Speaking of Psychology: Living in a lonely world, with Julianne Holt-Lunstad, PhD

Half of Americans say they are lonely and the average person reports having only one close friend. Loneliness can also make us sick, contributing to heart disease, depression, suicide and cognitive decline. Dr. Julianne Holt-Lunstad, professor of psychology and neuroscience at Brigham Young University, explains the science behind why social connectedness is so essential for our health.

Julianne Holt-Lunstad, PhD, is a professor of psychology and neuroscience at Brigham Young University. Her research is focused on the long-term health effects of social connection and has been seminal in the recognition of social isolation and loneliness as risk factors for early mortality. Holt-Lunstad has provided expert testimony in a U.S. Congressional hearing, provided expert recommendations for the U.S. Surgeon General Emotional Well-Being in America Initiative and is currently a member of the technical working group for the UK Cross Departmental Loneliness Team. She has been awarded the Citation Award for Excellence in Research by the Society of Behavioral Medicine, the George A. Miller Award from the American Psychological Association, the Mary Lou Fulton Young Scholar Award and the Marjorie Pay Hinkley Endowed Chair Research Award. Her work has been highlighted in the BBC 100 Breakthrough Health Discoveries in 2015, and has been covered in The New York Times, The Washington Post, Time Magazine, Scientific American, This American Life, The Today Show, and other major media outlets.

Kaitlin Luna: Hello and welcome to Speaking of Psychology, a bi-weekly podcast from the American Psychological Association. I'm your host, Kaitlin Luna. Before we get started, we want to remind you that we love hearing from our listeners. If you have any comments, questions or ideas for us, email me at kluna@apa.org. That's kluna@apa.org.

Half of Americans today say they are lonely and the average person reports having only one close friend. Loneliness can also make us sick, contributing to heart disease, depression, suicide and cognitive decline. Why is this happening and what can we do about it? In this episode of Speaking of Psychology, I'm speaking with Dr. Julianne Holt-Lunstad, professor of psychology and neuroscience at Brigham Young University, who's an expert on loneliness and social connectedness. Welcome, Dr. Holt-Lunstad.

Julianne Holt-Lunstad: Thank you.

Kaitlin Luna: So first, I wanted to ask do we have a loneliness epidemic and what trends are you seeing in your research?

Julianne Holt-Lunstad: You know, that's a great question and I've certainly heard this term being used –epidemic -- the Vivek Murthy, the former U.S. Surgeon General has, has suggested that we had a loneliness epidemic. So, have leaders from multiple nations and even recently I was attending a talk where someone from the World Health Organization also referred to this as an epidemic and I get this question a lot and so, I actually tried to look up the term epidemic to determine what, what the definition is and whether this met the criteria for that or not.

And of course, most definitions out there refer to infectious diseases, of course, this, this doesn't apply in that sense, but yet of course we use the term about other kinds of health issues. So, for instance that's been used to refer to as an obesity epidemic, an opioid epidemic. And so, from a standpoint that this is something that is health relevant, that affects a significant portion of the population and something that is concerning that should be prioritized, I do believe the evidence does apply.

There's some question about whether it is increasing or not, but we do have good evidence that a significant portion of the population is affected.

Kaitlin Luna: So, why do you think people are lonely today? I mean, you said you're not really quite sure if those numbers are increasing or if it's just maybe we're becoming more aware of it, but you know, what are some of the reasons you're seeing why people are feeling lonely?

Julianne Holt-Lunstad: Right and, and of course, I can only speculate in terms of why that is the case because certainly I and others have been studying this issue for some time and so we've had data on this for a while, but it seems to really only be widely acknowledged very recently and there seems to be some recent concern.

And so, of course even myself, I have thought about why it is that perhaps there is increasing attention and so, I mean one possibility is that simply we now have more evidence and so this is now simply getting acknowledged. But I do think that there may be more timely issues that may be contributing to increased awareness or increased concern. And so, for instance, one possibility is that the way in which we interact socially has changed dramatically with changes in technology. And of course, this is a hotly debated topic in terms of whether or not technology is increasing loneliness or not or can be a solution or both. But I do think that it is widely acknowledged that, that it has changed the way in which we interact socially and so this has perhaps led to increased awareness and perhaps concern about the potential effects but it's, it's probably not the only factor that may be leading to increased attention.

