After months defined by the COVID-19 pandemic, millions of people across the globe are longing for social connection. This episode of the Church News podcast features Julianne Holt-Lunstad, a professor of psychology and neuroscience at Brigham Young University, who addresses the long-term health effects of social connection.
According to her research, isolation and loneliness are risk factors for early mortality. Dr. Holt-Lunstad has worked with government organizations aimed at addressing the issue. She has also provided expert testimony in a U.S. congressional hearing and expert recommendations to the U.S. surgeon general. She talks about how human connection is the key to fighting the current loneliness epidemic and shares tools to eliminate loneliness in ourselves and others.
Sarah Jane Weaver: I’m Sarah Jane Weaver, editor of the Church News. Welcome to the Church News podcast. We are taking you on a journey of connection as we discuss news and events of The Church of Jesus Christ of Latter-day Saints with leaders, members and others on the Church News team. We end each Church News podcast by giving our guests the last word and the opportunity to answer the very important question, “What do you know now?” We hope each of you will also be able to answer the same question and say, “I have just been listening to the Church News podcast and this is what I know now.”
It seems like so many of us, after 18 months of dealing with the worldwide COVID-19 pandemic, are longing for social connection right now. However, long before coronavirus, millions of individuals across the globe faced loneliness and isolation. This episode of the Church News podcast features Julianne Holt-Lunstad, a professor of psychology and neuroscience at Brigham Young University. Her research has focused on the long-term health effects of social connection. Dr. Holt-Lunstad has worked with government organizations aimed at addressing the issue. She has provided expert testimony in a U.S. congressional hearing and provided expert recommendations to the U.S. surgeon general. Her work has been covered in the New York Times, The Washington Post, Time Magazine, Scientific American, the “Today” show and other major media outlets. She also runs the Social Connections and Health Research Laboratory at Brigham Young University. Welcome to the Church News podcast.
Professor Julianne Holt-Lunstad: Thank you.
Sarah Jane Weaver: I'm so grateful that you would take some time for us today to talk about this important issue. Your research is focused on long-term health effects of social connection — can you help us understand why this even matters?
Professor Julianne Holt-Lunstad: Yeah. This is something, of course, that I've been studying for my entire career, which has spanned approximately two decades. And certainly, I'm not the first one to study this topic, and there are many others who are doing research on this area — but for the past 18 months, as you said, this has been an issue that, I think, has become top of mind for our nation, the entire globe, as we have had to reduce social contact in a way to reduce the spread of this virus. So, this is something that many of us are concerned about in terms of our emotional well-being, our mental health, but we also have very strong evidence that this impacts our physical health. So, my research has focused on the physical health implications of this, including our risk for chronic illness, as well as premature mortality from all causes.
Sarah Jane Weaver: Well, I was so interested in a 2015 study where you found that loneliness is a risk factor for high blood pressure, heart disease, and strokes and depression, and an oft-repeated fact from the study said that loneliness is as bad for you as smoking. Can you talk about that?
Professor Julianne Holt-Lunstad: So, actually, that comparison comes from a meta-analysis that looked at 148 studies — so it wasn't just one study. And so, that particular comparison really looked at all the available data worldwide that have examined some aspects of how we connect socially with others. So, some aspect of our social relationships and how that impacts risk for premature mortality. So, these studies followed people over time — for years, sometimes decades — on average, they were followed for seven and a half years. And what this analysis found was that those who are more socially connected had a 50% increased odds of survival. So reduced risk for premature mortality, and because we knew that most people wouldn't necessarily know how to contextualize that — what does 50% mean? Because we know lots of things are important for health, and lots of things can either help or hurt our health. So we benchmarked it relative to other factors that quite seriously [affect] for health, and what we found was that lacking social connection carried a risk similar to smoking up to 15 cigarettes per day, but it also was comparable or exceeded the risk associated with excessive alcohol consumption, physical inactivity, obesity and air pollution. So what this suggests is that we need to start taking our relationships just as seriously for our health as we do some of these other factors.
Sarah Jane Weaver: And I understand that the long before COVID, 1 in 5 Americans were saying they were lonely or socially isolated.
