What is Social Erosion and How Can Peer Support Specialists Help Prevent It? (Copy)

Social support is like a “wonder drug” --- healthy levels of social support are associated with better physical health, better mental health, better life satisfaction, better use of healthcare, and longer lives!

 Mental illness is associated with low levels of social support – relatively fewer supportive relationships with family and friends.  Some have said that this is because people with lower social support are at higher risk to develop mental illness, and research suggests that this is partly true.  But there is growing evidence that mental illness causes people to gradually lose supportive relationships.  Called “social erosion”, this model developed from research on people with PTSD (Cox, Baugh, McCloskey, & Iyar, 2019; Shallcross, Arbisi, Polusny, Kramer & Erbes, 2016).  Researchers found that PTSD symptoms lead to a reduction in social support due to interpersonal difficulties, irritability with people, feelings of detachment from others, and avoidance of social situations. People with PTSD often perceive the world to be dangerous and view their social support network as a potential threat to their safety. They often avoid members of their support network in order to reduce the perceived threat and increase their perceived safety.  So over time, their social network ‘erodes’ away, as they avoid communications. 

 This is also relevant to other conditions, including anxiety, depression, and thought disorder.  In substance use disorders, there is often an erosion of relationships with people who are not using. Interestingly, in recovery from substance use disorders, relationships with people who are using are often replaced with relationships with people who are abstinent.

 Acceptance and Commitment Therapy (ACT), an evidence-based acceptance and mindfulness-based treatment, has been successfully used to improve interpersonal relationships and enhance social functioning in individuals with interpersonal problems. ACT targets cognitive and emotional barriers to values-based behavior in relationships, and encourages individuals to act on their values instead of falling into maladaptive interpersonal patterns that lead to poor social support. In a recent study (Kelly, Reilly, Ameral, Richter, & Fukuda, 2022), ACT for people with interpersonal problems resulted in a significant reduction in social erosion compared to treatment as usual.

 Peer Support Specialists need to be involved in preventing social erosion.  Social connection is part of the domain of Peer Support Specialists.  Maintaining peer support and community connections is part of SAMHSA’s definition of recovery. 

Ways you can fight social erosion for your clients:

1.     Educate clients and their family members about social erosion.  This is a subtle process that often goes unnoticed.  Educating people about it will help them see it and fight it.

 2.     Educate clinicians.  Social erosion is a fairly new concept and so many clinicians will not be watching for it, and fighting this tendency toward losing social support.

 3.     Create more opportunities for social connection.  Peer Support Specialists have a strategic role in building groups and activities in which social support can be increased.  Embrace that role and engage others in building more opportunities for your clients.

 4.     Remind clients about the importance of social connection --- it has more impact on their health and how long they live than many risk factors, including smoking and being overweight.  Your clients know that smoking and overeating can create problems for them, but do they know that low social support is more dangerous?  You need to help spread this information.

 5.     Partner with psychotherapists to provide prevention services for those at risk for social erosion.  Social erosion happens over time among those whose mental illness is present for months to years.  Psychotherapists typically work with many people who are at risk for social erosion.  They are natural partners for you in developing prevention strategies.

 6.     Remind clients and clinicians of the importance of measuring and tracking social networks over time.  There are simple ways to measure social support.  Tracking it in medical records and treatment plans will have a big impact.  These data will help everyone keep an eye on these key support variables and will fight the tendency to assume that because people are in formal treatment that they are automatically maintaining or improving their social support levels.

 REFERENCES

 Cox, D. W., Baugh, L. M., McCloskey, K. D., & Iyar, M. (2019). Social causation or social erosion? Evaluating the association between social support and PTSD among Veterans in a transition program. Journal of Military, Veteran and Family Health, 5(1), 71-79.

 Kelly, M. M., Reilly, E. D., Ameral, V., Richter, S., & Fukuda, S. (2022). A randomized pilot study of acceptance and commitment therapy to improve social support for veterans with PTSD. Journal of Clinical Medicine, 11(12), 3482.

 Shallcross, S. L., Arbisi, P. A., Polusny, M. A., Kramer, M. D., & Erbes, C. R. (2016). Social causation versus social erosion: Comparisons of causal models for relations between support and PTSD symptoms. Journal of Traumatic Stress, 29(2), 167-175.

KEY WORDS: Peer Support Specialist, Social Support, Social Erosion, Recovery, Peer Support, Peer Support Training, Peer Support Certification, Peer Support Jobs