Efficacy of an Internet-based self-help intervention with human guidance or automated messages to alleviate loneliness: a three-armed randomized controlled trial

Abstract

Loneliness is a prevalent and stigmatized phenomenon associated with adverse (mental) health outcomes. However, evidence-based interventions to alleviate loneliness are scarce. This randomized controlled trial (ClinicalTrials.gov-ID: NCT04655196) evaluated the efficacy of an internet-based cognitive behavioral self-help intervention (ICBT) to reduce loneliness by comparing two intervention groups with guidance or automated messages against a waitlist control group. Adults (N = 243) suffering from loneliness were recruited from the general public and then randomly assigned (2:2:1) to a 10-week ICBT with human guidance (GU) or automated messages (AM) or to a waitlist control group (WL). Loneliness, assessed with the UCLA-9, was the primary outcome. Outcomes were assessed at baseline and 10 weeks (post) and analyzed using mixed-effects models. The pooled intervention conditions resulted in lower loneliness scores at post-assessment than the WL (Cohen’s d = 0.57, 95% CI [0.25; 0.89]) and reduced depressive symptoms, social anxiety, social avoidance behavior, and rejection sensitivity (d = 0.32–0.52). The GU group had lower loneliness scores at post-assessment than the AM group (d = 0.42, 95% CI [0.13; 0.70]). ICBT effectively alleviated loneliness, and guidance increased the reduction in loneliness compared to automated messages. Alleviating loneliness with ICBT further seems to reduce the overall burden of psychopathological symptoms.

Evidence-based health messages increase intention to cope with loneliness in Germany: a randomized controlled online trial

“…The risk factors for loneliness include gender, limited use of coping strategies, and low education, self-esteem, and self-efficacy 4 – 6 . Loneliness is a documented contributor to psychopathological symptoms 7 , yet there is a lack of research exploring and evaluating the effectiveness of innovative, scalable interventions designed to reduce loneliness 8 , 9 .…”

“…While effective, such face-to-face trainings can be hard to scale across large populations, limiting access and ability to impact large numbers of individuals. Online delivery can be used to increase access and a recent study found that a 10-week internet-based study effectively alleviated loneliness through self-help interventions, with human guidance and automated messages 8 . However, even online, accessible interventions may demand significant time investments (i.e., weeks to months) which limit their scalability to broad public audiences.…”

“…However, we could not significantly quantify its effectiveness due to a limited sample size ( N = 252). There is a pressing need to measure the effectiveness of innovative health edutainment interventions in order for them to be used to promote public health globally at scale 8 , 9 , 32 .…”