Tim Moss
Tim Moss is an Associate Professor in Health Psychology at the University of the West of England, Bristol, UK, and Associate Head of the Department of Psychology. He is registered with the Health Care Professions Council, the regulatory body for psychology in the UK. He is former programme director of the professional doctorate in health psychology programme and the MSc health psychology at UWE, as well as contributing to other MSc and undergraduate programmes. He is the supervisor of several PhD students in the field of psychosocial adjustment to differences of appearance. Tim is the co-ordinator of the Derriford Appearance Scales project, (www.derriford.info), providing measurement tools, advice and consultancy in the field of appearance and visible difference in the UK, Europe, Japan, and the US amongst others.
Tim is an active researcher in the field of Appearance Psychology, as a member of the Centre for Appearance Research. He has contributed to several six-figure grants, most recently taking the academic lead on an EU Project investigating Positive Psychology interventions for unemployed youth.
Tim has worked as a member of the BPS health psychology training committee, and as a BPS assessor for the stage 2 qualification in health psychology. He is has acted as a visitor for the Health Care Professions Council, involved in the evaluation of professional training programmes in psychology. From 2010, Tim has represented professional psychology training on the Advisory board of the Psychology Network. He is also a fellow of the Royal Society for Public Health, and maintains an interest in public health applications of psychology.
Tim is a Chartered Psychologist, a Fellow of the Higher Education Academy, and also a Fellow of the Royal Society for Public Health.
Previously, Associate Head of Department of Psychology at UWE, with the Research/Knowledge Exchange portfolio, Tim was appointed Director of Postgraduate Research Studies for the Faculty of Health and Applied Sciences at UWE, covering the four departments of Biomedical and Biological Sciences, Allied Health Professions, Nursing/Midwifery, and Health and Social Sciences.
http://people.uwe.ac.uk/Pages/person.aspx?accountname=campus\tp-moss
Tim is an active researcher in the field of Appearance Psychology, as a member of the Centre for Appearance Research. He has contributed to several six-figure grants, most recently taking the academic lead on an EU Project investigating Positive Psychology interventions for unemployed youth.
Tim has worked as a member of the BPS health psychology training committee, and as a BPS assessor for the stage 2 qualification in health psychology. He is has acted as a visitor for the Health Care Professions Council, involved in the evaluation of professional training programmes in psychology. From 2010, Tim has represented professional psychology training on the Advisory board of the Psychology Network. He is also a fellow of the Royal Society for Public Health, and maintains an interest in public health applications of psychology.
Tim is a Chartered Psychologist, a Fellow of the Higher Education Academy, and also a Fellow of the Royal Society for Public Health.
Previously, Associate Head of Department of Psychology at UWE, with the Research/Knowledge Exchange portfolio, Tim was appointed Director of Postgraduate Research Studies for the Faculty of Health and Applied Sciences at UWE, covering the four departments of Biomedical and Biological Sciences, Allied Health Professions, Nursing/Midwifery, and Health and Social Sciences.
http://people.uwe.ac.uk/Pages/person.aspx?accountname=campus\tp-moss
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and including three clear factors was the best solution. The scale had good internal consistency, clear convergent validity, and good test-retest reliability. The three factors that emerged were appearance-related social avoidance, social distress, and negative affect. Consistent with expectations, (a) women scored higher than men (greater appearance distress), (b) the cause of appearance difference (burns, cleft lip/palate, etc.) was unrelated to appearance distress, and (c) those with visible differences were more concerned about their appearance than those without. The Taiwanese DAS19 is a user-friendly and psychometrically sound scale that fulfils an important clinical and scientific need. The items that were omitted from the translated version were considered in relation to cultural differences in the experience and expression of shame between Western countries and Taiwan/China, which demands a careful future analysis
To investigate the association of demographic, clinical and psychosocial variables with levels
of anxiety and depression in participants wearing an ocular prosthesis after eye
enucleation.
