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Crerand CE, Shehata A, Umbaugh H, Kapa HM, Hansen-Moore J, Nahata L, Buchanan C, Chen D, Rausch J, Udaipuria S, Jayanthi VR, Chan YM, Pratt KJ, Buschur E, Indyk J, Tishelman AC. Body image and psychosocial outcomes in youth and young adults with differences of sex development: a multi-method study. J Pediatr Psychol 2024:jsae041. [PMID: 38867313 DOI: 10.1093/jpepsy/jsae041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 05/17/2024] [Accepted: 05/22/2024] [Indexed: 06/14/2024] Open
Abstract
OBJECTIVE Differences of sex development (DSD) can affect the physical health, appearance, and psychosocial functioning of affected individuals, but little is known about how subjective appearance perceptions (body image) impact psychosocial outcomes. This study evaluated body image and its associations with psychosocial outcomes including quality of life, resilience, and psychosocial adjustment. METHODS This cross-sectional, multi-method study assessed body image and psychosocial outcomes including quality of life, adjustment, and resilience in 97 youth and young adults with DSD (mean age = 17 ± 3.7 years; 56% assigned female in infancy) using psychometrically sound instruments. A subsample (n = 40) completed qualitative interviews. RESULTS Quantitative results indicated that overall, participants were satisfied with their physical appearance, although less so with their primary sex characteristics. Body image dissatisfaction was associated with poorer psychosocial adjustment, quality of life, and resilience. Qualitatively, youth and young adults reported a variety of perceptions, both positive and negative, related to their body image and the impact of living with a DSD condition. Themes identified included appearance management; effects of DSD on body image; diagnostic factors and features; attitudes about diagnosis; and treatment. CONCLUSIONS Body image is significantly associated with psychosocial outcomes in youth and young adults with DSD, with qualitative findings highlighting both positive and negative body image experiences. Results have implications for clinical care including screening for appearance concerns, normalization of appearance variations, and intervention development to better support healthy body image and psychosocial functioning in youth and young adults with DSD.
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Affiliation(s)
- Canice E Crerand
- Center for Biobehavioral Health, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, United States
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, United States
- Department of Plastic Surgery, The Ohio State University College of Medicine, Columbus, OH, United States
| | - Ayah Shehata
- Center for Biobehavioral Health, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, United States
| | - Hailey Umbaugh
- Center for Biobehavioral Health, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, United States
| | - Hillary M Kapa
- Center for Biobehavioral Health, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, United States
| | - Jennifer Hansen-Moore
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, United States
| | - Leena Nahata
- Center for Biobehavioral Health, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, United States
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, United States
| | - Cindy Buchanan
- Department of Psychiatry, Children's Hospital of Colorado, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Diane Chen
- Potocsnak Family Division of Adolescent and Young Adult Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States
- Pritzker Department of Psychiatry and Behavioral Health, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States
- Departments of Psychiatry and Behavioral Sciences, and Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Joseph Rausch
- Center for Biobehavioral Health, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, United States
| | - Shivika Udaipuria
- Center for Biobehavioral Health, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, United States
| | - Venkata R Jayanthi
- Department of Urology, The Ohio State University College of Medicine, Columbus, OH, United States
| | - Yee-Ming Chan
- Division of Endocrinology, Boston Children's Hospital, Boston, MA, United States
- Department of Pediatrics, Harvard Medical School, Boston, MA, United States
| | - Keeley J Pratt
- Department of Human Sciences, College of Education and Human Ecology, The Ohio State University, Columbus, OH, United States
| | - Elizabeth Buschur
- Department of Endocrinology, The Ohio State University College of Medicine and Nationwide Children's Hospital, Columbus, OH, United States
| | - Justin Indyk
- Department of Endocrinology, The Ohio State University College of Medicine and Nationwide Children's Hospital, Columbus, OH, United States
| | - Amy C Tishelman
- Department of Psychology and Neuroscience, Boston College, Boston, MA, United States
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Guest E, Halliwell E, Mathews A, Alleva J, Harcourt D. More than my appearance: a pilot evaluation of the expand your Horizon Online functionality-based writing programme for adults with visible differences. Health Psychol Behav Med 2024; 12:2349004. [PMID: 38738214 PMCID: PMC11085943 DOI: 10.1080/21642850.2024.2349004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 04/22/2024] [Indexed: 05/14/2024] Open
Abstract
Background Adults with conditions that affect their appearance, known as visible differences, can experience appearance concerns, social anxiety, and depression. Interventions have been developed for this population to facilitate adjustment and coping skills; however, they have limited evidence of efficacy. The Expand Your Horizon [Alleva, J. M., Martijn, C., Van Breukelen, G. J., Jansen, A., & Karos, K. (2015). Expand Your Horizon: A programme that improves body image and reduces self-objectification by training women to focus on body functionality. Body Image, 15, 81-89. https://doi.org/10.1016/j.bodyim.2015.07.001] online functionality-based writing programme was adapted for adults with visible differences. Method A pilot randomised controlled trial with a wait-list control group was carried out to assess preliminary intervention efficacy and gain information about the acceptability and feasibility of the programme. Forty-four adults aged 21-63 years (M = 40.21; SD = 12.05) with visible differences took part. Various facets of body image (i.e. functionality appreciation and body appreciation) as well as depression and anxiety were assessed immediately pre- and post-intervention and at three-months. Results Participants reported enjoying the programme, felt that the format was acceptable, and it significantly increased functionality appreciation, which was maintained at three-months. However, there were no improvements in body appreciation, depression, and anxiety. Conclusions In future, a full trial should be carried out with an active control group.
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Affiliation(s)
- Ella Guest
- Centre for Appearance Research, University of the West of England (UWE), Bristol, UK
| | - Emma Halliwell
- Centre for Appearance Research, University of the West of England (UWE), Bristol, UK
| | - Abbi Mathews
- Centre for Appearance Research, University of the West of England (UWE), Bristol, UK
| | - Jessica Alleva
- Department of Clinical Psychological Science, Maastricht University, Maastricht, The Netherlands
| | - Diana Harcourt
- Centre for Appearance Research, University of the West of England (UWE), Bristol, UK
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O'Donnell N, Phillips B, Morgan JE, Howell D. 'It's not meant to be for life, but it carries on': a qualitative investigation into the psychosocial needs of young retinoblastoma survivors. BMJ Open 2024; 14:e082779. [PMID: 38688668 PMCID: PMC11086577 DOI: 10.1136/bmjopen-2023-082779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2024] Open
Abstract
OBJECTIVE AND DESIGN Retinoblastoma (Rb) is a rare childhood eye cancer, with 45% of individuals impacted by heritable disease and the remainder impacted non-heritably. The condition can leave survivors with life-long psychological and social challenges. This qualitative study examined the psychosocial needs of teenagers and young adults living beyond Rb. SETTING A qualitative, exploratory study was conducted using focus groups with teenagers and interviews with young adults. Participants were recruited via the Childhood Eye Cancer Trust and the two national Rb treatment centres in the UK. Reflexive thematic analysis was used to analyse data using exploratory and inductive methods. PARTICIPANTS 32 young survivors of Rb (10 heritable, 21 non-heritable, 1 unknown; 23 unilateral, 9 bilateral) aged between 13 and 29 years (12 male, 20 female). RESULTS Data were rich and spanned the life course: three key themes were generated, containing eight subthemes. Theme 1 describes participants' experiences of childhood and trauma, including survivor guilt, memories from treatment and impact on personality. Theme 2 focuses on the challenges of adolescence, including the psychological impact of Rb, the impact on identity, and the sense of normality and adaptation to late effects. The third theme considered adulthood and the development of acceptance, a state of being widely considered unachievable during childhood, as well as the 'work' needed to feel supported, including seeking out information, peer support and therapeutic strategies. CONCLUSIONS This study provides in-depth insight into the experiences of life beyond Rb. Findings highlight the need for specific psychosocial interventions informed by codesign.
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Affiliation(s)
| | - Bob Phillips
- Centre for Reviews and Dissemination, University of York, York, UK
| | | | - Debra Howell
- Department of Health Sciences, University of York, York, UK
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Waite E, Jenkinson E, Kershaw S, Guest E. Psychosocial Interventions for Children and Young People With Visible Differences Resulting From Appearance-Altering Conditions, Injury, or Treatment Effects: An Updated Systematic Review. J Pediatr Psychol 2024; 49:77-88. [PMID: 37944011 PMCID: PMC10799722 DOI: 10.1093/jpepsy/jsad080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 10/20/2023] [Accepted: 10/22/2023] [Indexed: 11/12/2023] Open
Abstract
OBJECTIVE Children and young people with visible differences can experience psychosocial difficulties, such as anxiety and teasing by others. Interventions targeting difficulties have previously been reviewed by Jenkinson et al. This review aimed to identify and critically assess recent studies evaluating the effectiveness of psychosocial interventions for children and young people with visible differences on psychosocial wellbeing, self-esteem, and social experiences and compare the findings with Jenkinson et al. using a replacement review process. METHODS Inclusion criteria are as follows: studies with participants aged 0-18 years with visible differences; investigating a psychosocial intervention; including comparison with an alternative intervention, control group, or pre- and post-intervention; and including a quantitative measure assessed pre- and post-intervention. Exclusion criteria are as follows: participants with body dysmorphic disorder or appearance changes due to eating disorders or obesity and studies not written in English. MEDLINE, AMED, and PsycInfo were searched and grey literature was included. Results were reviewed against eligibility criteria, data were extracted, and studies were evaluated using the Cochrane Risk of Bias 2 tool. RESULTS Using Jenkinson et al. as one source of studies, 24 studies were included evaluating a range of interventions such as social interaction skills training, residential social camps, and cognitive behavioral therapy. Risk of bias was high in 20 studies and of some concern in four studies. CONCLUSION There is some evidence of the effectiveness of hypnotherapy, a relaxation response resiliency program, integrative body-mind-spirit group, and therapeutic patient education, but more rigorous research is needed to confirm their impact on psychosocial outcomes.
