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Wellbeing Begins with “We”

The Physical and Mental Health Benefits of Interventions that Increase Social Closeness

Volume 6. Interventions and Policies to Enhance Wellbeing

Part 1. Individual and Group Interventions across the Life Course

  1. Bethany E. Kok,
  2. Barbara L. Fredrickson

Published Online: 17 DEC 2013

DOI: 10.1002/9781118539415.wbwell042



How to Cite

Kok, B. E. and Fredrickson, B. L. 2013. Wellbeing Begins with “We”. Wellbeing. 6:1:7:1–29.

Author Information

  1. University of North Carolina at Chapel Hill, U.S.A.

Publication History

  1. Published Online: 17 DEC 2013

Social closeness is an important contributor to psychological and physical wellbeing. Whether conceptualized as a fundamental psychological need (Baumeister & Leary, 1995; Deci & Ryan 2000), a bodily nutrient (Beckes & Coan, 2011), or a critical element in stress and coping (Lakey & Orehek, 2011), there is a general scientific consensus that humans function better when they feel close to others.

We define social closeness as a belief or perception about a person's degree of embeddedness in a social network or networks. In this formulation, social closeness may or may not be related to actual behaviors from relationship partners: what matters is the individual's perception of their relationships with others. In addition, social closeness is not limited to close relationships. Any interaction that reminds someone that they belong can increase social closeness.

Without social closeness, human beings seem to break down, with both mental and physical systems showing accumulating deficits over time. Adults with low levels of social closeness are more likely to become depressed (Glass, de Leon, Bassuk, & Berkman, 2006) and to suffer from inadequate nutrition (Locher et al., 2005) and a number of physical health issues. In a 3-year longitudinal sample of older adults ranging in age from 60 to 92, fewer interactions with family and friends predicted an increased likelihood of developing hypertension, cancer, heart disease, and emphysema, even after controlling for the negative effect of illness on frequency of social interactions (Tomaka, Thompson, & Palacios, 2006).

Loneliness, the perception that one is lacking in social closeness, is an independent predictor of negative mental and physical health outcomes in adults above and beyond actual frequency of social contacts (Routasalo, Tilvis, Kautiainen, & Pitkala, 2009). Lonely adults are at a greater risk for cardiovascular disease (Arthur, 2006), high blood pressure (Hawkley, Thisted, Masi, & Cacioppo, 2010), fatigue and inefficient sleep (Cacioppo et al., 2002; Hawkley, Preacher, & Cacioppo, 2010), decreased physical activity over time (Hawkley, Thisted, & Cacioppo, 2009) and decreased cognitive function over time (Seeman, Lusignolo, Albert, & Berkman, 2001).

The Need for Social Closeness Interventions

  1. Top of page
  2. The Need for Social Closeness Interventions
  3. Types of Social Closeness Interventions
  4. Interventions to Decrease Loneliness
  5. The Role of Social Media and Electronically Mediated Communication
  6. The Role of Personal Traits
  7. Social Closeness in the Community
  8. Conclusion
  9. References

The need for interventions to increase social closeness is particularly urgent as more and more adults in the United States and elsewhere are reporting social closeness deficits. From 1975 to 2004, the number of people who reported that they had no one with whom to discuss important matters has nearly tripled, while the average social network decreased in size by one third (data from the General Social Survey of non-institutionalized American adults; McPherson, Smith-Lovin, & Brashears, 2006). This decrease reflects a drop in both kin and non-kin social ties, and appears to be occurring across the age range (McPherson et al., 2006). Over the same period, Americans became 10% less likely to report that others around them were trustworthy, fair, or helpful and declined in general social capital, which includes time spent associating with others (Paxton, 1999). This trend is unlikely to reverse on its own. The United States is growing both more racially and ethnically diverse and more mobile over time (U.S. Census Bureau, 2000). Because increases in racial and ethnic diversity result in short-term isolationism and lesser trust (Goff, Steele, & Davies, 2008; Putnam, 2001) and geographic mobility strains social bonds (Oishi et al., 2007), there is a great need for interventions to maintain or increase social closeness.

Types of Social Closeness Interventions

  1. Top of page
  2. The Need for Social Closeness Interventions
  3. Types of Social Closeness Interventions
  4. Interventions to Decrease Loneliness
  5. The Role of Social Media and Electronically Mediated Communication
  6. The Role of Personal Traits
  7. Social Closeness in the Community
  8. Conclusion
  9. References

Interventions to increase social closeness run the gamut from nurturing existing feelings of social closeness to attempts to teach social skills in order to form new relationships, depending on the needs of the population under study. Interventions that nurture existing feelings of social closeness focus on enhancing the quality of existing relationships and interactions, by directing attention toward the potential for closeness in each social interaction and increasing positive social emotions (Fredrickson, Cohn, Coffey, Pek, & Finkel, 2008; Kok & Fredrickson, 2013; Kok et al., 2013). In contrast, interventions that target social isolation typically address barriers to forming social relationships, such as (a) improving social skills, (b) enhancing social support, (c) increasing opportunities for social interaction, and (d) addressing maladaptive social cognitions (Masi, Chen, Hawkley, & Cacioppo, 2011). Because interventions to alleviate social isolation in distressed populations have been reviewed in detail elsewhere (Masi et al., 2011), we will address them only briefly here, before moving on to interventions that aim to increase existing social closeness in nondistressed populations.