So, some other potential explanations that, or hypotheses that have been offered have been also, for instance, the divisive politics that we're seeing recently. Not only in the U.S., but elsewhere and this growing sense of a feeling of a fraying social fabric and whether this has led to divisive politics or divisive politics have led to increased isolation from each other and a feeling of isolation. It's difficult to say but for instance, there was a Reuters poll that showed that, that since the election, and I forget the exact percentage, but that a significant portion of people have actually ended relationships with family and friends over politics and have, have unfollowed people on social media over politics.

Kaitlin Luna: Not so surprising.

Julianne Holt-Lunstad: So, you know it's possible that that's playing a role.

We also know that there's changing demographics and so we have an increasing number of people who are living alone more so now than ever, and this is not just the case in the U.S., but also in the U.K. and Europe.

And we also have some evidence to suggest that network sizes are shrinking. We have fewer people who are getting married, fewer people that are having children and so with these changes in demographics with on top of that an increase in aging population, we also have increasing concern about how we're going to care for our aging population that will no longer have or have less likely to have familial or community resources to draw upon in older age. So, this might be another factor, but of course, we, we don't know the exact reason and it's likely a number of factors that are contributing to it. Those may be potential factors that are at least leading to increase awareness and concern around this issue.

Kaitlin Luna: Yeah, it's very interesting. As you mentioned, around the world we're reading of stories about you know, if you're talking about more older people, less younger people, there's a lot of changes in birth rates and things like that. And also, how you know even if it's not social services, necessarily, or enough people in the workforce to take care of older people, it could also just be older, more older people, if they don't have other people, younger people, more younger people in their lives, they might be more lonely, too. So, really interesting to see how it plays out over the years.

Julianne Holt-Lunstad: And, and one clarification I should make is, of course, just because someone lives alone or is unmarried or doesn't have children, doesn't necessarily mean that they are isolated or lonely. So, you could of course, have a wide social network and not feel lonely at all.

However, we do have some evidence that, for instance, living alone carries a significant risk for premature mortality in independent of loneliness, and there's some evidence to suggest that among those that live alone they are more likely to report loneliness, as well.

Kaitlin Luna: Yeah, I wanted to elaborate on that a little bit because I think sometimes people equate someone who likes to spend time alone, maybe a more introverted person -- they equate that with being lonely. But, as you said, it's not really necessarily the case. I mean, some people like to spend, you know, go on, I know people who like to go on vacations by themselves. You know, into the woods, you know, or whatnot, so it's not necessarily the person's lonely, they just need their space and time alone from other people.

Julianne Holt-Lunstad: Right. I think it is important to distinguish because I think we, we often use the terms social isolation and loneliness interchangeably and of course they can coexist, but they are independent. So, as you mentioned you can be on your own alone and not feel lonely, but of course people can still feel lonely even when surrounded by others.

So, it is important to recognize these distinctions that they don't always go hand-in-hand, but they certainly can co-occur also.

Kaitlin Luna: Yeah, I wanted to go back to what you mentioned about technology because, you know, as most things in this world, there's a, it's a good thing and a blessing and a curse. So, technology connects people with like minds from all over the world about various topics. So, someone could say I found someone who's interested in a very niche hobby that I'm into where I might not have found someone weren't my community and they might build an online community and feel really positive about that, but others might feel disconnected from others what, because they're communicating only through social media or text. So, I wanted to ask if being connected electronically is a substitute for face-to-face connections at all?

Julianne Holt-Lunstad: So, that's, it's a great question and I think we're still really trying to fully understand it because, of course, technology can come in lots of different forms and, and I think we often we often think of social media and Facebook when we think of technology. There’s a variety, right?

But, even among these kinds of uses – so, the use of smartphones or the use of social media -- even that the evidence is somewhat mixed in the sense of we find different effects across age for. So, for instance there are some uses that show beneficial effects among older adults, but the same type of usage shows more detrimental effects among younger adults. But, depending on how you even use it, it shows different findings. So, for instance, whether you are using it for communication versus passively, say scrolling a newsfeed.

But also, we have to keep in mind that much of the evidence that exists currently is cross sectional or correlational. And so, when we do find, for instance, a study that shows that people who spend more time online are more lonely, we can't say that it's the time spent online that made them lonely or whether people who are more lonely spend more time online.

