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Mobile apps may offer a valuable platform for delivering evidence-based psychological interventions for individuals with atypical appearances, or visible differences, who experience psychosocial appearance concerns such as appearance-based social anxiety and body dissatisfaction. Before this study, researchers and stakeholders collaboratively designed an app prototype based on acceptance and commitment therapy (ACT), an evidence-based form of cognitive behavioral therapy that uses strategies such as mindfulness, clarification of personal values, and value-based goal setting. The intervention also included social skills training, an established approach for increasing individuals’ confidence in managing social interactions, which evoke appearance-based anxiety for many.
In this study, the authors aim to evaluate the feasibility of an ACT-based app prototype via the primary objectives of user engagement and acceptability and the secondary feasibility objective of clinical safety and preliminary effectiveness.
To address the feasibility objectives, the authors used a single-group intervention design with mixed methods in a group of 36 participants who have a range of visible differences. The authors collected quantitative data via measures of program use, satisfaction ratings, and changes over 3 time points spanning 12 weeks in outcomes, including selected ACT process measures (experiential avoidance, cognitive defusion, and valued action), scales of appearance concerns (appearance-based life disengagement, appearance-fixing behaviors, appearance self-evaluation, and fear of negative appearance evaluation), and clinical well-being (depression and anxiety). Semistructured exit interviews with a subsample of 12 participants provided qualitative data to give a more in-depth understanding of participants’ views and experiences of the program.
In terms of user engagement, adherence rates over 6 sessions aligned with the upper boundary of those reported across mobile mental health apps, with over one-third of participants completing all sessions over 12 weeks, during which a steady decline in adherence was observed. Time spent on sessions matched design intentions, and engagement frequencies highlighted semiregular mindfulness practice, mixed use of value-based goal setting, and high engagement with social skills training. The findings indicate a good overall level of program acceptability via satisfaction ratings, and qualitative interview findings offer positive feedback as well as valuable directions for revisions. Overall, testing for clinical safety and potential effectiveness showed encouraging changes over time, including favorable changes in appearance-related life disengagement, appearance-fixing behaviors, and selected ACT measures. No iatrogenic effects were indicated for depression or anxiety.
An ACT-based mobile program for individuals struggling with visible differences shows promising proof of concept in addressing appearance concerns, although further revisions and development are required before further development and more rigorous evaluation.
Visible difference refers to an unusual physical appearance caused by a congenital or acquired health condition, injury, or medical intervention [
Acceptance and commitment therapy (ACT) offers a novel approach to the population with visible differences, with traditional cognitive behavioral therapy having dominated the research field to date [
In a cross-sectional study involving individuals with a range of visible differences, researchers [
Recent trials offer some evidence for the efficacy of book-based ACT self-help in related clinical areas of social anxiety [
Mobile apps offer a unique level of user functionality to facilitate everyday skills training and self-monitoring in self-help programs [
Research on existing ACT-based app interventions offers a valuable direction for designing ACT-based apps for behavior change. For example, participants who used a more complex ACT matrix health app made greater health improvements and used the app more than those who used a simpler version [
Another design consideration is whether to make a mobile app self-guided or guided. In general, higher levels of professional input may confer greater efficacy [
The aim of this study is to assess the feasibility, or proof of concept, of an ACT-based self-guided prototype mobile intervention for individuals with visible differences who experience appearance-related concerns. The prototype is delivered via a mobile-optimized web app that simulates a native mobile app, which is consistent with the recommendation to test low-cost iterations of behavior change apps before building full-scale versions [
The primary feasibility objectives target user engagement and acceptability, and the secondary objective is to determine whether the program indicates clinical safety and preliminary effectiveness.
A sample of 36 adults was recruited between July and November 2020. The primary recruitment strategy drew from 19 UK charities that represented and supported individuals with a range of congenital and acquired appearance-affecting conditions and advertised the study to potential participants via social media, newsletters, distribution lists, and web-based events. Researchers also promoted the study on relevant Reddit subgroups with the aim of boosting the number of male participants, given the comparatively higher use of Reddit by men versus women [
To be eligible, participants had to self-report as having a visible difference (defined to participants as a physical appearance they considered to be significantly different from a typical appearance, with a list of example causes given). Eligibility also included currently experiencing appearance concerns, defined as psychological and/or social difficulties related to their visible differences, such as appearance-based social anxiety, low mood, and body image concerns. Participants also had to be aged ≥18 years, a UK resident, own a smartphone and have regular internet access (either through home Wi-Fi and/or cellular data), and have experience in using apps. Participants were ineligible if they acquired a visible difference from traumatic injury in the preceding 6 months because of the heightened risk of unprocessed psychological trauma, for which a self-administered intervention would be clinically inappropriate. Ineligibility also included current experience of a mental health crisis (eg, suicidality or self-harm), undergoing talking therapy, or having appearance concerns primarily related to weight or eating. The sample’s mean age was 36.67 (SD 14.25) years. All other demographic characteristics are presented in
Demographic characteristics of total study sample (N=36).
