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Loneliness research and interventions: A

review of the literature
a
L. ANDERSSON
a
Section of Social Gerontology , Stockholm Gerontology Research
Center , Stockholm, Sweden
Published online: 09 Jun 2010.

To cite this article: L. ANDERSSON (1998) Loneliness research and interventions: A review of the
literature, Aging & Mental Health, 2:4, 264-274, DOI: 10.1080/13607869856506

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 A gin g & M ental H ealth (1998);2(4):264± 274

O RIG INA L A RTIC LE

Loneliness research and interventions: a review of the literature

L. AN DERSSON

Section of Social Geron tology, Stockholm Gerontology Research C enter, Stockholm , Sweden

A bstract
The paper describes and reviews concepts and studies in the area of social relations and health, with special em phasis on
loneliness. Related concepts such as social networks and social support are also considered. The fundamental distinction
between the objective manifestation of being alone and the subjective manifestation of experiencing loneliness is
Downloaded by [McGill University Library] at 12:43 20 November 2014

emphasized. The second part of the paper consists of a description of various network interventions followed by an
overview and discussion of loneliness interventions.

Introduction provide som e food for thought regarding interven-

F or quite som e time, there has been a growing
concern am ong policy m akers as well as am ong
practitioners that social relations are vital to mental
health and psychological wellbeing. In the report
`Psychogeriatric care in the com m unity’ , W H O
(1979) has listed three levels for prevention of insti-
tutionalization: prim ary prevention, which m eans to
be able to rem ain at hom e; secondary prevention,
w hich means discharge from hospital care as soon as
possib le; and tertiary prevention, which m eans the
prevention of deterioration in long-term patients.
F our to ® ve actions are recom m ended on each level
in order to reach the respective goals. At all levels,
prevention of social isolation or loneliness is listed as
necessary to w ellbeing.
There is also a concern w ith the role of interven-
tions and their in¯ uence on alleviating de® ciencies
in social relations. W ith respect to loneliness, W eiss
(1982) suggests that `it is im portant for those who
do research on loneliness to give thought to appli-
cation of their work. Concern for app lication can
help ensure that the research does not becom e ex-
cessively academ ic. The condition we are studying is
so disturbing that w e surely have som e responsibility
to do w hat we can to be helpful to those who
experience it.’
O ne purpose of this pap er is to brie¯ y review the
scienti® c efforts concerning social networks, with
special reference to w hat has been written about
loneliness. The latter is a pertinent restraint, as the
concept of networks generally has been used for
m any purposes. In the introduction, the broader
perspective will be brie¯ y presented. However, the
chief purpose is to review the ® eld in order to
tion initiatives.
For obvious reasons, m ost studies re¯ ect the situ-
ation in the W estern w orld; accordingly the cultural
setting will occasionally be referred to in the text.
W hile it is quite clear that societies differ to the
extent that aloneness is viewed as an integral part of
life or one to be avoided at all costs (Bow en, 1954;
D owns, 1972; Fortune, 1932; Larso n, 1990), m any
® ndings can nevertheless be generalized across dif-
ferent cultures.
Conceptual fram ework
For clarity it is necessary to describe and de® ne the
central concepts used throughout the text. Since
there is no consensus of de® nition, the view s of the
m ajority of scholars will be emphasized; som e
alternative standpoints w ill also be m entioned.
Social netw orks
T he concept social networks has its roots prim arily in
anthropology and sociology. W hile conducting re-
search in a ® shing parish in northern N orway,
Barnes (1954) noted the sim ilarity between the ways
the individuals were connected with each other and
the pattern of a ® shing net. An early de® nition
reads: `a speci® c set of linkages am ong a de® ned set
of persons, with the additional property that the
characteristics of these linkages as a whole m ay be
used to interpret the social behavior of the persons
involved’ (M itchell, 1969).
Once the concept of social networks became es-

C orrespondence to: Lars Andersson, PhD , Stockholm G erontology Research Center, Box 6401, S-113 82 Stockholm,
Sweden. Tel: 46 8 6905807 . Fax: 46 8 33 52 75. E-mail: Lars.Andersson;knv.ki.se
Received for publication 2nd February 1998. Accepted 3rd June 1998.
1360-786 3/98/040264± 11 $9.00 Ó Carfax Publishing Limited

