Dr. Jane Gilmore: Welcome to Mind the Kids. I'm Dr. Jane Gilmore, Honorary Consultant Clinical Psychologist and Child Development Programme Director at UCL. Prof. Umar Toseeb: I'm Umar Toseeb, Professor with a focus on child and adolescent mental health and special educational needs. Dr. Jane Gilmore: In each episode of Mind the Kids, we select a topic from the research literature and in conversation with invited authors sift through the data, dilemmas and debates to leave you with our takeaways for academics and practitioners. Today we're talking about social isolation, its impact and how to address it. This episode is called Only the Lonely. Prof. Umar Toseeb: Jane, loneliness. Yeah, so I'm interested to talk about this because I would, in my teaching of child and adolescent mental health and my research on child and adolescent mental health, I wouldn't have put loneliness up there, something that is pertinent enough to cover in my teaching. But after having read the editorial, I'm now reconsidering that because... loneliness is uncommon in adolescence and Roz talks about that in the editorial and it's not surprising given that adolescence is a period of a social period of life where peers are important, friendships are important and so people, adolescents tend to be quite quite social during that time. Dr. Jane Gilmore: I think that developmental issue is so much at the heart of this issue, isn't it? Because following a variety of data sets, and the most recent one is the Office of National Statistics showing that young people are probably the most likely demographic to feel lonely. But if we think about the teenage brain, there are lots of good developmental reasons for that. So that pull towards peer integration. And this is a question I'm going to ask Roz in a moment. This idea about, because there's such a pull towards peer integration and some people have described loneliness as like thirst, which I think is brilliant because it really brings to life the idea that there's a fundamental brain drive. But maybe that means that when we feel socially disconnected as a teenager, does that mean the brain signals that as a social emergency more than you might in another age group. And I don't know if there's something in that and that it might be that the same sort of objective experience might be experienced as more aversive because of that, you know, requirement from the brain to get connected. I think the other thing that I again, talking about the developmental stage is that intensity of emotion. So any emotional experience is likely felt at its greatest intensity during this period. So if you're feeling socially isolated, you're certainly feeling that with great intent because of that sensitivity in the teen brain. So it's interesting. Prof. Umar Toseeb: We think of lots of these things in child and adolescent mental health and development as a negative and, you know, loneliness, we're going to discuss it in various different contexts, but you it can be considered an adaptive thing, so children and young people, might be the trigger for them to then seek out social relationships is I think what Roz is saying in the editorial, but we're going to, we're going to find out about that. And I think on its own, it doesn't seem to be problematic because you sometimes people feel lonely and we shouldn't necessarily pathologize that experience if it happens sometimes. But for about one in five children and young people, it can become chronic and therefore become problematic. And I that's a running theme in this podcast series where we've been talking about various experiences that children and young people go through that can be considered quite adaptive yet needed and necessary. But then they become problematic or abnormal or maladaptive when it reaches a certain threshold of severity, frequency. But the distinction between what is normal and what is abnormal and atypical is usually quite fuzzy and blurred. And it's not quite clear at what point one thing becomes problematic. And I imagine it's not that clear for loneliness either as in what point does adaptive levels of loneliness become maladaptive levels of loneliness that are problematic. Dr. Jane Gilmore: And I think that, you know, and again, that question, the reading of the literature and again, Roz will help us here as our expert. But the idea of loneliness as an acute experience is probably quite a positive thing. But if it becomes a chronic experience, that's when we would be concerned. And actually loneliness has the, you know, potential to perpetuate. So some of the behaviors like social withdrawal or cognitions like self blame could be consequences of loneliness, but they also might maintain it or exacerbate it too. So there is certainly an indication that we need to do some intervention, which is why we are very pleased to hear about Roz's work a little bit more in a little bit more detail in the moment. Prof. Umar Toseeb: Conceptualization that you've made that is interesting because I think one of the more recent ways of thinking about mental health conditions like depression or anxiety is rather than thinking of them as symptoms that are caused by depression or symptoms that are caused by anxiety is experiences that are