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Affiliation(s)
- Emma Waite
- Centre for Appearance Research, University of the West of England (UWE) Bristol, UK
| | - Elizabeth Jenkinson
- Centre for Appearance Research, University of the West of England (UWE) Bristol, UK
| | | | - Ella Guest
- Centre for Appearance Research, University of the West of England (UWE) Bristol, UK
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Powell LD, Vasiliou VS, Thompson AR. An ACT self-help intervention for adults with a visible difference in appearance: A pilot feasibility and acceptability randomized controlled study. Body Image 2023; 47:101637. [PMID: 37839287 DOI: 10.1016/j.bodyim.2023.101637] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 09/14/2023] [Accepted: 10/06/2023] [Indexed: 10/17/2023]
Abstract
Individuals living with a visible difference in appearance experience high levels of social anxiety, yet self-help interventions for this heterogeneous population are not available. We conducted a pilot trial of a novel Acceptance and Commitment Therapy (ACT) based self-help intervention.Individuals with anxiety about having a visible difference in appearance (n = 284) were randomized to an ACT-based four-week intervention (n = 145) or a waitlist control condition (n = 139). We collected pre and follow-up (four-weeks after the completion of the intervention) data. Primary outcomes included social anxiety and impairments in functioning. Psychological flexibility (PF) was also examined. ANCOVAs, controlling for pre scores, indicated significant improvements in functioning by the intervention group. No significant differences were observed for anxiety and PF between conditions at follow-up. Drop out was 68% for the intervention and 41% for the control group, with no differences in the groups in age, origin, gender, or type of visible difference. Participants in the intervention group found the intervention almost equally, useful (77%) and helpful (73%). An ACT-based self-help intervention can alleviate distress related to visible difference in appearance. More sophisticated designs are needed now, to collect idiographic and longitudinal data and examine personalized changes across time in this population.
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Affiliation(s)
| | - Vasilis S Vasiliou
- South Wales Clinical Psychology Training, Cardiff University, 11th Floor, Tower Building, 70 Park Place, Cardiff CF10 3AT, Wales, UK; Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
| | - Andrew R Thompson
- University of Sheffield, School of Psychology, Sheffield, UK; South Wales Clinical Psychology Training, Cardiff University, 11th Floor, Tower Building, 70 Park Place, Cardiff CF10 3AT, Wales, UK.
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Wang H, Nicklaus K, Jewett E, Rehani E, Chen TA, Engelmann J, Bordes MC, Chopra D, Reece GP, Lee ZH, Markey MK. Assessing saliency models of observers' visual attention on acquired facial differences. J Med Imaging (Bellingham) 2023; 10:S11908. [PMID: 37091297 PMCID: PMC10118307 DOI: 10.1117/1.jmi.10.s1.s11908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 04/03/2023] [Indexed: 04/25/2023] Open
Abstract
Purpose Saliency models that predict observers' visual attention to facial differences could enable psychosocial interventions to help patients and their families anticipate staring behaviors. The purpose of this study was to assess the ability of existing saliency models to predict observers' visual attention to acquired facial differences arising from head and neck cancer and its treatment. Approach Saliency maps predicted by graph-based visual saliency (GBVS), an artificial neural network (ANN), and a face-specific model were compared to observer fixation maps generated from eye-tracking of lay observers presented with clinical facial photographs of patients with a visible or functional impairment manifesting in the head and neck region. We used a linear mixed-effects model to investigate observer and stimulus factors associated with the saliency models' accuracy. Results The GBVS model predicted many irrelevant regions (e.g., shirt collars) as being salient. The ANN model underestimated observers' attention to facial differences relative to the central region of the face. Compared with GBVS and ANN, the face-specific saliency model was more accurate on this task; however, the face-specific model underestimated the saliency of deviations from the typical structure of human faces. The linear mixed-effects model revealed that the location of the facial difference (midface versus periphery) was significantly associated with saliency model performance. Model performance was also significantly impacted by interobserver variability. Conclusions Existing saliency models are not adequate for predicting observers' visual attention to facial differences. Extensions of face-specific saliency models are needed to accurately predict the saliency of acquired facial differences arising from head and neck cancer and its treatment.
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Affiliation(s)
- Haoqi Wang
- The University of Texas at Austin, Department of Biomedical Engineering, Austin, Texas, United States
- The University of Texas MD Anderson Cancer Center, Department of Plastic Surgery, Houston, Texas, United States
| | - Krista Nicklaus
- The University of Texas at Austin, Department of Biomedical Engineering, Austin, Texas, United States
- The University of Texas MD Anderson Cancer Center, Department of Plastic Surgery, Houston, Texas, United States
| | - Eloise Jewett
- The University of Texas at Austin, Department of Biomedical Engineering, Austin, Texas, United States
| | - Eeshaan Rehani
- The University of Texas at Austin, Department of Biomedical Engineering, Austin, Texas, United States
| | - Tzuan A. Chen
- University of Houston, HEALTH Research Institute, Houston, Texas, United States
- University of Houston, Department of Psychological, Health, and Learning Sciences, Houston, Texas, United States
| | - Jeff Engelmann
- Rogers Behavioral Health, Oconomowoc, Wisconsin, United States
| | - Mary Catherine Bordes
- The University of Texas MD Anderson Cancer Center, Department of Plastic Surgery, Houston, Texas, United States
| | - Deepti Chopra
- The University of Texas MD Anderson Cancer Center, Department of Psychiatry, Houston, Texas, United States
| | - Gregory P. Reece
- The University of Texas MD Anderson Cancer Center, Department of Plastic Surgery, Houston, Texas, United States
| | - Z-Hye Lee
- The University of Texas MD Anderson Cancer Center, Department of Plastic Surgery, Houston, Texas, United States
| | - Mia K. Markey
- The University of Texas at Austin, Department of Biomedical Engineering, Austin, Texas, United States
- The University of Texas MD Anderson Cancer Center, Department of Imaging Physics, Houston, Texas, United States
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'Everybody is watching me': A closer look at anxiety in people with facial palsy. J Plast Reconstr Aesthet Surg 2023; 77:408-415. [PMID: 36638757 DOI: 10.1016/j.bjps.2022.11.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 09/09/2022] [Accepted: 11/16/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Objectives were to evaluate the sociodemographic and disease-related factors, and coping style associated with social interaction and social appearance anxiety in people with unilateral facial palsy. METHODS Medical data were extracted from electronic health records, and participants completed the Social Interaction Anxiety Scale (SIAS), Social Appearance Anxiety Scale (SAAS), and Coping Orientation to Problems Experienced inventory. Associations of SIAS and SAAS scores with sociodemographic and disease variables, and coping were assessed with multiple linear regression. RESULTS Among 111 participants (mean age 58.6 years; 59% women), higher age and greater use of emotion-focused coping were associated with lower SIAS scores, whereas greater use of avoidant coping was associated with higher SIAS scores. Higher age, male sex, and greater use of emotion-focused coping were associated with lower SAAS scores, whereas greater use of avoidant coping was associated with higher SAAS scores. CONCLUSIONS Healthcare providers should understand that women and younger people are more likely to have social appearance concerns and that this is not predicted by the objective severity of facial palsy.
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Tollow P, Hamlet C, Zucchelli F, Williamson H, Harcourt D. Experiences and impact of the UK lockdown amongst adults who have a facial visible difference. CURRENT PSYCHOLOGY 2023; 42:1-10. [PMID: 36718390 PMCID: PMC9878478 DOI: 10.1007/s12144-022-04089-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2022] [Indexed: 01/27/2023]
Abstract
Globally, COVID-19 has been shown to have had a wide ranging and significant impact on individuals' daily living, and physical and mental health. However, there are some groups of individuals who may encounter unique challenges with regards to COVID-19 and whose experiences have not been investigated thus far. Therefore, this study aimed to understand the experiences of adults with a facial visible difference in relation to COVID-19 and lockdown. Semi-structured interviews were conducted with 21 adults with a variety of facial visible differences (e.g., cleft lip/palate, facial scars, skin conditions) and analyzed using inductive reflexive thematic analysis. This analysis generated three themes (Escaping the external gaze; Existing feelings manifesting in new challenges; COVID-19 taking priority). The results of this study suggest that the first U.K. lockdown from the COVID-19 pandemic created significant challenges for some individuals with a facial visible difference, and ongoing restrictions and social distancing measures might be particularly challenging for those who experience anxiety around social encounters. These findings highlight the importance of providing appropriate and accessible support for people with facial differences during lockdown and as restrictions ease.
