Emotional isolation is a state of isolation where one may have a well-functioning social network but still feels emotionally separated from others.
Population-based research indicates that one in five middle-aged and elderly men (50–80 years) in Sweden are emotionally isolated (defined as having no one in whom one can confide). Of those who do have someone in whom they can confide, eight out of ten confide only in their partner. People who have no one in whom they can confide are less likely to feel alert and strong, calm, energetic and happy. Instead, they are more likely to feel depressed, sad, tired and worn out. Many people suffering from this kind of isolation have strong social networks, but lack a significant bond with their friends. While they can build superficial friendships, they are often not able to confide in many people. People who are isolated emotionally usually feel lonely and unable to relate to others.
In Relationships
Emotional isolation can occur as a result of social isolation, or when a person lacks any close confidant or intimate partner. Even though social relationships are necessary for emotional well-being, they can trigger negative feelings and thoughts and emotional isolation can act as a defence mechanism to protect a person from emotional distress. When people are emotionally isolated, they keep their feelings completely to themselves, are unable to receive emotional support from others, feel “shut down” or numb, and are reluctant or unwilling to communicate with others, except perhaps for the most superficial matters. Emotional isolation can occur within an intimate relationship, particularly as a result of infidelity, abuse, or other trust issues. One or both partners may feel alone within the relationship, rather than supported and fulfilled. Identifying the source of the distress and working with a therapist to improve communication and rebuild trust can help couples re-establish their emotional bond.
Effects on the Mind
Cacioppo and his team have found that the brains of lonely people react differently than those with strong social networks. The University of Chicago researchers showed lonely and non-lonely subjects photographs of people in both pleasant settings and unpleasant settings. When viewing the pleasant pictures, non-lonely subjects showed much more activity in a section of the brain known as the ventral striatum than the lonely subjects. The ventral striatum plays an important role in learning. It is also part of the brain’s reward centre, and can be stimulated by rewards like food and love. The lonely subjects displayed far less activity in this region while viewing pleasant pictures, and they also had less brain activity when shown the unpleasant pictures. When non-lonely subjects viewed the unpleasant pictures, they demonstrated activity in the temporoparietal junction, an area of the brain associated with empathy; the lonely subjects had a lesser response.
Social withdrawal is avoiding people and activities one would usually enjoy. For some people, this can progress to a point of social isolation, where people may even want to avoid contact with family and close friends most of the time. They may want to be alone because they feel it is tiring or upsetting to be with other people. Sometimes a cycle can develop where the more time they spend alone, the less they feel like people understand them. When people withdraw themselves from social interaction they tend to stay inside a set place (like a bedroom).
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Social rejection occurs when an individual is deliberately excluded from a social relationship or social interaction. The topic includes interpersonal rejection (or peer rejection), romantic rejection, and familial estrangement. A person can be rejected or shunned by individuals or an entire group of people. Furthermore, rejection can be either active by bullying, teasing, or ridiculing, or passive by ignoring a person, or giving the “silent treatment”. The experience of being rejected is subjective for the recipient, and it can be perceived when it is not actually present. The word “ostracism” is also commonly used to denote a process of social exclusion (in Ancient Greece, ostracism was a form of temporary banishment following a people’s vote).
Although humans are social beings, some level of rejection is an inevitable part of life. Nevertheless, rejection can become a problem when it is prolonged or consistent, when the relationship is important, or when the individual is highly sensitive to rejection. Rejection by an entire group of people can have especially negative effects, particularly when it results in social isolation.
The experience of rejection can lead to a number of adverse psychological consequences such as loneliness, low self-esteem, aggression, and depression. It can also lead to feelings of insecurity and a heightened sensitivity to future rejection.
Need for Acceptance
Social rejection may be emotionally painful, due to the social nature of human beings, as well as the essential need for social interaction between other humans. Abraham Maslow and other theorists have suggested that the need for love and belongingness is a fundamental human motivation. According to Maslow, all humans, even introverts, need to be able to give and receive affection to be psychologically healthy.
Psychologists believe that simple contact or social interaction with others is not enough to fulfil this need. Instead, people have a strong motivational drive to form and maintain caring interpersonal relationships. People need both stable relationships and satisfying interactions with the people in those relationships. If either of these two ingredients is missing, people will begin to feel lonely and unhappy. Thus, rejection is a significant threat. In fact, the majority of human anxieties appear to reflect concerns over social exclusion.
Being a member of a group is also important for social identity, which is a key component of the self-concept. Mark Leary of Duke University has suggested that the main purpose of self-esteem is to monitor social relations and detect social rejection. In this view, self-esteem is a sociometer which activates negative emotions when signs of exclusion appear.
Social psychological research confirms the motivational basis of the need for acceptance. Specifically, fear of rejection leads to conformity to peer pressure (sometimes called normative influence, cf. informational influence), and compliance to the demands of others. The need for affiliation and social interaction appears to be particularly strong under stress.
In Childhood
Peer rejection has been measured using sociometry and other rating methods. Studies typically show that some children are popular, receiving generally high ratings, many children are in the middle, with moderate ratings, and a minority of children are rejected, showing generally low ratings. One measure of rejection asks children to list peers they like and dislike. Rejected children receive few “like” nominations and many “dislike” nominations. Children classified as neglected receive few nominations of either type.
According to Karen Bierman of Pennsylvania State University, most children who are rejected by their peers display one or more of the following behavior patterns:
Low rates of prosocial behaviour, e.g. taking turns, sharing.
High rates of aggressive or disruptive behaviour.
High rates of inattentive, immature, or impulsive behaviour.
High rates of social anxiety.
Bierman states that well-liked children show social savvy and know when and how to join play groups. Children who are at risk for rejection are more likely to barge in disruptively, or hang back without joining at all. Aggressive children who are athletic or have good social skills are likely to be accepted by peers, and they may become ringleaders in the harassment of less skilled children. Minority children, children with disabilities, or children who have unusual characteristics or behaviour may face greater risks of rejection. Depending on the norms of the peer group, sometimes even minor differences among children lead to rejection or neglect. Children who are less outgoing or simply prefer solitary play are less likely to be rejected than children who are socially inhibited and show signs of insecurity or anxiety.
Peer rejection, once established, tends to be stable over time, and thus difficult for a child to overcome. Researchers have found that active rejection is more stable, more harmful, and more likely to persist after a child transfers to another school, than simple neglect. One reason for this is that peer groups establish reputational biases that act as stereotypes and influence subsequent social interaction. Thus, even when rejected and popular children show similar behaviour and accomplishments, popular children are treated much more favourably.
Rejected children are likely to have lower self-esteem, and to be at greater risk for internalising problems like depression. Some rejected children display externalising behaviour and show aggression rather than depression. The research is largely correlational, but there is evidence of reciprocal effects. This means that children with problems are more likely to be rejected, and this rejection then leads to even greater problems for them. Chronic peer rejection may lead to a negative developmental cycle that worsens with time.