interlinked to each other and they are mutually reinforcing and I suppose it'd be interesting to see where loneliness fits into that so where loneliness might then lead to withdrawal which then might lead to not finding pleasure in things that you usually find pleasure in, which then might lead to sleep problems, appetite problems, et cetera. So it'd be interesting to see where loneliness fits into that network of other characteristics that might indicate some sort of mental health difficulties. Dr. Jane Gilmore: And I think that's something that Roz has raised in her work as well about the idea that there is some positive evidence-based outcomes for loneliness as adjacent to mental health issues, but loneliness per se ⁓ as an opportunity to treat is that, know, there's less or there are, you know, that the evidence base there is not as well developed. So this is why this modular idea of looking at how to address loneliness as a concept in and of itself is really interesting. We need some expert ideas, don't we? I think we should bring Roz in and sort out this mess that we're in. Prof. Umar Toseeb: So today we're joined by Professor Roz Sharfan from the University College London. Roz is one of the authors of the editorial, How can we develop effective and timely interventions for young people with chronic loneliness, published in the JCPP. Welcome, Roz. Prof. Umar Toseeb: Jane and I have discussed some what we think loneliness is, but let's start with a definition. like, what is loneliness in the literature sense? And then what does loneliness look like in children and young people? Prof. Roz Shafran: Well, you're not far off in your conversations about expectations and discrepancies because the literature would say that loneliness is a subjective or unwelcome feeling or lack or loss of companionship. And it happens when there's a mismatch between the quantity or quality of relationships that we have and those that we want. And I think one of the questions is, you why is it something that psychologists might be interested in? And it's because it is that mismatch, that perception of a discrepancy between what you have and what you want that brings us into the psychological domain. Prof. Umar Toseeb: If we think about a child and a young person in primary school or secondary school, what might be some of the characteristic behaviors of loneliness? Is it like withdrawal? Is it a lack of friends? How might someone spot a lonely child or an adolescent?

Prof. Roz Shafran: Yeah, I mean, it that's not a straightforward question, as you might think. It's not social isolation. So there is a relationship between loneliness and social isolation. So the less social support you have, the more likely you are to be lonely. But it's not a 100 % correlation. It's about a 0.4 correlation. And it will look different for different people. So it might be that the child on the school bench is OK they don't have a mismatch between what they want and all the other kids are annoying them and that's fine they don't want to play with them and so on or, probably more likely, they're somebody that wants to make friends but doesn't know how to make friends so they might have a social skills deficit or they could be somebody that knows how to make friends but they're frightened of being rejected so they've got social anxiety disorder. It could be that they are significantly overweight and they've been bullied or teased about their weight and they feel like they wouldn't be welcome or they would be teased. it's hard to tell just from the behaviour but even beyond that, kind of understanding, it's very heterogeneous. That's the challenge and that's sort of the key with loneliness, that it's different for different people but certainly the of the heart of it in terms of kind of behaviours of avoidance, lack of opportunity, those sorts of things, anxiety, ⁓ the thoughts of the relationships, all of those can and will be part of some people's experiences, some children, young people's experiences of loneliness. Dr. Jane Gilmore: I guess that was why the idea of the modular treatment was so appealing because of that heterogeneous nature of the presentation. There's many, many roots to one presentation. Prof. Roz Shafran: Right, and sort of going across the age range. So you touched on the fact that it really is quite surprising. Many people think that loneliness is associated with the elderly. And it is true that it can peak in much older adults. And if they've experienced a bereavement and their social network's been dependent on that, then you can absolutely understand why they might experience loneliness. But you've also at the other end might have someone who wants a young person who just lacks those social skills and wants those relationships. So how do you develop an intervention for the older adults that's been bereaved or might be having difficulties with their physical health and can't get out and about versus the younger person who might lack social skills and might have an idea of how to form friendships but can't really implement that or maintain those friendships once they're formed. Dr. Jane Gilmore: And do think there's anything in that hypothesis that perhaps because of the, you know, the unique state of