Groups 4 Health reduces loneliness and social anxiety in adults with psychological distress: Findings from a randomized controlled trial
Open accessAbstract
OBJECTIVE: Loneliness is a key public health issue for which various interventions have been trialed. However, few directly target the core feature of loneliness-lack of belonging. This is the focus of Groups 4 Health (G4H), a recently developed intervention that targets the development and maintenance of social group memberships to support health. METHOD: To investigate the efficacy of this intervention, a randomized controlled trial was conducted with participants (N = 120) assigned to G4H or treatment-as-usual (TAU) by computer software. Assessment of primary (loneliness) and secondary (depression, social anxiety, general practitioner visits, multiple group membership) outcomes was conducted at baseline and 2-month follow-up using mixed-model repeated-measures analyses. RESULTS: G4H produced a greater reduction in loneliness (d = -1.04) and social anxiety (d = -0.46) than TAU (d = -0.33 and d = 0.03, respectively). G4H was also associated with fewer general practitioner visits at follow-up (d = -0.33) and a stronger sense of belonging to multiple groups (d = 0.52) relative to TAU (d = 0.30 and d = 0.33, respectively). Depression declined significantly in both G4H (d = -0.63) and TAU (d = -0.34), but follow-up analyses showed this was greater in G4H among those not receiving adjunct psychopharmacological treatment and whose symptoms were milder. CONCLUSIONS: Findings suggest that G4H can be a useful way to treat loneliness and highlight the importance of attending to group memberships when tackling this important social challenge. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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In the second trial, G4H led to significant improvements in loneliness (d = -1.04).
“Again, G4H led to significant improvements in loneliness (d = -1.04),multiple group memberships (d = 0.52), depression (d = -0.63),and social anxiety (d = -0.46),while also reducing primary care utilization relative to the control condition (d = -0.33).”
From Acceptability and Feasibility of an Intervention to Enhance Social Group Belonging: Evidence From Three Trials of Groups 4 Health (2022) · cites this paper as Haslam et al., 2019
The Primary analysis reports a significant reduction in loneliness for G4H and a significant time-by-condition interaction. However, it gives the G4H effect size as d = -1.16, not the claimed d = -1.04. (LLM, conf=0.90)
Experimental — accuracy not yet measuredIn the second trial, G4H reduced depression (d = -0.63).
“Again, G4H led to significant improvements in loneliness (d = -1.04),multiple group memberships (d = 0.52), depression (d = -0.63),and social anxiety (d = -0.46),while also reducing primary care utilization relative to the control condition (d = -0.33).”
From Acceptability and Feasibility of an Intervention to Enhance Social Group Belonging: Evidence From Three Trials of Groups 4 Health (2022) · cites this paper as Haslam et al., 2019
The Primary analysis reports that depression symptoms decreased significantly within the G4H group, but gives d = -0.67, not -0.63. Symptoms also decreased in the treatment-as-usual group, and the difference in change between groups was not significant (p = .108). (LLM, conf=0.90)
Experimental — accuracy not yet measuredIn the second trial, G4H led to significant improvements in multiple group memberships (d = 0.52).
“Again, G4H led to significant improvements in loneliness (d = -1.04),multiple group memberships (d = 0.52), depression (d = -0.63),and social anxiety (d = -0.46),while also reducing primary care utilization relative to the control condition (d = -0.33).”
From Acceptability and Feasibility of an Intervention to Enhance Social Group Belonging: Evidence From Three Trials of Groups 4 Health (2022) · cites this paper as Haslam et al., 2019
The ‘Multiple group memberships’ results (page unavailable) report a significant increase with G4H, but also a significant increase with treatment as usual. The paper gives d = 0.96 for G4H and d = 0.44 for treatment as usual; it reports 0.52 as the time-by-condition interaction coefficient (β), not as d. (LLM, conf=0.91)
Experimental — accuracy not yet measuredIn the second trial, G4H reduced primary care utilization relative to control (d = -0.33).
“Again, G4H led to significant improvements in loneliness (d = -1.04),multiple group memberships (d = 0.52), depression (d = -0.63),and social anxiety (d = -0.46),while also reducing primary care utilization relative to the control condition (d = -0.33).”