Methods
This cross-sectional study included 195 participants with an enucleated eye who were
attending an ophthalmic clinic for prosthetic rehabilitation between July and November
2014. Demographic and clinical data, and self-reported feelings of shame, sadness and
anger were collected. Participants also completed the National Eye Institute Visual Function
Questionnaire, the Facial Appearance subscale of the Negative Physical Self Scale, and
the Hospital Anxiety and Depression Scale. Regression models were used to identify the
factors associated with anxiety and depression.
Results
The proportion of participants with clinical anxiety was 11.8%and clinical depression 13.8%.
More anxiety and depression were associated with poorer vision-related quality of life and
greater levels of appearance concerns. Younger age was related to greater levels of anxiety.
Less educated participants and those feeling more angry about losing an eye are more prone
to experience depression. Clinical variables were unrelated to anxiety or depression.
Conclusions
Anxiety and depression are more prevalent in eye-enucleated patients than the general
population, which brings up the issues of psychiatric support in these patients. Psychosocial rather than clinical characteristics were associated with anxiety and depression. Longitudinal
studies need to be conducted to further elucidate the direction of causality before interventions
to improve mood states are developed.
individuals with visible differences. Face IT was tested against a nonintervention control group and standard CBT-based face-to-face delivery.
Eighty-three participants were assessed at four time points using the Hospital Anxiety and Depression Scales, Derriford Appearance Scale-24, Body Image Quality of Life Inventory and Fear of Negative Evaluation (FNE). The findings indicate a significant reduction in anxiety and appearance-related distress in both the Face IT intervention and the face-to-face condition. Similar findings were reported for depressive symptoms and FNE. Results at the three and six months
follow-up demonstrate increased improvements in psychological functioning with both interventions. This new online psychosocial intervention has been found to be effective at reducing anxiety, depression and appearance concerns amongst individuals with disfigurements, whilst increasing positive adjustment. A remote-access, computer-based intervention offers the potential to provide psychosocial support more easily and in a cost-effective manner to adults with appearance-related distress.
Keywords: psychosocial; disfigurement; CCBT; social anxiety; appearance
Conclusion. The DAS24 provides a widely applicable and acceptable short form of the original DAS59. It is sychometrically robust and discriminates well between patient
groups, between clinical and non-clinical populations, and within the general population between those concerned, and those not concerned, about their appearance."
was carried out with participants allocated to one of four conditions (guided imagery, implementation intention, relaxation, or control). METHOD: Outcome variables (exercise behaviour, exercise selfefficacy and exercise motivation), were measured pre- and post intervention. Imagery ability was
measured as a potential confounding variable of intervention efficiency. Using provided exercise diaries, fifty sedentary participants (34F, 16M) monitored their physical activity for two weeks. Average of the participants was 29 years (range 19 to 56). RESULTS: A one-way MANCOVA suggested
that 13% of the variation in the linear combination of the dependent variables was accounted for by group allocation. Univariate tests confirmed that significant differences existed between both intervention groups and control group (Implementation Intention - Control (p = 0.048; effect size (d) = 0.92), Guided Imagery- Control (p = 0.012; effect size (d) = 1.46). CONCLUSIONS: This study succeeded in increasing exercise behaviour using guided imagery and implementation intention interventions. These are self-managed, economic and practical interventions which may be further developed for
particular populations or behaviours. The results may challenge the subjective expected utility basis of social cognition models of health behaviour, as it highlights the importance of considering both conscious and pre-conscious processes antecedent to behaviour change.
Greater objective scar severity and visibility should intuitively cause greater psychosocial distress for patients. Previous research is contradictory and has often employed non-validated scar severity measures whilst neglecting patient-rated severity. The aim of this study was to assess the effects of objective and patient-rated scar severity, scar type and location on psychosocial distress.
