A new study examines the impact of social connection and acts of kindness on people diagnosed with clinically elevated symptoms of anxiety and/or depression, as compared with standard mental health treatment.
The Healing Power of Kindness
When you research mental health disorders and read lists of warning signs, risk factors, and symptoms, you notice several common items. From anxiety disorders to depressive disorders to psychotic disorders, you see the following symptoms:
- Withdrawal from friends and family
- Self-isolation
- Withdrawal from social activities
- Decreased participation in favorite hobbies and pastimes
An important thing to understand about these symptoms/warning signs is that the associated behaviors can exacerbate the symptoms and increase the severity of the diagnosed disorder. It’s a negative, self-reinforcing cycle. When a person withdraws, they often feel more isolated, and their sense of loneliness increases. The lonelier and more isolated they feel, the less likely they are to engage in activities that decrease feelings of loneliness and isolation.
While many therapeutic approaches not only focus on helping people address feelings within themselves but also include family therapy, very few directly address the problem of loneliness as related to social connection.
That’s an area where mental health treatment can improve, particularly with regards to treatment for anxiety and depression, disorders with symptoms that cause people to withdraw, self-isolate, and feel lonely.
The study we’ll discuss today addresses new ways to help people intentionally use acts of kindness and social connection to improve mental health. First, though, we’ll take a moment to address the real costs of loneliness – and why the study we’ll discuss is an important step in mental health treatment.
The Consequences of Loneliness
In a report published by the Surgeon General of the U.S. in May 2023, the top doctor in the nation summarized the impact of loneliness on mental and physical health:
“Loneliness is far more than just a bad feeling—it harms both individual and societal health. It is associated with a greater risk of cardiovascular disease, dementia, stroke, depression, anxiety, and premature death.
Loneliness is often associated with social isolation, but they’re not the same thing. Characteristics of loneliness include a sense of emptiness, feelings of separation, and feelings of not being needed or wanted when a person wants and needs to feel full, connected, and needed. Social isolation is slightly different. Characteristics of social isolation include a low number of social interactions, relationships, roles, and affiliations with groups of people – in essence, a person with few social relationships is considered socially isolated.
The consequences of loneliness and social isolation extend beyond negative subjective experiences. In fact, data shows the following.
Consequences of Loneliness and Isolation: Premature Mortality
- Compared to individuals who feel connected, individuals who feel lonely have a 26% increased risk of premature mortality.
- Compared to individuals with a robust social network, socially isolated individuals have a 29% increased risk of premature mortality.
With regards to anxiety and depression, data from the Surgeon General’s report we mention above shows the following.
Consequences of Loneliness and Isolation: Anxiety and Depression
- Loneliness doubles the chance of developing a depressive disorder
- Loneliness elevates rates of anxiety in adults 65+
- Isolation elevates rates of depression adults 65+
- Loneliness elevates risk of anxiety in children and teens
- Isolation elevates risk of anxiety in children and teens
- Having one close friend reduces risk of depression in children and teens
Those are the facts on the impact of loneliness and isolation on mental health, specifically on symptoms associated with anxiety and depression. But that’s not all. The Surgeon General’s report also presented the following.
Isolation, Socializing, and Friends: Surgeon General’s Report
- Overall time in social isolation increased by an average of 24 hours per month since 2001
- Time spent socializing decreased by an average of 20 hours per month since 2001
- In 1990, 25% of people said they had fewer than three close friends
- In 2021, 50% of people said they had fewer than three close friends
Now that we understand loneliness and isolation and their impact on mental health, let’s take a look at the study we mention above.
Acts of Kindness, Social Connection, and Mental Health
The study “Healing Through Helping: An Experimental Investigation of Kindness, Social Activities, and Reappraisal as Well-Being Interventions” sought to address the problems we mention above in the context of treatment for anxiety and depression.
Traditional treatment for anxiety and depression includes a combination of psychotherapy, medication (if needed), lifestyle changes, and social support. Most of us understand the basics of psychotherapy. Patients work with therapists on productive ways to process the negative thoughts, emotions, and behaviors common to anxiety and depression. Most of us understand the basics of the lifestyle changes that promote positive mental health, as well: a good diet, plenty of exercise/activity, and regular sleep.
With regards to social support, though, the approach is not as well defined. Therapists may advise patients to participate in depression or anxiety support groups. Or they may suggest accepting invitations from friends and family for social outings, or suggest joining social groups based on shared interests.
