Blog Post

Why social isolation has an impact on health even if you don't feel lonely

Becky Nixon • Apr 09, 2020

“Yes, but some people are quite happy living alone, we shouldn’t force them into contact”. I hear this fairly frequently, but is it true?

Being in the midst of Covid-19 isolation seems like a good time to finish a blog post I started some months ago about the difference between subjective loneliness (a feeling) and objective social isolation (actually having little or no contact). This is a follow up to a previous blog on the different types of loneliness.

The difference between loneliness and isolation

Loneliness is a subjective feeling, sometimes described as perceived isolation. This can be measured by a number of different scales, for example as described by the Campaign to End Loneliness or the Government's work on a national measure of loneliness linked to the Loneliness Strategy.

Isolation is an objective measure of the contact that people have with each other, both meaningful relationships and day-to-day social contact. It is common to hear people say that you can be lonely even in a crowd, or you can be physically alone but not feel lonely. However, even if people don’t feel lonely, being alone has an impact on health and wellbeing.

Some research, for example this meta-review , demonstrates a lack of correlation between feeling lonely and being socially isolated, yet both have an impact on health and wellbeing and mortality, as does living alone. This indicates that both social isolation and loneliness need to be addressed if we are concerned about people’s overall wellbeing, not purely the feeling of loneliness.


What are the mechanisms by which isolation impacts on health and wellbeing?

According to evidence, the mechanisms by which social connections improve wellbeing fall into two main categories:

A. Encouragement to lead a healthy lifestyle , including:

  1. Explicit encouragement, e.g. "You could go for a walk, you often say it cheers you up".
  2. Through belonging to a group, e.g. walking or other exercise.
  3. Mattering to other people and the roles that we play in relation to them or our own self-image, for example being a good role model for younger family members or friends.
  4. Influenced through social norms and common behaviour, for example in relation to obesity, people with friends with higher weights were more likely to weigh more themselves, with a study identifying that this was partly explained by people taking on different habits, e.g. eating second helpings or dessert being a norm, for example in this research and blog about the findings.

Motivational speaker Jim Rohn said that we are the average of the five people we spend most time with, meaning that we should choose wisely when we can (there is also research that suggests that it’s much more than five, and that it's not direct connections, those that are only online can also affect people).

B. Stress buffering

This may be emotional support from partners, family or close friends when recounting stories from our day, informal discussions with neighbours or others in the community about things going on in our neighbourhood, or those that we purposefully connect with because they have the same experience as us – death of a spouse, an illness, being a carer. It might be a mix of practical tips and emotional support and may differ from the support our friends and family give us because they are not in the same situation. Relationships are crucial to regulate our emotions, which are key to our wellbeing.

This stress buffering is not necessarily a conscious process, it's someone "being there" and "having our backs". Its lack may become more apparent if we face a bereavement or illness. As children, hopefully we learn emotional regulation from someone who is already good at it. This is also the basis of a therapeutic relationship, research shows that the “technique” does not matter, it’s the relationship with the therapist that’s crucial. Much of this is an unconscious process as highlighted in the book A General Theory of Love , “People do not learn emotional modulation as they do geometry or the names of state capitals. They absorb the skill from living in the presence of an adept external modulator, and they learn it implicitly. Knowledge leaps the gap from one mind to the other, but the learner does not experience the transferred information as an explicit strategy”.


What can we do to support people who are isolated?

These may be useful for isolated clients or family, but also equally apply to ourselves.

1. Encourage people to stay connected how they can : research indicates that face-to-face contact has a positive impact on someone’s chances of developing depression whereas the telephone doesn’t, although this is not a reason not to stay connected, particularly now there are increased online opportunities. Personally, the experience being able to see my mum through FaceTime is much superior to telephone contact, we can communicate through body language and not just talking, and it provides the opportunity for us to just be together whilst we’re cooking or pottering, meaning there is a greater sense of ongoing connection rather than having to fill the space with "conversation".

2. Specifically prompt people to open up about their worries and give them time to talk (without providing unsolicited advice or trying to solve their problem for them!) In my research with isolated older people I often hear people say that they value conversations with volunteers because, “I don’t want to worry my family,” or for family carers, “My family only want to talk about [my cared for] they’re not interested in me”. Ask questions, open potential worries up as a topic of conversation and indicate you’re there for them.

3. See how they can connect with others in similar situations , and encourage them to make the contact for peer support. Your local Voluntary Action or council may have a list of support groups.

4. Talk to people about how they can maintain healthy behaviours when no one’s watching or there to encourage them. Being on your own can be a reason not to bother cooking, but it can also be an opportunity to be able to eat what you want – this may be particularly the case for older people like my mother who spent many years caring and cooking mainly for other people and now she is alone is enjoying what she wants to eat. Particularly coming into spring and summer, once you’ve overcome the challenge of actually shopping, it can be really quick to put together healthy salad-based meals. Similarly around exercise – in fact the options for people who are at home a lot whether that’s through health, caring responsibilities, transport, or a low income have increased if people have access through the internet, and many are free. Help people identify what's possible for them, and check in on how they are doing. Some people need more external accountability than others, or need more information about why something is beneficial to be motivated (see Gretchen Rubin’s Four Tendencies quiz for more information).

One of the outcomes of Covid-19 may be a greater appreciation of what it's like to be housebound and to do things alone, and this may have a positive impact in the future for people who are isolated for whatever reason though greater understanding and a wider range of ways to connect and participate in activities that doesn't involve going out.

