PowerPoint Presentation

Intervention: approaches and sources of support

Goals of this moduleTo be able to:Recognise the continuum between normative discontent and extreme body image anxietyIdentify excessive concernDiscuss this sensitively & give helpful adviceUnderstand treatment approaches Recommend sources of support

ACTIVITY ONEwrite down one thing that you really LIKE about your appearance

write down one thing that you really DISLIKE about your appearance

Thinking about the feature that you DISLIKE:On a scale of 0 10

How noticeable is it to others? /10How much do you worry about it? /10

NoticeabilityDistressPlot your score below: 01010

NoticeabilityDistressPlotting noticeability and worryABCDA: highly noticeable & causing high distress

B: highly noticeable but not distressed

C:not very noticeable but very distressed

D: not very noticeable and not very distressed

How did you score?Most people are a D. We describe this normative discontentA would be typical of someone who has had a recent appearance altering injuryB is someone who looks unusual but is positive and confidentC is someone whose anxiety is disproportionate to their actual appearance

Is concern about appearance normal?How would you answer this question? Think about what you have learned from earlier parts of this course

Is concern about appearance normal?How would you answer this question? Think about what you have learned from earlier parts of this course

Interest in appearance is normal. Appearance anxiety becomes a problem when it significantly impacts and disrupts a persons day to day life

ACTIVITY TWO

How does your appearance impact on your life?

The following are the kinds of questions that we ask to see how Body Image investment impacts on day to day life (NB: there are no right or wrong answers! )

See how you score:

Fill in the gaps.How long does it take you to get ready each day?.................On how many occasions do you look in the mirror each day?........... For how long?........Are you ever late for an event because are not happy with your appearance? Yes/NoDo you ALWAYS wear make-up: at home?.....At work?........... On holiday?

ACTIVITY THREE (a)Write down all the ways that you regularly modify or adapt your appearance

Here are just some:Make-up, hair style, hair extensions, hair colour, dieting, tattoos, piercing, nail extensions, nail polish, manicure, pedicure, facials, non-invasive beauty treatments, skin care, hair removal, skin lightening, tanning, Botox, fillers, plastic surgery, orthodontics, etcClothes

ACTIVITY THREE (b)Thinking about the ways in which you modify your own appearance: how do you think excessive appearance concern would impact on these behaviours?

What effect might this have on behaviour in general?

Impact of Body Image anxiety on related behaviourRepeated mirror checking or avoidanceExcessive grooming and use of make-upTake ages to get readyKeep changing/buying clothesSeeking plastic surgery or expensive treatmentsSeeking reassurance from othersUsing clothes or make-up as a disguise

Negative impact of Body Image anxiety on general behaviourAVOIDANCE AND CHECKING Avoiding social situationsLimited involvement in other activitiesAvoiding situations where likely to feel the centre of attention Avoiding having photos takenAvoiding sex and intimacy

Comparisons with ideal images can increase appearance anxiety

Most of us have a less than ideal appearance!

ACTIVITY THREE (c)What affect might excessive Body Image anxiety have on beliefs about appearance?

How might this effect your beliefs about the self generally?

Impact of Body Image anxiety on beliefs about appearance?I am abnormal or inferiorOther people are more attractive than meI have to always look my bestIf other people saw me without my make-up they would not want to be with meI dont look feminine/masculine.I need plastic surgeryetc

Impact of Body Image anxiety on beliefs about the self?LOW SELF ESTEEM &SELF CONFIDENCEI am abnormal or inferiorOther people are better than meNo-one is ever going to want to be with meI am uselessI am no good at anythingEtc

ACTIVITY THREE (d)What affect might excessive Body Image anxiety have on mood and emotion?

