University of North Carolina at Chapel Hill Graduate School
Doi
Abstract
Aim: We used an integrative approach to examine the experience and impact of lonely feelings among persons diagnosed with a psychotic disorder. Study 1 evaluated relationships between loneliness and social cognition and functioning in a large sample of persons with schizophrenia or schizoaffective disorder. Study 2 assessed the impact of active engagement in an online social media platform specifically designed for individuals with first episode psychosis on loneliness severity and perceived social support. Study 3 examined which aspects of living with psychosis were associated with perceptions of loneliness, including symptomatology, perceptions of extant social relationships, and disruptions in school or work, among others. Methods: As part of Study 1, seventy-four stable outpatients with SSDs and 58 healthy controls completed the UCLA Loneliness Scale in addition to the standard Social Cognition Psychometric Evaluation (SCOPE) battery. For Study 2, twenty-six participants recruited from three first episode coordinated specialty care clinics in North Carolina were provided access to the moderated Horyzons platform for 12 weeks. During the intervention period, participants were encouraged to access therapeutic content and social components embedded within the site. Study 3 involved the implementation of semi-structured, qualitative interviews focused on experiences of loneliness with sixteen participants diagnosed with schizophrenia or schizoaffective disorder. During the interview, participants were asked to comment on current activities and social relationships, including their perceptions of the quantity, quality and types of relationships central to their social network. Results: Findings from Study 1 support prior research indicating persons diagnosed with a psychotic disorder experience greater levels of loneliness than normative groups. However, the results also indicate that self-reported loneliness is not associated with social cognitive abilities or functional outcome in psychosis. Regression analyses indicate that roughly half the variance in loneliness endorsed by persons with SSDs is accounted for by clinical variables, with loneliness most strongly associated with guilt and self-esteem. Results from Study 2 indicated that Horyzons was both feasible and very well tolerated, with a 92.3% retention rate and 79.2% of participants actively engaged in the platform. Preliminary results with engaged participants showed the greatest improvements in psychosis-related symptoms, followed by self-reported experience of negative emotions, depressive symptoms, and loneliness. Analyses revealed four key themes related to loneliness across participants involved in Study 3. Namely, participants reported that aspects of the physical environment (e.g., financial limitations), social context (e.g., lacking a romantic partner), and psychological functioning (e.g., psychotic and low mood symptoms) facilitated or exacerbated lonely feelings. Participants also commented on coping strategies employed to manage loneliness and provided suggestions for possible interventions. Conclusion: Taken together, these studies highlight the importance of cognition as it relates to loneliness. In particular, lonely feelings may be closely linked to the following cognitive processes: attention, perception, interpretation, attributions, and memory. Issues with measurement also arose as a central theme related to our understanding of loneliness in psychotic disorders. On their own, findings across the three studies of this dissertation may facilitate the identification of individuals who may be most at risk of intense loneliness. They may also help researchers identify specific target areas of treatment and inform the development of individualized treatment plans for persons with psychosis experiencing exacerbated lonely feelings.Doctor of Philosoph