In this study, the social component of treatment was a feature of the treatment, rather than a suggested supplementary activity: that’s what’s new about it – and that’s why we’re interested in the results.
The Study: How Researchers Assessed the Impact of Kindness on Mental Health
The research team recruited 122 participants with clinical diagnoses of moderate to severe depression and/or anxiety, divided them into three groups, and monitored their progress over five weeks, then checked in a final time after ten weeks. Here are the three groups:
- An acts of kindness group:
- Clinicians instructed participants to perform three acts of kindness at least two days each week
- A social activities group
- Clinicians instructed participants to engage in social activities at least two days each week
- A cognitive reappraisal group
- Clinicians instructed participants to keep a record of negative thoughts and how they revised them at least two days each week (Note: cognitive reappraisal is a standard technique in cognitive behavioral therapy)
To measure the impact of these protocols on mental health symptoms, researchers administered the following tests at baseline, five weeks, and ten weeks after initiation.
- DASS-D, Depression Anxiety and Stress Scales (Depression, Anxiety, Stress)
- MSPS, Multidimensional Scale of Perceived Social Support
- SWLS, Satisfaction With Life Scale
- SAS, Self-Absorption Scale
- SCS-R, Social Connectedness Scale, Revised
Here’s what they found:
Acts of Kindness Group (AK Group)
- Depression/Anxiety (DASS-D): Superior reduction/improvement compared to the CR group, similar reductions/improvements compared to SA group
- Social Connection (SCS-R): Superior increase/improvement compared to CR and SA groups
- Life Satisfaction (SWLS): Superior increase/improvement compared to CR group, similar increases/improvements to SA group
Social Activities (SA Group)
- Depression/Anxiety (DASS-D): Similar improvement compared to AK group, superior improvement compared to CR group
- Social Connection (SCS-R): Inferior improvement compared to AK group, superior improvement compared to CR group
- Life Satisfaction (SWLS): Similar improvement compared to AK group, superior improvement compared to CR group
Cognitive Reappraisal Group (CR Group)
- Depression/Anxiety (DASS-D): Inferior improvement compared to AK and SA groups
- Social Connection (SCS-R): Inferior improvement compared to AK and SA groups
- Life Satisfaction (SWLS): Inferior improvement compared to AK and SA groups
We’ll discuss these results now.
Kindness: Impact on Depression, Anxiety, Life Satisfaction, and Overall Mental Health
The results we report above may be somewhat misleading, because all participants in all three groups showed improvement across all metrics: symptoms of anxiety and depression, social connectedness, and life satisfaction.
That’s encouraging news.
Standard approaches are effective in reducing anxiety, depression, and stress. Standard approaches can also improve social connectedness. However, the acts of kindness (AK) group showed more robust improvement across all measures than both the social activities (SA) group and the cognitive reappraisal (CR) group. In addition, although the SA group and CR group showed improvement in social connectedness, only the AK group showed statistically significant improvement in social connectedness.
This means at least three things:
- For patients with depression and anxiety engaging in standard cognitive behavioral therapy (CBT), these results confirm its an effective modality.
- Patients with depression and anxiety can improve their overall symptoms severity, sense of social connectedness, and life satisfaction by engaging in social activity and performing acts of kindness in addition to standard CBT.
- Assigned acts of kindness, assigned social activity, and assigned cognitive restructuring improve outcomes, but assigned acts of kindness and social activity yield more robust improvements than cognitive restructuring, and acts of kindness yield more robust improvement than social activity alone.
In short, this study teaches us that performing acts of kindness has a powerful, measurable impact on mental health. It also shows us that assigned acts of kindness – a new adjunct component in CBT for anxiety/depression – can exist alongside and improve outcomes for patients engaging in standard CBT.
Here’s how the study authors describe their findings:
“Collectively, our results provide converging evidence with previous research that acts of kindness may be a promising intervention for individuals with clinical presentations. Although acts of kindness are often conceptualized as an exercise that is primarily relevant for improving well-being in asymptomatic samples, the results of the current study challenge that notion.”
This observation resonates with us. We know performing acts of kindness has a positive effect on mental health and wellbeing outside of the mental health treatment context. Now we know performing acts kindness has an objective, positive, quantitative therapeutic effect on mental health symptoms. That’s an important finding, and one we’ll remind ourselves of every day.
Gianna Melendez
Jodie Dahl, CpHT