Visible difference and social anxiety: An examination of relevant variables and the effectiveness of an acceptance-based intervention

The first part of this thesis is a systematic literature review examining the variables associated with social anxiety in adults living with skin conditions. The second part of this thesis is a randomised controlled trial examining the effectiveness of an acceptance-based self-help intervention which aimed to increase psychological flexibility in adults living with a visible difference in appearance.
Thirteen studies examining the relationship between social anxiety and other variables were included within the literature review. Moderate levels of social anxiety were present in the existing studies. Increased social anxiety was consistently associated with impairments in quality of life, increased distress, and reduced self-esteem. No clear link between social anxiety and skin condition visibility or severity was observed. The evidence examining the relationship between social anxiety and stigmatising experiences was limited but may suggest an association.
Participants within the research study (n = 284) were randomised to either an acceptance-based self-help condition or a waitlist condition for the four-week trial period. Participants self-reported moderate levels of fear of negative evaluation, distress and functional impairments associated with their visible difference in appearance. The intervention did not significantly improve psychological flexibility compared to the control condition. However, there was a significant reduction in functional impairments in the intervention condition. A significant reduction in fear of negative evaluation was also observed for the intervention condition within completer analyses, though this finding was non-significant in intention-to-treat analyses.