Interventions to Decrease Loneliness

  1. Top of page
  2. The Need for Social Closeness Interventions
  3. Types of Social Closeness Interventions
  4. Interventions to Decrease Loneliness
  5. The Role of Social Media and Electronically Mediated Communication
  6. The Role of Personal Traits
  7. Social Closeness in the Community
  8. Conclusion
  9. References

The powerful negative consequences of loneliness and social isolation may explain why interventions that reduce social isolation are much more common than interventions that nurture existing social closeness. Over 30 years of research, however, efforts to prevent and alleviate social isolation and loneliness have not been consistently successful. A review of loneliness interventions in older adults from 1970 to 2002 found that, of the 30 studies with quantitative outcomes assessment, only 10 were successful in alleviating loneliness (Cattan, White, Bond, & Learmouth, 2005). Another review of the loneliness intervention literature found similarly mixed results and suggested that this might be due, in part, to the need to carefully match intervention type to the needs of the target population (Hogan, Linden, & Najarian, 2002).

Recent work on the psychological processes underlying loneliness suggests that a person's beliefs about the nature of their social environment are the most important factor in predicting whether or not a person will perceive herself as socially isolated (Cacioppo & Hawkley, 2009). Cacioppo and Hawkley's loneliness model describes loneliness as a process driven by hypervigilance to social threats, which increases physiological stress and impairs self-regulatory ability (Cacioppo & Hawkley, 2009). Over time, hypervigilance to social threats can actually create the negative social environment that the lonely person fears. A longitudinal study of older adults found that the belief that others are unfriendly or threatening can create a self-fulfilling prophecy in which the lonely individual's behaviors discourage social interactions with others, leading to greater loneliness (Newall et al., 2009).

If beliefs about the social environment are the active ingredient in creating or guarding against loneliness, then interventions that target maladaptive social cognitions about the social environment should be most effective in relieving loneliness. A recent meta-analysis of loneliness interventions compared the effectiveness of interventions that targeted maladaptive social cognitions to interventions that attempted to directly alter a person's social behavior or social environment. The authors found that interventions to improve social skills, enhance social support, or increase opportunities for social interaction led to improvements in loneliness that were statistically significant but, with an average effect size of –.198, were insufficient to return individuals to normal functioning. In contrast, interventions that targeted maladaptive social cognitions had an average effect size of –.598, suggesting clinically significant improvement in loneliness (Lipsey & Wilson, 2001).

Although intervention protocols for changing maladaptive social cognitions vary widely, most employ cognitive behavioral therapy (CBT) administered by a clinician with the goal of helping participants identify, evaluate and modify maladaptive social cognitions. Maladaptive social cognitions might include the belief that there is nothing the person can do about their loneliness, or that the person is not interesting enough to appeal to others (Masi et al., 2011). Through CBT, the participant and therapist would discuss these thoughts and reframe them. For example, someone who believes their loneliness is out of their control attributes their situation to external and stable factors. A therapist might suggest that the participant instead view loneliness as a state that is partially under her own control and, thus, something she can take steps to change. Similarly, someone who avoids social interactions because he doubts he would be interesting to others might learn to reframe social interactions as opportunities to learn about other people.

According to the loneliness model, maladaptive social cognitions can create a self-fulfilling prophecy of increasingly negative interactions with others (Hawkley & Cacioppo, 2010). As a result, CBT may leave participants with a more realistic understanding of their loneliness but little knowledge of how to remedy their isolation. To address this, maladaptive social cognition interventions also include elements of the other intervention types. For example, one CBT-based intervention also gave participants a manual that included community resources, advice on self-care, and communication tips (Hartke & King, 2003), while another explicitly integrated social skills training alongside CBT (Hopps, Pepin, & Boisvert, 2003). In fact, all of the interventions identified by Masi et al. (2011) as addressing maladaptive social cognitions also involved elements of social skills training, enhancing social support, and creating opportunities for social interactions. Group therapy sessions with other lonely individuals, where participants discuss their concerns and support one another, are particularly common (Rodway, 1992).

Based on both loneliness theory and empirical research, it appears that the most effective interventions for treating loneliness address the excessively negative beliefs and expectations that lonely people hold about their social environments. As these negative beliefs are reframed or replaced, participants also receive social support from others in treatment, social skills training from facilitators, and resources to increase opportunities for future social connections. By using a combined approach, the interventions address both internal barriers, such as negative expectations that prevent participants from reaching out to others, and external barriers, such as lack of social skills or access to other people, that may prevent outreach attempts from being successful.

Interventions to Increase Social Closeness

Non-lonely individuals are those who report that their level of social closeness is adequate, that is, equal to what they expect or desire (Cacioppo & Hawkley, 2009). Attempts to increase social closeness in non-lonely individuals are driven by the positive psychological belief that wellbeing is more than the absence of illbeing (Gable & Haidt, 2005; Ryff & Singer 1998). Thus, social closeness may be more than the mere absence of loneliness, and cultivating social closeness in non-lonely individuals may lead to further increases in wellbeing. A meta-analysis of the effects of social relationships on mortality found that there is no identified “threshold” for an adequate amount of social connection (Holt-Lunstad & Smith, 2012), suggesting that interventions that increase social closeness can lead to benefits even in individuals who already report adequate levels of social closeness.

Non-lonely individuals by definition possess adequate social support and opportunities for social interactions; they are also more likely to possess appropriate social skills. As a result, social closeness interventions have focused modifying social cognitions in order to enrich the quality of already-existing social relationships and interactions. Similar to the interventions that address maladaptive social cognitions in lonely individuals, interventions to increase social closeness attempt to redirect participants' cognitions to focus on the positive elements of their social interactions or to self-generate positive social emotions such as gratitude.

