Chronic social exclusion and evidence for the resignation stage: An empirical investigation

Abstract

Experiences of social exclusion, including ostracism and rejection, can last anywhere from a few seconds to many years. Most research focused on short-term social exclusion whereas virtually no empirical work has investigated the experiences of long-term social exclusion. Williams (2009) theorized that prolonged experiences of social exclusion (i.e., ostracism) would cause individuals to pass from the reflexive and reflective stages to the resignation stage, characterized by the inability to recover threatened psychological needs and feelings of alienation, unworthiness, helplessness, and depression. Across two studies, we explored this prediction—and, in light of pain overlap theories, considered the possibility that chronic exclusion and chronic pain induce common psychological responses. Study 1 consisted of a quasi-experimental study involving five groups of participants: those with (1) chronic experiences of social exclusion (N=82), (2) chronic physical pain (N=82), (3) chronic hypertension (N=69), (4) chronic kidney disease (N=60), and (5) a group of healthy people (N=83). Participants filled out a questionnaire including measures of need threat, negative emotions, and the four key outcomes linked to the resignation stage (i.e., alienation, unworthiness, helplessness, and depression). Although our data showed little evidence to support the psychological overlap between chronic exclusion and chronic physical pain, the results suggested that chronic experiences of social exclusion were associated with higher levels of negative emotions and resignation stage outcomes compared to participants in all the other groups. Furthermore, we found that threatened psychological needs mediated the effect of social exclusion on the resignation stage outcomes. Study 2 tested, but found no support for, the possibility that acute experiences of social exclusion could increase the resignation stage outcomes. Overall, our research indicates that when people are exposed to short-term exclusion, they recover their threatened psychological needs. However, when enduring chronic social exclusion, they do not, and enter the resignation stage.

Full text

Article
Chronic social exclusion
and evidence for the
resignation stage: An
empirical investigation
Paolo Riva
1
, Lorenzo Montali
1
, James H. Wirth
2
,
Simona Curioni
3
, and Kipling D. Williams
4
Abstract
Experiences of social exclusion, including ostracism and rejection, can last anywhere
from a few seconds to many years. Most research focused on short-term social exclu-
sion, whereas virtually no empirical work has investigated the experiences of long-term
social exclusion. Williams theorized that prolonged experiences of social exclusion (i.e.,
ostracism) would cause individuals to pass from the reflexive and reflective stages to the
resignation stage characterized by the inability to recover threatened psychological
needs and feelings of alienation, unworthiness, helplessness, and depression. Across two
studies, we explored this prediction—and, in light of pain overlap theories, considered
the possibility that chronic exclusion and chronic pain induce common psychological
responses. Study 1 consisted of a quasi-experimental study involving five groups of
participants: (1) those with chronic experiences of social exclusion (n¼82), (2) those
with chronic physical pain (n¼82), (3) those with chronic hypertension (n¼69),
(4) those with chronic kidney disease (n¼60), and (5) a group of healthy people
(n¼83). Participants filled out a questionnaire including measures of need threat,
negative emotions, and the four key outcomes linked to the resignation stage (i.e.,
alienation, unworthiness, helplessness, and depression). Although our data showed little
evidence to support the psychological overlap between chronic exclusion and chronic
1
University of Milano–Bicocca, Italy
2
The Ohio State University at Newark, USA
3
Azienda Ospedaliera San Paolo, Italy
4
Purdue University, USA
Corresponding author:
Paolo Riva, Department of Psychology, University of Milano–Bicocca, Piazza Ateneo Nuovo, 1, 20126 Milano,
Italy.
Email: paolo.riva1@unimib.it
Journal of Social and
Personal Relationships
1–24
ªThe Author(s) 2016
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DOI: 10.1177/0265407516644348
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physical pain, the results suggested that chronic experiences of social exclusion were
associated with higher levels of negative emotions and resignation stage outcomes
compared to participants in all the other groups. Furthermore, we found that threatened
psychological needs mediated the effect of social exclusion on the resignation stage
outcomes. Study 2 tested, but found no support for, the possibility that acute experi-
ences of social exclusion could increase the resignation stage outcomes. Overall, our
research indicates that when people are exposed to short-term exclusion, they recover
their threatened psychological needs. However, when enduring chronic social exclusion,
they do not, and enter the resignation stage.
Keywords
Chronicphysicalpain,chronicsocialexclusion,exclusion,needthreat,ostracism,
rejection
In recent decades, hundreds of empirical studies found that various forms of social
exclusion (e.g., ostracism, rejection, isolation, bullying, and discrimination
1
) can cause a
wide array of negative consequences, including—but not limited to—painful feelings
(Eisenberger, Lieberman, & Williams, 2003), negative emotions (Gerber & Wheeler,
2009), a decline in cognitive abilities (Baumeister, Twenge, & Nuss, 2002), increased
social susceptibility (Riva, Williams, Torstrick, & Montali, 2014), and aggressive
responses (Twenge, Baumeister, Tice, & Stucke, 2001). Most of these previous research
focused on short-term episodes of threats to social connections. For instance, Nezlek,
Kowalski, Leary, Blevins, and Holgate (1997) randomly assigned participants to receive
feedback that either everyone or no one wants to work with them on a group task. In
another task, called Cyberball (Williams, Cheung, & Choi, 2000), participants believe they
are playing with other players in an online ball tossing game (they are actually computer
agents). Ostracized participants receive throws only at the beginning of the game but then
never again. With both manipulations, and potentially others (Wirth, In press), participants
do not know each other before the study and do not believe they will meet again with the
others after it, which suggests the manipulations are particularly minimal. However, in real
life, experiences of exclusion are likely to have consequences far more extreme than
researchers can observe when participants are being kept apart in a minimal lab paradigm.
To examine chronic experiences of social exclusion, Zadro (2004) conducted inter-
views with individuals who were ostracized and excluded for years and even decades. In
her interviews with over 50 long-term targets of ostracism, Zadro found chronically
ostracized individuals were no longer looking for belonging, it appeared that they had
become alienated; they were no longer looking for self-enhancement, they seemed
resigned to accept their changeless low self-worth; they were no longer seeking a sense
of personal control over their environment, they seemed to have embraced helplessness;
and—finally—they were no longer looking for recognition of their existence by others,
instead they appeared to have become depressed.
The insights gathered from these interviews helped Williams (2009) build his Tem-
poral Need Threat Model of Ostracism in a way that considered different durations of
ostracism experiences.
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Three temporal stages of responses to ostracism
Williams’s (2009) Temporal Need Threat Model of Ostracism posits three stages of
responses to ostracism: (1) reflexive (immediate), (2) reflective (coping), and (3) res-
ignation (long-term). Williams (2001) argued that a single episode of ostracism imme-
diately threatens four fundamental psychological needs: control, self-esteem, belonging,
and meaningful existence. He called this the ‘‘reflexive stage,’’ that is, when the
ostracized individual feels the immediate pain associated with a social threat. Currently,
over 200 publications report short-term, experimentally induced instances of ostracism
lead to threaten satisfaction of the four basic needs (effect sizes range from d¼1.0 to
2.0; Gerber & Wheeler, 2009; Hartgerink, van Beest, Wicherts, & Williams, 2015).
