Prolonged Grief Symptoms Predict Social and Emotional Loneliness and Depression Symptoms

A minority of bereaved individuals develops severe, persistent, and disabling grief, termed "prolonged grief." The International Classification of Diseases, eleventh edition (ICD-11) and the Diagnostic and Statistical Manual of Mental Disorders, fifth edition, text revision (DSM-5-TR) include such grief reactions as prolonged grief disorder (PGD). Loneliness is often experienced by bereaved persons and can have severe health consequences. Preliminary research suggests that loneliness may perpetuate grief, but prolonged grief may also aggravate loneliness. Since existing empirical research provides limited information on temporal relationships between both constructs, we aimed to fill this gap in knowledge. Bereaved adults (88% female, mean age 54 years) filled in questionnaires assessing general, social, and emotional loneliness and prolonged grief and depression symptoms across two time points, 6 months apart. Cross-lagged panel model analyses showed that prolonged grief symptoms predicted more severe general, social, and emotional loneliness, as well as more depression symptoms. Loneliness did not predict prolonged grief symptoms and depression symptoms. Depression symptoms did not predict prolonged grief symptoms and loneliness. Additionally, latent change score analyses demonstrated that within person changes in prolonged grief symptoms and loneliness were related. Findings are inconsistent with the notion that loneliness causes prolonged grief and depression. Possibly, severe grief could lead to stigmatization, reduced social support, and feeling socially disconnected, perpetuating loneliness and depression symptoms.

Loneliness and disability: A systematic review of loneliness conceptualization and intervention strategies

Introduction

People with disabilities experience loneliness to a greater extent than people without disabilities. To better understand this problem, we have conducted a systematic review of studies that involved disability and loneliness. The aims are to research what loneliness is and to conceptualize and define it in the context of disability, and the intervention strategies that have been developed.

Methods

The research protocol is based on the PRISMA guidelines. Two hundred and eighty-one papers were screened and 75 reports were assessed for eligibility.

Results

We have not found whether loneliness in disability is a single construct or a collection of various subtypes. We have found that there are protective factors against loneliness in disabled people, such as having a job or living in an environment without physical barriers.

Discussion

In terms of the interventions for people with disabilities, the same strategies have been adopted as for the non-disabled: social skills training, enhanced social support, opportunities for interactions, and cognitive training.

Lonesome no more? A two-year follow-up of internet-administered cognitive behavioral therapy for loneliness

The current study sought to investigate the long-term effects of an internet-administered programme based on CBT principles for which the initial efficacy has been reported in Käll, Jägholm, et al. (In press). Seventy-three participants who were recruited on the basis of experiencing frequent and prolonged loneliness were contacted to complete questionnaires measuring loneliness, quality of life, and symptoms of psychopathology two years after the conclusion of the initial treatment period. Additional items regarding use of the treatment techniques and strategies contained in the programme during the follow-up period was included. In total, 44 participants provided data for the loneliness measure at follow-up. The outcome data were analyzed with a piecewise mixed effects model to provide estimates of change for the continuous measures. Linear multiple regression analysis was used to investigate the relationship between use of treatment techniques and reliable change on the primary outcome measure. The results showed decreases in loneliness during the follow-up period for the sample as a whole. Additionally, an increase in quality of life and a decrease in social anxiety were noted, but no significant changes of depressive symptoms or generalized anxiety. Effect sizes for the observed changes from baseline to follow-up were in the moderate to large range for all measures. Reported use of the treatment techniques was not significantly related to reliable change in loneliness after the two-year period. In conclusion, the results of the study support the utility of internet-based CBT targeting loneliness and indicate that the benefits from the intervention can be enduring.

Telepsychology: A Primer for Counseling Psychologists

Telepsychology is having a profound influence on professional practice. Currently, however, many psychologists lack the requisite knowledge and skill to provide ethical and competent telepractice services. Moreover, the field has lagged in developing the educational and supervised experiences required to achieve competency. Yet, there is great opportunity as well. The purpose of this article is to identify the natural integration of the pillars of counseling psychology with the major domains of telepractice and to link telepractice to the values and mission of counseling psychologists. We present aspects of telepsychology including ethical and legal factors, asynchronous and synchronous practice, and group-focused practice along with technologies and the rules that govern them. We also describe interjurisdictional practice, and introduce a proposed curriculum based upon the benchmark competencies for infusion of telepsychology into training across the professional lifespan.

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.

Online Counseling

This article reviews the online-counseling literature with an emphasis on current applications and considerations for future research. It focuses on primary themes of counseling psychology including the history of process-outcome research and multiculturalism. It explores current gaps in the literature from a counseling psychology framework, including the field’s focus on normal and developmental challenges and tasks, client strength and resilience, education and career development, prevention and wellness, and multiculturalism. In general, current evidence indicates that online counseling may be a viable service option for some clients, especially those who are typically isolated; however, questions remain regarding the effectiveness and appropriateness of online counseling.

