Nicole Paraskeva

Psychosocial Predictors, Assessment, and Outcomes of Cosmetic Procedures: A Systematic Rapid Evidence Assessment

BackgroundRecent breast implant complications led to a UK government policy review of the evidence concerning cosmetic interventions. We synthesised cosmetic intervention research evidence covering psychosocial factors associated with requesting procedures and psychological outcomes, effects of procedures on psychological outcomes, preintervention assessments for identifying those at risk, alternative therapy effectiveness, and issues in achieving informed consent.MethodsUndertaking a systematic rapid evidence assessment, six databases and three journals were searched. Included studies were systematic reviews or primary studies of participants requesting cosmetic procedures; published 2002–2012; containing either psychological or psychosocial measures, a psychological outcome, or evaluation of informed consent. Reviewers independently assessed study eligibility, extracted data, and assessed quality, undertaking narrative synthesis.ResultsMethodological quality of the included 13 systematic reviews and 179 primary studies was low, with wide variation in psychosocial measures. Findings suggest several psychosocial factors (e.g., intimate partner violence) may be associated with requesting cosmetic surgery. Multiple factors (e.g., unrealistic expectations) may predict poor psychological outcomes. Current psychological screening tools focus predominantly on body dysmorphic disorder (BDD) symptoms. Psychological and pharmacological interventions are effective alternative BDD treatments. Patients and doctors bring different needs to informed consent discussions, inconsistently matched to those required by professional ethics, litigation risk, and facilitating profit.ConclusionsSystematically reviewing this literature for UK policy has highlighted that some groups may be at risk of poor post-cosmetic procedure outcomes. Practitioners and patients must explore reasons for seeking cosmetic procedures and discuss all potential results and alternative solutions. Future research should employ more robust methodologies to identify effects in those at risk, led by consensus on a core set of psychological outcomes.Level of Evidence IIIThis journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Consumer opinion on social policy approaches to promoting positive body image: Airbrushed media images and disclaimer labels

Disclaimer labels on airbrushed media images have generated political attention and advocacy as a social policy approach to promoting positive body image. Experimental research suggests that labelling is ineffective and consumers’ viewpoints have been overlooked. A mixed-method study explored British consumers’ (N = 1555, aged 11–78 years) opinions on body image and social policy approaches. Thematic analysis indicated scepticism about the effectiveness of labelling images. Quantitatively, adults, although not adolescents, reported that labelling was unlikely to improve body image. Appearance diversity in media and reorienting social norms from appearance to function and health were perceived as effective strategies. Social policy and research implications are discussed.

Assessing the effectiveness of interventions to support patient decision making about breast reconstruction: A systematic review

BACKGROUND Decision making about breast reconstruction (BR) following a diagnosis of breast cancer, Ductal Carcinoma in Situ (DCIS), or to reduce future breast cancer risk, is difficult and complex. This paper systematically reviews interventions aiming to support patients facing the option of BR, and assesses their effectiveness in improving a range of patient outcomes. METHODS Ten databases were searched for articles published up to October 2017 that evaluated interventions to support patient decision making about BR within controlled trials. All included studies were assessed for methodological quality. Descriptive analyses of patient outcomes within included studies were performed. RESULTS The search yielded 3291 articles. Eight studies met the inclusion criteria resulting in the evaluation of seven distinct interventions (n = 1212). Six studies were assessed to be of weak methodological quality, with one of moderate and one of strong quality. Three out of five interventions demonstrated a reduction in decisional conflict (ds = 0.26-0.69) and two out of three interventions resulted in reductions in decisional regret (ds = 0.27-3.69) at various time points. Treatment choice was altered in two of five studies. There were no changes in patient-reported anxiety levels, whilst the impact on depression was mixed. In all studies which reported on it, improvements in patient satisfaction and involvement in decision making were found. CONCLUSIONS Few interventions are currently available. Whilst some findings are encouraging, improvements on patient outcomes are mixed. Further research should focus on the development and evaluation of effective interventions.

Altered Appearance from Cancer

In this chapter, we delineate various appearance alterations that can result from cancer and its treatment. We focus on describing the impact of appearance changes involving weight, scarring from surgery, alopecia, ascites, and lymphedema. We also examine the influence of patient-related factors (i.e., gender, age) and treatment-related factors on appearance-related distress. Various models of adjustment to alterations in appearance are presented with particular attention to predisposing factors, intervening cognitive processes, and measurable outcomes identified by large-scale research studies conducted by the Appearance Research Collaboration. Finally, we identify gaps in knowledge and directions for future research needed to advance our understanding of an individual’s experiences of living with an altered appearance due to cancer.

