Real Health speaks with Sarah Y. Vinson, MD, an Atlanta-based physician who specializes in adult, child and adolescent, and forensic psychiatry, about loneliness and mental health.

What’s the difference between being alone and being lonely, and how can people recognize these differences?
Being alone doesn’t have a negative connotation or the negative feelings that can come with loneliness, per se. Let’s look at people who are introverts and extroverts. Unlike extroverts, who like being with other people, introverts actually gain energy from being alone, and solitude recharges them. So being alone in and of itself isn’t a bad thing. Some people actually prefer to be that way, and there’s nothing wrong with that or pathological about that. This is just how some people are wired. Everyone’s experience of being alone is different and shaped by their personality. Also, being alone may not necessarily mean not physically having someone else in the room; it can also mean not feeling connected to others. There are those who are married, or people who are in a room filled with other folks at work every day, who still feel a sense of loneliness. Human beings have a natural drive to feel connected to each other—not only for the external rewards of being connected to other people but also for the internal rewards of feeling connected to each other. That’s a good feeling, and you can’t get a better release than when you’re holding hands with somebody you love, or when you hug your child, or when you hear your mother’s voice. The absence of that connection is what really characterizes loneliness. For most people, when they don’t feel connected to somebody, or to a significant person, that’s when the negative feeling of being lonely registers.

How can people who fear being alone deal with this feeling?
It really depends on what that person’s fear is based in. There are some people who just lack a key awareness about who they are or what they contribute to the world. They don’t know what their intrinsic value is. Often, people like that are excessively reliant on the feedback of others and interactions with others to give them that sense of personhood, or the sense that they matter in the world. That’s one set of people who have a hard time being alone. For those folks, it really is hard work to get past that feeling. These people have to really learn about themselves; they need to build on who they are, gain some sense of awareness and some sense of who they are in the world and what they have to offer that’s not dependent entirely on other people’s opinion of them. That’s part of a developmental process kids, teenagers, young adults and people who suffer trauma or early substance abuse undergo.

How are people who suffer from trauma affected by loneliness?
There are some people who really feel the need to have others around because it makes them feel safe. For example, you see it in women who’ve been traumatized, or people who’ve been to war. There’s a psychological phenomenon called agoraphobia where sometimes people feel they need a companion to go with them to public places. Therapy can help folks deal with this way of thinking. In the field of psychotherapy, there’s a term that’s used—cognitive distortion. Cognitive distortion is just a fancy name that describes a pattern of thought people engage in that isn’t completely based on reality. But folks rehearse this way of thinking so much that it becomes very real to them.

To address this way of thinking, doctors conduct therapy sessions that focus on someone’s thought patterns. The whole focus of this kind of therapy is to strengthen your interpersonal relationships. Realistically, there are a lot of ways that you can address loneliness. There isn’t necessarily one method that works for everyone. What I’ve found in working with a lot of people who feel alone is that they have folks in their lives who are willing to be there and who want to connect with them. But when people are depressed, they can feel guilty about anything, or they may feel insecure, so they choose not to reach out. Sometimes, it’s a matter of just reaching out to the people who are already around you and in your life.

What tips do you have for some easy ways people can connect when they feel isolated?
Reach out to the connections that you have already. For example, call up that old friend you haven’t talked to in years. This includes anyone you haven’t touched base with. Just to be clear, I’m not knocking social media. But often interactions online are so fleeting, superficial and lacking in human warmth that the more lonely and depressed connecting this way can make you feel.

How do feelings of depression relate to loneliness?
If there is some degree of anxiety or depression, often these disorders will make you want to withdraw and isolate yourself. People need to know these feelings can create a cycle: The more withdrawn and isolated you get, the more depressed it makes you feel, and the more depressed you become, the more you want to isolate yourself. The way to break out of this cycle isn’t to wait until you feel better. Part of feeling better will require you to step out and reconnect with people. And if you don’t feel like you have people in your life, pursue an interest. This can be a way to meet people that you know have some interests or goals in common with you. Don’t just sit at home thinking about how lonely you are. Try to engage with others who are involved in areas naturally of interest to you. Don’t try to force something. Look at the things that you like to do that are naturally appealing to you and try to find some group that does that sort of thing, because in those situations you have at least one thing in common with the people in these groups.

But if you’re someone who has a really hard time enjoying any time alone, then there’s some need for self-reflection. In my work, too, I’ve seen people enter into unhealthy relationships just to have somebody around, and that’s also not good for you. I think when you pursue a relationship with someone, you should always look at why you want to connect with that person. You must know that you’re OK on your own. Maybe it’s not that you’ll want to be alone, and that’s not how you have to be all the time. But if you notice a pattern in your relationships where people don’t treat you well, or you’re being lied to, or you’re being hurt, then it may be time to take a look at that and take a step back. Your goal is to always enter a relationship from a stronger, healthier place.