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What is the neurological mechanism behind the feelings associated with loneliness?

What is the neurological mechanism behind the feelings associated with loneliness?

Loneliness can be debilitating, and the feelings associated with it can be overwhelming, including feeling 'cold inside', sad, hopeless and even helpless.

Many things can 'cause' loneliness', both real and perceived, but what I am interested in is not the causes, but the neurological mechanisms that cause the feelings associated with loneliness.


COVID-19 Loneliness

As the world slowly sheds the weight of COVID-19, there is an opportunity for psychiatrists to pause and consider the role they are about to play in the coming months and years. Never before has the entire modern world been subjected to such collective feelings of fear, uncertainty, anxiety, and sorrow—and loneliness.

Individuals around the world did their part to slow the spread of COVID-19 by staying home. Populations that were not used to being alone, like children and teenagers, were suddenly cut off from their social networks. Family members were often isolated from each other. Many individuals have died from COVID-19, often without family, with little comfort or human contact except hospital staff.

About 36% of Americans reported feeling “serious loneliness” in the wake of the pandemic, according to Loneliness in America, a recent report by Harvard University. 1 Of these respondents, 61% were aged 18 to 25 years, and 43% reported increases in loneliness since the pandemic began.

The effects of pandemic-related isolation have been felt in every corner of society. It may take the form of exacerbated symptoms in some patients or freshly developing signs of mental illness in others. Medically, loneliness has been linked to heart disease and stroke. 2 It is also linked to increased rates of depression, anxiety, substance abuse, domestic abuse, and suicide. 3

Psychiatry often relies on pharmaceuticals to treat mental illness this pandemic serves as a good reminder that the best cure for loneliness can be as simple as kindness and compassion.

Studying Loneliness

More than any other species, humans are dependent on others for longer periods of time. In fact, the average individual spends about 80% of their waking hours in the company of others. 4 Loneliness is a state of mind that is characterized by feeling unwanted, empty, and cut off from other human beings. 5 It is also described as a negative reaction to the discrepancy between the relationships we desire versus those we have.

Loneliness is not necessarily the result of being alone. One can easily feel lonely even when surrounded by others. Because loneliness is more often a perception, feelings of isolation can trigger hypervigilance, in which the world appears to be a threatening place. 6 Individuals who are lonely tend to be more critical of themselves. 7 When these negative expectations are confirmed by the behavior of others, this creates a loneliness loop that is accompanied by feelings of hostility, stress, pessimism, anxiety, and low self-esteem. 8

Loneliness apparently loves company, with studies describing it as contagious. 9 It appears to spread through friends, rather than family members, and occurs in clusters, extending up to 3 degrees of separation. 10 Loneliness can be addressed both as a group and individually. One way to prevent loneliness is to encourage social activity. Obviously, for some people it is very hard to be social this is where emphasizing resiliency and perseverance is important.

“In loneliness, the lonely one eats himself in a crowd, the many eat him,” Friedrich Nietzsche once said. 11 Culturally, loneliness can be seen as a sign of weakness or self-pity. For instance, 1965 study of rhesus monkeys Found that when a group of socially isolated monkeys were reintroduced to their colony, they were driven off or eliminated. 12

In 2018, the United Kingdom’s BBC Radio 4 released results from The Loneliness Experiment, the largest survey ever conducted on the subject. 13 They study included more than 55,000 participants, aged 16 to 99 years, hailing from 237 countries, islands, and territories. It found that loneliness was higher in individualistic cultures such as the United States and Western Europe, which placed high value on self-reliance, loose social networks, and chosen relationships. In contrast, cultures with strong collectivist norms, including some Asian countries, are built on interdependence, tighter social networks, and stronger family connections. Some of these countries include Brazil, India, and the Philippines.

The study found young individuals experienced the most loneliness, with 40% of 16- to 24-year-olds feeling lonely often or very often, in comparison with 29% of individuals aged 65 to 75. Young men in particular were more susceptible to feelings of loneliness, and their loneliness was more intense and longer-lasting.

Most of the research on loneliness was conducted before COVID-19 sent us into lockdown, so it is too soon to consider the pandemic’s long-term effects. However, recent studies have tracked the impact of social distancing and quarantine, and they have left an intriguing bread-crumb trail of predictions.

Pandemic Worries

When COVID-19 struck, many experts worried suicide rates would skyrocket. 14 A 2020 report from the Centers for Disease Control and Prevention showed a 35% increase in suicide mortality in the US from 1999 to 2018, a trend most people expected to continue. 15

A March 2020 rapid review disseminated 24 studies in 10 countries that examined the psychological impact of quarantine. 16 It included those affected by SARS, Ebola, H1N1 influenza, Middle East respiratory syndrome, and equine influenza. Common quarantine side effects included posttraumatic stress disorder (PTSD), confusion, and anger. Stressors included the extension of quarantines, fear of infection, frustration, boredom, inadequate supplies and information, financial loss, and stigma.

The review also found health care workers in particular suffered from the loneliness and isolation of quarantine. Theyendured increased severe symptoms of PTSD, felt stigmatized, and reported greater loss of income. Health care workers also reported feeling lonely, guilty, angry, helpless, isolated, nervous, and sad. Many linked their quarantine experience to alcohol abuse and dependency symptoms. They also engaged in avoidance behavior, often not showing up to work or avoiding direct interactions with patients.

Like every facet of society, health and mental health organizations have had to rethink how to serve their patients, especially when they could not be treated in person. Mental health care providers were encouraged to find alternate ways to deliver services, provide clear pathways for those considering suicide, and quickly offer bereavement services when needed. We can assess for loneliness by using the revised University of California, Los Angeles (UCLA) loneliness scale. 17 One way to approach the conversation is to ask patients what they are doing during their free time and if they have any friends or family they spend time with. Since the COVID-19 pandemic, it is likely a lot more patients have indicated they are lonely.

Nurturing the Doctor-Patient Alliance

A 2018 meta-analysis examined the relationship between 30,000 patients and their therapists. 18 In a review of 295 independent studies published between 1978 and 2017, it found that positive clinical outcomes correlated with the strength of the therapeutic alliance between patients and their therapists. The better the relationship, the better the prognosis. The therapeutic alliance has become even more important due to the pandemic and quarantine. As psychiatrists, we must strengthen our relationship with patients so they trust us and improve. This is just as important and essential as medication management.

Individuals need quality information and strategies to cope with loneliness, in addition to help identifying and managing self-defeating thoughts. Comprehensive assessments like the revised UCLA Loneliness Scale and access to round-the-clock counseling networks could throw vital lifelines to patients suffering from loneliness. 19

Innovative Programs

In France, the VigilanS suicide prevention system was implemented before COVID-19 began. It rapidly adapted by following up with at-risk patients on the 10th day rather than the 20th. Early data regarding this intervention shows a sharp decrease in suicide attempts by those involved, however this is an ongoing study and final results are not yet published. 20 France’s art community also jumped to provide support. Cov’ Art is a public art movement designed to shore up resilience and provide messaging about suicide and interindividual violence. Some programs in the US include the National Alliance on Mental Illness, the National Suicide Prevention Lifeline, and the American Foundation for Suicide Prevention.

Social media, smartphones, and videoconferencing have also played a huge role in maintaining connections. Prior to COVID-19, social media was seen as something that made many individuals feel lonely. 21 During the pandemic, however, social media was one of the few safe ways to stay in contact with other people. In one study, it was noted that while adolescents indicated increased social media use during lockdown, it was not associated with increased happiness. It even showed a negative correlation between using social media and happiness. It also noted that using social media as a substitute for physical social relations makes adolescents feel less happy. 22

More than anything, individuals need to be comforted that they are not alone and shown a way to overcome their loneliness. Often, the solution is to address loneliness with kindness. A 2015 study observed 2 groups for 6 weeks 1 that performed acts of kindness for themselves and 1 that conducted good deeds for others. 23 The group that behaved altruistically flourished psychologically through improved social relationships and feelings of greater joy and wellbeing.

Harvard’s Loneliness in America study suggested that how we treat loneliness is a bellwether of not only society’s emotional and physical health but also its moral health. 24 In a society where many prioritize themselves, we need to help our patients—and ourselves—commit to being both present and compassionate for each other.

Pulling Together

Ironically, suicide rates generally dip after major events that are shared by large populations. 25 During COVID-19, CDC statistics found provisional suicide mortality rates in 2020 fell by 5.6% compared to 2019. 26 Provisional suicide mortality rate estimates provide an early indication of shifts in suicide mortality trends. 27 After the 9/11 terrorist attacks, suicide rates in New York declined significantly during the 180 days after the event. 28 Researchers suggest that a “pulling together” effect may be the reason behind this phenomenon. Shared experiences during COVID-19 led to a powerful sense of togetherness that helped to keep suicidal thoughts in check. Indeed, a 2006 study suggested that the “need to belong is so powerful that, when satisfied, it can prevent suicide.” 29 It noticed that fewer suicides occurred on Super Bowl Sundays, likely due to an increase of shared membership and group interaction on those days.

It is this line of reasoning that developed the Three-Step Theory. 30 First, suicide ideation occurs as a reaction to feelings of psychological pain and hopelessness. Second, feelings of connectedness were a key protective factor against escalating ideation. Third, suicide follows ideation when a someone determines they have the disposition and practical capacities to carry out the event.

To be sure, the stress of COVID-19 has affected mental health around the world. A CDC survey reported that more than 40% of respondents had symptoms of anxiety or depression. 31 It is interesting that while suicide rates declined, depression rates have increased. Major events that affect a whole population have an interesting effect in decreasing suicide while increasing rates of depression. Additionally, 26% indicated that they had started or increased substance use as a way to cope.

As psychiatrists, we tend to be biased in thinking that everything can be fixed with medication however, the danger is that we forget to see the human person in front of us. While medication can help, often their problem is much more complex and needs more than medication treatment. We should not overlook patients we think are lonely and instead provide tips, such as being active on social media and staying in touch with friends through Zoom and Facebook. Although in-person relationships are always better than virtual ones, virtual ones are better than nothing. The worst thing to do when lonely is to completely isolate and not talk to anyone through social media.

As psychiatrists, we are on the front lines and can affect whether some people live or die. Let us rise to the occasion and treat everyone with kindness and compassion and in doing so, save thousands of lives.

Dr Lagoy is staff psychiatrist at Community Psychiatry in San Jose, CA.

1. Harvard University. Loneliness in America: How the pandemic has deepened an epidemic of loneliness and what we can do about it. February 2021. Accessed May 13, 2021. https://mcc.gse.harvard.edu/reports/loneliness-in-america

3. Weeks DG, Michela JL, Peplau LA, Bragg ME. (1980). Relation between loneliness and depression: A structural equation analysis. Journal of Personality and Social Psychology. 198039(6):1238-1244.

4. Kahneman D, Krueger AB, Schkade DA, et al. A survey method for characterizing daily life experience: the day reconstruction method. Science. 2004306(5702):1776-1780.

6. Hawkley LC, Cacioppo JT. Loneliness matters: a theoretical and empirical review of consequences and mechanisms. Ann Behav Med. 201040(2):218-227.

7. Besser A, Flett GL, Davis RA. Self-criticism, dependency, silencing the self, and loneliness: A test of a mediational model. Personality and Individual Differences. 200335(8):1735-1752.

8. Breann A. What is the loneliness loop and how can I break free from it? Younique Foundation. Accessed May 13, 2021. https://youniquefoundation.org/what-is-the-loneliness-loop-and-how-can-i-break-free-from-it/

9. Remes O. Loneliness is contagious – and here’s how to beat it. Cambridge University. July 16, 2018. https://www.cam.ac.uk/research/discussion/loneliness-is-contagious-and-heres-how-to-beat-it

10. Cacioppo JT, Fowler JH, Christakis NA. Alone in the crowd: the structure and spread of loneliness in a large social network. J Pers Soc Psychol. 200997(6):977-991.

11. Nietzsche F. A Nietzche Reader Selected and translated. Penguin Books 1984.

12. Harlow HF, Dodsworth RO, Harlow MK. Total social isolation in monkeys. Proc Natl Acad Sci USA.196554(1):90-97.

14. Courtet P, Olié E, Debien C, et al. Keep socially (but not physically) connected and carry on: preventing suicide in the age of COVID-19. J Clin Psychiatry. 202081(3):20com13370.

15. Hedegaard H, Curtin SC, Warner M. Increase in suicide mortality in the United States, 1999–2018. NCHS Data Brief, no 362. National Center for Health Statistics 2020.

16. Brooks SK, Webster RK, Smith LE, et al. The psychological impact of quarantine and how to reduce it: rapid review of the evidence. Lancet. 2020395(10227):912-920.

17. Hughes ME, Waite LJ, Hawkley LC, Cacioppo JT. A short scale for measuring loneliness in large surveys: Results from two population-based studies. Res Aging. 200426(6):655-672.

