It’s no surprise that feeling lonely is associated with depression, but did you know that loneliness may also lead to chronic inflammation, changes in the brain, and even premature death?
Dr. Julianne Holt-Lunstad, professor of psychology at Brigham Young University and an expert on the physiological effects of social connections, explains how our current crisis of loneliness is as much a public health threat as smoking, alcohol use, and diabetes.
Discover the behavioral, psychological, and biological factors affected by loneliness, which groups are most at risk, and what we can all do to reconnect.
Phil Stieg: Today, our guest is Dr. Julianne Holt-Lundstad, a renowned psychologist and neuroscientist whose groundbreaking research has brought awareness to the health impacts of social isolation and loneliness. She has collaborated with the US Surgeon General, the World Health Organization, and the National Academy of Sciences to shape public health strategies addressing loneliness.
Today, we’ll hear from her how we can combat loneliness and why maintaining healthy social networks is one of the most important things we can do for our health.
Julianne, thank you so much for taking time to be with us.
Julianne Holt-Lunstad: Thank you. I’m so happy to be here.
Phil Stieg: Perhaps you can help us a little bit by describing what social isolation means to an expert like you, and frankly, how big of a problem is it in America?
Julianne Holt-Lunstad: There’s data to suggest that we may be less socially connected in a variety of ways. Isolation is really more objectively being alone, having few relationships, or infrequent social contact.
Whereas loneliness is more the subjective feeling alone. It’s a distressing feeling, and it’s based on the discrepancy between our desired level of connection and our actual level of connection.
Both of these are forms of lacking connection, but we can be socially disconnected in a variety of ways. We can also lack social support. We could have poor quality relationships. There are some estimates that suggest anywhere from approximately a quarter of the population to some estimates, as much as half of the population are reporting that they feel fairly or very lonely.
People are spending more time in isolation, less time with family, less time with friends, and less time with others. And of course, there are other kinds of data that suggests that social capital is declining. So our participation in groups, clubs, and other kinds of organizations, participation in religion. And some of these declines have been documented even farther back. And so we do have evidence to suggest that we are less connected as a society.
Phil Stieg: You touched upon the impact of loneliness and social isolation on your physical health. I was a little bit taken aback to find out that you suggested that it may be of the magnitude to diabetes and obesity, which are, frankly, the two major health care crises in America right now. So is it truly that prevalent?
Julianne Holt-Lunstad: So what we found was that being more socially connected was associated with a 50% increased odds of survival. Loneliness was associated with a 26% increased risk for earlier death, isolation by 29%, living alone by 32%.
What is the magnitude of how big that effect is on our risk for earlier mortality. We tried to compare it to a variety of things, including things like smoking and smoking cessation, excessive alcohol consumption, physical inactivity, obesity. And what we found was that this was on par with these other factors. We really need to take this just as seriously as we do these other factors.
Phil Stieg: Can you outline for us some of the specific physiological changes that an individual might experience as a result of being lonely?
Julianne Holt-Lunstad: Absolutely. I think this is a great question because many people just assume that maybe it’s just this interesting correlation, but don’t recognize that we go from being more or less socially connected or lonely to then having heart disease or stroke or dying earlier. And making those links is critically important.
I’ll share with you a couple of the key pathways, – the psychological pathways, the behavioral pathways, and the biological pathways. Behaviorally, I’ll start with that because that’s one that I think most people may be able to readily resonate with.
Being more socially connected, we have people in our lives that may encourage healthier kinds of behaviors. From the time we’re little, We have people in our lives who encourage us to eat our fruits and vegetables, to brush our teeth, to look both ways before we cross the street. We have people in our lives who are looking out for our well-being and encouraging healthier behaviors. And even into adulthood, we have others that might encourage us to get more sleep, to go see a doctor when needed, to remind us to take our medications. These kinds of social encouragement, we may be engaging in healthier kinds of behaviors, and therefore at lower risk for these kinds of illnesses.
The psychological factors are often studied in terms of stress and a sense of meaning and purpose in life. Many people readily point to their close relationships as what brings them meaning and purpose in life. That through that, there may be increased self-care and/or risk-taking.
The biological factors are not independent of psychological or biological or behavioral, but we do see independent kinds of effects of the biological factors. I will point out one particular pathway that I think is really interesting because it may help illustrate the connection well, and that pathway is inflammation.
So for instance, loneliness can trigger a sense of threat in the central nervous system. This can be associated with a release of norepinephrine that can prime the bone marrow and an inflammatory response. Chronic inflammation has been associated with a number of chronic illnesses, including increased risk for poor cognitive health outcomes, poor physical health outcomes, and poor mental health outcomes.
