Timothy P. Moss

The DAS24: A short form of the Derriford Appearance Scale DAS59 to measure individual responses to living with problems of appearance

OBJECTIVES To develop a psychometrically robust and widely applicable short form of the Derriford Appearance Scale, (DAS59), which (1) will reliably and validly assess the distress and difficulties experienced in living with problems of appearance, (2) is acceptable to clinical and non-clinical populations, and (3) facilitates research and clinical decision-making through good standardization and sensitivity. DESIGN Cross-sectional survey designs using clinical (out-patient and in-patient) and general population samples. METHOD Twenty-five items were selected initially from the 59 items of the original DAS59. These were refined to 24 through item analyses and the scale was standardized on 535 patients with a range of problems of appearance and on a representative general population sample (N=1, 107). RESULTS All 24 items contributed well to the total score and internal consistency was high (alpha=.92). Test-retest reliability (6 months) was good (0.82), and criterion validity, with the DAS59, was excellent (0.88). Good construct validity was demonstrated in differences between (1) patient and general population samples, (2) members of the general population concerned and not concerned about their appearance, and (3) in patterns of convergent and divergent correlations with a range of established scales. The general population data revealed widespread concerns about appearance. CONCLUSION The DAS24 provides a widely applicable and acceptable short form of the original DAS59. It is psychometrically robust and discriminates well between patient groups, between clinical and non-clinical populations, and within the general population between those concerned, and those not concerned, about their appearance.

Electrochemotherapy for large cutaneous recurrence of breast cancer: A phase II clinical trial

Abstract Background. Cutaneous recurrences of breast cancer may cause considerable discomfort due to ulceration, oozing, and pain and can also be difficult to treat. Electrochemotherapy is a localised anticancer treatment using electric pulses to make cell membranes permeable, augmenting uptake of chemotherapeutic drugs, and thus enabling highly efficient tumour cell kill. This is the first systematic investigation of electrochemotherapy for larger cutaneous recurrences of breast cancer. Patients and methods. We conducted a phase II trial for patients with cutaneous recurrences where no further treatment options were available. Primary endpoint was objective response evaluated by clinical examination. Secondary endpoints included response evaluated by PET/CT, change in lung diffusion capacity, patient reported symptoms, and distress related to bodily appearance. Treatment consisted of bleomycin injection followed by application of electric pulses. Results. Seventeen heavily pre-treated patients received electrochemotherapy. Twelve patients were evaluable (follow-up > 8 weeks). CT showed four (33%) patients achieving over 50% tumour volume reduction, clinical examination showed one CR and one PR (OR 17%). Symptomatic relief included decreasing exudates, odour, and bleeding. Treatment was well tolerated; the main side effect was post-treatment pain. Conclusion. This first phase II study indicates that electrochemotherapy is a promising treatment alternative for cutaneous recurrences of breast cancer.

Evaluation of the effectiveness of Face IT, a computer-based psychosocial intervention for disfigurement-related distress

Some people who have a visible difference (disfigurement) experience psychosocial adjustment problems that can lead to social anxiety and isolation. The aim of thisstudy was to assess the effectiveness of a new computerised CBT-based intervention (Face IT) in reducing anxiety and appearance-related distress for individuals with visible differences. Face IT was tested against a non-intervention control group and standard CBT-based face-to-face delivery. Eighty-three participants were assessed at four time points using the Hospital Anxiety and Depression Scales, Derriford Appearance Scale-24, Body Image Quality of Life Inventory and Fear of Negative Evaluation (FNE). The findings indicate a significant reduction in anxiety and appearance-related distress in both the Face IT intervention and the face-to-face condition. Similar findings were reported for depressive symptoms and FNE. Results at the three and six months follow-up demonstrate increased improvements in psychological functioning with both interventions. This new online psychosocial intervention has been found to be effective at reducing anxiety, depression and appearance concerns amongst individuals with disfigurements, whilst increasing positive adjustment. A remote-access, computer-based intervention offers the potential to provide psychosocial support more easily and in a cost-effective manner to adults with appearance-related distress.

Understanding adjustment to disfigurement: the role of the self-concept

The objective of this study was to determine whether variation in psychological adjustment to physically disfiguring conditions is related to organisation of the content of appearance-related information in the self-concept. A cross-sectional design was employed, using 70 participants with a range of appearance problems recruited from support groups and the NHS. A postal paper and pencil task was completed by participants which assessed the level of their adjustment using the Derriford Appearance Scale, and measured the three self-concept variables – differential importance, compartmentalisation and complexity. Regression analyses showed that poor adjustment to disfigurement is related to greater differential importance of appearance-related self-aspects, greater compartmentalisation of appearance-related information and greater self-concept complexity. No moderating effects were found between these independent variables. The results have implications for psychological treatment strategies, particularly cognitive behavioural therapeutic interventions.

Psychological change after aesthetic plastic surgery: A prospective controlled outcome study

Aesthetic plastic surgery has been long practiced for primarily psychological rather than physical benefit to patients. However, evaluation of the psychological impact of aesthetic plastic surgery has often been of limited methodological rigor in both study design and appropriate measurement. This study is intended to evaluate the psychological impact of aesthetic surgery on patients seeking such intervention in regard to concerns about breasts, nose or upper limbs using standardised psychometric instruments. Participants were recruited through the Plastic Surgery Unit (Patients) and general surgery, ENT surgery and Maxillo-facial surgery (Comparisons) at a UK General Hospital. Outcome measures included the Crown–Crisp Experiential Inventory anxiety scale, Beck Depression Inventory and Derriford Appearance Scale-24, a valid and reliable measure of distress and dysfunction in relation to self-consciousness of appearance. Data were collected pre-operatively (T1) and 3 months post-operatively (T2) for both groups. Longitudinal appearance adjustment for the plastic surgery group was also assessed at 12 months (T3). Both groups were less depressed and anxious post-operatively. The improvement in anxiety was significantly greater in the plastic surgery group. Body site specific appearance distress was significantly improved for the plastics group only, and the level of improvement was related to the body site affected.