This first stage is followed by the ‘‘reflective stage,’’ when individuals assess,
appraise, cope, and recover from the social threat episode. If individuals successfully
cope in the reflective stage, their basic need satisfaction and affect will recover, which
keeps ostracized individuals from entering the ‘‘resignation stage.’’ Thus, Williams’s
model (2009) extended his predictions beyond reactions to acute social threats to include
the third stage of ostracism or the resignation stage. During the resignation stage, social
threats (e.g., ostracism) persist over time and the resources necessary for fortifying
threatened needs become depleted—the individual becomes resigned to the outcomes of
their exclusion. Belonging fortification could turn to alienation, self-esteem preservation
could turn to constant feelings of low self-worth, reactance could turn to learned help-
lessness, and attempts to prove worthy of attention could turn to depression (Williams,
2009). In short, unlike an acute episode of social exclusion (e.g., ostracism during
Cyberball) where individuals should recover, chronic social exclusion might persistently
threaten the fundamental psychological needs, ultimately producing a downward spiral
toward alienation, unworthiness, helplessness, and depression. Whereas qualitative
interviews provide anecdotal support for the resignation stage (Williams, 2001; Williams
& Zadro, 2001), empirical evidence is needed to support these predictions of the
Williams’s model (2009).
The overlap between social and physical pain
During the last decade, researchers argued that acute social exclusion elicits a pain
response (labeled social pain; see Eisenberger et al., 2003). This finding was accounted
for by pain overlap theories (Eisenberger & Lieberman, 2005; MacDonald & Leary,
2005), according to which individuals process social exclusion similarly to experiences
of physical pain.
Crucially, for the purposes of the present work, researchers recently found that the
neural overlap between the pain types also implies an overlap in their psychological
responses (Riva, Wirth, & Williams, 2011). Accordingly, researchers suggested that
even a short-term experience of physical pain (i.e., hand submerged in cold water) can
threaten need satisfaction (i.e., belonging, control, meaningful existence, and self-
esteem) in way similar to what social pain does (i.e., ostracism during Cyberball; Riva
et al., 2011, for similar results see Chen, Poon, & DeWall, 2015). Other results suggest
an overlap between fear of social pain and fear of physical pain (Riva, Williams, &
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Gallucci, 2014), such that high fear for either type of pain intensifies the subjective
experience of either type of pain. However, past research also showed that people can
‘‘relive’’ social pain more vividly and more painfully than they can physical pain (Chen
& Williams, 2010; Chen, Williams, Fitness, & Newton, 2008). This research suggests
that there may be departures between social and physical pain. For social exclusion,
especially if the exclusion led to rumination, then the individuals will be more likely to
continue feeling and experiencing the pain associated with it, even in moments when
actual social exclusion is not occurring. Thus, it remains unclear whether the psycho-
logical overlap of the aversive consequences of a brief social exclusion experience and
physical pain extend to chronic conditions as well, which leads us to the present research.
The present research
In the first study, we investigated whether chronic social exclusion produces outcomes
associated with the outcomes of the resignation stage (e.g., alienation) and whether
chronic exclusion and chronic pain induce common psychological responses. Building
from these findings, the second study ruled out the possibility that even experiences of
short-term social exclusion could increase resignation stage outcomes.
Study 1
The aim of Study 1 was twofold. Firstly, we tested—for the first time—the prediction
made by the third stage of the Williams’s resignation stage (2009), that chronic
experiences of social exclusion induce feelings of alienation, unworthiness, helplessness,
and depression. In pursuing this aim, we also investigated whether experiences of
chronic social exclusion are associated with high levels of negative emotions. Secondly,
considering current theories on pain overlap (Eisenberger & Lieberman, 2004; Mac-
Donald & Leary, 2005), we tested the possibility that experiences of chronic social
exclusion and physical pain induce common psychological responses (i.e., negative
emotions and resignation stage outcomes). To test our aims, we planned to conduct
several group comparisons.
To test the first aim, we began our analyses by comparing the responses provided by a
group of individuals who experienced chronic social exclusion with those of a group of
healthy participants. However, we also compared the responses of the chronic social
exclusion group against those provided by participants experiencing other chronic and
distressful conditions, such as experiences of chronic physical pain, chronic hyperten-
sion, and chronic kidney disease. In doing so, we investigated whether the consequences
potentially associated with chronic social exclusion are specifically linked to the
experience of prolonged exclusion itself or to the mere chronicity (i.e., the temporal
dimension) of a distressful (e.g., disease) condition.
In short, we tested the following comparisons in Hypothesis 1: We expected chronic
social exclusion to be associated with the higher levels of negative emotions and neg-
ative outcomes of the resignation stage (i.e., alienation, unworthiness, helplessness, and
depression) compared to individuals of all the other groups (i.e., healthy people and
physical pain, chronic hypertension, and chronic kidney disease patients). Furthermore,
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we considered a potential mechanism that could account for such effect. Given that
chronic social exclusion might persistently threaten the fundamental psychological
needs, leading an individual into a downward spiral toward alienation, unworthiness,
helplessness, and depression, we investigated the possibility that threatened psycholo-
gical needs would meditate the effect of chronic social exclusion on the outcomes of the
resignation stage.
To test our second aim, namely, the possibility that the experiences of chronic social
exclusion and chronic physical pain induce common psychological responses, we con-
trasted the responses of chronic social exclusion and chronic physical pain groups
against those reported by healthy participants and participants experiencing two other
distressful conditions (i.e., illnesses) that are chronic but not painful (i.e., chronic
hypertension and chronic kidney disease). In doing so, we investigated whether the
consequences potentially associated with both chronic social exclusion and physical pain
are linked to the presence of pain (both social and physical) rather than just to the
chronicity (i.e., the temporal dimension) of a distressful condition (i.e., chronic hyper-
tension and chronic kidney disease). This was meant to provide a conservative test of the
possibility that experiences of chronic social exclusion and chronic physical pain induce
common psychological responses.
This possibility led to Hypothesis 2: We predicted participants with chronic physical
pain will have higher levels of negative emotions and negative outcomes associated with
the resignation stage compared to healthy participants, to a group of patients with a mild
chronic (but not painful) physical illness (i.e., chronic hypertension), and to a group of
patients with a severe chronic (but not painful) illness (i.e., chronic kidney disease). In
line with Hypothesis 1, we still predicted a difference between chronic social exclusion
and chronic physical pain. However, the key prediction of Hypothesis 2 lies in the
expected difference between chronic physical pain and two other chronic, but not
painful, conditions (e.g., chronic hypertension and chronic kidney disease). Indeed, a
difference between chronic physical pain and the two other chronic, but not painful,
conditions would be needed to allow us to suggest that experiences of chronic social
exclusion and chronic physical pain induce common psychological responses.
As a preliminary step, to check the appropriateness of our samples, we expected
chronic social exclusion to be associated with the highest levels of social exclusion
symptoms (i.e., need threat), whereas chronic physical pain to be associated with the
highest levels of physical pain symptoms compared to all of the groups.
