Social disconnection in later life significantly impacts emotional and psychological well-being, yet scalable, evidence-based interventions remain limited. This pilot randomized controlled trial evaluated the preliminary efficacy of a single-session online Awareness, Courage, and Love (ACL) intervention in enhancing interpersonal closeness and well-being among older adults.
Method
Sixty-four community-dwelling older adults (aged ≥60) were randomly assigned to the ACL intervention group (n = 32) or a waitlist control (n = 32). Primary and secondary outcomes, including interpersonal closeness and mental health outcomes, were assessed at baseline, post-intervention, and 1-month follow-up.
Results
Interpersonal closeness significantly increased from baseline to post-intervention in both groups, with a nonsignificant trend favoring the ACL group. The ACL group displayed significant improvements in depressive symptoms from baseline to post-intervention, and from post-intervention to 1-month follow-up.
Conclusion
This pilot trial shows preliminary efficacy of a single-session ACL intervention, motivating multi-session testing to assess durability. Trial registration: ClinicalTrials.gov—NCT06524206 (date of registration: July 29, 2024)
AronA.AronE. N.SmollanD. (1992). Inclusion of other in the self scale and the structure of interpersonal closeness. Journal of Personality and Social Psychology, 63(4), 596–612. https://doi.org/10.1037/0022-3514.63.4.596
2.
AronA.MelinatE.AronE. N.ValloneR. D.BatorR. J. (1997). The experimental generation of interpersonal closeness: A procedure and some preliminary findings. Personality and Social Psychology Bulletin, 23(4), 363–377. https://doi.org/10.1177/0146167297234003
3.
BisbyM. A.BalakumarT.ScottA. J.TitovN.DearB. F. (2024). An online therapist-guided ultra-brief treatment for depression and anxiety: A randomized controlled trial. Psychological Medicine, 54(5), 902–913. https://doi.org/10.1017/S003329172300260X
4.
ChanS. C.-Y.HuangQ.-L.HoW.-S.ChanR.YeungC.WongS.TsaiM. (2024). An awareness, courage, and love online group intervention for Chinese older adults in the post-pandemic era: Study protocol for a randomised controlled trial. Healthcare, 12(21),Article 2158. https://doi.org/10.3390/healthcare12212158
5.
ChoiN. G.DiNittoD. M.MartiC. N.ChoiB. Y. (2022). Telehealth use among older adults during COVID-19: Associations with sociodemographic and health characteristics, technology device ownership, and technology learning. Journal of Applied Gerontology, 41(3), 600–609. https://doi.org/10.1177/07334648211047347
6.
CosardereliogluC.WalstonJ. D.AbadirP. M. (2025). From frailty to resilience: Exploring adaptive capacity and reserve in older adults—A narrative review. Frontiers in Aging, 6,Article 1520842. https://doi.org/10.3389/fragi.2025.1520842
7.
FakoyaO. A.McCorryN. K.DonnellyM. (2020). Loneliness and social isolation interventions for older adults: A scoping review of reviews. BMC Public Health, 20, 1–14. https://doi.org/10.1186/s12889-020-8251-6
8.
FanY.FanA.YangZ.FanD. (2025). Global burden of mental disorders in 204 countries and territories, 1990–2021: Results from the global burden of disease study 2021. BMC Psychiatry, 25(1),Article 486. https://doi.org/10.1186/s12888-025-06932-y
FungS. F.KongC. Y. W.LiuY. M.HuangQ.XiongZ.JiangZ.ZhuF.ChenZ.SunK.ZhaoH.YuP. (2022). Validity and psychometric evaluation of the Chinese version of the 5-item WHO well-being index. Frontiers in Public Health, 10,Article 872436. https://doi.org/10.3389/fpubh.2022.872436
11.
HawkleyL. C.CacioppoJ. T. (2010). Loneliness matters: A theoretical and empirical review of consequences and mechanisms. Annals of Behavioral Medicine, 40(2), 218–227. https://doi.org/10.1007/s12160-010-9210-8
12.
HolmanG.KanterJ.TsaiM.KohlenbergR. (2017). Functional analytic psychotherapy made simple: A clinician’s guide to using the Awareness-Courage-Love (ACL) model in session. New Harbinger Publications.
13.