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Affiliation(s)
- Philippa Tollow
- Centre for Appearance Research, University of the West of England, Bristol, UK
| | - Claire Hamlet
- Centre for Appearance Research, University of the West of England, Bristol, UK
| | - Fabio Zucchelli
- Centre for Appearance Research, University of the West of England, Bristol, UK
| | - Heidi Williamson
- Centre for Appearance Research, University of the West of England, Bristol, UK
| | - Diana Harcourt
- Centre for Appearance Research, University of the West of England, Bristol, UK
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Mathews A, Costa B, Mikkola A, Harcourt D. ' Scars: How Our Wounds Make Us Who We Are': Improving appearance-based stigma, conceptualisation of beauty and body esteem through a documentary. Scars Burn Heal 2023; 9:20595131231205398. [PMID: 38022894 PMCID: PMC10656807 DOI: 10.1177/20595131231205398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2023] Open
Abstract
Introduction Those with an altered appearance as a result of injury, health condition or treatment can face stigma, which may contribute to adverse psychosocial outcomes. However, current research tends to focus on supporting individuals themselves to cope, rather than targeting societal stigma. This study aimed to reduce societal stigma towards this group, through the use of a documentary about people with scars. Methods 146 adults completed questionnaires before and after viewing the documentary. Results After viewing, participants had reduced self-reported intentions to behave in a stigmatising way towards those with visible differences, broader conceptualisation of beauty, and more positive body-esteem. Qualitative data also suggested further positive impacts. Conclusion Those with visible differences (for example scars) are subject to societal stigmatisation which perpetuates psychological and social problems. Therefore, alleviating social stigma through the media, as demonstrated through the documentary in this study, may improve the lives of those living with visible differences. Lay Summary People with an altered appearance or scars as a result of injury, health condition or treatment can face stigma, which may contribute to harmful psychological and social outcomes. However, current research tends to focus on supporting affected individuals themselves to cope, rather than targeting societal stigma. This study aimed to find out whether a documentary about people with scars was successful at reducing viewers' stigma towards this group. A group of 146 adults completed questionnaires before and after viewing the documentary. After viewing, questionnaires indicated that participants had reduced intentions to behave in a stigmatising way towards those with visible differences. Furthermore, they also viewed a broader range of appearances as beautiful and felt more positive about their own bodies. Comments and feedback from participants also suggested further positive impacts. Those with visible differences (for example scars) are subject to societal stigmatisation which can cause and worsen mental health problems. Therefore, alleviating social stigma through the media, as demonstrated through the documentary in this study, may improve the lives of those living with visible differences.
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Affiliation(s)
- Abigail Mathews
- The Centre for Appearance Research, University of the West of England, Bristol, UK
| | - Bruna Costa
- The Centre for Appearance Research, University of the West of England, Bristol, UK
| | - Aida Mikkola
- The Centre for Appearance Research, University of the West of England, Bristol, UK
| | - Diana Harcourt
- The Centre for Appearance Research, University of the West of England, Bristol, UK
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Keeling M, Williamson H, Williams VS, Kiff J, Evans S, Murphy D, Harcourt D. Body image and psychosocial well-being among UK military personnel and veterans who sustained appearance-altering conflict injuries. MILITARY PSYCHOLOGY 2023; 35:12-26. [PMID: 37130559 PMCID: PMC10013218 DOI: 10.1080/08995605.2022.2058302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 03/23/2022] [Indexed: 10/18/2022]
Abstract
A modest but significant number of military personnel sustained injuries during deployments resulting in an altered-appearance (e.g., limb loss and/or scarring). Civilian research indicates that appearance-altering injuries can affect psychosocial wellbeing, yet little is known about the impact of such injuries among injured personnel. This study aimed to understand the psychosocial impact of appearance-altering injuries and possible support needs among UK military personnel and veterans. Semi-structured interviews with 23 military participants who sustained appearance-altering injuries during deployments or training since 1969 were conducted. The interviews were analyzed using reflexive thematic analysis, identifying six master themes. These themes indicate that in the context of broader recovery experiences, military personnel and veterans experience a variety of psychosocial difficulties related to their changed appearance. While some of these are consistent with evidence from civilians, military-related nuances in the challenges, protective experiences, coping approaches, and preferences for support are evident. Personnel and veterans with appearance-altering injuries may require specific support for adjusting to their changed appearance and related difficulties. However, barriers to acknowledging appearance concerns were identified. Implications for support provision and future research are discussed.
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Affiliation(s)
- Mary Keeling
- Centre for Appearance Research, Department of Social Sciences, Faculty of Health and Applied Sciences, University of the West of England, Bristol, England
| | - Heidi Williamson
- Centre for Appearance Research, Department of Social Sciences, Faculty of Health and Applied Sciences, University of the West of England, Bristol, England
| | - Victoria S. Williams
- Centre for Appearance Research, Department of Social Sciences, Faculty of Health and Applied Sciences, University of the West of England, Bristol, England
| | - James Kiff
- Centre for Appearance Research, Department of Social Sciences, Faculty of Health and Applied Sciences, University of the West of England, Bristol, England
| | - Sarah Evans
- Centre for Appearance Research, Department of Social Sciences, Faculty of Health and Applied Sciences, University of the West of England, Bristol, England
| | - Dominic Murphy
- Combat Stress & King’s Centre for Military Health Research, King’s College London, London, UK
| | - Diana Harcourt
- Centre for Appearance Research, Department of Social Sciences, Faculty of Health and Applied Sciences, University of the West of England, Bristol, England
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van Dalen M, Pasmans SGMA, Aendekerk EWC, Mathijssen IMJ, Koudstaal MJ, Williamson H, Hillegers MHJ, Utens EMWJ, Okkerse JME. Acceptability and feasibility of an online psychosocial intervention for Dutch adolescents with a visible difference: A mixed-methods study. Body Image 2022; 41:298-307. [PMID: 35378339 DOI: 10.1016/j.bodyim.2022.03.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 03/08/2022] [Accepted: 03/14/2022] [Indexed: 10/18/2022]
Abstract
Adolescents with a visible difference can experience difficult social situations, (e.g., people staring or making unwanted comments) and are at risk for mental health problems. Unfortunately, interventions for adolescents with a visible difference experiencing appearance-related distress are scarce and lack an evidence-base. This study tests the acceptability and feasibility of YP Face IT, an innovative online psychological intervention using social skills training and cognitive behavioural therapy, to Dutch adolescents. Adolescents aged 12-17 with a visible difference and access to an internet-enabled computer or tablet participated. They completed YP Face IT (eight sessions) and questionnaires were administered pre- and post-intervention. After completing YP Face IT, participants were interviewed to assess the acceptability and feasibility of YP Face IT and study procedures. Overall, 15 adolescents consented to participation, one person dropped out after one session. Most adolescents appreciated the intervention and all would recommend it to other adolescents experiencing appearance-related distress. Everyone reported learning experiences after following the sessions. Some struggled with motivation, but reminders by the website and research team were helpful. The Dutch YP Face IT intervention may be acceptable and the current study design is feasible to use. An RCT should be conducted to assess the effectiveness of the intervention.
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Affiliation(s)
- M van Dalen
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC Sophia Children's Hospital, The Netherlands
| | - S G M A Pasmans
- Department of Dermatology, Erasmus MC Sophia Children's Hospital, The Netherlands
| | - E W C Aendekerk
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC Sophia Children's Hospital, The Netherlands
| | - I M J Mathijssen
- Department of Plastic and Reconstructive Surgery and Hand Surgery, The Dutch Craniofacial Centre, Erasmus MC Sophia Children's Hospital, The Netherlands
| | - M J Koudstaal
- Department of Oral and Maxillofacial Surgery, The Dutch Craniofacial Centre, Erasmus MC Sophia Children's Hospital, The Netherlands
| | - H Williamson
- Department of Social Sciences, University of the West of England, United Kingdom
| | - M H J Hillegers
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC Sophia Children's Hospital, The Netherlands
| | - E M W J Utens
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC Sophia Children's Hospital, The Netherlands; Research Institute of Child Development and Education, University of Amsterdam, The Netherlands; Academic Center for Child Psychiatry Levvel/Department of Child and Adolescent Psychiatry, Academic University Medical Center, The Netherlands
| | - J M E Okkerse
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC Sophia Children's Hospital, The Netherlands.
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Evaluating the effectiveness and acceptability of information and therapy guides for improving the psychosocial well-being of people with facial palsy. J Plast Reconstr Aesthet Surg 2022; 75:3356-3364. [PMID: 35623976 DOI: 10.1016/j.bjps.2022.04.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 04/12/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Facial palsy (FP) can have a negative impact on an individual's psychological and social well-being, irrespective of esthetic severity. There is a lack of psychological interventions tailored specifically for this population and individuals with FP report difficulties accessing specialist psychological treatment. This paper describes a pilot study evaluating the effectiveness, acceptability, and feasibility of information and therapy guides for this population. DESIGN Quasi-experimental, repeated measures design. METHODS Six separate information and therapy guides were designed, drawing on cognitive behavioral therapy, acceptance and commitment therapy, and social skills training approaches. These were tested by 132 participants with FP, over a 4-to-6-week period. Participants completed self-report measures assessing psychological well-being, social function, and appearance-related distress before and after the testing period, as well as provided feedback on the perceived effectiveness, acceptability, and feasibility of the intervention. RESULTS After completing an information and therapy guide, participants reported significant improvements in psychological well-being and social function, as well as improvements in appearance-related distress. Ninety percent of participants reported having found it helpful to complete a guide, while 79.7% reported feeling more able to cope with FP and 95.3% agreed that the guide had been easy to understand and use. CONCLUSIONS Self-guided information and therapy guides are an acceptable and effective intervention for improving the psychosocial well-being of people with FP. They provide a low-intensity, universal, and cost-effective option for supporting the psychological needs of this population. CLINICAL TRIAL REGISTRATION NUMBER NCT03943953.