tablish ed, divergent views of what it constituted
naturally emerged.
The concept used m ost often in mental health
w ork is the ego-centered network, which consists of
one particular individual and everyone that he or she
knows or interacts w ith (W einberg & M arlowe,
1983). Another term for this is anchorage. Social
netw orks can also be exam ined in terms of:
· Size/range/extent. The num ber of people in the
network;
· Density. The degree to which m embers of the
network know each other;
· Reachability/accessibility. T he extent to which one
can com m unicate with other mem bers of the net-
work;
· Directionality. T he extent to which relationships
are reciprocal (Auslander & Litwin, 1987;
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M itchell, 1969; W einberg & M arlow e, 1983).
Although there are other aspects of social networks,
the above-m entioned are the m ost frequently stud-
ied.
The individuals w ho are considered to be in-
cluded in a person’ s network are those w ho are seen
on a regular basis. T hey fall into the categories
relatives, friends, w ork-m ates, colleagues, etc. Ac-
cording to Erickson (1984), w ho writes from an
Anglo-Saxon perspective, the average social network
of an adult is usually com posed of 25 to 40 individ-
uals, w hereof three to six are intimates. In compari-
son the networks of psychiatric populations are
signi® cantly sm aller in size.
Social support and loneliness
D e® nitions and mutual relationship. Tw o concepts
often used by professio nals in this context are social
support and loneliness. In a general w ay they can be
seen as opposite notions. Social support is the posi-
tive pole and loneliness the negative. Social support
has been de® ned as `the degree to which a person’ s
basic social needs are grati® ed through interaction
w ith others’ (Thoits, 1982), or as `any m aterial,
inform ational, or emotional resource that, w hen ex-
changed am ong individuals, is perceived by the re-
cipient as bene® cial’ (W einberg & M arlowe, 1983).
Loneliness, on the other hand, has been de® ned as:
`the generalized lack of satisfying personal, social, or
com m unity relationships’ (Andersson, 1993c), or as
`an enduring condition of emotional distress that
arises w hen a person feels estranged from , m isun-
derstood, or rejected by others and/or lacks appro-
priate social partners for desired activities,
particularly activities that provide a sense of social
integration and opportunities for emotional inti-
m acy’ (Rook, 1984a).
These are the general notions, but there are ex-
ceptions. O ne exam ple can be seen concerning so-
cial support, where it has been noted that mem bers
of one’ s social network may be a source of problems
Loneliness research and interventions 265
and thus contribute to negative outcom es (G esten &
Jason, 1987; Rook, 1984b; T ilburg, 1985).
Concerning loneliness, m ost scholars agree that
there is also a positive form of loneliness. It is
voluntary, tem porary, self-in duced solitude, which
can be constructive when used for creative work
(From m -R eichm ann, 1959). To com plicate things
further, social support has often been used in the
negative sense, i.e. it is the lack of support that has
been em phasized in studies of social support and
wellbeing.
Although social support and loneliness m ay seem
to be a pair of concepts that can be used concur-
rently, this has actually been m ore the exception
than the rule and can be traced to the developm en-
tal history of the concepts. Social support research
has its source in the social network tradition. Lone-
liness research, on the other hand, has its roots in
research on personal relationships. This m eans that
research on social support and loneliness has fol-
lowed parallel tracks with m inimal cross-fertilization
as a result.
Objective versus subjective concepts. T here is one
fundam ental distinction to be m ade concerning all
the concepts m entioned, that is whether they rep-
resent an objective or a subjective phenom enon.
W hile social netw ork alm ost exclusively has been
regarded as an objective fact, and loneliness as a
subjective one, the opinion concerning social sup-
port is divided. Som e researchers have conceptual-
ized social support as an entirely objective
phenomenom , w hile others have conceptualized it
as entirely subjectiveÐ i.e. som ething that is per-
ceived by the recipient. In empirical research, it has
been used both ways, even in the sam e study (Cobb,
1976; Kahn & Antonucci, 1980; Sarason et al.,
1983).
W hat is valid for social support as well as for
loneliness w hen regarded as subjective phenom ena,
is the uncertainty which follow s from subjective
m easurem ents. If someone claim s that he or she
feels lonely, to what extent are w e prepared to
accept that an observed dysfu nction is asso ciated
with loneliness as such? A precautionary measure in
dealing with self reports has been brought up by
several authors (Costa & McCrae, 1987; W atson &
Pennebaker, 1989). C osta and M cCrae (1987)
claim to have identi® ed a single pervasive traitÐ
neuroticism Ð that represents a general tendency to
express negative em otionality. W atson and Pen-
nebaker (1989) report a sim ilar factor w hich they
term negative affectivity and assert that it is nearly
identical to anxiety.
It seems realistic to take into account som e sort of
general factor which in¯ uences respondents’ an-
swers to self-re port m easures. This in¯ uence has
been suggested to be a personality trait (Costa &
M cCrae, 1987). An alternative suggestion is that
state anxiety plays a central role. As soon as the
 266 Lars A ndersson
T ABLE 1. Com ponent models of social support and loneliness
W eiss (1974) C obb (1979) Kahn (1979)
Attachment Em otional support Affect
Social integration Network support
Reassurance of worth Esteem support Af® rmation
Reliable alliance M aterial support Aid
Guidance Instrumental support
Opportunity for
nurturance Active support*
*Cobb (1979) de® nes active support as re¯ ecting the receipt of care or `mothering’ by the target person, whereas Weiss (1974)
views opportunity for nurturance as re¯ ecting the target person providing care to others. From Cutrona and Russell (1987).
anxiety level is affe cted, it in turn in¯ uences answers
to various self-re port m easures.
M ain effect versus buffering effect. Concerning social
support, one further distinction m ust be m ade.
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T he use of this concept has centered around life
changes or life events. Social support is suggested to
act as a buffer against detrim ental effects resulting
from stressful situations. T his is termed the buf-
fering effect of social support, as opposed to the
m ain effect of social support, which refers to a direct
effect on w ellbeing. Explanations offered for m ain
effects tend to be quite general (Rook, 1984c). It
has been suggested that the netw ork provides the
individual w ith the feedback necessary for self-
m aintenance and wellbeing and protects against dis-
ordered functioning (Auslander & Litwin, 1987;
C assel, 1974). However, the proposed m odel clearly
requires further elaboration. More extensive empiri-
cal work has been done with the buffering m odel
than with the main m odel. In addition, m ore theor-
etical efforts have been m ade to interpret it. A
com m only held view is that the com ponents of
social support (as illustrated in Table 1) are m ore or
less bene® cial to the individual depending on the
particular type of stressful situation that exists. In
practice, this m eans that most results from research
on social support cover a limited part of social
relationships, due to the concentration on stress and
life events in the buffering m odel.
Loneliness
T hus, the effects of social support have been tested
in situations where som ething dram atic has occured.
In order to examine effects of enduring isolation, it
is m ore fruitful to approach loneliness research.
B eing alone versus experiencing loneliness. The rela-
tionship between the objective m anifestation of be-
ing alone and the subjective m anifestation of
experiencing loneliness is fundam ental to the under-
standing of the problems discussed in this review. It
is well established that a person w ho is alone or who
lives alone m ay either experience loneliness or not.
Likew ise, a person feeling lonely may be alone, live
alone or live with others. Of course, feelings of
Schaefer et al. (1981) C ohen et al. (1985)
Emotional support
Belonging support
Tangible aid Self-esteem support
Information support Tangible support
Appraisal support
loneliness are generally m ore comm on am ong those
living alone. It should also be pointed out that
feelings of loneliness on the individual level m ight be
m ore or less stable.
Social versus emotional isolation. The dichotom y
`social versus em otional isolation’ is im portant in
loneliness research. Em otional isolation can be seen
as the absence of an attachm ent ® gure in one’ s life,
whereas social isolation m ay be regarded as the
absence of a place in an accepting com m unity
(W eiss, 1973). O ne way of exam ining these con-
cepts is by using the sam e type of fourfold typology
as was used in the case of loneliness/aloneness. It
illustrates that an individual can be socially and
em otionally isolated, socially or emotionally iso-
lated, or neither socially nor emotionally isolated
(M ullins et al., 1988). People in the ® rst group
could bene® t from both social intervention pro-
gram s and psych ological therapies, and are m ost in
need of im m ediate social intervention and counsel-
ing.
C om ponents of support and loneliness
T he use of the terms social support or loneliness
does not m ean that they are seen as single entities
(cf. social versus em otional isolation). O n the con-
trary, there is a general consensus that different
com ponents of support and of loneliness should be
assesse d, because these com ponents seem to have
varying effects on outcom es (C ohen & W ills, 1985;
Kessler et al.). Several com ponent m odels have been
suggested. Cutrona and Russell (1987) have sum -
m arized som e m ajor m odels in the following m anner
(Table 1).
W eiss’ m odel is the only one that was originally
conceived in the context of loneliness, but it in-
cludes the m ajor elements of the conceptualizations
of social support (Cutrona & Russell, 1987). W hat
W eiss terms provisions are social functions that m ay
be obtained from social relationship s. W eiss claim s
that all six provisions are necessary in order to avoid
loneliness. Attachm ent is emotional closeness from
which one derives a sense of security; social inte-
gration is a sense of belonging to a group that shares
sim ilar interests and attitudes; reassurance of worth

