Given the potential for conditions that affect appearance to affect psychosocial wellbeing, there is a need for evidence-based interventions for this population. Objective severity is a poor predictor of distress associated with living with a visible difference, compared to societal and individual differences. Psychologically informed self-help interventions may offer a readily accessible and flexible form of support. This thesis therefore seeks to: (1) better understand the current state of research on self-help interventions targeting distress associated with having a visibly different appearance; and (2) test the acceptability and effectiveness of a specific self-help writing intervention.
The first part of this thesis comprises of a systematic review of self-help interventions. This review offers an update to a similar review conducted in 2013, which explored the acceptability, usability, and effectiveness of psychologically informed self-help interventions developed for populations with conditions that affect external appearance. The current review identified 13 papers, which used a diverse range of methodologies to examine the acceptability, usability, and/or effectiveness of specific self-help interventions in this population. Based on ratings on quality appraisal tools, the quality of qualitative papers examining the acceptability and informing development were generally high, whereas the quality of randomised studies was generally poor. However, appraisals should be considered in the context of pilot and feasibility studies. Common limitations related to high attrition, particularly in intervention arms of studies. Self-help materials were generally rated positively. However, positive feedback did not necessarily translate to greater uptake, adherence, or effectiveness. While there was some limited evidence for compassion-based interventions increasing self-compassion, there was a lack of consistent evidence for effects on alternative measures of distress.
The second part of this thesis reports the findings of a Randomised Controlled Trial, comparing a one-week functionality-focused writing intervention, to a control (creative writing). Of 451 adults with a dermatological condition randomised, 155 completed at least one post-intervention measure. For participants with relatively low and mid-range positive body image baseline scores, there was evidence of a positive effect of the intervention on measures of body appreciation and functionality appreciation. Effects were mostly maintained at one-month follow up and in intention-to-treat analysis, with smaller effect sizes. However, when compared to the control, there was no evidence of an effect of the intervention on measures of appearance anxiety, skin shame and dermatology quality-of-life. Feedback was generally positive. However, like many of the papers included within the systematic review, this study had high rates of attrition, limiting the ability to draw conclusions around the effectiveness of the intervention based on allocation rather than completion.
CORE (COnnecting REpositories)
CORE (COnnecting REpositories)