Mitigating loneliness in the integrative healthcare setting

By Julie Luzarraga

Situational loneliness is something we all experience at some point in our lives. It may be a move to a new city, the loss of a loved one, divorce, or even retirement. However, mental health therapists are seeing more chronic loneliness in patients. 

Loneliness is not defined by the amount of people a person interacts with. One can feel lonely in a crowd despite being surrounded by people. Loneliness is unique to each person’s perception of the difference between their desire for connection and the quality and quantity of social connections. We can think of chronic loneliness in the same way we think of chronic stress – the repeated experience of feeling lonely over time. In a 2009 study, Sharon Shiovitz-Ezra, PhD, and Liat Ayalon, PhD, defined chronic loneliness as “a more stable state that results from the inability of the individual to develop satisfying social relationships over the years.”   

In 2004, the General Social Survey found the number of people who felt they had no one they could discuss important matters with tripled from the time of the first survey in 1985. Over 60 percent of older adults report loneliness, according to a 2015 study in The American Journal of Geriatric Psychiatry.

Feeling lonely is uncomfortable and often correlated with depressive symptoms precipitating patients to seek counseling services. In the mental health space, chronic loneliness has become a major health risk.  

According to a 2007 study, loneliness is associated with increased inflammation and lower immune functioning. Nicole Valtorta, PhD and colleagues found poor social relationships were associated with a 29 percent increase risk of heart attacks and 32 percent increase risk of stroke.

At the 2017 Annual Convention of the American Psychological Association, Julianne Holt-Lunstad, PhD, a professor of psychology at Brigham Young University in Provo, Utah, presented data on the connection between loneliness and premature death and a large meta-analysis on the effects of social connection and health. Her meta-analysis found that people with social connections have a 50 percent lower risk of dying prematurely.

Practitioners in the integrative healthcare space often know that the opposite of loneliness, community and social connection, garners positive results in patients. The practice of integrative healthcare in which treatment is centered on a holistic understanding of the patient presents an opportunity for practitioners to identify and address loneliness in our patients.  

The Bravewell Collaborative article, “What is Integrative Medicine,” offers defining principles of integrative medicine including, “the care addresses the whole person, including body, mind, and spirit in the context of community.”

The practice of integrative medicine includes thoughtful consideration of the whole patient including how they relate or do not relate to a sense of community or social connection. Yet, traditional medical intervention often focuses on the individual. In the context of HIPAA and the traditional care model, providers don’t often think to encourage interaction or facilitate relationship building among their patients. As integrative practitioners, we are committed to shifting the traditional model of care—and we can take steps to help patients mitigate loneliness and improve their overall health.

Firstly, providers must pay attention to our own communities. Another defining principle of integrative medicine given by Bravewell is “practitioners of integrative medicine exemplify its principles and commit themselves to self-exploration and self-development.” Our desire to create a different approach in how we practice is grounded in how we take care of ourselves, including being aware of how we socially connect. How providers and staff interact with each other will parallel how we treat our patients.  

A parallel process happens when two or more systems reflect thinking, affect, and behavior. An example of an unhealthy parallel process is when employees and providers do not feel a mutual respect by one another and patients are not feeling heard or respected in their interactions with the employees and providers.

In a positive parallel process, when we feel connected through team building, shared respect, being part of professional organizations, and healthy working relationships, we are naturally more tuned in to our patients’ sense of community or lack thereof. Mental health professionals are trained to look for this parallel process in their clinical work with individuals and groups. In addition to asking team members about their experience in the work environment, a mental health provider who is part of the team may be able to give feedback on any parallel process dynamics in the group setting. The quality of our professional relationships and sense of connection will influence how our patients experience connection and community in their treatment.

In addition to taking a close look at our own social connections, we can create opportunities for relationship building to address loneliness in our patients. According to Revati Bhagchandani’s 2017 article in the International Journal of Social Science and Humanity, there are different types of loneliness, including:

• Interpersonal loneliness
• Social loneliness
• Cultural loneliness
• Psychological or existential loneliness

Mental health professionals are trained to work on social skills and cognitions that can reinforce perceived loneliness. Social and cultural loneliness can be addressed through groups or classes with people who share life experiences such as shared developmental stages of life, common physical conditions, or similar health goals. Classes and groups are not only educational, but offer a natural community. Yoga classes, mindfulness classes, support groups, and educational classes are all integrative approaches to healthcare that also bring people together.   

Integrative practitioners themselves can also engage with patients in group settings. An example is the Walk with a Doc program. David Sabgir, MD, a cardiologist, founded the initiative in 2005, looking for a different way to change behavior in his patient population. Sabgir invited his patients to simply go for a walk with him.  Over 100 people showed up and Walk with a Doc is now a grassroots effort spreading nationally. The program can provide support to practitioners looking to start a similar opportunity.

Shared medical appointments are also becoming more popular and give patients an opportunity to feel empowered and learn from each other. The Centering Healthcare Institute has developed an evidence-based model of group healthcare built on health assessment, interactive learning, and community building. In this model, patients are invited to become a more active part of their healthcare and connect with other group members. A typical session begins with patients recording their own vitals while music is playing in the background.  Healthy snacks are available for those waiting to be seen individually by the provider for a semi-private brief visit. Questions are directed to the group for sharing and encouragement. The emphasis is on learning from each other as much as from the professionals in the group. This type of environment not only encourages self-reliance, but builds connections within the group.

In the 2010 meta-analysis of interventions to reduce loneliness, the authors found that programs for improving social skills, building social support, increasing opportunities for social engagement, and learning social cognition skills were helpful in reducing perceived loneliness. Walking with a group trying to make positive change will increase opportunities for social engagement just as a yoga class or shared medical appointment.  For teaching social cognition skills, mental health therapists can be brought in as co-facilitators. Mental health therapists are trained to identify barriers to health communication in individuals and have group facilitation skills helpful in making a setting less didactic and more empowering for the participants. Patients and providers both can benefit from adding this expertise to group interventions in healthcare. 

Fostering connection and community building may improve patient experience, but more importantly, it’s good for our patients’ overall health. We have seen the psychological and physical health risks of loneliness.  Many of us know patients who have experienced losses contributing to loneliness or simply feel a more psychological loneliness. As integrative practitioners, we are obligated to address the rising experience of loneliness and its impact on health.  

References

• Bhagchandani, R. K.  (January 2017).  Effect of Loneliness on the Psychological Well-Being of College Students.  International Journal of Social Science and Humanity.  7:1.
• Bravewell Collaborative.  What Is Integrative Medicine.  Retrieved from http://www.bravewell.org/content/Downlaods/What_Is_IM_2011.pdf
• Centering Healthcare Institute.  https://www.centeringhealthcare.org/
• Cole, S.W., et al. (2007, September 13).  Social regulation of gene expression in human leukocytes.  Genome Biology.
• Hawkins, K, et al.  (March 2015).  The Impact of Loneliness on Quality-of-Life and Patient Satisfaction Among Sicker, Older Adults.  The American Journal of Geriatric Psychiatry.  23(3) S168-S169.
• General Social Survey.  http://gss.norc.org/
• Masi, C. M., et al.  (2010, August 17).  A Meta-Analysis of Interventions to Reduce Loneliness. Personality and Social Psychology Review.  15:219.
• Shiovitz-Ezra, S and Ayalon, L. (2009).  Situational versus chronic loneliness as risk factors for all-cause mortality.  International Psychogeriatrics.  00:0, 1–8.
• Walk with a Doc.  https://walkwithadoc.org/