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Information Attention Encoding/Storage Retrieval Processing Unconscious Unconscious Unconscious preferential Schematic preferential Influence guiding of attention association with schematic networked information selection of more accessible information Schematic Outcome Maladaptive Appearance Self-Schema Schematic information preferentially attended Appearance related information chronically selected for attention Figure 11: Model of Processing Influence of Appearance Self-Schema (Rosser, 2008) Limitations of this study Information associated with schema associated with stronger information networks – stronger encoding New appearance related-information associated with strong established negative stored information about appearance Schematic information more accessible and more readily available for interpretation of other stimuli New information interpreted utilising chronically accessible negative appearance self-related information, resulting in reinforcement of negative valence of schema and selfinterpretation There are a number of limitations to this study which should be considered when interpreting the results. Prior to the commencement of the study, the assumption was that those actively seeking treatment for their condition would have greater levels of appearance-related distress, and perhaps that previous research which has focused on populations such as these, was inherently biased in this respect. Accordingly, considerable efforts were made to recruit from community sources. In the event, differences between the adjustment profiles for the two groups were minimal. The extent to which clinic and community samples are truly different populations has been a source of debate amongst the collaboration during the research process. Although the large majority of the community sample (those recruited through general practices) were not accessing treatment at the time of the study, many will have experienced treatment in the past. Nevertheless, an important message from these results is that substantial numbers of people who are not seeking treatment will be experiencing appearance-related distress, which could be amenable to intervention. Although all participants believed themselves to have a disfigurement of some sort, this was impossible to verify in relation to the community sample (a substantial proportion of whom were not seen face to face by a member of the research team). However, the research team attempted to address this matter by using READ codes as a basis for recruitment in all participating practices which used them. This enabled targeted recruitment to those classified by their GP as having a condition which was potentially disfiguring. 68
The response rates to approaches to participate in the study varied from clinic to clinic, method of approach (e.g in person, by poster, by post or online), and within this, from week to week. A meaningful overall figure is impossible to calculate, thus we are not able to assess the representativeness of our sample through conventional means. All the researchers involved in the recruitment process were aware of the need to sample broadly, and all made considerable efforts to ensure this was achieved. Nevertheless, as acknowledged above, there is an underrepresentation of participants from ethnic minority groups in the current study, and more women agreed to take part than men. It could be also be argued that the lack of an objective rating of disfigurement is a limitation of the study, as is the broad (type of clinic attended), rather than a very specific classification of the condition of each participant. In addition to the lack of a relationship between severity and distress in the previous literature (outlined above), an accurate ‘objective’ rating for every participant would have been logistically very difficult to achieve. Considerable uncertainty exists in the literature in relation to how to classify the severity of various forms of disfigurement, and individual differences in raters have been shown to be considerable (Roberts-Harry 1997). Our results offer support to the value of assessing subjective assessments of severity, as these are likely to be more revealing as indicators of adjustment for clinicians, therapists and researchers. Appealing as the explanations of cognitive processes offered above are in attempting to interpret a large and complex data set, it should be noted that cognitive architecture can only be inferred as it cannot be directly observed. Concepts such as ‘schemata’ are to some extent notional, and the various processes and biases in attentional processes such as salience, valence, self discrepancy and social comparison are inevitably somewhat contrived. In reality they are interconnected, mutually dependent and overlapping. With these limitations in mind, however, the results of the study have led us to revisit and recast the conceptual framework of adjustment presented in the introductory section above. In this revised model, the important role of appearance-specific cognitions is acknowledged and highlighted. Although the model is presented in a linear format, the dynamic nature of the self system is also very evident in this and subsequent studies. Variables other than the ones measured in this study are also certain to play some part in adjustment. Three main factors are usually presented as promoting resilience or vulnerability in the psychological literature (Luthar et al 2002). These comprise the characteristics of the individual (cognitive functioning, personality variables, self efficacy and self perception), characteristics of the individual’s family, and the individual’s social context. Resilience is a product of a mutual influence between these three factors, which may function as potential mediators or moderators of the relationship between stressors, risk and outcomes. The collaboration chose to focus on those factors which are most amenable to intervention, and thus variables relating to family functioning and the influence of social context are not prominent in this work. In addition, in order to keep the burden of assessment at an acceptable level, and to include measures which could offer a profile of positive as well as negative adjustment, difficult decisions were made and additional individual factors which have featured in previous research, 69