Positive Social Attention

Attention to social cues is one technique through which individuals intuitively attempt to create social closeness (Jones, Hobbs, & Hockenbury, 1982). Individuals high in the need to belong are better at identifying emotions in the face and voice of others and show superior empathetic accuracy, behaviors which require careful attention to social cues (Pickett, Gardner, & Knowles, 2004). Perceived responsiveness, a measure of the extent to which a person in a relationship is perceived as understanding and satisfying their partner's needs (Reis, Clark, & Holmes, 2004), is also related to social attention, and predicts relationship satisfaction and social closeness. Responsive individuals are better able to provide wanted support and to capitalize on their relationship partner's good fortune (Gable, Reis, Impett, & Asher, 2004; Maisel, Gable, & Strachman, 2008). As a result, perceived partner responsiveness is related to higher perceived social support in relationship partners and higher relationship satisfaction for both partners in the future (Algoe & Haidt, 2009). To the extent that paying attention to social cues helps a person to correctly identify another's needs and respond to them in a responsive and satisfying way, it should increase closeness in the relationship.

To directly test whether positive social attention can lead to greater wellbeing, a randomized, controlled double-blind study used priming to increase the salience of positive social interactions and observed the effects over 8 weeks. Positive social interactions were primed through daily emails to working adult participants that either asked them to evaluate how “close” and “in tune” with others they felt during their three longest social interactions that day, items drawn from the UCLA loneliness scale (Russell, 1996). In the control condition, participants were asked to evaluate how “important” and “useful” their three longest daily tasks had been. Over time, participants in the social salience condition increased in attention to social stimuli as measured by a dot-probe task assessing response time to briefly shown social and non-social images, whereas participants in the control condition did not change. In addition, participants who had been primed with positive social interactions increased in daily positive emotions and vagal tone, both of which have been linked to social closeness (Kok & Fredrickson, 2013).

As an intervention, priming positive social interactions is relatively straightforward and can easily be administered via email, where it takes approximately 2 min a day to complete. This intervention may be most useful in the short term, as the effect on wellbeing was small and participants showed signs of habituation by 6 weeks (Kok & Fredrickson, 2013). As a result, increasing the salience of positive social interactions via email may be most useful for individuals with limited time and resources who are unable or unwilling to commit more time to an intervention. In addition, the intervention should stop or be changed after approximately 6 weeks, in order to avoid habituation.


Another potential route to social closeness is through meditation training that focuses on emotions. Emotions are elicited through appraisals of self-relevant information in the environment (Lazarus, 1991; Siemer, Mauss, & Gross, 2007). For example, appraising a raised hand as threatening might elicit either fear or anger, whereas appraising that same gesture as celebratory might elicit joy. In turn, emotions influence cognition and behavior by increasing the salience of appraisal-relevant schemas, heuristics, and behavioral response (Lerner & Keltner, 2000). A frightened person might pay more attention to threats, interpret ambiguous information as threatening, and be ready to flee, whereas a joyful person would be more likely to attend to positive elements of the situation, interpret ambiguous information positively, and be open and flexible in response to the situation (Fredrickson, 2003). Positive social emotions such as elevation and gratitude, for example, facilitate social closeness by promoting prosocial behavior toward nearby others and reinforcing ongoing relationships (Algoe & Haidt, 2009). Even non-social positive emotions might increase social closeness by broadening the scope of attention, for social and non-social information alike (Cohn & Fredrickson, 2006). By teaching individuals how to self-generate positive emotions, meditation training could lead to increased social closeness by increasing participants' perceptions of their closeness to others. Emotion training might also lead participants to change their behavior and engage in more positive social behaviors toward others, resulting in actual improvements in their relationships and increases in closeness.

Loving-kindness meditation (LKM) is an emotion-training practice drawn from the Buddhist tradition. LKM is a technique used to increase feelings of warmth and caring for self and others by directing one's emotions toward warm and tender feelings in an open-hearted way. (Salzberg, 1995). Like other meditation practices, LKM involves quiet contemplation in a seated posture, often with eyes closed and an initial focus on the breath. What distinguishes LKM from other meditative practices is training in directing one's emotions toward warm and tender feelings in an open-hearted way. Individuals are first asked to focus on their heart region and contemplate a person for whom they already feel warm and tender feelings (e.g., their child, a close loved one). They are then asked to extend these warm feelings first to themselves and then to an ever-widening circle of others. Examples of this training, in the form of guided meditation, are available in the books Force of Kindness and Real Happiness, both written by leading LKM teacher Sharon Salzberg (Salzberg, 2010, 2011).

Loving-kindness meditation appears to be an effective way of increasing social closeness. A longitudinal study collected daily data for 9 weeks on the lives of participants assigned to learn LKM or to a monitoring wait-list control condition. All participants completed a 1-week baseline recording period before being assigned to conditions. During this time, participants used the web once a day to complete an emotion questionnaire and a measure of social closeness. For the next 7 weeks, participants assigned to learn LKM attended weekly hour-long group meditation workshops led by a practitioner experienced in teaching LKM. They also received a guided meditation CD and encouragement to practice independently throughout the week. All participants, including those in the control condition, continued to complete the daily online questionnaires. After meditation training ended, data collection continued for an additional week. Participants in the wait-list condition were offered the chance to receiving training in LKM after the study had ended (Kok et al., 2013).

Participants in the meditation condition showed significant increases in both positive emotions and self-reported social closeness over the 9 weeks of the study. Using structural equation modeling, the authors found that changes in positive emotions mediated the relationship between LKM practice and social closeness. Participants who learned LKM experienced more positive emotions on a daily basis, and these increases in positive emotions drove increases in feelings of social closeness, suggesting that positive emotions may play a critical role in perceptions of relationship closeness (Kok et al., 2013). Critically, participants did not appear to habituate to the meditation; in fact, meditation may become more effective as practitioners become more experienced. A previous longitudinal study of the effects of LKM on daily emotions found that, over time, meditators experienced an increased “boost” in the positive emotions gained from each minute they reported meditating that day (Fredrickson, et al., 2008). In other words, the meditation appeared to yield more positive emotions as the study went on.

