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encounters, as well as subjective perceptions of the perceived severity and the perceived
noticeabilty of the disfiguration to others (Rumsey et al, 2004). Other more stable variables,
such as attributional style (Crocker et al, 1991), some coping processes (Fauerbach et al,
2002), and perceptions of social support (Robinson, 1997) may also serve to exacerbate or
ameliorate distress (see also Moss, 1997). As members of this collaboration recognised the
need to provide knowledge that would inform effective interventions, particular attention was
paid to those cognitive processes which are amenable to change, including salience, valence,
perceived noticeability and severity, and the relation of the appearance evaluation to subjective
individual and perceived cultural ideals and norms, and the way in which social comparison
relates to these. The research programme also provided the opportunity to assess the value
and utility of conceptualising adjustment in this way.
The third facet of the model is the observable and experienced effects of appearance concerns.
Existing work has already demonstrated the importance of social anxiety and avoidance (for
reviews, see Thompson & Kent, 2001; Rumsey & Harcourt, 2004), and to a lesser extent shame
and hostility (Kent & Thompson, 2002). Although conceptualised here as outcomes, it is
acknowledged that these constructs also serve a function in setting the psychological context for
the cognitive processes described above. For the purposes of modelling they are represented
here as outcomes, but there is an ongoing debate amongst researchers in the area (including
those in this collaboration) and most are of the view that they are not simply the last links in a
chain, but part of a dynamic process in which experience informs cognitions.
Design considerations in the research process
The use of mixed methodologies
This research collaboration has adopted a mixed methods approach. Debate concerning the
relative merits of quantitative and qualitative methods has ranged for some time, and has been
termed by some “the paradigm wars” (Dures, 2009). In the recent past, quantitative and
qualitative approaches were viewed by many as incompatible as the two approaches are
underpinned by different sets of assumptions about what knowledge can be acquired and the
methods of acquiring it. However, there is now widespread recognition that adherence solely to
one or other set of assumptions can impose an unnecessary rigidity on research. Research in
‘real world’ settings, particularly research which is orientated to client needs rather than driven
primarily by academic concerns, requires a flexible approach that can cope with complex, multifactorial
issues and takes practicalities into account (Dures, 2009). The current consensus is
that both methodological approaches have merits, particularly in research in which pragmatism
and critical realism have a place (Denscombe, 2008). Proponents of mixed methods argue that
understanding can be enhanced to a greater extent through the use of both approaches rather
than by one in isolation, but also believe that their use should be justified in relation to the
research question and that the rationale should be clearly specified. Johnson, Onwuegbuzie
and Turner (2007) have defined mixed methods as ‘a third methodological or research
paradigm…that will often provide the most informative, complete, balanced and useful research
results’ (p129). The different studies should talk to each other, much like a conversation
(Bryman 2007).
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