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A Novel Psychological Group Intervention Targeting Appearance-Related Distress Among People With a Visible Disfigurement (Inside Out): A Case Study. COGNITIVE AND BEHAVIORAL PRACTICE 2022. [DOI: 10.1016/j.cbpra.2022.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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14
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Reducing social anxiety in adolescents distressed by a visible difference: Results from a randomised control trial of a web-based intervention. Body Image 2022; 40:295-309. [PMID: 35121566 DOI: 10.1016/j.bodyim.2022.01.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 01/12/2022] [Accepted: 01/18/2022] [Indexed: 01/28/2023]
Abstract
A visible difference to the face or body may challenge adolescents' adjustment and engagement in life activities, where some require psychosocial support. However, evidence is limited for whether existing interventions for this adolescent group reduce social or appearance-related distress. We therefore conducted a parallel-group, randomised control trial to evaluate the effectiveness of Young Person's Face IT, a self-guided web-based psychosocial intervention developed for adolescents with a visible difference who experience distress. Adolescents (N = 189, aged 11-18) from two countries (Norway and the Netherlands), were randomly allocated to an intervention group or care as usual (CAU). Outcomes were body esteem, social anxiety, perceived stigmatisation, and life disengagement. Compared with CAU, participants who completed Young Person's Face IT showed reductions in social anxiety symptoms (ηp2 = 0.06). No significant improvements were found for the other outcomes. This study endorses web-based psychosocial support in reducing social anxiety in adolescents distressed by a visible difference. Future studies are needed to confirm the effectiveness of Young Person's Face IT and to explore potential long-term effects.
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15
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Zucchelli F, Donnelly O, Rush E, White P, Gwyther H, Williamson H. An Acceptance and Commitment Therapy Prototype Mobile Program for Individuals With a Visible Difference: Mixed Methods Feasibility Study. JMIR Form Res 2022; 6:e33449. [PMID: 35060908 PMCID: PMC8817209 DOI: 10.2196/33449] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 11/17/2021] [Accepted: 11/21/2021] [Indexed: 02/06/2023] Open
Abstract
Background Mobile apps may offer a valuable platform for delivering evidence-based psychological interventions for individuals with atypical appearances, or visible differences, who experience psychosocial appearance concerns such as appearance-based social anxiety and body dissatisfaction. Before this study, researchers and stakeholders collaboratively designed an app prototype based on acceptance and commitment therapy (ACT), an evidence-based form of cognitive behavioral therapy that uses strategies such as mindfulness, clarification of personal values, and value-based goal setting. The intervention also included social skills training, an established approach for increasing individuals’ confidence in managing social interactions, which evoke appearance-based anxiety for many. Objective In this study, the authors aim to evaluate the feasibility of an ACT-based app prototype via the primary objectives of user engagement and acceptability and the secondary feasibility objective of clinical safety and preliminary effectiveness. Methods To address the feasibility objectives, the authors used a single-group intervention design with mixed methods in a group of 36 participants who have a range of visible differences. The authors collected quantitative data via measures of program use, satisfaction ratings, and changes over 3 time points spanning 12 weeks in outcomes, including selected ACT process measures (experiential avoidance, cognitive defusion, and valued action), scales of appearance concerns (appearance-based life disengagement, appearance-fixing behaviors, appearance self-evaluation, and fear of negative appearance evaluation), and clinical well-being (depression and anxiety). Semistructured exit interviews with a subsample of 12 participants provided qualitative data to give a more in-depth understanding of participants’ views and experiences of the program. Results In terms of user engagement, adherence rates over 6 sessions aligned with the upper boundary of those reported across mobile mental health apps, with over one-third of participants completing all sessions over 12 weeks, during which a steady decline in adherence was observed. Time spent on sessions matched design intentions, and engagement frequencies highlighted semiregular mindfulness practice, mixed use of value-based goal setting, and high engagement with social skills training. The findings indicate a good overall level of program acceptability via satisfaction ratings, and qualitative interview findings offer positive feedback as well as valuable directions for revisions. Overall, testing for clinical safety and potential effectiveness showed encouraging changes over time, including favorable changes in appearance-related life disengagement, appearance-fixing behaviors, and selected ACT measures. No iatrogenic effects were indicated for depression or anxiety. Conclusions An ACT-based mobile program for individuals struggling with visible differences shows promising proof of concept in addressing appearance concerns, although further revisions and development are required before further development and more rigorous evaluation.
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Affiliation(s)
- Fabio Zucchelli
- Health and Applied Sciences, University of the West of England, Bristol, United Kingdom
| | - Olivia Donnelly
- North Bristol National Health Service Trust, Bristol, United Kingdom
| | - Emma Rush
- Vitiligo Support United Kingdom, London, United Kingdom
| | - Paul White
- Health and Applied Sciences, University of the West of England, Bristol, United Kingdom
| | - Holly Gwyther
- Health and Applied Sciences, University of the West of England, Bristol, United Kingdom
| | - Heidi Williamson
- Health and Applied Sciences, University of the West of England, Bristol, United Kingdom
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16
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Assessing the usability and acceptability of Face IT@home: an online CBT intervention for people with visible differences. COGNITIVE BEHAVIOUR THERAPIST 2022. [DOI: 10.1017/s1754470x22000381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
To increase access to support, an online psychosocial support tool for adults with visible differences was adapted for use without referral or supervision. This intervention combines a cognitive behavioural and social skills model of support. This study aimed to assess the usability and acceptability of Face IT@home as a self-help intervention. Eighty-one participants were recruited (32 with visible differences). Stage 1 included 14 participants (11 female, all with visible differences) who viewed two sessions of Face IT@home and undertook a semi-structured telephone interview. Stage 2 consisted of 14 think-aloud sessions (13 female, none with visible differences) with participants, supervised by researchers. Stage 3 employed 53 participants (47 female; 19 with visible differences), to view one session of Face IT@home and complete an online survey to evaluate usability and acceptability. User interviews, think-aloud studies and questionnaires identified usability and acceptability factors of Face IT@home that make it fit for purpose as a self-help tool. Participants suggested some changes to the Face IT@home program to improve usability. Participants reported that Face IT@home was a useful tool for people with visible differences and could be effective. The CBT-based model was considered a useful approach to addressing psychosocial concerns. The online self-help format will increase access to psychological support for adults with visible differences.
Key learning aims
(1)
The paper outlines an important cognitive behavioural framework for supporting adults with visible differences.
(2)
The paper demonstrates the importance of user testing and client involvement in developing intervention models.
(3)
The studies highlight one approach to the process of user testing that can produce a robust online intervention.
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17
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Kling J, Nordgreen T, Kvalem IL, Williamson H, Feragen KB. Recruiting hard-to-engage groups to online psychosocial interventions: Experiences from an RCT study targeting adolescents with a visible difference. Contemp Clin Trials Commun 2021; 24:100869. [PMID: 34877433 PMCID: PMC8628201 DOI: 10.1016/j.conctc.2021.100869] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 09/22/2021] [Accepted: 11/13/2021] [Indexed: 01/28/2023] Open
Abstract
Online interventions have the potential to reach individuals who are otherwise difficult to engage due to stigma and sensitive topics. However, these individuals also tend to be hard to recruit in clinical trials, a crucial step in order to provide evidence-based interventions. This highlights a need for more information about efficient recruitment strategies for difficult-to-engage groups. The present study aimed to share the systematised experiences of recruiting adolescents with a visible difference to an online psychosocial intervention RCT. With the intention to recruit 160 participants (age 12-17), recruitment efforts were nationwide and included multiple arenas (e.g., hospitals, schools, social media), and methods (e.g., in-consultation, targeted letters, posters). Ultimately, 102 participants were recruited, and results showed that recruitment involving patient organisations, hospital departments, and specialised resource centres were most successful in reaching participants. The most efficient recruitment strategy was targeted letters sent home to eligible patients/members, as 78% of the participants were recruited this way. Media and social media recruitment efforts yielded comparatively few participants. No participants were recruited through schools and educational health care services, primary health care services, or municipal and regional authorities. Our results are discussed in relation to barriers with recruiting difficult-to-engage groups to RCTs, providing useful recruitment tools to future similar studies. For instance, future studies are recommended to utilise targeted approaches over general population approaches. Also, results from recruitment efforts should routinely be reported, as this ultimately will provide more general strategies for effective recruitment and support studies in reaching recruitment goals.