the teenage brain, that even though sort of in theory, they have good social connection, that because they are pulled towards really wanting to integrated so strongly that it might feel more pernicious to feel lonely as compared to, for example, younger kids. Prof. Roz Shafran: I think there is definitely something in that and there's something in it about what is what they're seeing all around them and the social opportunities that there are in teenage and sort of early adulthood that maybe there are fewer of those as you can go through life and have different sorts of responsibilities. So absolutely, I think if you think about in terms of that sort of discrepancy, the... the desire for relationships might be stronger because of the teenage brain, the kind of missed opportunities might be here and looking on social media at all other people having all of these fabulous anxiety free social experiences as far as you can see, widens that discrepancy. So I think it's all of those things make teenage hood a very vulnerable time. And the other thing that I think is really critical is it isn't the use of social media per se and just seeing all of those, but it's actually the digitalization of social connection. And that's a different concept and it's a very important one. So I think that sort of idea that, you know, how deep can you have those relationships? How meaningful can those relationships be if they're on snap as the majority are, and then it never gets to the face to face stage, then you might have a lot of social connections but they're not the ones that you want, they're not the meaningful ones, they're not the people that you can rely on in times of trouble. Dr. Jane Gilmore: So they lack the intimacy that might be required to feel connected. So they're thin, but not deep. Prof. Umar Toseeb: It's an interesting point you make there Roz, which is around the digitalization of social connection. So digitalization might, the intention might have been to facilitate social connection and you'd hypothesize that it might reduce loneliness. But then it seems counterintuitive. And Jane's just touched on that. Why might that be? Is it because it's not as good quality or what you'd expect or need from a social connection and you're not getting that on the digital spaces? Or is there something else? Prof. Roz Shafran: I mean, I think all of those are really reasonable hypotheses. And again, it comes back to that definition that you might have a huge quantity of social relationships. And if what you want is lots of people to go out with, then there's not going to be a problem with that, because you can do that and you can meet up and you can go to the parties and you know, that's fine. On the other hand, if what you're really looking for is someone to connect on a on a deeper level to understand you, understand the way that you think be there to support you and your support them. I think that is less facilitated. I think that is harder if you're not meeting up face to face and it's harder to sort of go from the quantity to the quality. So it's very dependent, I think, on the individual and that personal kind of discrepancy and it depends on what they want. A best friend or actually lots of friends, it's different for different people. Prof. Umar Toseeb: And I'm stuck on this idea of, I've asked you this already, I'm going to ask you in a different way, which is, because I said, what does loneliness look like? And I understand that it's very difficult to pin down and spot the signs of loneliness. But in other areas of child and adolescent mental health, we can think about... which groups are at most risk. So you might find that, for example, and if I was to guess with loneliness, I might think that neurodiverse kids might be at increased risk because their social connection looks different or sexual minority kids might also be at increased risk. Do we know what those risk demographic groups look like? Prof. Roz Shafran: Yeah, we know something about that. I think they're two different questions, aren't they? What does loneliness look like? What are the, I'm a CBT therapist, so what are the thoughts, the feelings, the behaviors that encapsulate loneliness? And then the second question is, what are the risk factors for loneliness? And there can be emotional loneliness and social loneliness, and those are different and those have different sort of thoughts, feelings and behaviors attached to those. So it isn't a straightforward, you know, it's not like you can say that these are the typical thoughts, feelings, behaviours that you would characterise depression and so on. But the sort of cognitions are about wanting more and better friendships. The emotion is one of feeling distress, anxiety, feelings of failure, lack of self-worth lack of self-efficacy if you can't form those sorts of relationships and the behaviour might be avoidance, withdrawal or trying too hard in the social domain. So all of those can be behaviours associated with loneliness alongside anxiety, depression and the emotional states we're familiar with. So that's the first question. Then the second question in terms of risk factors, age is a risk factor we've talked about in an associated new year shaped way. Female sex looks