A social cure for better health

How a UQ program designed to reduce loneliness is gaining traction around the world.

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Image credit: Unsplash/natalia-y

Image credit: Unsplash/natalia-y

Loneliness and isolation are linked to poor physical and mental health. Studies have found that social disconnection poses a greater health threat than smoking, poor diet and lack of exercise.

In addition to being a factor in the development of mental health conditions such as depression, psychosis, and social anxiety, loneliness increases the risk of premature death by around 30 per cent.

Research also indicates that one in three adults over 45 years of age and 60 per cent of all adults often report feeling lonely.

The relationships we have with social groups — such as family, friendship, community, work, arts-based, sporting and other interest groups — influence our health in both positive and negative ways.

Yet while there is a wealth of evidence that shows losing valued social groups can have detrimental effects on a person’s health, practitioners haven’t had clear guidelines to deal with the adverse health effects of such loss and the social isolation that can come with it.

Until now.

A black and white image of a man sitting down and looking at his hands.

Image credit: Unsplash/Matthew Henry

Image credit: Unsplash/Matthew Henry

In recent years, a program that reduces loneliness, depression and anxiety caused by social disconnection has been developed by a team of UQ researchers.

Led by Professors Catherine Haslam and Alex Haslam from UQ’s School of Psychology, the team has drawn on their combined expertise across the fields of social, clinical, health, organisational and neuro-psychology to develop a program to help people who are vulnerable to social isolation and disconnection.

GROUPS 4 HEALTH (G4H) is an evidence-based intervention that directly targets the psychological distress that results from loneliness and social isolation. It provides people with the knowledge, skills and confidence to increase their social connectedness, and in particular, their group-based social identifications.

“G4H works on two pathways that are related to positive health outcomes following major life changes associated with such things as illness, trauma or retirement,” Professor Catherine Haslam explains.

“One of these pathways centres on how best to harness existing group memberships, while the other focuses on finding positive new groups to join in ways that protect and enhance health.

"The aim of the program is to put people in the driver’s seat and give them agency to understand how best to engage and manage the groups in their lives in ways that support their health and wellbeing.”

Catherine says a sense of social identification with others is important as it’s one of the main things that helps us tackle challenges in life.

“Sometimes this identification is associated with groups that we have been part of for a long time, like our family or friendship groups, but sometimes it is associated with groups that we have only just joined, for example, as a consequence of our shared experience of becoming a parent, surviving trauma, transitioning to retirement, or moving into care,” she explains.

“In all of this, the more positive and compatible groups that a person belongs to, the more likely it is that they will succeed in navigating a new or difficult period of their life.”

There are five key aspects of the G4H program that participants typically work through:

  1. Why groups matter: Raising awareness of the value of groups for health and of ways to harness these.
  2. Mapping groups: Using a new Social Identity Mapping tool to help people create a map of their social world that identifies existing group connections and areas for social growth.
  3. Making the most of groups: Identifying existing groups that are especially important for health and developing skills to maintain and strengthen these ties.
  4. Expanding groups: Using the G4H group as a platform for joining new social connections as part of a social plan developed in the program.
  5. Sustaining groups: Identifying and trialling strategies to ensure social group ties endure and learning how to deal with ongoing challenges that group life can present.

The Haslams and their team, including Dr Tegan Cruwys, Associate Professor Genevieve Dingle, Professor Jolanda Jetten and Dr Sarah Bentley, first developed G4H at UQ’s St Lucia campus in 2014.

The first G4H program training workshop was held that year, and are now run annually in Australia and internationally in a range of countries including the UK, Germany, and Switzerland.

As a result of its success, the program is being implemented across the globe in a range of conditions and contexts.

“G4H was first piloted in a study for adults experiencing psychological distress as a result of social isolation, with between 60–68 per cent of people showing an improvement in depression, social anxiety and loneliness after completing the program,” Catherine says.

“A randomised controlled trial (RCT) published in the Journal of Consulting and Clinical Psychology has confirmed its effectiveness in reducing loneliness, social anxiety and depression.

“Importantly, this trial compared G4H to ‘treatment as usual’ for depression, in which people received either drug treatment or other psychological therapies, and showed that G4H was more effective in reducing loneliness and social anxiety.

“Participation in G4H was also associated with fewer GP visits and a stronger sense of belonging to multiple groups.”

Image credit: Unsplash/Kristina Tripkovic

A black and white image of a hand resting against a window. It is raining outside the window.

In collaboration with Rotary Health and Headspace, the researchers are now in the final stages of another RCT comparing G4H with cognitive behavioural therapy in young people presenting with depression and social isolation. Early findings from this trial are showing that G4H can improve social anxiety and group belonging.

Professor Alex Haslam emphasises how this sense of belonging to groups is important.

“Humans are social animals and our social groups play a key role in shaping the way we think, feel and act in different situations,” he explains.

“For example, social groups provide mental stimulation, help us deal with stress and challenge, and motivate us to engage in healthy behaviours such as exercise.

“Social groups have this impact because they provide us with a sense of meaning, purpose and belonging, the means to enhance self-esteem and perceived control, as well as access to social support.”

G4H is now being applied across the lifespan to help people manage a range of life-changing situations.

One of the biggest G4H adaptations has been for retirees. GROUPS 4 HEALTH: RETIREMENT is an online program developed to help retirees engage in social planning as they transition out of work and to support their adjustment during what can be a period of great social upheaval.

This engagement in social planning is particularly important in light of evidence showing that financial planning is not the most important predictor of retirement adjustment.