is the recognition of one’ s com petence by others;
reliable alliance is the assu rance that others can be
counted upon for tangible assistance; guidance is
the assu rance that others can be counted upon for
advice or inform ation; and opportunity for nur-
turance is the sense that others rely upon one for
their wellbeing.
To com plete the overview, it must be m entioned
that loneliness has also been described in term s of
existential loneliness, m eaninglessness and self-
estrangement (Andersson, 1986; From m -R eich-
m ann, 1959). H owever, the latter concepts will not
be dealt with here.
E pidem iology of loneliness
O ne way to identify those who experience loneliness
is to exam ine com m on demograph ic factors, such as
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age, gender, m arital status and socio-econom ic
status. It is important to note that irrespective of the
various distinctions and com ponent models of the
concept, the empirical data has m ostly been based
on single-item m easures of the experience of loneli-
ness.
A ge
A curve depicting the proportions of different age
groups reporting loneliness assu m es the character of
a shallow `u’ . T hus, adolescents report loneliness to
a somewhat higher extent than adults and young-old
retirees (Andersso n, 1982; 1993c; Peplau et al.,
1982). Although the data is less frequent, it seem s as
if there is an increase of loneliness in the highest age
groupsÐ from approxim ately age 75 and up. It
should be noted that even when the proportions are
the sam e, the content of the loneliness feeling m ight
differ in age groups (Perlm an & Peplau, 1984).
According to m any studies, at least one person in
four reports loneliness to occur constantly or fairly
often, and a ® gure of app roxim ately 25% lonely is
quite frequent in nationw ide representative sam ples
from different countries (Andersso n, 1982; Peplau
et al., 1982). H ow ever, differences in the form u-
lation of questions and different cultural heritage
can m ake direct com pariso ns problematic (HofstaÈ t-
ter, 1957).
A Eurobarom eter study w as conducted in 1992/
93 in the then 12 countries of the European Union
plus Sweden. Q uestions regarding loneliness were
phrased identically in all countries. Respondents
w ere aged 60 and above. T he percentage w ho re-
ported often feeling lonely varied widely between
countries: from 4± 6% in D enm ark and Sweden,
7± 9% in G erm any, the N etherlands and the UK , to
10± 14% in Belgium , France, Ireland, Luxem bourg
and Spain, 17% in Italy, 23% in Portugal and 36%
in Greece (Andersso n, 1993a; W alker, 1993).
The ® gures support earlier studies, w hich have
shown that loneliness is m ore frequent in the tradi-
Loneliness research and interventions 267
tionally fam ily-oriented cultures of southern Europe
than in the m ore individualistic cultures of northern
Europe (Andersso n & SundstroÈ m , 1996; Im am oulu
et al., 1993; JylhaÈ & Jokela, 1990).
Gender
Although m ost studies show that wom en report
loneliness to a higher extent than m en, som e studies
report no differences (Andersso n, 1982; Peplau et
al., 1982; Q ureshi & W alker, 1989). Several inter-
pretations of the gender difference have been sug-
gested. It has, for exam ple, been proposed that there
is a gender bias in self-d isclosure, i.e. m en are less
prone to adm it feelings of loneliness (Peplau et al.,
1982). T here is, however, a confounding factor to
take into consideration.
M arital status
In studies w here m arital status has been exam ined
together w ith gender, an interesting pattern em erges
(Andersson, 1990; Peplau et al., 1982). Analyzing
the two factors together reveals that the group which
reports loneliness to the highest extent is non-m ar-
ried m ales, followed by non-married fem ales, and in
turn by m arried fem ales, and ® nally, m arried m ales.
T hus, it follows from these results that the rank
between the groups should have been different if
gender differences in self-d isclosure were the m ajor
explanation for differences in loneliness betw een
m ales and fem ales. In any case, the non-m arried
report loneliness to a higher extent than the m arried
(Andersson, 1990; Peplau et al., 1982; Townsend,
1973). It is im portant to notice, however, that this
association is not perfect and m any exceptions do
occur.
Socio-econom ic status
T his has not been a m ajor concern in loneliness
research. Some studies have reported a relationship
between loneliness and socio-econom ic status, i.e.
loneliness has been found to be m ore prevalent
am ong lower incom e groups (Perlm an & Peplau,
1984).
Apart from risk groups for loneliness identi® ed by
the well-known dem ographic variables, other groups
at risk can be identi® ed as well. Exam ples of such
groups are: single parents; fam ily caregivers; unem-
ployed; people who have m oved recently (either to a
new school, a new job or geographically); people
who live alone; people who have divorced or w ho
have becom e widows/widowers (Perlm an & Peplau,
1984).
It has been suggested that social isolation and
loneliness are asso ciated w ith lowered wellbeing and
that preventive m easures should be undertaken.
W hat support is there for such a position?
 268 Lars A ndersson

