Bridging Technology and Relationships

Social Psychology · Andreas Grivas, MSc Clinical Psychologist · August 30, 2023

Bridging Technology and Relationships

Few things shape our mental health as strongly as the quality of our relationships. Persistent loneliness, intense fear of social situations and ongoing conflict with a partner are not just uncomfortable experiences; they are linked with depression, anxiety and poorer physical health. Researchers describe loneliness as a subjective gap between the social life a person has and the one they want, a feeling that for some people becomes a sustained state associated with a wide range of psychiatric and psychosocial problems (Käll et al., 2020; Hickin et al., 2021). Relationship distress, in turn, has been linked to mental and physical health problems in both partners and their children (Doss et al., 2016). It may sound paradoxical that a screen could help people connect better with other people, yet a growing body of research suggests that structured, internet-delivered programmes based on Cognitive Behavioral Therapy (CBT) can do exactly that for some people.

CBT approaches interpersonal difficulties by looking at the thoughts, feelings and behaviours that keep them going. A person with social anxiety may predict that others will judge them harshly, monitor themselves intensely during conversations and rely on “safety behaviours” such as avoiding eye contact or rehearsing every sentence, all of which make interactions feel worse and confirm the original fear. A lonely person may interpret ambiguous signals as rejection and gradually withdraw. In couples, partners often become stuck in repetitive cycles of criticism and defensiveness. CBT works on these patterns through psychoeducation, identifying and testing unhelpful beliefs, gradual exposure to feared social situations, behavioural experiments and practical communication skills. A meta-analysis of 28 randomized controlled trials (3,039 participants) found that psychological interventions reduced loneliness compared with control groups, with a small-to-medium effect size (g = 0.43); CBT was the most common type of intervention, although results varied considerably between studies (Hickin et al., 2021).

Digital delivery has been studied most extensively for social anxiety disorder. A meta-analysis of 20 randomized controlled trials with 1,743 participants found that internet-based CBT (iCBT) produced a moderate reduction in social anxiety symptoms compared with control conditions (g = 0.55), that the benefits were maintained at 6- and 12-month follow-up, and that subgroup analyses did not show a meaningful difference between iCBT and face-to-face CBT (Guo et al., 2021). This is consistent with broader reviews concluding that therapist-guided iCBT is more effective than a waiting list for anxiety and depression and tends to be as effective as face-to-face CBT (Andersson et al., 2019).

Loneliness itself has also become a target of digital treatment. In a pilot randomized trial in Sweden, 73 adults from the general public received either an 8-week internet-based programme with CBT components or were placed on a waiting list. The programme reduced loneliness (between-group d = 0.77) and also improved quality of life and social anxiety (Käll et al., 2020). A larger three-arm trial with 170 participants then compared 9 weeks of therapist-guided iCBT with internet-based interpersonal psychotherapy and a waiting list. iCBT reduced loneliness more than the waiting list (d = 0.71) and more than interpersonal psychotherapy (d = 0.53), lowered symptoms of depression and generalized anxiety, and its gains were maintained, though not further improved, four months later (Käll et al., 2021).

Couple relationships have been studied as well. The OurRelationship programme is an 8-hour online intervention adapted from an evidence-based, behaviourally oriented couple therapy, combined with four 15-minute calls with project staff. In a randomized trial with 300 couples (600 participants) across the United States, couples who completed the programme reported greater improvements than waitlisted couples in relationship satisfaction (d = 0.69), relationship confidence (d = 0.47) and negative relationship quality (d = 0.57). They also reported improvements in individual functioning, including depressive (d = 0.71) and anxious symptoms (d = 0.94), especially when they started the programme with difficulties in those areas (Doss et al., 2016).

