Intervention: - PowerPoint Presentation

Slide1

Intervention: Approaches and sources of support Slide2

Goals of this moduleTo be able to:Recognise the continuum between normative discontent and extreme body image anxietyIdentify excessive concernDiscuss this sensitively & give helpful adviceUnderstand treatment approaches Recommend sources of supportSlide3

ACTIVITY ONEwrite down one thing that you really LIKE about your appearancewrite down one thing that you really DISLIKE about your appearanceSlide4

Thinking about the feature that you DISLIKE:On a scale of 0 – 10How noticeable is it to others? /10How much do you worry about it? /10Slide5

Noticeability

Distress

Plot your score below:

0

10

10Slide6

Noticeability

Distress

Plotting noticeability and worry

A

B

C

D

A: highly noticeable & causing high distress

B: highly noticeable but not distressed

C:not very noticeable but very distressed

D: not very noticeable and not very distressed Slide7

How did you score?Most people are a ‘D’. We describe this ‘normative discontent’A would be typical of someone who has had a recent appearance altering injuryB is someone who looks unusual but is positive and confidentC is someone whose anxiety is disproportionate to their actual appearanceSlide8

Is concern about appearance normal?How would you answer this question? Think about what you have learned from earlier parts of this courseSlide9

Is concern about appearance normal?How would you answer this question? Think about what you have learned from earlier parts of this courseInterest in appearance is normal. Appearance anxiety becomes a problem when it significantly impacts and disrupts a persons day to day lifeSlide10

ACTIVITY TWOHow does your appearance impact on your life?The following are the kinds of questions that we ask to see how Body Image investment impacts on day to day life (NB: there are no ‘right’ or ‘wrong’ answers! )See how you score:Slide11

Fill in the gaps….How long does it take you to get ready each day?.................On how many occasions do you look in the mirror each day?........... For how long?........Are you ever late for an event because are not happy with your appearance? Yes/NoDo you ALWAYS wear make-up: at home?.....At work?........... On holiday? …………… Slide12

ACTIVITY THREE (a)Write down all the ways that you regularly modify or adapt your appearanceSlide13

Here are just some:Make-up, hair style, hair extensions, hair colour, dieting, tattoos, piercing, nail extensions, nail polish, manicure, pedicure, facials, non-invasive beauty treatments, skin care, hair removal, skin lightening, tanning, Botox, fillers, plastic surgery, orthodontics, etcClothes Slide14

ACTIVITY THREE (b)Thinking about the ways in which you modify your own appearance: how do you think excessive appearance concern would impact on these behaviours? What effect might this have on behaviour in general?Slide15

Impact of Body Image anxiety on related behaviourRepeated mirror checking or avoidanceExcessive grooming and use of make-upTake ages to get readyKeep changing/buying clothesSeeking plastic surgery or expensive treatmentsSeeking reassurance from othersUsing clothes or make-up as a ‘disguise’Slide16

Negative impact of Body Image anxiety on general behaviourAVOIDANCE AND CHECKING Avoiding social situationsLimited involvement in other activitiesAvoiding situations where likely to feel the centre of attention Avoiding having photos takenAvoiding sex and intimacy Slide17

Comparisons with ‘ideal’ images can increase appearance anxietySlide18

Most of us have a less than ‘ideal’ appearance!Slide19

ACTIVITY THREE (c)What affect might excessive Body Image anxiety have on beliefs about appearance?How might this effect your beliefs about the self generally?Slide20

Impact of Body Image anxiety on beliefs about appearance?I am abnormal or inferiorOther people are more attractive than meI have to always look my bestIf other people saw me without my make-up they would not want to be with meI don’t look feminine/masculine….I need plastic surgeryetcSlide21

Impact of Body Image anxiety on beliefs about the self?LOW SELF ESTEEM &SELF CONFIDENCEI am abnormal or inferiorOther people are better than meNo-one is ever going to want to be with meI am uselessI am no good at anythingEtcSlide22

ACTIVITY THREE (d)What affect might excessive Body Image anxiety have on mood and emotion?Slide23

Impact of Body Image anxiety on moodDepressionAnxietyAnger/aggressionShameDisgustetcSlide24