Phil Stieg: Since this is about the brain, can you tell me a little bit about how loneliness can have an impact on mental health? The obvious would be, I guess, depression, but Are there other areas where mental health issues may arise because of loneliness?
Julianne Holt-Lunstad: It’s really interesting because I’ll share with you some of the work that we see on depression, which is so interesting because it appears to be bi-directional. Not only does being isolated and lonely increase your risk of developing depression, as well as the severity of that depression, but also depression can increase your risk for isolation and loneliness.
So what this also suggests, however, is that there is opportunity to potentially, by intervening on both, that we can prevent the other. And so, for instance investing in prevention efforts and increasing our social connection could potentially reduce our risk of developing depression and reducing the severity of that depression. And so I’ll also just share with you some interesting more practical ways in which some have tried to study this and intervene on it.
I’ll give you an example. Let’s say you message someone, you text someone, and they don’t respond right away. This could be interpreted as a number of different things, but a negative cognitive bias would lead It needs someone to be more likely to assume negative kinds of reasons for that. They must not like me. They are ignoring me. Whereas it could just be that they were driving, they were in a meeting, they had their phone off. There could have been a number of reasons for that, right?
Phil Stieg: But as Woody Allen said, it isn’t paranoia if it’s true.
Julianne Holt-Lunstad: But what some studies have suggested is that through cognitive behavioral therapy and intervening upon this negative cognitive bias, that if we can reduce that and start to reframe social situations to consider alternative kinds of explanations for others’ behaviors, that that can help. Because you can imagine now Well, okay, you assume someone is ignoring you, so you then text back again, Why haven’t you responded? And you start responding in ways that now elicit negative kinds of behaviors in return, which then reinforces others perhaps not wanting to engage with you. And so intervening upon this negative cognitive bias can be a way to disrupt these kinds of patterns that might be reinforcing and instead start patterns that would elicit more positive kinds of responses in return that would help with social connection.
Interstitial theme music
Narrator: Whether we realize it or not, the very act of living is a team sport. Our brains are wired for family ties, social connections, and community engagement. But something’s been happening in the past few decades, as we seem to be retreating more into individual pursuits. Membership in churches, civic associations, and fraternal organizations is way down. We just don’t seem to be joining clubs the way we once did.
Some thirty years ago, Harvard political scientist Robert Putnam sounded the alarm with a devastating article and book that documented the fragmenting of our social bonds – focusing not on church or a local Lions Club – but on the neighborhood bowling alley.
In “Bowling Alone: The Collapse and Revival of American Community,” Dr. Putnam noted that the number of people who regularly went out bowling had increased in the previous twenty years, but there had been a sharp decline in the number of people who joined bowling leagues. People still liked bowling, but they were doing it without the wider social interactions that would occur in a league environment.
Putnam saw this as a major red flag, as it was an indicator of a decline in what he refers to as “social capital”, a crucial factor in a healthy and productive society.
We develop social capital by joining clubs like bowling leagues and other organizations where we must interact with a wide variety of people and learn to trust our neighbors. Putnam’s concept of social capital was explored in a recent documentary by Pete and Rebecca Davis entitled “Join or Die”
Putnam (V.O. from “Join or Die”):
I mean, the core idea of social capital is so simple. I’m almost embarrassed to say it sometimes. It is that social networks have value. The reason that social networks are important is that they mean that if you cheat somebody, other people will hear about it.
So the more I lose by cheating, and therefore, the more likely I am to be honest. That leads to the core idea of reciprocity, which is I won’t cheat you if you don’t cheat me. But much more powerful is a norm of generalized reciprocity. That is, I’m gonna be nice to you just because you’re in this community, and you’re likely to be nice to me. Well, that’s a huge deal. If you can have generalized reciprocity in a community, that community can be enormously more productive because they don’t have to be constantly checking up on one another. I’ll do for you without expecting something right back from you because down the road, somebody else will do something for me.
Narrator: Putnam describes two types of social capital; bonding social capital – a kind of “sociological superglue” amongst the like minded, and bridging social capital – which provides a “sociological WD-40” to lubricate interaction between diverse communities.
“Bowling Alone” galvanized a generation of world leaders, and Putnam was celebrated by politicians like President Bill Clinton and publications like People Magazine. Now that we know that social connections are as crucial to the health of the “body politic” as they are to our individual hearts and minds, what can we do about it? The answer is pretty clear – join something!
Interstitial closing music.