18. Flückiger C, Del Re AC, Wampold BE, Horvath AO. The alliance in adult psychotherapy: A meta-analytic synthesis. Psychotherapy. 201855(4):316-340.

19. Russell D, Peplau LA, Cutrona CE. The revised UCLA Loneliness Scale: concurrent and discriminant validity evidence. J Pers Soc Psychol. 198039(3):472-80.

20. Fossi Djembi L, Vaiva G, Debien C, et al. Changes in the number of suicide re-attempts in a French region since the inception of VigilanS, a regionwide program combining brief contact interventions (BCI). BMC Psychiatry.202020(1):26.

21. Pittman M, Reich B. Social media and loneliness: Why an Instagram picture may be worth more than a thousand Twitter words. Computers in Human Behavior. 201662:155-167.

22. Cauberghe V, Van Wesenbeeck I, De Jans S, et al. How adolescents use social media to cope with feelings of loneliness and anxiety during COVID-19 lockdown. Cyberpsychology, Behavior, and Social Networking. 202124(4):250-257.

23. Nelson SK, Layous K, Cole SW, Lyubomirsky S. Do unto others or treat yourself? The effects of prosocial and self-focused behavior on psychological flourishing. Emotion. 201616(6):850-61.

24. Weissbourd R, Batanova M, Lovison V, Torres E. Loneliness in America: How the pandemic has deepened an epidemic of loneliness and what we can do about it. Harvard Graduate School of Education. February 2021. https://mcc.gse.harvard.edu/reports/loneliness-in-america

25. Nishio A, Akazawa K, Shibuya S, et al. Influence on the suicide rate two years after a devastating disaster: A report from the 1995 Great Hanshin-Awaji earthquake. Psychiatry Clin Neurosci. 200963(2):247-250.

26. Ahmad FB, Anderson RN. The leading causes of death in the US for 2020. JAMA. March 31, 2021. https://jamanetwork.com/journals/jama/fullarticle/2778234

27 Ahmad FB, Cisewski JA, Miniño A, Anderson RN. Provisional Mortality Data - United States, 2020. MMWR Morb Mortal Wkly Rep. 202170(14):519-522.

28. Claassen CA, Carmody T, Stewart SM, et al. Effect of 11 September 2001 terrorist attacks in the USA on suicide in areas surrounding the crash sites. Br J Psychiatry. 2010196(5):359-364.

29. Joiner TE, Hollar D, Van Orden K. On Buckeyes, Gators, Super Bowl Sunday, and the miracle on ice: “Pulling together” is associated with lower suicide rates. J Soc Clin Psychol. 200625(2).

30. Klonsky ED, May AM. The Three-Step Theory (3ST): A new theory of suicide rooted in the “ideation-to-action” framework. J Soc Clin Psychol. 20158(2).

31. Czeisler ME, Lane RI, Petrosky E, et al. Mental health, substance use, and suicidal ideation during the COVID-19 pandemic — United States, June 24–30, 2020. Centers for Disease Control and Prevention. 202069(32):1049-1057.


Let’s talk about loneliness – the importance of social psychology

Loneliness is an expanding challenge for health and care, and something that could affect any one of us at any point in our lives. This year’s focal point is about reducing the stigma about loneliness. We’re using the opportunity to shine a light on some social psychology research and how it can help tackle loneliness.

Imagine a situation where a person can go for days, weeks, months without seeing anyone. This torturous scenario is often harnessed in prisons as a form of disciplining violent and disruptive prisoners as well as for ensuring staff and fellow prisoner safety. Worryingly, it is increasingly becoming a situation that many ordinary people are finding themselves in up and down the country.

The numbers surrounding loneliness are worrying [1] . It is estimated that over 40% of us will experience loneliness at some point in our lives. There is a strong association between loneliness and age. According to Age UK, there are 1.2 million chronically lonely older people in the UK, half a million older people go at least 5 or 6 days without seeing or speaking to anyone at all and the television is the main company for approximately two fifths of all older people.

While it is widely perceived to be problem in older generations, it is in fact a multi-age issue, with 9 million people in the UK of all ages either feeling often, or always lonely, with the highest proportion being 16-24 year olds.

In an economic sense, it’s been estimated that loneliness and disconnected communities cost the UK economy £32 billion every year [2] . When it comes to our health, chronic loneliness is as bad as smoking 15 cigarettes a day, worse for you than obesity and increases the risk of heart disease and your overall risk of an early death. Unsurprisingly, it is also bad for our mental health. Isolated people are often trapped in a vicious circle of having a mental health problem causing loneliness, and loneliness worsening their mental health [3] .

It is becoming an increasingly large challenge facing our society, and policy makers and the health and social care sector are starting to take notice.

But what about the psychology behind loneliness? Before developing and implementing policies that can tackle this societal challenge, it is important to understand the psychology behind loneliness, and how humans interact.

Research by the Social and Evolutionary Neuroscience Group at the Department of Experimental Psychology has been investigating human relationships for over two decades at both an individual human bonding level, and large scale community social cohesions.

Researching social psychology involves navigating a branch of complexities in human behaviour that are dynamic, unpredictable and depend on highly refined levels of cognition and social skills e.g. empathy.

Some interesting findings from a study [4] have found that support networks and friendship circles have different roles between men and women. Whereas men seem to make a sharp distinction between sexual relationships and their wider social networks, female social worlds seem to be more integrated: you can still see these clusters but there's more overlap between them, suggesting differences in how men and women create and maintain their social networks. This could have implications on the way inclusion and community building activities are designed between men and women, which could create a more tailored approach in alleviating loneliness and isolation in men and women.

The lab have also spent a number of years investigating various social activities and assessing their effectiveness in forging bonds.

From comparing of groups of singers to arts and crafts group sessions [5] , they realised that quicker social bonding occurs between members of choirs compared to arts and craft group members, signifying that singing is a true ‘ice-breaker’ when meeting new people.

Choirs vs crafts, could the members of the Clapham Community choir be forging stronger bonds than this arts and crafts group in Bramley

The group have also investigated dancing as a catalyst for improved bonding, and results have shown that exertive synchronised dancing causes a large release of endorphins, yielding more positive experiences and enhanced bonding.

For the non-dancers, non-musicians and non-artisans, the group has investigated the effectiveness of laughter, and have shown that laughter adds a significant amount to the capacity of humans to connect in supporting bonding activities [6] .

Laughter, could it be the ultimate social glue as seen here with the graduates of the Laughter Yoga University?

When it comes to looking at loneliness within the context of the digital revolution, the Social and Evolutionary Neuroscience group have been investigating the potential social isolation and the levels of bonding between humans whose relationships are more digital than traditional.

So why is this research important? We’re already seeing the impact of this research being embraced to support health and care. As part of the NHS Long Term Plan and Universal Personalised Care plans, social prescribing is becoming increasingly prevalent in health and social care settings.

Where you might have traditionally gone to your GP and received a prescription for medication, patient groups who would benefit from it are receiving social prescriptions. Examples include referrals to classes, choirs, dance groups, walking groups and community groups. This is particularly pertinent to patient groups who are at risk of loneliness and socially isolated.

Given the expanding research that Oxford and the Social and Evolutionary Neuroscience group has been contributing to the field of human social behaviour, we could see a vast enhancement and expansion in social prescribing in the very near future.

A fascinating and resonant impact of how the work of social psychologists is helping tackle the challenges facing society today.


Everything You Need To Know About Anxiety

First and foremost, it's important to note the contrast between feeling nervous and experiencing clinical anxiety, which can be debilitating and otherwise involve outside treatment. In many settings, the two cases are synonymously referenced which can create confusion. Knowing and comprehending the difference between the two is better for everyone.

Feeling Nervous

As previously stated, it's normal to feel nervous when you're stepping out of your comfort zone or trying something new for the first time. During times like these, pushing through the nerves and feelings of discomfort is what matters. Nervousness should never impede your ability to grow, push yourself, and open yourself up to opportunities which would otherwise be unavailable. As a matter of fact, being able to rise above feeling nervous is a great sign and can build character in many situations.

Sometimes feeling nervous is a sign of danger or a sign that someone shouldn't do something which may get them into trouble. Sometimes people feel nervous before committing a crime, lying to their significant other, or otherwise behaving in ways which are dishonorable and not upstanding. In these situations, you shouldn't pull back from what you're thinking of doing. Sometimes feeling nervous is a good thing it can actually protect us from danger and keep us from making mistakes which we will later come to regret. This is why it's so important to be in tune with yourself and how you feel. Your emotions exist and come to the surface for a reason.

Clinical Anxiety

Those living with clinical anxiety generally experience feelings of nervousness or worry to a greater degree than those without it. Because the symptoms are often more severe, clinical anxiety should be treated accordingly. When someone without anxiety experiences nervousness, they're usually able to manage or push through this emotion without allowing it to negatively impact their ability to function and do well in everyday life. Clinical anxiety, however, is a whole other ballgame, and it's important for people to be cognizant of this.

There are many symptoms and common behaviors which are linked to clinical anxiety. More often than not, clinical anxiety is present when someone has a difficult time functioning due to their anxiety. This could take the form of struggling to concentrate, not feeling motivated, withdrawing from others, harboring extreme worries about the past or future, etc. Whenever someone experiences clinical anxiety, it's very important for them to have a strong, healthy support system. This is helpful for anyone, but especially paramount for those who struggle with their mental health.

Exploring The Psychology Of Anxiety

In the mainstream, there is lots of talk about anxiety, its symptoms, and how to treat it. However, the actual psychology of anxiety is a matter which is discussed much less commonly, yet is very critical for understanding mental health and the experiences of people who undergo anxiety. In most cases, the psychology of anxiety boils down to control, the interpretation of a particular situation, belief systems, and the overall ability (or lack thereof) to cope in situations which are not pleasant or comfortable.

It's fair to state that most people feel better in situations where they are in control. This is understandable &mdash when you're in control, you have the ability to manage what happens, what goes on, and what your experiences are. However, there will inevitably be situations in life where you're not able to control what's happening. One of the realities of life is that we cannot control every single thing that happens to or around us. In spite of this, we can control ourselves and the manner in which we react. Sometimes this presents more of a challenge than other times, which is where anxiety enters the equation.

The manner in which control is perceived can greatly impact degrees of experienced anxiety. It turns out that the experiences someone has can determine their perception of control and how they are able to cope when control is seemingly absent. If these experiences are hurtful, traumatic, and not dealt with, then this can cause problems, many of which manifest in the form of anxiety.

Interpretations Of Situations

Things are not always what they appear to be, yet the manner in which someone interprets a situation can greatly impact their emotional state. Under duress, it can be very easy to experience stress, anger, and other negative emotions. In many cases, when a situation is believed to impact a person's well-being, whether it's their physical, emotional, or financial well-being, this can generate feelings of nervousness or worry.

In essence, situations which are interpreted as threats tend to bring about various symptoms of anxiety. This is normal, particularly for anyone with a healthy sense of self-preservation. As human beings, we want to maintain safety and steer clear of danger. As previously stated, symptoms of anxiety tend to surface during circumstances where danger is present.

Belief Systems

Many people don't realize this, but there is a psychological link between belief systems and anxiety. If someone walks into a job interview and sees that the other candidates who are preparing for the job are wearing more formal attire, they may experience worry or nervousness. These feelings would be brought about by the belief that their chances of getting their dream job will be slim, due to the manner in which their competition is dressed. This may or may not be accurate, but the belief system has triggered the feelings of anxiety in this particular case.

Coping In Uncomfortable Situations

Anyone who has found themself in a challenging situation knows how tough it can be to cope. Believe it or not, the ability to cope during unpleasant times shares strong connections with the amount of control which a person believes they have. This doesn't mean that the two are completely tethered, but there are definitely links. When someone feels helpless and powerless, this is significantly more likely to generate feelings associated with anxiety, as opposed to a different situation where someone believes that things will eventually blow over.

Treatments For Anxiety

When anxiety interferes with a person's ability to successfully function in the world and do well for themselves, then that presents a very real problem. Left unchecked, anxiety can negatively impact relationships, businesses, professional opportunities, finances, and so much more. This is why having access to the various treatment options for anxiety is paramount.

Personal Lifestyle Choices

Believe it or not, the lifestyle that a person lives can significantly reduce or do away with feelings associated with anxiety in some cases. Some of the best lifestyle choices to help manage anxiety include living a balanced lifestyle, maintaining steady routines, eating a healthy diet, and avoiding caffeine, drugs and alcohol. Surrounding yourself with positive, like-minded people also makes a great difference as well. It's amazing, but the people in our lives truly have the power to increase or decrease the feelings of anxiety we experience.