A Systematic Review of the Effectiveness of Acceptance and Commitment Therapy (ACT) for Body Image Dissatisfaction and Weight Self-Stigma in Adults

Body image dissatisfaction (BID) and weight self-stigma are prevalent and associated with physical and psychological ill-health. Acceptance and Commitment Therapy (ACT) is increasingly employed for both, yet little is known about its effectiveness. Searches of 12 databases identified six studies using online, face-to-face or self-help ACT interventions for BID or weight self-stigma, of varying duration and intensity. Their effectiveness and quality were evaluated. Two reported improved BID, three improved weight self-stigma, and one reported no impact on weight self-stigma. Methodological issues (small sample sizes, lack of allocation concealment, attention control and long-term follow up) impacted the validity of findings. Due to the small number of studies and poor study quality, the effectiveness of ACT for BID and weight self-stigma remains unclear. Nonetheless findings suggest psychological flexibility may facilitate reduction in BID and weight self-stigma and indicate that brief online as well as lengthy face-to-face delivery may be useful. Suggestions for further research are made.

Body appreciation in British men: Correlates and variation across sexual orientation

Investigations of positive body image among men and across various social identities are lacking, and could contribute to a more complete understanding of the construct, including how positive body image can be improved. This study addressed this gap by investigating correlates of body appreciation - a key facet of positive body image - in men, and testing whether levels of body appreciation vary across sexual orientation. Data from a British community sample of 439 men (Mage = 39.13) showed that body appreciation inversely correlated with conformity to masculine norms and upward appearance-based social comparisons, and positively correlated with physical activity. Body appreciation was lower among sexual minority compared to heterosexual men, and athletic appearance-ideal internalisation and upward appearance-based social comparisons mediated this relationship. Replicating prior research among men, body appreciation positively correlated with body satisfaction, and inversely correlated with perceived appearance pressures from media and eating pathology. These findings have implications for interventions addressing body image among men.

Body Image in Primary Schools: A pilot evaluation of a primary school intervention program designed by teachers to improve children’s body satisfaction

Body Image in the Primary School (Hutchinson & Calland, 2011) is a body image curriculum that is widely available but has not yet been evaluated. This study evaluates a set of 6 of the 49 available lessons from this curriculum. Seventy-four girls and 70 boys aged 9-10 were recruited from four primary schools in the UK. Schools were randomly allocated into the intervention condition, where students received 6hours of body image lessons, or to lessons as normal. Body esteem was significantly higher among girls in the intervention group, compared to the control group, immediately post intervention, and at 3-month follow-up. Moreover, girls with lowest levels of body esteem at baseline reported the largest gains. Internalization was significantly lower among boys in the control group compared to the intervention group at 3-month follow-up. The pattern of results among the control group raises interesting issues for intervention evaluation.

Extending the evidence base for eating disorders prevention: the impact of a dissonance-based intervention on positive body image, intuitive eating and self-objectification

Recently, there have been significant advances in eating disorders (ED) prevention. Cognitive dissonance programs have demonstrated reductions in ED risk factors outlined in the dual pathway model (Stice, 1994) among university-age women in the USA and the UK. However, self-objectification theory proposes additional empirically supported risk-factors for EDs. In addition, body image research has recently expanded its focus to consider the promotion of positive body image. The present study examines the impact of a dissonance-based intervention on self-objectification, positive body image, and intuitive eating. Sixty-nine British women (M=19.06 years) took part in the intervention as part of their undergraduate psychology coursework. A separate sample of 47 undergraduate women formed a non-randomized control group. Baseline measures typically used to evaluate the intervention were administered alongside measures of self-objectification, positive body image, intuitive eating and life satisfaction pre- and immediate post- intervention, and at 8-week follow-up. As hypothesised, the intervention led to significant improvements relative to the control group in body dissatisfaction, dietary restraint, surveillance, body shame, body appreciation and intuitive eating at post-intervention and 8 week follow-up. It also improved life satisfaction at post-intervention only. The results suggest that dissonance-based interventions have benefits beyond risk factors identified in the dual-pathway model. This abstract was presented in the Prevention & Public Health stream of the 2014 ANZAED Conference.