Although meditation can be a time-intensive endeavor, even one brief session of LKM may be enough to affect feelings of closeness. In a study of the effects of short-term LKM practice on feelings of closeness toward a stranger, participants engaged in a 7-min guided LKM imagery session where they visualized receiving loving feelings from two loved ones standing nearby, then directed those feelings toward a photograph of a neutral stranger. Participants in the control condition also engaged in guided visualization: These participants visualized the features of neutral acquaintances, and then examined the features in the photograph of the neutral stranger. Relative to their ratings at the beginning of the study, meditators increased in feelings of closeness toward stranger measured both implicitly, through an affective priming task, and explicitly, whereas participants in the control condition showed a smaller increase in explicitly reported closeness but no change in implicit ratings (Hutcherson, Seppala, & Gross, 2008).

As an intervention, LKM is promising for many reasons. The changes in social closeness induced by LKM appear to be consequential for mental and physical health. Compared to participants in a monitoring, wait-list control group, participants randomly assigned to learn LKM over a 7-week workshop showed steady increases in daily positive emotions, which in turn predicted growth in range of resources, including mindfulness, positive social relations, environmental mastery, and self-reported physical health. These gains in resources were consequential for participants, in that they accounted for improved life satisfaction and reduced depressive symptoms (Fredrickson et al., 2008). Amount of time participants devoted to meditation practice also predicted an increase in the positive emotions they reported during social interactions on an ordinary workday some weeks after the meditation workshops ended. In another longitudinal study, participants in a 7-week LKM workshop showed increases in positive emotions, self-reported social closeness and vagal tone. Further modeling revealed that LKM drove changes in positive emotions, which led to changes in social closeness, which in turn led to higher vagal tone (Kok et al., 2013).

Pilot evidence suggests that LKM may also effectively treat the negative symptoms of schizophrenia, which include anhedonia, amotivation, and asociality (Johnson et al., 2011). Eighteen individuals diagnosed with schizophrenia-spectrum disorders met once a week for 6 weeks as a group with a therapist experienced in teaching LKM; they were also given guided meditation CDs and encouraged to practice outside of the group sessions. Participants continued to receive treatment as usual while in the study. Compliance was high, with participants attending an average of 84% of the training sessions; the majority of participants reported enjoying the meditation. After 6 weeks, pre–post analyses of positive emotions, negative symptoms, and satisfaction with life, environmental mastery and self-acceptance found significant improvements in all measures. These improvements were maintained at a 3-month follow-up. Although the absence of a control group makes it impossible to determine what drove the positive effects experienced by participants, the high rates of compliance and promising results of this pilot suggest that further investigation into LKM as a treatment for negative symptoms of schizophrenia is warranted.

An additional benefit of LKM is that it is potentially resistant to habituation, and may even improve in effectiveness over time. This feature, which is shared by other forms of meditation, can be attributed to the adaptive nature of meditative practice (Fredrickson et al., 2008). Because meditation is a purely mental activity, it changes to become more difficult as individuals increase in skill, maintaining a steady level of challenge. The balance of skill and challenge is a critical component of flow, a psychological state of deep absorption and joyful engagement in a task that leads to high-quality performance and the desire to continue engaging in the activity (Csikszentmihalyi, 2008). The rewards of matching challenge to skill were reflected in participants' continued compliance and increases in positive emotions gained per minute spent meditating over the course of a 7-week meditation training workshop (Fredrickson et al., 2008).

An additional meditative approach linked to social closeness is shamatha meditation, which trains adherents in focused attention and compassion (Wallace, 2006). Shamatha shares many features in common with LKM, though it includes additional attention training and focuses on fostering feelings of compassion for those who are suffering, an alternative way to build social closeness (Goetz, Keltner, & Simon-Thomas, 2010).

Shamatha meditation is associated with increases in a wide range of psychological wellbeing indicators. A recent study assessed changes in wellbeing for participants randomly assigned to an intensive 3-month shamatha meditation retreat relative to those in a wait-list control condition (Sahdra et al., 2011) Wellbeing was measured as a composite of mindfulness, attachment, depression, basic personality, empathy, anxiety, ego-resiliency, difficulties in emotion regulation, and psychological wellbeing, which were combined using factor analysis into an “adaptive functioning” latent variable. Meditators showed increases in adaptive functioning across the study, whereas participants in the wait-list control condition showed no change. The changes in adaptive functioning were maintained at 5-month follow-up.

Shamatha meditation is also associated with physiological changes linked to health, such as telomerase activity. Telomerase is an enzyme that maintains the protective “end caps” on DNA that promote genomic stability and prevent mutation, with higher telomerase activity indicating greater stability and thus, better health. Participants who had participated in the 3-month shamatha meditation retreat showed increased telomerase activity at the end of the study, relative both to themselves at the start of the study and to wait-list control participants matched on age, sex, and body mass index (BMI). Increases in perceived control mediated the relationship between retreat attendance and telomere length (Jacobs et al., 2011).

