12. Lexicon of Loneliness

Authors: Hope Linge, Elise Tarbi and Maija Reblin

Project: The StoryListening Study

August 2022

Context/ Purpose     

In a society suffering from a loneliness epidemic, human connections can be rare and special things (Murthy, 2020). Loneliness, though an emotional feeling, can have detrimental impacts on mental and physical health (Badal, 2021). Among older and seriously ill individuals, these effects are magnified, and loneliness has been identified as a significant risk factor for serious illnesses such as heart disease, lung disease, obesity, depression, and anxiety, as well as increased mortality rates (Ong, 2016; Yangus, 2018). Being able to identify expressions of loneliness in serious illness conversations could allow clinicians to better recognize loneliness in patients and intervene to prevent its harmful effects. We sought to create a corpus of loneliness and connection words that can provide a way of identifying and quantifying loneliness using natural language processing (NLP), allowing us to calculate the frequency and proportion of loneliness in conversation.

Methods

We started by reading pertinent literature on loneliness in health care settings (meta-analyses and qualitative meta-syntheses on loneliness, as well as existing measurement tools), and by pulling keywords from these articles, we created a preliminary list of 329 words and phrases relevant to loneliness and human connection (Bolmsjö, 2019; Donovan, 2020; Edberg, 2019; Ettema, 2019; Guntuku, 2019; Halam, 2022; Hipson, 2021; Holt-Lunstad, 2015; Holt-Lunstad, 2021; Karhe, 2015; Kitzmüller, 2018; Kotwal, 2021; Mansfield, 2021; Ong, 2016; Reinhardt, 2021; Rokach, 1988; Sjöberg, 2018; Vedder, 2022; Yanguas, 2018). We included a list of relationship terms from Badal and colleagues (2021). All of these words were focused around our central definition of loneliness, that it “is a subjective, unwelcome feeling of lack or loss of companionship that occurs when there is a mismatch between the quantity and quality of social relationships that a person has, and those that person wants” (Reinhardt, 2021). Then, using Word Net, a lexical dictionary of the English language, and thesaurus.com, an online reference work for finding synonyms, we generated the synonyms and antonyms of each word. After adding these related words, our list consisted of 1,055 words and phrases. We then organized this list by grouping words and phrases with the same stem if the stem had an important and relevant meaning (e.g., “connected,” “disconnected,” and “unconnected” were all grouped under the stem “connect”), leaving us with a list of 882 unique stems.

After refining the dictionary, three of the lab members most involved in generating the word list voted on whether each of the 882 words and phrases could be indicative of loneliness or human connection in a clinical conversation using a scale of 0 to 2 (zero being a word or phrase not used to express loneliness or connection, two being a word or phrase that would be used to express loneliness or connection, and one indicating uncertainty). This selection measure was modeled after the rating scale used by Gramling and colleagues in their 2021 uncertainty study. We kept 289 words and phrases whose mode was 2; we excluded 360 words and phrases whose mode was 0. Through small group discussion of the remaining terms, lab members excluded an additional 43 words. The remaining 188 words were brought to a larger group of lab members who voted either yes (this word is an expression of loneliness and/or connection) or no (this word is not an expression of loneliness and/or connection). After this second round of voting, we kept 53 words and phrases that had a majority of yes and excluded 81 words and phrases that had a majority of no. The remaining 49 words that did not reach a majority were brought to a lab meeting where a large group met to adjudicate their relevance. Throughout this meeting, 21 words and phrases were kept and 32 were excluded (4 words had different variations voted on separately due to group disagreement, causing the number of total words to increase from 49 to 53). In summary, out of the preliminary list of 882 words and phrases, 373 were kept in the final lexicon.

Further Considerations

            While the words and phrases in this lexicon are important indicators as to how loneliness and human connection manifest in clinical conversation, there are other conversational patterns indicative of loneliness that may be worth considering. For instance, how frequently people use plural versus singular pronouns (e.g., “we” versus “I”) (Badal, 2021), if they predominantly talk in the past, present, or future tense, and the tone and proportion of negativity present (Hipson, 2021) (e.g., using phrases like “cannot,” “do not,” “am not,” or “will not”). Additionally, who the speaker is (patient, clinician, or family member), how the transitions between speakers are handled, and the patient’s sentence syntax (complexity, mirroring patterns, and response length) (Badal, 2021) are other potential speech patterns warranting study.

