JMIR Publications

ABSTRACT

Background:

Mobile apps may offer a valuable platform to deliver evidence-based psychological interventions for individuals with an atypical appearance, or visible difference, who experience psychosocial appearance concerns such as appearance-based social anxiety and body dissatisfaction. Prior to this study, researchers and stakeholders collaboratively designed an app prototype based on Acceptance and Commitment Therapy (ACT), an evidence-based form of cognitive behavioural therapy that utilises 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 for many evoke appearance-based anxiety.

Objective:

In this study, the authors sought 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.

Methods:

To address the feasibility objectives, we employed 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 usage, satisfaction ratings, and changes over three timepoints 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 wellbeing (depression and anxiety). Semi-structured 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.

Results:

In terms of user engagement, adherence rates over six sessions aligned with the upper boundary of those reported across mobile mental health apps, with over a 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 semi-regular mindfulness practice, mixed use of value-based goal-setting and high engagement with social skills training. 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 in depression or anxiety were indicated.

Conclusions:

An ACT-based mobile program for individuals struggling with visible differences shows promising proof-of-concept in addressing appearance concerns, while further revisions and development are required prior to further development and more rigorous evaluation.