Below, we briefly consider what we have learned thus far about loneliness in terms of key implications from an applied perspective. There is a clear need for loneliness prevention, and Crowe and associates (2022), among others, have emphasized the key role of the public health system; they outlined myriad ways of proactively addressing loneliness and associated mental health challenges. Clearly, a complex array of factors contributes to loneliness, and this includes macro-level and micro- level influences. One implication of system-level influences is that while much of prevention is focused on the individual person, there is a need for a prevention focus that considers group processes and social dynamics and changes to physical and social settings (for discussions, see Rook, 1984; Trach et al., 2018). In short, it is not just up to the individual. A broad public health initiative embraced by communities and organizations is needed. There are numerous opportunities for innovative solu-tions, including digital solutions (see Guerra et al., 2022) and progress is being made through socially prescribed solutions to loneliness, which have deemed to be both necessary and useful (see Reinhardt et al., 2021).
A central premise of our approach to understanding and conceptualizing loneli-ness is that much of the distress and dysfunction can be traced to the experience of more extreme and persistent forms of loneliness that reflect unbearable loneliness, as outlined above. Because unbearable loneliness seems to be more likely among people who define themselves in negative ways, it is important to focus on develop-ing a more positive self-view and being able to stand being alone with oneself. Thus, there is a need for an intrapersonal focus along with an interpersonal focus as well as a focus on social and societal settings. The various ways of conceptualizing the self translate into multiple potential targets in terms of developing a more positive self-view. Possibilities here included increasing perceived self-efficacy and confidence in social situations and develop-ing unconditional self-acceptance that should counter self-criticism and self-hate. Most importantly, there is a need to build self-compassion. Rose and Kocovski (2021, 2023) have taken a domain-specific view and highlighted the need to develop social self-compassion as a response to adverse interpersonal experiences and situ-ations. For instance, people who have been excluded, bullied, or humiliated by someone else will need to learn to be especially kind to themselves when they have been mistreated. The natural tendency is to blame oneself to try to create a sense of controllability, but blaming the self, especially in dispositional terms, will not only add to distress but it can also foster increases in avoidance behavior.
It is known from developmental research that there are interventions with a social-emotional learning (SEL) focus that can be taught in schools and these inter-ventions are effective in reducing internalizing and externalizing problems in gen-eral (see Durlak et al., 2011). The goal of SEL is to provide young people with the social and emotional interpersonal and intrapersonal competencies that are needed to thrive from an interpersonal perspective. Ideally, this type of learning fosters the kind of interpersonal resilience that is seen as a key domain-specific facet of the broader resilience construct (see Flett et al., 2015). It is not difficult to envision a version of SEL with an interpersonal resilience focus that can be developed to pro-tect young people from bouts of unbearable loneliness and increase their capacities to be resilient and adaptable when feelings of loneliness are experienced. This focus can include specific themes such as how to promote a feeling of mattering to others and how to adaptively disengage by not using social comparison information as a basis for making negative self-appraisals rooted in unfavorable comparisons with peers.
One key developmental asset is to be able to adapt to situations in which being alone can escalate into feelings of loneliness. We have conducted some initial research indicating that there are individual differences in the reported capability to adapt to being alone and not surprisingly, lower adaptability is linked with elevated levels of self-reported loneliness. This work reflects a conceptualization and assess-ment of adaptability introduced by Martin et al. (2013). This approach to adaptabil-ity emphasizes cognitive adaptability, emotional adaptability, and behavioral adaptability. This framework has considerable utility from a prevention perspective because it should be possible to provide people with training that will enhance their ability to adapt on multiple levels to novel uncertain situations and isolating circum-stances that can result in feelings of loneliness.
Given our earlier observations and evidence cited linking loneliness with hope-lessness, a focus on reducing hopelessness and boosting hope within a social frame-work is essential and this should apply to lonely people of various ages. Hopefulness will be encouraged to the extent that people will develop a stronger and more posi-tive sense of self, but we have also found that it effective to share narrative accounts of people who have overcome adversity and found meaningful ways of connecting with other people. Any program targeting the prevention of loneliness should jointly aim to heighten awareness of loneliness and normalize feeling lonely as something that is part of most people’s lives. This normalization is required in order to decrease the general tendency to see loneliness as a reflection of the self. Young people who are presented with information about the prevalence of loneliness may not believe it based on their understanding and perception of peers. Here it is important to discuss the tendency to hide loneliness and depression behind a front. We have discussed these tendencies at length within the context of young people needing to present as perfect and maintaining their public image by keeping feelings of distress and isola-tion to themselves (see Flett et al., 2018). This analysis includes a specific emphasis on hiding feelings of loneliness, perhaps due to the stigma associated with loneli-ness. Unfortunately, this tendency to maintain a perfect front or at least seem as if everything is fine is quite common and extends to false and highly curated portray-als of the self on social media. The vulnerable person who believes and espouses these false portrayals can find it all too easy to feel uniquely inadequate and defi-cient, relative to peers.
One key prevention target is the tendency for lonely people to internalize the stigma. Rose et al. (2018) have provided an extensive analysis of the tendency for certain young people to stigmatize themselves. It has often been mentioned that loneliness carries a perceived stigma with it, and it should be almost certain that people who are characterized jointly by loneliness and psychological distress will be hypersensitive to social evaluation and they will anticipate being stigmatized for being lonely and not coping very well. Research has confirmed the tendency for loneliness to carry a stigma, especially when the lonely person is also someone who is reclusive (see Kerr & Stanley, 2021). Any stigma experienced by someone who is lonely will likely be magnified among those people who suffer from unbearable and chronic loneliness.
It is likely that given the propensity for people with high levels of loneliness to experience a sense of shame (see Sundqvist & Hemberg, 2021), lonely people who have experienced stigma or fear stigma will internalize it and experience self- stigma. Indeed, both the stigma and self-stigma of loneliness have been examined in recent research (see Barreto et al., 2022), and a measure of the stigma of loneliness has been developed. Clearly, given these findings, one vital prevention focus is to proactively address the stigma and self-stigma of loneliness through such means as heightening awareness of the prevalence of loneliness and normalizing loneliness. Moreover, in terms of self-stigma, an intervention focused on promoting self- acceptance and self-compassion can be put into place to specifically target feelings of shame and the internalization of stigma. Prevention efforts should begin early and include a focus on children and adolescents given evidence that children in grades two and four tend to stigmatize a hypothetical other portrayed as having chronic loneliness (see Rotenberg et al., 1997). This work signifies that at a rela-tively young age, children have developed negative views about the character or the stable personality attributes of people who are chronically lonely. As such, children may also have learned at an early age to hide their feelings of loneliness, perhaps as part of a general tendency to limit discussion or displays of negative feelings that might be seen as reflecting poorly on the self.
Summary
The current chapter began by discussing the prevalence of loneliness and how it is highly relevant to a focus on public mental health. Loneliness was discussed in terms of its myriad costs and consequences. A central focus was on the role of the self in loneliness and the description of a more extreme form of unbearable loneli-ness. While all types of loneliness need to be addressed in proactive interventions, this more extreme form of loneliness is highly deleterious in terms of mental health and physical health problems; as such, it represents an important initial focus. We also noted that much of the focus is on the individual, but it is important to consider broader societal and system-level influences on loneliness and this fits well with the need to counter the stigma and self-stigma that confronts people. One key thing we should all reflect on post-pandemic is that everyone has a basic need for satisfying connections with other people and there are some fundamental changes that can be implemented so that millions more people around the world are able to benefit from rich and satisfying relationships with the people in their lives.