Professional Therapy

Try as we might, dealing with anxiety on our own is not always possible&hellipand that's okay. As a matter of fact, it can actually be enlightening and beneficial to see a therapist. Working with a professional can not only help you learn more about anxiety and how to control it, but also afford you the luxury of learning more about yourself and who you are. Sometimes, it can be scary to open up to someone you've never met and share intimate details about yourself, even if they are a therapist. However, it's important to remember that a therapist is there to help you, not pass judgement on you.

A Final Word

The world would be a much better place if more people understood anxiety, the psychology behind it and the appropriate methods of treatment. Unfortunately, this condition is often stigmatized, and people are simply told to brush it off and get over it. This doesn't help and can make a tense situation ten times worse.

Whether you're dealing with anxiety or another matter entirely, it's important for you to know that you are not alone. Things may seem confusing or scary, but there are always people out there who are willing to help if you allow them to do so. Here at BetterHelp, we have an amazing team of therapists who would be thrilled to sit down with you and be of service. No matter who you are or what you may be going through, you are not alone.

Frequently Asked Questions (FAQS)


What is an anxiety disorder and its relationship to psychology?

Anxiety disorders are mental illnesses that cause substantial fear or worry that generally do not go away and can get worse in the long run.

We all feel nervous or worried from time to time. It is the way your brain reacts to stress and alerts you of the possible dangers ahead. However, if you are experiencing anxiety disorders in your daily life, it means that your symptoms are likely consistent and severe.

How does a psychologist help with anxiety?

Your psychologist will first examine you and ensure no physical triggers are causing your panic attacks or panic disorder.

Once it is established that you have physical symptoms of an anxiety disorder or panic disorder, you may require the services of a mental health professional to help you manage your anxiety disorders.

Many people don&rsquot realize that their anxiety disorders, panic attacks, or panic disorders can be treated.

Most people living with social anxiety respond well to talk therapy and medication. For talk therapy, there is cognitive behavioral therapy (CBT) which can help you understand different ways of thinking and how to manage anxiety disorder.

What are the different types of anxiety disorders?

  1. Specific Phobia: This is an excessive fear or anxiety related to an object or situation that almost always triggers an anxiety reaction or fear response in an individual. Phobia can lead to panic disorder and harm your mental health by making you avoid the object or situation.
  2. Separation Anxiety Disorder: This is a type of anxiety disorder that occurs when an individual experiences fear or anxiety from being separated from another person. Separation anxiety disorder is usually triggered when a person feels they can&rsquot survive without another individual.
  3. Social Anxiety Disorder (Social Phobia): Social anxiety disorder, also known as social phobia, is a type of anxiety disorder that results in extreme fear while in social situations. People living with social anxiety disorder find it difficult to meet new people, talk to people, and attend social gatherings. They are usually scared of being judged by others.
  4. Panic Disorder: This is occurs when an individual experiences consistent panic attacks for no obvious reason. Feelings associated with panic can be normal, but if they become consistent and severe, this may signal that the individual has a panic disorder.
  5. Agoraphobia: This is a type of anxiety disorder characterized by the fear of situations and places that might cause embarrassment, panic, or a lack of protection.
  6. Generalized Anxiety Disorder: GAD is characterized by consistent worry, restlessness, stress, or trouble concentrating.

You can manage symptoms of anxiety by doing the following:

Reduce/eliminate alcohol: A lot of people use alcohol to deal with anxiety. However, this can cause symptoms to worsen. Also, if you continue to rely on alcohol, you may begin to depend on it.

Quit smoking: Like alcohol, a lot of people rely on cigarettes when they experience anxiety. However, research suggests that smoking increases your risk of experiencing anxiety disorder in the future.

What is the first sign of anxiety?

According to the American Psychological Association, common physical symptoms of anxiety include tension or restlessness, increased blood pressure, nervousness, dizziness, sweating, the feeling of an imminent disaster, and doom or panic, among others.

Does anxiety go away if you ignore it?

If you are experiencing mild anxiety, it might go away on its own if whatever triggers it is no longer in the vicinity or has stopped happening.

However, if you are living with chronic anxiety and you ignore it, it can get worse and affect your daily life.

What are the main causes of anxiety?

The major causes of anxiety are the following:

Family history of a mental health condition: A family history of anxiety can lead to an increased risk of developing an anxiety disorder. However, it is important to note that just because your parents are living with an anxiety disorder or any other mental health condition, that does not mean you will automatically experience the same.

Stressful life event triggers, including:

  • Change of environment
  • Family problems
  • Relationship problems
  • Sexual abuse
  • Emotional abuse
  • Emotional shock after a traumatic event
  • Work stress
  • Pregnancy
  • Loss of a loved one

According to the American Psychological Association, anxiety can also be triggered by the anniversary of a traumatic event. Such events can be recreated by the survivors, thus triggering symptoms.

How are you diagnosed with anxiety?

Regardless of whether you're living with separation anxiety, obsessive compulsive disorder, or anxiety disorder, a doctor will conduct a physical examination and get to know your symptoms.

Furthermore, the doctor will determine what is causing the anxiety and offer their medical advice, and may recommend medication.

What will the doctor do for anxiety?

After the physical examination, the doctor will give you their medical advice and probably recommend medication, therapy, or a combination of treatments.

Exposure therapy is a form of cognitive-behavioral therapy that helps to reduce symptoms of anxiety.

You must stick to your doctor's medical advice and refrain from looking for solutions online but, if for any reason you&rsquore not satisfied with their medical advice, you may want to seek a second opinion.

Is anxiety a mental illness?
Occasional feelings of anxiety are normal but consistent and severe symptoms may mean you have an anxiety disorder.

Anxiety disorders belong to a group of mental illnesses that cause consistent and overwhelming fear and anxiety. This extreme anxiety can stop you from going to school or work, and make you avoid family and social gatherings.

Is anxiety considered a disability?
Anxiety disorders &mdash like phobias, obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), panic disorders, and generalized anxiety &mdash can be considered a disability in certain cases.

You may qualify for social security disability benefits once your condition is documented and severely debilitating.

What is the best job for someone with anxiety?
For someone living with an anxiety disorder, the following jobs may be beneficial:

  • Writer
  • Dog trainer
  • Counselor
  • Accountant
  • Artist
  • Landscaper
  • Stay at home parent
  • Computer Programmer

Can I take time off work due to stress?
If your doctor feels strongly that a break from work will help get rid of your stress condition, you may want to consider time away from your job.

As long as your doctor puts it in writing and your employer is okay with it, you're good to go.

With the Family and Medical Leave Act (FMLA), you are entitled to take up to 60 days unpaid job-protected leave every year and it doesn&rsquot have to be successive days.


Interpersonal Mechanism 3: Processing Emotions

Emotions are the primary language of interpersonal relationships, and central tasks in confronting and surmounting interpersonal problems in IPT comprise identifying, processing, and expressing emotions that arise. Early psychoanalytic theory viewed the very expression of emotions (�tharsis”) as curative, relieving internal tension created by repression (Freud & Breuer, 1955). Some conceptualizations of depression focused on repressed anger or 𠇊nger turned inward” (Abraham, 1911 Rado, 1928), implying that expressing anger openly might help alleviate depression.

Although some research supports this cathartic benefit for emotions such as aggression (e.g., Verona & Sullivan, 2008), contemporary emotion models emphasize the interplay of emotions and other factors. Emotion focused therapy (EFT) identifies emotion schemes – internalized emotional structures influenced by past interpersonal experiences – as major sources of distress and psychopathology (Greenberg & Watson, 2006). Mindfulness-based approaches propose that open, non-evaluative processing of emotions can alter cognitive appraisals, which are thought to worsen suffering (Lynch, Chapman, Rosenthal, Kuo, & Linehan, 2006). Mentalization-based treatment (Bateman & Fonagy, 2004) conceptualizes some psychiatric disorders as linked to confusion in interpreting emotional states. Its goal is to help the patient achieve reflective function – the ability to understand one’s own and others’ emotional states and to clearly distinguish them. This capacity putatively helps the patient to better modulate emotional responses (Bateman & Fonagy, 2004).

Processing Emotions within the Interpersonal Problem Areas

Interpersonal losses, changes, and conflicts generate varied, powerful emotions that individuals with depression and other psychiatric disorders may have difficulty tolerating, understanding, and expressing (Markowitz & Milrod, 2011). The individual in a role dispute, feeling frustrated and angry, may need help accepting the legitimacy and appropriateness of these feelings, understanding their interpersonal meaning (e.g., anger often means someone is bothering you, failing to respond to you) and then expressing them, perhaps initially in sessions and role plays with the therapist, and later directly to the relative, partner, friend, or boss. Someone experiencing a role transition, such as adjusting to a serious illness, may need to mourn the old role and adjust emotionally to the new role by increasing awareness, acceptance, and ability to express uncomfortable feelings of sadness, anger, shame, and guilt. The therapist seeks to help the patient first acknowledge the presence and depth of these feelings, then verbalize them, all the time accepting their legitimacy, validity, and social utility. In complicated grief, emotional processing may be a central thrust of IPT as the patient needs help processing the loss before s/he can reinvest in existing connections or establishes new ones.

Processing Emotions in IPT

IPT distinguished itself from Beck’s cognitive therapy partly through its emphasis on affect (feeling states) rather than cognitions or evaluative aspects of emotions (Elkin, Parloff, Hadley, & Autry, 1985). IPT invites, accepts, and validates affective expression, while emphasizing the interpersonal character and effects of emotions. Although its goal of processing emotions leads to overlap with subsequently developed emotion oriented therapies such as EFT and mentalization, IPT engages emotional processing primarily in the service of confronting and resolving the focal interpersonal problem. Emotion work is integral to adapting to interpersonal challenges, reacting to interpersonal stress, and overcoming conflicts. Again, IPT focuses on fixing the problem in the interpersonal context rather than an underlying problem in the patient. IPT further presumes that the psychiatric disorder may impede emotional processing and therefore resists drawing conclusions about lasting emotional handicaps which characterize personality pathology. By facilitating resolution of the problem area, emotional processing may contribute to enhanced social support and decreased stress ( Figure 2 ).

Broader Benefits of Emotional Processing

Although the primary goal of processing emotions in IPT is to facilitate resolution of the interpersonal problem, intensive work on difficult feelings their acceptance and consistent validation in a close, supportive therapeutic relationship and coaching on their constructive expression outside the therapy might expectably yield additional, broader lasting, emotional benefits for many patients. For example, patients should attain greater attunement to and normalization of feelings, and greater ability to express and verbalize such feelings in the interpersonal context ( Figure 2 , dashed line). Thus, Markowitz and colleagues (Markowitz, Milrod, Bleiberg, & Marshall, 2009) proposed that reflective function (Bateman & Fonagy, 2004), a presumably enduring ability to understand one’s own and others’ emotions, might mediate change in IPT for patients with chronic PTSD who are poorly attuned to their own emotional states.

Research on Emotional Processing

A secondary analysis of emotional factors in the TDCRP found that 𠇌ollaborative emotional exploration” was rated higher in IPT than in CBT sessions and that this dimension correlated with positive outcome (Coombs, Coleman, & Jones, 2002). However, this study used transcripts from a selected sample of sessions, and a coding system that overlapped problematically with alliance factors. State of the art assessment of emotional processing includes physiologic measures of arousal and ratings from taped sessions using validated coding systems. For example, Greenberg and Malcolm (2002) found that patients who experienced more intense emotions in EFT, as indicated by greater physiologic arousal, achieved greater problem resolution.[J14] IPT has yet to conduct such systematic examination of emotional factors.


The roles of fear of negative evaluation and social anxiety in the relationship between self-compassion and loneliness: a serial mediation model

Loneliness is an unpleasant experience of lacking desired interpersonal relationships. Abundant evidence has clarified the negative outcomes of loneliness, such as anxiety, even suicidal behaviors. However, relatively few is known about the internal buffering elements for loneliness, especially in adolescents. The current research aimed to investigate the relationship between self-compassion and adolescents’ loneliness, as well as the mediating roles of fear of negative evaluation and social anxiety in this relationship. A total of 871 Chinese adolescents completed a set of questionnaires, including the measures of loneliness, self-compassion, social anxiety and the fear of negative evaluation. We tested the proposed serial mediation model and the results suggested that self-compassion was negatively associated with loneliness, and social anxiety served as a mediator in the relationship. Besides, we found that the fear of negative evaluation and social anxiety serially mediated the negative association. Specifically, self-compassionate adolescents reported less fear of negative evaluation, which resulted in decreased social anxiety symptoms. In turn, the decreased social anxiety was linked to reduced feelings of loneliness. The present study sheds lights on the mediating effects of fear of negative evaluation and social anxiety in the relationship between self-compassion and loneliness. The theoretical and practical implications, as well as the limitations of the present study, are discussed.