Professor Julianne Holt-Lunstad: Yeah. So the prevalence rates of isolation and loneliness have varied to some extent, and that is a product of the fact that we don't have a standard national measurement of loneliness. And so some surveys are measuring it slightly different than others, and so that 1 in 5 is actually a conservative estimate. Some surveys suggest that that actually might be much higher.
So, for instance, a survey done by Cigna in 2019 — it found that 61% of Americans reported feeling lonely. So depending on the measure, it could be anywhere from 20% or over half of Americans may be feeling significantly lonely. And so what this suggests is that, regardless of what that exact prevalence, is that there are many, many people, a significant portion of the population are affected by this.
Sarah Jane Weaver: I didn't list your academic credentials at the beginning of this podcast, but can you give us some of your academic background, and then tell us what drove you to select this focus in your career?
Professor Julianne Holt-Lunstad: Yeah, so my training is in social psychology and health psychology. I have my Ph.D. in that, but my work is very interdisciplinary, and so I draw on and collaborate with others from multiple disciplines to really more comprehensively address this issue. And what's interesting is how I arrived at this, or how this evolved — during my Ph.D. training, I was doing a lot of research, looking at the biomechanisms of stress and physiology and, in particular, social support. I was doing a lot of laboratory-based studies looking at how stress affects our body, and how social support would potentially buffer some of these negative health effects of stress. And what I started to realize is that while, of course, our relationships can play an important role in helping us cope with stress, that our relationships can impact our health in much broader ways beyond even the context of stress, and so this really led to my work looking more broadly at this effect.
So, much of my research has looked at not only these overall associations with health, but has continued to look at some of these biomechanisms, as well as behavioral and psychological pathways that would explain how it is that our relationships get under our skin, so to speak, to actually affect our health. Then more recently, given the profound effects that we have found, my research has really started to almost overlap somewhat into public health, and we're starting to try and find ways that we can use this evidence to help find ways to reduce risk among our population, to help reduce the public health burden of this. So, looking at what kinds of strategies and interventions work best, both in terms of those focused on individuals, as well as institutional practices and policies that could potentially help reduce risk among those who are vulnerable.
Sarah Jane Weaver: Well, I want to take a deeper dive into something you said earlier about social isolation and loneliness being risk factors for early mortality. So, is connection really a life-and-death matter? And how is connection something that can enhance or even prolong our life?
Professor Julianne Holt-Lunstad: So, yes, we do have very robust evidence that being more socially connected reduces our risk for premature mortality; and conversely, that being isolated and lonely can increase our risk for premature death, and this is from all causes. I think many people may assume that this may be related specifically to perhaps suicide or violence, but much of this evidence is on disease-related mortality. So we have very, very robust evidence in terms of that.
And I should mention that this evidence also controls for other kinds of factors that might explain it. So even after adjusting for health-related behaviors, even after adjusting for demographics and other biological factors that might explain this, we still find that it's an independent predictor of premature mortality. So, I guess, the second part is — well, how does that happen? And so there are likely multiple ways that our relationships can influence our health.
For instance, from a behavioral standpoint, from the time we're little, we have others who look out for our well-being, right? So whether that's encouraging us to eat our vegetables, or to look both ways before we cross the street, or to get more sleep, or to go see a doctor, or reminders to take our medication, our relationships help us engage in healthier kinds of behaviors so that we're taking better care of ourselves and engage in less risk-taking behaviors. But, like I said, most of these studies controlled for all of those kinds of behaviors.
We also have evidence of some more direct biological ways in which our relationships can impact our health. So from a very broad perspective, scientists across multiple disciplines acknowledge that humans are a social species in the sense that, throughout human history, we have needed to rely on others for our survival. And what is argued is that our brains expect social proximity, and that when we lack proximity to others, particularly trusted others, that our brains can — this can trigger a heightened state of alert and threat, so we need to be much more vigilant to threats in our environment. But we also have to be much more alert, because we may have to deal with any kind of challenges that we might face alone, and it takes more work. And so what is argued is that — and we have evidence from neuroscience to suggest — that we use more metabolic resources when we face threats when we are alone vs. when we are with others, but this heightened state of threat can also trigger other parts of our body. So whether this is a fight-or-flight response, this can lead to signaling increases in heart rate and blood pressure, circulating stress hormones. Inflammation is another one, and inflammation is one where we have a lot of evidence that this can trigger inflammation, which, in turn, if heightened chronically, can put us at increased risk for a number of chronic illnesses — physical conditions like cardiovascular disease, cancer, diabetes — but also can increase your risk for mental health issues such as depression, and cognitive health issues, such as mild cognitive impairment, dementia and Alzheimer's disease. So this inflammatory response, if heightened on a chronic basis, can put us at increased risk for these chronic illnesses, which over time leads to this increased risk for earlier death.