Characteristics | Values, n (%) | ||
Gender (female) | 29 (81) | ||
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Skin condition (eg, alopecia, ichthyosis, psoriasis, eczema, and scarring) | 20 (56) | |
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Congenital craniofacial condition (eg, cleft lip and/or palate and craniosynostosis) | 6 (17) | |
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Other congenital conditions (eg, birthmark and inherited ichthyosis) | 7 (19) | |
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Acquired craniofacial condition (eg, facial palsy and malocclusion of jaw) | 3 (8) | |
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White | 32 (89) | |
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Mixed ethnic groups | 2 (6) | |
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Asian or Asian British | 1 (3) | |
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Black, African, or Caribbean | 1 (3) | |
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Single | 15 (42) | |
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Married or in a civil partnership | 9 (25) | |
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Dating or living with a partner | 9 (25) | |
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Separated or divorced | 2 (7) | |
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Would rather not say | 1 (3) | |
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Employed full time | 16 (44) | |
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Employed part time | 6 (17) | |
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Student | 5 (14) | |
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Retired | 3 (8) | |
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Unemployed | 3 (8) | |
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Unable to work | 3 (8) | |
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Graduate degree | 10 (28) | |
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Undergraduate degree | 10 (28) | |
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Vocational qualification | 10 (28) | |
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High school | 6 (17) |
The program
What
Choice point metaphor (toward and away moves); simple reflection on personal values
Passengers on a bus metaphor
Recording your passengers and toward or away moves
Reviewing your passengers and toward or away moves
Responding to your passengers (acceptance and commitment therapy social anxiety concepts of safety mode versus
Mindfulness training—your senses
Micromindfulness (text instructions)
Reviewing safety mode versus
Values and taking action (values clarification and setting a simple goal for the day)
Mindfulness training—breath and body
Tracking simple goals for the day
Mindfulness of breath and body
Reviewing valued action (setting a simple goal for the week) and mindfulness
Mindfulness training—breathing into intensity
Being around people—taking control (social skills)
Tracking simple goals for the week
Mindfulness of intense experiences
Social skills practice
Reviewing your goal and mindfulness
Being around people—managing negative reactions (social skills)
Mindfulness training—mindful mirror
Social skills practice
Mindful mirror
Reviewing your mindfulness and social skills
Mindfulness in daily life
Tracking long-term goals
As new content was introduced in each session, users were encouraged to complete all 6 sessions, which would represent full completion. However, the core components of the program in the form of mindfulness (incorporating acceptance and cognitive defusion), self-compassion, value clarification, value-based goal setting, and social skills were all covered by session 4, with sessions 5 and 6 building on and consolidating these components. Completion of sessions 1 to 4 could therefore be expected to represent a cutoff for minimal completion.
Program content was delivered via the Qualtrics XM (Qualtrics International Inc) survey web app, which was constructed by the first and fifth authors (FZ and HG). Qualtrics XM is a mobile-optimized survey platform that can accommodate many native app features, such as embedded multimedia, responsive content tailored to users’ actions, and discrete
Example
This study adopted a single-group mixed methods design. We chose this design for its suitability to the study’s objectives of user engagement, acceptability, and clinical safety and preliminary effectiveness, which together focused on assessing proof of concept before justifying native app development and more rigorous testing of a final product via a randomized design [
Led by this guidance, the authors used a range of mixed methods to meet the objectives. The authors aimed to assess user engagement via program adherence, duration of use, and in-program use. Acceptability was determined via satisfaction ratings and explored in greater depth through semistructured qualitative exit interviews.
