SOCIAL ISOLATION to SOCIAL ISOLATION to INTERACTIONINTERACTION& the BRAIN& the BRAIN

““I am alone therefore no one I am alone therefore no one wants to be with me. If no one wants to be with me. If no one wants to be with me, they are wants to be with me, they are not willing to help me. If they not willing to help me. If they

are not willing to help me I will are not willing to help me I will reject them too”reject them too”

Social Isolation & Mental Illness Social Isolation & Mental Illness blogblog

• 15th May 2006 by Elise Stobbe (pen name for Carley)

• Think about what it would be like to spend most of your time alone because being around other people is just too difficult. You feel that others are judging you for your mental illness, and so you are scared to face the world. You withdraw to avoid this stigmatization. This social withdrawal is emotionally very costly. But this is a two-way street — the mentally ill withdraw from society–society withdraws from them.

IF BEINGS FROM ANOTHER IF BEINGS FROM ANOTHER PLANET LANDED ON THE PLANET LANDED ON THE

PLANET EARTH 50,000 PLANET EARTH 50,000 YEARS AGO AND CAME YEARS AGO AND CAME

BACK TODAY WHAT WILL BACK TODAY WHAT WILL NOT HAVE CHANGED?NOT HAVE CHANGED?

The Important Role Social The Important Role Social Relationships Play In People’s Relationships Play In People’s

LivesLives

Friendship is a lot like food. We need it to survive. What is more, we seem to have a basic drive for it. Psychologists find that human beings have fundamental need for inclusion in group life and for close relationships. We are truly social animals.

ALIENATIONALIENATION

LONELINESSLONELINESS

STIGMASTIGMA

SELF STIGMASELF STIGMA

WHAT IS IT?WHAT IS IT?

• Social isolation can be defined as the absence of social interactions, contacts, and relationships with family and friends, with neighbors on an individual level, and with ''society at large" on a broader level.

• Social isolation is defined and then measured by the strength of the person's existing social network and the characteristics of the individuals and institutions providing support to him or her through this network. The absence or weakness of the social support network forms the basis for identifying individuals who are socially isolated.

PREVALENCEPREVALENCE

• General Social Survey funded by the National Science Foundation in 2004

• 25% of Americans say they have no one with whom they can discuss personal troubles. 2 X the # from 1985.

• Half as many Americans 8% can confide in a neighbor

• Studies show that between 10 to 25% of people without a mental illness report feeling lonely while 60% of people with mental illness report feeling lonely or isolated.

WHERE DOES IT BEGIN?WHERE DOES IT BEGIN?

SOCIAL ISOLATION

MENTAL ILLNESS

SOCIAL ANXIETY/SHYNESSPOOR SOCIAL SKILLS/PERCEIVED REJECTION

ENVIRONMENTALFACTORS

MASS MEDIA

HEALTH PROBLEMS

STIGMA

What we see in the isolated personWhat we see in the isolated person• Constricted thoughts• Range of thought limited• Problem solving skills limited• Concrete thinking• Hopeless and helpless• Here and now and distorted thinking• Self control and self regulation limited• Anger, resentment, betrayal• Stress, Fear• Self critical• Self preoccupied• Lethargic• Persistent fear of having to survive alone in a dangerous

and unfriendly world .

REHOSPITALIZATION

DEPRESSION

PREMATUREMORBIDITY

HEALTH PROBLEMS

PREDICTOR OF VIOLENCE

DELAYED CARE SEEKING

SocialIsolation

SOME CRITICAL RESULTS OF SOCIAL ISOLATION

Study on LonelinessStudy on LonelinessPsychologist John Cacioppo of the University of Chicago has been tracking Psychologist John Cacioppo of the University of Chicago has been tracking

the effects of loneliness. He performed a series of novel studies and the effects of loneliness. He performed a series of novel studies and reported that loneliness works in some surprising ways to compromise reported that loneliness works in some surprising ways to compromise

health.health.Perhaps most astonishing, in a survey he conducted, doctors themselves Perhaps most astonishing, in a survey he conducted, doctors themselves

confided that they provide better or more complete medical care to patients confided that they provide better or more complete medical care to patients who have supportive families and are not socially isolated. who have supportive families and are not socially isolated.

Living alone increases the risk of suicide for young and old alike. Living alone increases the risk of suicide for young and old alike. Lonely individuals report higher levels of perceived stress even when Lonely individuals report higher levels of perceived stress even when

exposed to the same stressors as non-lonely people, and even when they exposed to the same stressors as non-lonely people, and even when they are relaxing. are relaxing.