Sarah Jane Weaver: This is so interesting to me, because you answered a question that I've had for a long time. I have worked at the Church News for 25 years, so much of my career has been spent traveling, and for the first 20 years of my career, I always traveled alone. In recent years, I've traveled with a photographer or others, and it felt so different to me to be with someone else, and yet, I always knew we were doing the exact same thing, and I didn't know why. So, I'm glad to know that just having someone else there makes things a little less stressful.
Professor Julianne Holt-Lunstad: Oh, yeah. And, in fact, our brains don't have to work as hard if we can almost outsource some of that mental energy to those we're with. So, I'm sure when you are traveling with others, because you're with them, perhaps you could rely on them to help navigate how to get to your hotel or to get to the metro station or whatever it might be, and so when you have others and you can pool those resources, it doesn't take as much effort.
Sarah Jane Weaver: That is fascinating. Now, let's talk about the past 18 months, and how isolation during this time has impacted so many people.
Professor Julianne Holt-Lunstad: Yeah. Because of many of the varying recommendations and restrictions that, of course, vary across country, across locations and across time, this has changed; and certainly that's led to some degree of uncertainty, but researchers have actually examined to what extent this limiting social contacts, whether or not that actually led to increases in loneliness.
So, let me first start by distinguishing between social isolation and loneliness, because these are related terms that we often use interchangeably, but actually are distinct. So, social isolation refers to either objectively being alone or having few or infrequent social contacts; whereas loneliness is more of that subjective feeling alone; it's often described as the discrepancy between one's actual and desired level of social contact. Certainly, objectively, being alone increases your risk of feeling alone, so being isolated increases your risk of being lonely, but you can be isolated and not lonely. You might actually really enjoy your time alone, and enjoy that solitude; and conversely, you can be lonely, but not isolated, you might be surrounded by others, but still feel profoundly lonely, and so it's really important to recognize the difference there.
So, over the last 18 months during COVID, we've had to reduce that social contact, and so to some degree, we would expect that there are increases in isolation. But the bigger question is — how were people able to cope with it? Did people actually increase in their sense of loneliness? And, I'll tell you, there were lots and lots of studies done. It, in terms of some of the evidence that's come out, it's been somewhat of a renaissance — people have been very productive in their research during this time, and so many studies were just retrospective surveys, meaning they contacted people and just asked them, “Do you feel lonelier now than you did before?” And those surveys suggested that people did indeed feel lonely; but importantly, there were several studies that actually had already had data on individuals’ loneliness prior to COVID, and were able to follow up — so looking longitudinally at how this may have changed over time.
An analysis across 32 studies that looked over time found that not only did people increase in their severity of loneliness — so their score on a loneliness measure increased — but there was also an increase in prevalence, meaning more people reported being lonely also. So, what this suggests is that loneliness did, indeed, on average, increase over the time; but, of course — and I use the caveat on average, because we know that some people have been able to cope better than others. We've certainly seen that some people are more vulnerable than others, and so this is really important also for understanding what factors contribute to who are resilient, and how we can use this information, of course, then, to help people.
Sarah Jane Weaver: So interesting, because as the pandemic intensified last year, Elder D. Todd Christofferson, who's a member of the Quorum of the Twelve Apostles, asked members of the Church of Jesus Christ to — he used the term “constant consciousness.” So, we asked membership to develop a constant consciousness of those around them, and to seek out people who might be lonely or isolated. What does your research tell us about what happens when someone connects with a person who is lonely?
