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From Loneliness to Belonging




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In 2007, as an experienced nurse practitioner, I decided to pursue doctoral studies and sought a topic that fueled my passion to truly help my patients. After listening to patients and students, I chose to study loneliness as a health problem in need of intervention.

Researchers knew then that unmet human needs for love and belonging can lead to experiences of loneliness. Though we know that love and belonging are basic human needs, there were no well-studied and well-described evidence-based treatments for loneliness. 

Globally, experts agree that it is time to act on loneliness, which is a prevalent health problem, not a social problem. Up to 31 percent of older adults globally and more than 17 percent of adults in mid-life report loneliness as a problem. From analysis of Health and Retirement Study data, I learned that older people who were not married, perceived themselves to be in poor health and experienced multiple chronic conditions were more likely to be lonely. Lonely older people engage in less physical activity, use more tobacco, report more depressive symptoms, spend time in nursing homes and experience functional decline. Loneliness has also been shown to be an independent predictor of mortality. 

Feeling lonely produces a stress response likened to the fight-or-flight response that people have when under trauma and this contributes to health problems including higher blood pressure, cardiovascular illnesses like stroke and heart disease, thinking or memory problems, anxiety, sleep disorders, more frequent substance abuse and negative emotions, including worry, anger or fear. 
To make matters worse, there is a stigma of social undesirability associated with loneliness. When a person can’t identify where they are loved, fit or belong, they may feel shame and engage in self-isolating behaviors, further perpetuating the problem. 

With support from the Robert Wood Johnson Nurse Faculty Scholars Program and School of Nursing Research Funds, I studied loneliness in people who live in Appalachia and then worked with experts on theory and intervention development to build a program called LISTEN. This program helps people change their thinking about loneliness so that they can move toward healing. The LISTEN program includes five sessions that discuss belonging over the life course; past and current relationships; place in community; the meaning of loneliness; and coping with loneliness. These sessions help lonely people identify what matters most in their experience of loneliness, derive meaning of loneliness and belonging, sort out personal relationships, brainstorm ways of belonging, understand challenges of loneliness and identify individualized ways of coping.

Older adults who participated in our first study of LISTEN reported significantly less loneliness and fewer depressive symptoms, and had lower systolic blood pressure six weeks after the last LISTEN session. A second study was supported by the West Virginia Clinical and Translational Science Institute. In both studies, LISTEN received positive evaluations from participants. 

Following this work, I want to pursue a campaign on loneliness as a health problem to diminish stigma and integrate screening for loneliness into routine healthcare so that we can intervene prior to the development of depression and secure funding for larger trials of LISTEN. While our initial study was in the older population, LISTEN is not age specific, and it is important to remember that loneliness is a prevalent problem across age groups. As the adoptive mother of eight children from foster care in West Virginia – a population prone to loneliness – I am hopeful that LISTEN could also be used in trials with children, adolescents, people with substance use disorders and parents or new mothers who are lonely. Ultimately, my goal is that LISTEN be considered as a reimbursable treatment for loneliness to assist patients everywhere. 

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Laurie Theeke is a professor and director of the PhD program in the School of Nursing and holds bachelor’s, master’s and PhD degrees from WVU, all in nursing. She also teaches in the School of Medicine and works as a clinician at the Clark K. Sleeth Family Medicine Center.