Investigating hypervigilance for social threat of lonely children

Ambiguity potentiates effects of loneliness on feelings of rejection

For social species, having strong and high-quality social relationships is an important safety cue. Loneliness occurs when an individual perceives they have insufficient relationships resulting in feelings of lack of safety. States of perceived unsafety are linked to an increased tendency to construe ambiguous information - information lacking a unique clear interpretation - as threatening. Here, we explore whether the ambiguity of social cues of interpersonal rejection moderates effects of loneliness on feelings of rejection while undergoing social exclusion. Data were collected in 2021; 144 adults completed a progressive social exclusion paradigm where they were randomly assigned to be equally included, excluded, or over-included. Social exclusion/inclusion cues became more pronounced over the course of multiple rounds of a ball-tossing game (Cyberball) resulting in a scenario where ambiguity was highest in earlier rounds and decreased over time. Participants reported feelings of loneliness prior to the task and feelings of rejection throughout the task. Results demonstrated that higher loneliness predicted increased feelings of rejection regardless of exclusion condition. Notably, this positive relationship was strongest during earlier rounds when social cues were most ambiguous. These findings contribute to our understanding of how loneliness modulates social perception to enable organisms to adequately adapt to changing circumstances.

Revisiting the cognitive and behavioral aspects of loneliness: Insights from different measurement approaches

Loneliness is increasingly recognized as a critical public health issue that profoundly affects psychological well-being and social functioning. This study evaluates cognitive and behavioral differences associated with different facets of loneliness. We classified 790 German-speaking adults (MAge = 31.86 (12.48), 81% female) as lonely or not lonely based on three dimensions - loneliness frequency, distress, and chronicity - and tested for group differences regarding cognitive and behavioral aspects, as proposed by the cognitive model of loneliness, while controlling for depressive and social anxiety symptoms. The results indicate fair to substantial agreement between the three classification methods. Further, we found significant group differences regarding all components, such as interpretation bias, social avoidance, and self-esteem, with each loneliness classification method. Our findings highlight the multifaceted nature of loneliness and underscore the importance of applying diverse methods to fully capture its complexity. This study contributes to a more nuanced understanding of loneliness and its implications, suggesting that interventions should consider the specific dimensions of loneliness to effectively address its cognitive and behavioral ramifications.

Preliminary findings on psychometric properties of the adolescent story stem profile

Introduction

The Adolescent Story Stem Assessment Profile (ASSP) is a newly developed narrative measure aimed at assessing the psychological wellbeing of adolescents. This study investigates the psychometric properties of the ASSP within the British population, with the goal of elucidating its unique strengths and limitations.

Methods

We conducted an exploratory factor analysis on the responses of a community sample of adolescents in the UK (N = 182) to identify the underlying factors that reflect adolescents' internal representations as measured by the ASSP. Following this, we performed a series of analyses on the responses from both the community sample and a high-risk sample of adolescents in care (N = 67) to investigate the psychometric properties of the ASSP.

Results

We demonstrated satisfactory internal consistency, construct reliability, and discriminant validity among adolescents with varying levels of risk factors. The findings suggest that the ASSP is a promising tool for measuring mental health in adolescents, providing an economical and practically accessible method for both preventative and clinical applications.

Discussion

Our results yield critical insights into the complex nature of adolescents' psychological development, highlighting the necessity for tailored measures and interventions that address the diverse psychological needs of this population. Overall, this study represents a significant initial step toward establishing the ASSP as a valuable resource in both research and clinical practice, with implications for future studies aimed at enhancing our understanding of attachment to carers, peer relations, mentalization and affect competences in adolescence. The insights gained from this research underscore the importance of developing assessment tools that are sensitive to the unique psychological experiences of adolescents, ultimately contributing to more effective interventions and support strategies.

Social network intervention for loneliness and social isolation in a community setting: the PALS cluster-RCT

Background

Loneliness and social isolation are associated with adverse mental and physical health outcomes in adults. However, there is a lack of existing research on effective interventions and the contexts in which these could be implemented.

Primary objective

To assess the clinical and cost-effectiveness of a social network intervention compared to usual care among at-risk populations.

Design

A pragmatic, community-based, cluster randomised controlled trial with embedded health economic evaluation, process evaluation and qualitative study. Outcome assessments were conducted at baseline and at 3 and 6 months.

Setting

The study was conducted in collaboration with 44 community-based organisations in two regions in England.

Participants

Adults aged ≥ 18 years at risk of loneliness and social isolation.

Intervention

A facilitated social network tool ('project about loneliness and social networks'; PALS) designed to link people to opportunities for social involvement. First, participants map and reflect on personal social networks. Second, identification of local resources based on individual preferences, available support, and health and wellness needs.

Main outcome measures

The primary outcome was mental wellness at 6-month follow-up, measured by the Short Form questionnaire-12 items mental health component score (MCS). Secondary outcomes included the Short Form questionnaire-12 items Physical Health subscale, loneliness, social isolation, well-being and collective efficacy. Economic measures assessed the cost-effectiveness of the intervention in terms of costs, quality-adjusted life-years and net monetary benefits.

Results

We recruited 469 adults into the study, with 120 withdrawals (25.6%). The main trial results indicate little to no treatment effect of the intervention on either the primary or secondary outcomes compared to usual care. The within-trial economic evaluation found that PALS was inexpensive to deliver but there was no significant difference in quality-adjusted life-years, measures of well-being capability or costs, and the intervention did not lead to demonstrable cost-effectiveness in terms of net monetary benefits. The process evaluation found PALS to be acceptable to all types of community organisations, but low resource availability and capacity to sustain PALS was found across all community organisational contexts. Qualitative interviews (n = 20) highlighted that participants wanted to engage with meaningful social activities but barriers to doing so were psychological (i.e. confidence and competence) and practical (i.e. transport or cost).

Limitations

The timing of COVID-19 and associated restrictions (approximately splitting trial follow-up into thirds of pre-COVID, during the first lockdown, and following the trial reopening) meant its impact on the trial is difficult to assess. There were high levels of missing data (20-30% for most outcomes at 6 months), though methods to handle missing data did not change the conclusions of the trial.

Conclusions

Our findings do not provide strong evidence of the efficacy of the PALS social network intervention to address the complexities of loneliness and social isolation. Although the intervention was acceptable to participants and community organisations who hold the potential to deliver such an intervention, sustainability would require a networked approach between organisations to mitigate against the challenges found in each organisation.

Future work

Future interventions for loneliness would likely benefit from utilising a multistep approach providing tailored psychological, relational and social components.

Trial registration

This trial is registered as Current Controlled Trials ISRCTN19193075.

Funding

This award was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme (NIHR award ref: 16/08/41) and is published in full in Public Health Research; Vol. 13, No. 1. See the NIHR Funding and Awards website for further award information.

