Loneliness, social isolation and chronic illness: A randomised controlled trial of a remote-delivered psychological treatment for older adults with co-occurring loneliness and chronic illness.

In this randomised controlled trial, participants will receive access to an 8-week internet-delivered, psychological course, the Loneliness-enhanced Chronic Conditions Course, which has been adapted specifically for the current study from an existing resource (https://www.ecentreclinic.org/chronic-conditions-course). The Loneliness-enhanced Chronic Conditions Course provides good information and skills for managing the impacts of chronic conditions on people's emotional wellbeing, including feelings of loneliness and social connection. The Course runs for 8 weeks and consists of: (a) 5 online lessons with exercises for learning the information and skills. The duration of each lesson is approximately 20 to 30 minutes. Lessons are completed in weeks 1, 2, 4, 5 and 7. Lessons can be viewed in the online platform, or downloaded as PDF files. Lessons are accompanied by lesson worksheets which can be downloaded and/or printed as PDF files. Participants are encouraged to engage with the home-based exercises at a frequency and duration that is helpful for them, though a suggested time commitment of at least 30 minutes each week is encouraged. The first lesson (in week 1) is a introduction and overview of the course, including psycho-education about chronic health conditions, emotional wellbeing, and relationships/social connection. Participants are encouraged to identify their symptoms (e.g. thinking styles, physical symptoms, unhelpful habits) as a home-based exercise. Lesson 2 (week 2) introduces cognitive challenging skills, and participants are encouraged to practice thought challenging in the following two weeks. Lesson 3 (week 4) covers behavioural activation and relaxation strategies to manage mood and anxiety symptoms, and participants are provided with the resources to undertake activity scheduling as a home-based task. Lesson 4 (week 5) introduces activity pacing to manage symptoms such as pain and fatigue, and graded exposure to manage anxiety and avoidance. Following lesson 4, participants are encouraged to attempt activity pacing and/or graded exposure tasks as a home-based exercise. Finally, Lesson 5 (week 7) includes information and strategies relating to relapse prevention, and participants are given materials to help with goal-setting for the future, and also a relapse prevention plan. (b) Automatic emails that help guide people through the course with frequency of once or twice per week. Examples of these e-mails include; reminders when new lessons are available, congratulatory messages once a lesson has been completed, brief messages that reinforce the core concepts of the lessons, and e-mails inviting contact and encouraging engagement if a participant has not logged in for a while. (c) Additional Resources (articles in PDF format) developed specifically for this study. These resources provide information about different problems people often struggle with, including managing sleep, working with health professionals, etc. (d) Case Stories and examples based on previous participants. These case stories are briefly incorporated into each lesson, commonly in the form of worked examples on worksheets, or participants' experiences learning and practicing the skills within the lesson. Additional case stories are example as optional materials that can be accessed by participants at their own discretion, which provide more in-depth information and experiences. Adherence with the intervention is monitored via the study's secure web platform, which records information such as the number of participant logins, lesson completions; time spent completing each lesson; and number of downloads of additional resources.