            In the future, this dictionary could be combined with gold standard human-annotated loneliness conversations to compare performance. Furthermore, it could be used to compare the frequency of the words in the loneliness lexicon and the trajectory of loneliness within the conversations with other conversational features or self-report loneliness measures. This would allow us to test and improve the library, on the path to building interventions to mitigate the impact of loneliness in the seriously ill population. 

Word List

Strong subgroup: The strong subgroup consists of the unanimously selected words indicative of loneliness and/or connection in the first round of voting. These words are strong indicators of loneliness and/or connection in conversational settings:

Abandoned

Affection

Alienated

Assistant

Associate (associated,

   disassociated)

Aunt

Belong (belonging)

Betrayed

Bleak

Brother (stepbrother,

   brother-in-law)

Brushed aside

Brushed off

Buddy

By my side

By myself

Care (careful, careless,

   uncared for)

Cast away

Cat

Cherished

Child (stepchild,

   grandchild)

Chum

Church

Church-community

Club

Cohort

Cold-shoulder

Collaborate (collaborator)

Colleague

Community

Companion

    (companionship)

Company

Compassionate

Comrade

Confidante

Confide in

Correspondence

Count on

Cousin

Crying out

Cuddling

Dad

Daughter (granddaughter,

   stepdaughter,

   goddaughter,

   daughter-in-law)

Dejected

Demoralized

Desolate (desolation)

Disowned

Disrespected

Dog

Don’t have someone

Drifted apart

Embrace (embraced)

Estrange (estranged)

Family

Father (father-in-law)

Foe

Folk

Friend (girlfriend,

   boyfriend, friendly,

   unfriendly, friends,

   friendship)

Get together

Get with

God

Has my back

Heard from

Hug

Husband

Ignored

In the know

In touch

Inseparable

Intimacy

Invited

Jesus

Kept apart

Kept in the dark

Kid (stepkid, grandkid)

Kiss

Lean on

Left behind

Left high and dry

Left out

Listened to

Lone (lonely, alone,

   lonesome)

Lost

Love (loved, truelove,

   unloved)

MA

Married

Mate

Mentor

Misfit

Missing out

Mom

Mother (mother-in-law)

Neglect (neglected)

Neighbor

Nephew

Niece

No one

Nobody

Nobody to keep me

   company

Not a part of something

Not included

Not listened to

On my own

Ostracized

OT

Out of place

Pal

Parent

Participation

Partner

Relative

Rely on

Respected

Ridiculed

Roommate

Scorned

Share (shared, unshared)

Shun (shunned)

Shut out

Sibling (stepsibling)

Sidekick

Sister (stepsister,

   sister-in-law)

Solitary

Solitude

Son (stepson, godson,

   grandson, son-in-law)

Spouse

Support (supporter,

   unsupported)

Teacher

Team (teammate)

There for me

Together (togetherness)

Touch base with

Unaccompanied

Uncaring

Uncle

Understood

   (misunderstood)

Unite (united, reunite,

   disunite, disunited)

Unaccompanied

Visit

We

Wife

With me

With others

Withdrawn

All other terms: These terms did not meet criteria for being strong indicators of loneliness or connection:

Absence

Adrift

Affiliated

At home

Come over

Complemented

Degrading

DM

Email

Mail

Meet (meeting, meetup)

Powerless

Sympathetic

Acquaintance

Admirer

Astray

Brought together

Come together

Communal

Cooperation (cooperative)

Distrust

Divorced

Enemy

Ex

Faithful

Go away

Heartache

Hold hands

Household

Identify with

In sync

Just want someone

Lost identity

Loyalty

Mourning

Mutual

Negligent

Not allowed

Nurse

Person

Pet

Professor

PT

Reach out

Reclusive

Slighted

Society

Solo

Soul (soulmate)