Fundamental Link Between Emotions And Sound Perception Identified In New Study

We all know that certain songs and musical phrases can have a tremendous impact on the way we feel, but did you know that the way we feel has a tremendous impact on the way we perceive sounds?

Sound does not only affect our emotions &mdash our emotions also affect the way recognize and process sound. It&rsquos the neurological phenomenon by which we shrug on hearing signals similar to our alarm clock, and by which combat veterans suffering from post-traumatic stress disorder (PTSD) can have horrifying memories stirred up by the sound of thunder.

For a long time, the neurological mechanism behind these subjective, often troubling associations have remained a mystery. Now, in a study published in Nature Neuroscience, researchers from the Perelman School of Medicine at the University of Pennsylvania may have taken the first step towards a comprehensive model of the associative process underpinning the phenomenon.

"Emotions are closely linked to perception and very often our emotional response really helps us deal with reality," senior study author Dr. Maria N. Geffen, an assistant professor of head and neck surgery, told reporters. "For example, a fear response helps you escape potentially dangerous situations and react quickly. But there are also situations where things can go wrong in the way the fear response develops. That's what happens in anxiety and also in PTSD &mdash the emotional response to the events is generalized to the point where the fear response starts getting developed to a very broad range of stimuli."

In other words, our &ldquoauditory plasticity&rdquo &mdash or, the process whereby our perception of sound adapts according to the aural patterns we experience &mdash can be influenced by strong emotions to a point where similar sounds are mistakenly yoked together and interpreted as connoting one and the same thing. In PTSD cases where thunder and other harsh aural patterns trigger harrowing memories, the soldier&rsquos fear has effectively altered the way he or she understands such sounds &mdash and instead of discriminating between &ldquogunshot&rdquo and &ldquodoor slamming,&rdquo the brain recognizes the enter spectrum as a unit corresponding to anxiety and danger.

In the study&rsquos experiment, lab mice were taught how to distinguish between safe and potentially dangerous sound frequencies &mdash a process referred to in the study as &ldquoemotional discrimination learning.&rdquo By varying the difficulty of the task, researchers were able to develop different levels of sound comprehension among the mice, with certain subjects exhibiting much higher hearing acuity that others. The subjects exhibiting low acuity were intended to represent PTSD cases, where sound comprehension has been altered by a traumatic event.

"The animals presented with sounds that were very far apart generalize the fear that they developed to the danger tone over a whole range of frequencies, whereas the animals presented with the two sounds that were very similar exhibited specialization of their emotional response. Following the fine conditioning task, they figured out that it's a very narrow range of pitches that are potentially dangerous," Geffen explained.

By identifying the neurological mechanisms associated with PTSD, the study may anticipate key features of future treatment programs for the debilitating condition. In addition, it may potentially help researchers determine why seemingly traumatic events affect different people in vastly different ways.


Research examines how loneliness affects the social human brain

Research indicates loneliness is the perception of isolation -- even if one isn't actually isolated. Credit: iStock.com/lolostock

Loneliness is as close to universal as experiences come. Almost everyone has felt isolated, even rejected.

But the power of loneliness—its potential for causing depression and other serious health problems as well as its surprising role in keeping humans safe from harm—may be more profound than researchers had previously presumed, says neuroscience researcher John Cacioppo of the University of Chicago.

Cacioppo has spent nearly three decades exploring the social nature of the human brain, working to find the mechanisms behind traits such as loneliness, empathy, synchrony and emotional contagion. Through his research, funded by the National Science Foundation's (NSF) Directorate for Social, Behavioral and Economic Sciences, and the National Institute on Aging, he's helped turn loneliness from a curious afterthought in neuroscience to a serious area for research and explanation.

He and his collaborators have also incorporated new technology at each stage of their research, combining methods ranging from behavior studies to endocrinological testing, electrical and functional neuroimaging, and genetics. They're using those tools to identify the neural, hormonal, cellular and genetic mechanisms underlying social structures.

Using what they've learned, Cacioppo's team is evaluating therapies for loneliness, finding the most effective treatments and working to improve them. The researchers' collaborators include the U.S. Army, which turned to Cacioppo for help with studies that could be incorporated into training to help protect soldiers from isolation and related social problems.

During a visit to NSF, Cacioppo took some time to talk about loneliness—what it is, where it comes from and how it affects people.

Q. How do you define loneliness, in terms of your work?

A. It's defined as perceived social isolation. People can feel like they're on the social perimeter for a lot of different reasons. If you're the last one chosen on a high school team, that can feel really unpleasant. It's also clearly an evaluation of your net worth to that group. If that's a valued group, it matters to you. If it's not a valued group, it's no big deal.

That has effects on not just emotions but cognition. Research at Rush University has shown that older adults are more likely to develop dementia if they feel chronic loneliness.

Q. So just the perception, not whether or not someone is actually isolated, can trigger a physiological reaction?

A. Much of what goes with loneliness—behaviorally, physiologically—is so deep that we've got it in our genes. It's just like if I were to provide a painful stimulus to your arm, you would withdraw and complain of being hurt. That's not something you learn. The pain withdrawal reflex is in place due to your genetic endowment. And that mechanism is in place because it protects your body from tissue damage.

Loneliness is a mechanism that's in place because we need, as a social species, to be able to identify when our connections with others for mutual aid and protection are being threatened or absent. If there's no connection, there could be mortal consequences. Those are threats to our survival and reproductive success.

Q. Does that make loneliness almost like a fever—unpleasant, but there's a purpose to it?

A. That's exactly right. You would not want to eliminate the temporary feeling of loneliness. We've argued there's a benefit to that response to perceived isolation. But, like many individual variations of these kinds of states, there are pathologic extremes. I might be so sensitive to feeling connected or isolated as to be a complete wreck, or I can be so insensitive as to be a psychopath. That's just part of the normal distribution of individual differences that, for the most part, helps to protect our social body just as pain helps to protect our physical body.

Q. How does loneliness affect our social behavior and interactions?

A. When you feel lonely, you get more defensive. You focus more on self-preservation even though this is not done intentionally. Completely unbeknownst to you, your brain is focusing more on self-preservation than the preservation of those around you. This, in turn, can make you less pleasant to be around. Over time, this can increase the likelihood of negative social interactions. Thus, the focus on self-preservation can have short-term survival benefits but—if not reversed—can have long-term costs.

Q. It seems that loneliness can serve a useful purpose but—almost like an immune system that starts attacking things that aren't actually threats—it can go out of control.

A. That's exactly right. It's also very much like our stress system. Our stress system emerged in a different time of human history, and now we get stressed when we're in traffic. There's no saber-toothed tiger attacking there's no person with a spear coming to get me. I'm sitting in a safe car, but there's still that level of stress and hostility that a traffic jam can engender. Our stress response contributed to survival across human history, but in contemporary society chronic stress also contributes to morbidity and mortality.

Stress has an adaptive value, even today, although not to the extent we're expressing it. But knowing that does not mean we can simply turn it off when we wish. It's the same thing with loneliness. We're trying to educate the public about this, to say that loneliness isn't something that only certain individuals have. It's something we all have, we can all fall into, and nearly all of us experience at some point in our lives.

Q. Does this type of research into loneliness tell us anything about humans as a species?

A. The perception of loneliness is exacerbated by the feeling that one doesn't have anyone on whom he or she can depend or who can depend on him or her. As children, we're dependent on adults. When we grow to be adults, we think we're supposed to become independent—the king of the mountain. But in social mammals—not just humans—becoming an adult means being the individual upon whom others can depend. Our Western cultural notion of human nature does not capture our actual social nature particularly well.

Q. When you were starting your research into isolation decades ago, behavioral science and brain science weren't as closely linked as they are today, correct?

A. There were a number of people trying to put them together, but we didn't have the neuroimaging technologies we have today that have really transformed what we can ask. Today, someone can really look at the working, normal brain.

I was doing electroencephalography (EEG) 40 years ago, and we looked at very broad questions. I was doing it 20 years ago, and we looked at relatively sophisticated questions compared to 20 years prior, but not very sophisticated compared to today. I'm now asking questions about the whole brain in action rather than a single region in isolation. And genetics and genomics are also increasingly integrated into investigations of the social brain.

Q. The questions that you started asking at the very beginning of your research—have they led you on a linear path to where you are today? Or has your research taken you in unexpected directions?

A. Yes to both. The question we started with wasn't about loneliness and continues to not be about loneliness. It's about who we are as a species. What, fundamentally, are our brains doing? What are the factors that influence brain function? Partly, we're showing that the brain is organized in part to deal with and to promote salutary connections to other people. The fundamental question was "what is the social nature of our brain?"

One of the things that surprised me was how important loneliness proved to be. It predicted morbidity. It predicted mortality. And that shocked me. When we experimentally manipulated loneliness, we found surprising changes in the "personalities" of people. There's a lot more power to the perception of being socially isolated than any of us had thought.


It Takes Guts to Fend Off Loneliness and Achieve Wisdom

The evolving science of wisdom rests on the idea that wisdom’s defined traits correspond to distinct regions of the brain, and that greater wisdom translates into greater happiness and life satisfaction while being less wise results in opposite, negative consequences.

Scientists have found in multiple studies that persons deemed to be wiser are less prone to feel lonely while those who are lonelier also tend to be less wise. In a new study, published in the March 25, 2021 issue of the journal Frontiers in Psychiatry, researchers at University of California San Diego School of Medicine take the connection between wisdom, loneliness and biology further, reporting that wisdom and loneliness appear to influence — and/or be influenced by — microbial diversity of the gut.

The human gut microbiota is comprised of trillions of microbes — bacteria, viruses, fungi — that reside within the digestive tract. Researchers have known for a while about the “gut-brain axis,” which is a complex network that links intestinal function to the emotional and cognitive centers of the brain.

This two-way communication system is regulated by neural activity, hormones and the immune system alterations can result in disruptions to stress response and behaviors, said the authors, from emotional arousal to higher-order cognitive abilities, such as decision-making.

Past studies have associated gut microbiota with mental health disorders including depression, bipolar disorder and schizophrenia, as well as personality and psychological traits regarded as key, biologically based components of wisdom. Recent research has connected the gut microbiome to social behavior, including findings that people with larger social networks tend to have more diverse gut microbiotas.

The new Frontiers in Psychiatry study involved 187 participants, ages 28 to 97, who completed validated self-report-based measures of loneliness, wisdom, compassion, social support and social engagement.

The gut microbiota was analyzed using fecal samples. Microbial gut diversity was measured in two ways: alpha-diversity, referring to the ecological richness of microbial species within each individual and beta-diversity, referring to the differences in the microbial community composition between individuals.

“We found that lower levels of loneliness and higher levels of wisdom, compassion, social support and engagement were associated with greater phylogenetic richness and diversity of the gut microbiome,” said first author Tanya T. Nguyen, PhD, assistant professor of psychiatry at UC San Diego School of Medicine.

The authors said that the mechanisms that may link loneliness, compassion and wisdom with gut microbial diversity are not known, but observed that reduced microbial diversity typically represents worse physical and mental health, and is associated with a variety of diseases, including obesity, inflammatory bowel disease and major depressive disorder.

A more diverse gut microbiota may be less susceptible to invasion by outside pathogens, which could contribute to and help promote better resilience and stability of the community.

“It is possible that loneliness may result in decreased stability of the gut microbiome and, consequently, reduced resistance and resilience to stress-related disruptions, leading to downstream physiological effects, such as systemic inflammation,” the authors wrote.

“Bacterial communities with low alpha-diversity may not manifest overt disease, but they may be less than optimal for preventing disease. Thus, lonely people may be more susceptible to developing different diseases.”

Greater diversity of gut microbes may be associated with greater wisdom or vice versa similarly less diversity might mean higher likelihood of being lonely. Image is credited to UCSD

The relationship between loneliness and microbial diversity was particularly strong in older adults, suggesting that older adults may be especially vulnerable to health-related consequences of loneliness, which is consistent with prior research.

Conversely, the researchers said that social support, compassion and wisdom might confer protection against loneliness-related instability of the gut microbiome. Healthy, diverse gut microflora may buffer the negative effects of chronic stress or help shape social behaviors that promote either wisdom or loneliness. They noted that animal studies suggest that gut microbiota may influence social behaviors and interactions, though the hypothesis has not been tested in humans.

The complexity of the topic and study limitations, such as the absence of data about individuals’ social networks, diet and degree of objective social isolation versus subjective reports of loneliness, argue for larger, longer studies, wrote the authors.

“Loneliness may lead to changes in the gut microbiome or, reciprocally, alterations of the gut milieu may predispose an individual to become lonely,” said Dilip V. Jeste, MD, Distinguished Professor of Psychiatry and Neurosciences at UC San Diego School of Medicine and senior author of the paper. “We need to investigate much more thoroughly to better understand the phenomenon of the gut-brain axis.”

