We are the Association for Child and Adolescent Mental Health, or ACAMH for short. And this is ACAMH learn. Loneliness, as researchers, we tend to define loneliness as the kind of negative feelings that we experience if we are dissatisfied with the quality or quantity of our social connections. So there's a kind of feelings, emotional element to it that kind of unpleasant emotional feeling that you get if you're lonely. And also, there's kind of cognitive components. So the detecting and understanding that you're not getting what you need from your social connections as well. It's different to being kind of isolated or alone. Having alone time or being alone can be a positive thing. But specifically, loneliness is the kind of negative experience and negative feelings that you get if your social connections aren't necessarily meeting your needs. Yeah. And I think I would agree with that as well. I wouldn't necessarily see loneliness as a feeling. I think you're right that instead, it's this experience. So it comes with all sorts of different emotions, doesn't it? We often meet people who report loneliness, who are very angry, or we have others who are very, very sad. And so I think it comes with-- I often think about them as very uncomfortable negative emotions. But yeah, it definitely comes with those social cognitions, those negative social cognitions as well that I don't fit. I think as well, and I think this is useful when we're thinking about interventions too, is we often think about loneliness coming from the same place. But actually, when lonely-- you can be lonely for different reasons. So you might experience loneliness because you want more friends to be with. So you're dissatisfied with the number of people that you interact with. But you might also experience loneliness because you don't have a quality friendship or relationship. And we also know that there's another type of loneliness, the collective loneliness, which is about not feeling like you are connected to a bigger thing, such as society. And I think the source of that loneliness is really important. Even though the emotions, and the cognitions, and to some extent even the behaviour are the same, the actual source of that might be different, which means a different type of intervention. Yeah, I agree. There's a commonality in how loneliness feels. But the context in which it occurs can be quite different. And we all have different perspectives on how we want to connect with other people and who we want to connect with. And that changes across the lifespan as well, I think. So, like younger kind of people might be focused on having someone who's a companion, someone to play with, spend time with them that way and not be so much about the emotional connection. Whereas like as you get older, that emotional support becomes a lot more important. And just the kind of preferences for who you want to spend time with and the beliefs that you have and things like that can change. So it is really quite an individual experience, which, like you said, makes it difficult to measure and define-- and design interventions for. So I think that the underlying mechanisms of loneliness relates to how loneliness is a normal experience that most of us, at some point in our lives, will feel. And often, when we talk to young people, that's a pretty unanimous idea. When we ask them, who feels lonely? And they say, well, everyone at some point will feel lonely. So it's a pretty normal experience. And it can be useful, to motivate us to reconnect with other people. So those negative feelings. You kind of want to overcome them, and think of ways to overcome them, and notice the patterns in your relationships that maybe this isn't working that well for me. I'd like my relationships to look a different way, and think about ways to reconnect with people in a way that suits you. And so it really draws our attention to the fact that we're becoming socially disconnected. And being socially disconnected can have a really negative impact on us. As we are a social species, we do love connection and really gain a lot from it. But sometimes, it can be harder to find ways to connect. So you might identify that you've got an issue with your relationships, but not really know how to pick up on that and how to make things better. And that can become really detrimental when loneliness becomes more of this long term experience, where you can get stuck in feelings of loneliness and not really know how to reconnect in a way that suits you and how to get out of it. And so it can turn from this helpful feeling that kind of motivates you to a really unhelpful and actually demotivating one. Yeah, I really like that idea of seeing-- of trying to understand where loneliness comes from. Because it is such a normal experience. We all have it at some point. And I know John Cacioppo and various others, they've talked about this evolutionary perspective of loneliness. And you can imagine where it's come from. Once you started-- once upon a time, when we were on the peripheries of social groups, not in that tribe, being ostracised, you're really dangerous. So there are so many benefits to being the group, but there are also so many negative consequences to not being and a group that you can see where these emotions, those negative cognitions, where they all evolved from. They were about trying to make us more safe. And I find that really useful. Because it explains why we all experience it. I think it also explains why we have that variation as well across the population. Some people will