Rejected children are more likely to be bullied and to have fewer friends than popular children, but these conditions are not always present. For example, some popular children do not have close friends, whereas some rejected children do. Peer rejection is believed to be less damaging for children with at least one close friend.
An analysis of 15 school shootings between 1995 and 2001 found that peer rejection was present in all but two of the cases (87%). The documented rejection experiences included both acute and chronic rejection and frequently took the form of ostracism, bullying, and romantic rejection. The authors stated that although it is likely that the rejection experiences contributed to the school shootings, other factors were also present, such as depression, poor impulse control, and other psychopathology.
There are programs available for helping children who suffer from social rejection. One large scale review of 79 controlled studies found that social skills training is very effective (r = 0.40 effect size), with a 70% success rate, compared to 30% success in control groups. There was a decline in effectiveness over time, however, with follow-up studies showing a somewhat smaller effect size (r = 0.35).
In the Laboratory
Laboratory research has found that even short-term rejection from strangers can have powerful (if temporary) effects on an individual. In several social psychology experiments, people chosen at random to receive messages of social exclusion become more aggressive, more willing to cheat, less willing to help others, and more likely to pursue short-term over long-term goals. Rejection appears to lead very rapidly to self-defeating and antisocial behaviour.
Researchers have also investigated how the brain responds to social rejection. One study found that the dorsal anterior cingulate cortex is active when people are experiencing both physical pain and “social pain,” in response to social rejection. A subsequent experiment, also using fMRI neuroimaging, found that three regions become active when people are exposed to images depicting rejection themes. These areas are the posterior cingulate cortex, the parahippocampal gyrus, and the dorsal anterior cingulate cortex. Furthermore, individuals who are high in rejection sensitivity (see below) show less activity in the left prefrontal cortex and the right dorsal superior frontal gyrus, which may indicate less ability to regulate emotional responses to rejection.
An experiment performed in 2007 at the University of California at Berkeley found that individuals with a combination of low self-esteem and low attentional control are more likely to exhibit eye-blink startle responses while viewing rejection themed images. These findings indicate that people who feel bad about themselves are especially vulnerable to rejection, but that people can also control and regulate their emotional reactions.
A study at Miami University indicated that individuals who recently experienced social rejection were better than both accepted and control participants in their ability to discriminate between real and fake smiles. Though both accepted and control participants were better than chance (they did not differ from each other), rejected participants were much better at this task, nearing 80% accuracy. This study is noteworthy in that it is one of the few cases of a positive or adaptive consequence of social rejection.
Ball Toss/Cyberball Experiments
A common experimental technique is the “ball toss” paradigm, which was developed by Kip Williams and his colleagues at Purdue University. This procedure involves a group of three people tossing a ball back and forth. Unbeknownst to the actual participant, two members of the group are working for the experimenter and following a pre-arranged script. In a typical experiment, half of the subjects will be excluded from the activity after a few tosses and never get the ball again. Only a few minutes of this treatment are sufficient to produce negative emotions in the target, including anger and sadness. This effect occurs regardless of self-esteem and other personality differences.
Gender differences have been found in these experiments. In one study, women showed greater nonverbal engagement whereas men disengaged faster and showed face-saving techniques, such as pretending to be uninterested. The researchers concluded that women seek to regain a sense of belonging whereas men are more interested in regaining self-esteem.
A computerised version of the task known as “cyberball” has also been developed and leads to similar results. Cyberball is a virtual ball toss game where the participant is led to believe they are playing with two other participants sitting at computers elsewhere who can toss the ball to either player. The participant is included in the game for the first few minutes, but then excluded by the other players for the remaining three minutes. A significant advantage of the Cyberball software is its openness; Williams made the software available to all researchers. In the software, the researcher can adjust the order of throwing the balls, the user’s avatar, the background, the availability of chat, the introductory message and much other information. In addition, researchers can obtain the programme’s latest version by visiting the official website of CYBERBALL 5.0.
This simple and short time period of ostracism has been found to produce significant increases to self-reported levels of anger and sadness, as well as lowering levels of the four needs. These effects have been found even when the participant is ostracised by out-group members, when the out-group member is identified as a despised person such as someone in the Ku Klux Klan, when they know the source of the ostracism is just a computer, and even when being ostracised means they will be financially rewarded and being included would incur a financial cost. People feel rejected even when they know they are playing only against the computer. A recent set of experiments using cyberball demonstrated that rejection impairs willpower or self-regulation. Specifically, people who are rejected are more likely to eat cookies and less likely to drink an unpleasant tasting beverage that they are told is good for them. These experiments also showed that the negative effects of rejection last longer in individuals who are high in social anxiety.
Life-Alone Paradigm
Another mainstream research method is the Life Alone Paradigm, which was first developed by Twenge and other scholars to evoke feelings of rejection by informing subjects of false test results. In contrast to ball toss and cyberball, it focuses on future rejection, i.e. the experience of rejection that participants may potentially experience in the future. Specifically, at the beginning of the experiment, participants complete a personality scale (in the original method, the Eysenck Personality Questionnaire). They are then informed of their results based on their experimental group rather than the real results. Participants in the rejected group will be told that their test results indicate that they will be alone in the future, regardless of their current state of life. Participants in the accepted group will be told they will have a fulfilling relationship. In the control group, participants were told they would encounter some accidences. In this way, the participants’ sense of rejection is awakened to take the subsequent measurement. After the experiment, the researcher will explain the results to the participants and apologise.
Scholars point out that this method may cause more harm to the subjects. For example, the participants will likely experience a more severe effect on executive functioning during the test. Therefore, this method faces more significant issue with research ethics and harms than other rejection experiments. Consequently, researchers should use this test with caution in experiments and pay attention to the subjects’ reaction afterwards.
Psychology of Ostracism
Most of the research on the psychology of ostracism has been conducted by the social psychologist Kip Williams. He and his colleagues have devised a model of ostracism which provides a framework to show the complexity in the varieties of ostracism and the processes of its effects. There he theorises that ostracism can potentially be so harmful that humans have evolved an efficient warning system to immediately detect and respond to it.
In the animal kingdom as well as in primitive human societies, ostracism can lead to death due to the lack of protection benefits and access to sufficient food resources from the group. Living apart from the whole of society also means not having a mate, so being able to detect ostracism would be a highly adaptive response to ensure survival and continuation of the genetic line.
Temporal Need-Threat Model
The predominant theoretical model of social rejection is the temporal-need threat model proposed by Williams and his colleagues, in which the process of social exclusion is divided into three stages:
Reflexive;
Reflective; and
Resignation.
The reflexive stage happens when social rejection first occurs. It is an immediate effect happened on individuals. Then, the reflective stage enters when the individual starts to reflect and cope with social rejection. Finally, if the rejection last for the long term and the individual cannot successfully cope with it, the social rejection would turn to the resignation stage, where the individual is likely to suffer from severe depression and helplessness. These will likely push the individual into suicide or other extreme behaviour.