Split up

Trust

Unapproachable

Union (reunion)

Unity

Unsociable

Wedding

Agony

Apart

Connect (disconnected,

   unconnected, connected)

Contact (contacts)

Couple

Defenseless

Disgraced

Engaged (engagement,

   disengage, disengaged)

Fit in

Going away

Going to leave

Invisible

Involve (involved,

   uninvolved)

Isolated

Just me

Recognized

Rejected

Singled out

Thoughtful (unthoughtful,

   thoughtless)

Turn to

Barren (barrenness)

Chasm

Chosen

Denied

Depend (dependable,

   dependent)

Deserted

Despised

Discouraged

Disenfranchised

Disintegrated

Disjointed

Disregarded

Ditched

Division

Empty

Exclude (excluded)

Exposed

Fall apart

Familiar (unfamiliar)

Forget (forgotten)

Forsake

Forsaken

Fullness

Gather (gathering)

Give up

Guarded (unguarded)

Hidden

Hopelessness

Known (not known,

   unknown)

Marooned

Not good enough

Not moving

Overlook (overlooked)

Peerless

Remembered

Scattered

Seclude

Separate (separated)

Set apart

Sheltered

Stranded

Undeserving

Void

Aimless

Assistance

Attention (attentive)

Home (homelessness)

Social (socializing,

    antisocial)

Acquainted

Ally

Attending

Collective

Conflict (conflicting)

Despondency

Fellow (fellowship)

Guy

Hoedown

Hostile (hostility)

Kin

Left being

Liaison

Pharmacy

Presence

Role

Run by

Shamed

Shindig

Somebody

Someone

Welcome (unwelcome)

Encouragement

Listening

Blackball

Blacklisted

Blocked out

Cut off

Banned

Sidelined

Exclusive

Cut out

Mingling

Detached

Part of

Sole (solely)

Outsider

Celebrate (celebration)

Chat

Jilted

Barred

Help (helper, helpful,

   helpless, unhelpful)

Reconciliation

Encounter

Network

Accepted (unaccepted)

Blocked

Disheartened

Dismissed

Grief

Group

Missing

Sever

Single

Cheat on

Apathy

Favor

Inattentive

Ashamed

Heard (unheard)

See (unseen)

Popular (unpopular)

Worth (unworthy,

   worthless)

Divide

Drifting

Nothing (nothingness)

On their own

Rudderless

Unobserved

Humiliated

Inadequate

Closure

Purpose (unpurposed,

   purposeless)

Satisfied (dissatisfied,

   unsatisfied)

Vulnerable

Anxious

Party

Shut down

Myself

Stranger

Embarrassed

Gossip

Disinterested

Agreement

Touch

Join

Beside

Alien

Relate

Passed by

Depressed

Break up

Mocked

Mistrust

Unnoticed

Talk with

Among

Talk to

Assembly

Festivity

Defeated

Nonexistence

Despair

Turned down

Desirable

Acknowledge

Works Cited

Badal, V. D., et al. (2021). Do Words matter? Detecting social isolation and loneliness in older adults using natural language processing. Frontiers in psychiatry, 12.

Bolmsjö, I., Tengland, P. A., & Rämgård, M. (2019). Existential loneliness: An attempt at an analysis of the concept and the phenomenon. Nursing ethics, 26(5), 1310-1325.

Donovan, N. J., & Blazer, D. (2020). Social isolation and loneliness in older adults: review and commentary of a National Academies report. The American Journal of Geriatric Psychiatry, 28(12), 1233-1244.

Edberg, A. K., & Bolmsjö, I. (2019). Exploring existential loneliness among frail older people as a basis for an intervention: Protocol for the development phase of the LONE study. JMIR Research Protocols, 8(8), e13607.

Ettema, E. J., Derksen, L. D., & van Leeuwen, E. (2010). Existential loneliness and end-of-life care: A systematic review. Theoretical medicine and bioethics, 31(2), 141-169.

Gramling, R. et al. (2021). Conversational stories & self organizing maps: Innovations for the scalable study of uncertainty in healthcare communication. Patient Education and Counseling, 104(11), 2616-2621.