like that's a risk factor. Your mental health is a big risk factor. Jane, you touched on that at the beginning about perhaps the bidirectionality with mental health, but also physical health is a risk factor. Predictor of loneliness genetic, socio-environmental factors, workplace factors. there are lots of risk factors and we do know about them and they're in terms of your demography, in terms of your health, in terms of your brain biology, genetics and socio-environmental factors. So it is a multifaceted difficulty. And I think for us knowing that really quite strong evidence showing unsurprisingly that mental health problems can proceed loneliness. Dr. Jane Gilmore: And I think this is so interesting, Roz because the idea that, you know, as psychologists, we're sort of at the intersection, if we're looking at loneliness, we're at the intersection of so many influential factors, and you touched on those, those environmental factors, socioeconomic status, you know, and that we are addressing using psychological techniques, the internal factors, aren't we? But you... quite rightly are talking about those environmental issues that, know, talking about, for example, if you have a third space to go to, you're not at home, you're not at work or school, you're somewhere else, you might make a social connection. But that very much depends on the community you in and potentially your socioeconomic experience or your capacity to get there, you know, you have the bus fare to get there and all those things. So I think it's one of the the challenges of this because it's at the epicenter in some ways, but it's so much a systemic issue as well. Prof. Roz Shafran: Yeah, and when I first worked in this area, I was really quite shocked at how siloed it was because clearly if somebody is highly socially anxious, that is going to impede making of social relationships and impact loneliness. So you want to be pretty good at treating social anxiety now. We want to be able to help that person so they can form those relationships. On the other hand, if once they don't have the social anxiety, but they've got nowhere to go, to form those relationships and those social opportunities, then that isn't going to help either. So you absolutely need ⁓ the social mapping and the navigation aspect of the social world alongside the individual mental health interventions, I think. And it was really quite strange to me how that was even, that's even a question or why, why it's the way services are set up. It's an age old question, but in my mind you absolutely need the two to go hand in hand. Prof. Umar Toseeb: And in the editorial, you, I would, I think you would say that you advocate for the routine screening of loneliness. And I would say why, because if, for example, the risk that you have with screening is you then identify kids who are at risk or are experiencing loneliness. But then if we don't have the support in place and the resources to be able to support these kids then all you've really done is identified kids who are lonely, maybe told them that they're at risk of being lonely or they are lonely or you've validated or put a label on their experience but then no support has followed. Prof. Roz Shafran: So I think that again, so that's quite a difficult question. Just because you don't know about it doesn't mean it doesn't exist. So I think a more general question is because we don't have the resources, should we not even ask the question? I think that's the same principle applies to loneliness and applies to everything else. But I also think that until you know about it, you don't get the resources. So I think we have to identify what the need is. And I think you're right about your earlier point about not pathologizing normal experiences episodic loneliness can motivate you to do things can be adaptive in terms of social connections and so on. But chronic loneliness is different and much more associated with the kind of psychopathology. And I think if you're doing screening, and we know that this is a risk factor for the development of mental health problems, or we were interested in early intervention, we know that early intervention is cost effective. And the idea that we don't have anything that we can do. I would question that. I think there are things that we can do. There are different things. They're not always psychological. Social skills training for those that don't have it. Pretty effective, relatively short interventions that can truly make a difference. Online, digital, low cost, scalable, all of the things I'm sure that features of your other podcasts to enable it to be detected early, intervene early, let young people develop and their brains develop in the social way which they were designed to and really prevent some of the more significant mental health problems. And this sort of idea, loneliness is more deadly than smoking, which is kind of around from a study. Actually, people really minimise its impact. It has really significant health impacts, physical and mental health. And so, yeah, why shouldn't we try and catch it early, intervene early and make a difference to young people's lives? Dr. Jane Gilmore: I also think, you know, I wonder because we know that young people who are autistic