Overcoming Appearance Anxiety

Stress may have an impact on our physical wellbeing and potentially exacerbate a number of skin conditions, although this is complicated and the mechanisms by which this happens are not yet well understood. Certainly, feelings of nervousness and anticipated embarrassment can trigger some degree of flushing of the skin. Psychological factors can also influence perception of itch and drive scratching behaviour and this can also obviously further exacerbate skin conditions. Simple anxiety management techniques are worth trying, and relaxation techniques such as guided imagery, deep breathing, and mindfulness type exercises can be helpful. If scratching is an issue, then habit reversal, a three to four session psychoeducational intervention can be useful. If there are heightened levels of anxiety and other feelings such as low mood present, then it is advisable to consult with a dermatologist, psychiatrist, or psychologist for further advice and possibly for a referral for psychological therapy.

The majority of talking therapies centre on gaining recognition of what is going on before trying to make changes. Having these sorts of thoughts can be really upsetting and it is important to acknowledge that this thought is just that... a thought. In other words it is not a fact. In traditional cognitive behavioural therapy (CBT) we would firstly explore the affective impact that such thoughts have... generally we find it triggers and is bound up with feelings of low mood, anxiety, or even shame. We would also look at how it relates to coping behaviours; perhaps there is avoidance of meeting people, or putting others first (or any number of other coping behaviours - that whilst functional come at a price). An important stage in therapy is to be able to begin to stand back from our thoughts, feelings, and behaviours - so as to notice how they connect and reinforce one another. Gaining this recognition can help in mobilising change. In traditional CBT we might also look at identifying the type of thinking style (self-criticism, all or nothing thinking etc) as well as catching and specifying the exact content and impact. We may also look at underlying beliefs such as values associated with the meaning of appearance. Again recognition of process and content can inform 'restructuring' or change. In other cognitive approachs such as Acceptance and Committment Therapy (ACT) and Compassion Focussed Therapy (CFT) and Cognitive Analytic Therapy (CAT) the therapy may take a slightly different approach to facilitating change. CFT for example may help by focussing on additional techniques geared up to mobilse and increase self-compassion.

As far as I'm aware there is not any evidence that hypnosis can 'cure' any skin condition. Psychological interventions including self-help relaxation type exercises might help with confidence or/and with flushing. Talking therapies might also help with the management of secondary distress that can be associated with skin conditions such as rosacea and uticaria.

There are a number of specific charities that have resources in the form of booklets or leaflets or webpages that might be of interest/use. The Stroke Association have some general information about the emotional impact of stroke - https://www.stroke.org.uk/resources/emotional-changes-after-stroke. I'm a Trustee for the charity Changing Faces and they have a lot of resources relevant to people living with a visible difference of any type including those affecting the eye - https://www.changingfaces.org.uk/. Changing Faces also provides advice and support in managing the reactions of other people.

This sort of question is often associated with a sense that change might not be possible. However, I would argue that improvements in wellbeing can be achieved. There are a range of psychological approaches or therapies that can be useful in facilitating adjustment to real changes in appearance. It is important to acknowledge that feelings of loss associated with changes in appearance may be present and are normal. Further, changes to our bodies can act as significant triggers or reminders for the stressors or traumas that might have caused the change. Accredited or registered psychological therapists will want to form a bespoke or individual understanding of any given individuals presenting issues. They will want to provide space to explore feelings of loss in first instance if these are present. It might also be necessary to support someone in managing symptoms stemming from the cause of the changes, and this is particularly likely to be the case where there are signs of reliving present.

We all value our bodies, both in terms of how they appear and what they can do for us. Changes to appearance and functioning are not easy to accept and there is individual variation often related to the extent to which we previously valued appearance and our specific physical abilities. Cognitive Behavioural Therapy (CBT) can be useful in helping someone to stand back and explore how the relationship between thoughts and thinking styles associated with appearance can play a big role in maintaining appearance related feelings and coping behaviours. Techniques to make changes can then be gradually and sensitively introduced. I also like to help people explore the role society might have played in shaping underlying appearance related values. This can help seperate out what is important to the self from what is seemingly stereotypically 'valued' in society.

It can also help within therapy to explore other aspects of the self that can be grown and developed to enhance self-esteem. For example, there is evidence that focussing more on body functioning can help to grow body specific confidence. Most forms of CBT, including Compassion Based Approaches will also look to actively build self-esteem via building or rebuilding the ability to be self-compassionate. This is important as a lot of body dissatisfaction is maintained by self-critical (and typically harsh and unfair) thoughts. Some forms of CBT, such as Acceptance and Commitment Therapy (ACT) also look at realigning focus with wider life values as well as providing techniques for managing thoughts. For therapists, some further details as to how to adapt CBT can be found in our book shown on my profile page. There are also a number of good self-help books available including this one: https://overcoming.co.uk/585/Overcoming-Body-Image-Problems-Including-Body-Dysmorphic-Disorder---VealeWillsonClarke.