say, well, I don't experience loneliness that often. Whereas others definitely have these, certainly the cognitions and the behaviour, they're very highly in tune with their social surroundings. So they're experiencing loneliness a lot more often. And you need that variation across the population to be able to work out who will thrive and who will not. So I find that really useful. I suppose on top of that, what I do find weird is that given that it is so common and it is an experience we all have, how it is still so stigmatised, how people still don't want to talk about those experiences? Given that we all feel it, but also most of us overcome it as well. Yes, some people will get stuck, and that's when we have problems. But we are not talking huge numbers that will get stuck. Most people overcome it, and yet we still feel incredibly stigmatised. And it's not something that we talk to people about. Yeah, it's really interesting that kind of stigma around it. I know when I've talked to young people in the research that we do, and it's kind of like, you don't want to be seen as being lonely because then you're seen as being different from other people, which is in turn, like a lonely experience. So it's almost like the stigma just feeds into it more. Whereas if you acknowledge that you're feeling lonely and that it can also be a connective thing. Other people have experiences of loneliness, and you can connect over those shared experiences and learn something from each other. Yeah, absolutely. And I think that's why it's so powerful when we do talk about loneliness as normal and natural. I think that's a really nice way in. Because you see that so many people will say, OK, yeah, I get it, I get it. And you're not the only one. So that stigmatisation that can make you feel even more isolated, even more lonely. Actually, once we address that, we've got really good ways then of actually being able to get people into treatment, into interventions. Yeah, I agree with what you guys are saying. And I do find it very interesting that at least with young people, with the whole stigmatisation of loneliness, that it's definitely from the research we've done, still more stigmatised than, for example, mental health concerns. Because they have been to a certain extent kind of normalised. And it's a topic that it feels much more-- people feel much more comfortable talking about, feel much more accepted if they express any difficulties they've had, whereas loneliness hasn't reached that kind of yeah, that level yet. So yeah, it would be nice if there were ways to make it a bit more of an acceptable and normalised experience. Because like you say, everyone's going to experience it during their lives. I was just going to add, if we're thinking about mechanisms of loneliness, we can think about it at the individual level, like Lily was saying, how it kind of draws our attention to the negative feelings of loneliness draws, our attention to the fact that, yeah, we might be putting ourselves in a dangerous position because we're becoming socially disconnected. And so we start to pay more attention to social stimuli, things in our social world, that will help us to hopefully reconnect with others. But some people, there'll be lots of individual differences in this. If you find that more challenging, if you perhaps tend to interpret social kind of behaviours or signals in a certain way that's a bit more negative or it feels a bit more threatening, you're going to find it harder to make that reconnection with others. So there are we think there's probably like those kind of individual level factors about our thinking styles and behaviours. Also, there's kind of broader level, higher level things like our community, and social structures, and things like that. So it really-- also loneliness is going to be influenced by the facilities where you live, for example, what the sense of community is like, where you live. So you're kind of actual physical surroundings and also things like structural inequalities, like having access to the kind of personal and community resources that will allow you to connect with others and spend social time with others as well. So there's kind of different-- lots of different factors that might be at play, both personal and more broader broadly in society that can play a role, I think. Yeah, I really like that, Laura, thinking beyond the individual. Because of course, an individual doesn't function socially on their own. By social, it means other people. So you've got to-- it's about being an environment, where those other people will embrace acceptance and inclusion. And that then is escalated beyond just a pairing into a community and so on. So yeah, it's about those structures also supporting inclusion, supporting social connection. Yeah, I think that's really important for us to think about particularly, again, when we're thinking about intervention work. Research shows that loneliness is fairly low and stable in childhood. And then we see an increase in early adolescence, kind of peaking in late adolescence towards young adulthood, before decreasing again and remaining stable until we get into our older years. So kind of 70 plus. So there's a number of reasons why loneliness is so common in this age group of firstly, we can think of biological factors. So when you're kind of entering adolescence, there's a lot of hormonal changes and ongoing development of the brain. That can mean that young people are more sensitive to social information. And so those social threats that we talked about, paying