HwangJ.TomaC. L.ChenJ.ShahD. V.GustafsonD.MaresM. L. (2021). Effects of web-based social connectedness on older adults’ depressive symptoms: A two-wave cross-lagged panel study. Journal of Medical Internet Research, 23(1),Article e21275. https://doi.org/10.2196/21275
14.
KanterJ. W.KuczynskiA. M.TsaiM.KohlenbergR. J. (2018). A brief contextual behavioral intervention to improve relationships: A randomized trial. Journal of Contextual Behavioral Science, 10, 75–84. https://doi.org/10.1016/j.jcbs.2018.09.001
15.
KällA.BäckM.WelinC.ÅmanH.BjerkanderR.WänmanM.LindegaardT.BergM.MocheH.ShafranR.AnderssonG. (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
16.
KlaiberP.WenJ. H.DeLongisA.SinN. L. (2021). The ups and downs of daily life during COVID-19: Age differences in affect, stress, and positive events. The Journals of Gerontology: Series B, 76(2), e30–e37. https://doi.org/10.1093/geronb/gbaa096
17.
LaurenceauJ.-P.BarrettL. F.PietromonacoP. R. (1998). Intimacy as an interpersonal process: The importance of self-disclosure, partner disclosure, and perceived partner responsiveness in interpersonal exchanges. Journal of Personality and Social Psychology, 74(5), 1238–1251. https://doi.org/10.1037/0022-3514.74.5.1238
18.
LeonA. C.DavisL. L.KraemerH. C. (2011). The role and interpretation of pilot studies in clinical research. Journal of Psychiatric Research, 45(5), 626–629. https://doi.org/10.1016/j.jpsychires.2010.10.008
19.
LeungG. T. Y.de Jong GierveldJ.LamL. C. W. (2008). Validation of the Chinese translation of the 6-item De Jong Gierveld Loneliness Scale in elderly Chinese. International Psychogeriatrics, 20(6), 1262–1272. https://doi.org/10.1017/S1041610208007552
20.
LiuT.ChanR.YeungC.LeeL. C.ChanT. N.WeltonK.LumT. Y.WongS.HG. (2023). “Participation is fun and empowering”: A participatory approach to co-design a cultural art program for older Chinese at risk of depression in Hong Kong. Innovation in Aging, 7(5),Article igad041. https://doi.org/10.1093/geroni/igad041
21.
López-PinarC.Galán-DoñaD.TsaiM.MacíasJ. (2025). Meta-analysis of randomized controlled trials and single-case designs on the efficacy of functional analytic psychotherapy. Clinical Psychology: Science and Practice, 32(1), 26–45. https://doi.org/10.1037/cps0000221
22.
LuoZ.LiY.HouY.ZhangH.LiuX.QianX.JiangJ.WangY.LiuX.DongX.QiaoD.WangF.WangC. (2019). Adaptation of the two-item generalized anxiety disorder scale (GAD-2) to Chinese rural population: A validation study and meta-analysis. General Hospital Psychiatry, 60, 50–56. https://doi.org/10.1016/j.genhosppsych.2019.07.008
23.
MasiC. M.ChenH. Y.HawkleyL. C.CacioppoJ. T. (2011). A meta-analysis of interventions to reduce loneliness. Personality and Social Psychology Review, 15(3), 219–266. https://doi.org/10.1177/1088868310377394
24.
MontgomeryP.GrantS.Mayo-WilsonE.MacdonaldG.MichieS.HopewellS.MoherD. (2018). Reporting randomised trials of social and psychological interventions: The CONSORT-SPI 2018 extension. Trials, 19(1),Article 407. https://doi.org/10.5255/UKDA-SN-851981
25.
NakouA.DragiotiE.BastasN. S.ZagorianakouN.KakaidiV.TsartsalisD.MantzoukasS.TatsisF.VeroneseN.SolmiM.GouvaM. (2025). Loneliness, social isolation, and living alone: A comprehensive systematic review, meta-analysis, and meta-regression of mortality risks in older adults. Aging Clinical and Experimental Research, 37(1),Article 29. https://doi.org/10.1007/s40520-024-02925-1
26.
Newman-NorlundR. D.Newman-NorlundS. E.SayersS.McLainA. C.RiccardiN.FridrikssonJ. (2022). Effects of social isolation on quality of life in elderly adults. PLoS One, 17(11),Article e0276590. https://doi.org/10.1371/journal.pone.0276590
PodsakoffP. M.MacKenzieS. B.LeeJ.-Y.PodsakoffN. P. (2003). Common method biases in behavioral research: A critical review of the literature and recommended remedies. Journal of Applied Psychology, 88(5), 879–903. https://doi.org/10.1037/0021-9010.88.5.879
29.