Social relations and health
T here is an abundance of research which demon-
strates links between, on the one hand, factors such
as social support, social isolation or loneliness and
on the other hand, various health related factors.
Some exam ples of health related factors are de-
pression (Bragg, 1979; H orow itz et al., 1982), anxi-
ety (Schultz & Moore, 1984), fatigue (Berg et al.,
1981), m ental disorder (Freeman, 1988; Hov-
aguim ian et al., 1988), backache, headache, dizzi-
ness, palpitations and breathlessness (M iller &
Ingham , 1976), psycho som atic complaints (Stephan
et al., 1988), neuroticism (Stephan et al., 1988),
high consumption of hypnotics and sedatives (Berg
et al., 1981), m ore vigorous decline of im m unoglob-
ulin levels, higher urinary cortisol levels, lower levels
of natural killer cell activity, poorer T -lym phosyte
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pression and anxiety. Together, they seem to form a
syndrom e.
The few longitudinal studies are no absolute
guarantee for unproblem atic conclusions. As noted
by Kessler and co-workers (1985), spurious asso cia-
tions can also occur in such research designs due to
unm easured causes of the relevant variables. It is
also possible that while social isolation and loneli-
ness m ay be detrimental to health in som e cases,
health problem s m ay precipitate social isolation and
loneliness in others. In spite of these complications,
a deeper understanding of the (m ental) health ef-
fects of loneliness will certainly be reached with an
increased use of longitudinal data in com bination
with a control for factors such as anxiety and de-
pression.
Interventions