Co-authors include: Xinlian Zhang, Tsung-Chin Wu, Jinyuan Liu, Collin Le, Xin M. Tu and Rob Knight, all at UC San Diego.


Fundamental Link Between Emotions And Sound Perception Identified In New Study

We all know that certain songs and musical phrases can have a tremendous impact on the way we feel, but did you know that the way we feel has a tremendous impact on the way we perceive sounds?

Sound does not only affect our emotions &mdash our emotions also affect the way recognize and process sound. It&rsquos the neurological phenomenon by which we shrug on hearing signals similar to our alarm clock, and by which combat veterans suffering from post-traumatic stress disorder (PTSD) can have horrifying memories stirred up by the sound of thunder.

For a long time, the neurological mechanism behind these subjective, often troubling associations have remained a mystery. Now, in a study published in Nature Neuroscience, researchers from the Perelman School of Medicine at the University of Pennsylvania may have taken the first step towards a comprehensive model of the associative process underpinning the phenomenon.

"Emotions are closely linked to perception and very often our emotional response really helps us deal with reality," senior study author Dr. Maria N. Geffen, an assistant professor of head and neck surgery, told reporters. "For example, a fear response helps you escape potentially dangerous situations and react quickly. But there are also situations where things can go wrong in the way the fear response develops. That's what happens in anxiety and also in PTSD &mdash the emotional response to the events is generalized to the point where the fear response starts getting developed to a very broad range of stimuli."

In other words, our &ldquoauditory plasticity&rdquo &mdash or, the process whereby our perception of sound adapts according to the aural patterns we experience &mdash can be influenced by strong emotions to a point where similar sounds are mistakenly yoked together and interpreted as connoting one and the same thing. In PTSD cases where thunder and other harsh aural patterns trigger harrowing memories, the soldier&rsquos fear has effectively altered the way he or she understands such sounds &mdash and instead of discriminating between &ldquogunshot&rdquo and &ldquodoor slamming,&rdquo the brain recognizes the enter spectrum as a unit corresponding to anxiety and danger.

In the study&rsquos experiment, lab mice were taught how to distinguish between safe and potentially dangerous sound frequencies &mdash a process referred to in the study as &ldquoemotional discrimination learning.&rdquo By varying the difficulty of the task, researchers were able to develop different levels of sound comprehension among the mice, with certain subjects exhibiting much higher hearing acuity that others. The subjects exhibiting low acuity were intended to represent PTSD cases, where sound comprehension has been altered by a traumatic event.

"The animals presented with sounds that were very far apart generalize the fear that they developed to the danger tone over a whole range of frequencies, whereas the animals presented with the two sounds that were very similar exhibited specialization of their emotional response. Following the fine conditioning task, they figured out that it's a very narrow range of pitches that are potentially dangerous," Geffen explained.

By identifying the neurological mechanisms associated with PTSD, the study may anticipate key features of future treatment programs for the debilitating condition. In addition, it may potentially help researchers determine why seemingly traumatic events affect different people in vastly different ways.


COVID-19 Loneliness

As the world slowly sheds the weight of COVID-19, there is an opportunity for psychiatrists to pause and consider the role they are about to play in the coming months and years. Never before has the entire modern world been subjected to such collective feelings of fear, uncertainty, anxiety, and sorrow—and loneliness.

Individuals around the world did their part to slow the spread of COVID-19 by staying home. Populations that were not used to being alone, like children and teenagers, were suddenly cut off from their social networks. Family members were often isolated from each other. Many individuals have died from COVID-19, often without family, with little comfort or human contact except hospital staff.

About 36% of Americans reported feeling “serious loneliness” in the wake of the pandemic, according to Loneliness in America, a recent report by Harvard University. 1 Of these respondents, 61% were aged 18 to 25 years, and 43% reported increases in loneliness since the pandemic began.

The effects of pandemic-related isolation have been felt in every corner of society. It may take the form of exacerbated symptoms in some patients or freshly developing signs of mental illness in others. Medically, loneliness has been linked to heart disease and stroke. 2 It is also linked to increased rates of depression, anxiety, substance abuse, domestic abuse, and suicide. 3

Psychiatry often relies on pharmaceuticals to treat mental illness this pandemic serves as a good reminder that the best cure for loneliness can be as simple as kindness and compassion.

Studying Loneliness

More than any other species, humans are dependent on others for longer periods of time. In fact, the average individual spends about 80% of their waking hours in the company of others. 4 Loneliness is a state of mind that is characterized by feeling unwanted, empty, and cut off from other human beings. 5 It is also described as a negative reaction to the discrepancy between the relationships we desire versus those we have.

Loneliness is not necessarily the result of being alone. One can easily feel lonely even when surrounded by others. Because loneliness is more often a perception, feelings of isolation can trigger hypervigilance, in which the world appears to be a threatening place. 6 Individuals who are lonely tend to be more critical of themselves. 7 When these negative expectations are confirmed by the behavior of others, this creates a loneliness loop that is accompanied by feelings of hostility, stress, pessimism, anxiety, and low self-esteem. 8

Loneliness apparently loves company, with studies describing it as contagious. 9 It appears to spread through friends, rather than family members, and occurs in clusters, extending up to 3 degrees of separation. 10 Loneliness can be addressed both as a group and individually. One way to prevent loneliness is to encourage social activity. Obviously, for some people it is very hard to be social this is where emphasizing resiliency and perseverance is important.

“In loneliness, the lonely one eats himself in a crowd, the many eat him,” Friedrich Nietzsche once said. 11 Culturally, loneliness can be seen as a sign of weakness or self-pity. For instance, 1965 study of rhesus monkeys Found that when a group of socially isolated monkeys were reintroduced to their colony, they were driven off or eliminated. 12

In 2018, the United Kingdom’s BBC Radio 4 released results from The Loneliness Experiment, the largest survey ever conducted on the subject. 13 They study included more than 55,000 participants, aged 16 to 99 years, hailing from 237 countries, islands, and territories. It found that loneliness was higher in individualistic cultures such as the United States and Western Europe, which placed high value on self-reliance, loose social networks, and chosen relationships. In contrast, cultures with strong collectivist norms, including some Asian countries, are built on interdependence, tighter social networks, and stronger family connections. Some of these countries include Brazil, India, and the Philippines.

The study found young individuals experienced the most loneliness, with 40% of 16- to 24-year-olds feeling lonely often or very often, in comparison with 29% of individuals aged 65 to 75. Young men in particular were more susceptible to feelings of loneliness, and their loneliness was more intense and longer-lasting.

Most of the research on loneliness was conducted before COVID-19 sent us into lockdown, so it is too soon to consider the pandemic’s long-term effects. However, recent studies have tracked the impact of social distancing and quarantine, and they have left an intriguing bread-crumb trail of predictions.

Pandemic Worries

When COVID-19 struck, many experts worried suicide rates would skyrocket. 14 A 2020 report from the Centers for Disease Control and Prevention showed a 35% increase in suicide mortality in the US from 1999 to 2018, a trend most people expected to continue. 15

A March 2020 rapid review disseminated 24 studies in 10 countries that examined the psychological impact of quarantine. 16 It included those affected by SARS, Ebola, H1N1 influenza, Middle East respiratory syndrome, and equine influenza. Common quarantine side effects included posttraumatic stress disorder (PTSD), confusion, and anger. Stressors included the extension of quarantines, fear of infection, frustration, boredom, inadequate supplies and information, financial loss, and stigma.

The review also found health care workers in particular suffered from the loneliness and isolation of quarantine. Theyendured increased severe symptoms of PTSD, felt stigmatized, and reported greater loss of income. Health care workers also reported feeling lonely, guilty, angry, helpless, isolated, nervous, and sad. Many linked their quarantine experience to alcohol abuse and dependency symptoms. They also engaged in avoidance behavior, often not showing up to work or avoiding direct interactions with patients.

Like every facet of society, health and mental health organizations have had to rethink how to serve their patients, especially when they could not be treated in person. Mental health care providers were encouraged to find alternate ways to deliver services, provide clear pathways for those considering suicide, and quickly offer bereavement services when needed. We can assess for loneliness by using the revised University of California, Los Angeles (UCLA) loneliness scale. 17 One way to approach the conversation is to ask patients what they are doing during their free time and if they have any friends or family they spend time with. Since the COVID-19 pandemic, it is likely a lot more patients have indicated they are lonely.

Nurturing the Doctor-Patient Alliance

A 2018 meta-analysis examined the relationship between 30,000 patients and their therapists. 18 In a review of 295 independent studies published between 1978 and 2017, it found that positive clinical outcomes correlated with the strength of the therapeutic alliance between patients and their therapists. The better the relationship, the better the prognosis. The therapeutic alliance has become even more important due to the pandemic and quarantine. As psychiatrists, we must strengthen our relationship with patients so they trust us and improve. This is just as important and essential as medication management.

Individuals need quality information and strategies to cope with loneliness, in addition to help identifying and managing self-defeating thoughts. Comprehensive assessments like the revised UCLA Loneliness Scale and access to round-the-clock counseling networks could throw vital lifelines to patients suffering from loneliness. 19

Innovative Programs

In France, the VigilanS suicide prevention system was implemented before COVID-19 began. It rapidly adapted by following up with at-risk patients on the 10th day rather than the 20th. Early data regarding this intervention shows a sharp decrease in suicide attempts by those involved, however this is an ongoing study and final results are not yet published. 20 France’s art community also jumped to provide support. Cov’ Art is a public art movement designed to shore up resilience and provide messaging about suicide and interindividual violence. Some programs in the US include the National Alliance on Mental Illness, the National Suicide Prevention Lifeline, and the American Foundation for Suicide Prevention.

Social media, smartphones, and videoconferencing have also played a huge role in maintaining connections. Prior to COVID-19, social media was seen as something that made many individuals feel lonely. 21 During the pandemic, however, social media was one of the few safe ways to stay in contact with other people. In one study, it was noted that while adolescents indicated increased social media use during lockdown, it was not associated with increased happiness. It even showed a negative correlation between using social media and happiness. It also noted that using social media as a substitute for physical social relations makes adolescents feel less happy. 22

More than anything, individuals need to be comforted that they are not alone and shown a way to overcome their loneliness. Often, the solution is to address loneliness with kindness. A 2015 study observed 2 groups for 6 weeks 1 that performed acts of kindness for themselves and 1 that conducted good deeds for others. 23 The group that behaved altruistically flourished psychologically through improved social relationships and feelings of greater joy and wellbeing.

Harvard’s Loneliness in America study suggested that how we treat loneliness is a bellwether of not only society’s emotional and physical health but also its moral health. 24 In a society where many prioritize themselves, we need to help our patients—and ourselves—commit to being both present and compassionate for each other.

Pulling Together

Ironically, suicide rates generally dip after major events that are shared by large populations. 25 During COVID-19, CDC statistics found provisional suicide mortality rates in 2020 fell by 5.6% compared to 2019. 26 Provisional suicide mortality rate estimates provide an early indication of shifts in suicide mortality trends. 27 After the 9/11 terrorist attacks, suicide rates in New York declined significantly during the 180 days after the event. 28 Researchers suggest that a “pulling together” effect may be the reason behind this phenomenon. Shared experiences during COVID-19 led to a powerful sense of togetherness that helped to keep suicidal thoughts in check. Indeed, a 2006 study suggested that the “need to belong is so powerful that, when satisfied, it can prevent suicide.” 29 It noticed that fewer suicides occurred on Super Bowl Sundays, likely due to an increase of shared membership and group interaction on those days.

It is this line of reasoning that developed the Three-Step Theory. 30 First, suicide ideation occurs as a reaction to feelings of psychological pain and hopelessness. Second, feelings of connectedness were a key protective factor against escalating ideation. Third, suicide follows ideation when a someone determines they have the disposition and practical capacities to carry out the event.

To be sure, the stress of COVID-19 has affected mental health around the world. A CDC survey reported that more than 40% of respondents had symptoms of anxiety or depression. 31 It is interesting that while suicide rates declined, depression rates have increased. Major events that affect a whole population have an interesting effect in decreasing suicide while increasing rates of depression. Additionally, 26% indicated that they had started or increased substance use as a way to cope.

As psychiatrists, we tend to be biased in thinking that everything can be fixed with medication however, the danger is that we forget to see the human person in front of us. While medication can help, often their problem is much more complex and needs more than medication treatment. We should not overlook patients we think are lonely and instead provide tips, such as being active on social media and staying in touch with friends through Zoom and Facebook. Although in-person relationships are always better than virtual ones, virtual ones are better than nothing. The worst thing to do when lonely is to completely isolate and not talk to anyone through social media.

As psychiatrists, we are on the front lines and can affect whether some people live or die. Let us rise to the occasion and treat everyone with kindness and compassion and in doing so, save thousands of lives.