From Acceptability and Feasibility of an Intervention to Enhance Social Group Belonging: Evidence From Three Trials of Groups 4 Health (2022) · cites this paper as Haslam et al., 2019
The GP visits Results section reports a significant time-by-condition interaction: visits tended to decrease with G4H and increase with treatment as usual. But the decrease within G4H was not significant, and its reported effect size was d = -0.21, not d = -0.33. The Discussion describes the evidence on GP visits as mixed. (LLM, conf=0.88)
Experimental — accuracy not yet measuredIn the second trial, G4H reduced social anxiety (d = -0.46).
“Again, G4H led to significant improvements in loneliness (d = -1.04),multiple group memberships (d = 0.52), depression (d = -0.63),and social anxiety (d = -0.46),while also reducing primary care utilization relative to the control condition (d = -0.33).”
From Acceptability and Feasibility of an Intervention to Enhance Social Group Belonging: Evidence From Three Trials of Groups 4 Health (2022) · cites this paper as Haslam et al., 2019
The Social anxiety results report a significant reduction for G4H but not for treatment as usual. The reported G4H effect size is d = -0.53, not the claimed d = -0.46 (page unavailable in our copy). (LLM, conf=0.91)
Experimental — accuracy not yet measured
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“Given the clear role of identity and sharing experiences in reducing loneliness, interventions such as Groups4Health [73, 74], which aim to build stronger social identities, might be particularly promising.”
BackgroundHaslam, C., Lam, B. C. P., Yang, J., Steffens, N. K., Haslam, S. A., Cruwys, T., Boen, F., Mertens, N., Brandt, K. D., Wang, X., et al. (2021) · Psychology of sport and exercise · doi:10.1016/j.psychsport.2021.102049 · Cited by 52 · see citing works
Self-citationTackling loneliness together: A three-tier social identity framework for social prescribing
Haslam, S. A., Haslam, C., Cruwys, T., Sharman, L. S., Hayes, S., Walter, Z. C., Jetten, J., Steffens, N. K., Cardona, M., Rue, C. J. L., et al. (2024) · Group Processes & Intergroup Relations · doi:10.1177/13684302241242434 · Cited by 48 · see citing works
Self-citationBrown, A., & Leite, A. C. (2022) · Journal of Applied Social Psychology · doi:10.1111/jasp.12934 · Cited by 49 · see citing works
Bruner, M. W., McLaren, C. D., Mertens, N., Steffens, N. K., Boen, F., McKenzie, L., Haslam, S. A., & Fransen, K. (2021) · Psychology of sport and exercise · doi:10.1016/j.psychsport.2021.102106 · Cited by 44 · see citing works
Self-citationBarnett, P., Steare, T., Dedat, Z., Pilling, S., McCrone, P., Knapp, M. R. J., Cooke, E., Lamirel, D., Dawson, S., Goldblatt, P., et al. (2022) · BMC Psychiatry · doi:10.1186/s12888-022-03864-9 · Cited by 44 · see citing works
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Quinn, E. A., Millard, E., & Jones, J. M. (2025) · Nature Mental Health · doi:10.1038/s44220-024-00368-1 · Cited by 52 · see citing works
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Cruwys, T., Haslam, C., Rathbone, J. A., Williams, E., & Haslam, S. A. (2021) · Journal of Affective Disorders · doi:10.1016/j.jad.2021.08.029 · Cited by 37 · see citing works
Self-citationHaslam, S. A., Reutas, J. A., Bentley, S. V., McMillan, B., Lindfield, M., Luong, M., Peters, K., & Steffens, N. K. (2023) · PLoS ONE · doi:10.1371/journal.pone.0286263 · Cited by 43 · see citing works
Self-citationSocial group connections support mental health following wildfire
Cruwys, T., Macleod, E., Heffernan, T., Walker, I. A., Stanley, S. K., Kurz, T., Greenwood, L., Evans, O., & Calear, A. L. (2023) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-023-02519-8 · Cited by 37 · see citing works
Self-citationBehavioral and Neural Dissociation of Social Anxiety and Loneliness
