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Principal Investigator: LISHAM ASHRAFIOUN
Organization: VETERANS AFFAIRS, UNITED STATES DEPARTMENT OF
Fiscal Year: 2024
Funding agency: Veterans Affairs
Loneliness—a subjective emotional state characterized by the perception of social isolation—is a
psychosocial stressor that is associated with increased mortality and chronic pain. Individuals who have
chronic pain and report loneliness experience greater pain-related interference in activities, depression, and
suicidal ideation. Importantly, there are potentially effective interventions that can be used to decrease
loneliness; however, there are no studies that have directly intervened on loneness among Veterans with
chronic pain. Cognitive-Behavioral Therapy for Loneliness (CBT-L) intervenes on loneliness by addressing
negative beliefs that perpetuate loneliness, increase negative affect, and reduce one’s ability to engage in
social activities. For a Veteran with chronic pain, this is critical as addressing negative affect, and having a
sense that one has social support and engages social support are key aspects of increasing functioning. While
CBT for Chronic Pain (CBT-CP) comprises skills to promote social functioning, more robust efforts may be
needed to better address lonely while also addressing functional impairment.
The proposed two-year study uses a novel application of a brief, phone-delivered, evidence-based
intervention, CBT-L, to decrease loneliness by modifying socially-relevant maladaptive thinking patterns,
increasing engagement in enjoyable and social activities, and improving problem solving skills. Participants will
be recruited nationally using online advertising. The objectives of the current proposal are to adapt CBT-L to
optimize its impact on Veterans with chronic pain, examine if the recruitment, retention, and treatment delivery
is feasible and if CBT-L is acceptable to participants, and assess parameters of key outcomes among
participants randomized to receive CBT-L versus CBT-CP to inform a subsequent larger clinical trial.
To achieve these objectives, we will adapt a manual through an evidence-based, iterative process then
conduct one-arm trial of CBT-L (n=8) in Veterans with chronic pain reporting loneliness. After refining the
manual and procedures following the one-arm trial, we will randomize a total of 40 participants to receive either
CBT-L or CBT-CP. We will assess loneliness, the quality and quantity of social interactions, and pain outcomes
such as pain-related interference, and pain catastrophizing at baseline and after the treatment period. We will
also track participant flow, therapist adherence to the manual, participant homework completion and participant
satisfaction with the treatment.
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