Attentional and interpretative biases in appearance concern: An investigation of biases in appearance-related information processing.

The present study examined associations between high levels of appearance concern and information processing biases in interpretation and attention. An opportunity sample (N=79) categorised ambiguous stimuli as related or unrelated to appearance. Participants then responded to the same stimuli in a modified visual dot-probe task assessing attentional bias. Participant responses were assessed in relation to level of appearance concern. The results indicated a valence specific bias towards interpretation of ambiguous stimuli as negative and appearance-related in individuals with higher levels of concern. There was also evidence of attentional bias towards information perceived as appearance-related in participants with higher levels of appearance concern. The study findings suggest that association between appearance-orientated information processing biases and level of appearance concern; this association may lead to mutually reinforcing bias and concern.

Existence of benefit finding and posttraumatic growth in people treated for head and neck cancer: a systematic review

Background. The impact of head and neck cancer (HNC) in long-term survivors differs widely among individuals, and a significant number of them suffer from the negative effects of disease, whereas others report significant positive effect. This systematic review investigated the evidence the implications of treatment for HNC and subsequent development of Benefit Finding (BF) or Posttraumatic Growth (PTG). Purpose. To understand how differing medical, psychological and social characteristics of HNC may lead to BF/PTG and subsequently inform post-treatment interventions to encourage positive outcomes. Method. In February 2012, five databases including Pubmed, and Psych Info, were searched, for peer-reviewed English-language publications. Search strings included key words pertaining to HNC, BF, and PTG. One thousand three hundred and sixty three publications were identified, reviewed, and reduced following Cochrane guidelines and inclusion/exclusion criteria specified by a group of maxillofacial consultants and psychologists. Publications were then quality assessed using the CASP Cohort Critical Appraisal tool. Findings. Five manuscripts met the search and selection criteria, and were sourced for review. All studies were identified as being level IIb evidence which is a medium level of quality. The majority of studies investigated benefit finding (80%) and were split between recruiting participant via cancer clinics and postal survey. They focused on the medical, psychological and social characteristics of the patient following completion of treatment for HNC. Conclusion. Demographic factors across the papers showed similar patterns of relationships across BF and PTG; that higher education/qualification and cohabitation/marriage are associated with increased BF/PTG. Similarly, overlap with disease characteristics and psychosocial factors where hope and optimism were both positively correlated with increased reported BF/PTG.

The Moderated Relationship of Appearance Valence on Appearance Self Consciousness: Development and Testing of New Measures of Appearance Schema Components

This paper describes the creation and psychometric properties of two independent measures of aspects of appearance schematicity – appearance salience and valence, assessed by the CARSAL and CARVAL, and their relation to appearance self-consciousness. Five hundred and ninety two participants provided data in a web based task. The results demonstrate the sound psychometric properties of both scales. This was demonstrated by good item total characteristics, good internal reliability of each scale, and the independence of the two scales shown through principal components analysis. Furthermore, the scales show independent and moderated relationships with valid measures of appearance related psychosocial distress. Negatively valenced appearance information was associated with increased appearance self-consciousness. More crucially, the impact of negative valence on appearance self-consciousness was exacerbated by the moderating effect increased salience of appearance.

Systematic Review: Psychosocial Interventions for Children and Young People With Visible Differences Resulting From Appearance Altering Conditions, Injury, or Treatment Effects

OBJECTIVE Evaluate critically the evidence of the effectiveness of psychosocial interventions for children/young people (<18 years old) with visible differences in improving self-esteem, social experiences, psychological well-being, and behavioral outcomes. METHODS Studies were systematically identified using electronic databases, appraised according to eligibility criteria and evaluated for risk of bias. Findings were reported using the PRISMA checklist. RESULTS Studies were identified that evaluated residential social camps, exercise with counseling, social skills training (SIST), behavioral therapy (BT), and cognitive behavioral therapy (CBT). Risk of bias within studies was high. Camp studies and exercise with counseling showed little or no effect postintervention on self-esteem, social experiences, and psychological well-being. The five studies evaluating SIST, CBT, and BT provided limited support for their effectiveness. CONCLUSIONS Evidence base is inconclusive. Further rigorous research using appropriate outcome measures to evaluate the effectiveness of interventions for young people with visible differences is required.

Incorporating User Perspectives in the Design of an Online Intervention Tool for People with Visible Differences: Face IT

BACKGROUND Individuals with visible differences can experience social anxiety in relation to their appearance. Social skills-based psychosocial interventions have to date shown only limited effectiveness at addressing their concerns. AIMS To incorporate user perspectives in the development of an online psychosocial intervention, known as Face IT. METHOD AND RESULTS Study one consisted of a needs assessment with 12 individuals with a visible difference and six health professionals in order to identify the difficulties experienced by those with visible difference and obtain feedback on the proposed content of Face IT. The findings demonstrated support for the social skills model and the use of an online intervention. Study two consisted of an empirical usability evaluation of Face IT with 14 potential users and 14 health professionals. Based on feedback from the participants, changes were made to the graphics and navigation of the programme. The clinical content has been made more acceptable. CONCLUSIONS The findings indicate support for the importance of social skills-based psychosocial interventions for addressing the needs of those with a visible difference, and have allowed modifications to be made to Face IT ahead of a randomized controlled trial of effectiveness.