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Nurses in a counseling role, clinical nurse specialists, occupational therapists and maxillofacial technicians frequently find themselves in a setting where they spend time with patients as part of their physical treatment. They are ideally placed to deliver a psychosocial intervention at this third level of the PLISSIT model. The training days for health professionals at Changing Faces have included this tier for health professionals working in head and neck cancer. Ideally, supervision from expert staff such as psychologists should be available. Computer-based interventions such as FaceIT, developed by Bessell and colleagues, are a recent addition to psychological treatment and the evaluation of this approach indicates that it is extremely effective (Bessell et al, 2008). FaceIT could be part of an intervention provided by a non-psychologist, but has been evaluated as part of package where it is supervised rather than standing alone. It could also be a very useful addition or first step to an intensive treatment offered by a psychologist or person with a recognised training in CBT. It offers the enormous advantage that the intervention can be completed remotely. Level Four: Intensive Treatment This final level of intervention relies on specialised training in psychological therapy. The CBT model outlined in Chapter 6 should be delivered by someone with a relevant qualification in psychology or training in CBT. This stepped care model suggests that a non-specialist can provide the first three levels of intervention to include behavioural approaches to managing problems of visible difference. They must be provided with additional training; resources and clinical governance arrangements should be in place to ensure supervised practice. This level of intervention can be effective when there is: • Good agreement between objective and subjective assessment of visibility • Clear evidence of intrusion from other people with concrete examples • Inadequate social skills, particularly poor eye contact • Visible safety behaviours – baggy clothes, hats and camouflage, unkempt appearance • Inability to deal comfortably with staring and questions about appearance • Preoccupation with appearance is situation specific rather than constant An intensive intervention provided by a psychologist or other specialist is more appropriate when there is: • A mismatch between subjective and objective visibility of appearance • Multiple appearance-related concerns • Past history of or current body image concerns • External shame is assumed in the absence of concrete examples (“no-one actually says anything but I know what they are thinking”) • High frequency of checking particularly in the form of reassurance elicited from other people • Safety behaviours are more internalised • Preoccupation with appearance is continuous • High levels of anticipatory anxiety and post event analysis 208
Level of intervention Level 1 Permission Level 2 Level 3 Level 4 Description Example of intervention Limited information Specific suggestions Intensive treatments Sensitive exploration of psychosocial concerns Written information, recommended websites and contact details for support groups. Answering basic questions about visible difference Social skills training, dealing with staring, comments and questions. Managing social situations proactively Cognitive behaviour therapy aimed at identifying and modifying maladaptive appearance schemas Health professional background All health practitioners including GPs, practice nurses, NHS direct All health practitioners working with target groups including doctors and nurses in relevant specialties Nurses in a counseling role, clinical nurse specialists, occupational therapists, maxillofacial technicians, support groups Specialist training in CBT Figure 13: Stepped care framework for interventions to promote psychosocial adjustment in appearance concern The skills for providing this stepped care approach are fully developed in the manual, together with worked patient examples, sessional guides and suggested techniques. We anticipate that in the next phase of our work in appearance, we will start to offer training at the different levels outlined, using the manual to inform and support this training. 209
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Identifying the psychosocial factor
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Follow-on Studies: Emma Halliwell,
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Warwick Site (Lead: Dr. Rodger Char
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SECTION 3 Page OVERALL SYNTHESIS OF
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Study 3 3.1 Response rates for resp
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Introduction EXECUTIVE SUMMARY This
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The Impact of Appearance-Related Di
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Research Further investigation shou
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Participants were recruited from ho
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BACKGROUND & RATIONALE FOR THE RESE
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The challenge of developing compreh
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STAGE ONE (Inputs/Predisposing Fact
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In order to address the first aim o
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Role of the advisory panel in the r
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credit is due to Anjte Lindenmeyer,
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INTRODUCTION The largest part of th
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South West (via the Bristol site) a
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INPUTS/ PREDISPOSING FACTORS Age Ge
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Appearance-related processing Valen
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Anger/hostility The Refined Aggress
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RESULTS Due to the size of the data
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Figure 4.1(b) Comparative box-and-w
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Table 4.2 Correlation of quantitati
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Table 5.1(c) Frequency of number of
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Table 6.1(a) Frequency and percenta
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Table 7.1 summarises the degree of
