The Development of LISTEN: A Novel Intervention for Loneliness


Purpose: The purpose of this paper is to present the development of LISTEN (Loneliness Intervention using Story Theory to Enhance Nursing-sensitive outcomes), a new intervention for loneliness. Methods: LISTEN was developed using the Medical Research Council (MRC) framework for intervention development. Extensive literature review revealed that belonging, relating, placing in community, challenges, and meanings of coping were concepts significant to loneliness. Past interventions were limited but it was determined from a recent meta-analysis that enhanced effectiveness might result from interventions that targeted the poorly adapted cognitive processes of loneliness. These processes include social undesirability, stigma, and negative thoughts about self in relation to others. LISTEN is designed to be delivered in a determined logical sequence of 5 sessions, each focusing on the concepts relevant to loneliness as derived from the literature. For each session, intervention delivery is guided by the concepts from story theory (including intentional dialogue, nurse as listener, examination of self in relation to others and community, synthesizing concerns and patterns, and identifying messages) and the principles of cognitive restructuring (self-assessment of maladaptive cognitions, emotions, and behaviors, identifying challenges of changing, reconceptualization of self, new skill acquisition through group interaction, and identifying patterns of meaning in loneliness). Results: LISTEN is developed and the first randomized trial is complete with a sample of 27 lonely, chronically ill, community dwelling, and older adults. LISTEN was evaluated as feasible to deliver by the study team and acceptable for significantly diminishing loneliness by participants of the LISTEN groups who were compared to attention control groups (p < 0.5). Conclusions: LISTEN has the potential to enhance health by diminishing loneliness which could result in improving the long-term negative known sequelae of loneliness. Future longitudinal randomized trials are needed in varied populations to assess long term health and healthcare system benefit of using LISTEN to treat loneliness.

Share and Cite:

Theeke, L. and Mallow, J. (2015) The Development of LISTEN: A Novel Intervention for Loneliness. Open Journal of Nursing, 5, 136-143. doi: 10.4236/ojn.2015.52016.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Theeke, L.A. (2010) Sociodemographic and Health-Related Risks for Loneliness and Outcome Differences by Loneliness Status in a Sample of U.S. Older Adults. Research in Gerontological Nursing, 3, 113-125.
[2] Hawkley, L.C., Masi, C.M., Berry, J.D. and Cacioppo, J.T. (2006) Loneliness Is a Unique Predictor of Age-Related Differences in Systolic Blood Pressure. Psychology and Aging, 21, 152-164.
[3] Theeke, L.A., Horstman, P., Mallow, B., Culp, A.M., Lucke-Wold, A., Domico, J. and Barr, T.L. (2014) Quality of Life and Loneliness in Stroke Survivors Living in Appalachia. Journal of Neuroscience Nursing, 46, E3-E15.
[4] Smith, M.J., Theeke, L., Culp, S., Clark, K. and Pinto, S. (2014) Psychosocial Variables and Self-Rated Health in Young Adult Obese Women. Applied Nursing Research, 27, 67-71.
[5] Whisman, M.A. (2010) Loneliness and the Metabolic Syndrome in a Population-Based Sample of Middle-Aged and Older Adults. Health Psychology, 29, 4.
[6] Amato, L., Paolisso, G., Cacciatore, F., Ferrara, N., Canonico, S., Rengo, F. and Varricchio, M. (1996) Non-Insulin-Dependent Diabetes Mellitus Is Associated with a Greater Prevalence of Depression in the Elderly. The Osservatorio Geriatrico of Campania Region Group. Diabetes & Metabolism, 22, 314-318.
[7] Theeke, L.A. and Mallow, J. (2013) Loneliness and Quality of Life in Chronically Ill Rural Older Adults. American Journal of Nursing, 113, 28-37.
[8] Seo, Y., Yates, B., Dizona, P., Laframboise, L. and Norman, J. (2014) Predictors of Cognitive/Affective and Somatic Depression in Heart Failure Patients. Clinical Nursing Research, 23, 259-280.
[9] Perissinotto, C.M., Stijacic Cenzer, I. and Covinsky, K.E. (2012) Loneliness in Older Persons: A Predictor of Functional Decline and Deathloneliness in Older Persons. Archives of Internal Medicine, 172, 1-7.
[10] Luo, Y., Hawkley, L.C., Waite, L.J. and Cacioppo, J.T. (2012) Loneliness, Health, and Mortality in Old Age: A National Longitudinal Study. Social Science Medicine, 74, 907-914.
