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Susan Krigel, PhD, is a licensed clinical psychologist with the Midwest Cancer Alliance. Her cancer-related career has spanned 10 years, and began when she worked as a Cancer Information Specialist for the National Cancer Institute. In her role at the Midwest Cancer Alliance, she utilizes her clinical and research skills to create and conduct programs with cancer patients across Kansas and western Missouri, focusing on improving the quality of life during survivorship. Programs are delivered both in person and via telemedicine. She also participates in professional development programs for healthcare providers.

Loneliness: The New Smoking, Part 2

This second installment of this blog on loneliness focuses on how loneliness may compromise health and can be combatted against.
PUBLISHED: 6:00 AM, FRI MARCH 24, 2017
Talk about this article with nurses and others in the oncology community in the General Discussions Oncology Nursing News discussion group.
The first part of this blog focused on the definition, prevalence, timeframe, and consequences of chronic loneliness. This portion will focus on the proposed mechanisms by which loneliness may compromise health and various strategies to combat loneliness.

HOW EXACTLY DOES LONELINESS IMPACT HEALTH?

The response to this question is lengthy; it describes the proposed mechanisms by which loneliness impairs health. Humans are designed to be social creatures. Cavemen and women were intended to be a part of a group, because being amongst others was protective against threats, such as marauding mastodons. As a result, when an individual perceives loneliness, the fight or flight response is initiated: respiration, blood pressure, heart rate increase, blood sugar elevates, intestinal muscles relax, pupils dilate, and blood flow is diverted to muscles. These changes enable an individual to fight or flee a threat, which is helpful when facing a short-term threat, but when this heightened state of arousal becomes chronic, deleterious changes may take place. Chronic hyperarousal results in hypertension, which in turn may lead to cardiovascular changes, eventually raising the risk of cardiovascular disease and stroke.1 Also, chronic hyperarousal may lead to activation of the HPA axis, resulting in increased inflammation and compromised immune functioning. This process may increase the expression of hormones, which may in turn lead to the creation of an environment that promotes tumor growth and progression.2

WHICH STRATEGIES MAY DECREASE LONELINESS?

Several types of interaction have been explored in the effort to reduce levels of chronic loneliness. The results of a meta-analysis conducted in 20113 documented that programs to increase opportunities for social contact or to improve social skills were ineffective in reducing levels of chronic loneliness. Programs focusing on enhancing social support (through mentoring or conference calls, for example) produced a small but significant reduction in chronic loneliness. 

The most effective interventions were programs designed to address maladaptive social cognitions. This approach has been referred to as social cognitive behavioral therapy (CBT).Therapy focuses on changing maladaptive social perceptions and cognitions. Individuals are taught to identify automatic negative thoughts about both other people and social interactions in general, and how to examine the accuracy of the thoughts. Once the automatic negative thoughts are replaced with more accurate cognitions, the individual is more able to benefit from social interactions, reducing their level of loneliness.

John Cacioppo, a leading researcher in this field, has created a program based on social cognitive retraining to reduce chronic loneliness. The four-step program is known by the acronym EASE5:

Extend Yourself. Push yourself to connect with other people, even if you are hesitant to do so. Start small and go slowly, such as volunteering at a shelter or becoming an assistant coach for a kids’ sports team.
Develop an action plan. Don’t wait for the invitations to come in. Look at your calendar and be proactive in scheduling in social events.
Selection. When it comes to reducing chronic loneliness, it is the quality, not quantity, of relationships that matters. Create connections that are meaningful in your life. Look for people that share your values. Join organizations that promote values that are important to you, such as a political action group, book club, or church choir.
Expect the best. As explained above, lonely people tend to have maladaptive automatic thoughts regarding social interactions, and may be hypervigilant in detecting social slights. Work at identifying and changing those thoughts! Approach social interactions with hope and positive expectations. Try to be understanding and forgiving of perceived slights and view the relationship as a whole.
Read the first part of this bill by Susan Krigel here.

References
  1. Valtorta NK, Kanaan M, Gilbody S, et al: Loneliness and social isolation as risk factors for coronary heart disease and stroke:  systemic review and meta-analysis of longitudinal observational studies.  Heart 102:1009-1016, 2016
  2. Lutgendorf SK, Sood AK: Biobehavioral factors and cancer progression:  physiological pathways and mechanisms. Psychosomatic Medicine 73:724-730, 2011
  3. Masi CM, Chen HY, Hawkley LC, Cacioppo JT: A meta-analysis of interventions to reduce loneliness. Personality and Social Psychology Review 15(3):219-266, 2011
  4. Cacioppo S, Grippo AJ, London S, Goossens L,  Cacioppo JT: Loneliness:  clinical import and interventions. Perspectives on Psychological Science 10(2):238-249, 2015
  5. Cacioppo JT: Easing your way out of loneliness. Psychology Today online blog
  6. https://www.psychologytoday.com/blog/connections/200812/easing-your-way-out-loneliness
  7. Posted Dec. 12, 2008


Talk about this article with nurses and others in the oncology community in the General Discussions Oncology Nursing News discussion group.
More from Susan Krigel, PhD
Exploring loneliness and its effect on health. Part 1 of 2.
PUBLISHED: Wed February 22 2017
The first section of this blog provided statistics on suicide and warning signs,
PUBLISHED: Thu August 13 2015
Have you encountered patients who have voiced the wish to kill themselves?
PUBLISHED: Wed July 15 2015
Have you come across an article or book that impacted you strongly, or that you found helpful in understanding some aspect of the cancer experience?
PUBLISHED: Wed June 03 2015
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