attention to how you communicate and how other people are communicating with you, and maybe interpreting those in a more negative way than neutral or positive. So it means that kind of there's still development that needs to be done in the way that we manage complex and strong emotions. And this is also a period of our life where we establish our own identity, our own values, and our beliefs and figure out who we are as a person. So we move away from understanding ourselves in relation to family, maybe, and our parents, and the ideas that we've grown up with in childhood and develop our own sense of identity. And that can come at a challenge in terms of how we relate to other people. So say we've got childhood friends, and we've grown up with the same ideas, and then we get to adolescence. And suddenly, we've got different beliefs about things, different values, and that can create conflict. And we see quite a lot of relationship conflict and social conflict in adolescence in particular. So that can mean that we see more loneliness kind of occurring. And there are a lot of transitions that happen at this stage. So like biological transitions, but also changing schools, starting your first job, and things like this that can really disrupt those social relationships and lead to feelings of loneliness. I think that's actually really key, is you have this powerful need for social connection in those years, particularly as you work out who you want to be in the world. At the same time, when your social relationships are in flux quite a lot because of transitions to school or the workplace. So it does really make sense that you've got heightened levels of loneliness. And I find it quite interesting that when you look at the data now, you're finding that the point at which we start seeing that dip into that that peak is beginning to drop again. That's moved slightly. It always used to be that we would start seeing that sort of 21, we're now beginning to see that 25, 26, probably because there is more flux at that time than there ever has been before in society. So I think that comes back again to what Laura was saying earlier on about societal systems having some impact on our experiences of loneliness as well. And both are getting stuck in them, but also just those very natural responses to change. Yeah. And when we think about young people and loneliness, a topic that often comes up or people often ask about is what role does social media have to play in this. And yeah, what impact does kind of social media into the kind of advancing technology having on young people. So, I mean, social media is such a rapidly changing kind of thing that it makes it quite hard to pin down and study. And so, yes, I think further research needs to be done specifically looking at it in relation to young people's loneliness. But because it's such a broad thing, there's so many different types of social media, lots of different ways you can use it. It's the kind of answer to that question is going to be more than a simple yes or no. It's going to be like, well, it depends. So there can be sometimes potentially more beneficial, uses for social connection via social media, and also potential for it to have negative consequences for young people. So we think that the more active forms of using social media, kind of actually chatting with friends and interacting with posts, they're more likely to be beneficial in terms of social connection. But then using social media more passively, just scrolling through posts and not interacting with anything or other people is probably more likely to have a negative impact on people's feelings of loneliness. I mean, you're right that the question always comes up is loneliness-- when people talk about there being an epidemic of loneliness, which we know as researchers, there is not. It's been very stable. The latest OECD report very clearly says that loneliness isn't going up across the world. We're definitely interacting less in person with others. But we are-- our loneliness doesn't seem to be affected by that. I mean, in my mind, in terms of technology, I suppose I want us to embrace it. This whole argument around the world about banning technology, banning phones. I think is not helpful. I think we've got technology here. It's about teaching us how to ensure we have those social relationships online, as well as offline, but make sure that all of those things we value about social relationships that contribute to us or protect us from experiencing loneliness, that we do those online. We're coming together for coffees. We're coming together for the gossips, that we have time to do those, and that rather than thinking, no, we're not going to do that. Instead, we embrace it and think, how can we ensure that our groups can still work together and still function together socially? So, as we've said, kind of that core experience of loneliness, the feelings that arise, and the cognitions, and the thinking patterns might pretty much be the same across ages. So young people and adults are quite similar in the way that they describe loneliness. Is it being this painful emotional experience with sadness, and anger, and those kind of negative emotions, and thoughts of blaming yourself, comparing yourself to others and things like that? But I think what can be a lot different, as we've talked about there's all of these developmental challenges that young people face, which isn't true for adults in the same way. So it's very much that young people are having to navigate all of these different