Cbt for Appearance Anxiety: Psychosocial Interventions for Anxiety Due to Visible Difference (Hardcover)

Description

This clinical manual provides a CBT-based psychosocial intervention for use with individuals distressed about their appearance due to a disfigurement from birth, accident or illness, or those coping with another visible difference.

• Contains a wealth of case material with specific relevance to physical health conditions that affect appearance, practical advice on assessment, and session-by-session guidance for addressing common issues
• Written by leading academics and clinicians working in the management of disfigurement and rational appearance anxiety
• Uses a flexible stepped-care model that allows for use by experienced CBT practitioners as well those wishing to deliver a more basic psychological intervention
• Identifies the psychological factors involved in appearance anxiety while also addressing the practical concerns of living with a visible difference, such as managing the reactions of others

Table of Contents

Foreword
Preface

1 Background, Clinical Problems, Common Presentation and Treatment Considerations 1

• Physical and Treatment-Related Factors 3
• Socio-Cultural Factors 3
• Psychological Factors and Processes 3
• Body Image Disturbance 3
• Clinical Problems and Presentation 4
• Common Features in Referral 8
• Visibility of Condition 8
• Shame 9
• The Meaning of Visible Difference 9
• The Experience of Loss 9
• Physiological Responses 10
• Culture 10
• Gender 11
• Age 11
• Expectations of Treatment 11
• Association of Physical Change with Psychological Outcome 12
• Fix It Solutions 12
• Treatment Considerations 13

2 A Stepped-Care Approach to Psychosocial Intervention 15

• The PLISSIT Model 16
• Level 1: Permission 16
• Level 2: Limited Information 18
• Level 3: Specific Suggestions 18
• Level 4: Intensive Treatment 19

3 Models and Frameworks: Expanding the Conceptual Approach to Managing

• Appearance-Related Distress 21
• Explanation for Choice of Therapeutic Approach 22
• Behavioural Approaches: Fear Avoidance and Social Skills Training 22
• Building an Evidence Base 25
• Cognitive Approaches: Comparison of Appearance Anxiety and Social Phobia 26
• Use of Safety Behaviours 28
• Anticipatory and Post-Event Processing 29
• The Role of Assumptions and Schema in Appearance Anxiety 32
• Summary 33
• Deriving a Cognitive Behavioural Treatment Model: Identifying Factors and Processes
• Contributing to Successful Adjustment to Disfiguring Conditions 34
• Working Framework of Adjustment to Disfiguring Conditions 34
• The ARC Framework of Adjustment to Disfiguring Conditions 34
• Predisposing Factors 35
• Intervening Cognitive Processing 36
• Socio-Cognitive Processing 37
• Outcomes 41
• The ARC Research Programme Findings 43
• The Studies 43
• Summary of Findings 43
• Key Messages from the Research Programme 45
• Implication of These Findings for Design of Interventions 45
• Summary 47

4 Clinical Assessment 48

• Eliciting the Problem 49
• Summarizing 51
• Motivation and Self-Efficacy 52
• Readiness for Change 53
• Measurement Tools 55
• Generic Measures of Psychological Constructs (as used in the ARC Study) 55
• Measures of Psychological Constructs Specifically Related to Appearance 57
• Measures of Body Image 58
• Measures of Psychological Constructs Specifically Related to a Condition Type 58
• Body Dysmorphic Disorder (BDD) 59
• Core Clinical Dataset 59
• Regular Subjective Measures of Frequency for Events, Thoughts and Feelings 60
• Goal Setting 61
• The SMART Acronym 61
• Challenges in Treatment for Appearance-Related Problems 62
• Introducing a Biopsychosocial Model 62
• Treatment ‘buy-in’ 63

5 Social Skills and Coping Strategies 64

• Staring, Questions, Comments and Loss of Anonymity 66
• Making the Most of Appearance 66
• Developing a Positive Approach to Visible Difference 67
• Posture, Smiling and Eye Contact 67
• Developing Verbal Skills 68
• Learning to Have a Conversation 68
• Answering Questions About Appearance 68
• Managing Staring 70
• Putting it into Practice 71
• Taking the Initiative in Social Encounters 72
• Managing Anger and Developing Assertiveness 73
• Anger 73
• Managing Intimacy 75
• Disclosing a Disfiguring Condition to a Partner 75
• Summary 77

