Point of care: Only lonely?

By Michael C. LaFerney | 09/17/2018

Recognizing loneliness is part of healthcare—your patients’ and yours.

Point of care: Only lonely?Loneliness can be harmful to one’s health. The author offers suggestions for overcoming those lonely feelings.

Michael LaFerney“Now, don’t you ever be ashamed; you’re only lonely.” So go the lyrics to the popular song “You’re Only Lonely,” recorded by J.D. Souther in 1979. One definition of loneliness is “when a person has fewer interpersonal relationships than desired or when these relationships are not as satisfying as desired” (Weiten, Dunn, & Hammer, 2015). 

Being “only” lonely can be detrimental to one’s health. Loneliness can lead to depression, alcoholism, immune system dysfunction, poor sleep, and a variety of illnesses (Hawkley & Cacioppo, 2009). People who are lonely often are shy and have poor social skills and a self-defeating attribution style. As our society becomes more mobile and hurried, we may lack the time to establish meaningful relationships (Weiten et al., 2015). 

Who is lonely?
As a clinical nurse specialist, I often see patients who come for treatment for a depressive disorder but, upon examination, realize they are “only” lonely! The prevalence of loneliness is unknown but thought to be quite high. Who is lonely? Adolescents and young adults are the loneliest age group. College students often complain of loneliness as do people who live alone and without a partner. Gay and lesbian college students, specifically, are likely to be lonely. Men are less likely to admit being lonely than women, but rates may be similar.

Even children can be lonely. They can learn social behaviors that promote rejection by peers, especially if they have an insecure attachment style with caregivers. Children can develop behaviors that lead to lifelong estrangement from others, leading in turn to chronic loneliness. 

There are several types of loneliness. Absence of a person with whom to share intimate feelings may cause emotional loneliness. Divorce or the death of a partner may lead to this type of loneliness. Social loneliness can develop if you lose your job and the friends with whom you had daily contact. The same can happen if you move to a new city for a job or to attend college. People can develop transient periods of loneliness even when things seem to be going well. The death of a partner or a move can trigger transitional loneliness. If a person goes for a long period without meaningful relationships, loneliness can become chronic and lead to depression and even suicide. 

How you can help your patients
So, how can you as a nurse help a person overcome loneliness? In my role as a counselor and therapist, I help reduce a client’s loneliness by being there, listening actively, reflecting feelings, and providing feedback about his or her situation and ways to improve it. Cognitive therapy is an important tool for changing negative thoughts that can lead to loneliness (Young, 1982).

Lonely people often have irrational thoughts, such as “I should be liked by everyone” or “I must be unlovable to be so lonely.” These thoughts can lead to self-defeating behaviors that further reinforce lonely feelings. Changing these cognitions can lead to behaviors that result in more self-promotion and interaction with others. 

Examining what they are doing to alleviate feelings of loneliness can help people determine if their efforts are working or if they need a new plan. “I haven’t met anyone at this activity; I think I’ll try something new” is more effective than “I tried going to this class and it didn’t work, so I gave up.” Also, seeing loneliness as temporary and due to an outside cause, as in “We tried it, and it didn’t work out,” is more effective in combatting loneliness than developing an ongoing internal frame of reference that observes, “I am so unlovable that I’ll never find anyone.” 

Encouraging clients to persist and try new things, instead of developing a pattern of avoiding social situations, is important. If a college student isn’t making friends in the classroom, suggest trying extracurricular activities, such as clubs or teams. 

Internet interaction
The statement “No one ever met another person by staying home” is no longer true. The internet offers a wide variety of ways to meet and interact with others. Online dating services can lead to meeting other people. Chat lines and games can also be played interactively on the net. Many patients with illnesses such as chronic fatigue syndrome say that internet support groups are a great way to connect with others.

One drawback of the internet, of course, is that people may develop internet addiction or avoid meeting people face to face in settings where intimacy can be shared (Weiten et al., 2015). Human touch is an important part of the human experience. 

Some people do not desire relationships with others, but that is more consistent with mental illness than “normal” behavior. For example, people with schizoid personalities do not care to be around other people, and whether you like them or not is not important to them. Patients with paranoia may avoid others and have difficulty maintaining relationships. People with social anxiety may avoid others for fear of embarrassment, which increases their feelings of loneliness. Patients with depression may lack the energy to meet others. Treating the symptoms of their illness may lead to better social interaction and decreased loneliness. 

Lonely? You’re not alone
If you occasionally feel lonely, know that you’re not alone. Over the years, loneliness has been the subject of many hit songs: In “Eleanor Rigby,” the Beatles sang, “Ah, look at all the lonely people!” To help ensure that loneliness is not a theme song for your patients—or you, for that matter—learn to recognize the symptoms and how to combat them by trying the above suggestions. RNL

Michael C. LaFerney, PhD, RN, PMHCNS-BC, is a psychiatric clinical nurse specialist at Arbour SeniorCare in Haverhill, Massachusetts, USA. 

References

Hawkley, L. C., & Cacioppo, J. T. (2009). Loneliness. In H. T. Reis & S. Sprecher (Eds.), Encyclopedia of human relationships (pp. 985–990). Thousand Oaks, CA: Sage Publications.

Weiten, W., Dunn, D. S., & Hammer, E. Y. (2015). Psychology applied to modern life (11th ed.). Stamford, CT: Cengage Learning. 

Young, J. E. (1982). Loneliness, depression, and cognitive therapy, theory and applications. In L. A. Peplau & D. Perlman (Eds.), Loneliness: A sourcebook of current theory, research and therapy. New York, NY: Wiley.

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