Content Specificity of Interpretation Bias Related to Social and Emotional Loneliness in Emerging Adulthood

According to cognitive theories, loneliness is associated with biased cognitive processes. However, studies investigating interpretation bias (IB) related to feelings of loneliness are scarce. The current study aimed to investigate (a) whether emotional loneliness (perceived absence of intimacy) and social loneliness (perceived absence of satisfying connections) are associated with a negative IB while controlling for related psychosocial symptoms, and (b) whether these two types of loneliness show content-specific IB. Sample 1 included an unselected university sample (N = 138, 81.9% female, M = 20.8 years, SD = 4.4), and Sample 2 utilized a preselected university sample with elevated anxiety/depression levels (N = 315, 69.5% female, M = 23.8 years, SD = 4.3). Participants completed questionnaires on emotional and social loneliness, social isolation, social anxiety, depression, hostility, and an ambiguous scenarios task measuring IB. The results showed that emotional and social loneliness were uniquely associated with a negative IB related to the unavailability of social network. Social loneliness was additionally positively related to an IB for rejection and negatively to an IB for hostility in Sample 2. These results provide evidence for a content-specific negative IB in both types of loneliness. Future studies are needed to replicate these findings as it could aid in developing an effective treatment program for loneliness targeting underlying cognitions in young adults.

The Bidirectional Relation Between Bullying/Victimization and Negative Automatic Thoughts among Children

As a common form of negative interpersonal interaction in childhood, school bullying is closely related to individual negative cognition. Few studies have assessed whether there is an interaction between different kinds of school bullying roles and negative cognition. The present study administered four questionnaire follow-up tests among Chinese children over two years to explore the bidirectional relation and underlying mechanisms between bullying/victimization and negative automatic thoughts (about self/others). A total of 993 children with MT1age = 9.66 ± 0.72 participated in the study, including 647(65.16%) boys and 346(34.84%) girls. Results indicated a bidirectional relation between victimization and negative automatic thoughts (about self/others); negative automatic thoughts (about self/others) predicting bullying; negative automatic thoughts (about self/others) form two vicious cycles with victimization separately, in which victimization plays a mediating role. The findings suggest that considering improving children's negative cognition of self and others is an important pathway to reduce the occurrence of bullying and victimization in children and to stop children from falling into the cycle of victimization, which is crucial for children to have healthy relationships later in adolescence.

Loneliness and teacher-student relationships in children and adolescents: Multilevel cross-cultural meta-analyses of cross-sectional and longitudinal studies

This study synthesized the literature from international and Chinese databases regarding the associations between loneliness and the quality of affective teacher-student relationships (TSRs) among children and adolescents ages 5.34-17.09 years. Forty-seven studies published between 2005 and 2023 were included in a cross-sectional meta-analysis using a multi-level approach. Moderators of the relationship, including culture, study, sample, and measurement characteristics, were also examined. Findings indicated a significant medium effect size (r = -0.226) between loneliness and TSRs with effects moderated by students' gender and national cultural background (i.e., Hofstede's Power Distance and Long-term/Short-term Orientation Dimensions). Longitudinal meta-analyses were performed with six studies by using cross-lagged regression to investigate the prospective effects between these two variables. Results showed that loneliness predicted subsequent TSRs (β = -0.1661) and TSRs predicted subsequent loneliness (β = -0.0917), indicating a reciprocal prospective relationship over time. The findings emphasize not only the role of teachers in students' experiences of loneliness, but also the role that loneliness has on an individual's relationships with others. Recommendations for intervention include (a) increasing teacher awareness of student loneliness and (b) ensuring that any school-based work considers the specific social-cultural perspective.

Childhood Predictors of Nonsuicidal Self-Injury in Adolescence: A Birth Cohort Study

OBJECTIVE

Nonsuicidal self-injury (NSSI) is rare in childhood but becomes prevalent in adolescence, which suggests that early intervention might be indicated. As childhood predictors of NSSI in adolescence are largely unknown, identifying these predictors was the aim of this study.

METHOD

In a birth cohort sample (n = 759) of Norwegian children, NSSI at 12, 14, or 16 years of age was regressed on predictors of NSSI at age 6 (parental factors: depression, parenting stress, negativity/hostility, emotional availability to the child; child factors: temperamental negative affectivity, emotion regulation, symptoms of emotional and behavioral disorders; external events: victimization from bullying, serious negative life events). Semistructured clinical interviews with adolescents and their parents were used to assess DSM-5-defined NSSI and NSSI disorder.

RESULTS

NSSI during the preceding 12 months at 12, 14, or 16 years of age was reported by 81 adolescents (10.0%, 95% CI 8.2-11.9), and NSSI disorder was reported by 20 adolescents (2.7%, 95% CI 1.9-3.8). In multivariable logistic regression analysis, female gender (odds ratio 11.6, 95% CI 4.0-33.5), parenting stress (odds ratio 4.8, 95% CI 1.4-16.5), and parental negativity/hostility (odds ratio 1.8, 95% CI 1.2-2.7) predicted NSSI, whereas child factors and external events were not predictive.

CONCLUSION

Parental factors when the child is 6 years of age-parenting stress and negativity/hostility toward the child-predict NSSI in adolescence. Universal and indicated programs targeting these aspects of parenting during childhood might reduce NSSI in adolescence.

PLAIN LANGUAGE SUMMARY

Almost 1 in 4 adolescents engage in deliberate self-harm without wanting to die from it. However, childhood predictors of nonsuicidal self-injury are largely unknown. This study from Norway followed 759 children from birth until adolescence. The authors found that children who perceived their parents as more negative and hostile at 6 years old were at increased risk of engaging in self-injury when they became adolescents. Children whose parents reported more stress in the parenting role were also at increased risk of engaging in self-harm during adolescence. The authors conclude alleviating parental stress and improving parent-child relations at an early age might decrease the risk of adolescent self-harm.

DIVERSITY & INCLUSION STATEMENT

We worked to ensure race, ethnic, and/or other types of diversity in the recruitment of human participants. We worked to ensure sex and gender balance in the recruitment of human participants. We worked to ensure that the study questionnaires were prepared in an inclusive way. We actively worked to promote sex and gender balance in our author group. The author list of this paper includes contributors from the location and/or community where the research was conducted who participated in the data collection, design, analysis, and/or interpretation of the work.

The Impact of Loneliness and Social Anxiety on Casual Social Contacts

Introduction In the wake of the COVID-19 pandemic, loneliness and social isolation have become major public health crises. Loneliness has reached epidemic levels and negatively impacts both health and quality of life. "Casual contacts" is a developing line of research that may hold promise in stemming the current crisis. Casual contacts refer to interactions and relationships with people who are neither family nor friends. Our objectives are to (a) document the impact of casual contacts on community-based adults (Studies 1 and 2) and (b) study the impact of loneliness (Studies 1 and 2) and social anxiety (Study 2) on responses to casual contact. Based on prior studies, we expect to find that casual contacts have a generally positive impact on mood. However, the association of both loneliness and social anxiety with hypervigilance to social threat leads to the broad hypothesis that individuals with each of these conditions would be more likely to respond negatively to casual contacts than would others without those conditions. Method This correlational research recruited convenience samples of English-speaking adults living in the United States, using the online platform Survey Monkey. There were no selection criteria beyond (a) language and location and (b) the sample being generally balanced for age and gender. Partial correlation and analysis of covariance were used to examine the association of loneliness and social anxiety with feeling worse after casual contacts, while controlling for age, gender, household size, household income, and size of town. Because the current study examines a novel area, individual differences that affect how people experience casual contacts, we ran two studies enabling us to examine whether the results replicated. In total, we surveyed 546 community-dwelling adults about their casual contacts, 174 in Study 1 and 372 in Study 2. Data cleaning was used to minimize/eliminate meaningless and random answers resulting in a final total study sample of 393 participants: 123 in Study 1 and 270 in Study 2. Results The results indicate that casual contacts are common, with fewer than 4% having neither verbal nor electronic contact with an acquaintance weekly, and typically have a positive impact (Study 1 and Study 2). Nevertheless, a significant minority of casual contacts result in negative experiences, which is more probable among respondents who were lonely (Study 1 and Study 2) and/or had higher levels of social anxiety (Study 2). Exploratory analyses showed that both loneliness and social anxiety are linked to feeling worse for longer periods of time after casual contacts and that positive feelings tend to dissipate more rapidly for those with higher loneliness scores (Study 2).  Conclusions These results indicate that clinicians developing interventions that involve casual contacts must consider how to do so safely and effectively for those with a higher degree of loneliness and/or social anxiety.