6 Cognitive Behavioural Therapy 78

• Techniques in Cognitive Behavioural Therapy 79
• Socratic Dialogue 79
• Eliciting Negative Automatic Thoughts 82
• Unhelpful Beliefs Record Form 84
• Negative Automatic Thinking Styles Associated with Anxiety 84
• Triple Column Technique 87
• Pie Charts 87
• Manipulating Safety Behaviours 88
• Anxiety management techniques 88
• Target, Tools, Troubleshoot, Test 89
• Cost–Benefit Analyses 90
• Some Techniques for Dealing with Appearance-Related Self-Criticism and Shame 93
• Functional Analysis of Self-Criticism 94
• Identifying the power of self-criticism 94
• Summary 97

7 Planning Treatment and Sessional Guides 98

• Introduction 102
• Working at Level 1 102
• Working at Level 2 104
• Working at Level 3 105
• Session 1 106
• Structure Outline 106
• Working at Level 3 Using FaceIT (www.faceitonline.org.uk) 108
• Working at Level 4 using CBT 108
• Planning Treatment and Sessional Guides 108
• Clinical Examples 112
• Example 7.4 112
• Session 1 112
• Session 2 116
• Review Data 116
• Set Agenda 116
• Restatement of Formulation 117
• Elicit Patient Understanding 118
• Session 3 118
• Review of Homework and Reformulation 118
• Set Agenda 119
• Introduction to Answering Questions About Her Face 119
• Role of Self-Focused Attention Discussed 119
• TTTT 119
• Homework 119
• Session 4 119
• Review of Homework and Reformulation 119
• Set Agenda 120
• Reattribution of Beliefs 120
• Design Behavioural Experiments 121
• Homework 121
• Session 5 121
• Review of Homework 121
• Set Agenda 121
• Strategies for Attentional Training 122
• Development of Personal Coping Approaches 122
• Homework 122
• Session 6 122
• Review of Homework 122
• Measure Noticeability and Worry 122
• Reattribution of Beliefs 122
• Feedback from Behavioural Experiments 122
• Development of Personal Coping Approaches 123
• Homework 123
• Session 7 123
• Review of Homework 123
• Set Agenda 123
• Schema-Focused Reattribution 123
• Preparation for Ending 123
• Homework 123
• Session 8 124
• Review of Homework 124
• Schema-Focused Reattribution 124
• Planning for Ending 124
• Homework 124
• Session 9 124
• Homework 124
• Agenda 124
• Outcome 125
• Example 7.5 126
• Session 1 126
• Summary 129
• Session 2 130
• Review Data 130
• Introduction to Social Comparison Processes 130
• Restatement of Formulation 130
• Elicit Patient Understanding 131
• Introduction to Compassionate Thinking 132
• Homework 132
• Session 3 132
• Review of Homework and Reformulation 132
• Set Agenda 132
• TTTT 132
• Introduction to NATs 132
• Section 4 133
• Review of Homework and Reformulation 134
• Set Agenda 134
• Reattribution of Beliefs 136
• Design Behavioural Experiments 136
• Session 5 137
• Review of Homework and Reformulation 137
• Set Agenda 137
• Session 6 137
• Review of Homework and Reformulation 137
• Set Agenda and Review Progress 138
• Measure Noticeability and Worry 138
• Reattribution of Beliefs 138
• Feedback from Behavioural Experiments (Disclosure) 138
• Homework 138
• Sessions 7, 8 and 9 138
• Review of Homework and Development of Final Reformulation (See Figure 7.13) 138
• Set Agenda 139
• Focus on Schema-Focused Reattribution 139
• Session 10 140
• Outcome 140
• Example 7.6 140
• Session 1 140
• Summary 144
• Session 2 144
• Review Data 144
• Noticeability and Worry Graph 145
• Set Agenda 145
• Introduction to Social Comparison Processes 146
• Self-Efficacy 146
• Safety Behaviours 146
• Restatement of Formulation 146
• Homework 147
• Session 3 147
• Review of Homework and Reformulation 147
• Set Agenda 147
• TTTT 147
• Anxiety Management 148
• Introduction to NATs 148
• Homework 148
• Session 4 148
• Review of Homework and Reformulation 148
• Set Agenda 148
• Design Behavioural Experiments 149
• Homework 149
• Session 5 149
• Review of Homework 149
• Set Agenda 149
• Homework 149
• Session 6 150
• Review of Homework 150
• Set Agenda 150
• Measure Noticeability and Worry 150
• Design of Behavioural Experiments 151
• TTTT: Role Play Her Response If Her Breasts Are Mentioned 151
• Homework 151
• Session 7 151
• Review of Homework 151
• Set Agenda 151
• Focus on Reattribution 151
• Preparation for Ending 152
• Homework 152
• Sessions 8, 9 and 10 152
• Session 11 152
• Homework 154
• Agenda 154
• Outcome 154
• Example 7.7 154
• Session 1 154
• Summary 157
• Session 2 157
• Review Data 157
• Plan Homework 158
• Therapeutic Buddy 158
• Homework 158
• Session 3 158
• Review of Homework and Reformulation 158
• Homework 159
• Session 4 160
• Review of Homework and Reformulation 160
• Set Agenda 160
• Set Homework 160
• Session 5 160
• Review of Homework 160
• Set Agenda 160
• Homework 161
• Session 6 161
• Review of Homework and Reformulation 161
• Set Agenda 161
• Completion of Rating Scales and Outcomes 161
• Sessions 7 and 8 161
• Set Agenda 161
• Session 9 162
• Completion of Rating Scales and Outcomes 162
• Summary and Feedback 162
• Outcome 162
• Long-Term Outcome and Maintenance of Change 162
• Complete Maintenance 162
• Partial Maintenance 163
• Slip-Back and Sub-maintenance 163
• Slip-Back and Failure 163
• Social Support and Therapeutic Partners 164
• Summary 164
• Additional Resources 165