Dr Lagoy is staff psychiatrist at Community Psychiatry in San Jose, CA.

1. Harvard University. Loneliness in America: How the pandemic has deepened an epidemic of loneliness and what we can do about it. February 2021. Accessed May 13, 2021. https://mcc.gse.harvard.edu/reports/loneliness-in-america

3. Weeks DG, Michela JL, Peplau LA, Bragg ME. (1980). Relation between loneliness and depression: A structural equation analysis. Journal of Personality and Social Psychology. 198039(6):1238-1244.

4. Kahneman D, Krueger AB, Schkade DA, et al. A survey method for characterizing daily life experience: the day reconstruction method. Science. 2004306(5702):1776-1780.

6. Hawkley LC, Cacioppo JT. Loneliness matters: a theoretical and empirical review of consequences and mechanisms. Ann Behav Med. 201040(2):218-227.

7. Besser A, Flett GL, Davis RA. Self-criticism, dependency, silencing the self, and loneliness: A test of a mediational model. Personality and Individual Differences. 200335(8):1735-1752.

8. Breann A. What is the loneliness loop and how can I break free from it? Younique Foundation. Accessed May 13, 2021. https://youniquefoundation.org/what-is-the-loneliness-loop-and-how-can-i-break-free-from-it/

9. Remes O. Loneliness is contagious – and here’s how to beat it. Cambridge University. July 16, 2018. https://www.cam.ac.uk/research/discussion/loneliness-is-contagious-and-heres-how-to-beat-it

10. Cacioppo JT, Fowler JH, Christakis NA. Alone in the crowd: the structure and spread of loneliness in a large social network. J Pers Soc Psychol. 200997(6):977-991.

11. Nietzsche F. A Nietzche Reader Selected and translated. Penguin Books 1984.

12. Harlow HF, Dodsworth RO, Harlow MK. Total social isolation in monkeys. Proc Natl Acad Sci USA.196554(1):90-97.

14. Courtet P, Olié E, Debien C, et al. Keep socially (but not physically) connected and carry on: preventing suicide in the age of COVID-19. J Clin Psychiatry. 202081(3):20com13370.

15. Hedegaard H, Curtin SC, Warner M. Increase in suicide mortality in the United States, 1999–2018. NCHS Data Brief, no 362. National Center for Health Statistics 2020.

16. Brooks SK, Webster RK, Smith LE, et al. The psychological impact of quarantine and how to reduce it: rapid review of the evidence. Lancet. 2020395(10227):912-920.

17. Hughes ME, Waite LJ, Hawkley LC, Cacioppo JT. A short scale for measuring loneliness in large surveys: Results from two population-based studies. Res Aging. 200426(6):655-672.

18. Flückiger C, Del Re AC, Wampold BE, Horvath AO. The alliance in adult psychotherapy: A meta-analytic synthesis. Psychotherapy. 201855(4):316-340.

19. Russell D, Peplau LA, Cutrona CE. The revised UCLA Loneliness Scale: concurrent and discriminant validity evidence. J Pers Soc Psychol. 198039(3):472-80.

20. Fossi Djembi L, Vaiva G, Debien C, et al. Changes in the number of suicide re-attempts in a French region since the inception of VigilanS, a regionwide program combining brief contact interventions (BCI). BMC Psychiatry.202020(1):26.

21. Pittman M, Reich B. Social media and loneliness: Why an Instagram picture may be worth more than a thousand Twitter words. Computers in Human Behavior. 201662:155-167.

22. Cauberghe V, Van Wesenbeeck I, De Jans S, et al. How adolescents use social media to cope with feelings of loneliness and anxiety during COVID-19 lockdown. Cyberpsychology, Behavior, and Social Networking. 202124(4):250-257.

23. Nelson SK, Layous K, Cole SW, Lyubomirsky S. Do unto others or treat yourself? The effects of prosocial and self-focused behavior on psychological flourishing. Emotion. 201616(6):850-61.

24. Weissbourd R, Batanova M, Lovison V, Torres E. Loneliness in America: How the pandemic has deepened an epidemic of loneliness and what we can do about it. Harvard Graduate School of Education. February 2021. https://mcc.gse.harvard.edu/reports/loneliness-in-america

25. Nishio A, Akazawa K, Shibuya S, et al. Influence on the suicide rate two years after a devastating disaster: A report from the 1995 Great Hanshin-Awaji earthquake. Psychiatry Clin Neurosci. 200963(2):247-250.

26. Ahmad FB, Anderson RN. The leading causes of death in the US for 2020. JAMA. March 31, 2021. https://jamanetwork.com/journals/jama/fullarticle/2778234

27 Ahmad FB, Cisewski JA, Miniño A, Anderson RN. Provisional Mortality Data - United States, 2020. MMWR Morb Mortal Wkly Rep. 202170(14):519-522.

28. Claassen CA, Carmody T, Stewart SM, et al. Effect of 11 September 2001 terrorist attacks in the USA on suicide in areas surrounding the crash sites. Br J Psychiatry. 2010196(5):359-364.

29. Joiner TE, Hollar D, Van Orden K. On Buckeyes, Gators, Super Bowl Sunday, and the miracle on ice: “Pulling together” is associated with lower suicide rates. J Soc Clin Psychol. 200625(2).

30. Klonsky ED, May AM. The Three-Step Theory (3ST): A new theory of suicide rooted in the “ideation-to-action” framework. J Soc Clin Psychol. 20158(2).

31. Czeisler ME, Lane RI, Petrosky E, et al. Mental health, substance use, and suicidal ideation during the COVID-19 pandemic — United States, June 24–30, 2020. Centers for Disease Control and Prevention. 202069(32):1049-1057.


Everything You Need To Know About Anxiety

First and foremost, it's important to note the contrast between feeling nervous and experiencing clinical anxiety, which can be debilitating and otherwise involve outside treatment. In many settings, the two cases are synonymously referenced which can create confusion. Knowing and comprehending the difference between the two is better for everyone.

Feeling Nervous

As previously stated, it's normal to feel nervous when you're stepping out of your comfort zone or trying something new for the first time. During times like these, pushing through the nerves and feelings of discomfort is what matters. Nervousness should never impede your ability to grow, push yourself, and open yourself up to opportunities which would otherwise be unavailable. As a matter of fact, being able to rise above feeling nervous is a great sign and can build character in many situations.

Sometimes feeling nervous is a sign of danger or a sign that someone shouldn't do something which may get them into trouble. Sometimes people feel nervous before committing a crime, lying to their significant other, or otherwise behaving in ways which are dishonorable and not upstanding. In these situations, you shouldn't pull back from what you're thinking of doing. Sometimes feeling nervous is a good thing it can actually protect us from danger and keep us from making mistakes which we will later come to regret. This is why it's so important to be in tune with yourself and how you feel. Your emotions exist and come to the surface for a reason.

Clinical Anxiety

Those living with clinical anxiety generally experience feelings of nervousness or worry to a greater degree than those without it. Because the symptoms are often more severe, clinical anxiety should be treated accordingly. When someone without anxiety experiences nervousness, they're usually able to manage or push through this emotion without allowing it to negatively impact their ability to function and do well in everyday life. Clinical anxiety, however, is a whole other ballgame, and it's important for people to be cognizant of this.

There are many symptoms and common behaviors which are linked to clinical anxiety. More often than not, clinical anxiety is present when someone has a difficult time functioning due to their anxiety. This could take the form of struggling to concentrate, not feeling motivated, withdrawing from others, harboring extreme worries about the past or future, etc. Whenever someone experiences clinical anxiety, it's very important for them to have a strong, healthy support system. This is helpful for anyone, but especially paramount for those who struggle with their mental health.

Exploring The Psychology Of Anxiety

In the mainstream, there is lots of talk about anxiety, its symptoms, and how to treat it. However, the actual psychology of anxiety is a matter which is discussed much less commonly, yet is very critical for understanding mental health and the experiences of people who undergo anxiety. In most cases, the psychology of anxiety boils down to control, the interpretation of a particular situation, belief systems, and the overall ability (or lack thereof) to cope in situations which are not pleasant or comfortable.

It's fair to state that most people feel better in situations where they are in control. This is understandable &mdash when you're in control, you have the ability to manage what happens, what goes on, and what your experiences are. However, there will inevitably be situations in life where you're not able to control what's happening. One of the realities of life is that we cannot control every single thing that happens to or around us. In spite of this, we can control ourselves and the manner in which we react. Sometimes this presents more of a challenge than other times, which is where anxiety enters the equation.

The manner in which control is perceived can greatly impact degrees of experienced anxiety. It turns out that the experiences someone has can determine their perception of control and how they are able to cope when control is seemingly absent. If these experiences are hurtful, traumatic, and not dealt with, then this can cause problems, many of which manifest in the form of anxiety.

Interpretations Of Situations

Things are not always what they appear to be, yet the manner in which someone interprets a situation can greatly impact their emotional state. Under duress, it can be very easy to experience stress, anger, and other negative emotions. In many cases, when a situation is believed to impact a person's well-being, whether it's their physical, emotional, or financial well-being, this can generate feelings of nervousness or worry.

In essence, situations which are interpreted as threats tend to bring about various symptoms of anxiety. This is normal, particularly for anyone with a healthy sense of self-preservation. As human beings, we want to maintain safety and steer clear of danger. As previously stated, symptoms of anxiety tend to surface during circumstances where danger is present.

Belief Systems

Many people don't realize this, but there is a psychological link between belief systems and anxiety. If someone walks into a job interview and sees that the other candidates who are preparing for the job are wearing more formal attire, they may experience worry or nervousness. These feelings would be brought about by the belief that their chances of getting their dream job will be slim, due to the manner in which their competition is dressed. This may or may not be accurate, but the belief system has triggered the feelings of anxiety in this particular case.

Coping In Uncomfortable Situations

Anyone who has found themself in a challenging situation knows how tough it can be to cope. Believe it or not, the ability to cope during unpleasant times shares strong connections with the amount of control which a person believes they have. This doesn't mean that the two are completely tethered, but there are definitely links. When someone feels helpless and powerless, this is significantly more likely to generate feelings associated with anxiety, as opposed to a different situation where someone believes that things will eventually blow over.

Treatments For Anxiety

When anxiety interferes with a person's ability to successfully function in the world and do well for themselves, then that presents a very real problem. Left unchecked, anxiety can negatively impact relationships, businesses, professional opportunities, finances, and so much more. This is why having access to the various treatment options for anxiety is paramount.

Personal Lifestyle Choices

Believe it or not, the lifestyle that a person lives can significantly reduce or do away with feelings associated with anxiety in some cases. Some of the best lifestyle choices to help manage anxiety include living a balanced lifestyle, maintaining steady routines, eating a healthy diet, and avoiding caffeine, drugs and alcohol. Surrounding yourself with positive, like-minded people also makes a great difference as well. It's amazing, but the people in our lives truly have the power to increase or decrease the feelings of anxiety we experience.

Professional Therapy

Try as we might, dealing with anxiety on our own is not always possible&hellipand that's okay. As a matter of fact, it can actually be enlightening and beneficial to see a therapist. Working with a professional can not only help you learn more about anxiety and how to control it, but also afford you the luxury of learning more about yourself and who you are. Sometimes, it can be scary to open up to someone you've never met and share intimate details about yourself, even if they are a therapist. However, it's important to remember that a therapist is there to help you, not pass judgement on you.

A Final Word

The world would be a much better place if more people understood anxiety, the psychology behind it and the appropriate methods of treatment. Unfortunately, this condition is often stigmatized, and people are simply told to brush it off and get over it. This doesn't help and can make a tense situation ten times worse.

Whether you're dealing with anxiety or another matter entirely, it's important for you to know that you are not alone. Things may seem confusing or scary, but there are always people out there who are willing to help if you allow them to do so. Here at BetterHelp, we have an amazing team of therapists who would be thrilled to sit down with you and be of service. No matter who you are or what you may be going through, you are not alone.

Frequently Asked Questions (FAQS)


What is an anxiety disorder and its relationship to psychology?

Anxiety disorders are mental illnesses that cause substantial fear or worry that generally do not go away and can get worse in the long run.

We all feel nervous or worried from time to time. It is the way your brain reacts to stress and alerts you of the possible dangers ahead. However, if you are experiencing anxiety disorders in your daily life, it means that your symptoms are likely consistent and severe.

How does a psychologist help with anxiety?

Your psychologist will first examine you and ensure no physical triggers are causing your panic attacks or panic disorder.

Once it is established that you have physical symptoms of an anxiety disorder or panic disorder, you may require the services of a mental health professional to help you manage your anxiety disorders.

Many people don&rsquot realize that their anxiety disorders, panic attacks, or panic disorders can be treated.