Reflexive Stage
The reflexive stage is the first stage of social rejection and refers to the period immediately after social exclusion has occurred. During this stage, Williams proposed that ostracism uniquely poses a threat to four fundamental human needs; the need to belong, the need for control in social situations, the need to maintain high levels of self-esteem, and the need to have a sense of a meaningful existence. When social rejection is related to the individual’s social relationships, the individual’s need for belonging and self-esteem is threatened; when it is not associated with it, it is primarily a threat to a sense of control and meaningful existence.
Another challenge that individuals need to face at this stage is the sense of pain. Previous scholars have used neurobiological methods to find that social exclusion, whether intentional or unintentional, evokes pain in individuals. Specifically, neurobiological evidence suggests that social exclusion increases the dorsal anterior cingulate cortex (dACC) activation. This brain region, in turn, is associated with physiological pain in individuals. Notably, the right ventral prefrontal cortex (RVPFC) is also further activated when individuals find that social rejection is intentional; this brain region is associated with the regulation of pain perception, implying that pain perception decreases when individuals understand the source of this social rejection. Further research suggests that personal traits or environmental factors do not affect this pain.
Thus, people are motivated to remove this pain with behaviours aimed at reducing the likelihood of others ostracising them any further and increasing their inclusionary status.
Reflective Stage
In the reflective stage, individuals begin to think about and try to cope with social rejection. In the need-threat model, their response is referred to as need fortification, i.e. the creation of interventions that respond to the needs they are threatened by in the reflective stage. Specifically, when individuals’ self-esteem and sense of belonging are threatened, they will try to integrate more into the group. As a result, these rejected individuals develop more pro-social behaviours, such as helping others and giving gifts. In contrast, when their sense of control and meaning is threatened, they show more antisocial behaviour, such as verbal abuse, fighting, etc., to prove they are essential.
Resignation Stage
When individuals have been in social rejection for a long time and cannot improve their situation through effective coping, they move to the third stage, resignation, in which they do not try to change the problem they are facing but choose to accept it. In Zadro’s interview study, in which she interviewed 28 respondents in a state of chronic rejection, she found that the respondents were depressed, self-deprecating and helpless. This social rejection can significantly impact the physical and psychological health of the individual.
Controversy
The controversy over temporal need-threat model has focused on whether it enhances or reduces people’s perception of pain. DeWall and Baumeister’s research suggests that individuals experience a reduction in pain after rejection, a phenomenon they refer to as emotional numbness, which contradicts Williams et al.’s theory that social rejection enhances pain perception. In this regard, Williams suggests that this phenomenon is likely due to differences in the paradigm used in the study, as when using a long-term paradigm such as Life-Alone, individuals do not feel the possibility of rejoining the group, thus creating emotional numbness. This is further supported by Bernstein and Claypool, who found that in separate cyberball and life-alone experiments, stronger stimuli of rejection, such as life-alone, protected people through emotional numbness. In contrast, in the case of minor rejection, such as that in cyberball, the individual’s system detects the rejection cue and draws attention to it through a sense of pain.
Popularity Resurgence
There has been recent research into the function of popularity on development, specifically how a transition from ostracisation to popularity can potentially reverse the deleterious effects of being socially ostracised. While various theories have been put forth regarding what skills or attributes confer an advantage at obtaining popularity, it appears that individuals who were once popular and subsequently experienced a transient ostracisation are often able to employ the same skills that led to their initial popularity to bring about a popularity resurgence.
Romantic
In contrast to the study of childhood rejection, which primarily examines rejection by a group of peers, some researchers focus on the phenomenon of a single individual rejecting another in the context of a romantic relationship. In both teenagers and adults, romantic rejection occurs when a person refuses the romantic advances of another, ignores/avoids or is repulsed by someone who is romantically interested in them, or unilaterally ends an existing relationship. The state of unrequited love is a common experience in youth, but mutual love becomes more typical as people get older.
Romantic rejection is a painful, emotional experience that appears to trigger a response in the caudate nucleus of the brain, and associated dopamine and cortisol activity. Subjectively, rejected individuals experience a range of negative emotions, including frustration, intense anger, jealousy, hate, and eventually, resignation, despair, and possible long-term depression. However, there have been cases where individuals go back and forth between depression and anger.
Rejection Sensitivity
Karen Horney was the first theorist to discuss the phenomenon of rejection sensitivity. She suggested that it is a component of the neurotic personality, and that it is a tendency to feel deep anxiety and humiliation at the slightest rebuff. Simply being made to wait, for example, could be viewed as a rejection and met with extreme anger and hostility.
Albert Mehrabian developed an early questionnaire measure of rejection sensitivity. Mehrabian suggested that sensitive individuals are reluctant to express opinions, tend to avoid arguments or controversial discussions, are reluctant to make requests or impose on others, are easily hurt by negative feedback from others, and tend to rely too much on familiar others and situations so as to avoid rejection.
A more recent (1996) definition of rejection sensitivity is the tendency to “anxiously expect, readily perceive, and overreact” to social rejection. People differ in their readiness to perceive and react to rejection. The causes of individual differences in rejection sensitivity are not well understood. Because of the association between rejection sensitivity and neuroticism, there is a likely genetic predisposition. Rejection sensitive dysphoria, while not a formal diagnosis, is also a common symptom of attention deficit hyperactivity disorder (ADHD), estimated to affect a majority of people with ADHD. Others posit that rejection sensitivity stems from early attachment relationships and parental rejection; also peer rejection is thought to play a role. Bullying, an extreme form of peer rejection, is likely connected to later rejection sensitivity. However, there is no conclusive evidence for any of these theories.
Health
Social rejection has a large effect on a person’s health. Baumeister and Leary originally suggested that an unsatisfied need to belong would inevitably lead to problems in behaviour as well as mental and physical health. Corroboration of these assumptions about behaviour deficits were seen by John Bowlby in his research. Numerous studies have found that being socially rejected leads to an increase in levels of anxiety. Additionally, the level of depression a person feels as well as the amount they care about their social relationships is directly proportional to the level of rejection they perceive. Rejection affects the emotional health and well being of a person as well. Overall, experiments show that those who have been rejected will suffer from more negative emotions and have fewer positive emotions than those who have been accepted or those who were in neutral or control conditions.
In addition to the emotional response to rejection, there is a large effect on physical health as well. Having poor relationships and being more frequently rejected is predictive of mortality. Also, as long as a decade after the marriage ends, divorced women have higher rates of illness than their non-married or currently married counterparts. In the case of a family estrangement, a core part of the mother’s identity may be betrayed by the rejection of an adult child. The chance for reconciliation, however slight, results in an inability to attain closure. The resulting emotional state and societal stigma from the estrangement may harm psychological and physical health of the parent through end of life.