Methods
Patients were recruited from a specialist scar service at a plastic surgery clinic. Skin scars were quantitatively assessed using the “Manchester Scar Scale” (MSS) – a validated measure with high inter-rater reliability and correlation with histological and clinical findings. Scars were scored twice independently: first at consultation and later from photographs – their mean provided a final score. Patients also rated their scars as ‘very good’; ‘good’; ‘neutral’; ‘fair’; or ‘poor’ and completed the Derriford Appearance Scale (DAS24) and Dermatology Life Quality Index (DLQI).
Results
Eighty-three patients (57 women, 69%), with an average age of 34 +/- 15 (16 – 65) years were recruited. Mean psychosocial questionnaire scores were: DAS24 45.8 +/- 17.9 (15 – 91); DLQI 7.5 +/- 6.6 (0 – 26). Participants had on average 2.4 +/- 4.3 (1 – 30) scars with an MSS score of 33.4 +/- 53.3 (5.4 – 480) and subjective score of 2.6 +/- 1.2 (0 – 4). Correlation between psychosocial distress and objective severity was not significant (Kendall’s tau: DAS24 0.16 p=0.07; DLQI 0.16 p=0.06), though was for psychosocial distress and subjective severity (Kendall’s tau: DAS24 0.47 p<0.0001; DLQI 0.58 p<0.0001). Patients with non-visible scars experienced greater psychosocial distress than patients with visible scars (mean difference: DAS24 10.4 p=0.030; DLQI 4.1 p=0.013). Scar type was unrelated to psychosocial distress.
Conclusions
Patient-rated scar severity and scar visibility are correlated with patient psychosocial distress rather than clinician’s objective severity rating or scar type. Although counter-intuitive, results are consistent with research into other disfiguring conditions and should therefore form an integral part of clinical assessment. In addition to improving objective scar severity we recommend that treatment should address patient factors to improve self-perception and quality of life (QoL). Currently there are no measures that directly measure scar-related QoL, which should be developed in order to improve future management of scar patients.
KEY WORDS: appearance, plastic surgery, surgical outcome, prospective controlled trial
identified shared subjective
explanations of smoking among
non-smokers, current smokers and
ex-smokers, to consider whether some
representations were protective or
facilitated quitting. Four factors were
identified: named independent
addiction; independent non-addiction;
anti-smoking; and social addiction.
The first two factors were dominated
by current and ex-smokers, and the
last two by non-smokers. Differences
emerged on the use of the ‘addiction’
concept, the use of smoking as a tool
for affect management, the role of
image manipulation and the general
positive and negative perceptions of
smoking. The functional use of the
different shared smoking
representations is discussed.
surgeon contacted the Centre
for Appearance Research with
a problem. Why was it, he wanted
to know, that although there was
great diversity in the extent of
physically disfiguring conditions in
his outpatient clinics, and a similar
diversity in the degree of distress
and behavioural avoidance in his
patients, he could identify no
pattern relating the two? An
examination of what was then the
best available literature revealed
a lack of clarity in outcomes,
processes, and relevant models
to investigate this relationship.
Thus began a long-term
research programme to explain
the antecedents of good and poor
psychosocial outcome in relation
to visible differences.
psychosocial intervention programmes for adults with visible differences. Twelve papers met the inclusion criteria. None of the
papers demonstrated adequately the clinical effectiveness of the interventions. The review concluded that further research was
needed to demonstrate adequately the effectiveness of existing interventions, and a greater number of Randomised Controlled Trials
and experimental studies were required to increase the methodological validity of intervention studies.
severity upon psychological adjustment has yet to be explored fully. In this study, 400 patients with a range of physical
differences in appearance were recruited through general plastic surgery outpatient clinics and waiting lists. Patients completed
the Derriford Appearance Scale 24 (DAS24), a measure of psychological distress and behavioural dysfunction related to selfconsciousness
of appearance. Severity in the outpatient group was objectively rated by plastic surgeons, and severity amongst
the waiting-list group was subjectively rated by the patients themselves. Multiple regression modelling demonstrated a linear
relationship between subjective adjustment and severity, with greater perceived severity associated with poorer adjustment.
