CBT for Appearance Anxiety: Psychosocial Interventions for Anxiety due to Visible Difference

CBT for Appearance Anxiety: Psychosocial Interventions for Anxiety Due to Visible Difference......Page 5
Copyright
......Page 6
Content
......Page 9
Foreword......Page 17
Preface......Page 18
1 Background, Clinical Problems, Common Presentation and Treatment Considerations......Page 20
Body Image Disturbance......Page 22
Clinical Problems and Presentation......Page 23
Visibility of Condition......Page 27
The Experience of Loss......Page 28
Culture......Page 29
Expectations of Treatment......Page 30
Fix It Solutions......Page 31
Treatment Considerations......Page 32
2 A Stepped-Care Approach to Psychosocial Intervention......Page 34
Level 1: Permission......Page 35
Level 3: Specific Suggestions......Page 37
Level 4: Intensive Treatment......Page 38
3 Models and Frameworks: Expanding the Conceptual Approach to Managing Appearance-Related Distress......Page 40
Behavioural Approaches: Fear Avoidance and Social Skills Training......Page 41
Building an Evidence Base......Page 44
Cognitive Approaches: Comparison of Appearance Anxiety and Social Phobia......Page 45
Use of Safety Behaviours......Page 47
Anticipatory and Post-Event Processing......Page 48
The Role of Assumptions and Schema in Appearance Anxiety......Page 51
Summary......Page 52
The ARC Framework of Adjustment to Disfiguring Conditions......Page 53
Predisposing Factors......Page 54
Intervening Cognitive Processing......Page 55
Socio-Cognitive Processing......Page 56
Outcomes......Page 60
Summary of Findings......Page 62
Implication of These Findings for Design of Interventions......Page 64
Summary......Page 66
4 Clinical Assessment......Page 67
Eliciting the Problem......Page 68
Summarizing......Page 70
Motivation and Self-Efficacy......Page 71
Readiness for Change......Page 72
Generic Measures of Psychological Constructs (as used in the ARC Study)......Page 74
Measures of Psychological Constructs Specifically Related to Appearance......Page 76
Measures of Psychological Constructs Specifically Related to a Condition Type......Page 77
Core Clinical Dataset......Page 78
Regular Subjective Measures of Frequency for Events, Thoughts and Feelings......Page 79
The SMART Acronym......Page 80
Introducing a Biopsychosocial Model......Page 81
Treatment ‘buy-in’......Page 82
5 Social Skills and Coping Strategies......Page 83
Making the Most of Appearance......Page 85
Posture, Smiling and Eye Contact......Page 86
Answering Questions About Appearance......Page 87
Managing Staring......Page 89
Putting it into Practice......Page 90
Taking the Initiative in Social Encounters......Page 91
Anger......Page 92
Disclosing a Disfiguring Condition to a Partner......Page 94
Summary......Page 96
6 Cognitive Behavioural Therapy......Page 97
Socratic Dialogue......Page 98
Eliciting Negative Automatic Thoughts......Page 101
Negative Automatic Thinking Styles Associated with Anxiety......Page 103
Pie Charts......Page 106
Anxiety management techniques......Page 107
Target, Tools, Troubleshoot, Test......Page 108
Cost–Benefit Analyses......Page 109
Some Techniques for Dealing with Appearance-Related Self-Criticism and Shame......Page 112
Identifying the power of self-criticism......Page 113
Summary......Page 116
7 Planning Treatment and Sessional Guides......Page 117
Working at Level 1 (Table 7.1)......Page 121
Working at Level 2 (Table 7.1)......Page 123
Working at Level 3 (Table 7.1)......Page 124
Structure Outline......Page 125
Planning Treatment and Sessional Guides......Page 127
Session 1......Page 131
Set Agenda......Page 135
Restatement of Formulation......Page 136
Review of Homework and Reformulation......Page 137
Review of Homework and Reformulation......Page 138
Reattribution of Beliefs......Page 139
Set Agenda......Page 140
Feedback from Behavioural Experiments......Page 141
Homework......Page 142
Agenda......Page 143
Outcome......Page 144
Session 1......Page 145
Summary......Page 148
Restatement of Formulation......Page 149
Elicit Patient Understanding......Page 150
Introduction to NATs......Page 151
Section 4......Page 152
Set Agenda......Page 153
Design Behavioural Experiments......Page 155