The immune system tends to be harmed when a person experiences social rejection. This can cause severe problems for those with diseases such as HIV. One study by Cole, Kemeny, and Taylor investigated the differences in the disease progression of HIV positive gay men who were sensitive to rejection compared to those who were not considered rejection sensitive. The study, which took place over nine years, indicated significantly faster rate of low T helper cells, therefore leading to an earlier AIDS diagnosis. They also found that those patients who were more sensitive to rejection died from the disease an average of 2 years earlier than their non-rejection sensitive counterparts.
Other aspects of health are also affected by rejection. Both systolic and diastolic blood pressure increase upon imagining a rejection scenario. Those who are socially rejected have an increased likelihood of suffering from tuberculosis, as well as suicide. Rejection and isolation were found to affect levels of pain following an operation as well as other physical forms of pain. Social rejection may cause a reduction in intelligence. MacDonald and Leary theorise that rejection and exclusion cause physical pain because that pain is a warning sign to support human survival. As humans developed into social creatures, social interactions and relationships became necessary for survival, and the physical pain systems already existed within the human body.
In Popular Culture
Artistic depictions of rejection occur in a variety of art forms. One genre of film that most frequently depicts rejection is romantic comedies. In the film He’s Just Not That Into You, the main characters deal with the challenges of reading and misreading human behaviour. This presents a fear of rejection in romantic relationships as reflected in this quote by the character Mary, “And now you have to go around checking all these different portals just to get rejected by seven different technologies. It’s exhausting.”
Social rejection is also depicted in theatrical plays and musicals. For example, the film Hairspray shares the story of Tracy Turnblad, an overweight 15-year-old dancer set in the 1960s. Tracy and her mother are faced with overcoming society’s expectations regarding weight and physical appearances.
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The hedgehog’s dilemma, or sometimes the porcupine dilemma, is a metaphor about the challenges of human intimacy. It describes a situation in which a group of hedgehogs seek to move close to one another to share heat during cold weather. They must remain apart, however, as they cannot avoid hurting one another with their sharp spines. Though they all share the intention of a close reciprocal relationship, this may not occur, for reasons they cannot avoid.
Arthur Schopenhauer conceived this metaphor for the state of the individual in society. Despite goodwill, humans cannot be intimate without the risk of mutual harm, leading to cautious and tentative relationships. It is wise to be guarded with others for fear of getting hurt and also fear of causing hurt. The dilemma may encourage self-imposed isolation.
Schopenhauer
The concept originates in the following parable from the German philosopher Schopenhauer:
One cold winter’s day, a number of porcupines huddled together quite closely in order through their mutual warmth to prevent themselves from being frozen. But they soon felt the effect of their quills on one another, which made them again move apart. Now when the need for warmth once more brought them together, the drawback of the quills was repeated so that they were tossed between two evils, until they had discovered the proper distance from which they could best tolerate one another. Thus the need for society which springs from the emptiness and monotony of men’s lives, drives them together; but their many unpleasant and repulsive qualities and insufferable drawbacks once more drive them apart. The mean distance which they finally discover, and which enables them to endure being together, is politeness and good manners. Whoever does not keep to this, is told in England to ‘keep his distance’. By virtue thereof, it is true that the need for mutual warmth will be only imperfectly satisfied, but on the other hand, the prick of the quills will not be felt. Yet whoever has a great deal of internal warmth of his own will prefer to keep away from society in order to avoid giving or receiving trouble or annoyance. (Schopenhauer, 1851; Parerga and Paralipomena).
Freud
It entered the realm of psychology after the tale was discovered and adopted by Sigmund Freud. Schopenhauer’s tale was quoted by Freud in a footnote to his 1921 work Group Psychology and the Analysis of the Ego (German: Massenpsychologie und Ich-Analyse). Freud stated, of his trip to the United States in 1909:
“I am going to the USA to catch sight of a wild porcupine and to give some lectures.”
Social Psychological Research
The dilemma has received empirical attention within the contemporary psychological sciences. Jon Maner and his colleagues (Nathan DeWall, Roy Baumeister, and Mark Schaller) referred to Schopenhauer’s “porcupine problem” when interpreting results from experiments examining how people respond to ostracism. The study showed that participants who experienced social exclusion were more likely to seek out new social bonds with others.
In Popular Culture
The parable of the hedgehog’s dilemma was referenced in the anime series Neon Genesis Evangelion, especially in its fourth episode of the same name.
The award-winning short film Henry is a modernist version of the hedgehog’s dilemma: in this story, the hedgehog eventually finds social comfort through a turtle, that is, a fellow social creature who is invulnerable to the hedgehog’s spines. In the context of the original dilemma, this can be taken to represent the need for variability in human social preferences.
The Japanese vocaloid song Harinezumi by Tota Kasamura is about the hedgehog’s dilemma.
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Social isolation is a state of complete or near-complete lack of contact between an individual and society. It differs from loneliness, which reflects temporary and involuntary lack of contact with other humans in the world. Social isolation can be an issue for individuals of any age, though symptoms may differ by age group.
Social isolation has similar characteristics in both temporary instances and for those with a historical lifelong isolation cycle. All types of social isolation can include staying home for lengthy periods of time, having no communication with family, acquaintances or friends, and/or wilfully avoiding any contact with other humans when those opportunities do arise.
Effects
True social isolation over years and decades can be a chronic condition affecting all aspects of a person’s existence. Social isolation can lead to feelings of loneliness, fear of others, or negative self-esteem. Lack of consistent human contact can also cause conflict with (peripheral) friends. The socially isolated person may occasionally talk to or cause problems with family members.
In the case of mood-related isolation, the individual may isolate during a depressive episode only to ‘surface’ when their mood improves. The individual may attempt to justify their reclusive or isolating behaviour as enjoyable or comfortable. There can be an inner realisation on the part of the individual that there is something wrong with their isolating responses which can lead to heightened anxiety. Relationships can be a struggle, as the individual may reconnect with others during a healthier mood only to return to an isolated state during a subsequent low or depressed mood.
Perceived Social Isolation in Humans
Research indicates that perceived social isolation (PSI) is a risk factor for and may contribute to “poorer overall cognitive performance and poorer executive functioning, faster cognitive decline, more negative and depressive cognition, heightened sensitivity to social threats, and a self-protective confirmatory bias in social cognition.” PSI also contributes to accelerating the ageing process: Wilson et al. (2007) reported that, after controlling for social network size and frequency of social activity, perceived social isolation is predictive of cognitive decline and risk for Alzheimer’s disease. Moreover, the social interactions of individuals who feel socially isolated are more negative and less subjectively satisfying. This contributes to a vicious cycle in which the person becomes more and more isolated.