Associations of state and chronic loneliness with interpretation bias: The role of internalizing symptoms

Loneliness is common and, while generally transient, persists in up to 22% of the population. The rising prevalence and adverse impacts of chronic loneliness highlight the need to understand its underlying mechanisms. Evolutionary models of loneliness suggest that chronically lonely individuals demonstrate negative interpretation biases towards social information. It may also be that such biases are exacerbated by momentary increases in state loneliness, or elevated anxiety or depression. Yet, little research has tested these possibilities. The current study aimed to advance understandings of loneliness by examining associations of chronic loneliness with individual differences in negative interpretation bias for social (relative to non-social) stimuli, and testing whether these associations change in the context of increased state loneliness and current levels of anxiety and depressive symptoms. These aims were explored in 591 participants who completed an interpretation bias task before and after undergoing a state loneliness induction. Participants also self-reported chronic loneliness, anxiety, and depression. Linear mixed models indicated that only state (but not chronic) loneliness was associated with more positive interpretations of non-social stimuli, with greater anxiety and depressive symptoms predicting more negative interpretations. Implications of these findings for present theoretical models of loneliness are discussed.

Understanding the link between theory of mind and loneliness among primary school students: A cross-lagged panel model analysis

This study aimed to investigate the longitudinal association between theory of mind (ToM) and loneliness as well as the potential moderating effects of parenting style on this association. A total of 689 Chinese third-grade students (341 girls and 348 boys; Mage = 9.23 years, SD = 0.66) were recruited from eight primary schools and were followed from Grade 3 to Grade 5. These students reported their primary caregivers' parenting style in third grade and completed the same ToM task and loneliness questionnaire at each time point from Grade 3 to Grade 5. The study's results indicated a bidirectional relationship between ToM and loneliness, implying that children with less developed ToM abilities tend to feel lonelier and, conversely, that higher levels of loneliness are associated with lower ToM skills. Moreover, the study demonstrated that parenting style influenced the association between ToM and loneliness. Specifically, the impact of ToM at Grade 3 on reducing loneliness at Grade 4 was greater among children who experienced high levels of rejection from their caregivers compared with those with low levels of rejection. In addition, this study found that loneliness at Grade 3 had a greater influence on ToM at Grade 5 for children experiencing low levels of emotional warmth from their caregivers than for those who experienced high levels of emotional warmth. These findings highlight the significance of ToM as both a precursor and consequence of children's loneliness and emphasize the variation in these longitudinal relationships based on the parenting styles of primary caregivers.

Threatened by others or by everything? The effects of momentary and trait loneliness on daily appraisals of social company and being alone in young adults

Theoretical accounts of loneliness suggest that it may lead to psychopathological consequences by increasing the perception of social threat. However, it is unclear whether the real-life effects of both trait and state loneliness are specific to social situations. To answer this question, two experience sampling studies were conducted with prestratified samples of young adults (18-35) with moderate (Study 1, N = 64) or low and high (Study 2, N = 103) levels of loneliness. Participants were asked to report their emotional states and appraisals of social and nonsocial situations. Multilevel modelling of momentary and time-lagged associations revealed that trait loneliness was associated with less positive (Study 1) and more negative (Study 2) company appraisals. Importantly, in Study 2, trait loneliness was also related to less positive and more negative appraisals of being alone. Momentary loneliness was related to less positive and more negative appraisals of both types and predicted negative social appraisals over time in both studies. In Study 2, time-lagged interaction effects on social appraisals were found between the two levels. The results suggest that in highly lonely individuals, both levels of loneliness may lead to a general negativity bias and have a synergistic effect.

Bedtime procrastination related to loneliness among Chinese university students during post-pandemic period: a moderated chain mediation model

BACKGROUND

This study examined the relationship between loneliness and bedtime procrastination among Chinese university students, the mediating effects of COVID-19 risk perception and self-regulatory fatigue, and connectedness to nature's protective role, post pandemic.

METHODS

We recruited 855 students to complete the Loneliness, Perceived Risk of COVID-19 Pandemic, Self-Regulatory Fatigue, Bedtime Procrastination, and Connectedness to Nature Scales. Data for descriptive statistics, correlation analysis, and moderated chain mediation effects were analyzed using SPSS 24.0 and process 3.5 macros.

RESULTS

Loneliness positively correlated with bedtime procrastination, COVID-19 risk perception mediated the impact of loneliness on bedtime procrastination, self-regulatory fatigue mediated the effect of loneliness on bedtime procrastination, and COVID-19 risk perception and self-regulatory fatigue mediated the effect between loneliness and bedtime procrastination. Furthermore, connectedness to nature mediated the impact of COVID-19 risk perception on self-regulatory fatigue.

CONCLUSIONS

The results indicate the effects and potential mechanisms of loneliness on bedtime procrastination after the relaxation of the pandemic prevention and control policy in China from the perspective of self-regulatory resources and provide insights into improving university students' sleep routine and mental health post pandemic.

Depressive symptoms and loneliness among early adolescents: a psychometric network analysis approach

BACKGROUND

Previous studies demonstrate a high prevalence of depression and loneliness among adolescents. Although they often co-occur, the relationship between symptoms of depression and loneliness remains poorly understood. This study investigates: (a) the symptoms of depression that are connected to loneliness; (b) the role played by loneliness in the network of depression symptoms; and (c) whether the method used to measure loneliness (single-item direct or multi-item indirect) affects the relationship of loneliness with depressive symptoms.

METHODS

Participants were 496 Polish adolescents (50.8% girls) aged 11 to 13, who completed: (a) the 10-item Major Depressive Disorder subscale of the Revised Child Anxiety and Depression Scale; (b) the 11-item De Jong Gierveld Loneliness Scale (indirect loneliness), and (c) a single direct question evaluating loneliness: 'I'm lonely'. Networks were estimated using a Gaussian Graphical Model.

RESULTS

Loneliness shows a direct relationship with three affective symptoms of depression: sadness, worthlessness, and anhedonia, which mediate relationships with somatic symptoms. In contrast to previous studies, loneliness has the lowest level of centrality among all elements of the network. The method used to assess loneliness did not significantly affect the connections between loneliness and depressive symptoms.

CONCLUSIONS

Loneliness and depression overlap since they are formed by the same cognitive biases and deficits in emotion regulation but differ in the level of generality. In loneliness, they have an interpersonal context, while symptoms of depression can be intrapersonal. This helps us to understand why cognitive interventions, as compared to those which are social, are more effective in reducing loneliness.

