It seems to be common sense that having someone to lean on in a time of need would be a good thing. And, not surprisingly, social psychological and clinical psychological research has confirmed that. But, in delving into the scientifically based questions of how, why, when and what kind of social support is most beneficial to people in times of stress, mental illness or well-being, social scientists have identified the truly important role that our relationships with others play in our psychological and physical health. When it comes to health, who we know is just as important, if not more so, than what we know.
When Things Are Good
Researchers have been breaking down the concept of social support into its component parts and exploring how relationships benefit health for over 30 years. They have examined how social ties benefit people when they are in a time of stress and when they are in a time of relative well-being in their lives.
Thoits (2012) outlines the seven ways in which having social ties benefit people overall.
Having a social group (which can include family, friends, community members, coworkers, and neighbors), creates a potential for social influence and comparison. Simply put, if we surround ourselves with people doing positive things, we are more likely to do positive things. Unfortunately, the opposite is also true, having unhealthy people in our surroundings increases the likelihood that we will make poor choices and live an unhealthy life. So, it turns out research supports the old wisdom “be careful who you choose for friends.”
Close members of a social group also offer the potential for positive social control. Meaning, they can actively encourage self-care and good decision making. However, this can also backfire if the person isn’t receptive to the “support”, instead sees it as dominating and intrusive and resists the positive health changes.
Relationships with others typically come with a sense of purpose and mattering to someone else. When we feel that we are meaningful to others, we are more likely to take good care of ourselves and work towards psychological well-being. For instance, when someone’s spouse is involved in the treatment of depression, they are more likely to stay compliant with treatment and work towards getting better (Sher et al, 2005).
Related to having a sense of purpose, self-esteem comes from feeling valued and worthwhile in the eyes of others. In turn, positive self-esteem is associated with lower symptoms of anxiety, depression, and distress while correlating positively with life satisfaction and happiness (Baumeister et al, 2003; Taylor and Stanton, 2007; Thoits, 2003).
When we feel we are successful at maintaining our relationships, we develop a sense of control and mastery. We feel like we can do things well. This confidence in our own abilities translates to confidence in our ability to cope with challenges that arise and reduce our perceived level of anxiety and depression in the face of such challenges (Taylor and Stanton 2007).
Feeling part of a group, either a family or a circle of friends in a community, creates a sense of acceptance and belonging. The absence of feeling a sense of belonging, say loneliness, has been linked to depression, anxiety, poor health habits and poor health (Cacioppio et al, 2002; Uchino 2004).
And, finally, having positive people around us allows us to believe that, if the time should come when we do need someone’s help, that help will be available. The importance of this perceived social support cannot be underestimated and has been found to be more important to well-being in many ways than actual received social support during isolated periods of stress. Feeling that people “have your back” is more important to overall sense of well-being (Lakey & Cronin, 2008).
When Things Are Not So Good
During difficult times, social support takes on the role of Stress-Buffering. Positive, supportive relationships can buffer or protect us from the stress of whatever challenge we are facing. Support during difficult times (major life events, physical illness or mental health illness) can come in the forms of visible and deliberate support or emotional sustenance. Visible support can include taking care of things for someone, providing information that they need, offering advice, or problem-solving. Emotional support can include love, caring, empathy, willingness to listen to venting and validation of feelings and concerns (Thoits, 2012).
The challenge of difficult times is that, while in the middle of a stressful situation or an episode of mental illness, it can be very challenging to explain what you are going through and what kind of help you need. In turn, the people that care about you often experience their own frustration and anxiety in feeling helpless and not knowing how to support you. This can often strain the very relationships that could be helpful and creates another layer of unnecessary stress.
In an effort to outline what kinds of help are most beneficial to people and from whom, Thoit (2012) makes a distinction between the kind of help that is beneficial from family and close friends (what she calls the primary group/significant others) and the kind of help that is beneficial from others who have gone through similar situations (secondary group/similar others). Thoit (2012) suggests that Significant Others are most helpful in reducing perceived stress when they offer love, caring, concern, compassionate presence of “being there” and assistance in actual tasks. She warns against Significant Others offering problem-focused advice and recommendations on how to cope. While these efforts could be well meaning, they can be perceived as being motivated by the Significant Other’s desires for things to be better and can be met with resistance to positive change. Simply put, we want to know that our loved ones understand our struggle and are there for us as we figure out what we need to do; we do not want our loved ones to tell us how to fix it. The role of providing information, advice giving and coping encouragement appears to be more effective when it come from Similar Others, who have been through it themselves and are coming from a place of personal experience.