Kaitlin Luna: Great. Yeah, exactly. It's not really clear-cut and money, right?

Julianne Holt-Lunstad: And, and even those that the studies that have followed people over time, these are typically very short-term, follow-up and so, we really currently lack the evidence to, to know what the long-term effects of, of these may be and so, we do know, however, that there's robust evidence that being socially connected can have powerful influences on our health and well-being. So, to the extent to which this increases actual connection, so physical contact or even a feeling of connection is likely to be associated with more positive effects and the extent to which these may detract or take away time from spending with others or eliciting feelings of feel feeling more disconnected, that this would likely have more detrimental effects.

Kaitlin Luna: So, what does the research say about why social relationships are important for our physical and mental health?

Julianne Holt-Lunstad: Yeah, so we have now decades of research that has examined this and in particular, my own research, we looked at the overall risk associated with lacking social connections on risk for premature mortality. And so, what we found was when we looked across a variety of ways of measuring social connections, whether it be network size or feelings of loneliness or isolation or social support, averaged across these and keep in mind we had 148 studies with over 300,000 participants and these followed people over time and what they found was the extent to which they reported that they were socially connected predicted who was alive and who was not alive at the follow-up, to the extent that this was associated with a 50 percent increase in survival.

And just to put that into perspective, the magnitude of that effect is comparable and, in some cases, exceeds the other kinds of risk factors that we take very seriously for our health. So, for instance, this exceeds the risk associated with obesity, physical inactivity and air pollution. So, those are the risk of lacking social connection.

And we've also looked specifically at indicators that look specifically at lack of social connections. So social isolation, living alone and loneliness. And in that meta-analysis, we had over 3.4 million participants and, and again, what we found was that each of these, even though they are conceptually distinct, each of these were significant predictors of premature mortality. So, we have and keep in mind there has been additional research that has been published since this time that has also found similar findings, so we have very robust data that lacking social connections is a significant risk factor and that being socially connected is a significant protective factor.

Kaitlin Luna: Yeah, it's all very fascinating how and how important, that is, not only an individual's health and well-being but that well-being includes social connections and having others in our lives. It's really powerful to show how necessary it is for our health and well-being.

Julianne Holt-Lunstad: Yes. Yes. I think often times we may assume that our relationships are just associated with psychological well-being or emotional well-being because certainly our relationships can influence us. But, it's really important to recognize just how important our relationships are for our physical health, as well.

Kaitlin Luna: So, now I want to focus on different generations and how loneliness affects different age groups. So, there was a study from Cigna that said that members of Generation Z -- so those are teenagers and young adults between 15 and 21 -- that study found that they that group is more likely than any other age group to feel lonely and on a similar spectrum, APA does a Stress in America report every year and this one was released in late, in early November, which found that Generation Z was also most likely to report poor mental health and 91 percent of those surveyed experienced at least one physical or emotional symptom of stress over a one-month span. So, how does stress and loneliness relate to each other and what are you seeing in Generation Z?

Julianne Holt-Lunstad: Yeah, so much of my, my work looks at the physiological effects of relationships and also stress and so there's, of course, a wide literature that shows the stress impacts a variety of health-relevant physiological processes that can increase risk for physical health problems and our relationships or lack thereof, can impact this, as well. So, whether our relationships help us cope with stress and buffer some of these negative effects or our relationships can also be sources of stress and whether that's through poor quality relationships or a sense of lack on the part of our relationships that we cannot count on them. So, for instance there's work in neuroscience that supports the idea that our relationships are adaptive also because they provide a sense of safety and security and that when we are alone or with -- compared to those, compared to when we are with others, particularly trusted others, that for instance, we need to be more vigilant to threats in our environment.

And so, this can have an effect on our bodies as our bodies are preparing to handle whatever threats they may be facing. So, in this way, our, our, our relationships can have a powerful influence on our physiology. That is very much related to the kinds of processes that occur when we are under stress or as I mentioned can also be sources of stress.

We also know that this can have an impact on behaviors, as well. So, whether it's due to non-social stress or more social, socially-related stress, that we may engage in poor health behaviors whether that is eating poorly or getting insufficient sleep or not getting enough exercise. But, the kinds of things that people do to cope with stress may result in poor health behaviors that also may ultimately be a pathway by which our relationships may influence health.

