psychobiological stress response in humans, given that social isolation would have signaled survival threat throughout our evolutionary history. However, when prolonged, the stress of loneliness increases risk for both physical and mental health problems. Epidemiological research indicates that young adults experience particularly high rates of loneliness. Furthermore, the high prevalence of loneliness in this age group may be one factor contributing to the increasing rates of mental illness among the current cohort of young adults (i.e., the Millennials, people born in the 1980s and 1990s). Yet little is known about how to mitigate loneliness in this age group. Multi-session cognitive-behavioral interventions have demonstrated efficacy for reducing loneliness in a few studies; however, brief interventions are needed for use as primary prevention measures. The primary aim of the present study was therefore to develop and test the efficacy of two, single-session interventions to reduce loneliness among young adults. The first intervention, termed the Negative Affect Treatment (NAT), taught skills (reappraisal and avoidance reduction) to decrease negative affect in social situations. The second intervention, termed the Positive Affect Treatment (PAT), taught skills (noticing positives and performing kind acts) to increase positive affect in social situations. Method: Young adults (N = 180) who wished to increase their social connections were recruited to participate. Participants completed baseline measures in the lab and were then randomized to receive one of three single-session interventions: NAT, PAT, or active control (which taught two skills for self-monitoring of daily activities). Interventions sessions (approximately 60 minutes) were conducted in the lab, guided by detailed protocols. Participants then practiced their assigned skills daily for 13 days, prompted by daily messages delivered to their smartphones. At Day 14 and Day 28, participants completed follow-up measures via online survey. Results: Participant retention was good (89% completed the study), and adherence to daily skills practice was excellent (participants completed a mean of 18.16 (SD = 6.90) daily skills out of 26 possible skills practice sessions). Multilevel linear modeling was used to examine change from baseline (Day 0) to follow-up (Day 28) in loneliness. Results revealed modest decreases in loneliness during the study period (Cohen’s d = -0.19, p = .003); however, loneliness change did not differ between the NAT and control intervention (Cohen’s d = 0.15, p = .35), or between the PAT and control intervention (Cohen’s d = 0.02, p = .89). Mediation analyses indicated that neither the NAT nor the PAT engaged its target mechanism of NA or PA, respectively, which likely explains the limited efficacy of the active interventions. At Day 28, participants in the NAT reported higher treatment satisfaction than those in the control intervention (p = .02). Qualitative feedback at Day 28 suggested that participants desired a more comprehensive loneliness intervention that taught more skills and afforded for a longer practice period. Discussion: Loneliness improvement did not differ between the NAT, PAT, and control conditions, and could be explained by extra-therapeutic factors (e.g., regression to the mean, maturation) or non-specific therapeutic factors shared across the three conditions (e.g., expectancy, effort justification, therapist attention). Additional research is therefore needed to develop and test more effective interventions for loneliness among young adults. Cognitive-behavioral treatments that teach the flexible use of emotion regulation skills across social contexts should be examined in future studies. In addition, researchers should continue to explore scalable modes of treatment delivery (e.g. internet-delivered interventions). Finally, additional research on the causes of chronic loneliness among young adults will further inform treatment development research.
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