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Affiliation(s)
- Johanna Kling
- Centre for Rare Disorders, Rikshospitalet, Oslo University Hospital HF, Norway
| | | | | | - Heidi Williamson
- Centre for Appearance Research, University of the West of England, Bristol, UK
| | - Kristin B. Feragen
- Centre for Rare Disorders, Rikshospitalet, Oslo University Hospital HF, Norway
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Gibson C, O’Connor M, White R, Jackson M, Baxi S, Halkett GKB. 'I Didn't Even Recognise Myself': Survivors' Experiences of Altered Appearance and Body Image Distress during and after Treatment for Head and Neck Cancer. Cancers (Basel) 2021; 13:cancers13153893. [PMID: 34359793 PMCID: PMC8345413 DOI: 10.3390/cancers13153893] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 07/26/2021] [Accepted: 07/30/2021] [Indexed: 11/16/2022] Open
Abstract
Simple Summary In interview data collected from 21 people diagnosed with head and neck cancer in the previous six years, participants reported adequate procedural preparation but little or no preparation related to appearance. Body image distress contributed to psychosocial issues for many people, negatively impacting their adaptation to altered appearance. The main themes included; Preparation (sub-themes: Decision-making; and Preparation for Altered Appearance); Altered Appearance (sub-themes: Weight Loss; Face, Skin and Hair Changes; and Reconstructive Surgery); and Consequences (sub-themes Reactions from Others; Adapting to Altered Appearance). Current practice provides information pre-treatment about many aspects of coping; however, the subject of appearance is not routinely addressed. Communication skills training for health professionals that improves their comfort and sensitivity in discussing and conveying compassion around issues of altered appearance, body image, and trauma, is needed to decrease suffering for survivors, support healthy adaptation to living with altered appearance, and increase patient satisfaction with health care. Abstract Purpose: Preparation for head and neck cancer treatment is focused on practicalities of treatment. Little or no time is spent prior to treatment discussing aesthetic results of treatment or the psychosocial impact of living with an altered appearance after treatment. The objective of this study was to explore the experiences of survivors of head and neck cancers, with a focus on the psychosocial impact of altered appearance. Methods: A qualitative research approach based on social constructionist theory was used. Twenty-one semi-structured interviews were conducted with survivors of head and neck cancer who had been diagnosed in the previous six years. Thematic analysis was used to identify themes. Results: People diagnosed with HNC reported feeling rushed into treatment, with adequate procedural preparation but little or no preparation related to appearance. The main themes included: Preparation (sub-themes: Decision-making; and Preparation for Altered Appearance); Altered Appearance (sub-themes: Weight Loss; Face, Skin and Hair Changes; and Reconstructive Surgery); and Consequences (sub-themes Reactions from Others; Adapting to Altered Appearance). Conclusions: Body image distress related to altered appearance, contributed to psychosocial issues for many people diagnosed with head and neck cancer. Current practice provides information pre-treatment about many aspects of coping; however, the subject of appearance is not routinely addressed. Communication skills training for health professionals that improves their comfort and sensitivity in discussing and conveying compassion around issues of altered appearance, body image, and trauma, is needed to decrease suffering for survivors, support healthy adaptation to living with altered appearance, and increase their satisfaction with health care.
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Affiliation(s)
- Chandrika Gibson
- Curtin School of Nursing, Faculty of Health Sciences, Curtin University, Perth, WA 6845, Australia;
- Correspondence: ; Tel.: +61-0411-954-851
| | - Moira O’Connor
- WA Cancer Prevention Research Unit (WACPRU), School of Population Health, Faculty of Health Sciences, Curtin University, Perth, WA 6845, Australia;
| | - Rohen White
- Department of Radiation Oncology, Sir Charles Gairdner Hospital, Nedlands, WA 6845, Australia;
| | - Melanie Jackson
- GenesisCare Perth Radiation Oncologist, Wembley, WA 6014, Australia;
| | - Siddhartha Baxi
- GenesisCare Gold Coast Radiation Oncologist, John Flynn Hospital, Tugun, QLD 4224, Australia;
| | - Georgia K. B. Halkett
- Curtin School of Nursing, Faculty of Health Sciences, Curtin University, Perth, WA 6845, Australia;
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Zucchelli F, Donnelly O, Rush E, Smith H, Williamson H. Designing an mHealth Intervention for People With Visible Differences Based on Acceptance and Commitment Therapy: Participatory Study Gaining Stakeholders' Input. JMIR Form Res 2021; 5:e26355. [PMID: 33759791 PMCID: PMC8075076 DOI: 10.2196/26355] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 02/02/2021] [Accepted: 02/04/2021] [Indexed: 01/22/2023] Open
Abstract
Background Given their growing popularity, mobile health (mHealth) apps may offer a viable method of delivering psychological interventions for people with an atypical appearance (ie, visible difference) who struggle with appearance-related distress. Acceptance and Commitment Therapy (ACT), a third-wave cognitive behavioral approach, has been used effectively in mHealth and is being increasingly applied clinically to common psychosocial difficulties associated with visible differences. We planned to design an ACT-based mHealth intervention (ACT It Out) for this population. Objective The aim of this study is to gain key stakeholder input from user representatives and psychological clinicians to optimize the intervention’s design for future development and uptake. To do so, we explored considerations relating to mHealth as a delivery platform for adults with visible differences and elicited stakeholders’ design preferences and ideas based on initial author-created content. Methods Within a participatory design framework, we used a mix of qualitative methods, including usability sessions and a focus group in a face-to-face workshop, and interviews and textual feedback collected remotely, all analyzed using template analysis. A total of 6 user representatives and 8 clinicians were recruited for this study. Results Our findings suggest that there are likely to be strengths and challenges of mHealth as an intervention platform for the study population, with key concerns being user safeguarding and program adherence. Participants expressed design preferences toward relatable human content, interactive and actionable features, flexibility of use, accessibility, and engaging content. Conclusions The findings offer valuable design directions for ACT It Out and related interventions, emphasizing the need to carefully guide users through the intervention while acknowledging the limited time and space that mHealth affords.
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Affiliation(s)
- Fabio Zucchelli
- The Centre for Appearance Research, University of the West of England, Bristol, United Kingdom
| | - Olivia Donnelly
- The Outlook Service, Southmead Hospital, North Bristol NHS Trust, Bristol, United Kingdom
| | - Emma Rush
- Vitiligo Support UK, London, United Kingdom
| | - Harriet Smith
- The Centre for Appearance Research, University of the West of England, Bristol, United Kingdom
| | - Heidi Williamson
- The Centre for Appearance Research, University of the West of England, Bristol, United Kingdom
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20
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Gholizadeh S, Rice DB, Carboni-Jiménez A, Kwakkenbos L, Boruff J, Krishnan A, Malcarne VL, Thombs BD. Effects of cosmetic and other camouflage interventions on appearance-related and psychological outcomes among adults with visible differences in appearance: a systematic review. BMJ Open 2021; 11:e046634. [PMID: 33687957 PMCID: PMC8098928 DOI: 10.1136/bmjopen-2020-046634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE Visible differences in appearance are associated with poor social and psychological outcomes. Effectiveness of non-surgical cosmetic and other camouflage interventions is poorly understood. The objective was to evaluate effects of cosmetic and other camouflage interventions on appearance-related outcomes, general psychological outcomes and adverse effects for adults with visible appearance differences. DESIGN Systematic review. DATA SOURCES MEDLINE (Ovid), EMBASE (Ovid), PsycINFO (Ovid) CINAHL and Cochrane Central databases searched from inception to 24 October 2020. Two reviewers independently reviewed titles and abstracts and full texts. ELIGIBILITY CRITERIA Randomised controlled trials in any language on non-surgical cosmetic or other camouflage interventions that reported appearance-related outcomes, general psychological outcomes or adverse effects for adults with visible appearance differences. DATA EXTRACTION AND SYNTHESIS Two reviewers independently extracted data, assessed intervention reporting using the Template for Intervention Description and Replication checklist, and assessed risk of bias using the Cochrane risk of bias tool. Outcomes included appearance-related outcomes, general psychological outcomes (eg, depression, anxiety) and adverse effects. RESULTS One head-to-head trial and five trials with waiting list or routine care comparators were included. All had unclear or high risk of bias in at least five of seven domains. Effect sizes could not be determined for most outcomes due to poor reporting. Between-group statistically significant differences were not reported for any appearance-related outcomes and for only 5 of 25 (20%) other psychological outcomes. Given heterogeneity of populations and interventions, poor reporting and high risk of bias, quantitative synthesis was not possible. CONCLUSIONS Conclusions about effectiveness of non-surgical cosmetic or other camouflage interventions could not be drawn. Well-designed and conducted trials are needed. Without such evidence, clinicians or other qualified individuals should engage with patients interested in cosmetic interventions in shared decision making, outlining potential benefits and harms, and the lack of evidence to inform decisions. PROSPERO REGISTRATION NUMBER CRD42018103421.
