A Novel Psychological Group Intervention Targeting Appearance-Related Distress Among People With a Visible Disfigurement (Inside Out): A Case Study

People with a medical condition that leads to visible disfigurement often face significant psychosocial challenges related to their disfigurement, such as psychological distress, negative self-esteem and feelings of shame. In addition, they often encounter social difficulties including stigmatization, dealing with reactions of others and limitations in personal relationships. The availability of evidence-based psychological support tailored to these specific patients' needs is limited. The aim of this study is to describe the development and content of Inside Out, a 5-session, theory-based psychological group intervention for people with a visible disfigurement due to a medical condition. This group intervention is based on a combination of Cognitive Behavioral Therapy, Acceptance and Commitment Therapy, and Competitive Memory Training. One case, a woman with facial palsy and psychological distress due to appearance-related problems, is presented to illustrate the intervention. This detailed description provides an in-depth illustration of the course and content of this treatment. Qualitative results show that this treatment is feasible and highly valued by the patient. Scores on pre-, post- and 3-month followup assessments showed improvements in psychological distress and level of acceptance of the condition. This case study shows how a psychological group intervention might contribute to the improvement of psychological wellbeing in individuals with a visible disfigurement.