Professor Julianne Holt-Lunstad: So, one of the things that's really interesting is, as I mentioned, I spent much of my early career focused on social support and this idea of how social support can buffer some of the negative health effects of stress, and so, I'll tell you, in March of 2020, when everyone was frantically trying to figure out how we cope with this, I thought to all of the evidence we have about social support and how we can help others. What this evidence suggests is that not only does our perception of support influence how we interpret and perceive the situation and how our bodies respond, but what is so — I think — so fascinating is that we have evidence that not only does being on the receiving end of support and perceiving the availability of support potentially help us, but that providing support to others, in some cases, can have an even bigger benefit, which I think might be surprising to some people. But what it suggests is that one of the best ways to help ourselves is by helping others.
Sarah Jane Weaver: Well, you know, in The Church of Jesus Christ of Latter-day Saints, we have a program that tries to deal with that — it's called ministering. We've all heard so much about ministering: Are we doing it well? Should we be doing it better? But there is something to that idea that there's somebody who should be looking out for you who actually has a stewardship to look out to you, who you can call if you have a problem and then you should, in return, be doing that for someone else.
Professor Julianne Holt-Lunstad: Yeah, yeah — I mean, just knowing that you've got someone you can depend on is huge. That can impact the extent to which you perceive a situation as stressful, or not, because if you know you have the resources to cope with whatever challenge you might be facing, it's far less stressful, and so knowing you have someone that you can count on is so important, and similarly, having that role. So, one of the ways that we suspect that providing support to others may be beneficial is that it can also provide a sense of meaning and purpose, and this can also lead to greater social bonding by kind of bridging that gap — connecting to someone, you're much more likely to, in turn, build trust, build reciprocity and, ultimately, a stronger relationship. So that trust and that social bond, in essence, are resources that you can draw upon not only in the current situation, but can help you in future situations.
I can give you one example: It's really interesting when I think back on that very first week when they announced the lockdown, and I remember many of the grocery stores didn't have much. I remember one of my neighbors texting saying that they were going to a grocery store and asked if anyone needed something, and that they just could just drop it off at a doorstep if you needed it. Of course, this was a very stressful time, and while I didn't take this neighbor up on that offer, just simply knowing, “OK, I've got someone I can count on just makes it so much more bearable.” It can ease those perceptions of stress, knowing you have someone you can count on, even if there's no actual contact — so yeah, that, in terms of ministering, building now that trust can be so important.
Sarah Jane Weaver: So what you're saying is that scientific data actually backs up Church leaders’ teaching that ministering matters.
Professor Julianne Holt-Lunstad: Yeah. Of course, with all of these, we have to, as I think you mentioned earlier — “Is it working? Well, how can we do it better?” Certainly, there are ways that we can improve upon how we're doing right, and so, certainly, we can — whether it's ministering, or any relationship for that matter — we know when someone's offering is genuine, or when someone is going through the motions. Really trying to build those bonds of trust come through time, and sincerity and responsiveness. The extent to which we effectively do this will depend, in some regard, in how we ourselves contribute to that relationship.
Sarah Jane Weaver: And some people blame social media for some of these problems. I have seen research that says the more time people spend on social media, the more disconnected they might be, which is interesting — it's a tool for connection. Can you talk about that? Is it important that all of our connections be real life? Can technology aid us in our connections and make us feel less lonely?
Professor Julianne Holt-Lunstad: So, the evidence when it comes to tech-based communication, including social media, is really complex, and part of that is because there are so many different platforms: Apps, tools, environments, and so it becomes really challenging, because I often get the question of “Is this all good or all bad?” as if we're talking about the same thing, and so it becomes really complex because, in some ways, we're interested in, “Can we connect remotely?” In some ways, we're asking, “Can we connect via social media?” which is a specific use, versus, say, using video platforms such as Zoom.
There are different kinds of tools that we can use — and interestingly, the one challenge of this is that much of the data that I mentioned earlier, in terms of establishing the health benefits of social connections, is primarily based on in-person connection, and so we know much less about connecting remotely — connecting online, connecting via social media. There is some evidence to suggest that time spent on social media has been linked to some poor kinds of emotional well-being outcomes, including loneliness. However, this evidence is primarily correlational, meaning we have an association; but we don't know — for instance, so what that means is we find that higher social media use is associated with higher loneliness. What we don't know is, is it that social media is causing greater loneliness, or that those who are lonely are using social media more? And it's likely bidirectional. There is some evidence that, over time, that does suggest some degree of negative impact. However, we don't have as much long-term evidence, and there's evidence to suggest even that is complex.
