A common elements approach to the development of a modular cognitive behavioral theory for chronic loneliness.

Abstract

Background: Loneliness is a transdiagnostic clinical phenomenon that can significantly impact mental health and wellbeing across the lifespan.Objective: The aim was to combine existing theory and evidence-based treatment approaches to propose a comprehensive transdiagnostic cognitive behavioural analysis of the maintenance of chronic loneliness relevant across disorders, age groups and populations. Method:A distillation and matching model-framework approach was taken to identify interventions designed to reduce loneliness. Eligible studies were coded for the presence of practice elements. The findings were combined with an analysis of the broader literature on loneliness and psychopathology to derive a comprehensive cognitive behavioural analysis of the maintenance of loneliness over time across populations. Results: The search yielded 11 studies containing 14 practice elements with relative frequencies ranging from 7% to 64 %. The identified practice elements target putative mechanisms such as negative interpersonal appraisals, anxiety and social skills deficits. Counter-productive behaviour and cognitive processes such as self-focused attention were identified as maintenance factors based on the broader literature. A modular transdiagnostic model with multiple pathways is proposed to be consistent with the existing theoretical and treatment literature. Conclusions: Combining the distillation and matching model-framework with existing theory from the literature is a novel approach for developing a model of factors that maintain loneliness over time. The model has varying treatment implications for different populations including children with autism spectrum disorders and bereaved older adults. Targeting COMMON ELEMENTS APPROACH TO LONELINESS 3 transdiagnostic processes has the potential to transform interventions for loneliness across a range of formats and settings. What is the public health significance of this article?The systematic review and distillation procedure show that loneliness has been addressed with a wide range of techniques and strategies in efficacious interventions, with the most frequent ones targeting the participant's social skills. Additionally, the derived model generates potential ways of developing interventions for populations where loneliness is of concern.

Effects of a Digital Mental Health Program on Perceived Stress in Adolescents Aged 13-17 Years: Protocol for a Randomized Controlled Trial

“…We will also examine changes in brooding (the maladaptive component of rumination) as a secondary outcome. Finally, as sleep disturbance [84,85], optimism [86,87], and loneliness [88,89] have been identified as other potential transdiagnostic risk factors for future mental health impairment that may begin in adolescence, we also examined changes in sleep disturbance, optimism, and loneliness as additional exploratory outcomes.…”

Internet-based interventions for loneliness : Efficacy and latent psychopathological profiles of treatment seekers

“…The occasional presence of loneliness is thus not necessarily cause for concern. This concern has instead been suggested to be reserved for the long-lasting and frequent versions, where the loneliness assumes a more stable form that is sometimes termed chronic loneliness (Käll et al, 2020;Young, 1982). From a clinical perspective this kind of loneliness is of great interest.…”

“…However, an obstacle in translating these into clinical practice has been the disconnect between the findings from cognitive neuroscience making up the basis for these models (e.g., Cacioppo, Balogh, et al, 2015) and the clinical methods (e.g., CBT) promoted as a potential antidote for loneliness, not unlike the divide described by McNally (2001) for anxiety disorders. Keeping this in mind, we conducted a synthesis of the literature on the maladaptive cognitive and behavioural tendencies found in this population and what could be gathered from previous successful interventions with the aim of arriving at a clinically useful, testable model of how loneliness is perpetuated over time (Käll et al, 2020). The model can be seen in Figure 1.…”

“…A cognitive behavioural model of chronic loneliness. From Käll et al (2020). Reprinted with permission.…”

Therapist-Guided Internet-Based Treatments for Loneliness: A Randomized Controlled Three-Arm Trial Comparing Cognitive Behavioral Therapy and Interpersonal Psychotherapy

“…The rationale behind using CBT as a means of reducing loneliness stems in part from the connection between this state and maladaptive cognitive processes [10]. Additionally, behavioral patterns such as an overreliance on avoidance or a lack of social skills are important to consider [11]. Examples of prior CBT interventions for loneliness are described in the online supplementary material (for all online suppl.…”