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With a lot of people in flux at the moment with working patterns, with workplaces starting to open up and people going back to working elsewhere, I was reflecting on my early morning walk on what Gretchen Rubin calls the strategy of the clean slate to make habit change. For me, the change is not my own, but my daughter's. She has recently started an apprenticeship at a medical centre in a town around 12 miles away. In the morning she gets on the bus at 7.45am, so I have got into the habit of leaving the house with her and having an early morning walk, usually along the canal above, before settling to work. For some reason, the last bus back leaves at 3.25, before the schools and work has actually finished for most people (and then they wonder why it's not used much!) so I pick her up every night. Her work is closer to my gym than where we live, and now the pool is open again it motivates me to finish work an hour earlier and to have a swim before I get her as I'm driving halfway there already. Hopefully my daughter will soon be driving herself now lessons and tests have started again, so I was wondering whether I would keep these activities up when our routine changes again. This is where the power of habit takes over. Habitual behaviour happens in a different part of our brain from conscious thought ( this blog I wrote earlier talks a bit about this) and can easily over-ride other intentions. Habit change is about reprogramming our neural pathways until we do that activity "without thinking". If we repeat an action enough times, then our brains start to associate one thing with another in an "if...then" pattern, e.g. if my daughter is leaving the house to get her bus then it's time for me to go for a walk. Think of this rewiring as a route across a park - as more and more people walk along new route the grass gets worn away and the pathway gets more established, like these . Hopefully by the time my daughter passes her test and I wave her off on her own, my morning walk routine will be so established that I will carry on doing it, same for the early evening swim. It's difficult to say how long it will take any individual to form a habit, a study by Philippa Lally and colleagues at UCL identifies an average of 66 days, but so many factors come into play that it can vary, for example some of these could be how committed are you to the habit, how convenient/inconvenient it is, what social reinforcement you have for doing/not doing it. With some provisos Lally's article identified a range of 18-254 days. Action point When you are facing a change in your life such as changing where or how you work as you may be doing at the moment, think about whether this could help you to make or break any habits. If the strategy of the clean slate doesn't work for you, Gretchen Rubin in her book Better than Before has many other practical strategies that you can try. Using psychology for individual and organisational development I am working with colleagues to develop a series of courses, workshops and resources around using psychology in the VCSE to improve individuals, organisations and services, for example around areas of motivation and engagement; personality in the work place; working effectively including looking at habits, understanding yourself and avoiding procrastination; and the effects of trauma on the brain. If you are interested in any of these, please sign up below for my newsletter where they will be announced later in the year or contact admin@ideastoimpact.co.uk
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I heard this on a podcast but can no longer remember who suggested this, but the idea was that a seven is a cop out and it's easy to end up with lots of sevens with no way of differentiating between them - make them a 6 or an 8. The next bit is more of an art than a science (sorry to anyone who was hoping to add up the scores and get a neat formula to make the decisions for them!) Make sure you have a system for recording tasks now and into the future. I use ToDoist - there are other similar apps or you can just use a diary and a notebook. This gives me the ability to sort by projects (which I review weekly) and by discrete tasks to do on specific days. It gives me a list of the activities that I need to do in the shorter term, and the ability to note things that need doing in the future - I may not have dealt with the actual task, but at least I know when I need to start thinking about it so it's not cluttering up my brain. 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In terms of delegation, you don't want to dump things on other people who are over-loaded themselves, but it's worth considering delegating authority and decision-making to empower workers to deal with more activities which then don't need to come back to you - this may help to make everyone's lives easier. Identify anything that can be done quickly (e.g. in about 10 or 15 minutes), start by clustering these Post-Its in preparation to them in - most of these are probably not going to be things that need a lot of brain power, so batch it with other similar tasks and put it into a time in your day that's not your best thinking / quality work time. (However, recognise if you're someone who needs to get some of these things out of the way before you settle on bigger pieces of work because otherwise they are sitting there bugging you! There is no one-size-fits all approach to effectiveness.) 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Is there a particular emotion you are feeling about it? Procrastination is often about avoiding negative emotions, sometimes it's helpful to just recognise this - read this New York Times article around the work of Dr Fuschia Sirois. Otherwise you might just want to "Eat the frog" and get on and do them, so they are not continuing to have a negative impact on you. (Mark Twain possibly said something like "Eat a live frog first thing in the morning and nothing worse will happen to you the rest of the day".) Go through each of the Post-It notes and put an activity and timescale into whatever system you have. Hopefully this has helped you feel more in control and either demonstrated that you are able to manage the work you have and to get it out of your overloaded brain, or it's demonstrated that there are more fundamental issues requiring a revision of your wider organisational strategy or structure to ensure that your organisation's work is more realistic. Need some help? Ideas to Impact can help you work through planning and prioritisation through Power Hours - a customised mix of coaching, mentoring and/or consultancy depending on your needs, or through workshops and facilitation for your organisation or through various workshops and training sessions . Contact Marlen Tallet, admin@ideastoimpact.co.uk if you would like to book a specific session, or Becky Nixon becky@ideastoimpact.co.uk for a more general discussion about how we can help you.
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An increasing number of charities are producing high quality impact reports to promote what they do. These have more of a “marketing” approach and different from impact reports that are more evaluative, for example this one that Ideas to Impact researched and wrote for Clinks. I've been working with a few clients recently to plan, collect information for, and design impact reports, and to get ideas I analysed other organisations reports, so to help others, here is the information I collected: this post contains a list of some of the things that you can include in your impact report to give you ideas about the content and the format. Impact reports are sometimes linked with the annual report, and sometime separate. Here is a report that Ideas to Impact produced in partnership with VASL’s Community Champions project. Some other examples are linked below.
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