Healing Loneliness with Attachment

By Alexander Danvers, PhD, Director of Treatment Outcomes, Sierra Tucson

 

People in the U.S. are getting lonelier. In 2023, the U.S. Surgeon General Vivek Murthy issued a warning of the epidemic of loneliness in the country. According to large national surveys conducted by Cigna in 2018 and 2019, over half of adults in the U.S. report feeling lonely—and that number has remained high since. All this loneliness hurts our physical and mental health. Lonely people tend to have more issues with sleep, substance use, depression, and anxiety.

 

What should we do?

One obvious response would be to spend less time alone. However, loneliness isn’t just about being around people. There are plenty of people who can feel alone in a crowd, or people who enjoy peaceful solitude. Loneliness is really about not having the kinds of social connections you want. Research my colleagues and I conducted at the University of Arizona illustrates that point. In this research, we looked at large groups of people who had allowed us to make brief audio recordings of their daily lives throughout the day, to see how much time they spent alone. We also asked them how lonely they felt on questionnaires. The results indicated that spending time alone isn’t very strongly related to feeling lonely at all. In fact, being alone anywhere from 25% to 75% of the day was associated with equally low levels of feeling lonely. It was only when time alone got very high (more than 75% of the day alone) that loneliness started to increase.

 

The Quality of our Relationships

Our research showed that loneliness wasn’t just about being around other people. So what does work? One large survey study found that the people who said they were less lonely also reported having good relationships with family and romantic partners. That suggests it’s about quality, not quantity—strong relationships, not just being around people all day. So how do we measure strong relationships?

In 2022, I started working at Sierra Tucson, a large, nationally recognized residential mental health facility. There I oversee the collection of data on treatment outcomes. In our Measurement Based Care program, we give regular assessments of mental health symptoms like levels of depression, anxiety, and PTSD. We also look at people’s attachment styles. Attachment styles are patterns of relating to close others in our daily lives, such as close friends, romantic partners, and family members. Our assessment captures two aspects of attachment:

• Attachment Anxiety is a worry that other people won’t be there when you need them, and won’t be willing to get as close as you want.
• Attachment Avoidance is a discomfort of being close or depending on other people.

 

Ideally, both these dimensions are low. That would be considered secure attachment. High scores on one or both of these dimensions are often related to difficulties relating to other people.

Attachment styles capture the strength of our connections. If you have a more secure attachment style, you’re likely to be able to form stronger, more satisfying relationships. This difficulty forming strong, stable relationships can also influence other aspects of your life.

Recently, I analyzed the data we collected in 2023 to examine the way attachment is related to the mental health issues we encounter day-to-day at Sierra Tucson. In broad studies of the U.S. population, it’s typical to see 60% of people having a secure attachment style. Among the people we see at our mental health facility, it’s only 28%. Among the general population, it’s rare to see someone who is high in both attachment anxiety and attachment avoidance. At Sierra Tucson, 45% of our residents are high on both.

This is typically the most difficult attachment style to deal with, because it involves a push-pull dynamic of not wanting to depend on others but also wanting deeper feelings of closeness and connection. Our data show that people dealing with mental health problems are much more likely to have difficulty with attachment.

When I analyzed the 2023 Sierra Tucson outcomes data, I also found large correlations between attachment and mental health symptoms. People higher in either attachment anxiety or attachment avoidance (or both) had higher PTSD symptoms, higher depression symptoms, and higher anxiety symptoms. They also had more problems sleeping and experienced more difficulties from chronic pain, although these relationships were smaller. Overall, when people have difficulty forming strong attachments to others, they end up having more difficulty with mental health.

Here’s what I was seeing in two of my recent research projects: First, feeling lonely isn’t about how much time you spend with other people—it’s about having strong relationships. Second, difficulties forming strong relationships can be measured by attachment styles, and these are related to larger issues with mental health. Were these issues linked?

I went back to the scientific literature, and I found evidence for a connection. A large study of college students published in 2011 found that attachment style was related to loneliness. Being less secure—and especially having higher attachment anxiety—was related to feeling lonelier. Further, statistical modeling suggested a pathway to explain the relationship:

• Feeling less secure—and especially having more attachment anxiety—is related to feeling like you have less social support, or the ability to get help from others when you need it.
• Feeling like you have less social support is related to feeling lonelier.

 

This study suggested that people’s attachment styles make them see other people differently. When they are less secure, they see other people as less willing to support them. The feeling that “no one has my back” then makes them feel lonely.

Identifying this pathway is good, because we can change attachment styles. People learn attachment styles from the patterns they establish in their close relationships. When people have less secure attachment, it suggests they were in a relationship that established an unhealthy pattern. Establishing healthy patterns of relating, however, can change attachment style. One place this happens is therapy. Another key finding from our 2023 Sierra Tucson data was that, over the course of their stay in treatment, people’s attachment styles steadily became more secure. Our data suggest that having restorative experiences with therapists can help heal attachment wounds.

The research and reading I’ve done over the past year suggests a deeper story about loneliness. Loneliness is about not having the kinds of deep, satisfying connections we want. Getting those connections may involve looking at the patterns of attachment we have formed in our past relationships. When we take the time to examine these patterns, often with the help of a strong connection to a therapist, we may be able to undo our loneliness.

 

Alexander Danvers, Ph.D., is a psychologist with expertise in mobile sensing, machine learning, and psychophysiology. Dr. Danvers joined Sierra Tucson in 2022 from the U.S. Army Research Labs, where he was a civilian research scientist working on mobile sensing and artificial intelligence projects. 

Learn more at sierratucson.com or call  800-842-4487