This month we turn our attention to a recent article written by an international team of researchers, comprising of our own colleagues, Dr Christopher Byrne, Principal Psychologist at Redford Court in Liverpool, and our Clinical Director, Dr Rudi Coetzer, as well as Dr Christian Salas from Diego Portales University in Chile, and Dr Richard Ramsey from Macquarie University in Australia.

The article focuses on loneliness after brain injury. It gives us insight into how common loneliness is, what its impact is, and what factors may contribute to loneliness.

The authors integrate a model of loneliness (reaffiliation motive) with profiles of executive dysfunction (Stuss, 2011) including, for example, energisation - the ability to initiate and sustain a response, and metacognition - which relates to the ability to observe our own mental processes (self-awareness) and understand what other people are thinking (theory of mind). They explain how deficits of energisation can reduce someone’s ability to initiate social contacts or reconnect with others, and how problems with metacognition may make it difficult for people to understand why it is hard to make connections with others, or even recognise that this is a difficulty.

Byrne and colleagues also highlight the importance of distinguishing objective social isolation, such as having a small social network, from perceived loneliness, which could be described as feeling lonely “in the midst of people”, as an old poem goes [2].

We all feel lonely sometimes, but persistent loneliness, which is often experienced by people with brain injury [3], can become maladaptive, and even affect negatively health in the same way smoking or high cholesterol do [4]. The RAM model offers a way to understand how some of the symptoms of brain injury can affect loneliness. It is hoped that by understanding what contributes to feeling lonely, we will also be able to understand how we can help people reconnect and feel less lonely.

To view the article in full, including the Clinical Implications of the proposed model, follow this link.


[1] Byrne C, Salas CE, Coetzer R & Ramsey R (2022) Understanding loneliness in brain injury: linking the reaffiliation motive model of loneliness with a model of executive impairment. Frontiers Integrative Neuroscience. 16:883746.

[2] Camões, L. V. d. (1524-1580) Love is a fire that burns unseen (R. Zenith, translator),

[3] Byrne, C., Saville, C., Coetzer, R., & Ramsey, R. (2022). Stroke survivors experience elevated levels of loneliness: A multi-year analysis of the national survey of wales. Arch. Clin. Neuropsychol. 37, 390-407. doi:10.1093/arclin/acab046

[4] Pantell, M., Rehkopf, D., Jutte, D., Syme, S. L., Balmes, J., and Adler, N. (2013). Social isolation: a predictor of mortality comparable to traditional clinical risk factors. American Journal of Public Health, H.2013.301261