Psychosocial interventions for adults with visible differences: a systematic review
Open accessPublished version of a preprint
Abstract
UNLABELLED: Background. Some individuals with visible differences have been found to experience psychosocial adjustment problems that can lead to social anxiety and isolation. Various models of psychosocial intervention have been used to reduce social anxiety and appearance related distress in this population. The objective of this review was to update a previous systematic review assessing the efficacy of psychosocial intervention programs for adults with visible differences. The original review (Bessell & Moss, 2007) identified 12 papers for inclusion. Methods. A search protocol identified studies from 13 electronic journal databases. METHODS: Studies were selected in accordance with pre-set inclusion criteria and relevant data were extracted. Results. This update identified an additional four papers that met the inclusion criteria. Two papers provided very limited evidence for the efficacy of a combined cognitive-behavioural and social skills training approach. None of the papers provided sufficient evidence for the optimal duration, intensity or setting of psychosocial interventions for this population. Discussion. The review concluded that a greater number of Randomised Controlled Trials and experimental studies were required to increase the methodological validity of intervention studies.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
This study used a randomized design with a control group and collected qualitative data to address previous methodological drawbacks.
“by using a randomized design with a control group, and examining participants ' viewpoints, collecting qualitative data.”
From An ACT self-help intervention for adults with a visible difference in appearance: A pilot feasibility and acceptability randomized controlled study. (2023) · cites this paper as Norman & Moss, 2015
The Methods (Analysis; page not provided) say the authors qualitatively synthesised data across studies, not that they collected qualitative data from participants. The Results (Risk of bias assessment) identify randomized trials as studies the review assessed, while the Discussion recommends more controlled studies. This paper was a systematic review, not a randomized study with its own control group. (LLM, conf=0.88)
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measuredThe availability of high-quality studies assessing the effectiveness of psychological interventions for people with visible disfigurement is limited.
“Furthermore, the availability of high-quality studies assessing their effectiveness is limited (Norman & Moss, 2015).”
From A Novel Psychological Group Intervention Targeting Appearance-Related Distress Among People With a Visible Disfigurement (Inside Out): A Case Study (2023) · cites this paper as Norman & Moss, 2015
The availability of evidence-based psychological support tailored to the specific needs of people with visible disfigurement is limited.
“The availability of evidence-based psychological support tailored to these specific patients' needs is limited.”
From A Novel Psychological Group Intervention Targeting Appearance-Related Distress Among People With a Visible Disfigurement (Inside Out): A Case Study (2023) · cites this paper as Norman & Moss, 2015
The availability of high-quality studies exploring the effectiveness of cognitive-behavioural interventions for appearance anxiety is limited.
“However, the availability of high-quality studies exploring effectiveness is limited [21,27-28].”
From The role of psychological flexibility in appearance anxiety in people who have experienced a visible burn injury. (2019) · cites this paper as [27]
Previous studies had methodological drawbacks.
“Then, this study attempted to address previous methodological draw backs (Norman & Moss, 2015)”
From An ACT self-help intervention for adults with a visible difference in appearance: A pilot feasibility and acceptability randomized controlled study. (2023) · cites this paper as Norman & Moss, 2015
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
Cochrane Handbook for Systematic Reviews of Interventions: Cochrane Book Series
(2008) · doi:10.1002/9780470712184 · Cited by 25,048 · see citing works
The need to belong: Desire for interpersonal attachments as a fundamental human motivation.
Baumeister, R. F., & Leary, M. R. (1995) · Psychological Bulletin · doi:10.1037//0033-2909.117.3.497 · Cited by 23,245 · see citing works
Cochrane Handbook for Systematic Reviews of Interventions
Tarsilla, M. (2010) · Journal of MultiDisciplinary Evaluation · doi:10.56645/jmde.v6i14.284 · Cited by 5,228 · see citing works
Evidence-based practice in psychology.
American Psychological Association (2006) · American Psychologist · doi:10.1037/0003-066x.61.4.271 · Cited by 2,478 · see citing works
Synthesising qualitative and quantitative evidence: A review of possible methods
Dixon-Woods, M., Agarwal, S., Jones, D., Young, B., & Sutton, A. (2005) · Journal of Health Services Research & Policy · doi:10.1177/135581960501000110 · Cited by 2,132 · see citing works
The Social Psychology of Facial Appearance
Bull, R. H. C., & Rumsey, N. (1988) · Springer eBooks · doi:10.1007/978-1-4612-3782-2 · Cited by 347 · see citing works
Altered body image: appearance‐related concerns of people with visible disfigurement
Rumsey, N., Clarke, A., White, P., Wyn‐Williams, M., & Garlick, W. (2004) · Journal of Advanced Nursing · doi:10.1111/j.1365-2648.2004.03227.x · Cited by 286 · see citing works
An evaluation of the impact of social interaction skills training for facially disfigured people
Robinson, E., Ramsey, N., & Partridge, J. (1996) · British Journal of Plastic Surgery · doi:10.1016/s0007-1226(96)90156-3 · Cited by 246 · see citing works
Bloom, H. S. (1987) · Evaluation Review · doi:10.1177/0193841x8701100407 · Cited by 216 · see citing works
Body image, eating disorders and obesity
Ardovini, C. (1997) · Eating and Weight Disorders - Studies on Anorexia Bulimia and Obesity · doi:10.1007/bf03339971 · Cited by 185 · see citing works
Body image: A cognitive self-schema construct?
