I think, therefore I am: The contributions of threat interpretations in generating and managing youth loneliness

Lead Research Organisation: Queen Mary University of London
Department Name: Wolfson Institute of Population Health

Abstract

Loneliness is a negative emotion that occurs when one perceives his/her social relationships and networks to fall short of his/her social needs. Because loneliness is thought to have evolved as a powerful motivator to connect with others and solicit their support, it may arise during periods of life that are characterised by social turbulence. One such period is youth, where there are major changes in the external social environment such as the amount of time spent with peers and in the emergence of new peer hierarchies and cliques - but also in internal factors, such as the need for peer approval and the aversiveness of peer rejection. Accordingly, as these social changes may bring about instability in social relationships, loneliness can arise to facilitate re-connection with others, and therefore be considered a normal part of growing up for many young people. However for some young people loneliness can be intense, upsetting and persistent, predicting poorer mental and physical health. Delivering interventions to manage loneliness in youth is therefore crucial, made more so as this may reflect a period of plasticity for learning more effective ways of regulating emotions. As some negative thinking styles such as a tendency to endorse threatening over benign expectations and explanations of ambiguous social situations is associated with youth loneliness, measuring and targeting these earlier in life may be a powerful 'vaccine' for reducing the risk of loneliness.

However before any early interventions programs are planned around the targeting of threat interpretations, there are some key questions that need to addressed. First there is only one study showing that threat interpretations precede and predict risk for loneliness rather than reflect consequences. Disentangling these roles may inform whether it is useful to modify threat interpretations in order to alter loneliness. In addition it is not clear whether threat interpretations affect loneliness by influencing social withdrawal behaviour, as theories would suggest. Second all studies investigating threat interpretations in relation to loneliness have used questionnaires about hypothetical social scenarios rather than directly assess thoughts to real-life events. Establishing the relationship between threat interpretations and loneliness in everyday life is important, again for informing whether it is helpful to modify these thinking styles to alter lonely feelings. Finally, although methods have been developed for challenging threat interpretations related to other social behavioural problems like social anxiety, it is not clear if these methods are as relevant to and well tolerated by young people who are lonely.

The goals of this research are to address these questions. Three studies will be performed. First a longitudinal study of around 1000 young people will be conducted to examine the cross-time relationships between threat interpretations, social withdrawal and loneliness with a nested interview study supplementing quantitative data. Second an ecological momentary assessment study that assesses threat interpretations to real social situations and loneliness at several times in the day for a week will be conducted to investigate these relationships in daily life. Finally, together with some young people we will develop some materials for a training program that aims to modify threat interpretations. These will then be presented to another group of young people to assess for relevance, acceptability and how helpful and feasible such an intervention is. Potential effectiveness at reducing loneliness and threat interpretations, and changing social behaviour will be considered.

These studies will generate data to support further investigation into cognitive interventions for youth
loneliness and contribute to the national dialogue on loneliness between professionals/practitioners working with youth, policymakers, the public and young people themselves.

Planned Impact

Loneliness has become a major public health and social issue in the UK and a national strategic priority. Because the topic of loneliness - its causes, correlates and management - has attracted the attention of research scientists, clinical, health and educational professionals/practitioners, policymakers, nongovernmental organisations, the wider public and young people themselves, there are multiple beneficiaries of this research.

First and foremost, young people who suffer from loneliness will benefit from this research. A brief survey of 15 young people highlighted the widespread impact of loneliness on a) well-being "It's made me very depressed at some points in my life", b) on self-concept "Loneliness has definitely taken a huge toll on my self confidence because I feel like people just don't really want to be around me or that I just don't know how to properly socialise/make friends", c) on difficulties with social behaviour "Means I am more likely to isolate myself", and d) on work "i had to repeat a year of university due to being severely depressed of which loneliness was a key factor in that." Although our research on loneliness interventions for young people is at an early stage of development, our studies on the mechanisms of loneliness and more generally our proposed dissemination efforts on these findings through schools and universities may help reduce stigma about feeling lonely, and bring further recognition and credibility to the loneliness experiences of many young people. Relatedly, our efforts to engage the wider public about loneliness and to contribute to the national dialogue on this issue through a series of public events and social media will also help parents, families and friends to look out for these negative, distressing feelings in young people, before they become entrenched in a vicious cycle of negative thinking, social withdrawal and loneliness.

Second, other research scientists will benefit from our findings by increasing the profile of loneliness research, highlighting new research directions to pursue in particular the need for a more evidence-based approach to identifying new therapeutics. We plan to submit manuscripts of our studies to developmental science and applied journals for greatest impact. We also plan to guest edit a special issue on youth loneliness in a high impact journal, and to present our findings at international conferences in order to engage other academic researchers in this area. Beyond academic researchers, other beneficiaries include clinical, educational and health professionals/practitioners working with young people, who have an interest in tackling loneliness. Our findings will raise awareness of the urgent need to develop cost-effective evidence-based interventions that can be easily implemented by these individuals.