Impact of Body Image anxiety on moodDepressionAnxietyAnger/aggressionShameDisgustetc

Summary: Body Image AnxietyFocus on inappropriate ideals of appearance can lead people to feel inferior and abnormalAppearance takes up too large a part of self conceptPeople experience low self esteem and low self confidence Social anxiety can lead to social avoidance and a reluctance to take part in activities

Body dysmorphic disorderExtreme Body Image anxiety is classified as a psychiatric condition (BDD) often associated with Obsessional Compulsive Disorder(OCD)and Depression

BDD occurs in about 3 in 100 people and up to 15 in 100 people who request cosmetic surgery

BDD is treated by a specialist psychologist using Cognitive Behaviour Therapy (CBT) and medication

Summary: When should we be concerned?We become concerned when people are taking hours to get ready, check their appearance in the mirror on multiple occasions, repeatedly ask for reassurance from other about their looks, are late or miss events, feel compelled to wear make up and behave in ways that prevent them acting spontaneously or living a normal life

Treatment approaches: what needs to change?Biomedical approaches aim to improve appearance by medical or surgical means

Psychological approaches aim to reduce the impact of appearance anxiety, by modifying beliefs and behaviour

27A Cognitive behavioural model of Body Image anxietyCognitive behavioural therapy (CBT) is a systematic treatment that aims to identify and challenge unhelpful beliefs (cognitions)and change behaviourIn Body Image anxiety, this means examining beliefs about appearance, examining the evidence that supports them and reducing associated social anxiety and avoidance behaviours

BELIEFSBEHAVIOURS FEELINGSPHYSIOLOGY A COGNITIVE BEHAVIOURAL MODELMaintenance cycle

BELIEFSBEHAVIOURS FEELINGSPHYSIOLOGY A COGNITIVE BEHAVIOURAL MODELI must always look immaculate, I dont look like other people, I am deformed, to be successful I must be beautifulMaintenance cycle

BELIEFSBEHAVIOURS FEELINGSPHYSIOLOGY A COGNITIVE BEHAVIOURAL MODELI must always look immaculate, I dont look like other people, I am deformed, to be successful I must be beautifulMirror gazing, social avoidance, avoid intimacy ; safety behaviours: big jackets, make up, excessive grooming, asking for reassuranceMaintenance cycle

BELIEFSBEHAVIOURS FEELINGSPHYSIOLOGY A COGNITIVE BEHAVIOURAL MODELI must always look immaculate, I dont look like other people, I am deformed, to be successful I must be beautifulMirror gazing, social avoidance, avoid intimacy ; safety behaviours: big jackets, make up, excessive grooming, asking for reassuranceAnxious, lonely, despairing, unhappy, disgusted, ashamed, angryMaintenance cycle

BELIEFSBEHAVIOURS FEELINGSPHYSIOLOGY A COGNITIVE BEHAVIOURAL MODELI must always look immaculate, I dont look like other people, I am deformed, to be successful I must be beautifulMirror gazing, social avoidance, avoid intimacy ; safety behaviours: big jackets, make up, excessive grooming, asking for reassuranceAnxious, lonely, despairing, unhappy, disgusted, ashamed, angryHeart races, palpitations, rapid breathing, faintness, sweaty, blushingMaintenance cycle

What does a specialist psychologist do?Works within a clear evidence based framework helps to identify and modify unhelpful beliefs (by examining and challenging the evidence that supports them)helps to dismantle unhelpful behaviours and replace them with more helpful alternatives

Levels 0-2 of a stepped care approach is ideal for vocational trainers Raise the subject; sensitive discussion; offer support

Advice: introduction to information and self help materials, on-line intervention, onward referral to health professional support

(Level 3,4&5: Specialist led)

Stepped Care Interventions

Levels 0 2 relevant for vocational trainersLevels 3 5 require health professional supportActivity Four(a)Thinking about the impact of Body Image anxiety on behaviour: write down four things that might cause you to be concerned about someone

Activity Four(a)Thinking about the impact of Body Image anxiety on behaviour: write down four things that might cause you to be concerned about someoneLate or absent, excessive attention to appearance, mirror checking, seeking reassurance, social avoidance etc

Activity Four(b)Raising the subject

Write down some ideas about what you might say to raise the subject with someone you are concerned about

Activity Four(b)Raising the subjectI notice that you are often late for activities: why do you think this is a problem for you?Prompt: does it take you long to get ready?I notice that you often ask other people if you look okay: do you find yourself worrying about this?I notice that you check your appearance a lot do you think you worry more than other people?