Method
Participants: Groups and recruitment procedures for each group
We conducted an a priori power analysis to estimate our sample size (using GPower 3.1;
Faul, Erdfelder, Lang, & Buchner, 2007). With an a¼.05 and power ¼.95, the pro-
jected sample size needed to detect a medium effect size (f¼.25) was approximately
N¼300 for a between-group comparison (analysis of variance [ANOVA], fixed effects,
omnibus, one way). Overall, we recruited 379 participants (54%females; M
age
¼51.78,
SD ¼15.45) in a quasi-experimental design that was subdivided into five groups. Thus,
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our sample size should be adequate for the objectives of this study. Table 1 contains the
demographic data for each group.
Chronic social exclusion
We recruited a group of people with experiences of chronic social exclusion, which we
operationalized as exclusion that has lasted longer than 3 months. In doing so, we
paralleled the International Association for the Study of Pain (IASP) (1979) oper-
ationalization of chronic physical pain (see below). Specifically, we recruited partici-
pants based on the question, ‘‘Recently, have you felt socially excluded for more than 3
months?’’ Participants in the chronic social exclusion group were recruited through a
Facebook page, flyers, and advertisements in local newspapers; all of which included the
screening question, an e-mail contact, and a link to an online survey.
For this group, we asked additional screening questions. Participants were asked first
what form of social exclusion they were suffering from the most; participants chose from
exclusion (4%), ostracism (11%), rejection (6%), betrayal (4%), humiliation (1%),
abandonment (22%), bereavement (12%), loneliness (36%), and mobbing (4%). A
second question assessed the duration of the instance of social exclusion participants
experienced (M
months
¼81.44, approximately 6 and 3
=
4years; SD ¼96.90). A third
question asked if they were taking any medications (if so, which ones) to cope with their
situation of social exclusion.
Chronic physical pain
As our primary comparison group, we recruited a group of people who reported
experiences of chronic physical pain. The IASP (1979) defined chronic physical pain as
those that lasted longer than 3 months. Accordingly, patients were recruited from pri-
mary care offices, identified by their general practitioners based on the IASP-defined
diagnosis of chronic physical pain, and then contacted. Those who agreed to participate
were given a paper-and-pencil questionnaire packet.
For this chronic pain group, we also asked screening questions related to the specific
form of chronic physical pain, its duration, the treatments options they were using, and
the effectiveness of the pain treatment. Participants first indicated what form of physical
pain they were suffering from; participants indicated osteoarthritis (32%), arthritis (4%),
osteoporosis (4%), low back pain (17%), rheumatoid arthritis (4%), ankylosing spon-
dylitis (1%), neuralgia (21%), neuropathy (10%), neurogenic arthropathy (2%), and
Table 1. Demographics (Study 1).
Group nAge (SD) Females Nationality, # of Italians
Chronic social exclusion 82 43.29 (9.45) 49 (59%) 82 (100%)
Chronic physical pain 82 56.13 (14.21) 49 (59%) 80 (98%)
Chronic hypertension 69 54.86 (13.97) 41 (54%) 67 (97%)
Chronic kidney disease 60 61.62 (16.27) 27 (43%) 57 (95%)
Healthy subjects 83 46.20 (15.83) 42 (50%) 83 (100%)
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other types of chronic pain (5%). We also assessed the duration (M
months
¼12.69;
SD ¼27.05) and the treatments options they were using of these patients’ chronic
physical pain. Finally, for this sample, we measured the subjective effectiveness of the
pain medication: ‘‘Please rate the EFFECTIVENESS of your pain medication on your
pain’’ on a scale from 1 (ineffective)to10(very effective).
Mild chronic, but not painful, physical illness—chronic hypertension
Chronic hypertension is a medical condition in which the blood pressure is chronically
high. For the purposes of the current study, we considered this a ‘‘mild’’ form of physical
illness based on the evidence that chronic hypertension per se usually produces no
symptoms (including physical pain; Kottke, Tuomilehto, Puska, & Salonen, 1979). To
recruit participants for this group, general practitioners contacted participants they
diagnosed with chronic hypertension. Those who agreed to participate were given a
questionnaire packet. Participants were also asked to indicate the duration of their
condition (M
months
¼59.32, approximately 5 years; SD ¼49.39) and their treatment
options for their chronic hypertension.
Severe chronic, but not painful, illness—chronic kidney disease
Chronic kidney disease is defined as the presence of kidney damage evidenced by
specific laboratory findings, instrumental or pathological, or reduced renal function that
persisted for at least 3 months (National Kidney Foundation, 2002). The severity of
chronic kidney disease is described by six stages of increasing severity. Chronic kidney
disease is a life-threatening disease, thus, for the purposes of the current study, we
considered it as a severe form of physical illness. However, to try to avoid as much as
possible the comorbidity between chronic kidney disease and physical pain symptoms,
we considered only patients in the first three stages of the disease (pain symptoms are
more likely to occur in the three last stages of the disease; de Zeeuw, 2008; National
Kidney Foundation, 2002).
A researcher from a large hospital in Italy contacted patients who were eligible for the
study. Those patients who agreed to take part in the study received a questionnaire
packet. Participants were also asked to indicate the duration of their condition (M
months
¼
120.56, approximately 10 years; SD ¼124.74) and their treatment options they were
using for their chronic kidney disease. Causes of each participant’s chronic kidney
disease varied (diabetes, hypertensions, glomerulonephritis, cardio renal syndromes,
asymptomatic nephrolithiasis) as did the severities of the condition (however, patients
were always within the first three stages of the disease).
Healthy people
Finally, we recruited a group of healthy participants who had (1) not felt socially
excluded for more than 3 months in the last 6 months, (2) not felt physical chronic pain
for more than 3 months in the last 6 months, and (3) not experienced any other chronic
illnesses for more than 3 months in the last 6 months.
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Dependent variables: Control measures
All participants who met the selected criteria for each group filled out several ques-
tionnaires related to their general characteristics and amount of social and physical pain
they experienced.
General health measure: The Short Form for Health (SFH) survey. This survey assessed
participant’s general health conditions. Specifically, the SFH-12 (Ware, Kosinski, &
Keller, 1996) is a 12-item questionnaire designed to measure two key component of
health: mental (a¼.83) and physical (a¼.84). Scale responses varied according to each
of the 12 questions, with higher scores indicating a better level of general health.
Social exclusion symptoms: The Need-Threat Scale. The Need-Threat Scale (Williams, 2009)
evaluated the prevalence of social exclusion and consisted of 20 items measuring
satisfaction of four fundamental needs, that is, belonging (e.g., ‘‘I felt rejected’’), self-
esteem (e.g., ‘‘I felt liked’’), control (e.g., ‘‘I felt powerful’’), and meaningful existence
(e.g., ‘‘I felt invisible’’) during the past 6 months. Responses were rated on a 5-point
scale (1 ¼not at all to 5 ¼very much). For the purpose of the present study, we created
an average responses on the four basic needs (a¼.93) scored, so that higher scores
indicate that the basic needs are threatened (e.g., low sense of belonging to others).
Physical pain symptoms: The Neuropathic Pain Scale. We used this scale (adapted from Galer
& Jensen, 1997) to assess physical pain symptoms over the past 6 months. This scale
includes 2 items related to the intensity and unpleasantness of physical pain ‘‘In the last
six months, how intense/unpleasant the pain has been?’’ Five items related to the qua-
lities of pain (i.e., sharp, hot, dull, cold, and itchy), 1 item evaluated the patient’s pain
reaction to light touch or clothing, and 2 final items captured the intensity of the deep and
surface pain. All the items are rated on an 11-point scale (ranging from 0 ¼no pain to
10 ¼most intense/unpleasant pain imaginable). We averaged the 10 items to create an
overall index of physical pain symptoms (a¼.92), with higher scores indicating more
physical pain symptoms.
