RESUMEN
INTRODUCTION: Due to scarring, appearance anxiety is a common psychological difficulty in patients accessing burns services. Appearance anxiety can significantly impact upon social functioning and quality of life; thus, the availability of effective psychological therapies is vital. Acceptance and Commitment Therapy (ACT) is considered useful for treating distress associated with other health conditions and may lend itself well to appearance anxiety. However, no published research is currently available. METHODS: Three single case studies (two male burns patients; one female necrotising fasciitis patient) are presented where appearance anxiety was treated using ACT. A treatment protocol was followed and evaluated: the Derriford Appearance Scale measured appearance anxiety; the Work and Social Adjustment Scale measured impairment in functioning; the Acceptance and Action Questionnaire measured acceptance (willingness to open up to distressing internal experiences); and the Committed Action Questionnaire measured engagement in meaningful and valued life activities. Measures were given at every treatment session and patient feedback was obtained. One-month follow-up data were available for two cases. RESULTS: After the intervention, all patients had reduced functional impairment and were living more valued and meaningful lives. No negative effects were found. DISCUSSION: These case studies suggest that ACT may be a useful psychological therapy for appearance anxiety. The uncontrolled nature of the intervention limits the conclusions that can be drawn. CONCLUSION: A pilot feasibility study to evaluate the effectiveness of ACT for appearance anxiety is warranted. LAY SUMMARY: Many patients with scars can feel distressed about their appearance. This is known as appearance anxiety and can include patients accessing burns services. Appearance anxiety can stop patients from enjoying a good quality of life and impact upon important areas of daily functioning. It is therefore important that psychological therapies are effective. However, research investigating the effectiveness of psychological therapies is limited. This paper describes the psychological therapy of three patients who were distressed about scarring. A psychological therapy called Acceptance and Commitment Therapy (ACT) was used as part of standard care and evaluated using questionnaires and patient feedback. After the course of ACT, all patients were less impacted day-to-day by their appearance anxiety and were living more valued and meaningful lives. No negative effects were found. These case studies suggest that ACT may be a useful psychological therapy for appearance anxiety and further research evaluating it should be completed.
RESUMEN
BACKGROUND: Individuals with visible differences can experience appearance anxiety that is distressing and disruptive to daily functioning. Understanding psychological factors that maintain appearance anxiety related to scarring is important in developing theoretical understanding of adjustment to injury, and in identifying targets for psychological therapies. This study aimed to investigate whether psychological flexibility, a key element underpinning acceptance and commitment therapy (ACT), was associated with appearance anxiety. It was hypothesised that reduced psychological flexibility (lower acceptance, cognitive defusion, mindfulness, and committed action) would be related to increased appearance anxiety. The role of psychological flexibility in the maintenance of appearance anxiety was investigated using a cross-sectional quantitative questionnaire study. METHOD: Seventy-eight burns patients (47 female, 31 male; M age=45.2years) completed the Derriford Appearance Scale (DAS-24), the Acceptance and Action Questionnaire (AAQ-II), the Cognitive Fusion Questionnaire (CFQ), the Five Facet Mindfulness Questionnaire (FFMQ), and the Committed Action Questionnaire (CAQ-8). RESULTS: As hypothesised, increased appearance anxiety was related to reduced acceptance (rs(76)=0.80, p<0.001, one-tailed) and cognitive defusion (rs(76)=0.76, p<0.001). Reduced levels of mindfully describing (r(72)=-0.39, p<0.001), acting with awareness (r(72)=-0.57, p<0.001), non-judging (r(72)=-0.61, p<0.001) and non-reactivity (r(72)=-0.28, p<0.01) as well as reduced committed action (r(72)=-0.57, p<0.001) were also related to increased appearance anxiety. CONCLUSIONS: Individuals experiencing appearance anxiety associated with a burn injury may struggle with accepting difficult emotions, stepping back from distressing thoughts, being mindful and engaging in valued action. These findings suggest that ACT may be useful in treating appearance related anxiety and concerns associated with conditions causing a visible difference.