A new study revealed that adults who participated in an internet-based cognitive behavior therapy (ICBT) program to treat loneliness reported a significant decrease in loneliness that remained two years later. The findings were published in Internet Interventions.
Prolonged loneliness has been linked to a range of harmful outcomes, including adverse physical health effects and suicidal behavior. When it comes to the treatment of loneliness, CBT has shown the most potential. More recently, Internet-based CBT has been contemplated as a way to distribute such interventions.
Study authors Anton Käll and associates conducted a follow-up to an initial study (Käll et al., 2019) which demonstrated the effectiveness of ICBT interventions designed to target loneliness. In the follow-up study, the researchers aimed to clarify whether ICBT can effectively reduce loneliness in the long-term and whether the techniques learned during the intervention would play a role in its effectiveness.
The initial study included 73 adults with scores above 40 on the UCLA Loneliness Scale and who “reported subjective distress linked to a lasting experience of loneliness.” Participants were randomly assigned to either an 8-week ICBT treatment (36 subjects) or to a wait-list condition (37 subjects) where they would receive ICBT treatment only at the completion of the study.
The ICBT intervention included 8 modules that addressed loneliness using cognitive and behavioral techniques and included homework tasks. As the authors write, “The main focus of the intervention was to identify what might constitute valued social contact for the participant in question, increase behaviors that might realize this contact, and address obstacles that might hinder this realization (e.g. negative automatic thoughts, sensitivity to rejection).”
Results from the initial study showed that the ICBT treatment group showed significantly lower loneliness scores compared to the wait-list group.
To determine whether these positive effects would be long-term, the follow-up study was conducted two years after the initial treatment period. Forty-four of the original subjects participated in the follow-up and were re-assessed on loneliness, quality of life, generalized anxiety, depression, and social anxiety. They were additionally questioned on their use of treatment techniques and their use of additional psychotherapy.
Results from the follow-up study revealed a decrease in loneliness during the period from post-treatment to follow-up. Participants additionally showed a significant increase in quality of life and a significant decrease in social anxiety. For nearly 60% of the follow-up participants, loneliness scores indicated a statistically reliable change from pre-treatment assessment.
“Compared to the long-term effect of other ICBT interventions summarized by Andersson et al. (2018) the effects sizes in the present study were in the lower range. In sum, while treatment effects were maintained over time, they appear to be lower than the average effect from comparable internet interventions for other conditions,” the authors say.
Next, researchers analyzed subjects’ use of the techniques they had learned throughout treatment. The use of these strategies was relatively low, with subjects reporting using only 2.84 techniques on average during the follow-up period. Moreover, no technique was associated with reliable change throughout the study. As the authors explain, these findings can be interpreted in several ways.
The infrequent use of strategies could indicate that subjects did not encounter the opportunity to use certain techniques or that they simply did not remember them. Researchers say, “further investigations are warranted to help clarify if and how the rehearsal and use of the techniques actually help achieve enduring results in ICBT.”
The authors address that their study was limited by a small sample and a shortage of assessment points during the follow-up period and that further studies are needed to clarify their findings. Still, the study provides support for ICBT treatment in the long-term reduction of loneliness.
The study, “Lonesome no more? A two-year follow-up of internet-administered cognitive behavioral therapy for loneliness”, was authored by Anton Käll, Ulrika Backlund, Roz Shafran, and Gerhard Andersson.