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Affiliation(s)
- Shadi Gholizadeh
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
- Department of Psychiatry, McGill University, Montreal, Québec, Canada
- Department of Psychology, San Diego State University, San Diego, California, USA
| | - Danielle B Rice
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
- Department of Psychology, McGill University, Montreal, Québec, Canada
| | - Andrea Carboni-Jiménez
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
- Department of Psychiatry, McGill University, Montreal, Québec, Canada
| | - Linda Kwakkenbos
- Department of Clinical Psychology, Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
| | - Jill Boruff
- Schulich Library of Physical Sciences, Life Sciences, and Engineering, McGill University, Montreal, Québec, Canada
| | - Ankur Krishnan
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
| | - Vanessa L Malcarne
- Department of Psychology, San Diego State University, San Diego, California, USA
- Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California San Diego, San Diego, California, USA
| | - Brett D Thombs
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
- Department of Psychiatry, McGill University, Montreal, Québec, Canada
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Québec, Canada
- Department of Medicine, McGill University, Montréal, Québec, Canada
- Department of Educational and Counselling Psychology, McGill University, Montréal, Québec, Canada
- Biomedical Ethics Unit, McGill University, Montreal, Québec, Canada
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21
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van Dalen M, Pasmans SGMA, Aendekerk ML, Mathijssen I, Koudstaal M, Timman R, Williamson H, Hillegers M, Utens EMWJ, Okkerse J. Investigating online psychological treatment for adolescents with a visible difference in the Dutch YP Face IT study: protocol of a randomised controlled trial. BMJ Open 2021; 11:e041449. [PMID: 33483443 PMCID: PMC7831738 DOI: 10.1136/bmjopen-2020-041449] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION This paper outlines the study protocol for the Dutch Young People (YP) Face IT Study. Adolescents with a visible difference (ie, disfigurement) often experience challenging social situations such as being stared at, receiving unwanted questions or being teased. As a consequence, some of these adolescents experience adverse psychosocial outcomes and appearance-related distress. To address this appearance-related distress, an online psychotherapeutic intervention, YP Face IT, has been developed. YP Face IT uses social interaction skills training and cognitive-behavioural therapy. The Dutch YP Face IT Study tests whether this intervention is effective in reducing social anxiety and improving body esteem. METHODS AND ANALYSIS Participants are adolescents aged 12-18 with a visible difference and experiencing appearance-related distress. In this two-armed randomised controlled trial, 224 adolescents will be randomised to care as usual or YP Face IT. Adolescents will complete questionnaires at baseline, at 13 weeks and at 25 weeks. Primary outcomes are differences in social anxiety and body esteem between YP Face IT and care as usual. Secondary outcomes are differences in aspects of self-worth, perceived stigmatisation, health-related quality of life, life engagement, appearance-related distress and depressive symptoms between the two groups. ETHICS AND DISSEMINATION Research ethics approval was obtained from the medical ethics review committee in Rotterdam (reference number MEC-2018-052/NL63955.078.18). Findings will be disseminated through academic peer-reviewed publications, conferences and newsletters to patient associations and participants of the study. TRIAL REGISTRATION NUMBER The Netherlands Trial Register (NL7626).
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Affiliation(s)
- Marije van Dalen
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-Sophia Children's Hospital, Rotterdam, Netherlands
| | - Suzanne G M A Pasmans
- Department of Dermatology, Centre of Pediatric Dermatology, Erasmus MC-Sophia Children's Hospital, Rotterdam, Netherlands
| | - Marie-Louise Aendekerk
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-Sophia Children's Hospital, Rotterdam, Netherlands
| | - Irene Mathijssen
- Department of Plastic and Reconstructive and Hand Surgery, The Dutch Craniofacial Centre, Erasmus MC Sophia-Children's Hospital, Rotterdam, Netherlands
| | - Maarten Koudstaal
- Department of Oral and Maxillofacial Surgery, The Dutch Craniofacial Centre, Erasmus MC-Sophia Children's Hospital, Rotterdam, Netherlands
| | - Reinier Timman
- Department of Psychiatry, unit of Medical Psychology and Psychotherapy, Erasmus MC, Rotterdam, Netherlands
| | - Heidi Williamson
- Department of Health and Social Sciences, University of the West of England, Bristol, UK
| | - Manon Hillegers
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-Sophia Children's Hospital, Rotterdam, Netherlands
| | - Elisabeth M W J Utens
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-Sophia Children's Hospital, Rotterdam, Netherlands
- Research Institute of Child Development and Education, University of Amsterdam, Amsterdam, The Netherlands
- Academic Center for Child Psychiatry Levvel/Department of Child and Adolescent Psychiatry, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Jolanda Okkerse
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-Sophia Children's Hospital, Rotterdam, Netherlands
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22
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Gee C, Maskell J, Newcombe P, Kimble R, Williamson H. Australian health professionals' perspectives of psychosocial adjustment to visible differences: A qualitative analysis of pediatric populations. Body Image 2020; 33:13-26. [PMID: 32086188 DOI: 10.1016/j.bodyim.2020.02.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Revised: 02/07/2020] [Accepted: 02/08/2020] [Indexed: 10/25/2022]
Abstract
Living with a visible difference (e.g., disfigurement) can compromise a child's psychological wellbeing. Although some children can adjust well, others can develop a range of appearance-related issues such as social anxiety, low self-esteem, and body dissatisfaction. However, current research fails to confirm what factors contribute to appearance-related distress, and what factors buffer the consequences of living with a visible difference. Semi-structured qualitative interviews were conducted with 16 Australian specialist health professionals who care for children with visible differences. Interviews explored the type of appearance-related psychosocial concerns presented to a pediatric hospital, perspectives on the impact of appearance-related distress, as well as factors and processes that health professionals perceive influence adjustment. Data were subjected to inductive thematic analysis. Rich evidence was offered by health professionals, which demonstrated deep understanding of the psychological wellbeing of their patients. Three themes were identified: Mind, Body, and Soul; Stages of Life; and Individual Differences. Findings highlighted the complexity of appearance-related distress, with individual differences in adjustment, and the powerful impact it can have on a child's short and long-term psychosocial wellbeing. The importance of reaching consensus in the conceptualisation and measurement of psychological wellbeing is stressed, and key domains associated with adjustment are proposed.
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Affiliation(s)
- Caroline Gee
- Centre for Children's Burns and Trauma Research, Child Health Research Centre, The University of Queensland, Level 7, 62 Graham Street, South Brisbane, Queensland, 4101, Australia.
| | - Jessica Maskell
- Gold Coast University Hospital, Social Work Department, 1 Hospital Boulevard, Southport, Queensland, 4217, Australia.
| | - Peter Newcombe
- Institute for Teaching and Learning Innovation, Level 3, Building 17, Staff House Road, The University of Queensland, St Lucia, Queensland, 4072, Australia.
| | - Roy Kimble
- Centre for Children's Burns and Trauma Research, Child Health Research Centre, The University of Queensland, Level 7, 62 Graham Street, South Brisbane, Queensland, 4101, Australia; Pegg Leditschke Children's Burns Centre, Queensland Children's Hospital, Level 5, 501 Stanley Street, South Brisbane, Queensland, 4101, Australia.
| | - Heidi Williamson
- Centre for Appearance Research, University of the West of England, Frenchay Campus, Bristol, BS16 1QY, United Kingdom.
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Experiential avoidance and cognitive fusion mediate the relationship between body evaluation and unhelpful body image coping strategies in individuals with visible differences. Body Image 2020; 32:121-127. [PMID: 31869761 DOI: 10.1016/j.bodyim.2019.12.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 12/09/2019] [Accepted: 12/09/2019] [Indexed: 01/26/2023]
Abstract
Psychological flexibility, the capacity to be open to any internal stimuli and act in accordance with valued ends, has been identified as an explanatory variable in how people cope with body concerns. The role of psychological flexibility is unexplored in adults with an atypical appearance due to a health condition, injury, or medical treatment (collectively visible difference), who often encounter multiple day-to-day body image threats. Testing two core components of psychological flexibility, namely experiential avoidance (a desire to avoid or get rid of unpleasant internal experiences) and cognitive fusion (taking thoughts literally), can also provide a more precise theoretical model, with clearer implications for psychological intervention. This survey study investigated whether each psychological flexibility component mediated the relationship between body evaluation and two unhelpful body image coping strategies (behavioural avoidance and appearance-fixing behaviours) in 220 adults with various causes of visible difference. Controlling for demographic variables and subjective noticeability of visible difference, results suggest that cognitive fusion partially mediated the relationship for both body image coping strategies, and experiential avoidance partially mediated behavioural avoidance but not appearance-fixing behaviours. Cognitive fusion may be a particularly important cognitive process in the mechanisms underpinning unhelpful body image coping strategies in this population.
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Shepherd L, Turner A, Reynolds DP, Thompson AR. Acceptance and commitment therapy for appearance anxiety: three case studies. Scars Burn Heal 2020; 6:2059513120967584. [PMID: 35154811 PMCID: PMC8832325 DOI: 10.1177/2059513120967584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Introduction: Due to scarring, appearance anxiety is a common psychological difficulty in
patients accessing burns services. Appearance anxiety can significantly
impact upon social functioning and quality of life; thus, the availability
of effective psychological therapies is vital. Acceptance and Commitment
Therapy (ACT) is considered useful for treating distress associated with
other health conditions and may lend itself well to appearance anxiety.