Dependent variables: Negative emotions and resignation stage outcomes
Negative emotions: The Rejected-Related Emotions Scale. Based on the previous 6 months,
participants completed 20 items assessing five clusters of negative emotions (adapted
from Buckley, Winkel, & Leary, 2004): anger, anxiety, sadness, hurt, and rejection.
Items were rated on a 5-point scale (ranging from 1 ¼not at all to 5 ¼very much), and
we averaged them together to create an overall index of negative emotions (a¼.96;
higher scores indicating more negative emotions).
Resignation stage measures
All participants were asked to complete the following four scales, each of which
were selected to correspond to a specific construct (e.g., alienation) predicted by the
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Williams’s (2009) resignation stage. Participants were instructed to respond to each of
the following scales based on how they felt during the past 6 months.
Alienation: Sense of Belonging Instrument. This scale (Hagerty & Patusky, 1995) assesses
stable feelings of the divorce between the self and others. We adopted it to assess par-
ticipant’s feelings of alienation. In the short term, threats to social belonging have been
generally measured as a psychological—temporary—state in which the individuals
perceive a separation between self and others (e.g., ‘‘When the event happened, I felt
excluded’’). By contrast, the Sense of Belonging Instrument (SOBI) assesses stable
feelings of the divorce between the self and others. From the general scale, we used the
subscale called SOBI-P (psychological state). The scale consists of 18 items (e.g., ‘‘I feel
like an outsider in most situations,’’ ‘‘I generally feel that people accept me’’ reversed-
coded; a¼.96). Items were rated on a 5-point scale (ranging from 1 ¼never true for me
to 5 ¼always true for me), with higher scores indicating increased feelings of alienation.
Unworthiness: Self-Esteem Scale. Self-esteem has been conceptualized as a mechanism by
which one assesses her/his own inclusionary status (Leary & Baumeister, 2000). The
Rosenberg’s Self-Esteem Scale (Rosenberg, 1965) assesses global self-esteem, or trait
self-esteem as it is relatively enduring, by focusing on people’s general feelings toward
themselves both across time and situations. We adopted this scale as a proxy to assess
feelings of unworthiness. The scale consisted of 10 items (e.g., ‘‘On the whole, I am
satisfied with myself,’’ ‘‘All in all, I am inclined to feel that I am a failure,’’ reversed
coded; a¼.86) that were rated on a 5-point scale (ranging from 1 ¼totally disagree to
5¼totally agree). Higher scores indicate more feelings of unworthiness.
Helplessness: Beck Hopelessness Scale. We adopted the Beck Hopelessness Scale (Beck,
Weissman, Lester, & Trexler, 1974) to measure helplessness, with the idea that the
helplessness construct largely overlaps with that of hopelessness, as measured by the
Beck’s Scale. This 20-item self-report scale was designed to measure three major
aspects, that is, negative feelings about the future (e.g., ‘‘My future seems dark’’), loss of
motivation (e.g., ‘‘I could give up because I cannot make things better for me’’), and
negative expectations (e.g., ‘‘Things do not go as I want them to go’’). Items were rated
on a 5-point scale (1 ¼totally disagree to 5 ¼totally agree). For the purposes of the
present study, an overall index was created (a¼.89), with higher scores indicating more
feelings of helplessness.
Depression: Beck Depression Inventory. We adopted this scale to assess depression (Beck,
Steer, Ball, & Ranieri, 1996). Compared to the original version, we did not include the
item related to suicidal thoughts (for ethics reasons), leaving 20 items that were rated on
a 4-point scale that varied according to each item (e.g., ‘‘I feel sad much of the time’’; ‘‘I
am so sad or unhappy that I can’t stand it’’). We averaged the items together to create an
overall index (a¼.97), with higher scores indicating increased feelings of depression.
Resignation overall index. We created an overall index by averaging together all of the
68 individual items from the four scales (e.g., alienation, unworthiness, helplessness, and
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depression; a¼.98). Because items of one scale were rated on 4-point scales, whereas
the others were rated on 5-point scales, each individual score was standardized prior to
being averaged to create the overall index. This scoring is similar to previous procedures
researchers used to create an overall index of need threat following exploring short-term
social exclusion (e.g., Wirth, Sacco, Hugenberg, & Williams, 2010).
Demographics
We also asked participants to indicate their sociodemographic information, including
age, gender, nationality, education, marital status, and job position.
Results and discussion
Statistical analysis
We performed one-way ANOVAs to test the overall differences between groups. Our
specific hypotheses were tested using post hoc analysis with Bonferroni correction to
control for multiple comparisons.
Preliminary analyses
Demographics. The distribution of male and female did not vary across groups (w¼6.4;
p¼.171; see Table 1 for descriptive statistics) and neither did participant’s nationality
(w¼6.7; p¼.154). However, groups did vary in terms of participant’s age as parti-
cipants with chronic social exclusion were significantly younger than those with chronic
physical pain, chronic hypertension, and chronic kidney disease, F(4, 375) ¼20.95,
p< .001. Because of this, we included age as a covariate in all the analyses.
Main analyses on control measures
Health condition. Firstly, the analyses showed significant group differences on the mental
component summary scale (e.g., feeling nervous and depressed vs. happy and calm),
F(4, 369) ¼61.52, p< .001, Z
p
2
¼.40. Post hoc analyses (see Table 2 for all the
descriptive statistics) showed that the participants with chronic social exclusion expe-
rienced worse mental health than did healthy participants and those with chronic
physical pain, chronic hypertension, and chronic kidney disease.
We also found that participants with chronic physical pain experienced worse mental
health compared to those reported by the healthy participants. Chronic physical pain was
associated with lower levels of mental health than was chronic hypertension. However,
the difference in this measure between chronic physical pain and chronic kidney disease
was not significant.
Secondly, the analyses showed significant group differences on the physical com-
ponent summary scale (e.g., limitations with work and other daily activities as a result of
physical health), F(4, 369) ¼38.86, p< .001, Z
p
2
¼.30. Post hoc analyses showed that
participants with chronic social exclusion experienced worse physical health than
did healthy participants. As expected, we found that individuals with chronic social
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exclusion experienced better physical health than did those with chronic physical pain.
However, we found that people with chronic social exclusion experienced worse
physical health than did those with chronic hypertension, whereas the difference between
chronic social exclusion and chronic kidney disease was not significant.
Finally, we found that the participants with chronic physical pain experienced worse
physical health than did healthy participants, participants with chronic hypertension, and
chronic kidney disease.
Social exclusion symptoms. The analyses showed significant group differences in the
overall index of need threat, F(4, 367) ¼84.56, p< .001, Z
p
2
¼.48
2
. Post hoc analyses
showed that the participants with chronic social exclusion experienced more social
exclusion symptoms than did healthy participants and participants with chronic physical
pain, chronic hypertension, and chronic kidney disease.
Then, we found that participants with chronic physical pain felt more social exclusion
symptoms compared to those reported by the healthy participants. By contrast, chronic
physical pain did not differ in this measure compared to chronic hypertension and
chronic kidney disease.