To test the secondary objective of whether the program indicated clinical safety and preliminary effectiveness, we assessed changes in a range of outcomes over 3 time points. The outcomes included (1) appearance-related life disengagement and appearance-fixing behaviors as primary outcomes of targeted behavior change; (2) measures of key targeted ACT processes, cognitive fusion, and experiential avoidance, as indicated in prior research [
Ethical approval was granted by the university faculty research ethics committee. The first author (FZ) contacted interested individuals by their chosen method, then arranged a 15- to 20-minute orientation telephone call, in which FZ confirmed individuals’ eligibility, guided participants in setting up the program, and oriented them to the platform. Before commencing the program, participants were instructed to check and complete a web-based consent checklist, followed by baseline outcome measures. Upon consent, participants were sent a £10 (US $13.28) web-based shopping voucher to compensate for any data use costs. Outcome measures were sent to participants after 8 weeks (allowing 2 additional weeks for anticipated time slippage) and after 12 weeks, when a second compensatory £10 (US $13.28) web-based shopping voucher was sent to completers. Access to
Semistructured exit interviews with FZ were planned for a representative subsample of up to half of the sample, including program noncompleters. Full completers were invited after the 12-week measurement, and noncompleters were invited 3 weeks after their final use of
This study coincided with the COVID-19 pandemic. In consultation with the user representative lead (third author, ER), we decided to commence the study in July 2020 when national COVID-19
Diagram of participant flow, dropout, and reasons for exclusion (where N refers to the number of potential participants and n refers to a subsample of the population under study).
Data embedded within the program were collected on total and session-by-session duration of use, as well as self-reported engagement with key content features, including value-based goals and mindfulness and social skills exercises. Session-by-session program adherence was monitored and recorded daily by the first author (FZ).
Satisfaction rating questions were embedded at the end of each program session, with ratings ranging from 1 (
The Body Image Life Disengagement Questionnaire [
The 10-item Body Image Coping Strategies Inventory–Appearance-fixing (BICSI-AF [
The Body Esteem for Adolescents and Adults–Appearance subscale [
The 6-item Fear of Negative Appearance Evaluation Scale (FNAES [
The Brief Experiential Avoidance Questionnaire [
The 7-item Cognitive Fusion Questionnaire (CFQ [
The Comprehensive Assessment of Acceptance and Commitment Therapy–Valued Action subscale [
The 14-item Hospital Anxiety and Depression Scale (HADS [
Anxiety and depression caseness on the scale range of 0 to 21 is indicated by subscale scores of 8 to 10 (mild), 11 to 14 (moderate), and 15 to 21 (severe). As the HADS alone is insufficient for a diagnosis, this study did not exclude participants scoring in the severe range. Instead, automated messages offering support contact details and a suggestion to consider whether involvement in the study was suitable were presented to any participants scoring in the severe range.
To explore areas related to (1) program acceptability and (2) clinical safety and preliminary effectiveness in more depth, the first author (FZ) conducted semistructured interviews via telephone, lasting an average of 27 (SD 10.0; range 14-38) minutes. The schedule explored participants’ overall impression of
Frequencies and descriptive data (mean and SD) were calculated for data pertaining to user engagement and acceptability. Adherence was recorded in increments of 0.5 sessions to include partially completed sessions, which were defined as when participants completed a minimum of one-third of the relevant session without completing the full session. In exploratory analyses of the predictive effect of demographic data on user engagement, we used a binomial logistic regression model with age and education level (dichotomized into categories of higher education and high school or vocational training) as the independent variables and adherence (full completion or noncompletion) as the dependent variable. Independent sample
To assess clinical safety and preliminary effectiveness, mixed model repeated measure (MMRM) analyses were used to determine the significance level of any changes in scores between baseline and week 8, baseline and week 12, and across all time points. Hedge
Interview data were analyzed by the first author (FZ) on NVivo software version 12 (QSR International) using thematic analysis from a primarily deductive approach; namely, themes were generated to answer the specific research questions of acceptability and preliminary effectiveness. The first author (FZ) followed the Braun and Clarke [
Out of the 6 sessions, participants completed an average of 3.32 (SD 1.85) sessions by week 8 and 3.72 (SD 2.11) by week 12. Of 36 participants, 16 (42%) completed the entire program by week 12, and 19 (53%) participants completed the suggested minimal completion cutoff of ≥4 sessions. Session-by-session adherence rates showed a slightly steeper dropout rate in the first half of the program (up to session 3), as shown in
Session-by-session program adherence.
