Power of Social Interactions and the Desire for Connectedness to Empower Health and Wellness

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Social connection is a pillar of lifestyle medicine. Humans are wired to connect, and this connection affects our health. From psychological theories to recent research, there is significant evidence that social support and feeling connected can help people maintain a healthy body mass index, control blood sugars, improve cancer survival, decrease cardiovascular mortality, decrease depressive symptoms, mitigate posttraumatic stress disorder symptoms, and improve overall mental health. The opposite of connection, social isolation, has a negative effect on health and can increase depressive symptoms as well as mortality. Counseling patients on increasing social connections, prescribing connection, and inquiring about quantity and quality of social interactions at routine visits are ways that lifestyle medicine specialists can use connection to help patients to add not only years to their life but also health and well-being to those years.

It is time to appreciate and utilize connection and social bonds as part of lifestyle counseling. Individuals need connections in their lives in the workplace and at home. Fostering these connections is critical to health and wellness. Lifestyle medicine is the growing specialty that works to formalize the counseling and prescriptions for healthy habits, including regular exercise, nutritious foods, stress management, smoking cessation, and moderate alcohol use. Incorporating social support and connections is critical for overall health and for healthy habits to be sustainable. The social ecological model of change stresses that we exist in communities and these groups have an important impact on individuals and their behaviors. There are decades of research that support the importance of social connection. Moreover, humans have lived in groups for thousands of years. In a meta-analysis by Holt-Lunstad and colleagues at Brigham Young University, they examined 148 articles published on the effects of human interactions on health outcomes, and they reported that social connections with friends, family, neighbors, or colleagues improves the odds of survival by 50%. High social support and social integration are associated with the lowest relative odds of mortality compared to many other well accepted risk factors for cardiovascular disease. The review article by Holt-Lunstad and colleagues is a powerful demonstration of the evidence base behind social connection and health. Low social interaction was reported to be similar to smoking 15 cigarettes a day and to being an alcoholic, to be more harmful than not exercising, and to be twice as harmful as obesity. In addition, the devastating effects of loneliness and social isolation have been well researched.

Prescribing social interactions and encouraging friendships has the potential to have a healing effect on patients. Social connection should be viewed and treated as a vital sign much like physical activity. The “Exercise Is Medicine” campaign helped bolster support for the exercise prescription. The time is right for a “Connection Is Medicine” campaign. Asking patients how many close friends they have, if they belong to any organizations or groups that meet regularly, and how often they spend time socializing with others is one way to ensure that social connection receives the attention it deserves. Answers to these questions can be used to improve a patient’s weight management, diabetes control, hypertension, mood, and even immune function. By exploring the research from 50 years ago as well as the most recent data, this article strives to highlight the power of social interactions and to introduce the concept of the connection prescription as an integral part of the health care equation.

Connection as a Basic Human Need

Seminal psychological theories, such as Maslow’s “Hierarchy of Needs,” included the concept of social connection. Abraham Maslow documented and explained the importance of connection, which he called “love and belongingness,” in his book Motivation and Personality, published in 1954. In his hierarchy, there are 5 important needs for psychological growth and development: (a) physiological, (b) shelter, (c) love and belongingness, (d) esteem, and (e) self-actualization. As Maslow describes it, feeling part of a group larger than oneself such as a work community, religious affiliation, community center, volunteer organization, team, interest group, or club is an essential component in the self-actualization process. Close associations with other, smaller groups or even dyads, such as immediate family, close friend, or a life partner, and specifically feeling close to someone, not lonely, are also important for human health and happiness. The self-determination theory developed by psychologists, Edward Deci and Richard Ryan, focuses on 3 basic human needs for sustained, volitional motivation: (a) autonomy, (b) competence, and (c) relatedness. Relatedness is referred to as feeling socially connected to others. This is similar to the love and belongingness in Maslow’s “Hierarchy of Needs.” According to Ryan and Deci, when 1 of these 3 basic needs is obstructed, then a person suffers. It is only when all 3 needs are met that a person feels motivated to tenaciously pursue goals and can thus achieve optimal performance, creativity, and well-being.

Many prominent psychologists and psychiatrists have written extensively about social interactions and their importance in human development. For example, Dr Robert Brooks, a Harvard psychologist, clearly demonstrates the profound effect of just one charismatic adult in a person’s life in his books, Raising Resilient Children, The Charismatic Advisor, and the Power of Resilience. Dr Brooks defines a charismatic adult as a person who a child feels connected to and from whom the child gathers strength. This strength helps children manage through adversity and to persevere despite setbacks. Children are not the only ones who need charismatic adults in their lives. Adults need these people too. The term charismatic adult was originally coined by the late Dr Julius Segal, a psychologist and trauma expert who wrote Winning Life’s Toughest Battles: Roots of Human Resilience,” published in 1986. Dr Brooks carries forward the importance of the charismatic adult and the value of this influential connection in his works and writings today. Connections to others have the potential to propel us forward in our goals and encourage us to persevere when times are difficult.

Physiological Basis of Connection

From the beginning of our lives, we are wired to connect. First, as a newborn, the sound of her baby’s cry, prompts the production of oxytocin in the mother. Oxytocin is the hormone produced in nerve cell bodies in the hypothalamus and then released into the bloodstream from the posterior pituitary. This hormone serves as a signal for the mother to bond with her child, as it causes milk let down for breastfeeding. Oxytocin is not just released in a mother when she hears her baby crying, but it also has other functions in addition to milk let down. There is evidence that oxytocin is released with holding hands, hugging, massaging, and sexual intimacy, Researchers have discovered that petting an animal can cause the release of oxytocin and a pleasant feeling results. There is evidence that oxytocin works in concert with other neurotransmitters such as γ-aminobutyric acid (GABA)–inhibitory neurons for anti-anxiety, through serotonin, a neurotransmitter involved in mood regulation, and through dopamine, a neurotransmitter involved with the nucleus accumbens and the reward system creating feelings of pleasure. Oxytocin seems to facilitate a social attunement, activating more for social stimuli (faces) and activating less for nonsocial stimuli (cars). For these reasons, oxytocin is often called the “bonding hormone.”

References:

Holt-Lunstad J, Smith TB, Layton JB. Social relationships and mortality risk: a meta-analytic review. PLoS Med. 2010;7(7):e1000316. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2910600/)

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Critchley JA, Capewell S. Mortality risk reduction associated with smoking cessation in patients with coronary heart disease: a systematic review. JAMA. 2003;290:86-97. (https://pubmed.ncbi.nlm.nih.gov/12837716)

Holman CD, English DR, Milne E, Winter MG. Meta-analysis of alcohol and all-cause mortality: a validation of NHMRC recommendations. Med J Aust. 1996;164:141-145. (https://pubmed.ncbi.nlm.nih.gov/8628131)

Fine MJ, Smith MA, Carson CA, et al. Efficacy of pneumococcal vaccination in adults. A meta-analysis of randomized controlled trials. Arch Intern Med. 1994;154:2666-2677. (https://pubmed.ncbi.nlm.nih.gov/7993150)

Taylor RS, Brown A, Ebrahim S, et al. Exercise-based rehabilitation for patients with coronary heart disease: systematic review and meta-analysis of randomized controlled trials. Am J Med. 2004;116:682-692.

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