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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
Page 29 and 30: In order to address the first aim o
Page 31 and 32: Role of the advisory panel in the r
Page 33: credit is due to Anjte Lindenmeyer,
Page 36 and 37: INTRODUCTION The largest part of th
Page 38 and 39: South West (via the Bristol site) a
Page 40 and 41: INPUTS/ PREDISPOSING FACTORS Age Ge
Page 42 and 43: Appearance-related processing Valen
Page 44 and 45: Anger/hostility The Refined Aggress
Page 46 and 47: RESULTS Due to the size of the data
Page 48 and 49: Figure 4.1(b) Comparative box-and-w
Page 50 and 51: Table 4.2 Correlation of quantitati
Page 52 and 53: Table 5.1(c) Frequency of number of
Page 54 and 55: Table 6.1(a) Frequency and percenta
Page 56 and 57: Table 7.1 summarises the degree of
Page 58 and 59: Figure 7.1(a): Scores on the DAS 24
Page 60 and 61: 10.1 Appearance-related Social Anxi
Page 62 and 63: HADS Anxiety, and the relative magn
Page 64 and 65: 10.4 Aggression When entering the v
Page 66 and 67: elatively small but statistically s
Page 68 and 69: 11. Clinic Specific Data In order t
Page 70 and 71: Table 11.3: Percentage of participa
Page 72 and 73: anxiety was in the low to mild rang
Page 74 and 75: Visibility and areas of concern The
Page 76 and 77: affect and 46% for both anxiety and
Page 78 and 79: likely they are to have difficultie
Page 82 and 83: such as shame, were omitted. Where
Page 84 and 85: RATIONALE In an attempt to offer pa
Page 86 and 87: FINDINGS Theme I. Descriptive Accou
Page 88 and 89: easts made her ‘flat chested’ a
Page 90 and 91: confidence to other people’s reac
Page 92 and 93: them noticing: ‘I try to hide my
Page 94 and 95: 5.) Time Structures What was striki
Page 97 and 98: STUDY 3 LONGITUDINAL QUANTITATIVE S
Page 99 and 100: Table 3.1 Response rates for respon
Page 101 and 102: Table 3.4 Regression Model for DAS2
Page 103 and 104: Table 3.6 Regression Model for Depr
Page 105 and 106: Table 3.8 Regression Model for Posi
Page 107 and 108: 0.016), and optimism (r = -0.183, n
Page 109: and follow up). However, focusing o
Page 112 and 113: SUMMARY • Twenty-six participants
Page 114 and 115: There were ten well adjusted stable
Page 116 and 117: Stage 1 - predisposing factors - ch
Page 118 and 119: Appearance schema - beliefs about o
Page 120 and 121: “I’m in charge ...I think that
Page 122 and 123: “Only when people don’t underst
Page 124 and 125: appearance anxiety and coping with
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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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leaving 82 invitations not responde
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The vignettes alternated between de
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162
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SUMMARY • The study involved the
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METHOD Participants Student sample
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Clinic attendees On the anxiety sub
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170
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SUMMARY • Semi-structured intervi
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Seven key themes were identified an
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“I've heard tell that a lot of pe
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4. Physical adaptation From so smal
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6. Emotional impact & Emotional sup
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182
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SUMMARY • This study investigates
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Table 12.1 Demographic data by grou
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variance in anxious mood was accoun
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appearance of younger people (Harri
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SUMMARY • This study is recruitin
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METHOD Participants GPs from across
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196
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The results of each study have been
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Others expressed dissatisfaction wi
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Age Gender Ethnicity Relationship s
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Whilst the main thrust of this rese
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a strong evidence base in other are
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Nurses in a counseling role, clinic
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210
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This series of studies represents t
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Ben-Tovim, D.I. and Walker, M.K. (1
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Crocker, J., Voelkl, K., Testa, M.
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Greenberg, L. S. and Safran, J. D.
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Macgregor, F., Abel, T.M., Brut, A.
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Pollard, L., Choy, E.H. and Scott,
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Scheier, M.F., Carver, C.S. and Bri
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Wright, G.E., Parker, J.C., Smarr,
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