Telephone-Based Behavioral Interventions Reduce Loneliness in Older Adults: JAMA

A new study found that Telephone-based behavioral interventions and mindfulness programs, led by trained lay counselors, are scalable and effective in reducing loneliness and improving well-being among older adults. These findings published in the Journal of the American Medical Association suggest that benefits can last up to 12 months and may be further strengthened by addressing social isolation.

The randomized clinical trial ran from April 2021 through April 2024, a period marked by pandemic-related isolation that disproportionately affected older adults in the Helping Alleviate Loneliness in Hong Kong Older Adults (HEAL-HOA) study.

The study focused on individuals aged 65 and older who lived alone, lacked digital access, experienced financial hardship, and reported high levels of loneliness. Of more than 4,100 people screened, 1,151 participants were enrolled and randomly assigned to either telephone-based behavioral activation (Tele-BA), telephone-based mindfulness (Tele-MF), or telephone-based befriending (Tele-BF), which served as an attention-control condition.

Each participant received eight 30-minute phone sessions over four weeks. Unlike befriending, which emphasized friendly conversation, behavioral activation encouraged participants to re-engage in meaningful activities, while mindfulness focused on awareness, emotional regulation, and acceptance.

Loneliness was measured using the UCLA Loneliness Scale and the De Jong Gierveld Loneliness Scale. Participants were assessed at baseline and followed up at 1, 3, 6, and 12 months.

At the 12-month mark, both Tele-BA and Tele-MF showed statistically significant reductions in loneliness compared with befriending alone. Behavioral activation and mindfulness also led to notable improvements in secondary outcomes, including sleep quality, psychological well-being, and life satisfaction. These benefits persisted well beyond the end of the four-week intervention period.

This study found that reduced social isolation at 6 months partially explained the improvements in loneliness at one year, accounting for roughly 14% to 18% of the total effect. This suggests that while emotional and cognitive changes play a major role, even modest increases in social connection can reinforce long-term gains.

The findings are especially significant because the interventions were delivered by lay counselors rather than highly specialized clinicians, making them far more scalable and cost-conscious. Overall, the study suggest that low-cost, telephone-based behavioral and mindfulness programs could become a cornerstone of public health strategies to combat late-life loneliness. 

Reference:

Tang, V. F. Y., Jiang, D., Kwok, J. Y. Y., Yeung, D. Y.-L., Choi, N. G., Warner, L. M., Ho, R. T. H., & Chou, K.-L. (2026). Behavioral activation and mindfulness interventions in reducing loneliness and improving well-being in older adults: The HEAL-HOA randomized clinical trial. JAMA Network Open, 9(2), e2557170. https://doi.org/10.1001/jamanetworkopen.2025.57170