Mindfulness meditation fosters present-focused awareness and nonjudgmental acceptance and is associated with a wide variety of positive health outcomes within both individuals (Brown, Ryan, & Creswell, 2007) and couples (Gambrel & Keeling, 2010). Mindfulness is also associated with relationship-relevant capabilities, including empathy (Greason & Cashwell, 2009), emotion regulation (Baer, Smith, & Allen, 2004; Brown & Ryan, 2003) and sustained attention (Tickle-Degman & Rosenthal, 1990). A handful of studies have linked mindfulness to measures of social closeness such as secure attachment (Shaver, Lavy, Saron, & Mikulincer, 2007) and feelings of belonging (Brown & Kasser, 2005; Brown & Ryan, 2003, 2004), though we are unaware of any work investigating whether changes in social closeness might mediate the positive health effects of mindfulness meditation. Further research in this area is needed (Brown et al., 2007).

Meditation, whether LKM, shamatha, mindfulness, or another type of practice, can be a potent source of psychological and physiological change. However, these practices are complex and involve many different potential mechanisms of action, making it difficult to determine whether the benefits derived from meditation are driven by changes in social closeness or other psychological processes. To our knowledge, no published work to date has explicitly tested whether changes in compassion-driven social closeness contributed to the psychological and physical benefits of shamatha meditation. Similarly, although it is known that LKM increases social closeness (Hutcherson et al., 2008; Kok et al., 2013), we know of only one published study that has empirically tested whether social closeness mediates the relationship between LKM and changes in health (Kok et al., 2013).


Gratitude interventions have the potential to combine the potency of meditation training with the straightforwardness and ease of administration of a positive social attention intervention. Gratitude, a positive social emotion, has been theorized to foster social closeness in three ways: Feelings of gratitude help individuals to “find” helpful or kind others and “reminds” them of existing positive relationships. Expressions of gratitude also help to “bind” a benefactor and a recipient together (Algoe, 2012). In a study of the developing relationships between new inductees into a sorority and their older sorority mentors, gratitude felt by an inductee toward her mentor predicted how much the inductee and mentor liked one another 1 month later. In addition, inductees who felt more gratitude reported feeling more integrated into the sorority at the 1-month follow-up (Algoe, Haidt, & Gable, 2008). Similar effects were observed in two longitudinal observational studies of married couples, where past feelings of gratitude predicted future relationship satisfaction (Algoe, Gable, & Maisel, 2010; Gordon, Arnette, & Smith, 2011). By creating and reinforcing links between benefactor and recipient, gratitude serves as a powerful social closeness induction.

Studies that experimentally manipulated gratitude in the laboratory confirm that gratitude increases social closeness, both to strangers and within existing relationships. Participants who felt grateful to a confederate who helped fix an ostensibly broken computer were more likely to choose to work with that confederate again and to help the confederate in a competitive game, even at cost to themselves (Bartlett, Condon, Cruz, Baumann, & Desteno, 2012). In a longitudinal study comparing the effects of expressions of gratitude, thoughts of gratitude, positive thoughts, or an active neutral control, participants asked to express gratitude toward a friend twice a week for 3 weeks were more willing to disclose concerns about the relationship to their friend, an effect mediated by increases in positive perceptions of the friend (Lambert & Fincham, 2011). By expressing gratitude toward their friend, participants began to think more positively of the friend, which made them more willing to talk to their friend about any concerns they had with the relationship. The authors describe disclosing concerns as “relationship maintenance,” suggesting that expressions of gratitude may have increased the participants' feelings of closeness to the friend and desire to keep the relationship strong.

Gratitude appears to promote prosocial behavior toward people in general, as well as toward a benefactor. Across four studies, participants who were briefly thanked for completing a task were more likely to help others in unrelated tasks, such as calling alumni for a university fundraiser, relative to those in a neutral control condition. The effect of gratitude on prosocial behavior toward others was mediated by participants' reports that they felt valued, trusted, or close to the benefactor, again suggesting that gratitude works by increasing social closeness (Grant & Gino, 2010).

There are a wide variety of gratitude interventions. In the “gratitude visit” intervention, participants are asked to write and deliver a letter expressing gratitude for something the recipient has done for them (Seligman, Steen, Park, & Peterson, 2005). In the “count your blessings” intervention, participants keep a “gratitude journal” and record three things they are grateful for each day (Seligman et al., 2005). Relative to participants in an active control group or a “write about your best self” group, those in the gratitude letter condition showed significant increases in happiness over 1 month but returned to baseline within 3 months, whereas participants in the “gratitude journal” condition increased in happiness and decreased in depression throughout the 6-month monitoring period. Strikingly, participants in the “gratitude journal” condition also reported that they continued to use their gratitude journal after the study had ended.

Gratitude interventions are relatively easy to administer and appear to have lasting positive effects. They are vulnerable to habituation, and seem to be most effective when practiced at intervals rather than every day (Sheldon & Lyubomirsky, 2006). In a review of the potential of gratitude interventions for use in counseling psychology, Nelson (2009) cited the potential of gratitude as an intervention but called for further research comparing gratitude interventions to one another, exploring individual differences that might contribute to the success or failure of gratitude interventions, and urged researchers to explore the role of gratitude in child development.

Family and Group Therapies

Although many interventions target the individual, others work at the level of dyads and groups, including couples, families, and work groups. There are a wide variety of couples and family therapies, which can be roughly divided into emotional, behavioral, and insight-based forms (Carr, 2009). Emotion-based couples therapy addresses attachment needs, behavioral couples therapy teaches communication and negotiation skills, and insight-based therapy focuses on understanding the effect of previous relationships and family behavioral patterns on behaviors in the present (Carr, 2009).