Lieberz, J., Shamay‐Tsoory, S., Saporta, N., Kanterman, A., Gorni, J., Eßer, T., Kuskova, E., Schultz, J., Hurlemann, R., & Scheele, D. (2022) · Journal of Neuroscience · doi:10.1523/jneurosci.2029-21.2022 · Cited by 40 · see citing works
Haslam, S. A., Haslam, C., Jetten, J., Cruwys, T., & Bentley, S. V. (2020) · Social Science & Medicine · doi:10.1016/j.socscimed.2020.113566 · Cited by 36 · see citing works
Self-citationO’Day, E. B., Butler, R. M., Morrison, A. S., Goldin, P. R., Gross, J. J., & Heimberg, R. G. (2021) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2021.102362 · Cited by 36 · see citing works
Understanding and Improving Athlete Mental Health: A Social Identity Approach
Stevens, M. R., Cruwys, T., OLIVE, L. S., & Rice, S. (2024) · Sports Medicine · doi:10.1007/s40279-024-01996-4 · Cited by 40 · see citing works
Self-citationCruwys, T., Haslam, C., Steffens, N. K., Haslam, S. A., Fong, P., & Lam, B. C. P. (2019) · BMC Geriatrics · doi:10.1186/s12877-019-1281-1 · Cited by 31 · see citing works
Self-citationJensen, M. T., Nielsen, S. S., Jessen-Winge, C., Madsen, C. M. T., Thilsing, T., Sønderlund, A. L., & Christensen, J. R. (2024) · International Journal of Obesity · doi:10.1038/s41366-024-01468-9 · Cited by 31 · see citing works
Hayes, S., Carlyle, M., Haslam, S. A., Haslam, C., & Dingle, G. A. (2022) · British Journal of Clinical Psychology · doi:10.1111/bjc.12358 · Cited by 30 · see citing works
Self-citationReducing loneliness among people with substance use disorders: Feasibility of ‘Groups for Belonging’
Ingram, I., Kelly, P. J., Haslam, C., O'Neil, O. J., Deane, F. P., Baker, A., & Dingle, G. A. (2020) · Drug and Alcohol Review · doi:10.1111/dar.13121 · Cited by 28 · see citing works
Self-citationDingle, G. A., Sharman, L. S., Hayes, S., Haslam, C., Cruwys, T., Jetten, J., Haslam, S. A., McNamara, N., Chua, D., Baker, J. R., et al. (2024) · Frontiers in Psychology · doi:10.3389/fpsyg.2024.1359855 · Cited by 27 · see citing works
Self-citationSocial support facilitates physical activity by reducing pain
Stevens, M. R., Cruwys, T., & Murray, K. (2020) · British Journal of Health Psychology · doi:10.1111/bjhp.12424 · Cited by 27 · see citing works
Self-citationLamont, R. A., Calitri, R., Mounce, L. T. A., Hollands, L., Dean, S. G., Code, C., Sanders, A., & Tarrant, M. (2022) · Applied Psychology Health and Well-Being · doi:10.1111/aphw.12348 · Cited by 27 · see citing works
Misery loves company: Predictors of treatment response to a loneliness intervention
Cruwys, T., Haslam, C., Haslam, S. A., & Dingle, G. A. (2022) · Psychotherapy Research · doi:10.1080/10503307.2022.2143300 · Cited by 25 · see citing works
Self-citationCohen, E. E. A., Davis, A., & Taylor, J. (2022) · Applied Psychology Health and Well-Being · doi:10.1111/aphw.12351 · Cited by 25 · see citing works
Wolska, K., & Creaven, A. (2022) · British Journal of Clinical Psychology · doi:10.1111/bjc.12397 · Cited by 27 · see citing works
Cruwys, T., Haslam, C., Haslam, S. A., Rathbone, J. A., & Donaldson, J. L. (2022) · Behavior Therapy · doi:10.1016/j.beth.2022.06.011 · Cited by 23 · see citing works
Self-citationBoosting neighbourhood identification to benefit wellbeing: Evidence from diverse community samples
Cruwys, T., Fong, P., Evans, O., Batterham, P. J., & Calear, A. L. (2022) · Journal of Environmental Psychology · doi:10.1016/j.jenvp.2022.101816 · Cited by 24 · see citing works
Self-citationCruwys, T., Lee, G. C., Robertson, A. M., Haslam, C., Sterling, N., Platow, M. J., Williams, E., Haslam, S., & Walter, Z. C. (2023) · Comprehensive Psychiatry · doi:10.1016/j.comppsych.2023.152394 · Cited by 23 · see citing works
Self-citationMultiple group membership supports resilience and growth in response to violence and abuse
