Before a recent Psychiatry Conference in the USA a speculative pre-conference paper challenged all attendees to think about the relationship of Anxiety to Loneliness.
It’s a great challenge to us all, as how much of our modern “anxiety-epidemic” is a reflection of the changes from the “Village Lifestyle” of the past where everyone was supported, spoken to daily, encouraged and challenged by people they knew to achieve things. Today in most of our modern cities there is little genuine social interaction that meets primal needs for belonging.
We have all studied Hertzberg and Maslow’s “Hierarchy Of Needs”, and yet we have often forgotten to factor them in to our treatment plans for anxiety and depression. The pre-conference “think-piece” was a challenge to reflect deeply upon the impact of the modern impersonal world we live it and ask ourselves how much “mental illness” is simply a reflection of our disconnection to social networks.
The study that the paper referred to, was a very small one, but opens the door to this important issue. Only 69 patients were involved, testing whether social support, isolation and loneliness shaped how people with anxiety responded to Cognitive therapies. CBT is acknowledged by most as the “gold standard” for treating anxiety and depression, yet what the study found was that the people who get most out of CBT are those with positive social interactions, and who have balanced and healthy “lifestyle factors” (exercise, gut health, and spend time in nature).
The paper challenges us to ask whether we have the “basic” human needs met before we enter into CBT training with people. It appears from this study that unless the client/patient has their exercise, nature exposure and gut health right, they get minimal benefit from the CBT itself.
While it’s a small sample the challenge is a very good one. In any earlier “blog” I had reflected on “lifestyle psychiatry” as just “normal” self-care that was foundational for all stress/anxiety management, but even though I had always encouraged these things I had not tied them to the success or otherwise of the CBT I will teach to nearly everyone I work with. It may be that we need to get the lifestyle and “human needs” met far more formally and be sure we are defeating loneliness well before we try to defeat any aberrant cognitive issues with the CBT tool.
Always good to be challenged about these things.
Dr John C McEwan
At Monarch Psychology Rooms, Greenlane.