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Internet-based interventions for loneliness: Efficacy and latent psychopathological profiles of treatment seekers
Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.ORCID iD: 0000-0003-1579-8791
2021 (English)Doctoral thesis, comprehensive summary (Other academic)Alternative title
Internetbaserade interventioner mot ensamhet : Effektivitet och latenta psykopatologiska profiler hos de behandlingssökande (Swedish)
Abstract [en]

Loneliness is an adverse emotional reaction thought to stem from an unwanted and impoverished social situation. Though it commonly makes brief appearances across the lifespan for most people, it has received increasing attention as a factor relevant to somatic and psychological well-being when assuming a more chronic form. For this reason, developing ways of alleviating loneliness is an important item on the research agenda tied to this phenomenon. Psychological interventions, and cognitive behavioural therapy (CBT) in particular, have been proposed to have potential for this. This thesis sought to evaluate the effects of two different kinds of internet-based interventions targeting loneliness: one based on CBT, and one based on interpersonal psychotherapy (IPT).

In addition to this general aim, Study I also investigated the presence of different subgroups in the sample of people seeking help within the framework of projects. Using the statistical method known as Latent Profile Analysis we discovered five profiles consisting of symptoms of common psychiatric disorders and loneliness. The profiles mainly differed as a function of symptom severity, though one of the larger groups was also characterised primarily by their high ratings of social anxiety. The results suggest that the sample seeking help for their loneliness can exhibit both clinical and non-clinical levels of common mental health problems.

Study II served as the pilot evaluation of an ICBT programme for loneliness. A total of 73 participants were included in a randomised controlled trial where the participants were randomised to either 8 weeks of active treatment or a wait-list control group. The results indicated significantly lower loneliness ratings after the treatment phase for the ICBT condition with a moderate-to-large effect size compared to the control group. Significant differences favouring the ICBT condition were also noted for two of the four secondary measures.

Study III followed up on the participants two years after the conclusion of the initial treatment period. At this point, the control group had also received access to a version of the ICBT programme with therapist support on-demand. The results indicated that the decrease in loneliness was sustained, along with similarly lasting effects on the secondary outcomes of interest.

Study IV aimed to replicate the findings from the second study with a similar ICBT programme. However, this study also employed an internet-based IPT intervention to allow for conclusions regarding the possibility of reducing loneliness by other means than CBT. A sample of 170 participants were recruited and randomised to one the treatment conditions or to a waitlist control group. The results indicated that the ICBT condition had a significantly steeper reduction in loneliness than both the waitlist and the IPT condition after the conclusion of the treatment. Both active conditions produced a significant increase in quality of life.

In conclusion, internet-based psychological interventions can be efficacious for reducing loneliness, though the efficacy was only found for participants who received access to the ICBT condition in Study II and IV. The benefits from this treatment programme were sustained up to two years after the conclusion of the intervention. For these reasons, ICBT is proposed to be a good candidate for offering help to people experiencing distressing feelings of loneliness.

Abstract [sv]

Ensamhet är en aversiv känsloreaktion som har sitt ursprung i en oönskad social situation. I kronisk form har den påkallat uppmärksamhet som en faktor med implikationer för fysisk och psykisk hälsa. På grund av detta har tillvägagångssätt för att minska ensamhet blivit en viktig punkt på forskningsagendan kopplad till detta fenomen. Psykologiska interventioner, och mer specifikt kognitiv beteendeterapi (KBT), har hävdats ha potential för att åstadkomma detta. Denna avhandling utvärderade effekterna av två internetbaserade interventioner inriktade mot ensamhet: en baserad på KBT och en baserad på interpersonell psykoterapi (IPT). Dessutom intresserade sig en av studierna för den deltagarheterogenitet som fanns i termer av psykiatriska symptom.

Personerna som sökte hjälp inom ramarna för studierna kunde delas in i fem undergrupper som främst skiljde sig åt gällande hur grav symptombörda de uppvisade, men i viss mån även sett till vilken typ av psykiatriska symptom som dominerade. Resultaten från de kliniska prövningarna pekar på att det framtagna KBT-programmet har positiva effekter i form av minskad ensamhet och psykiatrisk samsjuklighet. Effekterna kvarstod även över tid. IPT-programmet var inte lika framgångsrikt.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2021. , p. 117
Series
Linköping Studies in Arts and Sciences, ISSN 0282-9800 ; 817Linköping Studies in Behavioural Science, ISSN 1654-2029 ; 233
Keywords [en]
Cognitive behavioural therapy, ICBT, Internet interventions, Interpersonal psychotherapy, Latent profile analysis, Loneliness
Keywords [sv]
Ensamhet, IKBT, Internetinterventioner, Interpersonell psykoterapi, Kognitiv beteendeterapi, Latent profilanalys
National Category
Applied Psychology
Identifiers
URN: urn:nbn:se:liu:diva-180398DOI: 10.3384/9789179290580ISBN: 9789179290573 (print)ISBN: 9789179290580 (electronic)OAI: oai:DiVA.org:liu-180398DiVA, id: diva2:1604004
Public defence
2021-11-26, Online through Zoom (contact britt-marie.alfredsson@liu.se) and C3, C Building, Campus Valla, Linköping, 10:00 (English)
Opponent
Supervisors
Available from: 2021-10-18 Created: 2021-10-18 Last updated: 2021-10-18Bibliographically approved
List of papers
1. Exploring Latent Profiles of Psychopathology in a Sample of Lonely People Seeking Treatment
Open this publication in new window or tab >>Exploring Latent Profiles of Psychopathology in a Sample of Lonely People Seeking Treatment
2021 (English)In: Journal of Psychopathology and Behavioral Assessment, ISSN 0882-2689, E-ISSN 1573-3505, Vol. 43, no 3, p. 686-696Article in journal (Refereed) Published
Abstract [en]