Neuroimaging Studies
In the first resting state fMRI functional connectivity (FC) study on PSI, PSI was found to be associated with increased resting-state FC between several nodes of the cingulo-opercular network, a neural network associated with tonic alertness. PSI was also associated with reduced resting-state FC between the cingulo-opercular network and the right superior frontal gyrus, suggesting diminished executive control. Cacioppo and colleagues (2009) found that lonely individuals express weaker activation of the ventral striatum in response to pleasant pictures of people than of objects, suggesting decreased reward to social stimuli. Lonely individuals also expressed greater activation of the visual cortex in response to unpleasant depictions of people (i.e. negative facial expressions) than of objects; non-lonely individuals show greater activation of the right and left temporoparietal junction (TPJ), a region implicated in theory of mind. The authors interpreted the findings to represent that lonely individuals pay greater attention to negative social stimuli, but non-lonely individuals, to a greater degree than lonely individuals, insert themselves into the perspective of others. Moreover, Kanai et al. (2012) reported that loneliness negatively correlated with gray matter density in the left posterior temporal sulcus, an area involved in biological motion perception, mentalising, and social perception.
Overall, several neuroimaging studies in humans on perceived social isolation have emphasized implications of the visual cortex and right-hemispheric stress-related circuits underlying difference between lonely and non-lonely individuals. One population-genetics study marked a 50× increase in the neuroimaging research on perceived social isolation. The investigators tested for signatures of loneliness in grey matter morphology, intrinsic functional coupling, and fibre tract microstructure. The loneliness-linked neurobiological profiles converged on a collection of brain regions known as the default mode network. This higher associative network shows more consistent loneliness associations in grey matter volume than other cortical brain networks. Lonely individuals display stronger functional communication in the default network, and greater microstructural integrity of its fornix pathway. The findings fit with the possibility that the up-regulation of these neural circuits supports mentalising, reminiscence and imagination to fill the social void.
Social Isolation in Rodents
Experimental manipulations of social isolation in rats and mice (e.g. isolated rearing) are a common means of elucidating the effects of isolation on social animals in general. Researchers have proposed isolated rearing of rats as an etiologically valid model of human mental illness. Indeed, chronic social isolation in rats has been found to lead to depression-, anxiety-, and psychosis-like behaviours as well signs of autonomic, neuroendocrine, and metabolic dysregulation. For example, a systematic review found that social isolation in rats is associated with increased expression of BDNF in the hippocampus, which is associated with increased anxiety-like symptoms. In another example, a study found that social isolation in rats is associated with increased brain-derived neurotrophic factor (BDNF) expression in the prefrontal cortex. This results in the dysregulation of neural activity which is associated with anxiety, depression, and social dysfunction.
The effects of experimental manipulations of isolation in nonhuman social species has been shown to resemble the effects of perceived isolation in humans, and include: increased tonic sympathetic tone and hypothalamic-pituitary-adrenal (HPA) activation and decreased inflammatory control, immunity, sleep salubrity, and expression of genes regulating glucocorticoid responses. However, the biological, neurological, and genetic mechanisms underlying these symptoms are poorly understood.
Neurobiology
Social isolation contributes to abnormal hippocampal development via specific alterations to microtubule stability and decreased MAP-2 expression. Social isolation contributes to decreased expression of the synaptic protein synaptophysin and decreased dendritic length and dendritic spine density of pyramidal cells. The underlying molecular mechanism of these structural neuronal alterations are microtubule stabilisations, which impair the remodelling and extension of axons and dendrites.
Research by Cole and colleagues showed that perceived social isolation is associated with gene expression – specifically, the under-expression of genes bearing anti-inflammatory glucocorticoid response elements and over-expression of genes bearing response elements for pro-inflammatory NF-κB/Rel transcription factors. This finding is paralleled by decreased lymphocyte sensitivity to physiological regulation by the HPA axis in lonely individuals. This, together with evidence of increased activity of the HPA axis, suggests the development of glucocorticoid resistance in chronically lonely individuals.
Social isolation can be a precipitating factor for suicidal behaviour. A large body of literature suggests that individuals who experience isolation in their lives are more vulnerable to suicide than those who have strong social ties with others. A study found social isolation to be among the most common risk factors identified by Australian men who attempt suicide. Professor Ian Hickie of the University of Sydney said that social isolation was perhaps the most important factor contributing to male suicide attempts. Hickie said there was a wealth of evidence that men had more restricted social networks than women, and that these networks were heavily work-based.
A lack of social relationships negatively impacts the development of the brain’s structure. In extreme cases of social isolation, studies of young mice and monkeys have shown how the brain is strongly affected by a lack of social behaviour and relationships.
In Social Animal Species in General
In a hypothesis proposed by Cacioppo and colleagues, the isolation of a member of a social species has detrimental biological effects. In a 2009 review, Cacioppo and Hawkley noted that the health, life, and genetic legacy of members of social species are threatened when they find themselves on the social perimeter. For instance, social isolation decreases lifespan in the fruit fly; promotes obesity and type 2 diabetes in mice; exacerbates infarct size and oedema and decreases post-stroke survival rate following experimentally induced stroke in mice; promotes activation of the sympatho-adrenomedullary response to an acute immobilisation or cold stressor in rats; delays the effects of exercise on adult neurogenesis in rats; decreases open field activity, increases basal cortisol concentrations, and decreases lymphocyte proliferation to mitogens in pigs; increases the 24-hour urinary catecholamine levels and evidence of oxidative stress in the aortic arch of rabbits; and decreases the expression of genes regulating glucocorticoid response in the frontal cortex.
Social isolation in the common starling, a highly social, flocking species of bird, has also been shown to stress the isolated birds.
Background
Social isolation is both a potential cause and a symptom of emotional or psychological challenges. As a cause, the perceived inability to interact with the world and others can create an escalating pattern of these challenges. As a symptom, periods of isolation can be chronic or episodic, depending upon any cyclical changes in mood, especially in the case of clinical depression.
Every day aspects of this type of deep-rooted social isolation can mean:
Staying home for an indefinite period of time due to lack of access to social situations rather than a desire to be alone;
Both not contacting, and not being contacted by, any acquaintances, even peripherally; for example, never being called by anybody on the telephone and never having anyone visit one’s residence; and
A lack of meaningful, extended relationships, and especially close intimacy (both emotional and physical).
Contributing Factors
The following risk factors contribute to reasons why individuals distance themselves from society.
Ageing – Once a person reaches an age where problems such as cognitive impairments and disabilities arise, they are unable to go out and socialise.
Health and disabilities – People may be embarrassed by their disabilities or health problems, such that they have a tendency to isolate themselves to avoid social interaction out of fear that they would be judged or stigmatised. Sometimes, rather than embarrassment, the disability itself and a person’s lack of a support network can be the cause of social isolation.