A binomial logistic regression model with age and education level as predictors of adherence was statistically significant (
Participants spent an average of 25.7 (SD 14.67) minutes per session and 317.65 (SD 74.10) minutes in total over an average of 6.9 (SD 3.84) weeks. The engagement rates with value-based goal-setting activities are shown in
Engagement rates with value-based goal-setting activities set in sessions 3, 4, and 6.
Goals | Participants who set a goala | Participants who set a behavioral goalb | Example participant goal (value) | Participants who met the goal, n (%)b | |||||||
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N | n (%) | N | n (%) |
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Unknown | ||
Goal for day (session 3) | 22 | 20 (91) | 20 | 18 (90) | “Allow my partner to touch my scar.” (intimacy) | 10 (50) | 3 (15) | 5 (25) | 2 (10) | ||
Goal for week (session 4) | 19 | 18 (95) | 18 | 16 (89) | “Exercise at the front of gym class.” (courage) | 10 (58) | 2 (10) | 2 (10) | 4 (22) | ||
Long-term goal (session 6) | 16 | 5 (33) | 5 | 5 (100) | “Eat out with friends again.” (self-care) | N/Ac | N/A | N/A | 5 (100)d |
aPercentage of participants who set a goal is taken from participants who started the session only.
bPercentage of participants who (1) set a behavioral (rather than affective) goal and (2) rated their goal as met are taken from participants who set a goal only.
cN/A: not applicable.
dParticipants were not followed up regarding the outcome of their long-term goal.
As presented in
Average satisfaction rating scores over all completed sessions (n=30).
Satisfaction ratings | Values, mean (SD) | Scores ≥4 ( |
Sessions were interesting | 4.28 (0.59) | 30 (85.7) |
Sessions were easy to understand | 4.45 (0.64) | 31 (88.6) |
Sessions helped me | 3.86 (0.76) | 21 (60) |
Of the 36 participants, 12 (33%) participants took part in exit interviews. The mean age of the interview participants was 39.9 (SD 15.49) years. Of the 12 participants, 10 (83%) were female, 2 (17%) were male, and 11 (92%) were White. Of the 12 participants, 6 (50%) had completed all 6 sessions of the program, and 6 (50%) had not. Thematic analysis of the interviews generated 4 overall themes, with 3 relevant to program acceptability. These are presented in the following sections with illustrative quotes.
Most participants described the program’s mobile features favorably, especially in terms of giving flexible and immediate access:
...it felt like a little pocketbook. And just to sort of pull it out if I was waiting for my daughter to come out of work, I could just read something and it focused my mind a bit.
Participants particularly highlighted the tailored text reminders (simulating notifications) as a crucial feature in prompting the use of the program:
I liked that this alerted you as well, you could set it to send you text messages and it reminded you to be mindful...even though I was busy with work, some of those I set them and they came through during the day and I just did them. Which I thought was super helpful.
All participants felt that the multimedia elements of
There’s like a video of the people on the bus...even though I now think about it as maybe too simple, it actually is probably quite effective because I remember it very vividly.
Some participants described the content as
Well I sound strange given I didn’t complete it, but it was still very positive, the bits that I did actually do. It was very clear...the information was very sort of concise and clear.
Others felt improvements could be made to improve the clarity and navigation of the program:
I wasn’t sure to do these [exercises], do they get recorded [in the program] or are you just doing it for yourself? That wasn’t clear enough to me I don’t think.
Some participants, including noncompleters, discussed the effort required to fully engage, such as needing strong motivation, self-discipline, and sufficient energy to work through the program in the face of competing demands and stressors:
...with all the apps you’ve got on your phone...it’s massive competition for attention and those other things like Tik Tok and Instagram, they’re obviously geared towards trying to reward. And this [program] requires a lot more self-discipline and it’s something that’s not necessarily going to make you feel good or anything like that.
To place participants’ views in context, it is noteworthy that they highlighted challenging personal circumstances and stressors as a barrier to engaging fully in the course, especially given that the study spanned the COVID-19 pandemic: “...when obviously the pandemic started to happen with the Coronavirus and the lockdown and then things changed at home, I just found it kind of impossible to remember to actually go on it” [female, 24 years, congenital condition].
Of the 4 themes from the interview data, 1 (25%) related to clinical safety and preliminary effectiveness.
Descriptive statistics and mixed model repeated measure results for baseline to week 8, baseline to week 12, and combined time effects.