Summary: Body Image AnxietyFocus on inappropriate ‘ideals’ of appearance can lead people to feel inferior and abnormalAppearance takes up too large a part of self conceptPeople experience low self esteem and low self confidence Social anxiety can lead to social avoidance and a reluctance to take part in activitiesSlide25

Body dysmorphic disorderExtreme Body Image anxiety is classified as a psychiatric condition (BDD) often associated with Obsessional Compulsive Disorder(OCD)and DepressionBDD occurs in about 3 in 100 people and up to 15 in 100 people who request cosmetic surgeryBDD is treated by a specialist psychologist using Cognitive Behaviour Therapy (CBT) and medicationSlide26

Summary: When should we be concerned?We become concerned when people are taking hours to get ready, check their appearance in the mirror on multiple occasions, repeatedly ask for reassurance from other about their looks, are late or miss events, feel compelled to wear make up and behave in ways that prevent them acting spontaneously or living a normal life Slide27

Treatment approaches: what needs to change?Biomedical approaches aim to improve appearance by medical or surgical meansPsychological approaches aim to reduce the impact of appearance anxiety, by modifying beliefs and behaviourSlide28

A Cognitive Behavioural model of Body Image anxietyCognitive behavioural therapy (CBT) is a systematic treatment that aims to identify and challenge unhelpful beliefs (cognitions)and change behaviourIn Body Image anxiety, this means examining beliefs about appearance, examining the evidence that supports them and reducing associated social anxiety and avoidance behavioursSlide29

BELIEFS

BEHAVIOURS

FEELINGS

PHYSIOLOGY

A

COGNITIVE

BEHAVIOURAL MODEL

Maintenance cycleSlide30

BELIEFS

BEHAVIOURS

FEELINGS

PHYSIOLOGY

A COGNITIVE BEHAVIOURAL MODEL

I must always look immaculate,

I don’t look like other people, I am deformed, to be successful I must be beautiful…

Maintenance cycleSlide31

BELIEFS

BEHAVIOURS

FEELINGS

PHYSIOLOGY

A COGNITIVE BEHAVIOURAL MODEL

I must always look immaculate,

I don’t look like other people, I am deformed, to be successful I must be beautiful…

Mirror gazing,

social

avoidance, avoid intimacy ; safety behaviours: big jackets, make up, excessive

grooming, asking for reassurance

Maintenance cycleSlide32

BELIEFS

BEHAVIOURS

FEELINGS

PHYSIOLOGY

A COGNITIVE BEHAVIOURAL MODEL

I must always look immaculate,

I don’t look like other people, I am deformed, to be successful I must be beautiful…

Mirror gazing, social avoidance, avoid intimacy ; safety behaviours: big jackets, make up, excessive grooming, asking for reassurance

Anxious, lonely, despairing, unhappy, disgusted, ashamed, angry

Maintenance cycleSlide33

BELIEFS

BEHAVIOURS

FEELINGS

PHYSIOLOGY

A COGNITIVE BEHAVIOURAL MODEL

I must always look immaculate,

I don’t look like other people, I am deformed, to be successful I must be beautiful…

Mirror gazing,

social

avoidance, avoid intimacy ; safety behaviours: big jackets, make up, excessive

grooming, asking for reassurance

Anxious, lonely, despairing, unhappy, disgusted, ashamed, angry

Heart races, palpitations, rapid breathing,

faintness, sweaty, blushing

Maintenance cycleSlide34

What does a specialist psychologist do?Works within a clear evidence based framework helps to identify and modify unhelpful beliefs (by examining and challenging the evidence that supports them)helps to dismantle unhelpful behaviours and replace them with more helpful alternativesSlide35

Levels 0-2 of a stepped care approach is ideal for vocational trainers Raise the subject; have a sensitive discussion; offer supportAdvice: introduction to information and self help materials, on-line intervention, onward referral to health professional support(Level 3,4&5: Specialist –led)Slide36

Stepped Care InterventionsLevels 0 – 2 relevant for vocational trainersLevels 3 – 5 require health professional supportSlide37

Activity Four(a)Thinking about the impact of Body Image anxiety on behaviour: write down four things that might cause you to be concerned about someoneSlide38

Activity Four(a)Thinking about the impact of Body Image anxiety on behaviour: write down four things that might cause you to be concerned about someoneLate or absent, excessive attention to appearance, mirror checking, seeking reassurance, social avoidance etcSlide39