are more likely to feel lonely. There may also be an importance in naming that sense of disquiet, if you like, and young people might need some support to describe what it is that's going on. And so, you know, wonder if it's a feeling of, you know, lonely or whatever. And then, you know, defining that problem, you know, talking about problem doesn't create a problem. And that then we could support young people to find ways around it. And as you say, some of these interventions are not about internal processes. Some of them are about connecting and finding a way to connect, sometimes using digital means, I imagine. mean, the world is a tiny place if we're thinking digitally, that's a start, at least finding a tribe, somebody who loves the same thing that you do and so on. I think identifying and I hear what you're saying, Umar, about, you know, what, so what we're going to do now, we see the size of the storm. Well, at least we know the size of the storm and we can put the, you know, our weather gear on. think that that's, but it's an interesting question. Getting the screening, I think is the challenge, you know, across trusts that, you know, the feasibility and, know, every time we do know these podcasts, there's a new issue that we must be exploring. And loneliness is definitely another one that we must be exploring, but how do we get that feasibility, you know, explore that feasibility and do systematic screening across different trusts that are very different countries. Each trust has their own ⁓ challenges and ways of doing things. So how do we get that across? I think that's one of our challenges. Prof. Roz Shafran: Yeah, I mean, one of the advantages I think in loneliness, maybe perhaps compared to other areas, maybe, maybe not, is that there's quite a lot of population based work, population based surveys in order to assess the scale of the problem. And it's interesting in my thought, well, you know, lonely, shall I cover it, but it's actually been the subject of a US Surgeon General's report about the epidemic of loneliness. And he's written and spoken very eloquently. And I think because he had experienced it personally, it resonated with him. So I think once you have that experience, it really can impact you in all kinds of ways. And he would be very clear about the impact that it has and the need for screening, not just in mental health trusts, it's not just a mental health problem, but in... trusts and on a population level. So we have pretty good screeners and they're not very long. And I think that's a bit different and makes it more feasible, at least in principle, than let's say where you have to have very long screening questions. we've screened for depression in primary care. Add a question on loneliness. I know everybody thinks their area is the most important, right? And that's what I do. Dr. Jane Gilmore: Yep, just one. So what screener would you recommend? Are you thinking UCLA loneliness or what would you? Prof. Roz Shafran: Yeah and there have been some national surveys, we've had a loneliness czar doing it on a population level so I think it would depend on how much you know are you going for the absolute one item are you lonely or are you going to go for a four item UCLA so it depends on on your purpose but and I know it is very difficult there's a PhD student at UCL who has managed to get loneliness measure in IAPT services at the beginning. And that's taken a very long time and longer than you would think. But I think the reason they will have done it, and the work led by Sonya Johnson, the reason that they've done it is the argument about how important it is to mental health and important to understanding the trajectory of mental health and the outcomes for mental health disorders more generally. Prof. Umar Toseeb: I think the reason I was asking or making the point was like you've picked up on a lot of, and we've had this on this podcast series, anyone who's come onto the podcast has advocated for their area of whatever it is that they're investigating and all of them are important. So like, you know, we've talked about friendships, we've talked about family environments, we've talked about social media, we've talked about digital spaces. We've talked about neurodiversity and I think social anxiety, paranoia. And I think that everyone maybe to greater or lesser extent would advocate for some sort of screening. And I was thinking that if I was a parent listening to this, I think rather than thinking of this as a formal screening process where a parent wouldn't think, I'll get a questionnaire out, but it's just, it's another thing that's on the parent's radar. And I think that's where my question was coming from, in like, and I can now, I think after doing like what we're on the eighth episode or something, I can understand to some extent the problem that policymakers face because every expert will advocate for their thing and that somebody then needs to make a judgment on which one are we going to go with. Prof. Roz Shafran: Right. And how, you know, maybe, maybe you're one of your guests should be a policymaker. So how do you make those those judgments? But loneliness is transdiagnostic and ⁓ loneliness is across the age range. Loneliness influences