The Practical Aspects of Online Counseling

This article addresses the practical aspects of online counseling, including ethics, training, supervision, technology, and competency issues. The authors discuss online counseling’s strengths and limitations and present guidelines for what types of clients and counseling psychologists may be appropriate for online counseling. To illustrate the components and skills associated with online counseling, the authors present and discuss an example of a synchronous-chat online session.

The Development of LISTEN: A Novel Intervention for Loneliness

PURPOSE

The purpose of this paper is to present the development of LISTEN (Loneliness Intervention using Story Theory to Enhance Nursing-sensitive outcomes), a new intervention for loneliness.

METHODS

LISTEN was developed using the Medical Research Council (MRC) framework for intervention development. Extensive literature review revealed that belonging, relating, placing in community, challenges, and meanings of coping were concepts significant to loneliness. Past interventions were limited but it was determined from a recent meta-analysis that enhanced effectiveness might result from interventions that targeted the poorly adapted cognitive processes of loneliness. These processes include social undesirability, stigma, and negative thoughts about self in relation to others. LISTEN is designed to be delivered in a determined logical sequence of 5 sessions, each focusing on the concepts relevant to loneliness as derived from the literature. For each session, intervention delivery is guided by the concepts from story theory (including intentional dialogue, nurse as listener, examination of self in relation to others and community, synthesizing concerns and patterns, and identifying messages) and the principles of cognitive restructuring (self-assessment of maladaptive cognitions, emotions, and behaviors, identifying challenges of changing, reconceptualization of self, new skill acquisition through group interaction, and identifying patterns of meaning in loneliness).

RESULTS

LISTEN is developed and the first randomized trial is complete with a sample of 27 lonely, chronically ill, community dwelling, and older adults. LISTEN was evaluated as feasible to deliver by the study team and acceptable for significantly diminishing loneliness by participants of the LISTEN groups who were compared to attention control groups (p < 0.5).

CONCLUSIONS

LISTEN has the potential to enhance health by diminishing loneliness which could result in improving the long-term negative known sequelae of loneliness. Future longitudinal randomized trials are needed in varied populations to assess long term health and healthcare system benefit of using LISTEN to treat loneliness.

A systematic review of internet-based self-help therapeutic interventions to improve distress and disease-control among adults with chronic health conditions

The evidence base of internet-based self-help interventions has been rapidly growing for mental health conditions over the past decade. However, to date a systematic review of the application of this technology to chronic health conditions has not been reported. The objective of the present review was to therefore critically appraise the research on the efficacy of internet self-help interventions for distress and disease outcomes in adults with physical health complaints. Electronic searches were conducted in Embase, CINAHL, MEDLINE and PsychINFO, and reference lists were examined. Twenty four studies met inclusion criteria, covering 8 health conditions. Across health conditions, consistent evidence was obtained that online therapeutic interventions were efficacious in improving disease-symptoms and control, with the exception of diabetes. Mixed evidence was obtained for distress outcomes: 3 health conditions demonstrated consistent benefit (irritable bowel syndrome, tinnitus, and one heterogeneous chronic illness population); one condition obtained moderate support (chronic pain); while results were not promising for diabetes. The limited research conducted among epilepsy, cancer, and chronic fatigue precluded conclusions from being drawn. Few studies met all methodological quality criteria. This review demonstrates that internet-based self-help interventions hold guarded promise in the amelioration of distress and disease-control, and further research implications are discussed.

Healing pathways: a program for women with physical disabilities and depression

Objective. The objective of this study was to test the efficacy of the Healing Pathways (HP) program in reducing clinically significantly depressive symptoms in women with physical disabilities (WPD). Healing Pathways is a peer-implemented group mental health treatment program targeting WPD who have clinically significant cooccurring depressive symptoms. Participants. Eighty women were randomized in this trial. Design. This study used a community-based participatory intervention research design. Using community-based recruiting methods, participants were recruited from Centers for Independent Living, local disability service organizations, via Craig's list as well as other community locations such as grocery stores and bus stops. Women participated in the HP program for 14 weeks. Results. The primary outcome variable for this study was reduction in depressive symptoms as measured by the Center for Epidemiologic Depression Scale (CES-D). We found that there was a significant interaction effect of treatment by time on depression scores, F(3,210) = 9.51, P < 0.0001, partial η (2) = 0.101. Investigation of the predicted mean profile over time in the intervention group demonstrated that depression scores decreased greatly from baseline to the first posttest and remained stable in the two followups, whereas there was a little change in the mean profile over time in the control group. Conclusion. The HP program has demonstrated initial efficacy in reducing depressive symptoms in women with physical disabilities.

Factors influencing acceptance of disability in individuals with spinal cord injury in Neiva, Colombia, South America

PURPOSE

The aim of the present study was to determine the level of acceptance of disability as measured by the Acceptance of Disability Scale (ADS) within a sample of individuals with spinal cord injury (SCI) from Neiva, Colombia and to examine the influence of sociodemographic variables, injury characteristics, and level of depression on ADS score.