Most people living with social anxiety respond well to talk therapy and medication. For talk therapy, there is cognitive behavioral therapy (CBT) which can help you understand different ways of thinking and how to manage anxiety disorder.

What are the different types of anxiety disorders?

  1. Specific Phobia: This is an excessive fear or anxiety related to an object or situation that almost always triggers an anxiety reaction or fear response in an individual. Phobia can lead to panic disorder and harm your mental health by making you avoid the object or situation.
  2. Separation Anxiety Disorder: This is a type of anxiety disorder that occurs when an individual experiences fear or anxiety from being separated from another person. Separation anxiety disorder is usually triggered when a person feels they can&rsquot survive without another individual.
  3. Social Anxiety Disorder (Social Phobia): Social anxiety disorder, also known as social phobia, is a type of anxiety disorder that results in extreme fear while in social situations. People living with social anxiety disorder find it difficult to meet new people, talk to people, and attend social gatherings. They are usually scared of being judged by others.
  4. Panic Disorder: This is occurs when an individual experiences consistent panic attacks for no obvious reason. Feelings associated with panic can be normal, but if they become consistent and severe, this may signal that the individual has a panic disorder.
  5. Agoraphobia: This is a type of anxiety disorder characterized by the fear of situations and places that might cause embarrassment, panic, or a lack of protection.
  6. Generalized Anxiety Disorder: GAD is characterized by consistent worry, restlessness, stress, or trouble concentrating.

You can manage symptoms of anxiety by doing the following:

Reduce/eliminate alcohol: A lot of people use alcohol to deal with anxiety. However, this can cause symptoms to worsen. Also, if you continue to rely on alcohol, you may begin to depend on it.

Quit smoking: Like alcohol, a lot of people rely on cigarettes when they experience anxiety. However, research suggests that smoking increases your risk of experiencing anxiety disorder in the future.

What is the first sign of anxiety?

According to the American Psychological Association, common physical symptoms of anxiety include tension or restlessness, increased blood pressure, nervousness, dizziness, sweating, the feeling of an imminent disaster, and doom or panic, among others.

Does anxiety go away if you ignore it?

If you are experiencing mild anxiety, it might go away on its own if whatever triggers it is no longer in the vicinity or has stopped happening.

However, if you are living with chronic anxiety and you ignore it, it can get worse and affect your daily life.

What are the main causes of anxiety?

The major causes of anxiety are the following:

Family history of a mental health condition: A family history of anxiety can lead to an increased risk of developing an anxiety disorder. However, it is important to note that just because your parents are living with an anxiety disorder or any other mental health condition, that does not mean you will automatically experience the same.

Stressful life event triggers, including:

  • Change of environment
  • Family problems
  • Relationship problems
  • Sexual abuse
  • Emotional abuse
  • Emotional shock after a traumatic event
  • Work stress
  • Pregnancy
  • Loss of a loved one

According to the American Psychological Association, anxiety can also be triggered by the anniversary of a traumatic event. Such events can be recreated by the survivors, thus triggering symptoms.

How are you diagnosed with anxiety?

Regardless of whether you're living with separation anxiety, obsessive compulsive disorder, or anxiety disorder, a doctor will conduct a physical examination and get to know your symptoms.

Furthermore, the doctor will determine what is causing the anxiety and offer their medical advice, and may recommend medication.

What will the doctor do for anxiety?

After the physical examination, the doctor will give you their medical advice and probably recommend medication, therapy, or a combination of treatments.

Exposure therapy is a form of cognitive-behavioral therapy that helps to reduce symptoms of anxiety.

You must stick to your doctor's medical advice and refrain from looking for solutions online but, if for any reason you&rsquore not satisfied with their medical advice, you may want to seek a second opinion.

Is anxiety a mental illness?
Occasional feelings of anxiety are normal but consistent and severe symptoms may mean you have an anxiety disorder.

Anxiety disorders belong to a group of mental illnesses that cause consistent and overwhelming fear and anxiety. This extreme anxiety can stop you from going to school or work, and make you avoid family and social gatherings.

Is anxiety considered a disability?
Anxiety disorders &mdash like phobias, obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), panic disorders, and generalized anxiety &mdash can be considered a disability in certain cases.

You may qualify for social security disability benefits once your condition is documented and severely debilitating.

What is the best job for someone with anxiety?
For someone living with an anxiety disorder, the following jobs may be beneficial:

  • Writer
  • Dog trainer
  • Counselor
  • Accountant
  • Artist
  • Landscaper
  • Stay at home parent
  • Computer Programmer

Can I take time off work due to stress?
If your doctor feels strongly that a break from work will help get rid of your stress condition, you may want to consider time away from your job.

As long as your doctor puts it in writing and your employer is okay with it, you're good to go.

With the Family and Medical Leave Act (FMLA), you are entitled to take up to 60 days unpaid job-protected leave every year and it doesn&rsquot have to be successive days.


Interpersonal Mechanism 3: Processing Emotions

Emotions are the primary language of interpersonal relationships, and central tasks in confronting and surmounting interpersonal problems in IPT comprise identifying, processing, and expressing emotions that arise. Early psychoanalytic theory viewed the very expression of emotions (�tharsis”) as curative, relieving internal tension created by repression (Freud & Breuer, 1955). Some conceptualizations of depression focused on repressed anger or 𠇊nger turned inward” (Abraham, 1911 Rado, 1928), implying that expressing anger openly might help alleviate depression.

Although some research supports this cathartic benefit for emotions such as aggression (e.g., Verona & Sullivan, 2008), contemporary emotion models emphasize the interplay of emotions and other factors. Emotion focused therapy (EFT) identifies emotion schemes – internalized emotional structures influenced by past interpersonal experiences – as major sources of distress and psychopathology (Greenberg & Watson, 2006). Mindfulness-based approaches propose that open, non-evaluative processing of emotions can alter cognitive appraisals, which are thought to worsen suffering (Lynch, Chapman, Rosenthal, Kuo, & Linehan, 2006). Mentalization-based treatment (Bateman & Fonagy, 2004) conceptualizes some psychiatric disorders as linked to confusion in interpreting emotional states. Its goal is to help the patient achieve reflective function – the ability to understand one’s own and others’ emotional states and to clearly distinguish them. This capacity putatively helps the patient to better modulate emotional responses (Bateman & Fonagy, 2004).

Processing Emotions within the Interpersonal Problem Areas

Interpersonal losses, changes, and conflicts generate varied, powerful emotions that individuals with depression and other psychiatric disorders may have difficulty tolerating, understanding, and expressing (Markowitz & Milrod, 2011). The individual in a role dispute, feeling frustrated and angry, may need help accepting the legitimacy and appropriateness of these feelings, understanding their interpersonal meaning (e.g., anger often means someone is bothering you, failing to respond to you) and then expressing them, perhaps initially in sessions and role plays with the therapist, and later directly to the relative, partner, friend, or boss. Someone experiencing a role transition, such as adjusting to a serious illness, may need to mourn the old role and adjust emotionally to the new role by increasing awareness, acceptance, and ability to express uncomfortable feelings of sadness, anger, shame, and guilt. The therapist seeks to help the patient first acknowledge the presence and depth of these feelings, then verbalize them, all the time accepting their legitimacy, validity, and social utility. In complicated grief, emotional processing may be a central thrust of IPT as the patient needs help processing the loss before s/he can reinvest in existing connections or establishes new ones.

Processing Emotions in IPT

IPT distinguished itself from Beck’s cognitive therapy partly through its emphasis on affect (feeling states) rather than cognitions or evaluative aspects of emotions (Elkin, Parloff, Hadley, & Autry, 1985). IPT invites, accepts, and validates affective expression, while emphasizing the interpersonal character and effects of emotions. Although its goal of processing emotions leads to overlap with subsequently developed emotion oriented therapies such as EFT and mentalization, IPT engages emotional processing primarily in the service of confronting and resolving the focal interpersonal problem. Emotion work is integral to adapting to interpersonal challenges, reacting to interpersonal stress, and overcoming conflicts. Again, IPT focuses on fixing the problem in the interpersonal context rather than an underlying problem in the patient. IPT further presumes that the psychiatric disorder may impede emotional processing and therefore resists drawing conclusions about lasting emotional handicaps which characterize personality pathology. By facilitating resolution of the problem area, emotional processing may contribute to enhanced social support and decreased stress ( Figure 2 ).

Broader Benefits of Emotional Processing

Although the primary goal of processing emotions in IPT is to facilitate resolution of the interpersonal problem, intensive work on difficult feelings their acceptance and consistent validation in a close, supportive therapeutic relationship and coaching on their constructive expression outside the therapy might expectably yield additional, broader lasting, emotional benefits for many patients. For example, patients should attain greater attunement to and normalization of feelings, and greater ability to express and verbalize such feelings in the interpersonal context ( Figure 2 , dashed line). Thus, Markowitz and colleagues (Markowitz, Milrod, Bleiberg, & Marshall, 2009) proposed that reflective function (Bateman & Fonagy, 2004), a presumably enduring ability to understand one’s own and others’ emotions, might mediate change in IPT for patients with chronic PTSD who are poorly attuned to their own emotional states.

Research on Emotional Processing

A secondary analysis of emotional factors in the TDCRP found that 𠇌ollaborative emotional exploration” was rated higher in IPT than in CBT sessions and that this dimension correlated with positive outcome (Coombs, Coleman, & Jones, 2002). However, this study used transcripts from a selected sample of sessions, and a coding system that overlapped problematically with alliance factors. State of the art assessment of emotional processing includes physiologic measures of arousal and ratings from taped sessions using validated coding systems. For example, Greenberg and Malcolm (2002) found that patients who experienced more intense emotions in EFT, as indicated by greater physiologic arousal, achieved greater problem resolution.[J14] IPT has yet to conduct such systematic examination of emotional factors.


The roles of fear of negative evaluation and social anxiety in the relationship between self-compassion and loneliness: a serial mediation model

Loneliness is an unpleasant experience of lacking desired interpersonal relationships. Abundant evidence has clarified the negative outcomes of loneliness, such as anxiety, even suicidal behaviors. However, relatively few is known about the internal buffering elements for loneliness, especially in adolescents. The current research aimed to investigate the relationship between self-compassion and adolescents’ loneliness, as well as the mediating roles of fear of negative evaluation and social anxiety in this relationship. A total of 871 Chinese adolescents completed a set of questionnaires, including the measures of loneliness, self-compassion, social anxiety and the fear of negative evaluation. We tested the proposed serial mediation model and the results suggested that self-compassion was negatively associated with loneliness, and social anxiety served as a mediator in the relationship. Besides, we found that the fear of negative evaluation and social anxiety serially mediated the negative association. Specifically, self-compassionate adolescents reported less fear of negative evaluation, which resulted in decreased social anxiety symptoms. In turn, the decreased social anxiety was linked to reduced feelings of loneliness. The present study sheds lights on the mediating effects of fear of negative evaluation and social anxiety in the relationship between self-compassion and loneliness. The theoretical and practical implications, as well as the limitations of the present study, are discussed.


Research examines how loneliness affects the social human brain

Research indicates loneliness is the perception of isolation -- even if one isn't actually isolated. Credit: iStock.com/lolostock

Loneliness is as close to universal as experiences come. Almost everyone has felt isolated, even rejected.

But the power of loneliness—its potential for causing depression and other serious health problems as well as its surprising role in keeping humans safe from harm—may be more profound than researchers had previously presumed, says neuroscience researcher John Cacioppo of the University of Chicago.

Cacioppo has spent nearly three decades exploring the social nature of the human brain, working to find the mechanisms behind traits such as loneliness, empathy, synchrony and emotional contagion. Through his research, funded by the National Science Foundation's (NSF) Directorate for Social, Behavioral and Economic Sciences, and the National Institute on Aging, he's helped turn loneliness from a curious afterthought in neuroscience to a serious area for research and explanation.

He and his collaborators have also incorporated new technology at each stage of their research, combining methods ranging from behavior studies to endocrinological testing, electrical and functional neuroimaging, and genetics. They're using those tools to identify the neural, hormonal, cellular and genetic mechanisms underlying social structures.

Using what they've learned, Cacioppo's team is evaluating therapies for loneliness, finding the most effective treatments and working to improve them. The researchers' collaborators include the U.S. Army, which turned to Cacioppo for help with studies that could be incorporated into training to help protect soldiers from isolation and related social problems.

During a visit to NSF, Cacioppo took some time to talk about loneliness—what it is, where it comes from and how it affects people.

Q. How do you define loneliness, in terms of your work?

A. It's defined as perceived social isolation. People can feel like they're on the social perimeter for a lot of different reasons. If you're the last one chosen on a high school team, that can feel really unpleasant. It's also clearly an evaluation of your net worth to that group. If that's a valued group, it matters to you. If it's not a valued group, it's no big deal.

