Creating and designing Face IT part 2

hi my name is Dr Ali Norman and this is the face at home program welcome to the second part of one of our videos looking at the creating and designing of the

faer at home tool in the first video I talked you through the design process and showed you the basic content of the program today we're going to be talking about how we developed this into a

randomized control toal and tested its Effectiveness for individuals visible difference so just to talk about the the outline of the original program so we had eight sessions it started with an

introduction to what we know to about visible difference um this is a process of trying to normalize how people feel and the distress that people experience as a result of having a visible

difference session two then moved on to looking at non-verbal communication skills so how to use things like um gestures and eye contact and smiling and posture in order to improve confidence

within social interactions um and then this was built upon in the session three by looking at verbal skills as well um we then had a session in on session four

on goal setting so this was helping people to set their their bar at an appropriate level so making sure that they were setting goals that were appropriate to their level of distress

or to their um level of disability um making sure that they were able to achieve what they needed to achieve and there were some bits in here that looked also at things like intimacy for example

and how to deal with um romantic relationships we then moved on to a session on cognitive restructuring so this was looking at um negative body image for people with visible difference

and how to help them to have a more positive body image and it also looked at some of the assumptions that uh people make about um people visible

differences but also some of the assumptions that people visible differences can sometimes make about the interactions they have with other people um so it talks about this idea that if

um if you feel U low about your own body image then sometimes that can then feed into you assume that other people are thinking negatively about your body image as well um um but also looking at

things like safety behaviors and introducing this idea that sometimes the way that we behave in social situations may actually be exacerbating any kind of social um problems that we may have when

interacting so for example things like wearing a baseball cap over the eyes will reduce eye contact and therefore make social interactions more difficult session six was then designed

to bring a lot of this information together so looking at how we use non-verbal and verbal communication skills together um teaching uh service

uses things like stock phrases so things that they can say to individuals um if they are asked about their appearance so that they don't have to think on their

feet and then starts to introduce the idea of anxiety management so for those of you who know about cognitive behavioral therapy this is effec of the exposure element of it um but it starts

off um small in section six looking at different ways of managing anxiety and then moves into session seven where they're actually exposed to social situations that um potentially might be

problematic and this is done in two different ways within section six and seven um in session six there are a series of videos where individuals can play out

social scenarios and choose what they want to have happen next and they're given feedback on their options so that they can see how different situations might work um and then in session seven

they have a similar kind of thing but these are all um firstperson videos so the idea is to get a sense that they are in those situations themselves and this acts as a form of vicarious exposure to

individuals particularly if they are so anxious they're not ready to engage in those social situations themselves um and then Session 8 consisted of a summary of all of the materials throughout the the seven

sessions um was done in a principal format so that individuals could take that away as a top up so to come back to the randomized control trial um in that original study

we had 83 participants and the T trial tested um the face it program against um a fa face-to-face delivery of a similar form

of intervention um and also a no treatment control so we had a fairly even mix of participants across those three different conditions um and there were

no differences at basine in terms of the different measures or demographics that we um we were measuring we uh did several different outcome measures as part of this

controlled trial so that we had the hospital anxiety and depression scale which was taken at Baseline um post intervention and then again at three and

six month followup um we use the dford appearance scale the 24 item version to assess um fear of negative valuation and social anxiety Associated specifically

with appearance we use the fear of negative evaluation scale more generally to see how it correlated with the the Das and we also use the body image quality of life infantry at the same

points as well and what we were hoping to achieve with this particular measure was to see whether or not the program was tapping into social anxiety and

concerns around um interaction specifically or whether it had a wider change in body image um more generally so in terms of the findings we didn't find much of a change in

depression from across the different time points um and there wasn't much of a change in the body image quality of life either um there was some change in the fear of negative

evaluation um but this was explained very much more by the the Das so I haven't gone into those particular measures today the this is a a a graph that shows

the differences across the anxiety um measures so we have our preschools here reducing really nicely in this curve here down to six months for both the computer group so this is the face it

program group and also for the face to-face group and then we also we have our control group here which is staying broadly similar across the different

time points as we might imagine um so this was exactly what we were hoping to see um as we can see here the the lines are pretty similar for the face to-face

group and for the um control sorry for the computer group the face it group um with the face-to-face delivery of the intervention being slightly more

effective than the um online delivery which is again what we would expect to see in terms of um delivery so what we were trying to achieve with the faet

program was not to replace uh face-to-face delivery but to provide an additional form of intervention so we were expecting that it would not necessarily be quite as effective but it

was still um statistically uh significant changes over time and what was really nice to see was that quite often what you see with the online interventions is that you see a nice

drop off pre- to post but then the results start to either um Trail off or actually there's an increase then in symptoms over the next 3 to six months but actually what we see in this one is

the same as what we see in face to face is that there continues to be a reduction in the anxiety scores which suggests that in both the face-to-face delivery and the faic group individuals

were continuing to use these social skills um in their day-to-day lives after intervention and what we see is a very similar effect then for the dord appearance scale so the measure of

appearance concern so again we have a nice flat line for our control group and we have a significant reduction in um appearance concerns for both our face it

group and our face to-face delivery over uh the course of intervention and then into followup and again we see that increasing reduction suggesting that people are continuing to use the skills

provided to them um what we have on the side of the screen here are different quotes for people that took part in the randomized control in terms of their experiences of using the

program one of the other things that we did as part of the trail was we asked them at post intervention to um rate their AC acceptability of the face it program so it was important to us not

only to develop an intervention that we need to be effective but also something that we knew would be acceptable to individuals um in the real world so we

asked them to um rate the acceptability the overall usefulness and the satis satisfaction of the program so usefulness and satisfaction were out of

a maximum score of 10 where 10 being the most positive it could be um and the acceptability rating was out of 60 so as you can see we've got um for the

computer and delivery and the face to face so face it and then the face Toof face delivery we've got similar acceptability scores in the high 50s uh sorry in the low 50s and then we also

have both for usefulness and satisfaction um nice High um marks for both the face-to-face delivery and for face it

itself we then asked individuals to say which they would have preferred so this was across the board it didn't matter if they were in the control group the face tof face group or the faet group we

asked them what their preference for intervention would have been and what we see is that it was a roughly even spit split between computer and uh face to-face delivery and it wasn't

necessarily the choice um the individuals who had been put in that particular group who chose that particular aspect so for example um we found that it was a fairly even split in

terms of those that did the faceit program as to whether they would have preferred to do um face to face instead or actually more happy to be doing the online and a similar thing seemed to be

the case for the face tof face group what we did see was that it seemed to be that men particularly were more comfortable using the faceit program than the um face-to-face delivery

whereas women preferred overall the face-to-face delivery and then the final question that we asked them at post intervention was whether or not they would find it acceptable if they were

offered it so if we think back to our hierarchy of different intervention levels uh what we wanted to see was if there were no other forms of intervention currently available to

individuals would they accept the computer-based program if it was offered to them and thankfully what we saw was that 19 % of the participants in the trial said that yes they would

definitely have um accepted it thank you for listening this was the second part of two videos looking at the creation and the design process of the fa at home

tour we will be producing another video looking at the future developments of the face at home project and looking at how we might be able to improve access to people with visible differences in

the future so please keep an eye out on our YouTube channel or join us on other social media platforms such as Facebook or Twitter thank you