difficulties they're facing with development, developing their identity. And they're actually surrounded by people as well, which is it can be very different to older adults. As the kind of social circles are getting smaller, and maybe they're less mobile, and less able to go out, and socialise as much. And there's more of social isolation involved in those experiences. For young people, it's very much that they're surrounded by people all the time, and that means that the loneliness that is experienced isn't for a lack of having people around you. It's more to do with those connections and the importance of having quality connections or connections that mean something important to you. So we see as well, in childhood, I think I mentioned before about having others to play with in middle adolescence, kind of having those close friendships that have emotional support, becoming more important. In late adolescence, we get romantic relationships, coming up as important. So young people talk about not having a romantic partner and that leading to feelings of loneliness. And then in young adulthood, we see this network of relationships becomes important. So it might be the romantic, the family relationships, friends, and also community, and how those relationships kind of support you through going into young adulthood, which is quite a challenging time to be in and figuring out, how to be an adult is quite a difficult challenge. So that's where we see the context of loneliness arise in that age group. You said something in there, Lily, and I forget what it is. It's taken me off on a train of thought, which is that children and young adolescents don't really have any autonomy on who they're spending their time with. So they are with people that they just might not fit with. I think back to my own school years, I just liked being in the library and reading my books, which was really not in thing to do. But the minute I went to college and I went to university, suddenly, I started fitting because there were other people like me, and I realised there were many other people like me. But that was when I had choice of who to spend my time with and a choice about what I wanted to be. Whereas I think when you're a child, often, you're with-- your parents will decide which clubs you want to go to. So you're mingling with certain other types of children, and they will decide perhaps with you, but which school you go to. So I think the minute you start having your own autonomy, I suppose you have a little bit more control over things. And I suppose that's also links to the social media work as well. Because I often think young people will find often that they can find their tribe online. If you're in a community and, you are just so different, you will find other people like you online. And you hear wonderful stories where people have been able to really understand themselves and appreciate who they are by being able to go online and do that, find other people like them. They might not have access to in their own communities. OK, well, we've talked already that loneliness is adaptive, is useful. It feels horrible, but it actually we use that in a way to change our social relationships. So we adapt, and we start developing or creating different relationships to help us overcome loneliness. The issue for some people is that they might not have opportunities to be able to meet other people, or they might not have the social skills, perhaps, to be able to develop close relationships. So they can become stuck. And when you become stuck in loneliness, that's when we see that it is related to negative consequences, such as poorer well-being, mental health issues, also academic, poorer academic performance. It's also linked to dropping out of work and so on. So it's the getting stuck is key to us being able to do something about it through our interventions. And that might be much more preventative than us intervening later. It might be about providing people with the skills or creating communities where there are opportunities to engage. So when we feel that experience of loneliness, when we are in loneliness, we're able to overcome that through re-engagement or through reappraisal. I also think, though, that sometimes, and this is according to the academic literature, but we've found in some of the qualitative work that we've done that young people talk about, it is sometimes, you can be one single experience of loneliness can be so intense that it knocks you off course to such a degree that it can have big impacts on mental health. We don't yet know what contributes to that. And for me, we need to do a lot more work in understanding what's contributing to-- what should be adaptive experiences, but are knocking people off course and causing an issue. I think we now know what to do with the people who get stuck, but I think for those where it should be adaptive and for some reason isn't, that's where we need to start focusing, I think, for our intervention work. So are those kind of experiences where, it's like a one time experience that knocks you off course. Does that relate to the intensity of the experience? Yeah, it does tend to be. But it tends to-- the person talks about it as being intense. And of course, intensity of emotion. I'm not so sure how you measure it. You can't measure it in the same way you might blood pressure or heat. So you don't know from one person to the next. So it's how do we provide support for that person when our measurements don't really pick up on that? And I wonder as well, whether some of that