response to phytohemagglutinin (Kiecolt-G laser et

al., 1984a; 1984b), high frequency of seeking m edi-
U nder norm al circum stances, people turn prim arily
cal advice (Berg et al., 1981), alcohol use (Bell,
to fam ily, friends, relatives, neighbors, co-w orkers,
1956; N erviano & G ross, 1976), self-re ported m em-
etc. for help and support; that is, to w hat is com -
ory problem s (Bazargen & Barbre, 1992), suicide
m only referred to as the social network (social sup-
(Diam ant & W indholz, 1981; Trout, 1980),
port netw ork, inform al support system ). If no one in
schizophrenia (Jaco, 1954; Kohn & Clausen, 1955),
this prim ary net of relationships is available som e
and m ortality (Berkm an & Sym e, 1979; House et
individuals seek assistance from professionals such
al., 1982). Recent reviews of the area include C ohen
as physicians, teachers and clergy, as well as from
and McKey (1984), Ell (1984), C ohen and W illis
bartenders and beauticiansÐ at least in som e W est-
(1985), Gottlieb (1985) and Saraso n and Saraso n
ern cultures (Eddy et al., 1970). Although the infor-
(1985), W eeks (1994) and W enger et al., (1996).
m al helpers are the m ain source of support, there is
Thus, the research im pressively docum ents that
no doubt that professionals can play an im portant
social isolation and persistent loneliness present po-
role. However, it can be a role different from that
tential risks for em otional and physical disorders
for which m ost professionals traditionally have been
am ong a range of populations and situations (Ell,
trained (Garbarino, 1983). In the case of severe
1984; Rook, 1984a).
problems, the professional can work with a client in
O ne observation emanating from the factors
a variety of therapeutic m anners. Additionally, the
nam ed above, is that the in¯ uencial factors, w hether
professional can act as a contact between individuals
social isolation or loneliness, are not disease speci® c.
and social networks. Auslander and Litwin (1987)
It should be noted that m ost of the studies have
point out that there is no com m on conception as to
been correlational in nature. It would therefore be
what constitutes a network intervention. Their ow n
hazardous to m ake causal interpretations. A rela-
de® nition is `a planned activity by a professional that
tionship between social isolation and m ortality can
aim s to in¯ uence the functioning of an existing
be spurious, because both of the factors are related
inform al network or to bring about the creation of a
to poverty, for exam ple.
social network where one did not previously exist
Caution is warranted before unquestionably ac-
due to absence or inaccessibility’ . From this point
cepting long lists of correlates to a self-assessed
on, the review will em phasize interventions conduc-
variable. Andersson (1993b), for exam ple, statisti-
ted by professionals rather than by inform al groups.
cally controlled for the effect of anxiety when ana-
One m ay get the im pression that there is an
lyzing loneliness in com bination w ith a num ber of
abundance of interventions in this area. Biegel
health related variables. All of the signi® cant corre-
(1985) has presented an overview of social network
lations vanished with the exception of the corre-
interventions with special reference to the elderly
lation between loneliness and depression.
(Table 2).
Loneliness w as assessed with a single item m easure:
`Does it ever happ en that you feel lonely?’ . T he
question could be answ ered on a four-point scale N etwork interventions
from : `Yes, often’ to `No, never’ . The other vari-
ables included subjective health, psychosom atic Based on conceptualizations by Froland and co-
sym ptom s, health care use, self-esteem, and de- workers (1981), Biegel (1985) has identi® ed seven
pression. In the end there rem ained a hard core of types of network intervention: (1) clinical treatm ent,
variablesÐ the very variables w hich have been con- (2) fam ily caretaker enhancem ent, (3) case m anage-
sistently found connected with loneliness: de- m ent, (4) neighborhood helping, (5) volunteer link-
 Loneliness research and interventions 269