social development. The pros and cons to every field, as you said, Jane, the field isn't as well developed in terms of interventions, but we're also in a catch 22 that we don't know do our treatment if we have so few randomized controlled trials focusing directly on loneliness across the age range, across all different outcomes. It is really hard to tell. So I think we need all of that data to inform policymakers because otherwise they are flying blind. They're just flying by emotional arguments. Parents fly by emotional arguments, but we need clinical and cost-effectiveness data specifically designed for loneliness in order to answer those questions. Dr. Jane Gilmore: And I mean, one of the questions, well, I've got a question that's got three parts to it. The first is, could you give us a taster of some of the modules that you've developed as part of your paper and part of your team have rolled out? Are they adaptable for autism, which is another question, and how do we get hold of them? Prof. Roz Shafran: If people are interested, there's ⁓ Loneliness and Social Isolation in Mental Health Network at UCL run by Sonia Johnson and Alexandra Pittman. And if people want to access the manual, they can just email me. And my email is r.shafrann, S-H-A-F-R-A-N at UCL.AC.UK. And we'd be very happy to send it to people. We want it to be used. The second one is also relatively straightforward to answer because it was designed for children with autism in mind. So it doesn't need to be adapted. That brings us to the first one about the modularity. was based, the principles are based on modular interventions for anxiety, depression and conduct disorder in children, people and trauma from Bruce Chorpita and John Whites and his group. And the idea is you have some modules, but you have interference modules and you will do which modules you proceed down can be personalized. So for example, there's a social skills kind of training module. And if you are, a bereaved older adult, you're not going to be likely, let's say you've had lots of social relationships, you're missing your intimate partner, that's going to be a lot less relevant than if you are a child with autism. There's something about bullying. So if you've been bullied, again, that's going to be a relevant module for you, but not for others. There's going to, there's a module on hypervigilance to social rejection. And if you're socially anxious, that might be a module that you want to, to, to go down as well. So I think there are all these sort of different options. And again, there's something about making sure loneliness is the primary problem, seeing what else they've had. There might be some things about ⁓ problem solving, is in there, the challenging your negative cognitions and interpersonal appraisals, any unhelpful behavior, managing disagreements. All of those are sort of components, but it's very much personalized to the child and young person. Dr. Jane Gilmore: It's a superb framework. obviously for the loneliness issue because it has such a variety of roots to that experience. But the idea of a modular treatment package is such a great one anyway with young people because there is that variability. I really, mean, and that sounds superb. I'll be looking forward to exploring it a little bit more. Please do. I'll get on it. Prof. Roz Shafran: We'll send it over, Jane. Dr. Jane Gilmore: We've covered so much, Roz. I think it's been really helpful. ⁓ I don't know about you, Umar, but I'm definitely feeling more confident about the literature and what needs to be done next and also how to address it, whether this is in an academic or a clinical world. ⁓ There's a lot to be done, but this is a really encouraging start, I have to say. Prof. Umar Toseeb: Yeah, and I feel, Roz, that you've really advocated for loneliness as well. So I feel like ask me some challenging questions and you can... Dr. Jane Gilmore: Yeah, last one out the hot air balloon, I think. Prof. Roz Shafran: Well, thank you very much for taking an interest in it. Obviously, this is work that's been done with Tom Cawthorn, Sophie Bennett, Anton Carl, Gerhard Andersen and lots of others. there is a UCL have a loneliness and mental health social isolation kind of network that again, maybe is a link we could put on the website for people to join if they're interested, still very active and it goes across the age range and really involves people with lived experience in the development of interventions too, which is critical. And that network's run by Alexandra Pittman and Sonja Johnson. Prof. Umar Toseeb: So thank you so much, Ross. That was a fantastic discussion. Loneliness is higher up on my list of things to include on my child and adolescent mental health module. So I think we're up for a rewrite next year. So this will definitely be making the cut now. So thank you for participating. Prof. Roz Shafran Yes, well that's good news and I can send you some slides so you don't have to reinvent the wheel so definitely we'll make it in then. Prof. Umar Toseeb: Please do. I always feel cheeky asking for slides, but please do. send me slides, because then I'll be happy.