Kaitlin Luna: Is this more prevalent in younger people? Do you think young people today are more, more stressed and you know, experiencing more of these symptoms?

Julianne Holt-Lunstad: There is some data that suggests that this may be the case. So, for instance you mentioned the Cigna survey that showed that there's also some additional surveys not only here in the U.S., but also in the U.K. for example that suggests that this younger group may be showing the highest prevalence rates. And the big question is why might this be? And, of course, this is a life transition that may be marked with social transitions. And so, the question is whether that this has always been the case and we're just seeing more evidence of this now or whether this particular generation of teens and, and young adults are lonelier than previous generations.

There is some evidence to suggest that and while I don't know that we can say for sure why that is the case, a couple of hypotheses that may explain that may be related to changes in the technology, as we talked about earlier. So, the more widespread use of smartphones and social media, but it also may be that there may be growing pressure for younger generations to succeed.

So, for instance, greater pressure to do well in school, to do well beyond graduation. For instance, increases in children being involved in extracurricular activities, which of course is laudable, but may come at the expense of having time for friends and socializing and learning social skills.

And so, this increased pressure to do well and to be successful may be potentially one contributing factor. But, of course, as I said, I don't know that we can say for sure whether it's one or the other or both and other factors that you know we haven't even considered but it's certainly worth exploring further, given that we are seeing increases also of anxiety and depression on college campuses nationwide and so this is certainly an increased concern that needs to be addressed.

Kaitlin Luna: And for older adults over 45, an AARP study found that about 43 million adults over 45 are also report suffering from chronic loneliness. So, what are we seeing from members of Generation X and Baby Boomers?

Julianne Holt-Lunstad: Yeah so, both of these, as I mentioned, may be related with life transitions. So, for the younger generation, it may be transitioning from home to leaving home and for the older generation it may be the transition from the workplace into retirement. It may also be associated with other kinds of social transitions, such as children leaving home, also widowhood. And so, there may be important social disruptions that are occurring in these life transitions.

Among older adults, there's also the increased potential for health and mobility issues to potentially have an influence. So, with increasing health problems that may reduce one's ability to, to be social, so it may increase likelihood of isolation. And for instance, mobility, vision, hearing, loss of these that are untreated may reduce one's ability to interact with others, which of course would increase risk for loneliness.

So, there's a variety of factors that may be contributing to this and it's important to really be sensitive to what may be the contributing factor to start looking into the most effective ways to address it.

Kaitlin Luna: Yeah, absolutely. Absolutely. And I came across an article this week in the San Francisco Chronicle about senior co-housing as a way to combat loneliness. I mean, it sounded somewhat similar to like a retirement community slash college dorm, college living because it was basically in these settings seniors have their own individual home, but then they share common areas and communal meals several times a week. So, what do you think about this? Is this a solution to some of the loneliness that might come along with older adults if they experience the loss of their spouse? If they are living, need to move away from their home or something like that to maybe more of a smaller place or something?

Julianne Holt-Lunstad: Yeah, I've been really fascinated by, by these trends. It's, it's incredibly creative in the sense of I think oftentimes psychologists, when we think of interventions, we think of very much individual-based, almost therapy-based kinds of solutions and yet certainly we know from public health that the built environment can have powerful effects.

And of course, housing is part of that and so, I've seen increasing attention around designing communities to foster social connection and in particular, as we talked about, there are changes in our demographics and if we think about it, homes are often designed for single family, but yet our demographics are changing and there's a suggestion that our housing needs to change accordingly.

And so, I think, of course, with any kind of solution, we need to evaluate its effectiveness and collect data, but I'm certainly intrigued by this and of course, the component of intergenerational interaction is something that is of great interest recently and just as you know somewhat of an anecdote, I recently had the opportunity to visit some of the blue zones. These are communities around the world that have been identified as hotspots of longevity, where people live healthier, longer lives than anywhere else in the world and one of the things that I noticed is in these communities there was a lot of intergenerational interaction and so, for instance, even dinners and gatherings and in Greece were you know, the festival, the dancing, you see children - you know, grandparents, all ages and you’re not separated by age. There wasn't an adult table and a child. Everyone was interacting, and certainly older adults were revered for their wisdom and so, it certainly caused me to reflect upon how the different generations can learn from each other and how there's so much to offer in, you know, in a bi-directional way that you know that the young can offer the old and that the old can offer the young. And so, I'm excited to see what kinds of possibilities might come out of these kinds of solutions and hope to see some of them here in the United States, as well.