Physical pain symptoms. We found significant group differences also on the measure of
physical pain symptoms, F(4, 366) ¼46.29, p< .001, Z
p
2
¼.33. Post hoc analyses
showed that participants with chronic social exclusion felt more physical pain than did
healthy participants. We then found that chronic social exclusion was associated with
fewer physical pain symptoms than chronic physical pain. However, chronic social
exclusion was still associated with worse physical pain symptoms compared to chronic
hypertension, whereas the difference between chronic social exclusion and chronic
kidney disease was not significant.
Table 2. Means and standard deviations (in parenthesis) of the scores on the mental and physical
component summary scales of SF-12, social exclusion and physical pain symptoms, and negative
emotions (Study 1).
a
Group
Chronic social
exclusion
Chronic
physical pain
Chronic
hypertension
Chronic
kidney disease
Healthy
subjects
Mental component
summary (0–4)
2.05 (0.56) 2.75 (0.60)
b
3.15 (0.58)
c,d
2.99 (0.71)
b,c
3.43 (0.58)
d
Physical component
summary (0–4)
2.42 (0.79)
b
1.98 (0.48) 2.59 (0.59)
c
2.41 (0.62)
b,c
2.97 (0.26)
Social exclusion
symptoms (1–5)
2.74 (0.65) 1.64 (0.54)
b
1.59 (0.55)
b
1.49 (0.49)
b,c
1.23 (0.54)
c
Physical pain
symptoms (0–10)
3.39 (2.23)
b
5.45 (1.67) 1.89 (2.04)
c
3.05 (2.57)
b
1.56 (1.47)
c
Negative emotions
(1–5)
3.94 (0.71) 2.85 (0.71) 2.52 (0.64)
b
2.47 (0.77)
b
2.23 (0.60)
b
Note: Means that have no superscript letters
(b,c,d)
in common in a given row are significantly different from each
other at p< .05.
a
Higher scores indicate higher levels of each outcome.
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Then, we found that the participants with chronic physical pain reported higher levels
of physical pain symptoms compared to healthy participants and compared to partici-
pants with chronic hypertension and chronic kidney disease.
Negative emotions and resignation stage outcomes
Negative emotions. A one-way ANOVA showed significant group differences in negative
emotions, F(4, 367) ¼75.21, p< .001, Z
p
2
¼.45. In line with Hypothesis 1, post hoc
analyses showed that participants with chronic social exclusion experienced more
negative emotions than did healthy participants and those with chronic physical pain,
chronic hypertension, and chronic kidney disease.
Then, we found that participants with chronic physical pain reported higher scores of
negative emotions compared to those reported by the healthy participants. In line with
Hypothesis 2, participants with chronic physical pain reported higher levels of negative
emotions than did participants with chronic hypertension and chronic kidney disease.
Resignation stage. A series of one-way ANOVAs showed significant group differences in
all the four key measures of the resignation stage, smallest F(4, 366) ¼30.01, p< .001
Z
p
2
¼.25, for unworthiness; see Table 3 for all the descriptive statistics. Post hoc
analyses showed that the participants with chronic social exclusion reported higher
levels of alienation, unworthiness, helplessness, and depression compared to those
reported by the healthy participants. Further supporting Hypothesis 1, we found that
participants experiencing chronic social exclusion reported higher levels of alienation,
unworthiness, helplessness, and depression compared to those reported by the partici-
pants with chronic physical pain, chronic hypertension, and chronic kidney disease.
Then, we found that participants with chronic physical pain reported higher scores of
alienation, unworthiness, helplessness, and depression compared to those reported by the
healthy participants. However, chronic physical pain did not differ on alienation,
unworthiness, helplessness, and depression scores from the chronic hypertension group.
Yet, providing mixed support for Hypothesis 2, participants with chronic physical pain
did report higher levels of alienation compared to participants with chronic kidney
Table 3. Means and standard deviations (in parenthesis) of the four outcomes associated with
resignation stage (Study 1).
a
Group
Chronic social
exclusion
Chronic
physical pain
Chronic
hypertension
Chronic kidney
disease
Healthy
subjects
Alienation 3.39 (.79) 2.27 (.81)
b
2.16 (.88)
b
1.79 (.72)
c
1.54 (.51)
c
Unworthiness 3.08 (.82) 2.42 (.63)
b
2.51 (.69)
b
2.23 (.64)
b,c
1.96 (.59)
c
Helplessness 3.49 (.66) 2.81 (.53)
b
2.80 (.51)
b
2.77 (.65)
b,c
2.38 (.54)
c
Depression 2.41 (.54) 0.68 (.53)
b
0.47 (.47)
b,c
0.65 (.51)
b,c
0.40 (.45)
c
Resignation overall
index
0.84 (.45) 0.08 (.43)
b
1.4 (.44)
b
0.22 (.42)
b,c
0.47 (.32)
c
Note: Means that have no superscript letters
(b,c)
in common in a given row are significantly different from each
other at p< .05.
a
Higher scores indicate higher levels of each outcome.
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disease. However, chronic physical pain did not differ on unworthiness, helplessness,
and depression scores from the chronic kidney disease group.
Resignation overall index. Finally, the analyses showed significant group differences on the
overall index of resignation, F(4, 370) ¼119.83, p< .001, Z
p
2
¼.56. Supporting
Hypothesis 1, post hoc analyses showed that the participants experiencing chronic social
exclusion reported more negative outcomes associated with the resignation stage com-
pared to those reported by the healthy participants and those with chronic physical pain,
chronic hypertension, and chronic kidney disease.
Then, we found that participants with chronic physical pain reported more negative
outcomes associated with the resignation stage compared to those reported by the
healthy participants. However, failing to provide support for Hypothesis 2, chronic
physical pain did not differ on the overall index of resignation from chronic hypertension
and chronic kidney disease.
Mediation analysis
According to Williams (2009), the resignation stage outcomes should be the result of the
depletion of fortification resources due to prolonged need threat. We tested this possi-
bility by considering that threatened psychological needs could mediate the link between
chronic social exclusion and the outcomes of the resignation stage (i.e., alienation,
unworthiness, helplessness, and depression).
We used a bootstrapping procedure (Hayes, 2013) estimating direct and indirect
effects of potential mediators. The independent variable was the group (coded as chronic
social exclusion ¼þ4, control groups ¼1111), the mediator was need threat,
and the dependent variable was the overall index of resignation (see Figure 1). As
expected, the group was associated with higher levels of the overall index of resignation
(b¼0.21, SE ¼0.01, t¼19.66, p< .001) and with higher levels of need threat
(b¼0.25, SE ¼0.01, t¼17.33, p< .001), and need threat was related with the
overall index of resignation (b¼0.70, SE ¼0.02, t¼35.93, p< .001). Supporting
our mediation hypothesis, the indirect path from the group to the overall index of res-
ignation through need threat was significant, a*b ¼0.15, 95%CI [0.12, 0.17].
–0.70**–0.25**
0.21** (0.15)
Resignation stage
outcomes
Group (chronic social
exclusion vs. control
groups)
Need threat
Figure 1. The mediational role of need threat on the link between chronic social exclusion and
the resignation stage outcomes (Study 1).
