Intervention: approaches and sources of support

1. Intervention: approaches and sources of support

2. Goals of this module • To be able to: • Recognise the continuum between normative discontent and extreme body image anxiety • Identify excessive concern • Discuss this sensitively & give helpful advice • Understand treatment approaches • Recommend sources of support

3. ACTIVITY ONE • write down one thing that you really LIKE about your appearance • write down one thing that you really DISLIKE about your appearance

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

5. Plot your score below: 10 Distress 10 0 Noticeability

6. Plotting noticeability and worry Distress A 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 C B D Noticeability

7. 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 injury • B is someone who looks unusual but is positive and confident • C is someone whose anxiety is disproportionate to their actual appearance

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

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

10. ACTIVITY TWO • How 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:

11. 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/No • Do you ALWAYS wear make-up: at home?..... • At work?........... On holiday? ……………

12. ACTIVITY THREE (a) • Write down all the ways that you regularly modify or adapt your appearance

13. 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, etc • Clothes

14. 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?

15. Impact of Body Image anxiety on related behaviour • Repeated mirror checking or avoidance • Excessive grooming and use of make-up • Take ages to get ready • Keep changing/buying clothes • Seeking plastic surgery or expensive treatments • Seeking reassurance from others • Using clothes or make-up as a ‘disguise’

16. Negative impact of Body Image anxiety on general behaviour • AVOIDANCE AND CHECKING • Avoiding social situations • Limited involvement in other activities • Avoiding situations where likely to feel the centre of attention • Avoiding having photos taken • Avoiding sex and intimacy

17. Comparisons with ‘ideal’ images can increase appearance anxiety

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

19. 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?

20. Impact of Body Image anxiety on beliefs about appearance? • I am abnormal or inferior • Other people are more attractive than me • I have to always look my best • If other people saw me without my make-up they would not want to be with me • I don’t look feminine/masculine…. • I need plastic surgery • etc

21. Impact of Body Image anxiety on beliefs about the self? • LOW SELF ESTEEM &SELF CONFIDENCE • I am abnormal or inferior • Other people are better than me • No-one is ever going to want to be with me • I am useless • I am no good at anything • Etc

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

23. Impact of Body Image anxiety on mood • Depression • Anxiety • Anger/aggression • Shame • Disgust • etc

24. Summary: Body Image Anxiety • Focus on inappropriate ‘ideals’ of appearance can lead people to feel inferior and abnormal • Appearance takes up too large a part of self concept • People experience low self esteem and low self confidence • Social anxiety can lead to social avoidance and a reluctance to take part in activities

25. Body dysmorphic disorder • Extreme Body Image anxiety is classified as a psychiatric condition (BDD) often associated with Obsessional Compulsive Disorder(OCD)and Depression • BDD occurs in about 3 in 100 people and up to 15 in 100 people who request cosmetic surgery • BDD is treated by a specialist psychologist using Cognitive Behaviour Therapy (CBT) and medication

26. 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

27. Treatment approaches: what needs to change? • Biomedical approaches aim to improve appearance by medical or surgical means • Psychological approaches aim to reduce the impact of appearance anxiety, by modifying beliefs and behaviour

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

29. A COGNITIVE BEHAVIOURAL MODEL Maintenance cycle BELIEFS PHYSIOLOGY BEHAVIOURS FEELINGS

30. 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 cycle BELIEFS PHYSIOLOGY BEHAVIOURS FEELINGS

31. 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 cycle BELIEFS PHYSIOLOGY BEHAVIOURS Mirror gazing, social avoidance, avoid intimacy ; safety behaviours: big jackets, make up, excessive grooming, asking for reassurance FEELINGS

32. 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 cycle BELIEFS PHYSIOLOGY BEHAVIOURS Mirror gazing, social avoidance, avoid intimacy ; safety behaviours: big jackets, make up, excessive grooming, asking for reassurance FEELINGS Anxious, lonely, despairing, unhappy, disgusted, ashamed, angry

33. 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 cycle BELIEFS PHYSIOLOGY BEHAVIOURS Heart races, palpitations, rapid breathing, faintness, sweaty, blushing Mirror gazing, social avoidance, avoid intimacy ; safety behaviours: big jackets, make up, excessive grooming, asking for reassurance FEELINGS Anxious, lonely, despairing, unhappy, disgusted, ashamed, angry

34. 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 alternatives

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

36. Stepped Care Interventions Levels 3 – 5 require health professional support Levels 0 – 2 relevant for vocational trainers

37. 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 someone

38. 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 someone • Late or absent, excessive attention to appearance, mirror checking, seeking reassurance, social avoidance etc

39. Activity Four(b) • Raising the subject • Write down some ideas about what you might say to raise the subject with someone you are concerned about

40. Activity Four(b)Raising the subject • I 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?

41. What to say…. • Do…… • Reassure that some concern is normal & that help is available when concern is excessive • Ask if they are being teased or bullied by someone else • Suggest that they read more about appearance anxiety • Offer the chance to talk to you more • Don’t………. • Tell them that they look fine to you • Tell 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 surgery

42. Offering advice • What comparisons are they making? Are there more suitable role models they could use? • Encourage social activities with other students • Recommend reading and websites for more information • Explain that help is available via: counselling (at college), via their doctor, or via online or telephone support

43. Accessing further support These are good self help texts which explain body image concern and help people to understand and change their behaviour

44. Websites • Changing 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.org

45. On-line interventions Online interventions are becoming available for adults and children

46. 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 normal • Recommend plastic surgery • Reassure them that they look beautiful to me • Tell them they are making a fuss about nothing • Encourage them to read more about Body Image problems • Encourage them to participate socially

47. Summary activity (cont) • Encourage them to spend less time in front of the mirror • Encourage them to research surgery on the Internet • Encourage them to go out without make-up from time to time • Encourage comparison with a wider group of people • Discuss sources of support • Explain how to access help

48. Summary Activity: yes / no • If I think someone might have a Body Image problem I should: • Explain that concern about appearance is normal • Recommend plastic surgery • Reassure them that they look beautiful to me • Tell them they are making a fuss about nothing • Encourage them to read more about Body Image problems • Encourage them to participate socially

49. Summary activity (cont) • Encourage them to spend less time in front of the mirror • Encourage them to research surgery on the Internet • Encourage them to go out without make-up from time to time • Encourage comparison with a wider group of people • Discuss sources of support • Explain how to access help

50. Conclusion • You can help identify and offer support: • Observe behaviour • Raise the subject and ask questions • Listen, normalise and support • Recommend information • Advise sources of further help