[11] Cacioppo, J.T., Hawkley, L.C., Crawford, L.E., Ernst, J.M., Burleson, M.H., Kowalewski, R.B., Malarkey, W.B., Van Cauter, E. and Berntson, G.G. (2002) Loneliness and Health: Potential Mechanisms. Psychosomatic Medicine, 64, 407-417.
[12] Currie, C. (2012) Social Determinants of Health and Well-Being among Young People. World Health Organization, Regional Office for Europe, Copenhagen.
[13] Galanaki, E.P., Polychronopoulou, S.A. and Babalis, T.K. (2008) Loneliness and Social Dissatisfaction among Behaviourally At-Risk Children. School Psychology International, 29, 214-229.
[14] Linares, L.O., Li, M., Shrout, P.E., Brody, G.H. and Pettit, G.S. (2007) Placement Shift, Sibling Relationship Quality, and Child Outcomes in Foster Care: A Controlled Study. Journal of Family Psychology, 21, 736-743.
[15] Matthey, S., Morgan, M., Healey, L., Barnett, B., Kavanagh, D.J. and Howie, P. (2002) Postpartum Issues for Expectant Mothers and Fathers. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 31, 428-435.
[16] Bekhet, A.K. and Zauszniewski, J.A. (2012) Mental Health of Elders in Retirement Communities: Is Loneliness a Key Factor? Archives of Psychiatric Nursing, 26, 214-224.
[17] Ben-Zur, H. (2012) Loneliness, Optimism, and Well-Being among Married, Divorced, and Widowed Individuals. The Journal of Psychology: Interdisciplinary and Applied, 146, 23-36.
[18] Van den Elzen, A.J. and Fokkema, C.M. (2006) Home Visits to the Elderly in Leiden: An Investigation into the Effect on Loneliness. Tijdschrift Gerontologie en Geriatrie, 37, 142-146.
[19] Fokkema, C.M. and van Tilburg, T.G. (2007) Loneliness Interventions among Older Adults: Sense or Nonsense? Tijdschrift Gerontologie en Geriatrie, 38, 185-203.
[20] Hartke, R.J. and King, R.B. (2003) Telephone Group Intervention for Older Stroke Caregivers. Topics in Stroke Rehabilitation, 9, 65-81.
[21] Martina, C.M. and Stevens, N.L. (2006) Breaking the Cycle of Loneliness? Psychological Effects of a Friendship Enrichment Program for Older Women. Aging & Mental Health, 10, 467-475.
[22] Shapira, N., Barak, A. and Gal, I. (2007) Promoting Older Adults’ Well-Being through Internet Training and Use. Aging & Mental Health, 11, 477-484.
[23] Savikko, N., Routasalo, P., Tilvis, R. and Pitkala, K. (2010) Psychosocial Group Rehabilitation for Lonely Older People: Favourable Processes and Mediating Factors of the Intervention Leading to Alleviated Loneliness. International Journal of Older People Nursing, 5, 16-24.
[24] Pitkala, K.H., Routasalo, P., Kautiainen, H., Sintonen, H. and Tilvis, R.S. (2011) Effects of Socially Stimulating Group Intervention on Lonely, Older People’s Cognition: A Randomized, Controlled Trial. The American Journal of Geriatric Psychiatry, 19, 654-663.
[25] Rook, K.S. and Sorkin, D.H. (2003) Fostering Social Ties through a Volunteer Role: Implications for Older-Adults’ Psychological Health. The International Journal of Aging and Human Development, 57, 313-337.
[26] Masi, C.M., Chen, H.Y., Hawkley, L.C. and Cacioppo, J.T. (2011) A Meta-Analysis of Interventions to Reduce Loneliness. Personality and Social Psychology Review, 15, 219-266.
[27] Cheng, S.T. (1992) Loneliness-Distress and Physician Utilization in Well-Elderly Females. Journal of Community Psychology, 20, 43-56.<43::AID-JCOP2290200107>3.0.CO;2-3
[28] Grov, C., Golub, S.A., Parsons, J.T., Brennan, M. and Karpiak, S.E. (2010) Loneliness and HIV-Related Stigma Explain Depression among Older HIV-Positive Adults. AIDS Care: Psychological and Socio-Medical Aspects of AIDS/ HIV, 22, 630-639.
[29] Meltzer, H., Bebbington, P., Dennis, M.S., Jenkins, R., McManus, S. and Brugha, T.S. (2013) Feelings of Loneliness among Adults with Mental Disorder. Social Psychiatry and Psychiatric Epidemiology, 48, 5-13.
[30] Craig, P., Dieppe, P., Macintyre, S., Michie, S., Nazareth, I. and Petticrew, M. (2008) Developing and Evaluating Complex Interventions: The New Medical Research Council Guidance. British Medical Journal, 337, a1655.