Prof. Roz Shafran: Just what's the point of doing them the same thing over and over. think much rather your time was spent disseminating like you are doing on the podcast so appreciate all that you're doing for that and I'll happily send you any slides. Prof. Umar Toseeb: Let's call it a day then. Thank you so much. Prof. Roz Shafran: Thank you both very much as well. Dr. Jane Gilmore: I'll tell you what, Umar, I thought that was such an interesting discussion. There is a lot to learn there, I think, and a lot to consider. It really made me think, I have to say, before I say what my sort of takeaways and my clinical thoughts are, I should say that I'm leaning very heavily on Roz's work and the loneliness and social isolation mental health network, you know, body of work because it really invited me into the loneliness literature. And I looked closer into the differentiation between social and emotional loneliness in a way hadn't before. So, Roz touched on that, didn't she? You know, that idea of emotional loneliness, implying a lack of intimacy, a lack of social loneliness is a lack of belonging into community. So it raises the idea of that internal and external processes which I think is something that I hadn't really considered in the depth that Ros brought to us. And the second clinical implication, I think from my point of view was talking about young people with autism who are like more likely to be lonely. That idea of the U-shaped curve where young and old people in the demographic are more likely to lonely does not apply in autism. There's more likely to be a steady increase in reported feelings of loneliness in autism. And that suggests to me that there's a very good case for offering intervention sooner rather than later. So in other words, the hope that learning some of those skills and behaviors in adolescence, if you can get those young people involved, will change their trajectory in adulthood. So I think there's a lot there for thinking about the transdiagnostic issues of loneliness, but also specific to particular conditions as well. It's adjacent to so much in mental and physical health as Roz told us. What was your impression? Prof. Umar Toseeb: I liked the way that Roz characterized loneliness as a trans diagnostic issue. So something that features and across a number of different diagnostic categories or labels or whatever you want to call it. And I think that is the way that this, this, might be the way for this to be put on people's radars. I've seen, you when we talk about depression or we talk about anxiety or we talk about whatever we want to talk about, it's the symptoms or characteristics of that condition or disorder, but actually loneliness seems to feature in lots of different things and therefore by addressing loneliness you might also be able to address other things too. And I think that the transdiagnostic framework is very in vogue at the moment and for good reason ⁓ and I'm part of promoting it. So I think that, yeah, I think thinking of loneliness as a trans diagnostic issue rather than an isolated thing. It makes it very useful framework to try and advocate for increased awareness and screening and then support. One of the things that I don't think that's social prescribing. I still don't know what is it, it when, so is it is social prescribing when a young person or anybody really has been identified as being at risk or has a need and then rather than that person being given medication or accessing talking therapy they are prescribed or recommended or referred to something that's happening in the community for example some sort of sports participation, museum participation, arts and those kinds of things is that what social prescribing is? Dr. Jane Gilmore: I mean, that's certainly my understanding. So Daisy Fancourt at UCL has a superb study and ongoing study. think it was I think it was following Covid, obviously, where there was a significant disconnect in social experiences. I mean, that's certainly true. think I think, you know, we're finding that, for example, GPs are being encouraged to get involved with social social prescribing. And that might be, you know, go for a walk. Now, that sounds that can be, you know, sounding very simplistic. But actually having somebody alongside you to help you to remind you to do something that will be good for you is very important. A lot of therapeutic experiences are actually about somebody saying, try this out and come back and tell me how it went. So there's a lot of non-specific things in there. And we've talked a bit about gardening off microphone and discovering gardening. know, it's an older person's game perhaps, but the point is it's got a lot of therapeutic benefits so there's lots of social experiences that have huge therapeutic effects, for example, you know, crafting is very mindful. There's a whole community of people that are knitting, you know, that there is there is something mindful in it in its activity. So, I mean, you know, the evidence base is growing. But I think a lot of people would have would say, you know, if I like doing if I'm doing something that I enjoy. I will feel the benefit. And I think that's that's a good starting point. But I think one of the interesting things here, Umar, is that sort of, know, there's there is a there is a difficulty in the language because we're talking