Haslam, C., Latilla, T., Muldoon, O. T., Cruwys, T., & Kearns, M. L. (2021) · Journal of Community & Applied Social Psychology · doi:10.1002/casp.2570 · Cited by 23 · see citing works
Self-citationSocial Prescribing: A Review of the Literature
Dingle, G. A., & Sharman, L. S. (2022) · Springer eBooks · doi:10.1007/978-3-031-06932-1_8 · Cited by 21 · see citing works
Self-citationSocial identity processes as a vehicle for therapeutic success in psychedelic treatment
Newson, M., Haslam, S. A., Haslam, C., Cruwys, T., & Roseman, L. (2024) · Nature Mental Health · doi:10.1038/s44220-024-00302-5 · Cited by 21 · see citing works
Self-citationStefanidou, T., Wang, J., Morant, N. J., Lloyd‐Evans, B., & Johnson, S. (2021) · BMC Psychiatry · doi:10.1186/s12888-021-03138-w · Cited by 19 · see citing works
Hikikomori in the Middle East: The role of problematic gaming, social media use, and loneliness
Shah, H., Helmy, M. S., & Vally, Z. (2024) · PLoS ONE · doi:10.1371/journal.pone.0312818 · Cited by 18 · see citing works
Rue, C. J. L., Haslam, C., Bentley, S. V., Lam, B. C. P., Steffens, N. K., Branscombe, N. R., Haslam, S. A., & Cruwys, T. (2023) · Journal of Occupational and Organizational Psychology · doi:10.1111/joop.12458 · Cited by 19 · see citing works
Self-citationGriffin, S. M., Lebedová, A., Cruwys, T., McMahon, G., Foran, A., Skrodzka, M., Gallagher, S. M., Ginty, A. T., & Muldoon, O. T. (2024) · Applied Psychology Health and Well-Being · doi:10.1111/aphw.12608 · Cited by 18 · see citing works
Self-citationMcNamara, N., Wakefield, J. R. H., Cruwys, T., Potter, A., Jones, B. A., & McDevitt, S. (2022) · Journal of Community & Applied Social Psychology · doi:10.1002/casp.2606 · Cited by 24 · see citing works
Self-citationA Group-Mediated Approach to Precision Medicine—Social Identification, Prevention, and Treatment
Beauchamp, M. R., & Rhodes, R. E. (2020) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2020.0024 · Cited by 18 · see citing works
Frerichs, J., Billings, J., Barber, N., Chhapia, A., Chipp, B., Shah, P., Shorten, A., Stefanidou, T., Johnson, S., Lloyd‐Evans, B., et al. (2020) · BMC Psychiatry · doi:10.1186/s12888-020-02961-x · Cited by 16 · see citing works
GROUPS 2 CONNECT: An online activity to maintain social connection and well‐being during COVID‐19
Bentley, S. V., Haslam, C., Haslam, S. A., Jetten, J., Larwood, J. L., & Rue, C. J. L. (2021) · Applied Psychology Health and Well-Being · doi:10.1111/aphw.12330 · Cited by 17 · see citing works
Self-citationStevens, M. R., Cruwys, T., Haslam, C., & Wang, V. (2021) · British Journal of Health Psychology · doi:10.1111/bjhp.12506 · Cited by 17 · see citing works
Self-citationÇelebi, E. Y., Adam‐Troian, J., & Mahfud, Y. (2020) · Journal of Interpersonal Violence · doi:10.1177/0886260520935863 · Cited by 16 · see citing works
What works to reduce loneliness: a rapid systematic review of 101 interventions
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Reduced loneliness mediates the effects of multiple group identifications on well‐being
van Dick, R., Frenzel, S. B., Erkens, V. A., Häusser, J. A., Haslam, S. A., Mojzisch, A., Steffens, N. K., & Junker, N. M. (2023) · British Journal of Social Psychology · doi:10.1111/bjso.12651 · Cited by 15 · see citing works
Self-citationOe, N., & Tadaka, E. (2023) · Healthcare · doi:10.3390/healthcare11111647 · Cited by 15 · see citing works
Rowlands, K., Willmott, D., Cardi, V., Bryan, D. C., Cruwys, T., & Treasure, J. (2021) · European eating disorders review · doi:10.1002/erv.2840 · Cited by 6 · see citing works
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Meta‐identification: Perceptions of others’ group identification shape group life
Steffens, N., Greenaway, K., Moore, S., Munt, K., Grundmann, F., Haslam, S., Jetten, J., Postmes, T., Skorich, D., & Tatachari, S. (2023) · European Journal of Social Psychology · doi:10.1002/ejsp.3014 · Cited by 11 · see citing works