might be predicted by some of those structural things that we talked about earlier. There's been such a focus on individual differences, and we haven't found what seems to be linked to intensity. We know younger people report higher intensity of loneliness, but they seem to be still able to overcome that. So we don't know. But looking at those other things and thinking beyond that-- beyond the individual, I think is going to be key for us understanding about problematic loneliness if we want to have an umbrella term. I was just going to add that although we kind of don't necessarily want to overdo it with making loneliness into a kind of problematic experience. Because we do also want to normalise it. We have it. But when we are talking about that kind of stuck in loneliness, feeling, or experience, I do think it's important to highlight, like Pam was saying, that it is known to be associated with lots of negative kind of consequences or outcomes. I think just to emphasise that it is something that we should pay attention to, whether that's kind of in preventative measures, like Pam was saying, or if someone is in that kind of stuck phase, and it's really-- they're really struggling with it, for interventions as well, that it is important. I think it might be-- although loneliness has become a bit more of a hot topic, in the recent years, I think it is still-- it's not going to be necessarily seen in the same way as depression, for example. But like Pam was saying, we know that, it is associated with mental health problems, particularly depression and anxiety. And that makes sense. We can think if we're feeling lonely. And that is understandably potentially going to lead to a kind of depression or anxiety. And also the other way around. If you're experiencing depression or anxiety, like particularly socially anxiety, you are potentially more likely to become socially isolated because of those experiences and feelings, which is going to potentially lead to loneliness. So there's kind of strong links there. But also, as Pam said, physical health outcomes. We know that it's kind of associated with more physical kind of health complaints, visits to your GP, those kind of things, sleep problems. So it has a broader impact than perhaps you might necessarily just think, oh, you're just feeling a bit lonely kind of thing. It does have serious kind of implications. And also, like Pam said, the impact, especially if we're thinking about young people on their ability to do well at school, get their kind of exams done and that kind of thing, it does have a negative impact on their academic achievements. And as we know, that might have a longer lasting impact into their adult life, in their work life, potential income, that kind of thing. So although we don't want to make normal loneliness a problematic thing, I do think it's also worth emphasising why we should also take it seriously. Yeah, I think that's really important, Laura. And, earlier, I said, we don't have an epidemic of loneliness. We've got a very small number of people that get stuck. I suppose it's not the number. It's the percentage is very small. But of course, our populations are increasing so much that we are talking about a lot of people whose lives are really impacted by their experiences of loneliness. And the other thing, I think, is really, really important that you touched on was that the health impacts. Because I think that's been given a lot of attention in the press. And I think because we talk there about the work for particularly cardiovascular health, I think that's led us to think that loneliness is much more of an older people problem. Because of course, you don't see very many young people with cardiovascular disease. But what we do see amongst young people are precursors to that. So you said about sleep. So we know our young people are not getting good quality sleep. We know that that's because of cortisol levels. And we know that then goes on to impact cardiovascular disease. So very early on in life, we are seeing the impacts of loneliness that we will have as big public health issues later on. And I think that's what governments need to be thinking about how can they save money, as well as how do they support people in the here and now. So I think it's a benefit all round by focusing on loneliness amongst youth. I think this is an interesting question. Can you spot people who are lonely is probably the question that I would ask. I don't think it's easy to recognise. Sometimes people don't even recognise when they are feeling it themselves. So it can be even more difficult for someone from an outside perspective to recognise it. I think there's probably some behaviours that are associated with loneliness, especially that more problematic loneliness, as we've said. So kind of withdrawing from social connections and kind of becoming more sensitive in social situations and more vigilant to how things are going in your interactions. That can be ways. But I mean, it's very difficult to pick up on, and it's not like a oh, this is happening. So that person's definitely feeling lonely. There can be various reasons why someone might withdraw or be feeling more vigilant and things like that. So it's very difficult, I think. Yeah, and I think because it's something internal. It's something to do with our cognitions and our emotions. There's very few behavioural features of loneliness. And I think that's where the confusion comes with social isolation people want there to be. And there is-- there just isn't that we found. There may be