However, no published research is currently available. Methods: Three single case studies (two male burns patients; one female necrotising
fasciitis patient) are presented where appearance anxiety was treated using
ACT. A treatment protocol was followed and evaluated: the Derriford
Appearance Scale measured appearance anxiety; the Work and Social Adjustment
Scale measured impairment in functioning; the Acceptance and Action
Questionnaire measured acceptance (willingness to open up to distressing
internal experiences); and the Committed Action Questionnaire measured
engagement in meaningful and valued life activities. Measures were given at
every treatment session and patient feedback was obtained. One-month
follow-up data were available for two cases. Results: After the intervention, all patients had reduced functional impairment and
were living more valued and meaningful lives. No negative effects were
found. Discussion: These case studies suggest that ACT may be a useful psychological therapy for
appearance anxiety. The uncontrolled nature of the intervention limits the
conclusions that can be drawn. Conclusion: A pilot feasibility study to evaluate the effectiveness of ACT for appearance
anxiety is warranted. Lay Summary Many patients with scars can feel distressed about their appearance. This is
known as appearance anxiety and can include patients accessing burns
services. Appearance anxiety can stop patients from enjoying a good quality
of life and impact upon important areas of daily functioning. It is
therefore important that psychological therapies are effective. However,
research investigating the effectiveness of psychological therapies is
limited. This paper describes the psychological therapy of three patients
who were distressed about scarring. A psychological therapy called
Acceptance and Commitment Therapy (ACT) was used as part of standard care
and evaluated using questionnaires and patient feedback. After the course of
ACT, all patients were less impacted day-to-day by their appearance anxiety
and were living more valued and meaningful lives. No negative effects were
found. These case studies suggest that ACT may be a useful psychological
therapy for appearance anxiety and further research evaluating it should be
completed.
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Affiliation(s)
- Laura Shepherd
- Department of Clinical Psychology &
Neuropsychology, Nottingham University Hospitals NHS Trust, Queens Medical Centre
Campus, Nottingham, UK
- Laura Shepherd, Department of Clinical
Psychology & Neuropsychology, Nottingham University Hospitals NHS Trust,
Queens Medical Centre Campus, Derby Road, Nottingham NG7 2UH, UK.
| | - Anna Turner
- Department of Clinical Psychology &
Neuropsychology, Nottingham University Hospitals NHS Trust, Queens Medical Centre
Campus, Nottingham, UK
| | - Darren P Reynolds
- Department of Clinical Psychology &
Neuropsychology, Nottingham University Hospitals NHS Trust, Queens Medical Centre
Campus, Nottingham, UK
| | - Andrew R Thompson
- South Wales Clinical Psychology Training
Programme, School of Psychology, Cardiff University, Cardiff, Wales, UK
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Hudson MP, Thompson AR, Emerson LM. Compassion-focused self-help for psychological distress associated with skin conditions: a randomized feasibility trial. Psychol Health 2019; 35:1095-1114. [DOI: 10.1080/08870446.2019.1707829] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Mark P. Hudson
- Department of Psychology, Clinical Psychology Unit, Western Bank, The University of Sheffield, Sheffield, UK
| | - Andrew R. Thompson
- Department of Psychology, Clinical Psychology Unit, Western Bank, The University of Sheffield, Sheffield, UK
| | - Lisa-Marie Emerson
- Department of Psychology, Clinical Psychology Unit, Western Bank, The University of Sheffield, Sheffield, UK
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Lewis CJ, Hodgkinson EL, Allison KP. Corrosive attacks in the UK - Psychosocial perspectives and decontamination strategies. Burns 2019; 46:213-218. [PMID: 31784238 DOI: 10.1016/j.burns.2019.06.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 05/28/2019] [Accepted: 06/04/2019] [Indexed: 10/25/2022]
Abstract
Acid attacks, or vitriolage, are defined as violent assaults involving the deliberate throwing of an acid or similarly corrosive substance with the intention to "maim, disfigure, torture or kill" [1]. The Acid Survivors Trust International suggest a prevalence of 1500 attacks reported worldwide per annum, although this is likely to be an underestimate by 40% [2]. The UK is thought to have one of the highest of rates of recorded corrosive attacks, with an increase from 228 attacks in 2012 to 601 in 2016. Most were reported by the London Metropolitan police force followed by Northumbria, Cambridgeshire, Hertfordshire, Greater Manchester and Humberside [[2]]. The chemical agents involved include acids, alkalis, oxidising and reducing agents, alkylating and chelating agents and solvents. They cause injury by producing a chemical interaction which can lead to extensive tissue destruction and extreme pain. Herein, we present a review on the changing epidemiology of corrosive attacks in the UK and currently employed management strategies.
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Affiliation(s)
- C J Lewis
- Department of Plastic Surgery, James Cook University Hospital, Middlesbrough, UK.
| | - E L Hodgkinson
- Psychology in Healthcare, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - K P Allison
- Department of Plastic Surgery, James Cook University Hospital, Middlesbrough, UK
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Pell C. What to Do When People Stare: A Workshop to Teach Individuals With Disfiguring Conditions to Contend With Staring and Improve Control of Social Interactions. J Burn Care Res 2019; 40:743-751. [DOI: 10.1093/jbcr/irz117] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Facial disfigurement due to any congenital or acquired condition is a social disability that can impede communication, contribute to awkward social interactions, and cause individuals with differences to be isolated and rejected. Yet, few interventions have been developed to address the psychosocial consequences of living with a visible difference, despite research indicating that the more visible the disfigurement is to others, the greater the social implication and challenge for the affected individual. This article reviews the impact of the “What to Do When People Stare” social and communication workshop, including its theoretical basis (drawn from anthropological research and theory pertaining to disfigurement), the phenomenon of staring, and the experience of being the target of a stare. The review highlights feedback from 46 individuals with disfiguring conditions caused by burns, dermatological conditions, and craniofacial conditions who completed a Workshop Evaluation Survey. The instructor, who has a facial difference, reviewed the science of staring, the role and influence of the media and beauty in society, myths associated with disfigurement, social and communication skills, and asked specific questions to elicit feelings and beliefs about why people stare, and how it feels to be the object of a stare. After completing the workshop, 80% of participants reported that they felt better prepared to cope with staring, and 83% reported a better understanding about the motives of staring. The workshop demonstrates the need to increase awareness of visible differences and to teach individuals with visible differences and the general public appropriate social skills for engaging with one another. The workshop’s success to date highlights the need for similar programs addressing the psychosocial communicative dimensions related to staring. Collaborations with burn centers and other nonprofit organizations that treat and assist individuals with psychosocial issues related to visible difference could strengthen content and assessment data.
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Shepherd L, Reynolds DP, Turner A, O’Boyle CP, Thompson AR. The role of psychological flexibility in appearance anxiety in people who have experienced a visible burn injury. Burns 2019; 45:942-949. [DOI: 10.1016/j.burns.2018.11.015] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 11/22/2018] [Accepted: 11/30/2018] [Indexed: 12/22/2022]
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29
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Stiernman M, Österlind K, Rumsey N, Becker M, Persson M. Parental and health care professional views on psychosocial and educational outcomes in patients with cleft lip and/or cleft palate. EUROPEAN JOURNAL OF PLASTIC SURGERY 2019. [DOI: 10.1007/s00238-019-01530-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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30
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Johns AL, Luquetti DV, Brajcich MR, Heike CL, Stock NM. In Their Own Words: Caregiver and Patient Perspectives on Stressors, Resources, and Recommendations in Craniofacial Microsomia Care. J Craniofac Surg 2018; 29:2198-2205. [PMID: 30334912 PMCID: PMC6224304 DOI: 10.1097/scs.0000000000004867] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
This study describes stressors, resources, and recommendations related to craniofacial microsomia (CFM) care from the perspective of caregivers of children with CFM and adults with CFM to inform improved quality of healthcare delivery. A mixed method design was used with fixed-response and open-ended questions from an online survey in English. The survey included demographics, CFM phenotypic information, and items about CFM-related experiences across settings. Themes were identified by qualitative analysis of responses to open-ended questions. Respondents (n = 51) included caregivers (n = 42; 90% mothers) and adults with CFM (n = 9; 78% female), who had a mean age of 45 ± 6 years. Most children were male (71%) with an average age of 7 ± 4 years. Respondents were primarily white (80%), non-Hispanic (89%), from the United States (82%), had a college degree (80%), and had private health insurance (80%). Reflecting the high rate of microtia (84%) in the sample, themes centered on the impact of hearing difficulties across settings with related language concerns. Negative social experiences were frequently described and school needs outlined. Multiple medical stressors were identified and corresponding suggestions included: providers need to be better informed about CFM, treatment coordination among specialists, and preference for a family-centered approach with reassurance, empathy, and clear communication. Advice offered to others with CFM included positive coping strategies. Overall, caregivers' and patients' responses reflected the complexity of CFM treatment. Incorporating these perspectives into routine CFM care has the potential to reduce family distress while improving their healthcare.
