Psychological flexibility and self-compassion in appearance concerns after burn injuries

This thesis investigated psychological flexibility and self-compassion in appearance concerns soon after burn injuries. Three studies were conducted with NHS ethics approval and pre-registration. A multi-centre prospective cohort study (n = 175) revealed that increased psychological flexibility and self-compassion during hospital admission were associated with decreased appearance concerns cross-sectionally and prospectively over six months. Psychological flexibility predicted appearance concerns over time. To gain more in-depth information, a qualitative study (n = 15) explored appearance concerns within three months of injury. Appearance concerns were influenced by the need for social acceptance and desire to conform to societal ideals and contributed to difficulties responding to appearance concerns with psychological flexibility and self-compassion. Early psychological interventions for appearance concerns were considered acceptable to many, within a therapeutic relationship. However, obstacles to engagement existed. Based on these findings, an early acceptance and commitment therapy (ACT) intervention (ProACTive) for appearance concerns after burn injuries was developed, and a mixed-methods acceptability study (n = 13) suggested that ProACTive was acceptable. Individuals valued the therapeutic relationship that ProACTive created and early support was considered important. Ratings of helpfulness were high and qualitative data suggested that ProACTive was helpful in allowing exploration and reflection on the impact of appearance changes, developing psychological flexibility and self-compassion, and preparing people for being around others. Positive affect increased and negative affect decreased. The importance of psychological flexibility and self-compassion in appearance concerns has been highlighted. Whilst further study is needed to determine its effectiveness, an acceptable early intervention (ProACTive) for appearance concerns has been developed and adopted in multiple NHS burns services.