Developing an interpretation bias modification training task for alleviating loneliness in young people

OBJECTIVE

Loneliness is common among young people and is associated with negative health outcomes. Because loneliness is associated with a bias for interpreting social situations as threatening, cognitive bias modification for interpretation (CBM-I) training is a potential early intervention tool. We developed and delivered a single session of mental imagery enhanced digital CBM-I training, assessing feasibility, acceptability, and magnitude of change in interpretational style and loneliness.

METHOD

CBM-I training materials were developed using a co-creation approach with 18-25-year-olds with experience of loneliness. Another group of 18-25-year-olds with high loneliness received either online CBM-I (n = 29) or control (n = 27) training.

RESULTS

CBM-I training uptake and retention rates were 88% and 92%, respectively. Participants found the training acceptable. The CBM-I group showed a reduction in social threat interpretations (d = 0.77), an increase in social benign interpretations (d = 0.84), and a decrease in loneliness (d = 0.56). The control group showed a small reduction in social threat interpretations (d = 0.21), no change in social benign interpretations (d = 0.04), and an increase in loneliness (d = 0.41).

CONCLUSIONS

Interpretation biases relevant to youth loneliness may be modifiable, and CBM-I training could reduce feelings of loneliness. This informs psychological models of loneliness, and the development of CBM-I interventions targeting loneliness in young people.

How to Help Clients Make Friends

Friendships have been declining for the past 30 years, resulting in severe mental and physical health consequences. However, multiple barriers prevent individuals from initiating and maintaining connections. This paper highlights the individual and societal-level challenges that limit social connection including fear of rejection, insecure attachment style, structural racism, and increased use of technology. To help clients make friends, we recommend clinicians assess loneliness, social competency, and attachment style; administer cognitive behavioral or behavioral activation therapies; and guide clients to assume others like them and be self-compassionate.

Tendency to Share Positive Emotions Buffers Loneliness-Related Negativity in the Context of Shared Adversity

Loneliness is associated with adverse outcomes, and the COVID-19 pandemic threatened to increase loneliness. How loneliness-related outcomes unfold, though, varies across individuals. Individuals' sense of social connectedness and engagement with others to regulate emotional experiences (interpersonal emotion regulation; IER) may modulate loneliness-related outcomes. Individuals failing to maintain social connectedness and/or regulate emotions may be at heightened risk. We assessed how loneliness, social connectedness, and IER related to valence bias, a tendency to categorize ambiguity as more positive or negative. Loneliness was associated with a more negative valence bias among individuals reporting above average social connectedness but who shared positive emotion less often (z=-3.19, p=.001). These findings suggest that sharing positive emotional experiences may buffer loneliness-related outcomes during shared adverse experiences.

Does loneliness before the age of twelve indirectly affect impaired control over drinking, alcohol use, and problems through perceived stress?

Loneliness is the pain of feeling socially isolated from others (Russell et al., 1980). The Stress-Dampening Hypothesis (Marlatt, 1987; Sayette, 1993; Sher, 1987) posits that individuals drink to alleviate negative affect. To date, it has not been determined whether loneliness experienced as a child can indirectly influence at-risk patterns of alcohol use through the mediating mechanism of stress and impaired control. Impaired control over alcohol use (IC) is the difficulty adhering to one's own self-proscribed limits on drinking behaviors (Heather et al., 1993). Impaired control is an at-risk pattern of use that is particularly relevant to emerging adults. Methods: We examined the direct and indirect relationships between childhood loneliness, stress, IC, and alcohol-related problems with a structural equation model. In a college student sample, we utilized a (k = 20,000) bootstrap technique and a model indirect command in Mplus to examine potential mediational pathways. Cisgender sex was included as a covariate. Results: Loneliness was directly linked to stress as well as to alcohol-related problems. Higher levels of loneliness were indirectly linked to both more alcohol use and alcohol-related problems through more stress and in turn, more impaired control over drinking. Conclusions: The current study is consistent with the Stress Dampening Hypothesis (Marlatt, 1987; Sayette, 1993; Sher, 1987). Our findings suggest that therapeutic interventions combating loneliness in childhood may disrupt the stress-dampening pathway to dysregulated alcohol use in emerging adulthood.

Interpersonal predictors of loneliness in Japanese children: variable- and person-centered approaches

BACKGROUND

Loneliness in children has been a major topic of interest in both clinical and developmental psychology. Further studies to investigate predictors of loneliness are needed for educational practices.

METHODS

A total of 1088 late elementary school-aged children (48.81% boys, M_age = 10.35) participated in a 1-year longitudinal survey. We used hierarchical linear modeling and mover-stayer latent transition analysis.

DISCUSSION

Findings from the variable- and person- centered approaches suggested that less positive peer relations, higher victimization, and higher relational aggression are predictors of higher future loneliness. Meanwhile, both approaches did not reach an agreement concerning predictors to reduce loneliness. This result highlighted a utility of a combined approach and sounded an alarm for overreliance on the variable-centered approach dominating child research.

CONCLUSION

To protect young children from loneliness, it will be more beneficial to prevent the development of loneliness rather than to apply interventions to reduce loneliness once established. Preventive practices need to be implemented to protect children from loneliness.

Perceived social isolation is correlated with brain structure and cognitive trajectory in Alzheimer’s disease

Both objective and perceived social isolations were associated with future cognitive decline and increase risk of Alzheimer’s disease (AD). However, the impacts of perceived social isolation depending on different clinical stages of AD have not been elucidated. The aim of this study was to investigate the influence of perceived social isolation or loneliness on brain structure and future cognitive trajectories in patients who are living with or are at risk for AD. A total of 176 elderly patients (mean age of 78 years) who had complaint of memory problems (39 subjective cognitive decline [SCD], 53 mild cognitive impairment [MCI], 84 AD) underwent structural MRI and neuropsychological testing. Loneliness was measured by one binary item question “Do you often feel lonely?.” Voxel-based morphometry was conducted to evaluate regional gray matter volume (rGMV) difference associated with loneliness in each group. To evaluate individual differences in cognitive trajectories based on loneliness, subgroup analysis was performed in 51 patients with AD (n = 23) and pre-dementia status (SCD-MCI, n = 28) using the longitudinal scores of Alzheimer’s Disease Assessment Scale-cognitive component-Japanese version (ADAS-Jcog). Whole brain VBM analysis comparing lonely to non-lonely patients revealed loneliness was associated with decreased rGMV in bilateral thalamus in SCD patients and in the left middle occipital gyrus and the cerebellar vermal lobules I − V in MCI patients. Annual change of ADAS-Jcog in patients who reported loneliness was significantly greater comparing to these non-lonely in SCD-MCI group, but not in AD group. Our results indicate that perceived social isolation, or loneliness, might be a comorbid symptom of patients with SCD or MCI, which makes them more vulnerable to the neuropathology of future AD progression.

Lonely in the Dark: Trauma Memory and Sex-Specific Dysregulation of Amygdala Reactivity to Fear Signals

Loneliness exacerbates psychological distress and increases the risk of psychopathology after trauma exposure. However, it is still unclear whether a lack of social connectedness affects trauma-related intrusions and the neural processing of fear signals. Moreover, it is uncertain, whether loneliness plays a different role in women and men. A prestratification strategy is used and n = 47 (n = 20 women) healthy lonely individuals and n = 35 controls (n = 18 women) are recruited. Participants are exposed to an experimental trauma and evoked intrusive thoughts in daily life are monitored for three consecutive days. Functional magnetic resonance imaging is used to assess neural habituation to fearful faces and fear learning (conditioning and extinction) prior to trauma exposure. The results reveal a significant interaction between loneliness and sex such that loneliness is associated with more intrusions in men, but not in women. A similar pattern emerges at the neural level, with both reduced amygdala habituation to repeated fearful faces and amygdala hyperreactivity during the conditioning of fear signals in lonely men. The findings indicate that loneliness may confer vulnerability to intrusive memories after trauma exposure in healthy men and that this phenotype relates to altered limbic processing of fear signals.