Self-citationConnecting groups and behaviours: A network analysis of identity‐infused behaviours
Hughes, E. A., Ellis, S., & Smith, J. R. (2023) · British Journal of Social Psychology · doi:10.1111/bjso.12674 · Cited by 11 · see citing works
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A Social Identity Theory of Digital Identity
Bingley, W., Worthy, P., Wiles, J., & Haslam, S. A. (2026) · Perspectives on Psychological Science · doi:10.1177/17456916261419813 · Cited by 15 · see citing works
Self-citationMeasurement of Shared Social Identity in Singing Groups for People With Aphasia
Tarrant, M., Lamont, R. A., Carter, M., Dean, S. G., Spicer, S., Sanders, A., & Calitri, R. (2021) · Frontiers in Psychology · doi:10.3389/fpsyg.2021.669899 · Cited by 10 · see citing works
Schilling, S., Armaou, M., Morrison, Z., Carding, P. N., Bricknell, M. C. M., & Connelly, V. J. (2024) · Frontiers in Psychology · doi:10.3389/fpsyg.2024.1293171 · Cited by 11 · see citing works
Effective interventions to reduce loneliness in big cities
Fischer, R. D., & Hartle, L. (2022) · Current Opinion in Psychiatry · doi:10.1097/yco.0000000000000844 · Cited by 10 · see citing works
Group-led creative writing and behavioural health in cancer: a randomised clinical trial
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Intergroup Contact Alleviates Loneliness: The Extensive Effect of Common Ingroup Identity
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Why Loneliness Matters in Clinical Practice: A Primer for Clinical- and Neuro-Psychologists.
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Social identification, identity integration and wellbeing in people who hear voices
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Reminders of an agentic ingroup buffer disease uncontrollability
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Self-citationDingle, G. A., Han, R., Huang, K., Alhadad, S. S. J., Beckman, E. M., Bentley, S. V., Edmed, S. L., Gomersall, S. R., Hides, L. M., Lorimer, N., et al. (2025) · Journal of Affective Disorders · doi:10.1016/j.jad.2025.03.011 · Cited by 5 · see citing works
Self-citation
- Authors
- Haslam, C., Cruwys, T., Chang, M. X. L., Bentley, S. V., Haslam, S. A., Dingle, G. A., & Jetten, J.
- Affiliations
- The University of Queensland (AU)
- Australian National University (AU)
- Corresponding author
- Haslam, Catherine
- ORCID
- Venue
- Journal of Consulting and Clinical Psychology
- Published
- 2019-09
- Volume
- 87
- Issue
- 9
- Pages
- 787-801
- ISSN
- 0022-006X (ISSN-L)
- 1939-2117
- OpenAlex
- W2967246001
- Cited by
- 207
- References
- 58
- Citations by year
- 2026: 19 · 2025: 26 · 2024: 39 · 2023: 36 · 2022: 30 · 2021: 35 · 2020: 16 · 2019: 5 · 2018: 1
- FWCI
- 20.88
- Type
- journal article
- Language
- en
- Open access
- green
- hdl.handle.net
- Locations
- Journal of Consulting and Clinical Psychology (publishedVersion)
- PubMed (publishedVersion)
- Open Research Exeter (University of Exeter) (acceptedVersion)
- ANU Open Research (Australian National University) (submittedVersion)
- Figshare (submittedVersion)
- Topics
- Social Sciences › Health › Health disparities and outcomes
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Clinical Psychology › COVID-19 and Mental Health
- Keywords
- loneliness, social anxiety, social group membership, sense of belonging, psychological distress, depression, general practitioner visits, computer-based intervention
- MeSH terms
- Phobia, Social, Adolescent, Adult, Aged, Anxiety Disorders, Major Depressive Disorder, Female, Follow-Up Studies, Group Processes, Humans, Loneliness, Male, Middle Aged, Psychotherapy, Social Identification, Stress, Psychological, Treatment Outcome, Young Adult
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