An important point runs through all of these studies: the digital programme is a structured space for learning and rehearsal, but the change itself happens offline. The key exercises involve starting a conversation, accepting an invitation, expressing a need to a partner or testing a feared prediction in real life. The effective programmes described above also included some human contact, from brief coaching calls to therapist guidance, which suggests that technology works best as a bridge back to people rather than as a substitute for them. Digital tools such as app-based CBT exercises can complement, but not replace, professional care.

The evidence also has clear limits. Most trials compared digital programmes with waiting lists rather than with active treatments, participants were usually self-selected volunteers from high-income Western countries, and follow-up periods were relatively short. The loneliness literature in particular shows large variation between studies, so it is still unclear what works best for whom (Hickin et al., 2021). Online treatment can also have downsides: a significant minority of people experience negative effects, although deterioration rates appear similar to those of face-to-face treatment (Andersson et al., 2019). Self-guided programmes are not suitable for relationships involving violence, coercive control or fear of a partner, where safety must come first and joint couple exercises may be harmful. They are also not a sufficient response to severe depression, suicidal thoughts, psychosis or substance misuse that drive social withdrawal.

It is worth seeking professional help if loneliness or social anxiety has persisted for months, if it prevents you from studying, working or maintaining friendships, or if conflict with a partner is escalating or making you feel unsafe. A clinical psychologist can assess what lies beneath the difficulty, whether that is social anxiety, depression, past trauma or relational patterns, and offer individual, group or couple therapy as appropriate. If you are in crisis or thinking about harming yourself, contact your local emergency number immediately.

In summary, internet-delivered CBT has a reasonable evidence base for social anxiety and encouraging early results for loneliness and couple distress. Used thoughtfully, with real-world practice and appropriate human support, digital tools can help people take the first steps toward closer and more satisfying relationships, while more severe or risky situations still call for in-person care.

References

  • Andersson, G., Titov, N., Dear, B. F., Rozental, A., & Carlbring, P. (2019). Internet-delivered psychological treatments: From innovation to implementation. World Psychiatry, 18(1), 20–28. https://doi.org/10.1002/wps.20610
  • Doss, B. D., Cicila, L. N., Georgia, E. J., Roddy, M. K., Nowlan, K. M., Benson, L. A., & Christensen, A. (2016). A randomized controlled trial of the web-based OurRelationship program: Effects on relationship and individual functioning. Journal of Consulting and Clinical Psychology, 84(4), 285–296. https://doi.org/10.1037/ccp0000063
  • Guo, S., Deng, W., Wang, H., Liu, J., Liu, X., Yang, X., He, C., Zhang, Q., Liu, B., Dong, X., Yang, Z., Li, Z., & Li, X. (2021). The efficacy of internet-based cognitive behavioural therapy for social anxiety disorder: A systematic review and meta-analysis. Clinical Psychology & Psychotherapy, 28(3), 656–668. https://doi.org/10.1002/cpp.2528
  • Hickin, N., Käll, A., Shafran, R., Sutcliffe, S., Manzotti, G., & Langan, D. (2021). The effectiveness of psychological interventions for loneliness: A systematic review and meta-analysis. Clinical Psychology Review, 88, 102066. https://doi.org/10.1016/j.cpr.2021.102066
  • Käll, A., Jägholm, S., Hesser, H., Andersson, F., Mathaldi, A., Norkvist, B. T., Shafran, R., & Andersson, G. (2020). Internet-based cognitive behavior therapy for loneliness: A pilot randomized controlled trial. Behavior Therapy, 51(1), 54–68. https://doi.org/10.1016/j.beth.2019.05.001
  • Käll, A., Bäck, M., Welin, C., Åman, H., Bjerkander, R., Wänman, M., Lindegaard, T., Berg, M., Moche, H., Shafran, R., & Andersson, G. (2021). Therapist-guided internet-based treatments for loneliness: A randomized controlled three-arm trial comparing cognitive behavioral therapy and interpersonal psychotherapy. Psychotherapy and Psychosomatics, 90(5), 351–358. https://doi.org/10.1159/000516989