Behavioral and Neural Dissociation of Social Anxiety and Loneliness

Loneliness is a public health concern with detrimental effects on physical and mental well-being. Given phenotypical overlaps between loneliness and social anxiety (SA), cognitive-behavioral interventions targeting SA might be adopted to reduce loneliness. However, whether SA and loneliness share the same underlying neurocognitive mechanisms is still an elusive question. The current study aimed at investigating to what extent known behavioral and neural correlates of social avoidance in SA are evident in loneliness. We used a prestratified approach involving 42 (21 females) participants with high loneliness (HL) and 40 (20 females) participants with low loneliness (LL) scores. During fMRI, participants completed a social gambling task to measure the subjective value of engaging in social situations and responses to social feedback. Univariate and multivariate analyses of behavioral and neural data replicated known task effects. However, although HL participants showed increased SA, loneliness was associated with a response pattern clearly distinct from SA. Specifically, contrary to expectations based on SA differences, Bayesian analyses revealed moderate evidence for equal subjective values of engaging in social situations and comparable amygdala responses to social decision-making and striatal responses to positive social feedback in both groups. Moreover, while explorative analyses revealed reduced pleasantness ratings, increased striatal activity, and decreased striatal-hippocampal connectivity in response to negative computer feedback in HL participants, these effects were diminished for negative social feedback. Our findings suggest that, unlike SA, loneliness is not associated with withdrawal from social interactions. Thus, established interventions for SA should be adjusted when targeting loneliness.SIGNIFICANCE STATEMENT Loneliness can cause serious health problems. Adapting well-established cognitive-behavioral therapies targeting social anxiety might be promising to reduce chronic loneliness given a close link between both constructs. However, a better understanding of behavioral and neurobiological factors associated with loneliness is needed to identify which specific mechanisms of social anxiety are shared by lonely individuals. We found that lonely individuals show a consistently distinct pattern of behavioral and neural responsiveness to social decision-making and social feedback compared with previous findings for social anxiety. Our results indicate that loneliness is associated with a biased emotional reactivity to negative events rather than social avoidance. Our findings thus emphasize the distinctiveness of loneliness from social anxiety and the need for adjusted psychotherapeutic protocols.

Choking under pressure: Does it get easier with age? How loneliness affects social monitoring across the life span

Previous experimental work showed that young adults reporting loneliness performed less well on emotion recognition tasks (Diagnostic Analysis of Nonverbal Accuracy [DANVA-2]) if they were framed as indicators of social aptitude, but not when the same tasks were framed as indexing academic aptitude. Such findings suggested that undergraduates reporting loneliness possessed the social monitoring skills necessary to read the emotions underlying others’ facial expressions, but that they choked under social pressure. It has also been found that undergraduates reporting loneliness have better recall for both positive and negative social information than their non-lonely counterparts. Whether those effects are evident across different age groups has not been examined. Using data from the British Broadcasting Corporation (BBC) Loneliness Experiment that included participants aged 16–99 years (N = 54,060), we (i) test for replication in a larger worldwide sample and (ii) extend those linear model analyses to other age groups. We found only effects for participants aged 25–34 years: In this age group, loneliness was associated with increased recall of negative individual information, and with choking under social pressure during the emotion recognition task; those effects were small. We did not find any such effects among participants in other age groups. Our findings suggest that different cognitive processes may be associated with loneliness in different age groups, highlighting the importance of life-course approaches in this area.

Community identification, social support, and loneliness: The benefits of social identification for personal well-being

Levels of loneliness across the world have reached epidemic proportions, and their impact upon population health is increasingly apparent. In response, policies and initiatives have attempted to reduce loneliness by targeting social isolation among residents of local communities. Yet, little is known about the social psychological processes underpinning the relationships between community belonging, loneliness, and well-being. We report three studies which apply the Social Identity Approach to Health to examine the mechanisms underpinning the relationships between community identity, health, and loneliness. Hypotheses were tested through secondary analyses of the 2014-2015 UK Community Life Survey (N = 4,314) as well as bespoke household surveys in a more (N = 408) and less (N = 143) affluent community at high risk of loneliness. Studies 1 and 2a demonstrated that the relationship between community identification and well-being was mediated by increased social support and reduced loneliness. In Study 2b, community identification predicted well-being through reduced loneliness, but not through social support. Our results are the first to evidence these relationships and suggest that community-level interventions that enhance community identification and peer support can promote a potential Social Cure for loneliness.

Positive and Negative Online Experiences and Loneliness in Peruvian Adolescents During the COVID-19 Lockdown

Global COVID-19 lockdowns have disrupted adolescents' in-person social networks, increasing likelihood of loneliness. Social media can help adolescents maintain and develop peer relationships across distance. In this short longitudinal study with 735 Peruvian adolescents (ages: 11-17) from low-to-middle-income urban settings, we investigated whether online experiences relate to loneliness during initial stages of lockdown. Loneliness remained constant between week 6 and 11 of lockdown, was higher for females and similar across school-grades. Positive and negative online experiences were more frequent for older students, and females experienced more negative online experiences than males. Greater positive online experiences related to lower loneliness, with the reverse pattern for negative online experiences. Our results suggest that positive online experiences may mitigate loneliness during physical isolation.

Brief induction of loneliness decreases vagal regulation during social information processing

Perceived social isolation, or loneliness, has been repeatedly linked to numerous adverse health outcomes. Much effort has been directed towards elucidating the mechanisms underlying its effects on the cardiovascular system, which may explain the deleterious effects on morbidity and mortality. It has been previously suggested that perceived social isolation can impair effective parasympathetic regulation and physiological adjustment to the demands of the social environment. Thus, the present study aimed at investigating the causal impact of an induction of loneliness on vagal activity during social stimuli processing. In the study, participants (N = 119) were led to anticipate either a future filled with satisfying relationships (Future Belong) or a lonely life (Future Alone). Then, they were asked to complete an implicit emotion regulation task while their cardiovascular activity was recorded. In the Future Belong group, a pattern of vagal suppression was observed between the resting period and task completion, which was followed by vagal recovery during the post-task resting period. However, in the Future Alone group, a change from the baseline HRV was observed only at the beginning of the task, but not during its consecutive stages. Moreover, in participants who believed in the given FA feedback, the initial vagal suppression was absent. These findings provide evidence that even a brief induction of loneliness can result in a blunted vagal suppression during social information processing. It can be hypothesized that the lack of the ability to regulate vagal activity while processing social cues may potentially underlie problems with social engagement and self-control.

Are biased interpretations of ambiguous social and non-social situations a precursor, consequence or maintenance factor of youth loneliness?