So for instance, passive use, just lurking on social media vs. actually actively communicating and trying to connect with others using these tools have shown different kinds of effects, and so one of the things that we're trying to explore is how do we use these tools more effectively? And how is it that we can use them to create stronger social connections to foster connection? Particularly when we can't be together and avoid replacing online time from in-person time. And so, certainly, the pandemic has demonstrated the need for being able to connect remotely, but we just need to study more how to do this effectively so that we can really capitalize on the strength and the efficiency and some of the wonderful things about technology, and avoid some of the negative pitfalls.
Sarah Jane Weaver: Well, and I do want to move to some solutions. What are some positive steps that a person who is lonely can take to connect with other people?
Professor Julianne Holt-Lunstad: There are ways that individuals can find ways to connect with others. So, one of the things I first want to acknowledge is that not everyone's lonely, this stems from the same cause, and so, in some ways, thinking about what might be causing one's loneliness might help us know how that individual might best reduce that — but I'll just mention a few ways in which research has shown that has been linked to lower loneliness.
For instance, participating in social groups has been associated with lower loneliness; but, of course, we know that you’ve got to find the right group where you feel like you belong. And so just like if you compare being physically active to being socially active, we know that being physically active is important for your health, but some people prefer walking to swimming and may not — and so we also need to think about what matches with individual's means, desires, as well as barriers that might exist.
So participating in social groups can be one way. Here's one that’s kind of interesting: Spending time in your neighborhood and in nature — that has also been linked to lower loneliness, and that may be the result of being part of it, and engaging in the community can help increase a feeling of connection to one's community.
Another one is gratitude. Expressing gratitude to others and letting them know how much you appreciate them or something they did — this can really help increase social bonding. So helping you and the other feel connected, that can also lead to lower loneliness.
I’ll mention one last one, and it ties back into what I was referring to earlier about providing support to others over the pandemic. My colleagues and I, we did an international randomized control trial where we randomly asked people to do small acts of kindness for people in their community — and this was over four weeks, and things that they could safely do during the pandemic. This could be things like just checking in on them and seeing how they’re doing, could be dropping something off, but just something simple and small acts of kindness. And what we found was that those who were randomly assigned to do the small acts of kindness showed significant reductions in loneliness over four weeks. And so this, I thought, was pretty remarkable, because something that literally anyone can do — and presumably, the person on the receiving end may have benefited — but what our findings showed was that it was the person who was doing the acts of kindness that showed reductions in loneliness.
Sarah Jane Weaver: It’s so interesting that some of the things that we’ve known for so long — like being kind and being grateful — can actually make us feel better about ourselves. I was pleased that President Russell M. Nelson issued an invitation last year for all of us to be a little more grateful. He even called it “the healing power of gratitude,” right in the middle of the pandemic.
And then I want to shift again: What can people do who notice that someone is lonely? And how do they reach out and help those who may need connection?
Professor Julianne Holt-Lunstad: They can use the exact same strategies of reaching out and doing these small acts of kindness for others. It can also be mindful and responsive to the individual and what might be leading to their isolation or loneliness. So, for instance, it might be that the individual recently lost someone close to them. For instance, loss of a spouse can put someone at an increased risk for loneliness, but, similarly, physical and mental health challenges can increase one's risk for loneliness. How we might approach reducing loneliness might differ slightly, depending on what that underlying cause might be. And so one thing that we've seen from research is that when we support others, the more we are responsive to their needs, the more beneficial it is. So, sometimes you can certainly provide support to others, but occasionally, we can be well-meaning and have good intentions, but are somehow missing the mark, and there's a mismatch between what we're offering and what they actually need or desire. So, the more that we can be responsive to that, the more beneficial it can be.