Review of Homework and Reformulation......Page 156
Review of Homework and Development of Final Reformulation (See Figure 7.13)......Page 157
Focus on Schema-Focused Reattribution......Page 158
Session 1......Page 159
Review Data......Page 163
Set Agenda......Page 164
Restatement of Formulation......Page 165
TTTT......Page 166
Set Agenda......Page 167
Homework......Page 168
Measure Noticeability and Worry......Page 169
Focus on Reattribution......Page 170
Homework......Page 171
Session 1......Page 173
Review Data......Page 176
Review of Homework and Reformulation......Page 177
Homework......Page 178
Set Agenda......Page 179
Set Agenda......Page 180
Complete Maintenance......Page 181
Slip-Back and Failure......Page 182
Summary......Page 183
Additional Resources......Page 184
8 The Emerging Adult: Facilitating Transition from Child to Adult Service......Page 185
Introducing the Problem of Transition......Page 186
Transition from the Health Professionals’ Perspective......Page 187
Guidance for Improving Transitional Care......Page 188
The Salience of Appearance to Young People......Page 189
Factors that Can Promote Adjustment to a Visible Difference among Young People......Page 190
Romantic Issues......Page 192
Transition as an Opportunity for Those with a Visible Difference......Page 193
Concluding Remarks......Page 194
9 Psychological Assessment for Cosmetic Surgery......Page 195
Is Cosmetic Surgery Effective?......Page 196
Access to Surgery in the NHS......Page 197
Onward Referral......Page 198
What Does the Surgeon Want from a Psychological Assessment?......Page 199
A Framework for Psychological Assessment......Page 200
Case Examples......Page 202
Health Professionals’ Knowledge of Cosmetic Procedures......Page 208
Additional Resources......Page 209
10 Models of Service Delivery......Page 210
Access to Psychology Services......Page 211
Mapping Service Models onto Stepped Care......Page 212
Factors and Processes Associated with Psychological Adjustment to Disfiguring Conditions......Page 213
Physical and Treatment-Related Factors......Page 214
Theoretical Underpinning......Page 215
The Use of Mixed Methodologies......Page 218
The Role of the Advisory Panel in the Research Process:......Page 219
Methods......Page 220
Materials......Page 222
Measures......Page 223
 Protocols Relating to Recruitment......Page 227
Participants......Page 228
Internal Consistency......Page 229
Demographic Factors......Page 231
Visibility and Areas of Concern......Page 234
Appearance-Specific Cognitive Factors......Page 237
Regressions by Outcome Variable......Page 240
Clinic-Specific Data......Page 246
Discussion......Page 247
The Multivariate Nature of Adjustment......Page 253
Rationale and Findings......Page 259
Discussion......Page 260
Rationale and Results......Page 261
Study 4: Experiences and Adjustment in People with Visible Difference over Time – A Qualitative Study......Page 270
Study 5: A Qualitative Study of the Experiences of People Who Identify Themselves as Having Adjusted Positively to a Visible Difference......Page 273
Study 6: Focus Group Studies of the Views of People from Ethnic Minority Community about Disfigurement......Page 275
Study 7: A Qualitative Study Exploring the Experiences of British South Asians Living with the Disfiguring Skin Condition Vitiligo......Page 276
Study 8: Appearance Concern, Hostility and Social Situations......Page 278
Study 10: Women with Limb Prostheses – Experiences and Adjustment......Page 279
Study 11: In the Context of Rheumatoid Arthritis Does Appearance Matter?......Page 282
Study 12: Working with Patients with Visible Differences – General Practitioners’ Beliefs, Decision-Making Processes and Training Needs......Page 283
Profiles of Adjustment and Distress......Page 285
The Multiple Nature of Appearance Concerns......Page 286
The Impact of Age, Gender and Ethnicity......Page 287
A Framework of Adjustment to Disfigurement......Page 288
Conclusions and the Way Forward......Page 289
Intervening Cognitive Processes......Page 291
Noticeability and Worry Graph (see Chapter 4)......Page 292
Other Sources of Help......Page 296
References......Page 299
Index......Page 312