The social interaction lonely people do have are not as positive as those of The social interaction lonely people do have are not as positive as those of other people, hence the relationships they have do not buffer them from other people, hence the relationships they have do not buffer them from

stress as relationships normally do. stress as relationships normally do. Loneliness raises levels of circulating stress hormones and levels of blood Loneliness raises levels of circulating stress hormones and levels of blood

pressure. It undermines regulation of the circulatory system so that the pressure. It undermines regulation of the circulatory system so that the heart muscle works harder and the blood vessels are subject to damage by heart muscle works harder and the blood vessels are subject to damage by

blood flow turbulence. blood flow turbulence. Loneliness destroys the quality and efficiency of sleep, so that it is less Loneliness destroys the quality and efficiency of sleep, so that it is less restorative, both physically and psychologically. They wake up more at restorative, both physically and psychologically. They wake up more at

night and spend less time in bed actually sleeping than do the nonlonelynight and spend less time in bed actually sleeping than do the nonlonely

NEED FOR SOCIAL NEED FOR SOCIAL RELATIONSHIPSRELATIONSHIPS

In fact, evidence has been growing that when our need for social relationships is not met, we fall apart mentally and even physically. There are effects on the brain and on the body. Some effects work subtly, through the exposure of multiple body systems to excess amounts of stress hormones. Yet the effects are distinct enough to be measured over time, so that unmet social needs take a serious toll on health, eroding our arteries, creating high blood pressure, and even undermining learning and memory.

ContinuedContinued

• A lack of close friends and a dearth of broader social contact generally bring the emotional discomfort or distress known as loneliness. It begins with an awareness of a deficiency of relationships. This cognitive awareness plays through our brain with an emotional soundtrack. It makes us sad. We might feel an emptiness. We may be filled with a longing for contact. We feel isolated, distanced from others, deprived. These feelings tear away at our emotional well-being.

Social Isolation Kills, But How and Social Isolation Kills, But How and Why? Why?

• First recognized in epidemiologic research of the late 1970s and 1980s and replicated and extended for more than a decade since then social isolation has been shown repeatedly to prospectively predict mortality and serious morbidity both in general population samples and in individuals with established morbidity, especially coronary heart disease. The magnitude of risk associated with social isolation is comparable with that of cigarette smoking and other major biomedical and psychosocial risk factors.

• Brumett et al

RESEARCHRESEARCH

• Recent scientific work has established both a theoretical basis and strong empirical evidence for a causal impact of social relationships on health. Prospective studies, which control for baseline health status, consistently show increased risk of death among persons with a low quantity, and sometimes low quality, of social relationships. Experimental and quasi-experimental studies of humans and animals also suggest that social isolation is a major risk factor for mortality from widely varying causes. The mechanisms through which social relationships affect health and the factors that promote or inhibit the development and maintenance of social relationships remain to be explored.

““Social Support May Extend Life Of Social Support May Extend Life Of People With Schizophrenia” People With Schizophrenia”

• "We found that the quantity of support significantly predicted the longevity of the patients," Christensen said. "The frequency of daily interactions with support providers or confidants seemed to make a difference in these people's lives."

• People with Schizophrenia who had frequent social interaction lived on average 25% longer than those who had little or no social interaction.

Christenson, Psychosomatic medicine March 1999

Make It An IssueMake It An Issue

• Loneliness can be a very painful place to be. We all experience it from time to time, but some people live it day after day for years on end. It is emotionally depleting, interpersonally inhibiting, and psychologically regressing. When we are lonely, we feel empty and very much alone. Intimacy needs are not met and, if they are, they somehow remain fundamentally unsatisfying. When we are lonely, our thinking can become distorted so that we may over-react to life events that we might otherwise take in stride. For these reasons, it is important that mental health professionals become acquainted with the condition of loneliness. If we can learn to identify loneliness in ourselves, our students, and our clients, we may be able to increase the potential for greater life satisfaction and potentiation.

MOVING FROM ISOLATION TO MOVING FROM ISOLATION TO INTERACTION WITH PSYCH INTERACTION WITH PSYCH

REHABREHAB

Instill HopeInstill HopeIndividualized ServicesIndividualized Services

Choice and ResponsibilityChoice and ResponsibilityCommunity IntegrationCommunity Integration

Skill DevelopmentSkill DevelopmentDrug Free LivingDrug Free Living

Recovery JourneyRecovery Journey

HopeHope - People who have psychiatric - People who have psychiatric disabilities can lead productive, satisfying disabilities can lead productive, satisfying

lives. This belief instills hope and is directly lives. This belief instills hope and is directly communicated through the words and actions communicated through the words and actions

of staff. Services will be offered that of staff. Services will be offered that incorporate environments that support incorporate environments that support

recovery, person-first language, cultural and recovery, person-first language, cultural and spiritual acceptance, and practices that spiritual acceptance, and practices that

promote recovery.promote recovery.