Loneliness is common in youth, with suggestions that these negative emotions confer vulnerability for anxiety and depression. Here, we investigated for the first time whether, consistent with psychological models of loneliness, biased interpretations of social situations could prospectively predict loneliness in youth. 104 young people completed measures of loneliness and interpretations of ambiguous social and non-social (bodily or health-related) situations at three time-points with intervals of three months between each. As government-imposed social distancing measures (to control the COVID-19 outbreak) occurred between Times 2 and 3 (but not between Times 1 and 2), this enabled us to assess whether restricted social activity could provoke greater predictive power of biased interpretational styles on loneliness. Using cross-lagged panel models, we showed that after estimating paths representing within-time across-variable ("concurrent") paths and across-time within-variable ("stability") paths, there were no significant cross-lag 'causal' paths between earlier interpretational style and later loneliness. Between Time 2 and 3, we demonstrated a significant cross-lag 'consequential' path between earlier loneliness and later threatening interpretations of social situations, but this became non-significant after controlling for concurrent anxiety and depression. Biased interpretational style may reflect a concurrent maintenance factor of youth loneliness.

Safe but Lonely? Loneliness, Anxiety, and Depression Symptoms and COVID-19

Background

The COVID-19 pandemic has led governments worldwide to implement unprecedented response strategies. While crucial to limiting the spread of the virus, “social distancing” may lead to severe psychological consequences, especially in lonely individuals.

Methods

We used cross-sectional (n = 380) and longitudinal (n = 74) designs to investigate the links between loneliness, anxiety, and depression symptoms (ADS) and COVID-19 risk perception and affective response in young adults who implemented social distancing during the first 2 weeks of the state of epidemic threat in Poland.

Results

Loneliness was correlated with ADS and with affective response to COVID-19’s threat to health. However, increased worry about the social isolation and heightened risk perception for financial problems was observed in lonelier individuals. The cross-lagged influence of the initial affective response to COVID-19 on subsequent levels of loneliness was also found.

Conclusion

The reciprocal connections between loneliness and COVID-19 response may be of crucial importance for ADS during the COVID-19 crisis.

Loneliness in the lives of Danish adolescents: Associations with health and sleep

Aims: We examined the relationship between loneliness and health among young adolescents. We also investigated the validity of a single-item measure of loneliness by comparing this to a composite score. Methods: The current data come from a nationally representative sample of 11- to 15-year-old adolescents (N=3305; F=52%) from Denmark collected in 2014 as part of the Health Behaviour in School-aged Children (HBSC) collaborative cross-national survey. Results: A series of binary logistic regressions showed that higher loneliness among adolescents, whether measured using the single- or multi-item measurement, was associated with poorer self-rated health, higher frequency of headache, stomach ache, backache, difficulties sleeping, greater sleep disturbance and more instances of feeling tired in the morning. Those associations were relatively consistent across sex and age groups. Conclusions:Loneliness is associated with poorer self-reported health and sleep problems among young adolescents. Those findings are similar across two measures of loneliness, suggesting robust findings. The development of interventions and health-education efforts to fight loneliness in adolescence is important.

Safe but Lonely? Loneliness, Anxiety, and Depression Symptoms and COVID-19

BACKGROUND

The COVID-19 pandemic has led governments worldwide to implement unprecedented response strategies. While crucial to limiting the spread of the virus, "social distancing" may lead to severe psychological consequences, especially in lonely individuals.

METHODS

We used cross-sectional (n = 380) and longitudinal (n = 74) designs to investigate the links between loneliness, anxiety, and depression symptoms (ADS) and COVID-19 risk perception and affective response in young adults who implemented social distancing during the first 2 weeks of the state of epidemic threat in Poland.

RESULTS

Loneliness was correlated with ADS and with affective response to COVID-19's threat to health. However, increased worry about the social isolation and heightened risk perception for financial problems was observed in lonelier individuals. The cross-lagged influence of the initial affective response to COVID-19 on subsequent levels of loneliness was also found.

CONCLUSION

The reciprocal connections between loneliness and COVID-19 response may be of crucial importance for ADS during the COVID-19 crisis.

Internet-Based Cognitive Behavior Therapy for Loneliness: A Pilot Randomized Controlled Trial

Loneliness has been described as a common source of discomfort based on a subjective discrepancy between the actual and desired social situation. For some people this feeling may become a sustained state that is associated with a wide range of psychiatric and psychosocial problems. While there are few existing treatment protocols, interventions based on cognitive behavioral therapy (CBT) have shown positive effects. The current study investigated the efficacy of an 8-week internet-based treatment containing CBT components aimed at reducing feelings of loneliness. Seventy-three participants were recruited from the general public and randomly allocated to treatment or a wait-list control condition. Participants were assessed with standardized self-report measures of loneliness, depression, social anxiety, worry, and quality of life at pretreatment and posttreatment. Robust linear regression analysis of all randomized participants showed significant treatment effects on the primary outcome measure of loneliness (between group Cohen's d = 0.77), and on secondary outcomes measuring quality of life and social anxiety relative to control at postassessment. The results suggest the potential utility of internet-based CBT in alleviating loneliness but more research on the long-term effects and the mechanisms underlying the effects is needed.

Loneliness and the recognition of vocal socioemotional expressions in adolescence

Lonely individuals show increased social monitoring and heightened recognition of negative facial expressions. The current study investigated whether this pattern extends to other nonverbal modalities by examining associations between loneliness and the recognition of vocal emotional expressions. Youth, ages 11-18 years (n = 122), were asked to identify the intended emotion in auditory portrayals of basic emotions (anger, disgust, fear, happiness, sadness) and social expressions (friendliness, meanness). Controlling for social anxiety, age, and gender, links between loneliness and recognition accuracy were emotion-specific: loneliness was associated with poorer recognition of fear, but better recognition of friendliness. Lonely individuals' motivation to avoid threat may interfere with the recognition of fear, but their attunement to affiliative cues may promote the identification of friendliness in affective prosody. Monitoring for social affiliation cues in others' voices might represent an adaptive function of the reconnection system in lonely youth, and be a worthy target for intervention.

Appreciating the 4 "Ts" of Loneliness When Providing Psychiatric Care for the Lonely Patient

Loneliness can be evaluated from a 4-concept viewpoint of territory, threat, trauma and trust (4 Ts). Territory refers to an area of ownership that is controlled on a daily basis and is fundamental to one's daily life. Lonely individuals often manage boundaries by gaining greater control over their physical environment by territorial behavior. They guard personal territory well as the only area where they can exert dominance and feel safe. Perceptions of social isolation or loneliness increase vigilance for threats, decrease trust, and heighten feelings of vulnerability. Clinical teams caring for the lonely must be especially attentive to a history of prior trauma. Clinicians who ask permission, who pay attention to nonverbal cues, distance, and speed as they enter the lonely person's space, and who respect boundaries may be more successful in gaining trust. Achieving trust diminishes the risk of physical harm, while allowing lonely persons the perceived control they need to permit health care interventions. Veterans are at higher risk for loneliness. Given their military training, they may be particularly attentive to boundaries, protecting the perimeter, watching for threats, and defending their space. In this article, we discuss the successful mental health treatment of a lonely male veteran in a Veterans Affairs Medical Center, by paying attention to the 4 Ts of loneliness. We used a 4-step approach of validation, mentalization, reality testing, and socialization to decrease the sense of threat as we sought acceptance to the patient's territory, followed by building trust and working on past trauma.