When It Comes to Mental Illness
When it comes to mental illnesses, such as Major Depression, Anxiety, Obsessive-Compulsive Disorder, Anorexia Nervosa, Bipolar Disorder, Borderline Personality Disorder or Schizophrenia, there is significant evidence that family involvement in treatment improved treatment compliance and treatment outcome (Dixon et al, 2001). Providing families with the education they need to understand a diagnosis, effectively support the individual going through it and take care of themselves as they deal with the increased stress that mental illness places on a family unit seems to improve outcome for everyone.
While positive support from family is very important, it seems that the bigger obstacle to successful treatment can lie in negative responses to mental illness from family. Sher et al. (2005) explored the role that a family’s beliefs about mental illness can have in an individual’s compliance with medication treatment for Major Depression. They found that, when a family expresses a negative attitude about medication treatment, a focus on “what will others think” and a belief that the individual is causing their own problems through the things that they do and the ways that they think, the person is more likely to be non-compliant with treatment. They conclude that it is imperative to understand the role that a patient’s social environment plays in their ability to benefit from treatment and discuss “the necessity of educating caregivers about the impact that causal attributions have on patients’ behavior.”
The Take Home Message
When it comes to our everyday lives, positive relationships and diverse relationships with others have significantly positive impact. Different types of relationships offer different kinds of support. So, just as in finance, a “diverse portfolio” is a good way to get all your bases covered.
When it comes to difficult times, it is important to reach out to both Significant Others and to those who have gone through something similar. While your family and friends can try to be helpful, there is definite benefit to seeking support from others who can speak from experience. If you are the Significant Other of someone going through a difficult time, the research supports that you have a very important role to play in showing your love, caring and willingness to help with daily tasks. However, as a Significant Other, it may be wiser to keep the problem-solving advice to a minimum unless asked.
When it comes to the treatment of mental illness, the primary rule of “first do no harm” applies. It is well-established that family psychoeducation can help improve treatment compliance and provide an understanding of the do’s and don’ts of supporting someone through a particular diagnosis (Dixon et al, 2001).
Baumeister, R., Campbell, J., Krueger, J., & Vohs, K. (2003). Does High Self-Esteem Cause Better Performance, Interpersonal Success, Happiness, Or Healthier Lifestyles? Psychological Science in the Public Interest, 4, 1-44.
Cacioppo, J., Hawkley, L., Crawford, L., Ernst, J., Burleson, M., Kowalewski, R., . . . Bernston, G. (2002). Loneliness and Health: Potential Mechanisms. Psychosomatic Medicine, 64, 407-417.
Dixon, L., McFarlane, W., Lefley, H., Lucksted, A., Cohen, M., Falloon, I., . . . Sondheimer, D. (2001). Evidence-Based Practices for Services to Families of People With Psychiatric Disabilities. Psychiatric Services, 52(7), 903-910.
Lakey, B., & Cronin, A. (2008). Low social support and major depression: Research, theory and methodological issues. In Risk Factor for Depression (pp. 385-408). San Diego, CA: Academic Press.
Sher, I., McGinn, L., Sirey, J., & Meyers, B. (2005). Effects of Caregiver's Perceived Stigma and Causal Beliefs on Patients' Adherence to Antidepressant Treatment. Psychiatric Services, 56(5), 564-569.
Taylor, S., & Stanton, A. (2007). Coping Resources, Coping Processes, And Mental Health. Annual Review of Clinical Psychology, 3, 377-401.
Thoits, P. (2003). Personal Agency in the Accumulation of Multiple Role-Identities. In Advances in Identity Theory and Research (pp. 179-194). New York: Kluwer Academic/Plenum.
Thoits, P. (2012). Mechanisms Linking Social Ties and Support to Physical and Mental Health. Journal of Health and Social Behavior, 52, 145-161.
Uchino, B. (2004). Social support and physical health understanding the health consequences of relationships. New Haven: Yale University Press.