Loneliness is a common experience in populations experiencing mental health problems. Associations with symptoms of psychopathology are prevalent, but little is known about the diversity of symptom profiles in people suffering from prolonged and distressing loneliness. The current study sought to investigate the existence of subgroups of loneliness and common forms of psychopathology in a sample of adults (n = 332) seeking treatment for their loneliness. Using latent profile analysis, five profiles were identified and differences in demographic factors were investigated. The profiles differed mainly in the severity of symptoms of depression, worry, and social anxiety, with the largest profile exhibiting minimal-to-mild symptoms (n = 109) across these indicators. The second largest group was characterized primarily by high ratings of social anxiety (n = 90). Overall, three of the five profiles, encompassing roughly half of the sample, scored at a clinical level on mental health symptom measures. Age was inversely related to symptom severity among the profiles, indicating that the older subgroups of the sample exhibited milder symptoms, particularly on social anxiety. The results provide insight into the heterogeneity of the clinical symptoms of people suffering from loneliness and add important knowledge that could help inform how to best intervene to help this population.

Place, publisher, year, edition, pages
Springer-Verlag New York, 2021
Keywords
Loneliness; Latent profile analysis; Social anxiety; Psychopathology
National Category
Psychology (excluding Applied Psychology)
Identifiers
urn:nbn:se:liu:diva-173904 (URN)10.1007/s10862-021-09870-7 (DOI)000617820400001 ()2-s2.0-85101022545 (Scopus ID)
Note

Funding Agencies|Linkoping University

Available from: 2021-03-09 Created: 2021-03-09 Last updated: 2022-05-23Bibliographically approved
2. Internet-Based Cognitive Behavior Therapy for Loneliness: A Pilot Randomized Controlled Trial
Open this publication in new window or tab >>Internet-Based Cognitive Behavior Therapy for Loneliness: A Pilot Randomized Controlled Trial
Show others...
2020 (English)In: Behavior Therapy, ISSN 0005-7894, E-ISSN 1878-1888, Vol. 51, no 1, p. 54-68Article in journal (Refereed) Published
Abstract [en]

Loneliness has been described as a common source of discomfort based on a subjective discrepancy between the actual and desired social situation. For some people this feeling may become a sustained state that is associated with a wide range of psychiatric and psychosocial problems. While there are few existing treatment protocols, interventions based on cognitive behavioral therapy (CBT) have shown positive effects. The current study investigated the efficacy of an 8-week internet-based treatment containing CBT components aimed at reducing feelings of loneliness. Seventy-three participants were recruited from the general public and randomly allocated to treatment or a wait-list control condition. Participants were assessed with standardized self-report measures of loneliness, depression, social anxiety, worry, and quality of life at pretreatment and posttreatment. Robust linear regression analysis of all randomized participants showed significant treatment effects on the primary outcome measure of loneliness (between group Cohens d = 0.77), and on secondary outcomes measuring quality of life and social anxiety relative to control at postassessment. The results suggest the potential utility of internet-based CBT in alleviating loneliness but more research on the long-term effects and the mechanisms underlying the effects is needed.

Place, publisher, year, edition, pages
Elsevier, 2020
Keywords
Internet-based cognitive behavior therapy; loneliness; CBT; guided self-help; digital intervention
National Category
Applied Psychology
Identifiers
urn:nbn:se:liu:diva-164178 (URN)10.1016/j.beth.2019.05.001 (DOI)000513074400005 ()32005340 (PubMedID)2-s2.0-85066831417 (Scopus ID)
Note