Sarah Jane Weaver: I'm the mother of three daughters — the youngest is in high school, the oldest is at Brigham Young University, and I tell them all the time: “I just want you to have one good friend, you don't need a million friends, I just want you to have one.” There has to be something healing about friendship, right?
Professor Julianne Holt-Lunstad: Oh, yes, there's definitely healing aspects of friendship, and I guess I would argue they ought to try to aim for a little bit higher than one.
Sarah Jane Weaver: Like, five?
Professor Julianne Holt-Lunstad: And it’s not so much that — and the reason I say that is simply because we do have research that having a diversity of types of relationships and roles in our life, to fill different kinds of needs — so for instance, we may go to our parents for something different than we go to for from our friends, or our co-workers, and so different kinds of relationships can fulfill different kinds of needs. In fact, what's so interesting about this is there's research that shows that even that beyond just the size of your social network, that diversity of types of relationships or social roles can actually even influence our immune system and the extent to which we are susceptible to viruses. Now, this research was done on colds and viruses prior to pandemic, but as well as our response to flu vaccines. So, what this suggests is that our immune system even can benefit from these different kinds of relationships.
But I think on a more practical level, we can all think of how we go to our relationships sometimes for advice. We can get different kinds of advice and life experiences from different kinds of people. Sometimes, we need emotional support from others, and different kinds of relationships can perhaps draw on, empathetically, from similar or from different kinds of perspective. Sometimes we need tangible support. The different kinds of relationships may be able to provide different kinds of resources, whether that be a ride to the airport, or dinner when you're sick, or notes at school — you can think of lots of ways in which we rely upon others. And so, having a diversity of relationships can help us ensure that a variety of needs are met and, similarly, that we can help others reciprocally.
Sarah Jane Weaver: Well, the next time my family takes a long drive or a family vacation, we're going to be listening to this podcast in the car so that we can all make more friends. Is there anything else about your research, or that you've learned about loneliness, that we have not talked about?
Professor Julianne Holt-Lunstad: I think the last thing I would mention is just that quality matters. Sometimes, I think when we start talking about loneliness, and social isolation, we may kind of fall into that trap that all relationships are good and, conversely, that not having them is bad, but really, in reality, what the research suggests is having more and better relationships is protective, and having few and poor-quality relationships can be detrimental. And so, we really need to foster and nurture positive relationships. So our relationships can bring us joy, satisfaction; they can also be a pain, they can bring conflict and craving, and in a workplace, abuse and neglect; and so we need to recognize that not all relationships are positive, that negativity and relationships can actually potentially be detrimental. And so really, what we want to do is not only increase our social contacts, but make sure that that contact is positive, quality, and deep, meaningful relationships in order to really have the positive kinds of benefits to our emotional well-being, our mental health, our physical health.
Sarah Jane Weaver: That is a great place to end. We have a tradition at the Church News podcast where we always give our guests the last word and we have them answer the same question, and the question that we ask everyone to answer is, “What do you know now?” And so, I'm hoping we can close today and have you share with us what you know now after studying, for so much of your adult life, the impact of social connection and the detriment of loneliness.
Professor Julianne Holt-Lunstad: What I know now is just how profoundly important our relationships are to our health and well-being, and over the decades, I've learned just how strong this evidence is, how widespread it is and how it impacts nearly every sector of society. But I've also learned now how complex it is, because it is incredibly complex to address. And so, I suspect that I can spend the rest of my career and lifetime trying to understand this better, and certainly I will be mentoring others along the way. I guess the last thing is, also, I've learned that really prioritizing my own relationships is just as important as studying them and talking about and how divinely essential our relationships are to every aspect of our life, that this is truly divinely essential — that we need each other.
Sarah Jane Weaver: You have been listening to the Church News podcast. I’m your host, Church News editor Sarah Jane Weaver. I hope you have learned something today about The Church of Jesus Christ of Latter-day Saints by peering with me through the Church News window. Please remember to subscribe to this podcast. And if you enjoyed the messages we shared today, please make sure you share the podcast with others. Thanks to our guests, to my producer, KellieAnn Halvorsen, and others who make this podcast possible. Join us every week for a new episode. Find us on your favorite podcasting channel or with other news and updates about the Church on thechurchnews.com.