How Can Friendships Support My Health? with Dr. Colleen Cullen

Welcome to Health Matters, your weekly dose of the latest in health and wellness from New York Presbyterian. I’m Faith Salie. 

I feel profoundly fortunate to have, I think, more truly dear friends than I can count on my fingers. Two of my very best friends I’ve known for 45 years, and two of my more recent dearest friends I’ve known for maybe a couple of years, but they all see me in different ways, and they all sustain me.

As it turns out, friendships aren’t just good for the soul – they also boost our mental and physical health. This week we spoke with Dr. Colleen Cullen, a psychologist at NewYork-Presbyterian and Columbia, on the power of friendships, and all the benefits they bring us. 

Faith: Dr. Colleen Cullen, thank you so much for joining us.

Dr. Cullen: Thanks for having me.

Faith: I am so excited to talk to you about friendships today because this is a topic that I feel like is near and dear to everyone’s heart. My friendships have buoyed me though the most challenging times in my life cheered me in my big, sparkly moments. And, perhaps, most importantly, you know, been quiet, comforting constants for me. Can you share a bit why friendships are important and how they have the power to benefit our health?

Dr. Cullen: Yeah, it’s an extremely important topic. I think it’s getting a lot of attention, as is well deserved of all of the important benefits of social connections and friendships being a really important part of that. We really need to prioritize our friendships and our social connectedness as an essential part of taking care of our health.

I think something that comes up for people that is pretty intuitive is that friendships can offer help or social support in a variety of ways. We can get emotional support. We can get what’s called instrumental support, like literally helping us with a task, potentially. We can also get advice or guidance or useful information on things that might be relevant to us. So that’s really important. 

Another piece that friendship can offer that I love talking about is validation. It doesn’t necessarily mean that people agree with everything that we’re saying. It means that they understand where we’re coming from, the way that we feel in a given moment makes sense to someone else. And that can have an incredibly soothing effect on us to feel seen and understood, to know that the way that we are feeling in a given moment makes sense to someone else.

So, that’s an array of benefits that friendship and social supports can offer.

Faith: So it makes sense that friendships, and having a good support system, can boost our mental health. How can friendship benefit our physical health as well?  

Dr. Cullen: You can see differences in the physical health of folks who have social supports versus those who feel more isolated and lonely. The Surgeon General issued an advisory related to loneliness in 2023. It was called Our Epidemic of Loneliness and Isolation. And there’s a statistic, I’m going to give you the direct quote that’s in the report. It says that the mortality impact of being socially disconnected is similar to that caused by smoking up to 15 cigarettes per day, which is just really paints a picture, which is why I wanted to share that with you. Starting with the idea of like the benefits, we see that we can reduce our risk of cardiovascular disease, dementia, stroke, depression, anxiety, premature death, by having social connectedness in our relationships. 

Faith: Why do you think that is? What is it about friendships and close relationships that helps preserve our health?

Dr. Cullen: One of the ways to think about this is we understand that social connection seems to be essential for people. We need food and water. And it seems as though for most people, we need some social connectedness as well.

Faith: It’s just that fundamental.

Dr. Cullen: There’s a whole bunch of different research on this. You can see an impact on your blood pressure, for example. And when you’re with someone, someone that you feel connected to seeing that there’s a change in blood pressure versus if you’re with someone who is not as connected to you. So there’s all kinds of different ways in which you can see physical benefits to having social supports and to having friendships.

Faith: All of these things that friendship offers that you just illuminated, how important are they to mental health?

Dr. Cullen: Yeah, they’re hugely important. So we can see that having social connections can have impacts on lower levels of depression, anxiety, a number of other mental health challenges that people might experience.

You know, talking about intimacy. We so often think about that, only in connection to our romantic relationships. And one of the things that I often talk about with patients is the idea that we don’t necessarily have to get all of our needs met from just one person. Different friendships offer different things. I certainly don’t think that one friend has to be all things to me. They have to understand my career and understand my family and understand what I’m going through emotionally and also have the same interests and hobbies, right? Like we can have different kinds of connections with different people, and take some of the heat off of any one individual relationship as well.

