An Evaluation of a Low-Intensity Cognitive Behavioral Therapy mHealth-Supported Intervention to Reduce Loneliness in Older People

Abstract

There is a high prevalence of loneliness among older people, especially in residential care settings. Loneliness is often accompanied by maladaptive cognitions which can affect the maintenance and establishment of meaningful social connections. This study implemented and evaluated a low-intensity Cognitive Behavior Therapy (LI-CBT) mHealth-supported intervention which targeted maladaptive cognitions in older people (≥60 years) experiencing loneliness. The three-month intervention using WhatsApp was implemented with older people in four inner-city residential care facilities. The intervention included three components: technology acceptance, psycho-education, and individualized positively worded messages addressing maladaptive cognitions. The intervention was evaluated using a randomized control design. Key outcomes were measured pre-, post-, and one month after the intervention. There were significant changes in social cognition (YSQ-SF T0–T1–T2, X2 = 9.69, p = 0.008) and loneliness levels (total loneliness T0–T1–T2, X2 = 14.62, p = 0.001), and an increase in WhatsApp usage (T0 = 26% vs. T1 = 60%, X2=15.22, p = 0.019). At 1-month follow-up, even with a significant reduction in WhatsApp usage, a significant reduction in loneliness was maintained. LI-CBT delivered via instant messaging may be effective in reducing loneliness experienced by older people.

A Systematic Review on Technology-Supported Interventions to Improve Old-Age Social Wellbeing: Loneliness, Social Isolation, and Connectedness

“…With respect to our first research question, we found that the lack of social relationships and infrequent contacts have been the most commonly addressed challenges to overcome loneliness and social isolation. One prominent strategy has been to train older adults to use computers and Internet ( n = 16) [ 30 – 35 , 37 – 39 , 41 , 42 , 46 , 50 , 51 , 53 ], although few technologies built specifically for older adults implemented this strategy [ 35 , 46 , 54 ]. After an initial training period, older adults in these studies were left to put in practice the skills learned to get in touch with others, with the exception of a single intervention where participants received continuous training [ 39 ].…”

“…Another strategy has been to ensure that the participants had someone to interact with ( n = 10). These would usually be health professionals responding or contacting participants with some frequency for checks or to facilitate the intervention [ 37 , 46 , 47 , 54 ] or other participants such as relatives who agreed to contact and support older adults during the study period [ 36 , 48 ]. Other interventions had volunteers making phone calls [ 43 ], trained interviewers having video chat conversations [ 44 ], and trained helpers linked to a virtual companion [ 40 ].…”

“…Tablet users reported feeling silly talking to a virtual pet, problems with audio, and delay in messages [ 40 ]. A number of studies also reported that reduced dexterity could lead to difficulties with texting and typing [ 33 ], with gestures such as tapping and swiping [ 48 , 52 ], and coordination issues such as requiring to hold voice icon to record audio messages [ 37 ].…”

“…We start by summarizing the interventions analyzed. ere were 13 interventions that considered loneliness as a primary outcome [30][31][32][33][34][35][36][37][38][39][40][41][42], one of which also considered social isolation [34]. Another 12 had loneliness and/or social connectedness as secondary outcomes (see Table 1, Outcomes).…”

Loneliness Relates to Functional Mobility in Older Adults with Type 2 Diabetes: The Look AHEAD Study

“…For example, Silver Sneakers, a gym membership and exercise classes, was shown to increase physical activity and to reduce social isolation and loneliness compared to matched controls [ 37 ]. In addition, a pilot, m-Health intervention targeting maladaptive cognitions in elderly individuals who are experiencing loneliness reduced these symptoms over three months [ 38 ].…”