PromislowD.AndersonR. M.SchefferM.CrespiB.DeGregoriJ.HarrisK.HorowitzB. N.LevineM. E.RioloM. A.SchneiderD. S.SpencerS. L.ValenzanoD. R.HochbergM. E. (2022). Resilience integrates concepts in aging research. iScience, 25(5),Article 104199. https://doi.org/10.1016/j.isci.2022.104199
30.
ReynoldsC. F.3rdJesteD. V.SachdevP. S.BlazerD. G. (2022). Mental health care for older adults: Recent advances and new directions in clinical practice and research. World Psychiatry, 21(3), 336–363. https://doi.org/10.1002/wps.20996
31.
SaijonkariM.ParonenE.LakkaT.TolmunenT.LinnosmaaI.LammintakanenJ.IsotaloJ.RekolaH.Mäki-OpasT. (2023). Promotive and preventive interventions for mental health and well-being in adult populations: A systematic umbrella review. Frontiers in Public Health, 11,Article 1201552. https://doi.org/10.3389/fpubh.2023.1201552
32.
SeifertA.CottenS. R.XieB. (2021). A double burden of exclusion? Digital and social exclusion of older adults in times of COVID-19. The Journals of Gerontology. Series B, Psychological Sciences and Social Sciences, 76(3), e99–e103. https://doi.org/10.1093/geronb/gbaa098
33.
SeppalaE.RossomandoT.DotyJ. R. (2013). Social connection and compassion: Important predictors of health and well-being. Social Research: An International Quarterly, 80(2), 411–430. https://doi.org/10.1353/sor.2013.0027
34.
ShapiraS.Yeshua-KatzD.Cohn-SchwartzE.Aharonson-DanielL.SaridO.ClarfieldA. M. (2021). A pilot randomized controlled trial of a group intervention via Zoom to relieve loneliness and depressive symptoms among older persons during the COVID-19 outbreak. Internet Interventions, 24,Article 100368. https://doi.org/10.1016/j.invent.2021.100368
35.
StataCorp. (2023). Stata statistical software: Release 18. StataCorp LLC.
36.
StokesA. C.LundbergD. J.EloI. T.HempsteadK.BorJ.PrestonS. H. (2021). COVID-19 and excess mortality in the United States: A county-level analysis. PLoS Medicine, 18(5),Article e1003571. https://doi.org/10.1371/journal.pmed.1003571
37.
SuY.RaoW.LiM.CaronG.D’ArcyC.MengX. (2023). Prevalence of loneliness and social isolation among older adults during the COVID-19 pandemic: A systematic review and meta-analysis. International Psychogeriatrics, 35(5), 229–241. https://doi.org/10.1017/S1041610222000199
38.
TsaiM.HardebeckE.RamosF. P.TurloveH.Nordal-JonssonK.VongdalaA.ZhangW.KohlenbergR. J. (2020). Helping couples connect during the COVID-19 pandemic: A pilot randomised controlled trial of an awareness, courage, and love intervention. Applied Psychology: Health and Well-Being, 12(4), 1140–1156. https://doi.org/10.1111/aphw.12241
39.
TsaiM.KohlenbergR. J.KanterJ. W.KohlenbergB.FolletteW. C.CallaghanG. M. (2009). A guide to Functional Analytic Psychotherapy: Awareness, courage, love, and behaviorism. Springer.
40.
Van OrdenK. A.BowerE.LutzJ.SilvaC.GallegosA. M.PodgorskiC. A.SantosE. J.ConwellY. (2021). Strategies to promote social connections among older adults during “social distancing” restrictions. The American Journal of Geriatric Psychiatry, 29(8), 816–827. https://doi.org/10.1016/j.jagp.2020.05.004
41.
WangW.BianQ.ZhaoY.LiX.WangW.DuJ.ZhangG.ZhouQ.ZhaoM. (2014). Reliability and validity of the Chinese version of the patient health questionnaire (PHQ-9) in the general population. General Hospital Psychiatry, 36(5), 539–544. https://doi.org/10.1016/j.genhosppsych.2014.05.021
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