[31] Campbell, M., Fitzpatrick, R., Haines, A., Kinmonth, A.L., Sandercock, P., Spiegelhalter, D. and Tyrer, P. (2000) Framework for Design and Evaluation of Complex Interventions to Improve Health. British Medical Journal, 321, 694.
[32] Craig, P., Dieppe, P., Macintyre, S., Michie, S., Nazareth, I. and Petticrew, M. (2013) Developing and Evaluating Complex Interventions: The New Medical Research Council Guidance. International Journal of Nursing Studies, 50, 587-592.
[33] Andersson, L. (1985) Intervention against Loneliness in a Group of Elderly Women: An Impact Evaluation. Social Science & Medicine, 20, 355-364.
[34] Casey, M.S. and Holmes, C.A. (1995) The Inner Ache: An Experiential Perspective on Loneliness. Nursing Inquiry, 2, 172-179.
[35] Theeke, L.A. (2009) Predictors of Loneliness in U.S. Adults over Age Sixty-Five. Archives of Psychiatric Nursing, 23, 387-396.
[36] Theeke, L.A., Goins, R., Moore, J. and Campbell, H. (2012) Loneliness, Depression, Social Support, and Quality of Life in Older Chronically Ill Appalachians. The Journal of Psychology: Interdisciplinary and Applied, 146, 155-171.
[37] Theeke, L.A. and Mallow, J.A. (2013) Loneliness and Quality of Life in Rural Chronically Ill Older Adults. American Journal of Nursing, 113, 28-38.
[38] Cohen-Mansfield, J. and Parpura-Gill, A. (2007) Loneliness in Older Persons: A Theoretical Model and Empirical Findings. International Psychogeriatrics, 19, 279-294.
[39] Hopps, S.L., Pepin, M. and Boisvert, J.M. (2003) The Effectiveness of Cognitive-Behavioral Group Therapy for Loneliness via Inter-Relay-Chat among People with Physical Disabilities. Psychotherapy, 40, 136-147.
[40] Liehr, P. and Smith, M. (2008) Story Theory. Middle Range Theory for Nursing, 2nd Edition, Springer Publishing Company, New York, 205-224.
[41] Wilson, K., Mottram, P.G. and Vassilas, C. (2008) Psychotherapeutic Treatments for Older Depressed People. Cochrane Database of Systematic Reviews, No. 1, Article ID: CD004853.
[42] Hawkley, L.C., Thisted, R.A., Masi, C.M. and Cacioppo, J.T. (2010) Loneliness Predicts Increased Blood Pressure: 5-Year Cross-Lagged Analyses in Middle-Aged and Older Adults. Psychology and Aging, 25, 132-141.
[43] Liehr, P., Meininger, J.C., Vogler, R., Chan, W., Frazier, L., Smalling, S. and Fuentes, F. (2006) Adding Story-Centered Care to Standard Lifestyle Intervention for People with Stage 1 Hypertension. Applied Nursing Research, 19, 16-21.
[44] Bell, A.C. and D’Zurilla, T.J. (2009) Problem-Solving Therapy for Depression: A Meta-Analysis. Clinical Psychology Review, 29, 348-353.
[45] Sharpe, L., Gittins, C.B., Correia, H.M., Meade, T.W., Nicholas, M.K., Raue, P.J., McDonald, S. and Arean, P.A. (2012) Problem-Solving versus Cognitive Restructuring of Medically Ill Seniors with Depression (PROMISE-D Trial): Study Protocol and Design. BMC Psychiatry, 12, 207.
[46] Maslow, A.H. (2013) Toward a Psychology of Being. Start Publishing LLC, New York.
[47] Mellor, D., Stokes, M., Firth, L., Hayashi, Y. and Cummins, R. (2008) Need for Belonging, Relationship Satisfaction, Loneliness, and Life Satisfaction. Personality and Individual Differences, 45, 213-218.
[48] Tomaka, J., Thompson, S. and Palacios, R. (2006) The Relation of Social Isolation, Loneliness, and Social Support to Disease Outcomes among the Elderly. Journal of Aging and Health, 18, 359-384.
[49] Stanley, M., Moyle, W., Ballantyne, A., Jaworski, K., Corlis, M., Oxlade, D., Stoll, A. and Young, B. (2010) Nowadays You Don’t Even See Your Neighbours: Loneliness in the Everyday Lives of Older Australians. Health & Social Care in the Community, 18, 407-414.
[50] Adam, E.K., Chyu, L., Hoyt, L.T., Doane, L.D., Boisjoly, J., Duncan, G.J., Chase-Lansdale, P.L. and McDade, T.W. (2011) Adverse Adolescent Relationship Histories and Young Adult Health: Cumulative Effects of Loneliness, Low Parental Support, Relationship Instability, Intimate Partner Violence, and Loss. Journal of Adolescent Health, 49, 278-286.