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Thus, in Study 1, providing evidence for the appropriateness of our samples, we first
found that chronic social exclusion was associated with the highest levels of social
exclusion symptoms (i.e., need threat), whereas chronic physical pain was associated
with the highest levels of physical pain symptoms compared to all of the groups.
In support of Hypothesis 1, we found that chronic social exclusion was associated with
higher levels of negative emotions, alienation, unworthiness, helplessness, and depression
compared to healthy participants and patients with chronic physical pain, chronic hyper-
tension, and chronic kidney disease. By doing so, we showed that the consequences
associated with chronic social exclusion could be linked to the presence of prolonged
experiences of exclusion rather than to the mere chronicity (i.e., the temporal dimension)
or distressfulness (e.g., the severity of a disease) of a condition. Furthermore, we found that
need threat mediated the effect of the group condition on the overall index of resignation,
which suggests a potential mechanism that can lead individuals to the resignation stage.
However, Hypothesis 2 received only partial support. We did find that chronic
physical pain was associated with higher levels of alienation, unworthiness, helplessness,
and depression compared to healthy participants. Furthermore, we found that chronic
physical pain was associated with higher levels of negative emotions compared to the
two control groups, chronic hypertension and chronic kidney disease. Yet, the same
results did not hold on resignation stage outcomes. We did not find consistent differences
between chronic physical pain compared with chronic hypertension and compared with
chronic kidney disease. These results suggest that chronic social exclusion and physical
pain may not overlap entirely in their psychological outcomes as they do in acute forms
(see Riva et al., 2011).
Nevertheless, it should be noted that the majority (i.e., 67 participants; 82%)ofthe
participants with chronic physical pain were currently taking pain medication to treat
their pain; this might (at least in part) explain the lack of differences between forms of
chronic physical pain. Therefore, we examined those individuals in the chronic physical
pain group whose treatment was perceived to be not adequate, inferred by both the report
of higher levels of physical pain symptoms and the effectiveness of the pain therapy.
First, we found that the report of physical pain symptoms was positively related with
negative emotions (r¼.41, p< .001), feelings of alienation (r¼.37, p< .001), help-
lessness (r¼.24, p¼.027), and depression (r¼.40, p< .001). Although the relationship
between physical pain symptoms and feelings of unworthiness was in the expected
direction, it did not reach the standard level of significance (r¼.16, p¼.15). However,
overall, the report of physical pain symptoms was positively related with the global
index of resignation stage (r¼.37, p< .001).
Moreover, we found that that the self-reported effectiveness of the pain therapy (only
for those who indicated they were taking medications for their physical pain; i.e., n¼67)
was negatively associated with negative emotions (r¼.33, p¼.009), feelings of
alienation (r¼.37, p¼.002) and feelings of unworthiness (r¼.30, p¼.016). The
association was in the same (negative) direction also for helplessness and depression,
even though it did not reach the standard level of significance (r¼.17, p¼.16;
r¼.20, p¼.11, respectively). However, overall, the self-reported effectiveness of the
pain therapy was negatively related with the global index of resignation stage (r¼.37,
p¼.002).
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This pattern of correlations showed that higher levels of chronic physical pain
symptoms and lower levels of self-reported effectiveness of the pain therapy were
associated with more negative outcomes of the resignation stage, suggesting that when
the pain medication does not adequately control the presence of physical pain symptoms,
experiencing chronic physical pain might be associated with feelings of alienation,
helplessness, depression, and unworthiness.
Study 2
Study 1 showed that chronic social exclusion is associated with the highest levels of
resignation stage outcomes (e.g., alienation) compared to other distressful conditions.
However, our data cannot speak to the possibility that even short-term experiences of
social exclusion can be linked with a detectable increase in the resignation stage out-
comes. If this possibility were true, we could not conclude that chronic social exclusion
is associated with psychological outcomes that are different from those produced by
short-term experiences of exclusion. Thus, in Study 2, we tested if levels of resignation
stage outcomes could increase immediately following an acute experience of social
exclusion, which, if they did not, would suggest resignation stage outcomes are unique to
prolonged experiences of exclusion. We tested this prediction in Hypothesis 3,
expecting that when people are exposed to short-term exclusion they recover and
therefore they do not enter the resignation stage.
Moreover, considering the predictions of the temporal model of ostracism (Williams,
2009), we wanted to compare need threat due to acute exclusion with that resulting from
chronic exclusion. Indeed, the theory argues that people exposed to short-term exclusion
would recover, as indicated by an assessment of their reflective responses. Thus, on the
reflective responses, the theory (Williams, 2009) would predict a difference between reflec-
tive responses caused by short-term exclusion and levels of need threat reported by partici-
pants enduring chronic experiences of exclusion. If individuals enduring chronic exclusion
would have more threatened needs than those in the reflective stage, then we will have further
evidence that chronic exclusion is uniquely related to resignation (see Hypothesis 1).
Method
Participants
One hundred and twenty-four participants (83 females; M
age
¼24.60, SD ¼9.60)
volunteered to participate in an online experiment. We set a minimum of about 60 par-
ticipants per group based on the sample sizes collected in the main study of this work
(see Table 1).
Procedure
Short-term social exclusion. We induced short-term social exclusion using a typical
manipulation of ostracism, Cyberball (Williams et al., 2000) in which participants were
randomly assigned to be ostracized, receiving a virtual ball from computer agents either
once from each player at the beginning and then never again, or included, receiving the
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ball throughout the entire game (inclusion). We chose this manipulation of short-term
exclusion because it has been widely adopted in past research (Hartgerink et al., 2015)
and because it usually produces strong effects (dranging from 1.0 to 2.0; Williams &
Jarvis, 2006; see also Hartgerink et al., 2015).
Resignation stage measures. Right after the end of the game, all participants completed the
same four scales adopted in the previous study aimed to assess the outcomes of the resig-
nation stage; that is, the Sense of Belonging Instrument (a¼.93; Hagerty & Patusky, 1995),
the Self-Esteem Scale (a¼.87; Rosenberg, 1965), the Beck Hopelessness Scale (a¼.87;
Beck et al., 1974), and the Beck Depression Inventory (a¼.86; Beck et al., 1996). Con-
sidering the wording of these scales items (e.g., ‘‘I generally feel that people accept me’’),
participants were instructed to respond to them based on how they generally feel.
Reflexive stage measures. Next, as manipulation checks, we asked participants how often
(0–100%) they received the ball and how ignored and excluded (from 1 ¼not at all to
5¼extremely) they felt during the game. Then, participants filled out the Need-Threat
Scale (Williams et al., 2000) that assessed the participants’ feelings of belongingness,
self-esteem, control, and meaningful existence. For the purpose of the present study, we
created an overall index by averaging the responses on the four basic needs (a¼.95),
with higher scores indicating greater threat to basic needs. Finally, we used the Rejected-
Related Emotions Scale (Buckley et al., 2004) to assessed how negative the participants
felt (i.e., anger, anxiety, sadness, hurt, and rejection). We averaged the resulting 20 items
to create an overall index of negative emotions (a¼.95; increasing values indicated
greater more negative emotions).
Reflective stage measures. Upon completion of reflexive stage measures, participants
completed the same basic needs (overall index a¼.94) and emotion (overall index
a¼.94) items as outlined earlier but responded based on how they felt right now rather
than how they felt during the game.