What to say.DoReassure that some concern is normal & that help is available when concern is excessiveAsk if they are being teased or bullied by someone elseSuggest that they read more about appearance anxietyOffer the chance to talk to you moreDont.Tell them that they look fine to youTell them that there are lots of people who have proper disfigurements Suggest they are silly or making a fuss about nothingGet drawn into a discussion about their appearance or whether they need surgery

Offering adviceWhat comparisons are they making? Are there more suitable role models they could use?Encourage social activities with other studentsRecommend reading and websites for more informationExplain that help is available via: counselling (at college), via their doctor, or via online or telephone support

Accessing further support

These are good self help texts which explain body image concern and help people to understand and change their behaviour

WebsitesChanging Faces is a charity set up to help people with visible difference in appearance. They have useful resources and ideas for everyone concerned about what they look like.

www.changingfaces.org

Online interventions are becoming available for adults and children

On-line interventions

Summary Activity: (please answer yes or no)If I think someone might have a Body Image problem I should:Explain that concern about appearance is normalRecommend plastic surgeryReassure them that they look beautiful to meTell them they are making a fuss about nothingEncourage them to read more about Body Image problemsEncourage them to participate socially

Summary activity (cont)Encourage them to spend less time in front of the mirrorEncourage them to research surgery on the InternetEncourage them to go out without make-up from time to timeEncourage comparison with a wider group of peopleDiscuss sources of supportExplain how to access help

Summary Activity: yes / noIf I think someone might have a Body Image problem I should:Explain that concern about appearance is normalRecommend plastic surgeryReassure them that they look beautiful to meTell them they are making a fuss about nothingEncourage them to read more about Body Image problemsEncourage them to participate socially

Summary activity (cont)Encourage them to spend less time in front of the mirrorEncourage them to research surgery on the InternetEncourage them to go out without make-up from time to timeEncourage comparison with a wider group of peopleDiscuss sources of supportExplain how to access help

ConclusionYou can help identify and offer support:

Observe behaviourRaise the subject and ask questionsListen, normalise and supportRecommend informationAdvise sources of further help

Managing disfiguring conditionsWhat are the problems?Negative impact on self perceptions (self esteem/worth)Encounters with others (self consciousness; social anxiety)Reactions of others (unwanted attention, stereotyping, avoidance)

Patient self reportin their attempt to go about their daily lives, people are subjected to visual and verbal assaults, and a level of familiarity from strangers (including) naked stares, startled reactions, double takes, whispering, furtive looks, curiosity personal questions, advice, manifestations of pity or aversion, laughter, ridicule and outright avoidance.

52Macgregor working with burns:

Old reference, but very clearly captures the patient experience

Supported by evidence from other clinical studies across conditions:

profound problems in social settings, high levels of social anxiety and avoidance and often, poor social skills. For children, problems with bullying, lowered parental and teacher expectation, school refusal etcAre they simply hypersensitive? Are people really responding negatively?Evidence from social proximitybut Strenta and KleckWhat are people responding to?Evidence from covarying social skills and appearance

(NEXT SLIDE: Factors associated with good psychological functioning)In a job interview, the following are importantGood social skillsDress smartlyGood eye contactRelaxed Smile!The goal is to put other people at ease: if you are positive about your appearance, other people will be too

Should appearance be mentioned?This is entirely up to the individual. A positive statement can be helpful such as:

you will notice I have a facial disfigurement: I think that managing this has helped me to develop my social skills and put the customer at easeBut no-one should feel pressured to talk about their appearance

What if the employer asks?In the UK this is illegal. However, people are often curious. Answers include:I dont think my appearance is relevant to this jobIt is not a problem for me so I dont think it needs to be a problem for othersThe advantage of looking distinctive is that people can always remember who they spoke to! (Humour can often be really helpful!)

Managing disfigurementThe key is putting other people at ease so that the social interchange between them is relaxed and positive a key skill in the workplace.

Managing job interviews is illustrated in the online programme www.faceitonline.org.uk