The team has also developed GROUPS 4 HEALTH: GOING HOME, working with people over the age of 50 who have been socially disconnected from others in their neighbourhoods and communities as a consequence of needing long-term hospitalisation. The program is used as a basis to transition people back into the community, so that they can reconnect and use their social resources as best as possible.

Another program, GROUPS 4 EDUCATION, is helping students transition to tertiary education and tackle the challenges of instability and mental health vulnerability that starting at university can create. The program, led by Dr Sarah Bentley, is being trialled at UQ, the University of Melbourne, the University of Exeter, Nottingham Trent University and Edinburgh University.

Another adaptation, GROUPS 4 BELONGING, led by Dr Genevieve Dingle, is helping people to work with social groups to support their recovery from substance misuse.

A black and white image of a man looking out of a window that is soaked with rain.

Image credit: Unsplash/Samuel Austin

Image credit: Unsplash/Samuel Austin

To further spread the word of the effectiveness of social connections for better health, the team published a book in 2018: The New Psychology of Health: Unlocking the Social Cure.

In this book, the researchers cover a broad range of topics, including the role group memberships play in decisions to engage in problematic behaviours such as smoking or excessive dieting, in recovery from stress, trauma, and depression, and in pain management.

“It’s important people understand that in all these cases, mental health is shaped not just by joining a group, but by seeing the group as a meaningful part of who one is,” Catherine says.

“A core theme is that the lack of a sense of ‘us’ is implicated in a range of the health problems we examine, but this is also a focus for intervention.”

Professor Alex Haslam says the book is for researchers, students and practitioners in the field, as well as people dealing with health outcomes of social isolation.

“Social isolation is a problem that touches the lives of all and knows no bounds,” he says.

“It affects the young and old, the rich and poor, and those who are in good and ill health.

“It also puts pressure on health services, with estimates suggesting around 10 per cent of adults suffer from the debilitating consequences of social isolation, while GPs spend around 20 per cent of their time dealing with the significant knock-on effects."

Importantly, Alex believes loneliness is “one of the biggest public health concerns we face as a society today”.

“Findings from epidemiological studies show that social disconnection is a greater risk to mortality than smoking, a poor diet and lack of exercise,” he says.

“Understanding which groups are a source of social cure – those that promote a sense of belonging, positive health behaviours, and boost self-esteem – and how they might be harnessed to support health and wellbeing is therefore the key starting point."

Alex says the team hopes to change the way people think about health and show them how social connections can be cultivated in order to secure long-term positive health outcomes.

“We are only at the beginning when it comes to harnessing the power of social processes to promote positive health outcomes,” he says.

The story so far:

2009: The first journal special issue on the topic 'Social identity, health and well-being: An emerging agenda for applied psychology' is published in Applied Psychology: An International Review.

2012: The Social Cure: Identity, Health and Well-being, the first book on the social identity approach to health, is published.

2014: The first G4H program training workshop is held in Brisbane.

2014: G4H training is extended internationally to the UK (2014), Switzerland (2016) and Germany (2017).

2016: The results of a pilot study published in the Journal of Affective Disorders confirm that G4H has the potential to reduce the negative health-related consequences of social disconnection.

2017: A trial of G4H in collaboration with Queensland Health (Metro North Hospital and Health Service) and BallyCara commences.

2017: A trial of GROUPS 4 EDUCATION at the University of Nottingham, UK, commences.

2017: A second journal special issue on the topic, Social Identities as Social Cures: Advancing the Social Identity Approach to Health and Well-being, is published in the European Journal of Social Psychology.

2018: In collaboration with Headspace, a Rotary Mental Health-funded RCT commences comparing G4H and cognitive behavioural therapy for depression in young people.

2018: The book The New Psychology of Health: Unlocking the Social Cure is published.

2019: A trial of GROUPS 4 EDUCATION with first-year students at the University of Melbourne commences.

2019: A pilot trial of GROUPS 4 BELONGING in collaboration with Lives Lived Well and the University of Wollongong to support recovery from substance misuse commences.

2019: UQ collaborates with AustralianSuper on GROUPS 4 HEALTH: RETIREMENT to support members engagement in social planning in transitioning to retirement.

2019: The results of a randomised controlled trial of G4H published in the Journal of Consulting and Clinical Psychology confirms its effectiveness in reducing loneliness, social anxiety and depression.

2019: A trial of GROUPS 4 EDUCATION to support first-year students transitioning to study at the University of Exeter, UK, commences.

2019–2020: A pilot of G4H with older people in collaboration with Relationships Australia commences.

2020: G4H training is held in Brisbane (APS College of Clinical Psychologists Conference) and Nottingham, UK (5th International Conference on Social Identity and Health).

2020: The New Psychology of Health: Unlocking the Social Cure wins the British Psychological Society’s award for “Book of the Year”.

Image credit: Unsplash/Vinayak Sharma

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Contact details

Professor Catherine Haslam, Professor Alex Haslam

Professor Catherine Haslam
UQ School of Psychology , Faculty of Health and Behavioural Sciences
Email: c.haslam@uq.edu.au
Phone: +61 7 3346 7565
Web: researchers.uq.edu.au/researcher/1722

Professor Alex Haslam
UQ School of Psychology , Faculty of Health and Behavioural Sciences
Email: a.haslam@uq.edu.au
Phone: +61 7 3346 7345
Web: researchers.uq.edu.au/researcher/1946

This article was last updated on 21 January 2021.

Professor Catherine Haslam, Professor Alex Haslam

Professor Catherine Haslam, Professor Alex Haslam