Guntuku, S. C., et al. (2019). Studying expressions of loneliness in individuals using twitter: an observational study. BMJ open, 9(11), e030355.

Haslam, S. A., et al. (2022). Social identity makes group-based social connection possible: Implications for loneliness and mental health. Current Opinion in Psychology, 43, 161-165.

Hipson, W. E., Kiritchenko, S., Mohammad, S. M., & Coplan, R. J. (2021). Examining the language of solitude versus loneliness in tweets. Journal of Social and Personal Relationships, 38(5), 1596-1610.

Holt-Lunstad, J., Smith, T. B., Baker, M., Harris, T., & Stephenson, D. (2015). Loneliness and social isolation as risk factors for mortality: a meta-analytic review. Perspectives on psychological science, 10(2), 227-237.

Holt-Lunstad, J. (2021). Loneliness and social isolation as risk factors: The power of social connection in prevention. American Journal of Lifestyle Medicine, 15(5), 567-573.

Karhe, L., & Kaunonen, M. (2015). Patient Experiences of Loneliness. Advances in Nursing Science, 38(4), E21-E34.

Kitzmüller, G., Clancy, A., Vaismoradi, M., Wegener, C., & Bondas, T. (2018). “Trapped in an empty waiting room”—the existential human core of loneliness in old age: a meta-synthesis. Qualitative Health Research, 28(2), 213-230.

Kotwal, A. A., et al. (2021). The epidemiology of social isolation and loneliness among older adults during the last years of life. Journal of the American Geriatrics Society, 69(11), 3081-3091.

Mansfield, L., et al. (2021). A conceptual review of loneliness in adults: Qualitative evidence synthesis. International journal of environmental research and public health, 18(21), 11522.

Murthy, V. H. (2020). Together: the healing power of human connection in a sometimes lonely world (First edition.). Harper Wave, an imprint of HarperCollinsPublishers.

Ong, A. D., Uchino, B. N., & Wethington, E. (2016). Loneliness and health in older adults: A mini-review and synthesis. Gerontology, 62(4), 443-449.

Princeton University “About WordNet.” WordNet. Princeton University. 2010.

Reinhardt, G. Y., Vidovic, D., & Hammerton, C. (2021). Understanding loneliness: a systematic review of the impact of social prescribing initiatives on loneliness. Perspectives in public health, 141(4), 204-213.

Rokach, A. (1988). The experience of loneliness: A tri-level model. The Journal of Psychology,122(6), 531-544.

Sjöberg, M., Beck, I., Rasmussen, B. H., & Edberg, A. K. (2018). Being disconnected from life: meanings of existential loneliness as narrated by frail older people. Aging & Mental Health, 22(10), 1357-1364.

Thesaurus.com. (n.d.). Dictionary.com. Retrieved August 12, 2022, from https://www.thesaurus.com/

Vedder, A., Boerner, K., Stokes, J. E., Schut, H. A., Boelen, P. A., & Stroebe, M. S. (2022). A systematic review of loneliness in bereavement: Current research and future directions. Current opinion in psychology, 43, 48-64.

Yanguas, J., Pinazo-Henandis, S., & Tarazona-Santabalbina, F. J. (2018). The complexity of loneliness. Acta Bio Medica: Atenei Parmensis, 89(2), 302.

11. “Zipper Plots” of Conversational Information Flow

Author: Larry Clarfeld
Project: Palliative Care Communication
Research Initiative

10. StoryListening Study Doula Reflections

Author: Matilda Garrido and Greg Brown
Project: StoryListening Study

Matilda and Greg are graduates of the University of Vermont End-of-life Doula Professional Certificate Program. They have been StoryListening Doulas within The Conversation Lab’s StoryListening Project—a brief conversational intervention designed to reduce the existential loneliness of grief during the social distancing of COVID. In this blog, they will share some experiences and lessons learned through their participation. 