Autism – autistic and allistic (non-autistic) people communicate very differently, leading to a mutual friction when they try talking to each other. As autistic people are in a steep minority, often unable to find peers who communicate the same way they do, they are often ostracised by the majority, who mistake their direct, semantic communication style for them being purposefully arrogant, brash, and obtuse.
Hearing loss – hearing loss can cause communication impairment, which can lead to social isolation particularly in older adults.
The loss of a loved one can contribute to social isolation. Studies have shown that widows who keep in contact with friends or relatives have better psychological health. A study conducted by Jung-Hwa Ha and Berit Ingersoll-Dayton concluded that widows who had a lot of social contact and interactions lead to fewer depressive symptoms. During a time of loss social isolation is not beneficial to an individual’s mental health.
Living alone – A 2015 study by the National Centre for Family & Marriage Research found 13% of adults in the United States were living alone, up from 12% in 1990. The rate of living alone for people under 45 has not changed, but the rate for Americans aged 45 – 65 has increased over the past 25 years. People over the age of 65 are living alone less often.
Isolation may be imposed by an abusive spouse.
Rural isolation – In rural areas, factors such as living far apart from one another, rural flight, a negligible amount of public spaces and entertainment, and lack of access to mental health-related resources all contribute to isolation. Limited access to broadband internet and cellular activity also make it harder for those experiencing isolation to connect online or reach people.
Unemployment – This can begin if someone is fired, dismissed, or released from a job or workplace, or leaves one of their own accords. If the person struggles or is unable to find a new job for a long period of time (i.e. months or years) the sense of isolation can become exacerbated, especially in men.
Independent home worker – The tasks implied in this kind of job generally doesn’t imply social interaction in the physical level, nor going outside. Interactions and payments can be made by digital media so the person remains isolated from society.
Retirement – or other source of fixed income, makes it unnecessary for the person to search for a job, this situation is similar to unemployment but with better living on one hand but without the need to go outside on the other hand.
Transportation problems – If the person does not have transportation to attend gatherings or to simply get out of the house, they have no choice but to stay home all day, which can lead to those feelings of depression.
Societal adversity – Desire to avoid the discomfort, dangers, and responsibilities arising from being among people. This can happen if other people are sometimes, or often, rude, hostile, critical or judgemental, crude, or otherwise unpleasant. The person would just prefer to be alone to avoid the hassles and hardships of dealing with people. Being a part of an outgroup and social categorisation can also play a part in creating adverse circumstances that the individual may attempt to avoid depending on the policies and attitudes of the society.
Substance abuse can be both cause and/or effect of isolation, often coinciding with mood-related disorders, especially among those living alone.
Economic inequality – Poorer children have fewer school-class friends and are more often isolated. Adults on welfare, such as the Ontario Disability Support Programme prioritise their monthly entitlement towards rent and low-cost meals, leaving opportunities to socialise at restaurants and movie theatres out of the question.
Self-esteem – A person with a low self-esteem or lack of self love can contribute to that person’s isolation. Having a low self-esteem can cause one to overthink and stress themselves out when being around people, and can ultimately eliminate that feeling by isolating themselves. Removing this feeling can lead to an unfortunate social life in the future and can also harm potential relationships with others. According to Northeastern University, having a low self-esteem can hold us back from reaching out to making plans with other people. It can make a person feel like they’re a burden to them, therefore once again isolating themselves from going out. This can also lead a person into thinking that they are not worthy of making friends and deserve any love; and also feeling like they do not deserve to have a happy life.
Lockdowns, such as those imposed in 2020 and 2021 in an attempt to prevent the spread of SARS-CoV-2.
Social isolation can begin early in life. During this time of development, a person may become more preoccupied with feelings and thoughts of their individuality that are not easy to share with other individuals. This can result from feelings of shame, guilt, or alienation during childhood experiences. Social isolation can also coincide with developmental disabilities. Individuals with learning impairments may have trouble with social interaction. The difficulties experienced academically can greatly impact the individual’s esteem and sense of self-worth. An example would be the need to repeat a year of school. During the early childhood developmental years, the need to fit in and be accepted is paramount. Having a learning deficit can in turn lead to feelings of isolation, that they are somehow ‘different’ from others.
Whether new technologies such as the Internet and mobile phones exacerbate social isolation (of any origin) is a debated topic among sociologists, with studies showing both positive correlation of social connections with use of social media as well as mood disorders coinciding with problematic use.
Isolation among the Elderly
Social isolation impacts approximately 24% of older adults in the United States, approximately 9 million people. The elderly have a unique set of isolating dynamics that often perpetuate one another and can drive the individual into deeper isolation. Increasing frailty, possible declines in overall health, absent or uninvolved relatives or children, economic struggles can all add to the feeling of isolation. Among the elderly, childlessness can be a cause for social isolation. Whether their child is deceased or they did not have children at all, the loneliness that comes from not having a child can cause social isolation. Retirement, the abrupt end of daily work relationships, the death of close friends or spouses can also contribute to social isolation.
In the United States, Canada, and United Kingdom, a significant sector of the elderly who are in their 80s and 90s are brought to nursing homes if they show severe signs of social isolation. Other societies such as many in Southern Europe, Eastern Europe, East Asia, and also the Caribbean and South America, do not normally share the tendency towards admission to nursing homes, preferring instead to have children and extended-family of elderly parents take care of those elderly parents until their deaths.] On the other hand, a report from Statistics Norway in 2016 stated that more than 30% of seniors over the age of 66 have two or fewer people to rely on should personal problems arise. Even still, nearly half of all members of senior communities are at high risk for social isolation, this is especially prevalent with seniors of a lower education and within the lower economic class and compounded with diminished availability of socialising options to these lower class individuals. There has also been an observed increase in physical gait among members of these communities.
Social isolation among older adults has been linked to an increase in disease morbidity, a higher risk of dementia, and a decrease in physical mobility along with an increase in general health concerns. Evidence of increased cognitive decline has been link to an increase in social isolation in depressed elderly women. At the same time, increasing social connectedness has been linked to health improvements among older adults.
The use of video communication/video calls has been suggested as a potential intervention to improve social isolation in seniors. However, its effectiveness is not known.
Isolation and Health and Mortality
Social isolation and loneliness in older adults is associated with an increased risk for poor mental and physical health and increased mortality. There is an increased risk for early mortality in individuals experiencing social isolation compared to those who are not socially isolated. Studies have found social isolation is associated with increased risk in physical health conditions including high blood pressure, high cholesterol, elevated stress hormones, and weakened immune systems. Research also suggests that social isolation and mortality in the elderly share a common link to chronic inflammation with some differences between men and women. Social isolation has also been found to be associated with poor mental health including increased risk for depression, cognitive decline, anxiety, and substance use. Social isolation in elderly individuals is also associated with an increased risk for dementia. However, not all studies found social isolation associated with the risk of poor health outcome.