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Figure 7.1(a): Scores on the DAS 24
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10.1 Appearance-related Social Anxi
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HADS Anxiety, and the relative magn
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10.4 Aggression When entering the v
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elatively small but statistically s
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11. Clinic Specific Data In order t
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Table 11.3: Percentage of participa
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anxiety was in the low to mild rang
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Visibility and areas of concern The
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affect and 46% for both anxiety and
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likely they are to have difficultie
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Information Attention Encoding/Stor
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such as shame, were omitted. Where
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RATIONALE In an attempt to offer pa
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FINDINGS Theme I. Descriptive Accou
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easts made her ‘flat chested’ a
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confidence to other people’s reac
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them noticing: ‘I try to hide my
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5.) Time Structures What was striki
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STUDY 3 LONGITUDINAL QUANTITATIVE S
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Table 3.1 Response rates for respon
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Table 3.4 Regression Model for DAS2
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Table 3.6 Regression Model for Depr
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Table 3.8 Regression Model for Posi
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0.016), and optimism (r = -0.183, n
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and follow up). However, focusing o
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SUMMARY • Twenty-six participants
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There were ten well adjusted stable
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Stage 1 - predisposing factors - ch
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Appearance schema - beliefs about o
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“I’m in charge ...I think that
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“Only when people don’t underst
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appearance anxiety and coping with
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114
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116
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SUMMARY • This study aimed to exp
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A focus group methodology was chose
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any situation. Strategies involved
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CONCLUSIONS Whereas previous resear
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SUMMARY • Nine focus group interv
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RESULTS Eight key themes were ident
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2e. Medical Interpretation There wa
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“I think I am nicer to a person w
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6d. Generational differences Elders
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• The myths about the foetal diso
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SUMMARY • Vitiligo is a condition
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identified themselves as South Asia
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“…my parents would have been de
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2a. Appearance shame and disgust Ma
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much…sometimes I just want to bec
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For respondents like AA (described
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study 6, that in addition to indivi
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AIMS The aims of this study were to
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154
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SUMMARY • Participants (n=38) too
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Page 176 and 177: SUMMARY • The study involved the
Page 178 and 179: METHOD Participants Student sample
Page 180 and 181: Clinic attendees On the anxiety sub
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Page 184 and 185: SUMMARY • Semi-structured intervi
Page 186 and 187: Seven key themes were identified an
Page 188 and 189: “I've heard tell that a lot of pe
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Page 192 and 193: 6. Emotional impact & Emotional sup
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Page 196 and 197: SUMMARY • This study investigates
Page 198 and 199: Table 12.1 Demographic data by grou
Page 200 and 201: variance in anxious mood was accoun
Page 202 and 203: appearance of younger people (Harri
Page 204 and 205: SUMMARY • This study is recruitin
Page 206 and 207: METHOD Participants GPs from across
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Page 210 and 211: The results of each study have been
Page 212 and 213: Others expressed dissatisfaction wi
Page 214 and 215: Age Gender Ethnicity Relationship s
Page 216 and 217: Whilst the main thrust of this rese
Page 218 and 219: a strong evidence base in other are
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Page 224 and 225: This series of studies represents t
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Page 228 and 229: Ben-Tovim, D.I. and Walker, M.K. (1
Page 230 and 231: Crocker, J., Voelkl, K., Testa, M.
Page 232 and 233: Greenberg, L. S. and Safran, J. D.
Page 234 and 235: Macgregor, F., Abel, T.M., Brut, A.
Page 236 and 237: Pollard, L., Choy, E.H. and Scott,
Page 238 and 239: Scheier, M.F., Carver, C.S. and Bri
Page 240 and 241: Wright, G.E., Parker, J.C., Smarr,
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