very, very subtle changes that certain people are able to see. But it's probably people that know individuals very, very well, who would be able to spot those. Yeah, I agree with both of you. It's such a kind of personal, internal kind of thing that it is really hard to know if someone's kind of feeling lonely just from just externally, just from seeing them as a person and their behaviour. I was just going to add that if we are thinking about young people in particular and at schools, we know that if we're thinking of at risk type groups in school. Like for loneliness, people with any kind of marginalised identity. Of course, if people are young, people are experiencing bullying. Also things like having immigrant status. So even like changing school a lot, those are kind of groups that we know are kind of at risk for feeling more lonely in school. We talk about there being at risk groups, and we do talk about those marginalised groups being key, really. I mean, the literature, definitely our biggest predictors of experiencing loneliness for all age groups is discrimination. What I think is interesting, though, is it highlights, again, that social structure. Because it's not necessarily that you belong to one of those groups. It's about how your marginalisation is viewed within the societies and the communities in which you live. So you can belong to one of those marginalised groups, but you might live in a community where there is total acceptance of you as an individual, that that person is much less likely to report experiences of loneliness than somebody who has that identity and is living with that identity in an environment where they continue to be discriminated against because of that. And that could be gender that could be to do with immigrant status, and so on. So I think that's, for me, really important, again, for us thinking about that multilayered system approach, us needing to address all of those systems really when we're thinking about intervention work. Yeah, it just comes in. It's kind of not just about the individual, but how the individual is treated within society. So it's-- yeah, like we've said before, the kind of piece of social interaction. And that doesn't happen on your own. So yeah. Absolutely. Well, we've just, I guess, talked about how hard it is to spot someone who's feeling lonely. But I guess in that context, we were thinking more of just in general life or that kind of thing. I suppose in research, we mostly measure it using self-report measures, questionnaires. That might be via question directly asking, something like, how often do you feel lonely, and asking for no response on a rating scale. Or we can use longer length measures, of course, where you're probing into more specific thoughts, feelings, behaviours that we think are associated with loneliness. So those are our key ways relying on self-report measures. Mostly, I would say at the moment. Yeah. And I think we have to look at self-report measures because it's internal of the individual and it's so individualised. And I know when research groups have tried to look at behaviour, look at speech, where we're not seeing any differences between someone who's reporting loneliness and somebody who isn't. So it feels at the moment that those options, other than self-report, are not open to us as researchers. As I say, that might change, but at the moment, that's what we have. And currently, we are working on a project to develop a new measure of loneliness for young people. So it's aimed at 10 to 24-year-olds in the UK at the moment. And the idea is that, like we've said, to understand about the experiences of loneliness, you kind of have to talk to young people about what that is. And previous measures haven't really done that. So it's all about developing the measure with young people, involving them in every step of the way so that we can hopefully, even though it is a difficult thing to measure, we can do our best by making sure that their experiences are representative as well as we possibly can by involving them in each step of the process. And I think it has been a wonderful process, actually, having those young people provide us with really clear details of what that experience has is like for them. And we've been able to think about how those experiences are they represented by the current measures, and they're not, which is why we wanted to develop this new measure. I think we've cracked it. I hope I'm not getting ahead of myself, but I feel like we have cracked it. And what feels good is that we have really listened to those young people and learned a lot, an awful lot. That has been quite surprising, I think, for the field, the research field. And it does mean we're going to have something quite unique in terms of a measurement soon measurement tool fairly soon. Yeah, I would just echo that as being part of the project as well. It's been, I think, really worth it in terms of having quite an in-depth process of constructing the questionnaire. So really kind of going through all the stages from the qualitative work with young people and to the psychometric testing at the end, I think it's been a really thorough process and involving, like you said, you both said, kind of involving young people so that obviously, they're kind of experiences that are included has been really valuable. And it's been very interesting as well to compare those to what we'd perhaps expect as researchers or when we ask other researchers in the field. So, yes, I think it's been well worthwhile. Fingers crossed. Yeah. [MUSIC PLAYING]