T ABLE 2. Social network interventions with the elderly

Type of network Locus Level

intervention Client group Helper type of help of help*

1. Clinical treatment An elderly individual Professional helpers, Non-geographic T, R

family, neighbors,
friends
2. Family caretaker Family mem bers of Family, neighbors, Non-geographic P, T
enhancement: the elderly friends, professional
education and training helpers
Direct services
3. Case m anagement An elderly individual Agency staff and Neighborhood, T
personal network non-geographic
4. Neighborhood helping An elderly individual Natural helpers, Neighborhood P, T, R
or at-large elderly in role-related helpers
the neighborhood (gatekeepers)
P, T, R
5. Volunteer linking An elderly individual Volunteers Neighborhood
community P, T, R
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6. Mutual aid/self-help At-large elderly in People with similar Neighborhood,

the neighborhood problems community or
non-geographic P, T, R
7. Comm unity At-large elderly in Lay and professional Neighborhood
em powerment the neighborhood helpers

*P 5 Prevention; T 5 Treatment; R 5 Rehabilitation; from Biegel (1985).

ing, (6) m utual help/self-he lp, and (7) com m unity
em powerm ent.
In clinical treatment, the professional works as a
catalyst rather than as a therapist, assessing prob-
lems through a social systems, rather than an in-
trapsychic, perspective. T he aim is to assess and
strengthen existing support system s. An intervention
can consist of involving all signi® cant m em bers of
an individual’ s social network in the speci® c prob-
lem, as well as the creation of new networks.
The aim of family caretaker enhancement is to ease
the burden for fam ily caretakers. The professio nal
can provide assistance to fam ily caretakers through
education and training or by supplying various ser-
vices.
In case management the professional should func-
tion as a coordinator of various public and private
services in order to address fragm entation, lack of
accessab ility and lack of accountability.
The aim of neighborhood helping is to establish
social support within a geographically de® ned com-
m unity. The professional accomplishes this w ith the
aid of natural helpers, w ho have been identi® ed as
pro® cient in this m atter. T hey provide em otional
support as well as problem -centered services.
Volunteer linking m eans that the professio nals train
and supervise inform al helpers who provide support
to individuals in need. T he inform al helpers are
recruited through som e speci® c characteristic or ex-
perience that they have. The relationship is clearly
one-sidedÐ from the professional, via the informal
helpers, to the helped individual.
M utual aid/self-help interventions can be divided
into those which approach existing self-h elp groups
and those whose aim is to create arti® cial netw orks.
In either case the approach is focused on a group of
clients, and the professio nal coordinates various ac-
tivities for the group. The groups m ay be divided
into those which m eet in response to a com m on
problem, and those w hich m eet to exchange ser-
vices. T he relationship is generally collegial.
Com munity empowerment aim s at creating groups
with collective strength, to gain access to resources
or organizations that are supposed to service them.
T he m ethod used here is to identify inform al leaders
in the com m unity and to facilitate their cooperation.
T he professional can also act in an advisory ca-
pacity.
It is obvious from the descriptions above that
aloneness or loneliness are generally not the core
concepts. Instead, the network interventions are
m ore social policy oriented. In som e cases they act
as substitutes for de® cient social services. In som e
cases, they help orient am ong the options for help
and care. And in som e other cases, they m ight lead
to the form ation of pressure groups to demand im -
proved conditions.
These program s have also been widely used in the
m ental health context, among clients w ith speci® c
psych iatric diagnoses.
Although prevention of aloneness and loneliness
can be effected by these program s, it is not their
m ain purpose. N evertheless, program s m ay be ini-
tiated when the primary purpose is to offer social
support. H ow ever, in m ost cases the arrangements
are far beyond the support sphere.
 270 Lars A ndersson

T ABLE 3. Overview of interventions

Goal of Individual Group Environmental

intervention approaches approaches approaches

Facilitate Cognitive Social skills Network building

social bonding behavior therapy training for (intentional and
lonely college students, unintentional)
Client-centered socially isolated
therapies children and dating Restructuring social
anxiety settings (e.g. school
Psychodynamic classroom modi® cation)
therapies Shyness groups
E nhance cop ing Improving Support groups
solitary skills for bereavem ent, divorce
(pleasurable and other social losses
scheduling)
Self-help groups
Prevention Early intervention C ommunity awareness
with high-risk and educational
groups (e.g. children programs
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of divorce)
Removing obstacles
to social contact

Adapted from Rook (1984).

