Judith S. Beck, PhD, President, Beck Institute for Cognitive Behavior Therapy
Amanda (not her real name), a 42-year-old woman, had been married for 12 years. She and her husband had two school-age children and a two-year old. She had a conflictual relationship with her parents and as the only child of only children, she had no extended family members. She had a fairly wide circle of friends, though, primarily the mothers of her children’s classmates, neighbors, and women from her church. She spoke, texted, or encountered at least five of them daily. Yet she was quite lonely! Her relationships tended to be superficial; she longed for a “best friend” in whom she would feel comfortable confiding. While she loved her husband, she had never felt as if he truly “got” her.
Loneliness is an ever-increasing problem, not only in the US, but also globally. Statistics vary, but between 16-36% of people report experiencing serious loneliness for a significant portion of most days. The former Surgeon General of the United States declared that loneliness was a public health epidemic and was partially responsible for serious mental and physical health risks, comparable to smoking!
Why are so many people lonely? Researchers from the Harvard Graduate School of Education conducted a national survey and concluded that loneliness was related to individuals’ use of technology; insufficient time with their families; being overworked, too busy, or tired; struggling with mental health problems; living in an individualistic society; lack of a religious or spiritual life; focusing too much on one’s own feelings; and remote work arrangements.
Most people think of loneliness as being linked to not having enough friends. But sometimes people feel lonely even though they have many relationships. Their relationships, though, lack depth, authenticity, or a feeling of real connection; or an individual may feel criticized, devalued, or unappreciated by others. Relationships may be unbalanced in some way, for example, when one person reveals a great deal about themselves while the other reveals little; or one gives much more emotional or physical support than the other. So, an individual can feel lonely despite having many friends, family members, and/or a life partner.
Cognitive Behavioral Therapy (CBT) can effectively address loneliness in several ways: by helping individuals connect better with others, develop new relationships, deepen intimacy in existing relationships, and become part of a community. Some of the problems described below that individuals encounter in improving their connections with others are practical; some are psychological.
Some people just lack communication skills. They may need to learn to consistently use non-verbal behaviors such as maintaining eye contact, assuming a relaxed posture, and smiling in social contexts. They may need to learn how to make small talk, how to change a subject, or how to deflect questions they don’t want to answer. They may need to learn how to be more forthcoming or assertive in certain relationships. On the other hand, they may need to learn how to listen more carefully and demonstrate that they have heard and understood the other person, respond more appropriately to others, and increase their awareness if they tend to dominate conversations.
Other practical problems that CBT therapists can help with include brainstorming about how and where an individual may be able to meet new people, particularly those that they feel compatible with. Therapists might recommend using dating and friendship apps, enrolling in classes (such as art, photography, creative writing, music, or theater), amateur sports leagues, wellness groups (yoga, mindfulness, Tai Chi), or special interest groups (book clubs, travel groups, hiking clubs).
Another practical problem is finding the time to reach out to others, make plans, and socialize. Therapists can help by examining a typical week’s schedule with the client, listing the tasks they are responsible for. Then they ask clients to put each task into one of three categories: essential, highly desirable, or desirable. Clients can evaluate which tasks could be delegated, eliminated, or done less frequently, less well, or for less time. Therapists can also help clients respond to unhelpful thoughts such as, “I always have to do an excellent job of cleaning,” or “I have to do anything a family member asks me to do.”
One of the greatest barriers to decreasing loneliness has to do with individuals’ thinking. They may have negative ideas about themselves that decrease their motivation to reach out to others (I don’t fit in; I don’t have anything to offer; I’m not likeable enough); about other people (Others won’t like me; Others will reject me; Others will act superior to me); and/or about relationships (Relationships always end; If there’s a problem in a relationship, it can’t be solved).
CBT therapists first need to gather information about a client’s loneliness. How long have they felt lonely? How secure was their attachment to parents, caregivers, siblings, and friends? When has their loneliness felt most acute? What was going on in their life then? When did they feel relatively less lonely? How was their life different at that time? How did they view themselves/others/relationships at both of these points in their life?
The therapist will ask what the client has already tried to do to decrease their loneliness and how well these efforts have worked. Then the therapist develops a conceptualization—a big-picture understanding—of why the client has a problem with loneliness, what unhelpful thoughts and actions have been obstacles, what specific practical problems (time, energy, geography) need to be solved, and what behavioral skills the client needs to learn or strengthen. Part of the conceptualization also includes whether the client has been engaging in unhelpful patterns of behavior, such as isolating themselves or failing to initiate conversations, make eye contact, or speak intimately with others (e.g., revealing their difficulties or weaknesses). The therapist then develops a treatment plan to address the most important parts of the loneliness problem, relates their conceptualization and the treatment plan (with rationales for each step) to the client, and elicits feedback.
How did I help Amanda? Amanda didn’t need help solving a practical problem. She already had enough friends. She didn’t need to improve her body language or her ability to initiate or carry on conversations. What she needed was to evaluate some unhelpful beliefs about herself and other people. She felt inferior to many of her friends who, she perceived, had graduate degrees, important jobs, greater achievements, and more disposable income. She feared their disapproval or criticism, so she kept conversations with her friends at a superficial level. She was careful to avoid displaying any sign of weakness and refrained from talking about her difficulties, like fulfilling her role as a wife and mother. Other people seemed to like her, but she maintained the belief, “If they really knew me, they wouldn’t want to connect with me.”
Amanda and I spent part of a session talking about where this belief had originated and how it had become strengthened through the years. Amanda related how her parents had emphasized the importance of presenting a positive appearance to everyone with whom they interacted. So, Amanda grew up assuming that it would be wrong to let others know that she had problems and flaws and that she felt unhappy at times. I asked her a question about her friends who commonly revealed their vulnerabilities: “What belief do you think they grew up with?” After some discussion, Amanda concluded that their parents probably gave them the idea that it was good to tell friends how they really felt.
Another important discussion (among many) involved discussing which one or two friends Amanda thought it would be easiest for her to practice confiding in. We then made a list of items Amanda could reveal to them about herself, from the most minor to the most major. Amanda was surprised at the positive reaction she received when she stopped hiding her vulnerability. Her friends sympathized with her and began to express some of their vulnerability, too. It took several months, but Amanda was able to meaningfully deepen her connection with several friends.
Certainly, there are many systemic and societal reasons why loneliness is so prevalent in the US and beyond. But if you’ve been feeling lonely, chances are there are things you can do right now to increase the number of connections you have with other people and improve the quality of the relationships you already have.
Reference:
Making Caring Common (2024). Loneliness in America: Just the Tip of the Iceberg? https://mcc.gse.harvard.edu/reports/loneliness-in-america-2024