Altabe, M. N., & Thompson, J. K. (1996) · Cognitive Therapy and Research · doi:10.1007/bf02228033 · Cited by 184 · see citing works
Facial appearance in adults who had cleft lip and palate treated in childhood
Marcusson, A., Paulin, G., & Östrup, L. (2002) · Scandinavian Journal of Plastic and Reconstructive Surgery and Hand Surgery · doi:10.1080/028443102753478327 · Cited by 177 · see citing works
Oxford Handbook of the Psychology of Appearance
Frith, H. (2012) · Oxford University Press eBooks · doi:10.1093/oxfordhb/9780199580521.001.0001 · Cited by 138 · see citing works
The treatment of body image disturbances.
Cash, T. F. (2001) · American Psychological Association eBooks · doi:10.1037/10502-004 · Cited by 135 · see citing works
Kent, G. (2000) · Psychology, Health & Medicine · doi:10.1080/713690187 · Cited by 123 · see citing works
The effectiveness of stand-alone cognitive-behavioural therapy for body image: a meta-analysis.
Jarry, J., & Ip, K. (2005) · Body image · doi:10.1016/j.bodyim.2005.10.001 · Cited by 118 · see citing works
Phobic nature of social difficulty in facially disfigured people
Newell, R., & Marks, I. (2000) · British Journal of Psychiatry · doi:10.1192/bjp.176.2.177 · Cited by 118 · see citing works
Bessell, A., & Moss, T. (2007) · Body Image · doi:10.1016/j.bodyim.2007.04.005 · Cited by 113 · see citing works
Self-citationThe Oxford handbook of the psychology of appearance
(2013) · Choice Reviews Online · doi:10.5860/choice.50-2963 · Cited by 104 · see citing works
Bessell, A., Brough, V., Clarke, A., Harcourt, D., Moss, T. P., & Rumsey, N. (2012) · Psychology, Health & Medicine · doi:10.1080/13548506.2011.647701 · Cited by 95 · see citing works
Self-citationSemple, C. J., Dunwoody, L., Kernohan, W. G., & McCaughan, E. (2009) · Supportive Care in Cancer · doi:10.1007/s00520-008-0480-7 · Cited by 54 · see citing works
Evaluation of a self-help leaflet in treatment of social difficulties following facial disfigurement
Newell, R., & Clarke, M. E. (2000) · International Journal of Nursing Studies · doi:10.1016/s0020-7489(00)00017-1 · Cited by 50 · see citing works
A survey of psychological need amongst adult burn-injured patients
Kleve, L., & Robinson, E. (1999) · Burns · doi:10.1016/s0305-4179(99)00070-4 · Cited by 50 · see citing works
A systematic review of self-help for disfigurement: Effectiveness, usability, and acceptability
Muftin, Z., & Thompson, A. R. (2013) · Body Image · doi:10.1016/j.bodyim.2013.07.005 · Cited by 49 · see citing works
Rehabilitation after Amputation: Psychotherapeutic Intervention Module in Indian Scenario
Srivastava, K., & Chaudhury, S. (2014) · The Scientific World JOURNAL · doi:10.1155/2014/469385 · Cited by 31 · see citing works
Papadopoulos, L., Walker, C., & Anthis, L. (2004) · Dermatology and Psychosomatics / Dermatologie und Psychosomatik · doi:10.1159/000083091 · Cited by 30 · see citing works
A Critical Review of Psychotherapy Research
Eppel, A. (2018) · Springer eBooks · doi:10.1007/978-3-319-74995-2_4 · Cited by 29 · see citing works
Bessell, A., Clarke, A. M., Harcourt, D. M., Moss, T., & Rumsey, N. (2010) · Behavioural and Cognitive Psychotherapy · doi:10.1017/s1352465810000305 · Cited by 27 · see citing works
Self-citationEditorial policies of the American Psychologist.
Anderson, N. B. (2006) · American Psychologist · doi:10.1037/0003-066x.61.1.1 · Cited by 13 · see citing works
Altered body image: auditing the appearance related concerns of people with visible disfigurement.