Measures | Baseline, mean (SD) | Week 8, mean (SD) | Week 12, mean (SD) | Baseline-week 8 | Baseline-week 12 | Combined time effect | |||||||||||||||||||
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Hedge |
Hedge |
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HADSb-Anxiety | 9.78 (3.67) | 8.21 (3.79) | 7.59 (3.05) | 2.76 (35) | —c | 0.41 (–0.91 to 0.08) | 7.15 (35) | — | 0.64 (0.15 to 1.13) | 3.66 (35) | .03 | |||||||||||||
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HADS-Depression | 6.33 (3.46) | 4.39 (3.43) | 4.39 (3.16) | 5.02 (35) | .03 | 0.56 (0.05 to 1.06) | 5.80 (35) | .02 | 0.58 (0.09 to 1.07) | 3.67 (35) | .03 | |||||||||||||
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BEAQe | 56.83 (10.92) | 50.46 (11.90) | 49.26 (12.55) | 4.85 (35) | .03 | 0.55 (0.05 to 1.06) | 6.84 (35) | .01 | 0.64 (0.15 to 1.13) | 4.23 (35) | .02 | |||||||||||||
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CFQf | 33.03 (6.00) | 29.00 (6.10) | 28.48 (6.88) | 6.96 (35) | .01 | 0.66 (0.15 to 1.17) | 8.17 (35) | .006 | 0.70 (0.20 to 1.19) | 5.37 (35) | .007 | |||||||||||||
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CompACT-VAg | 32.31 (7.16) | 36.32 (5.98) | 32.94 (5.99) | 5.97 (35) | .02 | 0.59 (0.09 to 1.10) | 0.15 (35) | — | 0.09 (–0.39 to 0.57) | 3.59 (35) | .03 | |||||||||||||
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BILD-Qh,i | 2.10 (0.58) | 1.77 (0.56) | 1.87 (0.71) | 5.27 (35) | .03 | 0.57 (0.06 to 1.07) | 1.95 (35) | — | 0.34 (0.14 to 0.83) | 2.76 (35) | — | |||||||||||||
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BICSI-AFi,j | 1.98 (0.59) | 1.68 (0.62) | 1.60 (0.61) | 3.91 (35) | — | 0.49 (–0.01 to 1.00) | 6.55 (35) | .01 | 0.62 (0.13 to 1.11) | 3.74 (35) | .03 | |||||||||||||
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FNAESk | 24.61 (5.49) | 19.28 (7.38) | 20.00 (6.63) | 10.20 (35) | .002 | 0.82 (0.31 to 1.34) | 9.4 (35) | .003 | 0.75 (0.26 to 1.25) | 7.36 (35) | .001 | |||||||||||||
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BESAA-Al | 1.12 (0.70) | 1.68 (0.91) | 1.63 (0.92) | 7.23 (35) | .01 | 0.69 (0.18 to 1.20) | 6.43 (35) | .01 | 0.63 (0.14 to 1.12) | 5.18 (35) | .008 |
aHedge
bHADS: Hospital Anxiety and Depression Scale.
cNot available.
dACT: acceptance and commitment therapy.
eBEAQ: Brief Experiential Avoidance Questionnaire.
fCFQ: Cognitive Fusion Questionnaire.
gCompACT-VA: Comprehensive Assessment of Acceptance and Commitment Therapy–Valued Action subscale.
hBILD-Q: Body Image Life Disengagement Questionnaire.
iPrimary outcome measures.
jBICSI-AF: Body Image Coping Strategies Inventory–Appearance-fixing.
kFNAES: Fear of Negative Appearance Evaluation Scale.
lBESAA-A: Body Esteem for Adolescents and Adults–Appearance subscale.
Relevant to clinical safety, some participants described the content as supportive and encouraging, especially the interaction from the app guide: “I came out of [a mindfulness exercise], before I read [the app guide’s] comment, thinking ‘Well that was pointless’, but then reading what she said, it was like well actually no, it’s quite difficult to do and I don’t feel so bad about it now” [female, 44 years, acquired craniofacial condition].
Most participants talked about specific ways in which using
[ACT It Out] actually inspired me to delete Facebook. I did find that it was a massive trigger to me...I think it was the question prompts, when it said about comparing yourself to others, and it really made me think actually I do that a lot of the time. I just thought “I don’t need that in my life. Why am I spending 2 hours scrolling through Facebook, to look at other people that look perfect?”