That has effects on not just emotions but cognition. Research at Rush University has shown that older adults are more likely to develop dementia if they feel chronic loneliness.

Q. So just the perception, not whether or not someone is actually isolated, can trigger a physiological reaction?

A. Much of what goes with loneliness—behaviorally, physiologically—is so deep that we've got it in our genes. It's just like if I were to provide a painful stimulus to your arm, you would withdraw and complain of being hurt. That's not something you learn. The pain withdrawal reflex is in place due to your genetic endowment. And that mechanism is in place because it protects your body from tissue damage.

Loneliness is a mechanism that's in place because we need, as a social species, to be able to identify when our connections with others for mutual aid and protection are being threatened or absent. If there's no connection, there could be mortal consequences. Those are threats to our survival and reproductive success.

Q. Does that make loneliness almost like a fever—unpleasant, but there's a purpose to it?

A. That's exactly right. You would not want to eliminate the temporary feeling of loneliness. We've argued there's a benefit to that response to perceived isolation. But, like many individual variations of these kinds of states, there are pathologic extremes. I might be so sensitive to feeling connected or isolated as to be a complete wreck, or I can be so insensitive as to be a psychopath. That's just part of the normal distribution of individual differences that, for the most part, helps to protect our social body just as pain helps to protect our physical body.

Q. How does loneliness affect our social behavior and interactions?

A. When you feel lonely, you get more defensive. You focus more on self-preservation even though this is not done intentionally. Completely unbeknownst to you, your brain is focusing more on self-preservation than the preservation of those around you. This, in turn, can make you less pleasant to be around. Over time, this can increase the likelihood of negative social interactions. Thus, the focus on self-preservation can have short-term survival benefits but—if not reversed—can have long-term costs.

Q. It seems that loneliness can serve a useful purpose but—almost like an immune system that starts attacking things that aren't actually threats—it can go out of control.

A. That's exactly right. It's also very much like our stress system. Our stress system emerged in a different time of human history, and now we get stressed when we're in traffic. There's no saber-toothed tiger attacking there's no person with a spear coming to get me. I'm sitting in a safe car, but there's still that level of stress and hostility that a traffic jam can engender. Our stress response contributed to survival across human history, but in contemporary society chronic stress also contributes to morbidity and mortality.

Stress has an adaptive value, even today, although not to the extent we're expressing it. But knowing that does not mean we can simply turn it off when we wish. It's the same thing with loneliness. We're trying to educate the public about this, to say that loneliness isn't something that only certain individuals have. It's something we all have, we can all fall into, and nearly all of us experience at some point in our lives.

Q. Does this type of research into loneliness tell us anything about humans as a species?

A. The perception of loneliness is exacerbated by the feeling that one doesn't have anyone on whom he or she can depend or who can depend on him or her. As children, we're dependent on adults. When we grow to be adults, we think we're supposed to become independent—the king of the mountain. But in social mammals—not just humans—becoming an adult means being the individual upon whom others can depend. Our Western cultural notion of human nature does not capture our actual social nature particularly well.

Q. When you were starting your research into isolation decades ago, behavioral science and brain science weren't as closely linked as they are today, correct?

A. There were a number of people trying to put them together, but we didn't have the neuroimaging technologies we have today that have really transformed what we can ask. Today, someone can really look at the working, normal brain.

I was doing electroencephalography (EEG) 40 years ago, and we looked at very broad questions. I was doing it 20 years ago, and we looked at relatively sophisticated questions compared to 20 years prior, but not very sophisticated compared to today. I'm now asking questions about the whole brain in action rather than a single region in isolation. And genetics and genomics are also increasingly integrated into investigations of the social brain.

Q. The questions that you started asking at the very beginning of your research—have they led you on a linear path to where you are today? Or has your research taken you in unexpected directions?

A. Yes to both. The question we started with wasn't about loneliness and continues to not be about loneliness. It's about who we are as a species. What, fundamentally, are our brains doing? What are the factors that influence brain function? Partly, we're showing that the brain is organized in part to deal with and to promote salutary connections to other people. The fundamental question was "what is the social nature of our brain?"

One of the things that surprised me was how important loneliness proved to be. It predicted morbidity. It predicted mortality. And that shocked me. When we experimentally manipulated loneliness, we found surprising changes in the "personalities" of people. There's a lot more power to the perception of being socially isolated than any of us had thought.


It Takes Guts to Fend Off Loneliness and Achieve Wisdom

The evolving science of wisdom rests on the idea that wisdom’s defined traits correspond to distinct regions of the brain, and that greater wisdom translates into greater happiness and life satisfaction while being less wise results in opposite, negative consequences.

Scientists have found in multiple studies that persons deemed to be wiser are less prone to feel lonely while those who are lonelier also tend to be less wise. In a new study, published in the March 25, 2021 issue of the journal Frontiers in Psychiatry, researchers at University of California San Diego School of Medicine take the connection between wisdom, loneliness and biology further, reporting that wisdom and loneliness appear to influence — and/or be influenced by — microbial diversity of the gut.

The human gut microbiota is comprised of trillions of microbes — bacteria, viruses, fungi — that reside within the digestive tract. Researchers have known for a while about the “gut-brain axis,” which is a complex network that links intestinal function to the emotional and cognitive centers of the brain.

This two-way communication system is regulated by neural activity, hormones and the immune system alterations can result in disruptions to stress response and behaviors, said the authors, from emotional arousal to higher-order cognitive abilities, such as decision-making.

Past studies have associated gut microbiota with mental health disorders including depression, bipolar disorder and schizophrenia, as well as personality and psychological traits regarded as key, biologically based components of wisdom. Recent research has connected the gut microbiome to social behavior, including findings that people with larger social networks tend to have more diverse gut microbiotas.

The new Frontiers in Psychiatry study involved 187 participants, ages 28 to 97, who completed validated self-report-based measures of loneliness, wisdom, compassion, social support and social engagement.

The gut microbiota was analyzed using fecal samples. Microbial gut diversity was measured in two ways: alpha-diversity, referring to the ecological richness of microbial species within each individual and beta-diversity, referring to the differences in the microbial community composition between individuals.

“We found that lower levels of loneliness and higher levels of wisdom, compassion, social support and engagement were associated with greater phylogenetic richness and diversity of the gut microbiome,” said first author Tanya T. Nguyen, PhD, assistant professor of psychiatry at UC San Diego School of Medicine.

The authors said that the mechanisms that may link loneliness, compassion and wisdom with gut microbial diversity are not known, but observed that reduced microbial diversity typically represents worse physical and mental health, and is associated with a variety of diseases, including obesity, inflammatory bowel disease and major depressive disorder.

A more diverse gut microbiota may be less susceptible to invasion by outside pathogens, which could contribute to and help promote better resilience and stability of the community.

“It is possible that loneliness may result in decreased stability of the gut microbiome and, consequently, reduced resistance and resilience to stress-related disruptions, leading to downstream physiological effects, such as systemic inflammation,” the authors wrote.

“Bacterial communities with low alpha-diversity may not manifest overt disease, but they may be less than optimal for preventing disease. Thus, lonely people may be more susceptible to developing different diseases.”

Greater diversity of gut microbes may be associated with greater wisdom or vice versa similarly less diversity might mean higher likelihood of being lonely. Image is credited to UCSD

The relationship between loneliness and microbial diversity was particularly strong in older adults, suggesting that older adults may be especially vulnerable to health-related consequences of loneliness, which is consistent with prior research.

Conversely, the researchers said that social support, compassion and wisdom might confer protection against loneliness-related instability of the gut microbiome. Healthy, diverse gut microflora may buffer the negative effects of chronic stress or help shape social behaviors that promote either wisdom or loneliness. They noted that animal studies suggest that gut microbiota may influence social behaviors and interactions, though the hypothesis has not been tested in humans.

The complexity of the topic and study limitations, such as the absence of data about individuals’ social networks, diet and degree of objective social isolation versus subjective reports of loneliness, argue for larger, longer studies, wrote the authors.

“Loneliness may lead to changes in the gut microbiome or, reciprocally, alterations of the gut milieu may predispose an individual to become lonely,” said Dilip V. Jeste, MD, Distinguished Professor of Psychiatry and Neurosciences at UC San Diego School of Medicine and senior author of the paper. “We need to investigate much more thoroughly to better understand the phenomenon of the gut-brain axis.”

Co-authors include: Xinlian Zhang, Tsung-Chin Wu, Jinyuan Liu, Collin Le, Xin M. Tu and Rob Knight, all at UC San Diego.


Let’s talk about loneliness – the importance of social psychology

Loneliness is an expanding challenge for health and care, and something that could affect any one of us at any point in our lives. This year’s focal point is about reducing the stigma about loneliness. We’re using the opportunity to shine a light on some social psychology research and how it can help tackle loneliness.

Imagine a situation where a person can go for days, weeks, months without seeing anyone. This torturous scenario is often harnessed in prisons as a form of disciplining violent and disruptive prisoners as well as for ensuring staff and fellow prisoner safety. Worryingly, it is increasingly becoming a situation that many ordinary people are finding themselves in up and down the country.

The numbers surrounding loneliness are worrying [1] . It is estimated that over 40% of us will experience loneliness at some point in our lives. There is a strong association between loneliness and age. According to Age UK, there are 1.2 million chronically lonely older people in the UK, half a million older people go at least 5 or 6 days without seeing or speaking to anyone at all and the television is the main company for approximately two fifths of all older people.

While it is widely perceived to be problem in older generations, it is in fact a multi-age issue, with 9 million people in the UK of all ages either feeling often, or always lonely, with the highest proportion being 16-24 year olds.

In an economic sense, it’s been estimated that loneliness and disconnected communities cost the UK economy £32 billion every year [2] . When it comes to our health, chronic loneliness is as bad as smoking 15 cigarettes a day, worse for you than obesity and increases the risk of heart disease and your overall risk of an early death. Unsurprisingly, it is also bad for our mental health. Isolated people are often trapped in a vicious circle of having a mental health problem causing loneliness, and loneliness worsening their mental health [3] .

It is becoming an increasingly large challenge facing our society, and policy makers and the health and social care sector are starting to take notice.

But what about the psychology behind loneliness? Before developing and implementing policies that can tackle this societal challenge, it is important to understand the psychology behind loneliness, and how humans interact.

Research by the Social and Evolutionary Neuroscience Group at the Department of Experimental Psychology has been investigating human relationships for over two decades at both an individual human bonding level, and large scale community social cohesions.

Researching social psychology involves navigating a branch of complexities in human behaviour that are dynamic, unpredictable and depend on highly refined levels of cognition and social skills e.g. empathy.

Some interesting findings from a study [4] have found that support networks and friendship circles have different roles between men and women. Whereas men seem to make a sharp distinction between sexual relationships and their wider social networks, female social worlds seem to be more integrated: you can still see these clusters but there's more overlap between them, suggesting differences in how men and women create and maintain their social networks. This could have implications on the way inclusion and community building activities are designed between men and women, which could create a more tailored approach in alleviating loneliness and isolation in men and women.

The lab have also spent a number of years investigating various social activities and assessing their effectiveness in forging bonds.

From comparing of groups of singers to arts and crafts group sessions [5] , they realised that quicker social bonding occurs between members of choirs compared to arts and craft group members, signifying that singing is a true ‘ice-breaker’ when meeting new people.

Choirs vs crafts, could the members of the Clapham Community choir be forging stronger bonds than this arts and crafts group in Bramley

The group have also investigated dancing as a catalyst for improved bonding, and results have shown that exertive synchronised dancing causes a large release of endorphins, yielding more positive experiences and enhanced bonding.

For the non-dancers, non-musicians and non-artisans, the group has investigated the effectiveness of laughter, and have shown that laughter adds a significant amount to the capacity of humans to connect in supporting bonding activities [6] .

Laughter, could it be the ultimate social glue as seen here with the graduates of the Laughter Yoga University?

When it comes to looking at loneliness within the context of the digital revolution, the Social and Evolutionary Neuroscience group have been investigating the potential social isolation and the levels of bonding between humans whose relationships are more digital than traditional.

So why is this research important? We’re already seeing the impact of this research being embraced to support health and care. As part of the NHS Long Term Plan and Universal Personalised Care plans, social prescribing is becoming increasingly prevalent in health and social care settings.

Where you might have traditionally gone to your GP and received a prescription for medication, patient groups who would benefit from it are receiving social prescriptions. Examples include referrals to classes, choirs, dance groups, walking groups and community groups. This is particularly pertinent to patient groups who are at risk of loneliness and socially isolated.

Given the expanding research that Oxford and the Social and Evolutionary Neuroscience group has been contributing to the field of human social behaviour, we could see a vast enhancement and expansion in social prescribing in the very near future.

A fascinating and resonant impact of how the work of social psychologists is helping tackle the challenges facing society today.