8 The Emerging Adult: Facilitating Transition from Child to Adult Service 166

• Introduction 167
• Introducing the Problem of Transition 167
• Transition from the Young Person’s Perspective 168
• Transition from the Parents’ Perspective 168
• Transition from the Health Professionals’ Perspective 168
• Guidance for Improving Transitional Care 169
• Issues Pertinent to Caring for Young People with Appearance Concerns 170
• The Salience of Appearance to Young People 170
• Reluctance to Seek or Accept Support 171
• Factors that Can Promote Adjustment to a Visible Difference among Young People 171
• Romantic Issues 173
• Transition as an Opportunity for Those with a Visible Difference 174
• Concluding Remarks 175

9 Psychological Assessment for Cosmetic Surgery 176

• Introduction 177
• Is Cosmetic Surgery Effective? 177
• Access to Surgery in the NHS 178
• Psychological Screening by the Surgeon 179
• NICE Guidelines 179
• Onward Referral 179
• What Does the Surgeon Want from a Psychological Assessment? 180
• What Does the Patient Want from a Psychological Assessment? 181
• A Framework for Psychological Assessment 181
• Case Examples 183
• Common Problems in Referral 189
• Liaising with the GP 189
• Health Professionals’ Knowledge of Cosmetic Procedures 189
• Summary 190
• Additional Resources 190

10 Models of Service Delivery 191

• Lay-Led Support 192
• Specialist Services 192
• Outlook 192
• Embedded Services 192
• Royal Free Hospital, London 192
• Access to Psychology Services 192
• Access to Mental Health Services 193
• Mapping Service Models onto Stepped Care 193
• Appendix 194
• Resources 272

References 280
Index 293

Author Information

Alex Clarke is a clinical and health psychologist specializing in disfigurement and altered appearance.

Andrew R. Thompson is Reader in Clinical Psychology at the University of Sheffield NHS Clinical Psychology Doctoral Training Programme.

Elizabeth Jenkinson is a registered Practitioner Health Psychologist, Chartered Psychologist and Senior Lecturer in Health Psychology at the University of the West of England.

Nichola Rumsey is Vocational Training Charitable TrustProfessor of Appearance Research at University of the West of England and is Co-Director of the Centre for Appearance Research.

Rob Newell is Emeritus Professor of Nursing Research at the University of Bradford.