Responses to all these measures were recorded on a 1 (not at all)to5(extremely)scale.
Results and discussion
Manipulation checks
Participants in the exclusion condition reported receiving the ball less often during the
game than included participants, t(122) ¼13.54, p< .001. Participants in the exclusion
condition also reported that they felt more excluded and ignored than participants in the
inclusion condition, t(122) ¼13.54, p< .001.
Resignation stage outcomes
The analyses showed no significant group differences on all the four key measures of the
resignation stage, largest t(122) ¼0.96, p> .34, d¼0.17, for alienation; see Table 4 for
all the descriptive statistics.
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Reflexive and reflective outcomes
We subjected the need-threat scores to a two-way mixed repeated measures ANOVA
with inclusionary status (excluded vs. included) as between-participant factor and
recovery stage (reflexive versus reflective) as within-participant factor. First, greater
need threat was associated with the exclusion condition, F(1, 122) ¼23.39, p< .001,
Z
p
2
¼.16, than the inclusion condition. There was also greater need threat in the
reflexive stage than in the reflective stage, F(1, 122) ¼57.94, p< .001, Z
p
2
¼.32. These
main effects were qualified by a significant interaction, F(1, 122) ¼68.37, p< .001,
Z
p
2
¼.36. Pairwise comparisons showed that, at the reflexive stage, excluded partici-
pants reported higher need-threat levels than included participants (p< .001). However,
such difference disappeared at the reflective stage (p¼.795), suggesting that excluded
participants had recovered.
The same analysis was conducted on negative emotions. Higher levels of negative
emotions occurred in the exclusion condition, F(1, 122) ¼11.44, p¼.001, Z
p
2
¼.09,
whereas no main effect of recovery stage was found, F(1, 122) ¼.66, p¼.416, Z
p
2
< .01.
However, a significant interaction qualified these factors, F(1, 122) ¼41.03, p< .001,
Z
p
2
¼. 25. In particular, at the reflexive stage, excluded participants reported higher
levels of negative emotions than included participants (p< .001). However, such dif-
ference dissipated at the reflective stage (p¼.493), suggesting again that excluded
participants had fully recovered.
Overall, Study 2 tested whether acute social exclusion could be sufficient to increase
the resignation stage outcomes. Our results showed that social exclusion increased need
threat and negative emotions at the reflexive stage. However, excluded participants
Table 4. Means and standard deviations (in parenthesis) of the dependent variables of each
dependent variable (Study 2).
a
Group Social inclusion, n¼66 Social exclusion, n¼58
Manipulation checks
I felt excluded and ignored 1.73 (1.01) 3.85 (1.38)
Percentage of throws received 31.44 (11.67) 7.84 (6.71)
Reflexive stage
Need threat 1.68 (0.71) 2.83 (0.74)
Negative emotions 1.53 (0.60) 2.39 (0.88)
Reflective stage
Need threat 1.74 (0.84)
b
1.69 (0.69)
b
Negative emotions 1.95 (0.82)
b
1.85 (0.71)
b
Resignation stage
Alienation 2.42 (0.87)
b
2.27 (0.74)
b
Unworthiness 2.69 (0.81)
b
2.69 (0.71)
b
Helplessness 2.55 (0.73)
b
2.53 (0.50)
b
Depression 1.71 (0.47)
b
1.71 (0.49)
b
Note: Means that have no superscript letter
(b)
in common in a given row are significantly different from each
other at p< .05.
a
Higher scores indicate higher levels of each outcome.
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recovered, as indicated by the assessment of need threat and negative emotions at the
reflective stage. Crucially, the resignation stage outcomes were not affected by such
short-term manipulation. We measured resignation stage outcomes right after the
manipulation; previous research showed that the effect of Cyberball are strongest
immediately after the game and they tend to decrease within minutes of the end of the
game (Hartgerink et al., 2015; see also Williams & Jarvis, 2006). Thus, by measuring the
resignation stage outcomes first, we measured them in a position where the strongest
effects following ostracism are generally found. Had we waited until later, a lack of
differences may have occurred simply because participants recovered. Thus, supporting
Hypothesis 3, our study suggested that short-term social exclusion is not sufficient to
elicit feelings of alienation, unworthiness, helplessness, and depression; these are dis-
tinct outcomes associated with long-term social exclusion.
Moreover, as we mentioned early, the theory (Williams, 2009) would predict a dif-
ference between reflective responses linked with short-term exclusion and levels of need
threat reported by participants enduring chronic experiences of exclusion. Accordingly,
there is a significant difference between the need-threat levels of the reflective responses
caused by experimentally induced exclusion (M¼1.69; SD ¼.69) and the need-threat
levels reported by chronically excluded individuals (M¼2.74; SD ¼.65), t(138) ¼9.18,
p< .001. This difference suggests that participants exposed to short-term exclusion have
their basic needs recovered, whereas those enduring long-term exclusion do not.
General discussion
Our findings provide the first empirical evidence that chronic experiences of social
exclusion—compared to three other distressful conditions and a healthy control group—
are uniquely associated with feelings of alienation, helplessness, depression, and
unworthiness. These findings support Williams’s (2009) resignation stage. Whereas
short-term responses to these need threats result in fortification, resources necessary to
fortify become depleted over time for those experiencing chronic social exclusion (see
Williams, 2009 for a review). This temporal prediction holds for all four needs, but
originally the need for control was the first to be discussed in this fashion (Wortman &
Brehm, 1975). Initially, the authors argue, threats to control result in an attempt to regain
control: the experience of reactance (Brehm, 1966). However, over repeated exposures
to control threat, learned helplessness develops (Seligman, 1975). Similarly, Williams
(2009) argues that initial attempts to fortify belonging, self-esteem, and meaningful
existence follow a temporal path of fortification (reflective stage), but a failure to fortify
needs may lead to resignation. Thus, fortifying a threatened belonging need eventually
gives way to alienation; self-esteem fortification gives way to unworthiness, reactance
gives way to helplessness, and strengthening meaningful existence gives way to
depression. In this sense, in Study 1 and in keeping with Hypothesis 1, we provided
empirical support to Williams’s resignation stage (2009). We provided evidence that
chronic experiences of social exclusion are associated with the highest self-reported
levels of the outcomes Williams contended were part of the resignation stage: aliena-
tion, helplessness, depression, and unworthiness. Further, we found that prolonged basic
need threat accounted for the effect of chronic social exclusion on the outcomes
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associated with the resignation stage. Finally, chronic experiences of social exclusion
were also associated with worst levels of any psychological outcome we considered
(e.g., negative emotions).
Our Hypothesis 2, investigating the possibility that social and physical chronic pain
would induce common psychological responses, received less support. In Study 1,
chronic physical pain was associated with higher levels of negative emotions compared
to healthy participants, participants with chronic hypertension, and those with chronic
kidney disease. However, chronic physical pain did not consistently differ on resignation
stage outcomes from the chronic hypertension and the chronic kidney disease group.
Overall, these three groups (chronic physical pain, chronic hypertension, and chronic
kidney disease) were associated with similar levels of feelings of alienation, help-
lessness, depression, and unworthiness, failing to provide direct support for a chronic
social exclusion and physical pain psychological overlap.
