Acceptance and commitment therapy for appearance anxiety: three case studies

Introduction: Due to scarring, appearance anxiety is a common psychological difficulty in patients accessing burns services. Appearance anxiety can significantly impact upon social functioning and quality of life; thus, the availability of effective psychological therapies is vital. Acceptance and Commitment Therapy (ACT) is considered useful for treating distress associated with other health conditions and may lend itself well to appearance anxiety. However, no published research is currently available.

Methods: Three single case studies (two male burns patients; one female necrotising fasciitis patient) are presented where appearance anxiety was treated using ACT. A treatment protocol was followed and evaluated: the Derriford Appearance Scale measured appearance anxiety; the Work and Social Adjustment Scale measured impairment in functioning; the Acceptance and Action Questionnaire measured acceptance (willingness to open up to distressing internal experiences); and the Committed Action Questionnaire measured engagement in meaningful and valued life activities. Measures were given at every treatment session and patient feedback was obtained. One-month follow-up data were available for two cases.

Results: After the intervention, all patients had reduced functional impairment and were living more valued and meaningful lives. No negative effects were found.

Discussion: These case studies suggest that ACT may be a useful psychological therapy for appearance anxiety. The uncontrolled nature of the intervention limits the conclusions that can be drawn.

Conclusion: A pilot feasibility study to evaluate the effectiveness of ACT for appearance anxiety is warranted.

Lay summary: Many patients with scars can feel distressed about their appearance. This is known as appearance anxiety and can include patients accessing burns services. Appearance anxiety can stop patients from enjoying a good quality of life and impact upon important areas of daily functioning. It is therefore important that psychological therapies are effective. However, research investigating the effectiveness of psychological therapies is limited. This paper describes the psychological therapy of three patients who were distressed about scarring. A psychological therapy called Acceptance and Commitment Therapy (ACT) was used as part of standard care and evaluated using questionnaires and patient feedback. After the course of ACT, all patients were less impacted day-to-day by their appearance anxiety and were living more valued and meaningful lives. No negative effects were found. These case studies suggest that ACT may be a useful psychological therapy for appearance anxiety and further research evaluating it should be completed.