Faith: What do you think of as the characteristics of a sustaining and healthy friendship?

Dr. Cullen: Well, one of the things that I think is really important to name is that friendships take work. If we want to have friendships in our life, we have to put into the relationships what we want to get out of them. It will take effort. I think most of us who have fulfilling friendships will say it’s absolutely worth it.

One part of having a positive friendship is that there is vulnerability within the relationship and that there’s reciprocal vulnerability. So thinking about being an authentic version of ourselves within the relationship, showing true parts of ourself, even the parts maybe that we’re not proud of. The reciprocal piece of that, right, we can offer that in relationships, and then we also want that in relationships as well. So having the ability for, let’s say, in a friendship of two people for both people to be able to be vulnerable with each other can be uh, an incredibly important part of having a high quality friendship.

Faith: I want to talk about the idea of chosen family. Some people call it found family. We call it framily, which are friends who become family. How do you think about those ideas when it comes to the kind of sustaining relationships that we really need in our lives?

Dr. Cullen: Well, I think starting with the idea that, you know, friendships in our life, like those are the first relationships that we get to choose and they can offer so much to us, right? We know the common sentiments around the idea that we, we can’t pick our family members, right?

They can offer lots of value in our life and we don’t pick most of them. Whereas friends, we can choose. We can look for certain things. We can prioritize certain things. We can have choice in that. And I think naming that, of course, you know, some people have really positive connections and relationships with their family of origin and some people don’t.

And there’s lots of marginalized folks that may not feel supported by their families. You know, we’ve seen that sadly with a lot of LGBTQ plus individuals who may feel rejection from their families of origin. And so that idea that we can create sort of a chosen family for ourselves, if We’re not getting what we need or want from our families of origin or even potentially to add in and have more and more in terms of those sort of supports in our life.

Faith: What do you recommend for folks who might feel shy or intimidated? When they want to reach out and, and create a relationship with someone new.

Dr. Cullen: Yeah, I mean, I think one piece is just to, you know, I was talking about validation from others, also to validate ourselves, to have some self compassion, to know that it can be scary to put yourself out there in some way, and to recognize that, that it can feel risky, and it can feel scary, and at the same time, remember why it might be important to you.

There’s all kinds of different ways that we can think about making connections. So, the idea of: is there a way that we can pursue community? Is there an organization that you might want to be involved in a religious or spiritual organization? Is there a volunteer organization that fits with your values, things that you’re passionate about and trying to find community in that way.

There can be sort of smaller acts that might happen. If you want to make connections at work, could you ask a coworker if they want to have coffee with you? Do you go to networking events in some way? Can you reach out to old friends that you’ve had. You can also think about the idea of trying to put yourself consistently in places where friendships might happen.

So, can you go to the same workout class, for example, each week where you have the opportunity to be consistently around the same group of people? You know, there’s benefits in having social interactions that are brief and that also can sometimes lead to longer connections.

And we know that for situations that are anxiety provoking, the more exposure we have, the more we do it over and over, it gets easier. So the more often that you have these sort of low stakes kind of interactions, the easier they will become.

The other thing I would say too is like when we are in that mode, potentially, of trying to make connections that we need to be mindful of avoidance in a variety of forms.

So we think about the idea of overt avoidance of, Oh, I was invited to that birthday party, but I’m not sure if I’ll really know anyone. So I don’t think I’m going to go, right, just avoiding things that are hard versus engaging and showing up and doing what we sometimes call the opposite action. So when there is fear, the urge us to avoid, and instead we approach the situation.

There’s also what we call covert avoidance. So the idea of, you know, you do decide to go to the, the birthday party, but you stand in the corner by yourself, or you spend time on your phone that you know that social crutch that we have all come to rely on.

Faith: And then that becomes a self fulfilling prophecy, right? Ugh, I knew I wasn’t gonna make a friend.