Study protocol for 'The Project About Loneliness and Social networks (PALS)': a pragmatic, randomised trial comparing a facilitated social network intervention (Genie) with a wait-list control for lonely and socially isolated people

INTRODUCTION

Loneliness and social isolation have been identified as significant public health concerns, but improving relationships and increasing social participation may improve health outcomes and quality of life. The aim of the Project About Loneliness and Social networks (PALS) study is to assess the effectiveness and cost-effectiveness of a guided social network intervention within a community setting among individuals experiencing loneliness and isolation and to understand implementation of Generating Engagement in Network Involvement (Genie) in the context of different organisations.

METHODS AND ANALYSIS

The PALS trial will be a pragmatic, randomised controlled trial comparing participants receiving the Genie intervention to a wait-list control group. Eligible participants will be recruited from organisations working within a community setting: any adult identified as socially isolated or at-risk of loneliness and living in the community will be eligible. Genie will be delivered by trained facilitators recruited from community organisations. The primary outcome will be the difference in the SF-12 Mental Health composite scale score at 6-month follow-up between the intervention and control group using a mixed effects model (accounting for clustering within facilitators and organisation). Secondary outcomes will be loneliness, social isolation, well-being, physical health and engagement with new activities. The economic evaluation will use a cost-utility approach, and adopt a public sector perspective to include health-related resource use and costs incurred by other public services. Exploratory analysis will use a societal perspective, and explore broader measures of benefit (capability well-being). A qualitative process evaluation will explore organisational and environmental arrangements, as well as stakeholder and participant experiences of the study to understand the factors likely to influence future sustainability, implementation and scalability of using a social network intervention within this context.

ETHICS AND DISSEMINATION

This study has received NHS ethical approval (REC reference: 18/SC/0245). The findings from PALS will be disseminated widely through peer-reviewed publications, conferences and workshops in collaboration with our community partners.

TRIAL REGISTRATION NUMBER

ISRCTN19193075.

When friends behave badly: Loneliness and children's expectations of friends and responses to transgressions

Previous research has shown that friendships buffer against loneliness, but some children remain lonely despite having best friends. The current study examines relationships between loneliness and Friendship Functions, expectations, and responses to friendship transgressions in children with best friends (8-11 years; N = 177). Children completed questionnaires that measured loneliness, fulfilment of Friendship Functions, Friendship Expectations, and the Transgressions of Friendship Expectations Questionnaire (MacEvoy & Asher, Child Development, 83, 2012, 104). Findings in the current study showed that loneliness was associated with lower Friendship Expectations and higher reliable alliance in existing best friendships. Loneliness was also associated with lower sadness and lower perceptions of feeling controlled and devalued by their friend when they transgress. Thus, children with best friends experiencing high loneliness may be more permissiveness of friendship transgressions and may need support to ensure that they do not allow their friends to be unfair to them. Statement of contribution What is already known on the subject? Friendships buffer children from loneliness, but some remain lonely despite having friends. Loneliness has been associated with poor-quality friendships. But there is no examination of why children remain lonely when they have friends. What the present study adds? Lonely children overemphasize friendship qualities that help to maintain the relationship. Loneliness was linked to expectations of being friends with less popular and well-liked peers. Lonely children placed less blame on their friends when they violated Friendship Expectations.

Loneliness predicts a preference for larger interpersonal distance within intimate space

Loneliness is thought to serve as an adaptive signal indicating the need to repair or replace salutary social connections. Accordingly, loneliness may influence preferences for interpersonal distance. If loneliness simply motivates a desire to socially reconnect, then loneliness may be associated with a preference for smaller interpersonal distances. According to the evolutionary model of loneliness, however, loneliness also signals an inadequacy of mutual aid and protection, augmenting self-preservation motives. If loneliness both increases the motivation to reconnect and increases the motivation for self-protection, then the resulting approach-avoidance conflict should produce a preference for larger interpersonal distance, at least within intimate (i.e., proximal) space. Here, we report two survey-based studies of participants’ preferences for interpersonal distance to distinguish between these competing hypotheses. In Study 1 (N = 175), loneliness predicted preferences for larger interpersonal distance within intimate space net gender, objective social isolation, anxiety, depressive symptomatology, and marital status. In Study 2 (N = 405), we replicated these results, and mediation analyses indicated that measures of social closeness could not adequately explain our findings. These studies provide compelling evidence that loneliness predicts preferences for larger interpersonal distance within intimate space, consistent with predictions from the evolutionary model of loneliness.

Interparental hostility and children's externalizing symptoms: Attention to anger as a mediator

This study examined children's attention biases to negative emotional stimuli as mediators of associations between interparental hostility and children's externalizing symptoms. Participants included 243 children (Mage = 4.60 years) and their parents and teachers across three annual measurement occasions. Cross-lagged latent change analyses revealed that the association between interparental hostility and children's externalizing symptoms was mediated by children's attention to angry, but not sad or fearful, adult faces. Consistent with defensive exclusion models, the multimethod, multi-informant assessment of interparental hostility at Wave 1 specifically predicted decreases in children's attention to angry faces from Waves 1 to 2 in a visual search task. Declines in children's attention to anger, in turn, predicted increases in teacher reports of their externalizing problems across the three waves. Follow-up analyses further indicated that children's decreasing levels of emotional security in the interparental relationship were associated with the decreases in children's attention to angry stimuli. Results are discussed in relation to how they inform and advance information processing and social threat models in developmental psychopathology. (PsycINFO Database Record

Examining the visual processing patterns of lonely adults

Prior research has shown that loneliness is associated with hypervigilance to social threats, with eye-tracking research showing lonely people display a specific attentional bias when viewing social rejection and social exclusion video footage (Bangee, Harris, Bridges, Rotenberg & Qualter, 2014; Qualter, Rotenberg, Barrett et al., 2013). The current study uses eye-tracker methodology to examine whether that attentional bias extends to negative emotional faces and negative social non-rejecting stimuli, or whether it could be explained only as a specific bias to social rejection/exclusion. It is important to establish whether loneliness relates to a specific or general attention bias because it may explain the maintenance of loneliness. Participants (N = 43, F = 35, Mage = 20 years and 2 months, SD = 3 months) took part in three tasks, where they viewed different social information: Task 1 - slides displaying four faces each with different emotions (anger, afraid, happy and neutral), Task 2 - slides displaying sixteen faces with varying ratios expressing happiness and anger, and Task 3 - slides displaying four visual scenes (socially rejecting, physically threatening, socially positive, neutral). For all three tasks, eye movements were recorded in real time with an eye-tracker. Results showed no association between loneliness and viewing patterns of facial expressions, but an association between loneliness and hypervigilant viewing of social rejecting stimuli. The findings indicate that lonely adults do not have a generalised hypervigilance to social threat, but have, instead, a specific attentional bias to rejection information in social contexts. Implications of the findings for interventions are discussed.

Loneliness in psychosis: a systematic review

PURPOSE

The aim of the review is to understand the relationships between loneliness and related psychological and social factors in individuals with psychosis. Loneliness is poorly understood in people with psychosis. Given the myriad of social challenges facing individuals with psychosis, these findings can inform psychosocial interventions that specifically target loneliness in this vulnerable group.

METHODS

We adhered to the PRISMA guidelines and systematically reviewed empirical studies that measured loneliness either as a main outcome or as an associated variable in individuals with psychosis.

RESULTS

A total of ten studies examining loneliness in people diagnosed with a psychotic disorder were examined. Heterogeneity in the assessment of loneliness was found, and there were contradictory findings on the relationship between loneliness and psychotic symptomatology. In individuals with psychosis, loneliness may be influenced by psychological and social factors such as increased depression, psychosis, and anxiety, poor social support, poor quality of life, more severe internalised stigma and perceived discrimination, and low self-esteem.