[51] Jones, A.C., Schinka, K.C., van Dulmen, M.H., Bossarte, R.M. and Swahn, M.H. (2011) Changes in Loneliness during Middle Childhood Predict Risk for Adolescent Suicidality Indirectly through Mental Health Problems. Journal of Clinical Child & Adolescent Psychology, 40, 818-824.
[52] Wei, M.F., Russell, D.W. and Zakalik, R.A. (2005) Adult Attachment, Social Self-Efficacy, Self-Disclosure, Loneliness, and Subsequent Depression for Freshman College Students: A Longitudinal Study. Journal of Counseling Psychology, 52, 602-614.
[53] Shankar, A., Hamer, M., McMunn, A. and Steptoe, A. (2013) Social Isolation and Loneliness: Relationships with Cognitive Function during 4 Years of Follow-Up in the English Longitudinal Study of Ageing. Psychosomatic Medicine, 75, 161-170.
[54] Hawkley, L.C. and Cacioppo, J.T. (2010) Loneliness Matters: A Theoretical and Empirical Review of Consequences and Mechanisms. Annals of Behavioral Medicine, 40, 218-227.
[55] Wilson, R.S., Krueger, K.R., Arnold, S.E., Schneider, J.A., Kelly, J.F., Barnes, L.L., Tang, Y. and Bennett, D.A. (2007) Loneliness and Risk of Alzheimer Disease. Archives of General Psychiatry, 64, 234-240.
[56] Buchman, A.S., Boyle, P.A., Wilson, R.S., James, B.D., Leurgans, S.E., Arnold, S.E. and Bennett, D.A. (2010) Loneliness and the Rate of Motor Decline in Old Age: The Rush Memory and Aging Project, a Community-Based Cohort Study. BMC Geriatrics, 10, 77.
[57] Holmen, K., Ericsson, K., Andersson, L. and Winblad, B. (1993) ADL Capacity and Loneliness among Elderly Persons with Cognitive Impairment. Scandinavian Journal of Primary Health Care, 11, 56-60.
[58] Bauminger, N. and Kasari, C. (2000) Loneliness and Friendship in High-Functioning Children with Autism. Child Development, 71, 447-456.
[59] Foxall, M.J. and Ekberg, J.Y. (1989) Loneliness of Chronically Ill Adults and Their Spouses. Issues in Mental Health Nursing, 10, 149-167.
[60] Theeke, L.A., Mallow, J.A., Barnes, E., Barr, T.L. and Theeke, E. (2014) The Results of the First Randomized Trial of Listen. State of the Science Congress on Nursing Research: Optimizing Health by Addressing Complexity, Washington DC.
[61] Theeke, L.A., Mallow, J.A., Barnes, E. and Barr, T.L. (2014) The Feasibility and Acceptability of the First Listen Trial: A Novel Cognitive Behavioral Therapy for Loneliness. State of the Science Congress on Nursing Research: Optimizing Health by Addressing Complexity, Washington DC.
[62] De Boer, A.G.E., van Lanschot, J.J.B., Stalmeier, P.F.M., van Sandick, J.W., Hulscher, B.F., de Haes, J.C.J. and Sprangers, M.A.G. (2004) Is a Single-Item Visual Analogue Scale as Valid, Reliable and Responsive as Multi-Item Scales in Measuring Quality of Life. Quality of Life Research, 13, 311-320.
[63] Theeke, L., Horstman, P., Mallow, J., Lucke-Wold, N., Culp, S., Domico, J. and Barr, T. (2014) Quality of Life and Loneliness in Stroke Survivors Living in Appalachia. Journal of Neuroscience Nursing, 46, 3-15.
[64] Theeke, L.A., Newsom, D., Mallow, J.A., Watson, J., Miner, A. and Legg, K. (2013) Loneliness in School Age Children: An Integrative Review of Quantitative Studies. Psychology and Education Journal, 50, 9.
[65] Mallow, J.A., Theeke, L.A., Barnes, E.R. and Mallow, B. (2014) Using mHealth Tools to Improve Rural Diabetes Care Guided by the Chronic Care Model. Online Journal of Rural Nursing and Health Care, 14, 43-65.
[66] Barnes, E., Theeke, L.A., Minchau, E., Mallow, J.A., Wampler, J. and Lucke-Wold, A. (2013) Relationships between Obesity and Depression Management in a University-Based Family Medicine Center. Journal of the American Association of Nurse Practitioners.

Copyright © 2023 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.