The three varieties of couples therapy appear to be effective across a wide range of disorders. In a recent review of the literature, couples therapy was an effective treatment for anxiety, depression, borderline personality disorder, alcoholism, substance abuse, and posttraumatic stress disorder (PTSD), among other disorders (Lebow, Chambers, Christensen, & Johnson, 2012). In a separate review, family therapy, in concert with medication, was more effective than medication alone in treating anxiety, depression, bipolar disorder, and schizophrenia, as well as chronic illnesses such as arthritis, stroke, and heart disease (Carr, 2009). Unfortunately, research on the mechanisms of change in couples and family therapy has not yet explored the potential role of social closeness (Sexton, Robbins, Hollimon, Mease, & Mayorga, 2003).

Although most couples therapies focus on alleviating distress, mindfulness-based relationship enhancement (MBRE) therapy targets healthy couples, with the aim of increasing relationship satisfaction by building stress coping skills in both members of a couple (Carson, Carson, Gil, & Baucom, 2004). MBRE is a modification of mindfulness-based stress reduction (MBSR), a well-known therapeutic program targeted to individuals (Kabat-Zinn, 1990), and combines elements of emotional, behavioral, and insight-based therapies. Like MBSR, MBRE trains participants in a combination of mindfulness, loving kindness, yoga, body awareness or body scan and other stress-reduction techniques, but these techniques have been adapted to work with couples. MBRE training takes place through eight weekly training sessions of 2.5 hr each, ending with a day-long retreat (Carson et al., 2004).

An initial test of MBRE found that, relative to those in a wait-list control condition, couples who received MBRE training reported increased relationship happiness and ability to cope with stress, as well as decreased relationship stress and overall stress (Carson et al., 2004). Practicing mindfulness the day of reporting was associated with improvements in relationship and stress variables that day and for 2 days afterward (Carson et al., 2004), encouraging evidence that the intervention effects were not due solely to expectation on the part of the participants. Subsequent analyses revealed that the positive effects of MBRE were partially mediated by increases in couples' acceptance of one anothers' difficult characteristics (Carson et al., 2004). Based in part on the success of MBRE, two recent reviews have proposed integrating mindfulness into marriage and family therapy (Gambrel & Keeling, 2010) and parent–child therapy (Duncan, Coatsworth, & Greenberg, 2009).

Team building is another form of group-based social closeness intervention common to work environments; it is typically used to improve performance or efficiency within the team. Unlike team training, which focuses on teaching new work-related skills, team-building interventions aim to clarify social roles within the team, improve social relations and resolve interpersonal conflicts that may interfere with the function of the team (Klein et al., 2009). A meta-analysis of the effectiveness of team building found that team building led to improvements in interpersonal relationships, role clarity, goal setting and problem solving and resulted in improved work performance. Changes in interpersonal relationships partially mediated the relationship between team building and performance (Klein et al., 2009), suggesting that team building is a group-based social closeness intervention that uses social closeness to improve work performance.


Interventions that focus specifically on increasing social closeness in non-lonely populations are few, but the findings suggest that increasing social closeness can be beneficial, even for people who report adequate social connections. The existing interventions target positive social attention, various positive emotions, compassion, or distress within existing relationships, with the aim of opening participants up to new relationship opportunities, enriching existing relationships, and changing maladaptive relationship behaviors. Initial studies have been promising, with positive effects on measures of mental and physical wellbeing and relationship satisfaction. Many of these studies hail from social psychology, which has a strong experimental tradition of closely matched control groups, random assignment to conditions, and double-blind or dual-blind designs but seldom focuses on assessing the clinical significance or practical utility of interventions. As a result, the studies described provide a conceptually and empirically strong starting point for future translational research on social closeness interventions for non-lonely populations by researchers in intervention-focused fields such as complementary and alternative medicine, clinical psychology or counseling.

The Role of Social Media and Electronically Mediated Communication

  1. Top of page
  2. The Need for Social Closeness Interventions
  3. Types of Social Closeness Interventions
  4. Interventions to Decrease Loneliness
  5. The Role of Social Media and Electronically Mediated Communication
  6. The Role of Personal Traits
  7. Social Closeness in the Community
  8. Conclusion
  9. References

Age and illness can make it difficult to travel to group or one-on-one therapy sessions; this is unfortunate, as individuals with mental or physical disabilities and older people are at particular risk for loneliness (Hawkley & Cacioppo, 2007; Pavri & Luftig, 2000). As a result, there is a great deal of interest in loneliness interventions that can be administered either online or through the phone. A meta-analysis of loneliness treatments compared in-person and electronically mediated interventions and found no difference in effectiveness (Masi et al., 2011). The electronically mediated interventions reviewed included CBT offered through inter-relay-chat (IRC, a text-based online program that allows both one-on-one and group-level conversations in real time; Hopps et al., 2003); an online peer-led support group using a message board system and email (Hill, Weinert, & Cudney, 2006); psychoeducational group therapy via weekly telephone conference calls with two to five other participants plus two facilitators (Hartke & King, 2003; Heckman & Barcikowski, 2006); weekly one-on-one phone calls from study staff offering social support (Coleman et al., 2005; Heller, Thompson, Trueba, Hogg, & Vlachos-Weber, 1991); and in-person training in computer use and the Internet together with access to web-enabled computers (Shapira, Barak, & Gal, 2007; White et al., 2002). The growing presence of Skype and other real-time video-and-audio communication techniques suggests that future loneliness interventions may integrate text-and-voice-based electronic training with face-to-face conversations via webcam.