Many participants described the course content as bringing about greater self-awareness of psychological processes and their link to overt behavior:
So I have some old habits as a result of my scarring which I didn’t know were there...For example when I go for a run I’ll wear a sports top, and while I’m running I touch my chest. I didn’t know I did that, because I was thinking people are looking at me, so I try and move my top around and things like that, which are a bit odd. And I hadn’t noticed that before until I did the app. I suppose [it was because of] those people when they gave their experiences [in ACT It Out], the little bubbles with personal experiences. That resonated with me.
The overall finding of this feasibility study was that a novel prototype mobile ACT program,
In terms of user engagement, over half of the participants completed the minimum cutoff of at least 4 of 6 sessions, and full completion rates were at the upper end of the 34% to 41% range reported in a recent meta-analysis on apps for anxiety, depression, and stress, whereas the observed decline in participant adherence over time similarly follows the meta-analytical findings [
Encouragingly, participants’ average time spent completing sessions was consistent with the design intentions of 30 minutes per session over 6 to 8 weeks, with individual sessions completed in a mixture of single and multiple sittings, according to supplementary interview data. This tallies with the interview findings that participants valued being able to flexibly work through the program according to their schedule. The finding that most participants reported completing mindfulness practices only semiregularly aligns with the literature on mindfulness app use, for example, the study by Mikolasek et al [
Overall, the program was rated as acceptable, with the percentage of affirmative satisfaction ratings pertaining to comprehensibility and interest well above acceptability thresholds of 70% used in comparable app feasibility studies, for example, the study by Huberty et al [
The interview data offered vital insight into participants’ experience of using the program in terms of its suitability and appeal, highlighting both strengths and areas for refinement. Participants’ accounts endorsed the added value of mobile-specific benefits such as tailored, immediately actionable reminders and remote, location-flexible accessibility. Most interview participants also described the content as appropriately clear, concise, and engaging for the mobile platform, a common challenge in adapting material from other self-help formats [
Results pertaining to the secondary objective of assessing the program’s clinical safety and preliminary effectiveness are only indicative, given the possibility of artifact findings arising from demand characteristics in single-group designs [
Importantly, for the purpose of checking for iatrogenic effects from the program, there was no increase in depression or anxiety over time. Similarly, both secondary appearance-related measures of appearance self-evaluation and fear of negative appearance evaluation, which were not directly targeted through the program’s focus on valued action, improved over the 3 time points. However, the FNAES [
A strength of the study is the comprehensive and stakeholder-focused process through which the program,
The limitations of this study include its co-occurrence with the COVID-19 pandemic and the potential for confounding effects on at least some data. Although data were collected during a period of lesser restrictions, the context of participants’ lives was nevertheless altered in ways relevant to common appearance concerns in individuals with visible differences. For example, the implementation of mandated mask-wearing may have offered individuals with facial differences such as cleft lip and/or palate a socially sanctioned means of concealment, and social restrictions may have similarly reduced some participants’ appearance concerns because of enforced minimization of social contact. Conversely, the widespread use of video calling and conferencing platforms during the pandemic has been indicated as a source of heightened appearance anxiety for individuals with visible differences (personal communication by Professor Diana Harcourt, October 14, 2021). Therefore, the exact impact of the pandemic context on participants’ data is difficult to determine. Nonetheless, the validity and reliability of certain outcome measures such as disengagement with appearance-salient activities may have been adversely affected.
The widespread disruption caused by the pandemic may also at least partly account for participants’ higher-than-expected anxiety scores at baseline, as suggested by an increase in anxiety scores since the pandemic in the general UK population [
Although the sample covered a wide range of appearance-affecting conditions and ages, participants were predominantly White females, and scarring was underrepresented in the sample, limiting the study’s generalizability to the visibly different population. The self-selecting nature of the interview subsample may also limit the validity of the interview findings, although half of the subsample were noncompleters, mitigating the potential for positivity bias.
Despite these limitations, overall findings suggest promising feasibility of the
acceptance and commitment therapy
Body Image Coping Strategies Inventory–Appearance-fixing
Cognitive Fusion Questionnaire
Fear of Negative Appearance Evaluation Scale
Hospital Anxiety and Depression Scale
mixed model repeated measure
randomized controlled trial
The Vocational Training Charitable Trust Foundation Research Team at the Centre for Appearance Research consists of Professor Diana Harcourt, Dr Amy Slater, Dr Nick Sharratt, Dr Claire Hamlet, Dr Ella Guest, Bruna Costa, Jade Parnell, Maia Thornton, and Dr Nicola Stock.
None declared.