Kaitlin Luna: Yeah, there's definitely a trend in urban and community planning. I’m definitely seeing it here in D.C. and other places where, you know, there's a wanting to get people out of cars and obviously more active and walking and creating a sense of space, even in a kind of suburban area where there might be shops and restaurants -- kind of a walkable area, which is very different from previous decades. So, as you mentioned, I think it's really fascinating where urban design or, you know, community planning can really fit into creating a sense of community and how powerful that is because you can really feel the difference between an area that's, where there's not a lot of people around, people really rely on their cars. It's not very friendly to people wanting to be out in that space, as opposed to an area where it really encourages walking and hanging out -- that kind of thing and encourages people to be out and being social with each other. Have you any more thoughts on that, about where we can go with urban planning and community design?

Julianne Holt-Lunstad: Oh yeah. It's, it's really fascinating. I'm just, you know as I mentioned, I think we often think about solutions from this individual perspective and yet we really need to think about it from the more of a community and even population wide level types of solutions and as we think about how we design our communities, not only do we need to think about, you know, how walkable it is but how that impacts people socially.

And there is, the World Health Organization has a health and all policy framework. And, if you think about how there are health implications for policy to policy and practices, I think we could extend that to social in all policy in the sense of what are the social implications of policy and practices, including things like urban design and transportation. I think most of us don't readily connect transportation as being a social issue, but whether it is impeding one's ability to get around and get out, certainly for older adults or those with mobility issues, this can be incredibly isolating. But, also just to how inviting and welcoming a community is or even a sense of feeling safe and secure. So, for instance, communities that, where there are safety concerns, people are less likely to be out in their community, less opportunity to engage with others and this can lead to greater isolation, as well.

So, everything from the safety of the community to just having spaces to gather, to even how well it's maintained. So, uneven sidewalks can be a problem for people getting out and interacting with others.

Just as another anecdote, when I was in one of these blue zones I met a 105-year-old man and the first time I met him he had been riding his bike, I think, 15 kilometers every single day.

So, not only was I incredibly impressed that he's riding a bike at 105, but that what I was impressed with is not only just the, of course, the physical health benefits of being physically active, but he was incredibly involved in his community. So, he was able to get out to the shops. He visited other people in the community. He was involved in the theater. He was out and about in the community. He wasn't waiting for others to come visit him.

And so, when we think about transportation and mobility, we do need to think about the social consequences that are related to these.

Kaitlin Luna: Yes, absolutely. I mean that's fascinating and shows the importance of also putting yourself out there. I mean, it's a two-way street. I mean, you know, you don't sometimes, maybe people are more shy or reserved, but you know, the importance of trying things and, you know, seeking out others with like interests, that sort of thing.

Julianne Holt-Lunstad: Absolutely.

Kaitlin Luna: You've spoken a lot about the trends you're seeing globally, and I know you were a recent keynote speaker of the U.K. campaign to end loneliness and I read another article about how Britain has recently appointed a minister of loneliness. So, can you talk more about what conversations people around the world are having about loneliness and how to combat loneliness?

Julianne Holt-Lunstad: Yeah, absolutely.

So, not only did they, did the U.K. appoint a minister for loneliness, but they recently published a national health strategy around loneliness, which really outlines a strategic plan for addressing this at a national level from assessment to multiple departments addressing this.

I also have been to Australia. I am on their Australian Coalition to End Loneliness. I'm on their scientific advisory board and they have multiple organizations in Australia that are also devoted to this. So, they have a national organization called Relationships Australia. We also know that many countries in Europe -- I was recently in Madrid, Spain and where there were people not only from Spain talking about their efforts, but from other nations, including Denmark and Germany and other countries.

And so, we do know that many of these other countries are looking into this at a national level and the U.K. is from my awareness, leading the way in terms of having a very strategic plan in place and an appointed government position to oversee this work. That's not to say that we aren't doing anything in the U.S. There are many organizations here in the U.S. that are highly interested in this and are addressing this, but certainly we have a long way to go to address this very complex issue.