Isolation among Children and Teens
Middle school is a time when youth tend to be sensitive to social challenges and their self-esteem can be fragile. During this vulnerable time in development, supporting students’ sense of belonging at school is of critical importance. Existing research finds that adolescents’ development of a sense of belonging is an important factor in adolescence for creating social and emotional well-being and academic success. Studies have found that friendship-related loneliness is more explanatory for depressive symptoms among adolescents than parent-related loneliness. One possible explanation is that friends are the preferred source of social support during adolescence.
Scientists have long known that loneliness in adults can predispose depressive symptoms later in life. Lately, scientists have also seen that lonely children are more susceptible to depressive symptoms in youth. In one study, researchers conclude that prevention of loneliness in childhood may be a protective factor against depression in adulthood. Socially isolated children tend to have lower subsequent educational attainment, be part of a less advantaged social class in adulthood, and are more likely to be psychologically distressed in adulthood. By receiving social assistance, studies show that children can cope more easily with high levels of stress. It is also shown that social support is strongly associated with feelings of mastery and the ability to deal with stressful situations, as well as strongly associated with increased quality of life.
Demographics
Research has shown that men and boys are more likely to experience social isolation in their lives.
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Masking is a process by which an individual changes or “masks” their natural personality to conform to social pressures, abuse or harassment.
Masking can be strongly influenced by environmental factors such as authoritarian parents, rejection, and emotional, physical, or sexual abuse. An individual may not even know they are masking because it is a behaviour that can take many forms.
Masking should not be confused with masking behaviour, which is to mentally block feelings of suffering as a survival mechanism (refer to Defence Mechanism).
Brief History
The term masking was first used to describe the act of concealing disgust by Ekman (1972) and Friesen (1969). It was also thought of as a learned behaviour. Developmental studies have shown that this ability begins as early as preschool and improves with age. In recent developmental studies, masking has evolved and is now defined as concealing one’s emotion by portraying another emotion. It is mostly used to conceal a negative emotion (usually sadness, frustration, and anger) with a positive emotion.
Causes
Contextual factors including relationships with one’s conversation partner, status differences, location, and social setting are all reasons as to why an individual would express, suppress, or mask an emotion. Masking is a façade to behave in certain ways that would help one hide their emotions and represses emotions that are not approved by those around them. Because a person wants to receive acceptance from the public, masking helps disguise characteristics like anger, jealousy or rage – emotions that would not be considered socially acceptable.
Situations
Personal space: Varies with individuals could be masking emotions to those close to them or strangers.
Setting.
Gender Differences
Masking negative emotions differ for each gender. Females tend to have an advanced ability when hiding their negative emotions towards something they dislike as compared to males. One of the possible reasons as to why females are able to mask their negative emotions better is society’s pressure that a girl must act nice.
Ethnicity
Masking also differs between cultures. Some studies state that certain cultures tend to moderate their expressions of emotion while others show a greater amount of positive emotions and expressions.
Autistic Masking
Some autistic people have been described as being able to “mask” or “camouflage” their signs of autism in order to meet social expectations. This may involve behaviour such as suppressing self-calming repetitive movements, faking a smile in an environment that they find uncomfortable or distressing, consciously evaluating their own behaviour and mirroring others, or choosing not to talk about their interests. As masking is often a conscious effort, it can be exhausting for autistic people to do this for an extended period of time (socially, but also in work contexts). In addition to making the person appear non-autistic or neurotypical, masking may conceal the person’s need for support. Such autistic people have cited social acceptance, the need to get a job, avoiding ostracism, or avoiding verbal or physical abuse as reasons for masking.
Research has found that autistic masking is correlated with depression and suicide. Many autistic adults in one survey described profound exhaustion from trying to pretend to be non-autistic. Therapies that teach autistic people to mask, such as some forms of applied behaviour analysis, are controversial.
Signs and Symptoms
Each person masks their emotions differently. During one’s childhood, an individual learns to behave a certain way when they receive approval from those around them and thus develops a mask. The individual is “not conscious of the role they’ve adopted and is projecting outwards to people they meet”. In some cases where the individual is highly conscious, they may not know that they are wearing a mask. Wearing a mask takes away energy from a person’s consciousness and, in the long run, wears out their energy.
Masking tendencies can be more obvious when a person is sick or weak, since they may no longer have the energy to maintain the mask.
Consequences
Little is known about the effects of masking one’s negative emotions. In the workplace, masking leads to feelings of dissonance, insincerity, job dissatisfaction, emotional and physical exhaustion, and self-reported health problems. Some have also reported experiencing somatic symptoms and harmful physiological and cognitive effects as a consequence
Masked Emotions
Emotions that are usually concealed:
Anger.
Anxiety.
Disgust.
Disinterest.
Embarrassment.
Fear.
Frustration.
Sadness.
Emotions that are expressed in place of the concealed emotions:
In 2020 the campaign reached around 271.5 million people – all without leaving our homes. The campaign saw almost 20,000 charities, organisations, companies and individuals get involved online.
Author(s): Jolanda Jetten, Stephen D. Reicher, S. Alexander Haslam, and Tegan Cruwys.
Year: 2020.
Edition: First (1st).
Publisher: SAGE Publications Ltd.
Type(s): Paperback and Kindle.
Synopsis:
Written by leading social psychologists with expertise in leadership, health and emergency behaviour – who have also played an important role in advising governments on COVID-19 – this book provides a broad but integrated analysis of the psychology of COVID-19
It explores the response to COVID-19 through the lens of social identity theory, drawing from insights provided by four decades of research. Starting from the premise that an effective response to the pandemic depends upon people coming together and supporting each other as members of a common community, the book helps us to understand emerging processes related to social (dis)connectedness, collective behaviour and the societal effects of COVID-19. In this it shows how psychological theory can help us better understand, and respond to, the events shaping the world in 2020.
Considering key topics such as:
Leadership.
Communication.
Risk perception.
Social isolation.
Mental health.
Inequality.
Misinformation.
Prejudice and racism.
Behaviour change.
Social Disorder.
This book offers the foundation on which future analysis, intervention and policy can be built.
In 1999 the Society declared 08 August as the “Admit You’re Happy Day”, now known as the “Happiness Happens Day”.
The idea was inspired by the event that happened the previous year on the same date- the first member joined the Society.
In 1998 the Society asked the governors in all 50 states for a proclamation, with nineteen of them sending one.
What is the Secret Society of Happy People?
Secret Society of Happy People (SOHP) is an organisation that celebrates the expression of happiness.
Founded in August 1998, the society encourages thousands of members from all around the globe to recognise their happy moments and think about happiness in their daily life.
Purpose of SOHP?
The Secret Society of Happy People supports people who want to share their happiness despite the ones who don’t want to hear happy news.
Their mottos include “Happiness Happens” and “Don’t Even Think of Raining on My Parade”.
The main purpose of the Society is to stimulate people’s right to express their happiness “as loud as they want”.