Interventions against loneliness
An overview, w hich is more pivotal for the purpose
of this paper is put forth by Rook (1984d). T he
presentation of the categories in T able 3 is an adap-
tation of Rook’ s (1984d) disposition. She describes
three general goals of loneliness interventions. First,
social bonding is facilitated by providing new oppor-
tunities for social contact, by providing support in a
transitional period, or by helping lonely people to
relate to others. A second goal is not to alleviate
loneliness itself, but to prevent loneliness from
evolving into other serious problem s. This can be
achieved by helping the individual cope with loneli-
ness. The third goal is to try to prevent loneliness
from occuring in the ® rst place.
Som e exam ples of individual approaches m en-
tioned include cognitive behavioral therapy, inter-
personal therapies, psychodynam ic therapies and
`friendly visitor’ program s.
Cogn itive behavioral therapy aim s at im proving the
lonely individual’ s behavior in social situations. It
has been shown that lonely people can show greater
m istrust and hostility in interactions (Jones, 1982).
T he therapy is intended to help individuals recog-
nize and correct this behavior.
Interpersonal therapies are built on the client± thera-
pist relationship. In these sessions the clients are
trained to express them selves and in the long run to
change their self-perceptions, i.e. the belief that their
real self is unlovable.
Psychodynamic therapies are also built on the cli-
ent± therapist relationship . T he approach is develop-
m ental and attem pts to identify childhood
experiences which have negatively affe cted adult
adjustm ent.
Friendly visitor program s are quite different from
the three app roaches above. T hey do not have to be
run by professionals and they do not attempt to
change the lonely person. Rather they provide the
opportunity to avoid loneliness through com panion-
ship. T hese program s are generally offered to house-
bound individuals.
Among the group approaches, Rook m entions so-
cial skills training, shyness groups, depression
groups and sem inars for the separated or the be-
reaved. T hese program s are typically aim ed at target
groups.
Social skills training has been used with groups
such as socially isolated children, students, and ado-
lescents w ith dating anxiety. M any of the program s
for socially isolated children have been developed
for school settings. T he techniques used with adults
are basically the sam e as those employed with chil-
dren/youth. According to Rook, m ost social skills
training program s emphasize skills needed to initiate
contact, but do not em phasize those needed to
m aintain contact. Som e characteristics com m on to
lonely people and thus subject to training are low
self-d isclosure (Solano et al., 1982), reluctance to
take social risks (Jones et al., 1981) and high self-fo-
cus (Jones, 1982).
Shyness groups have been suggested by Pilkonis
and Zim bardo (1979) in order to teach shy people
to restructure social encounters.
Depression groups m ight in som e cases be useful for
lonely people due to the close association betw een
depression and loneliness which was shown above.
As noted by Rook, self-re inforcem ent training, often
utilized in treatm ent of depression, m ight be useful
for lonely people.
Seminars for speci® c target groups, such as the sepa-
rated or the bereaved, naturally differ from the other
app roaches. Loneliness that results from a loss