We noted, however, that the majority (i.e., 82%) of participants of Study 1 in the
chronic physical pain group were receiving treatment for their physical pain. Among
them, the average evaluations of the effectiveness of pain therapy was above the mid-
point of the rating scale (M¼6.58; SD ¼1.79; median [Mdn]¼7.00), suggesting an
overall satisfaction of participants in our chronic physical pain sample with their pain
therapy effectiveness. Therefore, it is possible that an effective pain medication could
buffer the negative psychological consequences of chronic physical pain. Indeed, when
we looked at the possible relationship between the presence of chronic physical pain
symptoms and the outcomes of the resignation stage, we found a significant positive
association. The pattern of correlations showed that higher levels of chronic physical
pain symptoms were associated with higher levels of negative emotions and feelings of
alienation, helplessness, depression, and unworthiness; whereas lower levels of drug
therapy effectiveness (for physical pain) were associated with higher levels of negative
emotions and feelings of alienation, helplessness, depression, and unworthiness. How-
ever, future studies are needed to explore cases in which inadequate pain medication in
chronic physical pain conditions (e.g., intractable chronic pain conditions) might be
linked to the resignation stage.
Previous research showed that an over-the-counter painkiller known to reduce acute
physical pain could also reduce acute social pain (DeWall et al., 2010). As we already
noted, only a handful of our participants (N¼14) in the chronic social exclusion group
reported taking medications to deal with their experiences of social exclusion. Although
this must be considered with extreme caution (given the unequal sample size and con-
sidering the variety of medications reported by the 14 participants), our data suggested
that those who reported taking medication for their social exclusion did not differ on
negative emotions and any of the resignation stage outcomes compared with those who
reported taking no medication (largest t¼1.28, p¼.20, for unworthiness).
Thus, it is possible that, in the case of chronic social exclusion and unlike chronic
physical pain, removing the symptom (i.e., social pain) does not solve the problem.
Chronically socially excluded people would, most likely, need to either work on the
cause of their social exclusion (somehow addressing the source of social exclusion) or
change the way they perceive it through the implementation of psychological strategies
(e.g., reappraisal, mindfulness). When chronic physical pain participants did receive
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adequate treatment (according to their own evaluations), their conditions seem to
improve, as they did not necessarily feel worse than other chronic conditions. If people
with chronic social exclusion receive proper (e.g., psychological) treatment on a regular
basis, they might also experience similar effects. However, individuals experiencing
chronic social exclusion may avoid treatment because they do not want to feel stig-
matized, similar to individuals with mental health issues avoiding treatment because they
do not want the stigmatizing label of being mental ill (e.g., Corrigan, 2004). The dis-
crepancy between how different types of chronic pain victims seek out help and support
may be due to physical pain experiences being less stigmatizing than social exclusion
experiences. Future research should address these issues.
Finally, Study 2 suggested that acute experiences of social exclusion are not
sufficient to be associated with resignation stage outcomes (see Hypothesis 3). In
particular, we found that individuals enduring experiences of chronic social exclu-
sion have more threatened psychological needs compared with need-threat levels at
the reflective stage for those recovering from a short-term episode of social
exclusion. Williams’s (2009) temporal model of ostracism posits that exclusion that
persists over extended time impairs an individual’s ability to fortify the threatened
psychological needs, thus leading into the resignation stage. Thus, not only did we
provided evidence that the resignation stage outcomes are linked to the presence of
prolonged experiences of exclusion rather than to the mere chronicity or dis-
tressfulness of a condition, but we also provided a test that short-term exclusion
does not increase the resignation stage outcomes. We believe that this constitutes
important results that supported past theorizing (Williams, 2009) and are likely to
generate future research.
Limitations and future research
Our study is among one of the first empirical investigations of the psychological cor-
relates of long-term experiences of social exclusion. However, the results of this study
should be interpreted with several pertinent limitations in mind. Being a correlational
study on community samples, our findings come from individuals who sought to be part
of the study, so they should be viewed with caution; these individuals may be unique in
their pain experiences. Further, we cannot determine cause and effect with this study; it
is possible that people who had higher levels of alienation, unworthiness, helplessness,
and depression perceived themselves more readily on a call for experiences of social
exclusion. Nevertheless, the current study is a first step toward understanding the
consequences of experiencing continuous social exclusion from desired individuals
and groups.
In this work, we mirrored research on chronic physical pain by asking participants the
following question: ‘‘Recently, have you felt socially excluded for more than 3
months?’’ However, this question does not allow to distinguish between actual experi-
ences of chronic social exclusion (e.g., being ostracized or rejected repeatedly or for
prolonged time) and chronic social pain (e.g., pain associated with perceived social
separation that persists even in absence of social threats; see Riva, Wesselmann, Wirth,
Carter-Sowell, & Williams, 2014). The latter includes cases in which an individual who
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has experienced one of more instances of social exclusion (e.g., ostracism, social
rejection) continues perceiving the painful feelings of social distance even if the direct
causes of the social threat are no longer present. Accordingly, future research should
try to disentangle between actual experiences of chronic social exclusion and chronic
social pain.
Moreover, in Study 1, our chronic social exclusion group included a variety of social
threats, ranging from ostracism, to loneliness to bereavement. The aim of our study was
not to investigate the differences among these forms of social exclusion, but future
studies are needed to explore this issue. Furthermore, to test Hypotheses 1 and 2, we
considered two control groups with medical conditions that were known to be chronic
but not associated with physical pain per se. Physical pain is a common symptom for a
wide array of chronic illnesses, thus it is possible that its presence still contributed to
some of the negative psychological consequences associated with our control groups
(e.g., chronic kidney disease), as compared to healthy participants. Future studies should
further try to disentangle the temporal dimension of a distressful condition (e.g.,
chronicity) from the presence of pain per se.
Conclusion
In the short term, social exclusion has a valuable function: By virtue of its aversiveness it
protects the individual from engaging in behaviors (e.g., anti-normative behaviors) that
might promote further ostracism and exclusion and it motivates the individual to regain
social acceptance. Indeed, anthropologists argue that the threat and use of ostracism was
critical in the formation of civil societies (So¨derberg & Fry, In press). However, in some
circumstances, instances of social exclusion (including feelings caused by ostracism,
rejection, exclusion, bereavement, betrayal, humiliation, discrimination, and embar-
rassment) can extend over time and last for months and years. When this occurs, the
adaptive function of perceiving social exclusion might cease and individual may feel
resigned to their perpetual feelings of exclusion. Our present findings provide the first
empirical support for the resignation stage, laying the foundation for studying the con-
sequences of chronic experiences of social exclusion.
Acknowledgment
We would like to thank Laura Ferris and Verena Graupmann for helpful comments on an earlier
version of this article.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship,
and/or publication of this article.
Funding
The author(s) received no financial support for the research, authorship, and/or publication of this
article.
Riva et al. 21
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Notes
1. Social exclusion is broadly defined as the experience of being kept apart from others physically
(e.g., social isolation) or emotionally (e.g., being ignored or told one is not wanted; Riva & Eck,
2016). Thus, the term social exclusion was adopted throughout to include all these different
varieties (e.g., rejection, ostracism) of threats to social belonging.
2. The degrees of freedom changed in some analyses due to the participants’ ability to skip over
questions.
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