CONCLUSIONS

The relationship between loneliness and psychosis remains poorly understood due to a lack of rigorous studies. Although having strong social relationships is crucial to facilitate recovery from serious mental illness, psychosocial interventions that specifically target loneliness in individuals with psychosis are lacking and sorely needed. Interventions targeting loneliness in those with psychosis will also need to account for additional barriers associated with psychosis (e.g., social skill deficits, impoverished social networks, and negative symptoms).

The Role of Social and Interpersonal Factors in Placebo Analgesia

Placebo effects are beneficial clinical outcomes that emerge as a result of nonspecific contextual factors, transmitted primarily by the treating physician and the social, physical, and behavioral cues he or she displays. The patient-provider therapeutic alliance is critical for determining placebo effects and health outcomes. In this chapter, we review the recent literature, suggesting that provider social characteristics modulate placebo and clinical outcomes. We highlight the importance of studying not only the provider but also the patient's perception of the provider, which is subject to the influence of the patient's psychosocial orientation, such as their psychosocial motivations and perceptions of their interpersonal relationships broadly. We argue that psychosocial orientation can exaggerate the influence of the patient-provider relationship on placebo effects and can directly affect the likelihood of placebo effects emerging by modulating the underlying biological systems that support them. Here, we examine patient loneliness, or perceived social isolation, as a case example for understanding how patients' psychosocial orientation may affect placebo effects across diseases. We propose psychosocial mechanisms by which loneliness might modulate placebo effects across medical outcomes, and focus in particular on how loneliness might specifically alter behaviorally conditioned immune responses and placebo analgesia. Future studies should directly measure social factors to formally test the effects of social isolation on placebo effects and better elucidate the role of psychosocial and interpersonal factors in placebo effects and clinical outcomes.

I don't need your attention: ostracism can narrow the cone of gaze

Previous research has shown that ostracized participants seek inclusive cues, such as gaze directed at them, when trying to reaffiliate. However, instead of seeking reinclusion, ostracized individuals may sometimes withdraw from interactions if not offered an opportunity for reaffiliation. In the current study, after an ostracism manipulation with no reaffiliation opportunity, participants judged whether faces portraying direct gaze or slightly averted gaze (2°-8° to the left and to the right) were looking at them or not. Compared to an inclusion group and a non-social control group, ostracized participants accepted a smaller range of gaze directions as being directed at them, i.e., they had a narrower "cone of gaze". The width of the gaze cone was equally wide in the inclusion and control groups. We propose that, without an opportunity for reaffiliation, ostracized participants may start to view other people as particularly unapproachable, possibly indicative of a motivational tendency to disengage from interactions.

The impact of social exclusion on anticipatory attentional processing

The importance of understanding how we anticipate and prepare for social rejection is underscored by the mental and physical toll of continual social vigilance. In this study, we investigate the impact of social rejection on anticipatory attentional processes using the well-known Cyberball task, a paradigm in which participants engage in a game of catch with virtual avatars who after an initial period of fair-play (inclusion condition) then exclude the participant from the game (exclusion condition). The degree of anticipatory attention allocated by subjects towards the avatars was assessed by measuring P3b responses towards the avatars' preparatory actions (i.e. the phase preceding their exclusionary actions) using high density EEG. The results of the study show that relative to the inclusion, participants exhibit elevated levels of anticipatory attentional allocation towards the avatars during the exclusion block. This shift was however significantly moderated by participants' self-reported cognitive regulation tendencies. Participants with higher levels of self-reported cognitive reappraisal tendencies showed larger anticipatory P3b increases from the inclusion to exclusion block relative to participants with reduced levels of reappraisal tendencies. These results highlight the impact of social exclusion on anticipatory neural processing and the moderating role of cognitive reappraisal on these effects.

Biobehavioral assessment of the anxiety disorders: Current progress and future directions

It is difficult to accurately assess and differentially diagnose the anxiety disorders. The current system of assessment relies heavily on the subjective measures of client self-report, clinical observation, and clinical judgment. Fortunately, recent technological advances may enable practitioners to utilize objective, biobehavioral measures of assessment in a clinical setting. The current body of literature on two of these biobehavioral tools (eye-tracking and electrocardiogram devices) is promising, but more validation and standardization research is needed to maximize the utility of these devices. Eye-tracking devices are uniquely capable of providing data that can be used to differentially diagnose anxiety disorders from both other commonly comorbid and misdiagnosed disorders. Both eye-tracking and electrocardiogram devices are able to provide change-sensitive assessment information. This objective, real-time feedback can assist clinicians and researchers in assessing treatment efficacy and symptom fluctuation. Recently developed wearable and highly portable electrocardiogram devices, like the wearable fitness and behavior tracking devices used by many consumers, may be particularly suited for providing this feedback to clinicians. Utilizing these biobehavioral devices would supply an objective, dimensional component to the current categorical diagnostic assessment system. We posit that if adequate funding and attention are directed at this area of research, it could revolutionize diagnostic and on-going assessment practices and, in doing so, bring the field of diagnosis out of the 20th century.

The relation between anorexic symptoms in women and their reports of trustworthiness in interactions with close persons

The study examined the relation between women's anorexic symptoms and their reports of trustworthiness in interactions with close persons. Ninety-eight females (mean age=24years-10months) completed the anorexic symptom subscale of the SEDS and reported (ascribed) the extent to which they showed reliability, emotional, and honesty trustworthiness behaviors in interactions with their mother, father, and close friend. Negative linear relations were found between anorexic symptoms and ascribed: (a) trustworthiness with close friends; (b) reliability trustworthiness; and (c) at a trend level, honesty trustworthiness. These were qualified by curvilinear relations and by elevated anorexic vs normative group comparisons. It was found that women with elevated anorexic symptoms ascribed lower trustworthiness than did women with the normal range of anorexic symptoms. The findings were interpreted as supporting the conclusion that women with elevated levels of anorexic symptoms are inclined to believe that they are deceptive in their interactions with close persons, primarily friends.

Social exclusion impairs distractor suppression but not target enhancement in selective attention

Social exclusion has been thought to weaken one's ability to exert inhibitory control. Existing studies have primarily focused on the relationship between exclusion and behavioral inhibition, and have reported that exclusion impairs behavioral inhibition. However, whether exclusion also affects selective attention, another important aspect of inhibitory control, remains unknown. Therefore, the current study aimed to explore whether social exclusion impairs selective attention, and to specifically examine its effect on two hypothesized mechanisms of selective attention: target enhancement and distractor suppression. The Cyberball game was used to manipulate social exclusion. Participants then performed a visual search task while event-related potentials were recorded. In the visual search task, target and salient distractor were either both presented laterally or one was presented on the vertical midline and the other laterally. Results showed that social exclusion differentially affected target and distractor processing. While exclusion impaired distractor suppression, reflected as smaller distractor-positivity (Pd) amplitudes for the exclusion group compared to the inclusion group, it did not affect target enhancement, reflected as similar target-negativity (Nt) amplitudes for both the exclusion and inclusion groups. Together, these results extend our understanding of the relationship between exclusion and inhibitory control, and suggest that social exclusion affects selective attention in a more complex manner than previously thought.