FUTURE HOPE

ESTABLISH TRUST

LISTEN

Individualized ServicesIndividualized Services - Each person is - Each person is unique with his/her own needs, skills, unique with his/her own needs, skills,

culture, and aspirations. Services are stage-culture, and aspirations. Services are stage-based, incorporate best practice, and focus based, incorporate best practice, and focus

on on relationship buildingrelationship building. Each person is . Each person is encouraged and encouraged and empowered to establish empowered to establish recovery goalsrecovery goals, assess skills and abilities, , assess skills and abilities,

identify resources and develop and identify resources and develop and implement plansimplement plans relevant to his/her desires, relevant to his/her desires,

needs and preferencesneeds and preferences..

Choice and ResponsibilityChoice and Responsibility - - Each Each person is empowered to see that they have person is empowered to see that they have

choices and to take responsibility for choices and to take responsibility for directing their own recovery. Staff respects directing their own recovery. Staff respects

the autonomy of each person and works in a the autonomy of each person and works in a collaborative effort assisting him/her to collaborative effort assisting him/her to

identify choices and to evaluate all possible identify choices and to evaluate all possible outcomes of their decisionsoutcomes of their decisions. People . People

receiving services are encouraged and receiving services are encouraged and expected to move forward and take expected to move forward and take

calculated risks toward their journey of calculated risks toward their journey of recovery.recovery.

Community IntegrationCommunity Integration - - The local The local community comprised of family, friends, community comprised of family, friends,

businesses andbusinesses and citizens at large, is an citizens at large, is an important element of support for important element of support for

rehabilitation and recovery. People receiving rehabilitation and recovery. People receiving services are encouraged to become part of services are encouraged to become part of the larger community to the fullest extent the larger community to the fullest extent

possible by taking on possible by taking on roles roles such as worker, such as worker, friend, neighbor, and student. Strengthening friend, neighbor, and student. Strengthening relationshipsrelationships within the person’s own family within the person’s own family

is encouraged to the greatest extent is encouraged to the greatest extent possible.possible.

Skill DevelopmentSkill Development - People receiving - People receiving services are offered education and skills services are offered education and skills relevant to meeting their recovery goals. relevant to meeting their recovery goals.

Bridgeway supports people in skill Bridgeway supports people in skill development and provides opportunities for development and provides opportunities for

practice, giving feedback and practice, giving feedback and encouragement. As people begin to learn encouragement. As people begin to learn and work in the larger community, reliance and work in the larger community, reliance

on mental health services gradually on mental health services gradually decreases.decreases.

Drug Free LivingDrug Free Living - We acknowledge that many - We acknowledge that many people have substance abuse issues. With the people have substance abuse issues. With the

acceptance of this fact, a holistic program of acceptance of this fact, a holistic program of recovery is offered to help each person achieve a recovery is offered to help each person achieve a lifestyle free of drug and alcohol dependence. This lifestyle free of drug and alcohol dependence. This

approach allows for the individualization of approach allows for the individualization of services, since it meets each person at his/her services, since it meets each person at his/her stage of recovery. An assertive engagement stage of recovery. An assertive engagement

approach is used if the person is not yet ready to approach is used if the person is not yet ready to confront his/her substance abuse issues. People confront his/her substance abuse issues. People

who are in precontemplation are assisted to who are in precontemplation are assisted to develop healthy living skills, lengthen the time develop healthy living skills, lengthen the time

between relapses, and build intrinsic motivation to between relapses, and build intrinsic motivation to work on recovery goals.work on recovery goals.

Recovery JourneyRecovery Journey - Recovery is - Recovery is an individuals way of living a an individuals way of living a

satisfying, hopeful, and satisfying, hopeful, and independent life. Bridgeway staff independent life. Bridgeway staff

will will modelmodel, support and follow each , support and follow each person’s recovery journey toward person’s recovery journey toward

wellness encompassing the wellness encompassing the emotional, emotional, physical physical and spiritual and spiritual

facets of life. facets of life.

How Psych Rehab HelpsHow Psych Rehab Helps• Listen and engage…peel away the layers to get to

feelings and emotions…We instill HOPE• Establish a trusting relationship • Motivate…one thing you want to change?• Be a friend…expand community options• Connect to valued roles• Get in touch with interests• Talk about nutrition, smoking , sleeping, meds• Illness Management & Recovery and Wellness Recovery

Action Planning…involve others, RPP, soc. skills• Plan• Reframe• Use peers/self help• Affirm and legitimize experience• Teach coping skills

Wellness can include

• Exercise• Close contact with friends• Diet• Significant relationships• Getting adequate rest• Meditation/ stress reduction activities• Working• Keeping a routine/ schedule• Maintaining treatment

Make It An Issue!Make It An Issue!