Other Events
Happiness Happens Month:
Celebration of happiness was expanded in 2000, and thanks to the support of not-so-secretly-happy members from around the world, the Society declared August as Happiness Happens Month.
The purpose of Happiness Happens Day and Month is to share happiness and encourage people to talk and think about happiness.
HappyThon:
Every year, the Society organises an online social media event known as HappyThon, on Happiness Happens Day.
The aim of this event is to send inspirational messages via social networks, emails or texts, share happy moments, philosophy, quotes, etc.
HappyThon is the first online social media event that promotes happiness around the world.
Since 1998 the Society have been organising voting and announcing the Happiest Events and Moments of the Year.
Before the end of the century, a vote for 100 of the Happiest Events, Inventions and Social Changes of the Century was organised.
In the third week of January the Society hosted Hunt for Happiness Week.
They asked the current governors for a proclamation, with seven of them providing one.
In a survey of almost 1,500 US adults, McGinty and colleagues (2020) studied levels of psychological distress using the Kessler scale and levels of loneliness.
They compared the distress levels with national data from 2018. In 2018, the prevalence of serious psychological distress was 3.9%. In April 2020 it was 13.6%.
The authors note a worrying implication of these findings – that, since the Kessler scale is predictive of serious mental illness, the distress during the pandemic could transfer to longer term psychiatric disorders.
This is not outside the realms of possibility, especially since the social and economic impact of the pandemic is expected to be felt for years to come.
The authors should be commended both for their methodology and for their upfront discussion of its limitations – namely the potential for sampling bias.
People might have been more likely to respond to such a survey in April 2020 compared with 2018; therefore, the 2020 figures could be an overestimate.
Reference
McGinty, E.E., Presskreischer, R., Han, H. & Barry, C.L. (2020) Psychological Distress and Loneliness Reported by US Adults in 2018 and April 2020. JAMA. 324(1), pp.93-94. doi:10.1001/jama.2020.9740.
The Role of Telehealth in Reducing the Mental Health Burden from COVID-19.
Background
The psychological impact of the coronavirus disease 2019 (COVID-19) pandemic must be recognized alongside the physical symptoms for all those affected. Telehealth, or more specifically telemental health services, are practically feasible and appropriate for the support of patients, family members, and health service providers during this pandemic. As of March 18, 2020, there were >198,000 COVID-19 infections recorded globally, and 7,900 deaths. Psychological symptoms relating to COVID-19 have already been observed on a population level including anxiety-driven panic buying and paranoia about attending community events. Students, workers, and tourists who have been prevented from accessing their training institutions, workplaces, homes, respectively, are expected to have developed psychological symptoms due to stress and reduced autonomy and concerns about income, job, security, and so on. The Chinese, Singaporean, and Australian governments have highlighted the psychological side effects of COVID-19, and have voiced concerns regarding the long-term impacts of isolation and that the fear and panic in the community could cause more harm than COVID-19.
In the absence of a medical cure for COVID-19, the global response is a simple public health strategy of isolation for those infected or at risk, reduced social contact to slow the spread of the virus, and simple hygiene such as hand washing to reduce the risk of infection. While the primary intervention of isolation may well achieve its goals, it leads to reduced access to support from family and friends, and degrades normal social support systems and causes loneliness, and is a risk for worsening anxiety and depressive symptoms. If left untreated, these psychological symptoms may have long-term health effects on patients and require treatment adding to the cost burden of managing the illness. Clinical and nonclinical staff are also at risk of psychological distress as they are expected to work longer hours with a high risk of exposure to the virus. This may also lead to stress, anxiety, burnout, depressive symptoms, and the need for sick or stress leave, which would have a negative impact on the capacity of the health system to provide services during the crisis.
Treatment protocols for people with COVID-19 should address both the physiological and psychological needs of the patients and health service providers. Providing psychological treatment and support may reduce the burden of comorbid mental health conditions and ensure the well-being of those affected. Our challenge is to provide mental health services in the context of patient isolation, which highlights the role of telehealth (through videoconference, e-mail, telephone, or smartphone apps). The provision of mental health support (especially through telehealth) will likely help patients maintain psychological well-being and cope with acute and post-acute health requirements more favourably.
Examples of and evidence to support the effectiveness of telemental health are fairly diverse, especially in the context of depression, anxiety, and PTSD. Videoconferencing, online forums, smartphone apps, text-messaging, and e-mails have been shown to be useful communication methods for the delivery of mental health services.
China is actively providing various telemental health services during the outbreak of COVID-19. These services are from government and academic agencies and include counseling, supervision, training, as well as psychoeducation through online platforms (e.g., hotline, WeChat, and Tencent QQ). Telemental health services have been prioritised for people at higher risk of exposure to COVID-19, including clinicians on the frontline, patients diagnosed with COVID-19 and their families, policemen, and security guards. Early reports also showed how people in isolation actively sought online support to address mental health needs, which demonstrated both a population interest and acceptance of this medium.
Additional telehealth services have been previously funded by the Australian Government (Better Access Initiative programme), to address mental health needs of rural and remote patients during emergency situations, such as long-term drought and bushfires. In response to COVID-19, the Australian Government has responded with additional funded services through the Medicare Benefits Schedule, enabling a greater range of telehealth services to be delivered, including telehealth consultations with general practitioners and specialists. However, the expanded telehealth programme is restricted to special needs groups and the wider population does not have access to the programme. A major benefit of expanding telehealth, including mental health, with no restrictions would reduce person-to-person contact between health service providers and COVID-19 and reduce the risk of exposure of non-infected but susceptible patients in waiting room areas. To date, most of the Australian Government’s focus has been on managing medical needs of people during the epidemic, rather than providing resources to meet short- and long-term mental health implications. An expansion of access to telemental health support services with a focused public education campaign to promote these services would begin to address this need.
Communication of all health needs is important when patients are having to be isolated. The researchers support the use of telehealth as a valuable way of supporting both physical and psychosocial needs of all patients irrespective of geographical location. Simple communication methods such as e-mail and text messaging should be used more extensively to share information about symptoms of burnout, depression, anxiety, and PTSD during COVID-19, to offer cognitive and/or relaxation skills to deal with minor symptoms, and to encourage access to online self-help programmes. For people with COVID-19, telehealth can be used to monitor symptoms and also to provide support when needed.
While there is growing awareness of mortality rates associated with COVID-19, we should also be cognisant of the impact on mental health – both on a short- and a long-term basis. Telemental health services are perfectly suited to this pandemic situation – giving people in remote locations access to important services without increasing risk of infection.
Reference
Zhou, X., Snoswell,, C.L., Harding, L.E., Bambling, M., Edirippulige, S., Bai, X. & Smith, A.C. (2020) The Role of Telehealth in Reducing the Mental Health Burden from COVID-19. Telemedicine and e-Health. 26(4). https://doi.org/10.1089/tmj.2020.0068.
Mental Health Matters 
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