Finally various external stakeholders including policymakers, government ministers for loneliness strategy and non-governmental organisations will benefit from our findings. Many non-governmental organisations have been campaigning for funding resources to be dedicated to reducing loneliness in society. Through the dissemination of our findings, we hope to raise awareness and lend support to their campaigns by suggesting concrete directions in the development of novel evidence-based interventions. We will write and publish a national report on youth loneliness with interested charity partners and launch this at a high-profile seminar co-organised with interested stakeholders such as the Children's Society, who have already expressed interest. The aim of the report and seminar will be to bring academics, practitioners/professionals working with children, policymakers, and other non-governmental organisations in dialogue and to structure discussions around concrete strategies for reducing loneliness in society. Through such interactions we may also invite key stakeholders to co-produce grant applications to relevant funding bodies.
 
Description There were 3 studies proposed as part of this grant. One of the main studies (and another additional study) were completed as part of the grant whilst it was being held at King's College London, prior to the PI's move to Queen Mary. At Queen Mary, we completed the second main study. The third main study is currently being run with a no cost extension at Queen Mary. With further funding from the Rosetrees Trust, we were able to complete an additional two studies on youth loneliness during the COVID-19 pandemic (these are currently under review).

In brief, Study 2 aimed to co-create training stimuli that reflected the lived experiences of young people, and to use these stimuli in a single-session of Cognitive Bias Modification (CBM) training with guided mental imagery instruction to enhance effects. We carried out 15 individual interviews with young people aged 18-24 from diverse backgrounds who had experienced loneliness, asking them to tell us about situations that precipitated feelings of social disconnect. In their reflections of each situation, we asked them whether there were alternative ways of interpreting the situation. Using these personal descriptions to develop the context of training scenarios, and the alternative explanation of the situation that they generated, we were able to develop 92 scenarios. These scenarios were then rated by a different sample of 18-24 year olds (n=51) for relevance. Using these ratings, we selected items for use in the CBM training condition. Fifty young people with high loneliness scores were randomly allocated to receive the CBM or a comparison condition. This pilot study showed that not only were the training scenarios ecologically-valid, social threat interpretations were reduced in the CBM group but not the control group, while benign/positive interpretations increased in the CBM-I group but not the control group. Although the study was not designed to statistically assess loneliness reductions, we did note that in the CBM-I group, loneliness scores decreased from pre to post training, whereas scores in the control group slightly increased. This study is currently under peer review and has already received one round of reviews.
Exploitation Route Data from the already completed studies will lay the groundwork for further funding applications to run a feasibility trial of Cognitive Bias Modification training; we have submitted one unsuccessful application to the Medical Research Council and are currently preparing another application.
Sectors Education,Healthcare

 
Description Capturing loneliness across youth: Co-production of a new developmentally sensitive scale
Amount £869,067 (GBP)
Funding ID MR/X002381/1 
Organisation United Kingdom Research and Innovation 
Sector Public
Country United Kingdom
Start 01/2023 
End 12/2025
 
Description Attention biases in anxiety: methodological innovations and clinical implications 
Organisation National Institutes of Health (NIH)
Country United States 
Sector Public 
PI Contribution Our team are currently convening a consortium of researchers working in the area of attention biases and anxiety; this will enable us to discuss the most effective assessment and intervention tools around attention biases in relation to anxiety problems in community and clinic samples, but also in samples who have experienced early-life adversity.
Collaborator Contribution We have initiated links with leading experts in this area to convene a 3-day closed expert meeting on the study of attention biases in anxiety. After three more meetings, this consortium has gone on to form the Association for Cognitive Bias Modification with paid membership and elected officers (president, treasurer, secretary etc). I am the elected Secretary of this Association.
Impact Our first meeting will be in September 2017. Our first open meeting is planned for February 2022. Our second annual meeting which will be in person is this May (2023) held at the National Institute of Mental Health (US). Loneliness data from this grant will be presented there.
Start Year 2017
 
Description Independent replication of interpretation bias measure 
Organisation Sheffield Hallam University
Country United Kingdom 
Sector Academic/University 
PI Contribution We have shared our research protocol for developing our interpretation bias measure with these researchers, who are now going to independently verify our findings using internal funding. Together we may then apply for further funding.
Collaborator Contribution They have providing internal funding and resources to pilot and independently replicate our findings.
Impact As yet there are no outputs but we anticipate a jointly authored paper.
Start Year 2022
 
Description Campaign to End Loneliness International Conference 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Third sector organisations
Results and Impact The Campaign to End Loneliness organised an international conference around loneliness following the COVID-19 pandemic. The purpose was to gather cross-sector colleagues (policy makers, researchers, practitioners, third-sector organisations) and lived experience researchers to debate current research findings and ways to translate these into practice. I was a Panellist in a session around life course perspectives on loneliness.
Year(s) Of Engagement Activity 2021
URL https://lonelinessbeyondcovid-19.w.tame.events