In non-lonely populations, findings regarding the efficacy of electronically mediated social interactions are mixed, and research focuses largely on the effects of Internet use. In one early and influential study, researchers collected data on households in their first 2 years of Internet use and found that greater use of the Internet was associated with decreases in family communication, smaller social circles, and increased depression and loneliness over time (Kraut et al., 1998). On the other hand, use of the Internet by college students is associated with establishing new relationships and maintaining existing ties to geographically distant others (Ellison, Steinfield, & Lampe, 2007), an effect that may be particularly strong for people who find in-person interactions stressful or threatening (Ellison et al., 2007; Steinfield, Ellison, & Lampe, 2008). Generally, larger online friendship networks are associated with higher life satisfaction and perceived social support (Manago, Taylor, & Greenfield, 2012), though this relationship may not hold, or may even become negative, for individuals with a particularly large number of online friends (Kim & Lee, 2011). When it occurs, loneliness in online environments may be attributable to the absence of social cues, which is associated with decreases in psychological wellbeing and perceived social support (Kang, 2007), or to Internet addiction, which has been linked to social isolation and depression (Chou, Condron, & Belland, 2005). Other researchers have suggested that loneliness causes increased use of the Internet (Chou et al., 2005).

One concern regarding time spent online is that it may lead to decreased community engagement (Putnam, 2001). This may not be the case: in a national sample of 3,377 American adults who responded to the 1999 DDB Needham Life Styles Survey, time spent online was positively associated with volunteerism and attendance at public events (Shah, Schmierbach, Hawkins, Espino, & Donavan, 2002). Among college students, greater use of Facebook positively predicted social trust, political participation, and civic engagement (Valenzuela, Park, & Kee, 2009).

The study of electronically mediated communication is still in its infancy, and the technologies that enable electronically mediated communication are changing at an ever-increasing rate. Perhaps some forms of electronically mediated communication, such as video chat, may prove more effective in increasing social closeness than other forms, such as message boards. Use of electronically mediated communication may be helpful to those who are socially isolated, as it gives them opportunities to form social connections in a less threatening environment; for people with robust social networks offline, electronically mediated communication may act as an isolating force that reduces opportunities for in-person communication.

The Role of Personal Traits

  1. Top of page
  2. The Need for Social Closeness Interventions
  3. Types of Social Closeness Interventions
  4. Interventions to Decrease Loneliness
  5. The Role of Social Media and Electronically Mediated Communication
  6. The Role of Personal Traits
  7. Social Closeness in the Community
  8. Conclusion
  9. References

An intervention need not be effective for everyone in order to be useful; conversely, not all people respond in a similar way to a particular intervention. Because many factors contribute to the presence or absence of social closeness, differences in gender, health, personal beliefs, and cultural background, among others factors, should be considered when evaluating and choosing an appropriate intervention.

Responses to gratitude interventions may vary by gender. Across three studies, women reported feeling more comfortable with the emotion of gratitude and more likely to report experiencing gratitude in response to an experimental manipulation (Kashdan, Mishra, Breen, & Froh, 2009). Women's gratitude was also more likely to result in increased social closeness over a 3-month period. These effects were partially mediated by willingness to openly express emotions.

Some interventions are more demanding of participants' time and resources than others. In one study of LKM (Kok et al., 2013), responses were moderated by participants' starting level of vagal tone, a physiological index of self-regulatory capacity (Segerstrom & Nes, 2007). Participants with higher starting vagal tone showed a faster rate of increase in positive emotions in response to the meditation. Since almost all meditative practices require participants to regulate and control their attention, participants with impaired self-regulatory ability may have found it difficult to comply with the meditation instructions, thus decreasing the benefit they derived from the practice.

Emotion-focused approaches such as meditation may be viewed as overly simplistic or frivolous, which can reduce compliance with the intervention and may also decrease the benefits of meditative practice. Participants willing to participate in a meditation study are likely to be different from the average population in that they are more likely to have tried at least one type of meditative practice before enrolling in the study, and more likely to be White, female, well educated, and of higher socioeconomic status (Bair et al., 2002; Ni, Simile, & Hardy, 2002). In addition, participants are likely to come into the study already believing in the benefits of meditation. At present, it is difficult to know whether the beneficial effects of various meditative practices would also occur for individuals who are skeptical of the idea of meditative practice. These selection effects intensify in studies that require more intensive meditation (daily meditation, attending a week-or-months-long meditation retreat, etc.).

Research on social closeness interventions has largely been carried out with Western populations, even when, as in the case of meditation, the intervention itself is non-Western in origin. Cultural differences in the way that individuals from Western and Eastern cultures conceptualize identity may moderate the effectiveness of social closeness interventions. One frequently studied characteristic particular to Western culture is the focus on individualism—the idea that the self exists independent of a person's relationships with others. In contrast, individuals from cultures outside of the West are more likely to conceptualize the self as integrated within a web of social relationships, expectations, and obligations that shape a person's identity and beliefs (Triandis, 2001). This view, known as collectivism, may lead to significantly different responses to social closeness interventions than have been observed in Western samples.

For example, individuals with a more collective sense of self may be more responsive to the social closeness interventions that explicitly evoke connections between persons, such as meditation or gratitude inductions. Those with an individualist identity may respond more strongly to interventions that target personal behaviors or perspectives, such as loneliness interventions that address maladaptive cognitions, or the positive social attention intervention, which focuses on the individual's feelings about social interactions (Sin & Lyubomirsky, 2009). Because collectivism and individualism are individual traits that exist on a unidimensional continuum, individuals within the same culture may vary in the extent to which they think of their self as distinct from, or shaped by, their relationships with others. As a result, even when social closeness interventions are applied within one culture rather than cross-culturally, it would still be useful to take this trait into account when choosing the appropriate intervention for an individual.