Funding Agencies|Linkoping University

Available from: 2020-03-11 Created: 2020-03-11 Last updated: 2021-12-28Bibliographically approved
3. Lonesome no more?: A two-year follow-up of internet-administered cognitive behavioral therapy for loneliness
Open this publication in new window or tab >>Lonesome no more?: A two-year follow-up of internet-administered cognitive behavioral therapy for loneliness
2020 (English)In: Internet Interventions, ISSN 2214-7829, INTERNET INTERVENTIONS-THE APPLICATION OF INFORMATION TECHNOLOGY IN MENTAL AND BEHAVIOURAL HEALTH, Vol. 19, article id 100301Article in journal (Refereed) Published
Abstract [en]

The current study sought to investigate the long-term effects of an internet-administered programme based on CBT principles for which the initial efficacy has been reported in Kall, Jagholm, et al. (In press). Seventy-three participants who were recruited on the basis of experiencing frequent and prolonged loneliness were contacted to complete questionnaires measuring loneliness, quality of life, and symptoms of psychopathology two years after the conclusion of the initial treatment period. Additional items regarding use of the treatment techniques and strategies contained in the programme during the follow-up period was included. In total, 44 participants provided data for the loneliness measure at follow-up. The outcome data were analyzed with a piecewise mixed effects model to provide estimates of change for the continuous measures. Linear multiple regression analysis was used to investigate the relationship between use of treatment techniques and reliable change on the primary outcome measure. The results showed decreases in loneliness during the follow-up period for the sample as a whole. Additionally, an increase in quality of life and a decrease in social anxiety were noted, but no significant changes of depressive symptoms or generalized anxiety. Effect sizes for the observed changes from baseline to follow-up were in the moderate to large range for all measures. Reported use of the treatment techniques was not significantly related to reliable change in loneliness after the two-year period. In conclusion, the results of the study support the utility of internet-based CBT targeting loneliness and indicate that the benefits from the intervention can be enduring.

Place, publisher, year, edition, pages
Elsevier, 2020
Keywords
Internet-based cognitive behavior therapy; Loneliness; CBT; Guided self-help
National Category
Applied Psychology
Identifiers
urn:nbn:se:liu:diva-164032 (URN)10.1016/j.invent.2019.100301 (DOI)000512973600011 ()32071885 (PubMedID)2-s2.0-85078484005 (Scopus ID)
Note

Funding Agencies|Linkoping University

Available from: 2020-03-04 Created: 2020-03-04 Last updated: 2021-12-28Bibliographically approved
4. Therapist-Guided Internet-Based Treatments for Loneliness: A Randomized Controlled Three-Arm Trial Comparing Cognitive Behavioral Therapy and Interpersonal Psychotherapy
Open this publication in new window or tab >>Therapist-Guided Internet-Based Treatments for Loneliness: A Randomized Controlled Three-Arm Trial Comparing Cognitive Behavioral Therapy and Interpersonal Psychotherapy
Show others...
2021 (English)In: Psychotherapy and Psychosomatics, ISSN 0033-3190, E-ISSN 1423-0348, Vol. 90, no 5, p. 351-358Article in journal (Refereed) Published
Abstract [en]

Introduction: Chronic loneliness has been linked to many adverse outcomes, including mental health problems. Psychological treatment of loneliness can be effective, but the evidence base is limited. Objective: To investigate the efficacy of 2 internet-based interventions based on cognitive behavioral therapy (ICBT) and interpersonal psychotherapy (IIPT) relative to a wait-list control group and each other. Methods: A total of 170 participants were recruited and randomized to either 9 weeks of ICBT (n = 68), IIPT (n = 68), or a wait-list condition (n = 34). The primary outcome was loneliness, measured using the UCLA Loneliness Scale before, during, and after treatment. Secondary measures of psychiatric disorders and quality of life were administered before and after treatment. Follow-up was conducted 4 months after the treatment had ended. Primary outcome data were analyzed using growth curve modeling. Secondary outcomes were analyzed using robust regression models. The trial was preregistered (ClinicalTrials.gov ID: NCT03807154). Results: The ICBT condition had a significantly greater impact on loneliness compared to the wait-list and IIPT conditions. Effect sizes were moderate to large (Cohen d = 0.71) compared to the wait-list and moderate (d = 0.53) compared to IIPT. The IIPT condition did not differ significantly from the wait-list. Both active treatments led to significant increases in quality of life. Only the ICBT group had significantly lower symptoms of depression and generalized anxiety compared to the wait-list group. Treatment gains were maintained but not improved at follow-up. Conclusions: ICBT can be an efficacious option for alleviating loneliness. The IIPT intervention was not as effective.

Place, publisher, year, edition, pages
Karger, 2021
Keywords
Loneliness; Internet treatment; Cognitive behavioral therapy; Interpersonal psychotherapy; Guided self-help
National Category
Psychiatry
Identifiers
urn:nbn:se:liu:diva-180090 (URN)10.1159/000516989 (DOI)000668961400001 ()34182552 (PubMedID)
Note

Funding Agencies|Linkoping University

Available from: 2021-10-08 Created: 2021-10-08 Last updated: 2022-05-23

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