Phil Stieg: You touched upon it a little bit, but I want to ask who’s at risk for loneliness? And is it genetic? Is it gender? Is it ethnic? Is it age-related? Who’s liable to be lonely?
Julianne Holt-Lunstad: Because humans are social beings, no one is immune to loneliness. No one is. We see loneliness across all demographics, all age groups, all of these factors. However, the prevalence rates are higher among some groups than others. And so who’s most at risk? Interestingly, this has for so long been seen as an older adult issue, but what we are seeing is that the highest prevalence rate seems to be in youth, adolescents, and young adults. We also see that those who are struggling economically, that they are at higher risk, those that live alone, and those that identify with a group that is marginalized in some way.
There also seems to be increased risk during particular transitions in life. Such as leaving your home of origin for the first time, relocating to a new area, retirement, children leaving the home, death of a spouse, anything that could Oh, and I should also say becoming a parent. But anything that could potentially disrupt your social network could potentially be a trigger to become more isolated and lonely.
Phil Stieg: Do you think an individual who spends a lot of time alone, but they’re on their iPhone looking at apps and doing social media, is that another form of loneliness, or is that actually social interaction?
Julianne Holt-Lunstad: That is, I think, one of the biggest questions that scientists are really trying to understand. We do have really good evidence for the importance of in-person connections. What we are less clear on is how these digitally-mediated forms of interaction are potentially fulfilling various needs.
In some cases, they may be able to provide, for instance, emotional support. So many people will look to various groups online, particularly if they don’t have the kinds of support in their local communities.
We hear of many people maintaining relationships at a distance through some of these tools. But we also have experienced firsthand during the pandemic how interacting entirely remotely falls short. And we certainly have evidence of the importance of things like physical touch and how that can influence various neuropeptides, microbiome, these kinds of things that these digital tools might fall short of. And to what extent would spending significant time on these tools displace in-person interactions?
It is very complex and nuanced, so I don’t want to oversimplify it, but I do think we need a much better understanding of the strengths and limitations and where it might actually potentially do harm. And certainly, we know that there is positive and negative effects of relationships, whether they are digitally mediated or even in-person.
Phil Stieg: You’ve worked with the surgeon general, and obviously this is something that is important to him. What is your sense of why he prioritized this?
Julianne Holt-Lunstad: Certainly I can’t speak for him, but what I suspect is that even in his first term, he was already quite interested in the emotional well-being of Americans. And he had started an initiative in that first term, and that’s where we first became acquainted. And, of course, continued to pursue the kinds of factors that are related to that. And he’s certainly written and spoken quite a bit about that.
I think that it was already quite important to him well before the pandemic. But given the crisis of the pandemic, it elevated it also to a crisis level as we saw both nationally and globally how isolated and lonely people were, and recognizing not only did we have in essence, a dual public health crisis that was related to the pandemic, but also the recognition that it wasn’t entirely a pandemic issue, and that it really began before the pandemic and simply exacerbated by the pandemic, and that it was critical that awareness and action be done to address this issue.
Phil Stieg: My next question is probably impossible to answer, but — how do we avoid it? How do you help your adolescent not be lonely? How do you help your aging parents not be lonely? How do you help them? It’s hard to do alone.
Julianne Holt-Lunstad: Yeah. I love the question that, how do we prevent this? Because for far too long, our conversation has been primarily, what do we do about it? So it’s more trying to fix the problem after the problem exists. And moving upstream to prevention is so important.
In order for relationships and connections to flourish, we need the places and spaces to connect. So we can think about how our communities are designed, our workplaces are designed, having parks, libraries, places of worship, how all of these are places that bring people together. We need to invest in these kinds of places and spaces that can create community.
So we really need to cultivate a culture of connection. And this includes a culture of kindness, respect, service, and commitment to one another. And you may wonder, well, how do you change social norms? That sounds really, really hard.
Phil Stieg: You’re asking a bit much given the recent election.
Julianne Holt-Lunstad: Yes, and it is challenging. But it’s interesting because we do have other public health kinds of examples. We’ve seen how the social norms around the desirability and acceptability of smoking has changed over time. And so how these things are depicted in the media and in positions of leadership can have significant influences public perception and shaping the norms in our communities and society. And so each one of us can play a role, and particularly if we’re in positions of leadership, can play a role in modeling more prosocial kinds of norms.
Phil Stieg: Dr. Julianne Holt-Lunstad. Thank you so much for spending this time with us.
Julianne Holt-Lunstad: Thank you so much. I appreciate the opportunity.