Social Closeness in the Community

  1. Top of page
  2. The Need for Social Closeness Interventions
  3. Types of Social Closeness Interventions
  4. Interventions to Decrease Loneliness
  5. The Role of Social Media and Electronically Mediated Communication
  6. The Role of Personal Traits
  7. Social Closeness in the Community
  8. Conclusion
  9. References

Loneliness may be contagious. In a longitudinal study of the social networks of 12,067 participants drawn from the multigenerational Framingham Heart Study, people who interacted with someone who was feeling lonely reported feeling lonelier themselves, and that loneliness was then spread to their interaction partners (Cacioppo, Fowler, & Christakis, 2009). This implies that loneliness can become a community-wide problem. Individuals in the sample who were not lonely did not appear to transmit their “non-loneliness” to others, though “non-loneliness” was measured simply as low scores on the loneliness scale, and social closeness was not measured.

Research on the contagious effects of social closeness is scant. But in the same Framingham sample, a similar network study of the spread of happiness, an emotion strongly associated with social closeness (Fredrickson et al., 2008), found that happiness was more contagious than unhappiness (Fowler & Christakis, 2008); perhaps, then, interventions such as LKM might work to counter the contagion of loneliness through a potent combination of positive emotions and social closeness.

Individuals who are “flourishing” experience optimal levels of psychological, emotional, and social wellbeing (Keyes, 2007). They both “feel good” and “do good”: among other things, they report feeling closer to friends and family than non-flourishing individuals. According to Keyes (2007), flourishers are good for society because they miss less work, are sick less often, use less health care, have fewer chronic conditions and are less likely to experience mental illness than others, all factors that reduce their societal cost. Individuals who experience greater social closeness on a regular basis are also less likely to fall ill; as a result, they also miss less work, use fewer health-care resources and are diagnosed with fewer chronic illnesses or mental illnesses. Society as a whole benefits from social closeness.


  1. Top of page
  2. The Need for Social Closeness Interventions
  3. Types of Social Closeness Interventions
  4. Interventions to Decrease Loneliness
  5. The Role of Social Media and Electronically Mediated Communication
  6. The Role of Personal Traits
  7. Social Closeness in the Community
  8. Conclusion
  9. References

Social closeness is a fundamental human need; the socially close flourish, while the socially isolated suffer. The most effective social closeness interventions appear to target cognitions and emotions, either by reducing maladaptive social cognitions, redirecting attention toward social information, or fostering positive social emotions. At present, it is not known whether the interventions result in changes in behavior, or simply changes in perception that drive gains in wellbeing. Future work should include behavioral measures or event-sampling techniques such as the electronically activated recorder (EAR; Mehl, Pennebaker, Crow, Dabbs, & Price, 2001) or the day reconstruction method (DRM; Kahneman, Krueger, Schkade, Schwarz, & Stone, 2004) in order to determine whether the interventions affect participants' behavior toward others, and if so, in what way.

The majority of the interventions reviewed here did not follow up with their participants after the initial study was complete. When follow-ups were done, the results were mixed; the benefits gained from LKM appeared to persist as long as 15 months after the study, even for participants who stopped meditating (Cohn & Fredrickson, 2010). In contrast, the positive effects of writing and delivering a gratitude letter lasted only 1 month (Seligman, Ernst, Gillham, Reivich, & Linkins, 2009). An understanding of the duration of an intervention's effects is critical: some interventions may be most useful to create long-term change, whereas others may buffer against short-term adversity.

It appears that it is possible to increase social closeness even in individuals who do not report feeling socially isolated. Increasing social closeness leads to improvements in psychological wellbeing, indices of physical health, and relationship investment and satisfaction. These effects are moderated by individual differences in gender, self-regulatory capacity, existing social closeness, belief in the efficacy of the intervention, and cultural background. Future research will doubtless identify more factors that will help match a person with an effective intervention.

Social closeness has powerful positive effects on mental and physical health, with policy implications for any field concerned with human health and functioning. The following recommendations are based on the ideas of Umberson and Montez (2010): Social policies can work to increase awareness of the importance and benefits of social ties, both for policy makers and the average person. This may include social–emotional awareness or social skills training in order to decrease vulnerability to social isolation later in life. Policy makers can guard against actions that might harm or strain existing social ties, such as separating families or placing excessive burden on caregivers. Health-related policies can benefit from explicitly targeting and treating social isolation and abusive relationships, as being socially isolated or abused is a significant risk factor for many forms of physical and mental illness. Many existing policies, particularly those that make it easier for families to stay together or support older family members, already foster social closeness in a nonsystematic way. Groups with such policies can be encouraged to continue promoting social closeness and to share their methods with others. Finally, some individuals, such as those with chronic illnesses, mentally ill people, and elderly people, are particularly vulnerable to social isolation and should be a particular target of policy attention. By utilizing the current scientific knowledge of the impact of social closeness and how it can be manipulated through interventions, policy makers can more effectively safeguard health and wellbeing and decrease illness-related costs.

The literature on interventions that alleviate loneliness is extensive, with published work dating back to the 1930s (Rook, 1984). In contrast, social closeness interventions for non-lonely individuals have only begun to be studied, corresponding to the rise of the positive psychology movement (Gable & Haidt, 2005). It is our hope that the studies described here will serve as an inspiration to further work, in order to determine how best to harness the power of social closeness to maximize health and wellbeing.


  1. Top of page
  2. The Need for Social Closeness Interventions
  3. Types of Social Closeness Interventions
  4. Interventions to Decrease Loneliness
  5. The Role of Social Media and Electronically Mediated Communication
  6. The Role of Personal Traits
  7. Social Closeness in the Community
  8. Conclusion
  9. References
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