Kaitlin Luna: Yeah, I think it's fascinating because I think it's easy to assume that this could be, maybe an American problem because of an emphasis on an individuality, but it's fascinating to know that it's across the board in other countries where, you know, that might have some aspects of traditional life, like you said, in Spain, or things like that.

But, you know, perhaps this is just something that comes along with maybe some aspects of modern life. Maybe some more awareness, but yeah, it sounds like there's just a lot of really positive things happening in this, in this space or in all different countries.

Julianne Holt-Lunstad: Yeah and so I'm just excited to watch how this unfolds and, and importantly so that we can look to the kinds of solutions that are effective and how can we do them even more efficiently and more effectively.

Kaitlin Luna: Is there any research about how pets can help with loneliness? The American Veterinary Medical Association says that pet ownership is on the rise. Do you know if that has anything to do with people feeling lonely?

Julianne Holt-Lunstad: So, first off, I should mention that when we looked at the effects of being socially connected on longevity, we limited it to studies that were human based. But certainly, many people see their pets as a source of support and comfort and so, but there is some evidence to suggest that pet ownership and in particular, dog ownership, may be associated with better outcomes. I'm less familiar with the details of the strength of that evidence, but idea where that there is some evidence to suggest that pet ownership is associated with some benefits.

And, and of course, you know, there's whether it is that pets are a source of comfort and social support or whether it is that having something or someone that, that relies upon you, so that there's meaning and purpose or whether it's the physical activity of having to say for instance walk a dog or if it's that activity that gets you out interacting with other people, those are some, you know, potential explanations, but of course, I am less familiar with this work than I am with the human research.

Kaitlin Luna: Yeah, there's perhaps some like anecdotal things or, you know, you know a few gotta have a pet -- it doesn't hurt to have someone here, some comforting, cuddly animal around the house or active animal around the house depending on what kind of pet you have.

It's just -- as we wrap up here, I wanted to know if you have any advice for people who are feeling lonely? I mean, do you have anything that you can share to people who might be feeling this way?

Julianne Holt-Lunstad: Yeah, so, of course from a scientific standpoint, we're still trying to really identify what are the best approaches to reducing loneliness and I think the biggest challenge is going to be the fact that for different people, what's causing that loneliness may be very different. And so, the way in which that loneliness might reduce might mean a very different approach for one person then for another.

However, and it's, there has been surveys that have asked people when you've been lonely in the past, what has helped and what has not been helpful. And so, for instance, the recent BBC survey asks this and what I found so fascinating about it was that one of the top responses for what has been helpful was getting involved in social groups, but it was also one of the top responses for advice that was given to them that was not helpful.

Kaitlin Luna: Yeah, speak to that -- what's the individual person's needs.

Julianne Holt-Lunstad: Right. And so, that might be -- it may be helpful for some and not for others, but it might be that it might be that the right kind of social group might be helpful, but not all social groups might be helpful.

Kaitlin Luna: It's true. It's true. You definitely build connections with people. I mean, just being around others who, you know, might not be the same as when you have deep connections with people and can really, you know, be intimate with someone -- either a friendship or romantic relationship level.

Julianne Holt-Lunstad: Right and so, you know, one thing that might be incredibly challenging and difficult to do for some, though, is to reach out and reach out to other people. And so, there's some evidence to suggest that providing support to others can actually be more beneficial than receiving support. And so, and instead of, perhaps, waiting for others to help you or to reach out to you, find ways that you can help others and reach out to others.

Kaitlin Luna: Well, this has been a fascinating conversation. Thank you so much for joining us Dr. Holt-Lunstad.

Julianne Holt-Lunstad: My pleasure.

Kaitlin Luna: If you've been a longtime listener or are new to our podcast, please consider giving us a rating in iTunes or if you have time write a review, we'd really appreciate it.

Also, we'd like to hear from you directly, so if you have any questions, comments or ideas to share, please email me at kluna@apa.org, that's kluna@apa.org.

Speaking of Psychology is part of the APA podcast network, which includes other great podcasts like APA Journals Dialogue, about new psychological research and Progress Notes, about the practice of psychology. You can find all our podcasts on iTunes, Stitcher or wherever you get your podcasts. You can also go to our website speakingofpsychology.org and listen to more episodes and see more resources on the topics we discuss. I'm Kaitlin Luna with the American Psychological Association.