about lonely as a, know, it's a normal experience to feel lonely sometimes. And also the potential pathologising of loneliness. And I think that's sort of what you were getting at, wasn't it? That the language isn't quite there about, you know, a lonely feeling. And there's also the loneliness that we need to treat and get at, probably because it's chronic. But the language doesn't really get at the subtlety of that. And I think that that's one of our challenges when we're talking to young people and indeed, you know, messaging to the general public. Umar One of the things that stuck with me about what Roz said was, you know, I think to have personally experienced loneliness might then demonstrate its importance to people. And I definitely feel that during COVID and the first lockdown. think for the first like six months or something, I was living on my own and that was awful. Honestly, I think that that was the point where I was going through that conversation with Roz. I was like, let me think if I can relate. And yeah, I can relate. Like during that period, I was like, my God, this is awful. So I can now, if I can frame it with that in mind, I can see how much of a public health issue this might be because for me, it was six months during COVID when actually lots of other people are probably in a similar situation but if that becomes someone's reality and it definitely feels like it's not everyone else's experience then I can see that being problematic for a number of reasons. Dr. Jane Gilmore: And that's interesting that your experience was during Covid where it was an extraordinary time and it wasn't, you know, and there was an expectation that that time would end and it was an enforced situation in some ways. that, you know, I had lots of students who were living in halls, who were by themselves in, you know, in individual rooms. Some of them could come to, you know, the city for the first time or the country for the first time. And, you know, I had a worry about those young people really is a very serious and negative experience to be having for that length of time. And I, you know, I'm sorry to hear you were by yourself for six months. Prof. Umar Toseeb: Yeah, but you know, it was nice to bump into colleagues in the supermarket and then socially distanced way about them. But, know, anyways, let's not get into that. Whatever. It's over. We're in a good place now. We're in ⁓ a... whatever. Let's go on. Dr. Jane Gilmore: I'll tell, let's end on an up because I'll tell you during COVID, one of the few demographics that had improved mental health as a group were parents of teenagers because parents of teenagers knew where their teens were all the time. Now that wasn't necessarily, of course, we know for many young people, there was a significant impact on their wellbeing and their mental health in some instances, but the parents of teenagers as a group had an uptake in their wellbeing. Anyway, let's go to takeaways, shall we? What was your takeaway? Prof. Umar Toseeb: I think it was the loneliness is a trans diagnostic thing that occurs across a number of different mental health conditions. So it's a useful indicator to be investigating. Dr. Jane Gilmore: Yeah. So I mean, I think my takeaway was certainly that, you know, that feeling of integrated is a core part of human experience. We know that, but of course, I think it's particularly true for teenagers. So we need to ask the question. And I think Roz said, just ask that one question. Are you lonely or better yet use a screener if we can, if we're in a, you know, in a system clinic, the UCLA loneliness questionnaire is very brief. And we know now that there is a modular evidence based package for young people. So let's use it. Prof. Umar Toseeb: And that brings us to the end of the series. I can't believe we've gone through a whole of eight episodes. Yeah, I mean, we are back for a new series in the autumn. I almost feel like we're like Netflix has renewed us for another season, but we will be back in the autumn. But, we've had a range of different guests and I think a whole... a whole range of different topics within this space of child and adolescent development. Dr. Jane Gilmore: Yeah, and I think one of the great things about this podcast, I think, is that we've had the opportunity to think quite broadly across different literatures. And many of them are not our areas of expertise, but they've certainly ⁓ illustrated with each of whether it be the gateway between social anxiety and paranoia or the Manosphere or the the experiences of infants and parenting. Every topic has really opened up some really important principles. think whatever our area and whatever our area of work we can take, can apply and we can explore. I think we've been really lucky that we've had some fantastic guests that have been really able to illustrate the importance of their topic without us needing too much convincing. Prof. Umar Toseeb: And this is the point at which we hand over the reins for the Mind the Kids podcast to Clara Faria to take over the series. And so first up, she'll be speaking to Dr. Nicholas Fabiano from Ottawa on mental health and exercise. ⁓ Jane and I will be back in the autumn for our next series. So hopefully we'll see you then.