Jennifer Birdsall, Ph.D.

What is touch starvation?

Also known as “touch deprivation,” “skin hunger” or “hug deprivation,” touch starvation is what occurs when a person’s exposure to physical contact has been significantly reduced or eliminated, such as during the COVID-19 pandemic and associated social distancing.

I began researching this phenomenon and discovered there was a name for it after a number of psychologists in my organization sought consultation on ways to reduce the added psychological impacts they were seeing in their skilled nursing home patients from the lack of positive human touch. Further, the psychologists were expressing how difficult it was for themselves not being able to offer a needed hug or brief hand holding during their psychotherapy sessions with patients struggling from significant grief, depression and fears.

While most residents in long-term care communities understand the reasons we cannot hug or hold a hand with those we care about, the effects of long-standing touch starvation are nonetheless significant. 

Why is physical contact so important?

Positive human touch is an integral part of human interaction and a legitimate physical and emotional need. It is hardwired and begins at birth, starting with the physical contact between a mother and newborn that facilitates bonding. 

Positive physical touch in turn leads to a positive physiological experience at the neurochemical level. This not only occurs through physical contact between parents and children or between romantic partners, but includes all positive physical touch — even platonic contact among friends and colleagues, and between patients and their formal caregivers.  Examples are a hug or warm embrace, one arm linked through another, holding hands, a reassuring hand on a shoulder, high fives, handshakes, a pat on the back, etc.  Unfortunately, apart from the immediate family one lives with, most of these experiences are off limits due to COVID-19 infection control protocols and social distancing guidelines. 

Losing this part of the human experience and not knowing when it will safely return is yet another devastating consequence of the pandemic. Over time, the mental health consequences of touch starvation can include increases in stress, depression, anxiety, sleep disturbance and trauma-related symptoms. 

How does human touch impact our emotional well-being?

When we feel a friendly touch on our skin, for example a pat on the back, our brains release oxytocin, a neuropeptide involved in increasing positive, feel-good emotions. It does this by promoting a sense of positive social connection, trust, empathy, and bonding in relationships.  At the same time, it works to decrease fear and anxiety responses in the brain. Hence why oxytocin is affectionately known as the “cuddle hormone” or “love hormone.” Without physical contact, a person loses the positive emotional boost from this mood lifting hormone.

What can we do to reduce the negative impacts of touch starvation?

Oxytocin is not the only “feel good” hormone. Therefore, during a time of social distancing, it is important to focus on ways to increase the natural release of our other mood lifting neurochemicals including dopamine, serotonin, and endorphins.

Dopamine is a neurotransmitter that is important in the brain’s reward system. We get a boost of dopamine when we experience something pleasurable, including praise or when we complete a task.

Serotonin is a neurotransmitter that helps regulate mood. This is why certain antidepressants, called selective serotonin reuptake inhibitors (SSRIs), target serotonin by increasing the availability of serotonin in the brain. Activities that increase serotonin can improve our mood.

Endorphins are your body’s natural pain reliever, which your body produces in response to discomfort or stress. Endorphin levels also increase when you engage in reward-producing activities, such as eating and exercising.

What activities can we provide our residents to support the release of these three feel good neurochemicals? (Tip: these strategies will work for you too!)

1.     Connecting with others virtually. Help residents have virtual meetings with their family and friends. Engaging in pleasant events in general helps release serotonin and dopamine.  Plus, while not the same impact as in-person encounters and physical contact, having shared positive encounters with people you care about, even remotely, can release oxytocin through the bonding experience. 

2.     Moving and exercising. Encourage residents to move safely (e.g., stretching and chair exercises). Exercise can release endorphins. Regular exercise routines increase dopamine and serotonin production. 

3.     Getting outside. Enable safe, social-distanced opportunities for residents to spend time in outdoor areas. Sunlight increases the production of serotonin and endorphins. Plus, a change in scenery can improve mood. 

4.     Giving praise and compliments. Find opportunities to give genuine praise and compliments to your residents. Compliments and praise are a form of reward and lift a person’s mood by releasing dopamine.

5.     Smiling and Laughing. Find ways to make your residents laugh. All three “feel good” neurochemicals — dopamine, serotonin and endorphins — get released when we smile and laugh. Play funny movies, television shows or YouTube videos. Prepare a joke of the day that CNAs can share with their residents during care activities. Encourage CNAs and nursing staff to ask residents to share a funny memory from their past that will get everyone laughing. And finally, make sure staff are still smiling, as smiles are contagious — even from behind a mask, which can still be “seen” in the eyes. 

Jennifer Birdsall, Ph.D., a licensed clinical psychologist, is clinical director of CHE Behavioral Health Services in Los Angeles.