Rumsey, N., Clarke, A., White, P., Wyn‐Williams, M., & Garlick, W. (2004) · UCL Discovery (University College London) · Cited by 12 · see citing works
Papadopoulos, L. (2004) · Medical Entomology and Zoology · Cited by 12 · see citing works
Psychosocial interventions for visible differences: A systematic review
Bessell, A., & Moss, T. (2006) · UWE Research Repository (UWE Bristol) · Cited by 5 · see citing works
Self-citationIntroduction to Critical Appraisal of Medical Literature
Marchevsky, D. (2000) · Springer eBooks · doi:10.1007/978-1-4615-4205-6_14 · Cited by 3 · see citing works
Flagged first, then by citations
Research works printed but not linked: 2
- Goffman E Stigma 1968 London Penguin books
- Jolly M Peters K Cash TF Mikolaitis RA Gao W Block JA Body image intervention improves health outcomes in systemic Lupus Erythematosus Poster session presented at the Lupus conference: 9th International Congress, Vancouver, CA 2010 Lupus Research Institute New York
Cited by
Sorted by citations
Feragen, K. B., & Stock, N. M. (2017) · Psychology & Health · doi:10.1080/08870446.2016.1247838 · Cited by 75 · see citing works
“Nonetheless, there remains a need for further rigorous research using appropriate outcome measures, in order to evaluate the effectiveness of such interventions (Jenkinson, Williamson, Byron-Daniel, & Moss, 2015; Norman & Moss, 2015).”
BackgroundShepherd, L., Reynolds, D. P., Turner, A., O’Boyle, C. P., & Thompson, A. R. (2019) · Burns · doi:10.1016/j.burns.2018.11.015 · Cited by 54 · see citing works
Harcourt, D., Hamlet, C., Feragen, K. B., Garcia-Lopez, L.-J., Masnari, O., Mendes, J., Nobile, F., Okkerse, J., Pittermann, A., Spillekom-van Koulil, S., et al. (2018) · Body Image · doi:10.1016/j.bodyim.2018.02.001 · Cited by 46 · see citing works
Zucchelli, F., White, P., & Williamson, H. (2020) · Body Image · doi:10.1016/j.bodyim.2019.12.002 · Cited by 41 · see citing works
Zucchelli, F., Donnelly, O., Williamson, H., & Hooper, N. (2018) · Journal of Cognitive Psychotherapy · doi:10.1891/0889-8391.32.3.171 · Cited by 30 · see citing works
“One of the most consistent findings in the literature is that many people who struggle to adjust psychologically to having a visible difference experience social anxiety and withdrawal (Norman & Moss, 2015).”
BackgroundZucchelli, F., Donnelly, O., Rush, E., White, P., Gwyther, H., Williamson, H., & The VTCT Foundation Research Team at the Centre for Appearance Research (2022) · JMIR Formative Research · doi:10.2196/33449 · Cited by 21 · see citing works
Acceptance and commitment therapy for appearance anxiety: three case studies
Shepherd, L., Turner, A., Reynolds, D. P., & Thompson, A. R. (2020) · Scars, Burns & Healing · doi:10.1177/2059513120967584 · Cited by 19 · see citing works
Hotton, M., Johnson, D., Kilcoyne, S., & Dalton, L. (2022) · Journal of Plastic, Reconstructive & Aesthetic Surgery · doi:10.1016/j.bjps.2022.04.022 · Cited by 12 · see citing works
Powell, L. D., Vasiliou, V. S., & Thompson, A. R. (2023) · Body Image · doi:10.1016/j.bodyim.2023.101637 · Cited by 11 · see citing works
“It may be suggested that for those with high motivation, moderate distress, or long-waiting list for psychological support, may be benefited for this type and delivery of ACT (Norman & Moss, 2015).”
BackgroundMethodSiemann, I., Custers, J., van den Heuvel-Djulic, S., Pouwels, S., Kwakkenbos, L., & Spillekom-van Koulil, S. (2023) · Cognitive and Behavioral Practice · doi:10.1016/j.cbpra.2022.03.005 · Cited by 7 · see citing works
- Authors
- Norman, A., & Moss, T. P.
- Affiliations
- University of Plymouth (GB)
- University of the West of England (GB)
- Venue
- PeerJ
- Publisher
- PeerJ
- Published
- 2015-04-02
- Volume
- 3
- Pages
- e870
- ISSN
- 2167-8359 (ISSN-L)
- PMC
- PMC4389275
- OpenAlex
- W2015431396
- Cited by
- 53
- References
- 33
- Citations by year
- 2026: 1 · 2025: 5 · 2024: 7 · 2023: 6 · 2022: 7 · 2021: 8 · 2020: 3 · 2019: 6 · 2018: 6 · 2016: 4
- FWCI
- 0.48
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- PeerJ (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- UWE Research Repository (UWE Bristol) (submittedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- PEARL (University of Plymouth) (submittedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Body Image and Dysmorphia Studies
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Clinical Psychology › Psychological Treatments and Assessments
- Keywords
- visible difference, psychosocial interventions, social anxiety, appearance-related distress, social isolation, cognitive behavioral therapy, social skills training, adults, intervention efficacy
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
