In 2023, a report from the United States Office of the Surgeon General outlined an epidemic of loneliness and social isolation in America (Office of the Surgeon General, 2023). Among the report’s recommendations was the urgent need for psychosocial interventions to improve social connection. This recommendation is based on a wealth of data showing that the quality and frequency of social relationships strongly predict health and well-being (e.g., Holt-Lunstad et al., 2015). On the flip side, low social support is associated with a higher risk of depression. For example, in a study of over 100,000 people and 106 potential factors, including lifestyle (e.g., exercise) and environmental (e.g., green space) variables, only three factors significantly predicted a reduced risk of depression at follow-up (Choi et al., 2020). Of these three factors, social connection, or specifically, the “frequency of confiding in others,” was the strongest predictor.
Intensive mental health treatment (e.g., residential, inpatient, partial hospitalization, intensive outpatient programs) has the potential to improve social connection immediately because patients typically spend a lot of time with peers (e.g., in group therapy, having lunch, or hanging out during unstructured time). Spending time with peers during treatment provides opportunities for patients to share experiences, which can lead to feeling validated, collaborative learning, and a sense of belonging (e.g., Burlingame et al., 2018). Anecdotally, I have seen this happen many times at our partial hospital program at McLean Hospital. Patients often express that hearing about other people’s experiences made them feel less alone, and that receiving support from peers was instrumental in their recovery.
Despite the longstanding idea that connecting with other patients during treatment is helpful, surprisingly, very few studies have systematically measured the frequency and quality of social experiences during intensive psychiatric treatment. Thus, we currently know little about how patients perceive these social encounters or whether they are associated with clinical improvement.
A new article coming out soon in the Journal of Clinical Psychology addresses this important gap in knowledge. In this article, our research team describes how we developed and validated a measure of peer social interactions during group-based psychiatric treatment. We developed the measure in collaboration with patients and clinicians on our Patient Advisory Board and named this new self-report survey the “Fellow Travelers in Treatment” scale. The scale asks patients about how often patients engaged in specific social interactions (e.g., “I ate lunch with a fellow patient”), potential helpful aspects of social interaction (e.g., “I learned something useful from other patients about managing symptoms”), and potential harmful effects of social interactions (e.g., “A fellow patient interacted with me in a way that made me feel uncomfortable”).
We then asked 470 adults attending McLean Hospital’s Behavioral Health Partial Hospital Program to complete the survey on the day of their discharge, as well as measures of clinical symptoms. Here’s what we found:
Patients reported a wide range of experiences, with some people scoring at the lowest and some at the highest possible range for each item on the scale.
Frequency of social contact was not significantly related to symptom outcomes of depression and anxiety.
Patients who reported higher levels of respect from peers and learning from peers had lower depression and anxiety scores.
Patients with psychosis reported less social connection and respect.
Overall, this study highlights how important it is to pay attention to people’s social experiences during mental health treatment—not just their symptoms. This initial study assessed social connection and symptoms at the same time; thus, future work using the Fellow Travelers in Treatment scale is needed to test whether social connection during intensive hospital treatment influences improvement and recovery over time. As research continues to show how deeply loneliness can affect well-being, future efforts should focus on creating treatment environments that help people feel included, understood, and meaningfully connected to others.