Activity Four(b)Raising the subjectWrite down some ideas about what you might say to raise the subject with someone you are concerned aboutSlide40

Activity Four(b)Raising the subjectI notice that you are often late for activities: why do you think this is a problem for you?Prompt: does it take you long to get ready?I notice that you often ask other people if you look okay: do you find yourself worrying about this?I notice that you check your appearance a lot – do you think you worry more than other people?Slide41

What to say….Do……Reassure that some concern is normal & that help is available when concern is excessiveAsk if they are being teased or bullied by someone elseSuggest that they read more about appearance anxietyOffer the chance to talk to you moreDon’t……….Tell them that they look fine to youTell them that there are lots of people who have ‘proper’ disfigurements Suggest they are silly or making a fuss about nothing

Get drawn into a discussion about their appearance or whether they need surgerySlide42

Offering adviceWhat comparisons are they making? Are there more suitable role models they could use?Encourage social activities with other studentsRecommend reading and websites for more informationExplain that help is available via: counselling (at college), via their doctor, or via online or telephone supportSlide43

Accessing further support

These are good self help texts which explain body image concern and help people to understand and change their behaviourSlide44

WebsitesChanging Faces is a charity set up to help people with visible difference in appearance. They have useful resources and ideas for everyone concerned about what they look like.www.changingfaces.orgSlide45

Online interventions are becoming available for adults and childrenOn-line interventionsSlide46

Summary Activity: (please answer yes or no)If I think someone might have a Body Image problem I should:Explain that concern about appearance is normalRecommend plastic surgeryReassure them that they look beautiful to meTell them they are making a fuss about nothingEncourage them to read more about Body Image problemsEncourage them to participate sociallySlide47

Summary activity (cont)Encourage them to spend less time in front of the mirrorEncourage them to research surgery on the InternetEncourage them to go out without make-up from time to timeEncourage comparison with a wider group of peopleDiscuss sources of supportExplain how to access helpSlide48

Summary Activity: yes / noIf I think someone might have a Body Image problem I should:Explain that concern about appearance is normalRecommend plastic surgeryReassure them that they look beautiful to meTell them they are making a fuss about nothingEncourage them to read more about Body Image problemsEncourage them to participate sociallySlide49

Summary activity (cont)Encourage them to spend less time in front of the mirrorEncourage them to research surgery on the InternetEncourage them to go out without make-up from time to timeEncourage comparison with a wider group of peopleDiscuss sources of supportExplain how to access helpSlide50

ConclusionYou can help identify and offer support:Observe behaviourRaise the subject and ask questionsListen, normalise and supportRecommend informationAdvise sources of further helpSlide51

Managing disfiguring conditionsWhat are the problems?Negative impact on self perceptions (self esteem/worth)Encounters with others (self consciousness; social anxiety)Reactions of others (unwanted attention, stereotyping, avoidance)Slide52

The impacts of a visible disfigurement“in their attempt to go about their daily lives, people are subjected to visual and verbal assaults, and a level of familiarity from strangers (including) naked stares, startled reactions, ‘double takes’, whispering, furtive looks, curiosity personal questions, advice, manifestations of pity or aversion, laughter, ridicule and outright avoidance”. (

MacGregor

, 1962)Slide53

In a job interview, the following are important (for people with a disfigurement and for those with other appearance concerns)Good social skillsDress smartlyGood eye contactAppear relaxed Smile!The goal is to put other people at ease: “if you are positive about your appearance, other people will be too”Slide54

Should appearance be mentioned?This is entirely up to the individual. A positive statement can be helpful such as:“you will notice I have a facial difference: I think that managing this has helped me to develop my social skills and put the customer at ease”…………But no-one should feel pressured to talk about their appearanceSlide55

What if the employer asks?In the UK this is illegal. However, people are often curious. Answers include:I don’t think my appearance is relevant to this jobIt is not a problem for me so I don’t think it needs to be a problem for othersThe advantage of looking distinctive is that people can always remember who they spoke to! (Humour can often be really helpful!)Slide56

Managing disfigurementThe key is putting other people at ease so that the social interchange between them is relaxed and positive – a key skill in the workplace.Techniques for managing job interviews are illustrated in the online programme www.faceitonline.org.uk