Dr. Cullen: Absolutely, why did I show up, I knew that no one would talk to me. Right? And we’re not realizing the ways in which we are potentially making it difficult to engage with us versus the idea of having warm and open body language, and your body is faced towards other people and you’re making eye contact, right? That there’s ways in which we can make it more or less likely that people will want to engage with us.

And, to act interested in other people is such a great tool towards making connections. It feels so good to us as humans in general to know that someone is interested in us and they’re paying attention. And so to offer that to someone can make a real difference in an interaction.

Faith: Do you think it is more challenging for men to make and maintain friendships than women?

Dr. Cullen: There are no differences in terms of what our needs are for friendship, regardless of gender, so it’s not as though, you know, men need friendships less than women, for example. I think one of the things that comes up that we, you know, as a society have given some attention to is people who identify as men, oftentimes there’s societal expectations that there would be less vulnerability in some ways and that can feel like an even bigger leap or, you know, they may feel that it’s looked down upon in some way.

I think there’s some really good societal movement around this, but that can certainly get in the way of having quality friendships if there’s not vulnerability that’s happening in relationships.

Faith: How do you determine when a friendship is not quite healthy and maybe even needs to end?

Dr. Cullen: Yeah, I think one of the things is to sort of check in with ourselves, particularly I think after a given interaction, right? After I spend time with that person or talk to them, do I feel supported? Do I feel lighter? Do I feel heard? I think that’s a great one. Or, do I feel depleted? Do I feel misunderstood? Do I feel used in some way? And so, being able to check in with ourselves of – what is this friendship offering in our lives?

Faith: So let’s say you do check in and you kind of repeatedly feel depleted. Um, how do you recommend that people kind of exit a friendship with grace and love? Is it kind of okay just to let something fizzle out as a friend?

Dr. Cullen: Yeah. I think, you know, a lot of us have had this experience, right? That there’s no necessarily conflict, maybe we just don’t have as much in common or we’re both really busy. It’s just not feeling like it’s something that maybe both parties are interested in putting a lot of effort in as, we might be in a busy season of life and that can be okay.

I think there’s really a choice of: do you confront it directly? Do you let someone know that maybe you’re going to pull back in some way, or you don’t want to continue the friendship at this time, which I’ll just name like feels hugely awkward to do. As long as it’s a, essentially like a safe conversation to have, it can show respect to the other person, if you can, to find a way to have that conversation. I think it’s really good practice to be able to have some of those difficult conversations.

The idea that things can sort of fade out or change can be okay. When a relationship ends, it doesn’t mean that the relationship was a failure. It, I think that If it had good qualities in it, then it really had something to offer at some point in our life, and we can really value, respect, appreciate that, even if the relationship has ended in some way.

Faith: You mentioned earlier that friendships take work, so what are some easy things people can do to make sure we take care of our friends?

Dr. Cullen: That can look different for each of us, right? Like, how do you show up, maybe on a daily basis, maybe not. Like, how can you, check in on people in your life that you care about? It can be so meaningful to tell someone in your life that you were, you know, just thinking about them, they came to your mind, you show gratitude for them in some way. I think it’s being creative about it and being able to talk openly and, and try different things out at different times.

Find those different ways to reach out. I’ve heard of people running errands together, right? They do their grocery shopping together as a way to connect or, you know, if you’re exercising, you could do the exercise with a friend who might share the, the same goals that you have. It brings the, the sort of like barrier down.

It can be sending a text or a little voice note or, you know, you could send them like the tiniest of gifts to say that you’re thinking about them. Just all of those deliberate efforts showing gratitude and appreciation that they are meaningful to us and that we appreciate what they offer in our lives.

Faith: Dr. Colleen Cullen, thank you so much for talking to us about the importance of friendships.

Dr. Cullen: Yeah. Thank you so much for the opportunity,

Faith: Our many thanks to Dr. Cullen. I’m Faith Salie.

Health Matters is a production of New York Presbyterian. The views shared on this podcast solely reflect the expertise and experience of our guests. New York Presbyterian is here to help you stay amazing at every stage of your life.

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