METHODS

The ADS was administered to 40 adults with SCI from Nieva, Colombia who were recruited from an organization that connects individuals with disabilities to resources. Most (92.5%) participants were men, with a mean age of 34.75 years and approximately 12 years since injury. Fifty-five percent of subjects were diagnosed with paraplegia and the remainder with tetraplegia. Descriptive, linear model and multiple regression analyses were used to describe the relationship between the independent and dependent variables.

RESULTS

The mean total ADS score of this sample was 171.5, indicating overall low disability acceptance. After controlling for level of depression and time since injury, gender was significantly related to ADS score such that women reported higher acceptance of disability. After controlling for gender and time since injury, level of depression was significantly related to ADS score.

CONCLUSION

Acceptance of disability is a serious problem in this group of SCI survivors in Neiva, Colombia, especially among women and individuals with higher levels of depression. Because acceptance of disability is likely a problem for many individuals living with disability in the developing world, future researchers should investigate what interventions (e.g. counseling, pharmacological intervention, social service programs) can be implemented to improve acceptance of disability in this population.

A meta-analysis of interventions to reduce loneliness

Social and demographic trends are placing an increasing number of adults at risk for loneliness, an established risk factor for physical and mental illness. The growing costs of loneliness have led to a number of loneliness reduction interventions. Qualitative reviews have identified four primary intervention strategies: (a) improving social skills, (b) enhancing social support, (c) increasing opportunities for social contact, and (d) addressing maladaptive social cognition. An integrative meta-analysis of loneliness reduction interventions was conducted to quantify the effects of each strategy and to examine the potential role of moderator variables. Results revealed that single-group pre-post and nonrandomized comparison studies yielded larger mean effect sizes relative to randomized comparison studies. Among studies that used the latter design, the most successful interventions addressed maladaptive social cognition. This is consistent with current theories regarding loneliness and its etiology. Theoretical and methodological issues associated with designing new loneliness reduction interventions are discussed.

Facilitating online support groups for cancer patients: the learning experience of psycho-oncology clinicians

OBJECTIVE

Counsellor familiarity and engagement with technology-mediated communication represents an important factor in the ability to implement support programs to cancer patients. This study describes the experiences of a cohort of expert psycho-oncology counsellors who learned to facilitate online support groups (OSGs) and identifies the important elements of their learning experience that led to their engagement. PROCEDURE AND METHOD: Six psycho-oncology counsellors were trained to facilitate OSGs and later facilitated OSGs in their own practice context. They subsequently reflected on and discussed their experiences with OSGs over time: in a panel discussion within 6 months of training, and in two focus groups. A participatory method was used to describe and interpret key elements of the learning process.

RESULTS AND DISCUSSION

Three themes of the counsellors' learning experience emerged: immersion in experiential learning, perceptions of clinical value and benefit, and overcoming challenges with adapted skills. Counsellors described components of their experiential learning: co-facilitating online cancer support groups with an expert, debriefing online, and participating in an online peer supervision group, as critical to their becoming engaged. Despite initial challenges, the counsellors learned new skills, and adapted known clinical skills, to the text-only environment.

CONCLUSION

With appropriate training and practice over time, counsellors familiar with delivering face-to-face support groups to cancer patients became skilled and engaged in leading OSG's for cancer patients. Learning to facilitate OSGs shifted practice by significantly expanding the scope of services they were able to provide their patients and has implications for expanding access to support services.

Suicide prevention by online support groups: an action theory-based model of emotional first aid

In the last two decades, online support groups have become a valuable source of help for individuals in suicidal crisis. Their attractiveness is attributed to features that enhance help-seeking and self-disclosure such as availability, anonymity, and use of written communication. However, online support groups also suffer from limitations and potential risks as agents of suicide prevention. The Israeli Association for Emotional First Aid (ERAN) has developed a practical model that seeks to maximize the benefits and minimize the risks of online suicide prevention. The model applies the Action Theory concepts whereby individuals shape their own environment. The present paper presents the model, which is based on an online support group combined with personal chat and a telephonic help line. The online support group is moderated by paraprofessionals who function as both process regulators and support providers. The principles and practice of the model are described, the theoretical rationale is presented, and directions for future research are suggested.

Internet-administered cognitive behavior therapy for health problems: a systematic review

Cognitive-behavioral interventions are the most extensively researched form of psychological treatment and are increasingly offered through the Internet. Internet-based interventions may save therapist time, reduce waiting-lists, cut traveling time, and reach populations with health problems who can not easily access other more traditional forms of treatments. We conducted a systematic review of twelve randomized controlled or comparative trials. Studies were identified through systematic searches in major bibliographical databases. Three studies focused on patients suffering from pain, three on headache, and six on other health problems. The effects found for Internet interventions targeting pain were comparable to the effects found for face-to-face treatments, and the same was true for interventions aimed at headache. The other interventions also showed some effects, although effects differed across target conditions. Internet-delivered cognitive-behavioral interventions are a promising addition and complement to existing treatments. The Internet will most likely assume a major role in the future delivery of cognitive-behavioral interventions to patients with health problems.