9. Mindfulness & Conversational Turn-Taking

Author: Robert Gramling
Project: Palliative Care Communication
Research Initiative

Mindfulness is “awareness that arises through paying attention, on purpose, in the present moment, non-judgmentally.” Efforts to promote mindfulness in healthcare result in physicians feeling more curious about their patients’ experience. When seriously ill patients feel this non-judgmental curiosity from their clinicians, they are likely to more fully engage in conversation and, ultimately, share more about what matters most to them in their medical context. Very little, however, is empirically known about the relation between clinician mindfulness and actual features of healthcare conversations with seriously ill people. Here, we evaluate the degree to which clinician self-ratings of mindfulness (i.e., Trait Mindfulness) is associated with key conversational dynamics of engagement. 


8. Is silence a predictor of better communication outcomes?

Authors: Cailin Gramling & Robert Gramling
Project: Palliative Care Communication
Research Initiative

Within serious illness conversation, the feature of silence can act as a communicative and data rich moment. As established in our previously published paper (Durieux et al. Journal of Palliative Medicine. 2018), some types of pauses represent moments of human connection.


7. Timing of Fear, Sadness and Anger Expression in Palliative Care Consultations

Authors: Jack Straton & Robert Gramling
Project: Palliative Care Communication
Research Initiative
Figure One : Fear, Sadness, Anger

Fear, sadness and anger are commonly expressed during palliative care consultations (Alexander SC et. al. Journal of Palliative Medicine. 2015). Recently, we discovered that features of serious illness conversations organize into observable arcs in the shared narrative (Ross LA et. al. Patient, Education and Counseling. 2020).

Little, however, is known about the typical trajectory of fear, sadness and anger expression in these conversational stories and whether these arcs differ by the type of emotion. Better empirical understanding of the epidemiology of serious illness conversations is essential to guide effective quality measurement, system re-design, and communication training.


6. Word Prevalence: “Patient” vs. “Clinician”

Author: Larry Clarfeld
Project: Palliative Care Communication
Research Initiative

Words are chameleons, which reflect the color of their environment.” 

Something so simple as which words we choose to speak can be as nuanced and complex as any other aspect of human conversation. As the above quote from the influential American judge Billings Learned Hand suggests, the people with whom we converse can have a significant impact on what we say and how we say it. 


5. The VCL Temporal Reference Tagger

Author: Larry Clarfeld
Project: Palliative Care Communication
Research Initiative

“Have you decided to read this blog?”

Is this sentence referring to the past tense? The present? The future? All three? There is no universally accepted methodology for assigning temporal reference to text or speech, however when VCL alumnus Lindsay Ross wanted to investigate how temporal reference evolves in palliative care conversations, she was surprised to find there were no publicly available resources for accomplishing the task.  So, she created one.

In this blog post, we share the methodology behind the ‘VCL temporal reference tagger’ (TRT) and provide source code in Python for anyone wishing to use this tool in their own research endeavors.


4. Uncertainty Corpus

Author: Brigitte Durieux
Project: Palliative Care Communication
Research Initiative

As do any variables, language measures require conceptual framework; one must be able to recognize or mark something to quantify it.


3. A Case Study of Conversation Surrounding a Compassionate Silence

Author: Cailin Gramling
Project: Palliative Care Communication
Research Initiative

A compassionate silence is defined as: “A 2+ second pause in speaking that follows a moment of gravity…in which the person who speaks immediately following the pause acknowledges the gravity of that moment or makes a statement that offers to continue the expression of emotion (e.g., ‘‘It’s a lot to take in, isn’t it?,’’ ‘‘Can you tell me more?’’).

In order to fully understand an episode of such a silence, it needs to be examined within its surrounding environment.


2. The Value of Time

Author: Robert Gramling
Project: Palliative Care Communication
Research Initiative

As our science of palliative medicine grows, it is safe to put our empirical nickel down on two things.


1. Responding to Gravity

Author: Brigitte Durieux
Project: Palliative Care Communication
Research Initiative

Understandably, the end-of-life setting can be an emotional and heavy one. First and foremost, those affected are the people experiencing the end of their lives – but there also exists an emotional toll on clinicians and researchers within palliative care.