rather than from enduring circum stances has to be
treated separately, both theoretically and practically.
Finally, Rook m entions som e exam ples of environ-
mental approaches, such as netw ork building, restruc-
turing social settings and removing obstacles to
social contact.
N etwork building is concerned with creating new
opportunities for contact w hen the existing opportu-
nities are lim ited. Rook m akes three recom m enda-
tions with regard to these interventions. The ® rst is
that the interventions should be designed in ways
that distract the lonely individuals from their self-
consciousness. The second recom m endation is that
interventions should be designed to provide a basis
for identi® cation w ith com mon goals. T he third
recom m endation stresses the im portance of label-
ling: `Labels that emphasize social de® cits are likely
to m ake participants feel stigm atized.’
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Restructuring social settings involves efforts such as
m odifying classro om s in schools or any interior
m odi® cation that brings people together. Obviously,
the design of comm on space can help facilitate or
obstruct social contacts.
Removing obstacles to social contact concerns activi-
ties such as offering transportation to the elderly or
relief to those caring for chronically disabled fam ily
m em bers.
As is evident from this overview, effo rts differ
m arkedly. T here are exam ples of both prevention
and treatment; of individual, group level and en-
vironm ental efforts. T he interventions also differ in
their ® nancial requirem ents as well as other re-
sources needed for their accom plish m ent.
W ith regard to social support and the distinction
between m ain effect and buffering effect, G esten
and Jason (1987) note that evidence for m ain effects
encourages developm ent of interventions in normal
populations, whereas evidence for buffering effects
calls for a risk group approach. As a result, it has
been claim ed that both m odels are lim ited as a basis
for developing interventions (Auslander & Litwin,
1987): the m ain effect m odel is too general; the
buffering effect model is too restricted.
The review of interventions suggests that although
there are a large num ber to choose am ong, only a
few have been developed speci® cally to deal with
different expressions of isolation.
The discussion of com ponents of social support
and loneliness (Table 1), brings up a fundamental
aspect of interventions, namely the conceptual
level at which interventions should be applied. T he
behavioral scientist’ s conceptualizations, to som e
extent, resem ble the physicist’ s search for the ele-
m ents of m atter. Once a certain level with a few
com ponents is reached, new ® ndings lead to the
unveiling of another level with m ore components,
etc. O ne exam ple of this is W eiss’ (1974) six com-
ponents of the single entity loneliness, which have
been m erged into two basic categories: assistance-
related and non-assista nce-related, with the second
category being divided into `self-esteem related’ and
Loneliness research and interventions 271
`related to affectional ties’ (Cutrona & Russell,
1987).
W ith these conceptualizations as a starting point,
an intervention could either be based on any num -
ber of the six speci® ed categories, or on two or three
m ore general concepts. Here it is not relevant to
debate whether a certain conceptual level is m ore
basic than another. The point is rather to illustrate
that the socio-psyc hological factors are interm in-
gled, and in practice it is realistic to expect that if
som e com ponents on a particular conceptual level
are chosen as core concepts for an intervention,
other com ponents on the sam e conceptual level
m ight be in¯ uenced too, through a com m on factor.
N evertheless, a certain sensitivity is needed to
determ ine the m ost appropriate level of speci® city in
conducting interventions. W hile on the one hand, it
is reasonable to approach som eone who has always
lived alone in a different m anner from som eone w ho
has just lost a spouse, unnecessary specialization
m ay, on the other hand, be counterproductive.
Another com plication can be illustrated using the
categories `being alone’ and `feeling lonely’ . From
the point of view of interventions, the categories
represented by those who neither feel lonely nor are
alone, and by those who both feel lonely and are
alone, are not particularly troublesom e. But what
about those who are alone but do not feel lonely,
and those w ho feel lonely, despite not being alone?
Studies of the relationship between social relations
and health outcom es which distinguish betw een
these categories are scarce (W enger et al., 1996).
T here are m ore studies which have com pared the
relationship betw een health related variables (or
psych ological wellbeing) and quantity versus quality
of support (Foire et al., 1986; Gottlieb, 1985; Hen-
derson et al., 1981). The conclusion from these
studies is that subjective variables are stronger pre-
dictors of outcom e than are objective variables. O ne
com plication is that the self-re ported feelings of
loneliness or support m ay be part of the syndrom e
of negative affectivity. N evertheless, from a preven-
tive perspective, it is of m ajor importance that the
loneliness concept is included in discussions of poss-
ible interventions in the area. In practical arrange-
m ents, the objective dim ensions of the network are
com paratively easy to control. If the subjective fac-
tors are ignored, however, crucial interpretations of
outcom es are deliberately lost.
Thus, it would seem reasonable to offer individu-
als from the two groups `alone/not lonely’ and
`lonely/not alone’ the opportunity to participate in
an intervention, particularly if other signs of lowered
wellbeing are present. Am ong the `alone/not lonely’
one can ® nd the life-long isolates, som e of w hom are
quite satis® ed with the state of things. There are also
individuals with low ered wellbeing who are alone,
but do not necessarily express their dissatisfaction in
terms of loneliness. Either they m ay not want to
reveal their loneliness due to the stigma attached to
it (From m -R eichmann, 1959), or they fail to recog-
 272 Lars A ndersson
nize it. Instead they can report som atic problems or
vague feelings of dissatisfaction (Peplau, 1955;
Rook, 1984d). Am ong the `lonely/not alone’ we
® nd, for exam ple, m arried people who have com e to
feel lonely in marriage. Their need m ay often be as
m uch social as emotional.
Finally, the ® rst step in selecting an intervention is
to specify the particular purpose of the effort and the
particular target group. H ow ever, regardless of the
delineations used, the vast majority of interventions,
in any category, have not been acceptably evaluated.
M ost often the `evaluations’ have consisted of anec-
dotal reports or insuf® ciently designed studies with-
out control group or before± after m easurem ents. It
is therefore dif® cult or im possib le to determine the
scienti® c outcom es of such interventions. In Rook’ s
report (1984d), her general conclusion was that
`with the exception of social skills approaches, virtu-
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ally no publish ed evaluation studies of interventions
developed speci® cally for the problem of de® cient
interpersonal bonds exist.’ T horoughly evaluated in-
terventions which m eet reasonable standards both
w ith regard to feasibility and outcom e are, to a large
extent, still lacking. H owever, som e evaluations of
m ore or less successfu l interventions have been pub-
lished (Andersson, 1984; 1985; Benum et al., 1987;
H eller et al., 1991; Richm ond & Picken, 1986).
Irrespective of whether these evaluated interventions
are used as m odels or not, it is im portant that those
w ho engage in interventions against loneliness care-
fully evaluate their efforts in order to forward the
knowledge of how health and wellbeing m ay be
effected by alleviating loneliness.
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