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Affiliation(s)
- Alexis L. Johns
- Division of Plastic and Maxillofacial Surgery; Children’s Hospital Los Angeles, Los Angeles, CA, USA
| | - Daniela V. Luquetti
- Seattle Children’s Hospital, Craniofacial Center; Seattle Children’s Research Institute; University of Washington, Department of Pediatrics, Seattle, WA, USA
| | | | - Carrie L. Heike
- Seattle Children’s Hospital, Craniofacial Center; Seattle Children’s Research Institute; University of Washington, Department of Pediatrics, Seattle, WA, USA
| | - Nicola M. Stock
- Centre for Appearance Research, University of the West of England, Bristol, UK
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31
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Zucchelli F, Donnelly O, Williamson H, Hooper N. Acceptance and Commitment Therapy for People Experiencing Appearance-Related Distress Associated With a Visible Difference: A Rationale and Review of Relevant Research. J Cogn Psychother 2018; 32:171-183. [PMID: 32746433 DOI: 10.1891/0889-8391.32.3.171] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
People may have a visibly different appearance due to various causes, such as congenital conditions, injury, disease, or medical treatment. Some individuals with a visible difference experience social anxiety and isolation, body image dissatisfaction, shame and self-stigma, psychological trauma, and challenges managing their condition. In this article, we synthesize the relevant literature and present the theoretical rationale for the application of Acceptance and Commitment Therapy (ACT), a third-wave behavioral therapy combining mindfulness skills and value-driven action, to those experiencing distress relating to an unusual or altered appearance. We also outline how ACT may be tailored to the specific considerations of this population and recommend next steps in researching its acceptability and clinical effectiveness.
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Affiliation(s)
- Fabio Zucchelli
- Centre for Appearance Research, University of the West of England (UWE), Bristol, UK
| | - Olivia Donnelly
- Outlook & Clinical Health Psychology, North Bristol NHS Trust, Southmead Hospital, Bristol, UK
| | - Heidi Williamson
- Centre for Appearance Research, University of the West of England (UWE), Bristol, UK
| | - Nic Hooper
- Centre for Appearance Research, University of the West of England (UWE), Bristol, UK
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32
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Harcourt D, Hamlet C, Feragen KB, Garcia-Lopez LJ, Masnari O, Mendes J, Nobile F, Okkerse J, Pittermann A, Spillekom-van Koulil S, Stock NM, Williamson H. The provision of specialist psychosocial support for people with visible differences: A European survey. Body Image 2018; 25:35-39. [PMID: 29454284 DOI: 10.1016/j.bodyim.2018.02.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Revised: 02/05/2018] [Accepted: 02/05/2018] [Indexed: 10/18/2022]
Abstract
A substantial body of research has demonstrated the challenges commonly facing people with visible differences (disfigurements) and explored the potential benefits offered by specialist psychosocial support and intervention for those who are negatively affected. However, little is known about the availability of such support in Europe for people whose appearance is in any way different to 'the norm'. This survey of 116 psychosocial specialists from 15 European countries, working with a range of patient groups, has shown a tendency for specialists to prioritise Cognitive-behavioural-based approaches, amongst a wide range of other approaches and interventional techniques. It indicates variations in the availability of support, and a perceived need for improved access to interventions, additional training, and greater awareness of the psychosocial issues associated with visible differences.
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Affiliation(s)
- Diana Harcourt
- Centre for Appearance Research, University of the West of England, Bristol, BS16 1QY, UK.
| | - Claire Hamlet
- Centre for Appearance Research, University of the West of England, Bristol, BS16 1QY, UK
| | | | - Luis-Joaquin Garcia-Lopez
- Department of Psychology, Division of Clinical Psychology, University of Jaen, Building C5, 23071, Jaen, Spain
| | - Ornella Masnari
- Department of Psychosomatics and Psychiatry, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032, Zurich, Switzerland
| | - Jose Mendes
- INTELECTO - Psychology & Research, Rua do Monte, 52B, R/C Esquerdo Nascente, 9500-451, Ponta Delgada, Açores, Portugal
| | | | - Jolanda Okkerse
- Department of Child and Adolescent Psychiatry, Sophia Children's Hospital, Wytemaweg 80, 3015 CN, Rotterdam, The Netherlands
| | - Anna Pittermann
- General Hospital of Vienna, Medical University, Department of Plastic and Reconstructive Surgery, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | | | - Nicola Marie Stock
- Centre for Appearance Research, University of the West of England, Bristol, BS16 1QY, UK; Cleft Collective, University of the West of England, Bristol, UK
| | - Heidi Williamson
- Centre for Appearance Research, University of the West of England, Bristol, BS16 1QY, UK
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van Beugen S, van Middendorp H, Ferwerda M, Smit J, Zeeuwen-Franssen M, Kroft E, de Jong E, Donders A, van de Kerkhof P, Evers A. Predictors of perceived stigmatization in patients with psoriasis. Br J Dermatol 2016; 176:687-694. [DOI: 10.1111/bjd.14875] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2016] [Indexed: 12/22/2022]
Affiliation(s)
- S. van Beugen
- Institute of Psychology, Health, Medical and Neuropsychology Unit; Leiden University; Leiden the Netherlands
- Department of Medical Psychology; Radboud University Medical Center; Nijmegen the Netherlands
| | - H. van Middendorp
- Institute of Psychology, Health, Medical and Neuropsychology Unit; Leiden University; Leiden the Netherlands
- Department of Medical Psychology; Radboud University Medical Center; Nijmegen the Netherlands
| | - M. Ferwerda
- Institute of Psychology, Health, Medical and Neuropsychology Unit; Leiden University; Leiden the Netherlands
- Department of Medical Psychology; Radboud University Medical Center; Nijmegen the Netherlands
| | - J.V. Smit
- Department of Dermatology; Rijnstate Hospital; Velp the Netherlands
| | | | - E.B.M. Kroft
- Department of Dermatology; Ziekenhuisgroep Twente; Almelo the Netherlands
| | - E.M.G.J. de Jong
- Department of Dermatology; Radboud University Medical Center; Nijmegen the Netherlands
| | - A.R.T. Donders
- Department for Health Evidence; Radboud University Medical Center; Nijmegen the Netherlands
| | - P.C.M. van de Kerkhof
- Department of Dermatology; Radboud University Medical Center; Nijmegen the Netherlands
| | - A.W.M. Evers
- Institute of Psychology, Health, Medical and Neuropsychology Unit; Leiden University; Leiden the Netherlands
- Department of Medical Psychology; Radboud University Medical Center; Nijmegen the Netherlands
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Feragen KB, Stock NM. Psychological adjustment to craniofacial conditions (excluding oral clefts): A review of the literature. Psychol Health 2016; 32:253-288. [PMID: 27925479 DOI: 10.1080/08870446.2016.1247838] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE A congenital craniofacial anomaly (CFA) is expected to impact upon several domains of psychological, emotional and social functioning, yet no recent reviews have comprehensively summarised the available literature. Further, existing reviews tend to draw upon literature in the field of cleft lip and palate, and do not give substantive attention to other types of CFAs. DESIGN A review of 41 papers published between January 2000 and March 2016 pertaining to psychological adjustment to CFAs. MAIN OUTCOME MEASURES Findings are presented according to key psychological domains: General Psychological Well-being, Quality of Life, Behaviour, Emotional Well-being, Social Experiences, Appearance, and Treatment-Related Experiences. RESULTS Current literature offers a contradictory picture of adjustment to CFAs. Psychological adjustment appeared to be comparable to norms and reference groups in approximately half of the papers related to non-syndromic CFAs, while more variation was found across domains among samples with syndromic CFAs. Associations were found between adjustment, physical health and cognitive function in several papers. The review identified a number of gaps in the literature, such as the inclusion of a wide range of diagnoses within research samples. CONCLUSIONS This review demonstrates the complexity of findings, both within and across domains, and highlights a number of methodological challenges.
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Affiliation(s)
| | - Nicola Marie Stock
- b Centre for Appearance Research , University of the West of England , Bristol , UK
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Williamson H, Rumsey N. Perspectives of health professionals on the psychosocial impact of an altered appearance among adolescents treated for cancer and how to improve appearance-related care. J Psychosoc Oncol 2016; 35:47-60. [PMID: 27736466 DOI: 10.1080/07347332.2016.1247407] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
An altered appearance can impact the psychosocial well-being of adolescent cancer patients, yet patient reports imply a dearth of appearance-related support. Using a two-phase qualitatively driven mixed method design, 62 health professionals from a range of UK oncology care settings provided data relating to their views on the impact of appearance changes on adolescent patients (aged 12-18 years), of delivering appearance-related care, and their training needs. Integrated findings were divided into two main outcomes. The first comprises health professionals' perceptions of the psychosocial and behavioral impacts of appearance-related distress in their patients and their experiences of interventions that prevent or ameliorate appearance concern. The second illustrates personal barriers (among health professionals, adolescents, and parents) and organizational barriers that inhibit the delivery of appearance-related support, together with suggestions about how these may be overcome. The needs of patients are extensive and varied, but due to the barriers identified can be poorly addressed. Nonetheless, some practitioners are utilizing a variety of interventions supported by theory and/or evidence of their success in other clinical areas. Recommendations are made for the content, design, and coordination of interventions for adolescents and for the content of education programs to meet the training needs identified by participants.
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Affiliation(s)
- Heidi Williamson
- a Department of Health and Social Sciences , University of the West of England , Bristol , United Kingdom
| | - Nichola Rumsey
- a Department of Health and Social Sciences , University of the West of England , Bristol , United Kingdom
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