Similar modelling demonstrated a weak but statistically significant quadratic relationship between objectively rated severity and
adjustment for normally visible, but not for normally non-visible differences of appearance. Moderate, rather than mild or severe
objective severity was most related to poor adjustment.
disfiguring conditions is related to organisation of the content of appearance-related information in the
self-concept. A cross-sectional design was employed, using 70 participants with a range of appearance
problems recruited from support groups and the NHS. A postal paper and pencil task was completed by
participants which assessed the level of their adjustment using the Derriford Appearance Scale, and measured
the three self-concept variables – differential importance, compartmentalisation and complexity. Regression
analyses showed that poor adjustment to disfigurement is related to greater differential importance
of appearance-related self-aspects, greater compartmentalisation of appearance-related information and
greater self-concept complexity. No moderating effects were found between these independent variables.
The results have implications for psychological treatment strategies, particularly cognitive behavioural
therapeutic interventions.
and including three clear factors was the best solution. The scale had good internal consistency, clear convergent validity, and good test-retest reliability. The three factors that emerged were appearance-related social avoidance, social distress, and negative affect. Consistent with expectations, (a) women scored higher than men (greater appearance distress), (b) the cause of appearance difference (burns, cleft lip/palate, etc.) was unrelated to appearance distress, and (c) those with visible differences were more concerned about their appearance than those without. The Taiwanese DAS19 is a user-friendly and psychometrically sound scale that fulfils an important clinical and scientific need. The items that were omitted from the translated version were considered in relation to cultural differences in the experience and expression of shame between Western countries and Taiwan/China, which demands a careful future analysis
To investigate the association of demographic, clinical and psychosocial variables with levels
of anxiety and depression in participants wearing an ocular prosthesis after eye
enucleation.
Methods
This cross-sectional study included 195 participants with an enucleated eye who were
attending an ophthalmic clinic for prosthetic rehabilitation between July and November
2014. Demographic and clinical data, and self-reported feelings of shame, sadness and
anger were collected. Participants also completed the National Eye Institute Visual Function
Questionnaire, the Facial Appearance subscale of the Negative Physical Self Scale, and
the Hospital Anxiety and Depression Scale. Regression models were used to identify the
factors associated with anxiety and depression.
Results
The proportion of participants with clinical anxiety was 11.8%and clinical depression 13.8%.
More anxiety and depression were associated with poorer vision-related quality of life and
greater levels of appearance concerns. Younger age was related to greater levels of anxiety.
Less educated participants and those feeling more angry about losing an eye are more prone
to experience depression. Clinical variables were unrelated to anxiety or depression.
Conclusions
Anxiety and depression are more prevalent in eye-enucleated patients than the general
population, which brings up the issues of psychiatric support in these patients. Psychosocial rather than clinical characteristics were associated with anxiety and depression. Longitudinal
studies need to be conducted to further elucidate the direction of causality before interventions
to improve mood states are developed.
individuals with visible differences. Face IT was tested against a nonintervention control group and standard CBT-based face-to-face delivery.
Eighty-three participants were assessed at four time points using the Hospital Anxiety and Depression Scales, Derriford Appearance Scale-24, Body Image Quality of Life Inventory and Fear of Negative Evaluation (FNE). The findings indicate a significant reduction in anxiety and appearance-related distress in both the Face IT intervention and the face-to-face condition. Similar findings were reported for depressive symptoms and FNE. Results at the three and six months
follow-up demonstrate increased improvements in psychological functioning with both interventions. This new online psychosocial intervention has been found to be effective at reducing anxiety, depression and appearance concerns amongst individuals with disfigurements, whilst increasing positive adjustment. A remote-access, computer-based intervention offers the potential to provide psychosocial support more easily and in a cost-effective manner to adults with appearance-related distress.
Keywords: psychosocial; disfigurement; CCBT; social anxiety; appearance
Conclusion. The DAS24 provides a widely applicable and acceptable short form of the original DAS59. It is sychometrically robust and discriminates well between patient
groups, between clinical and non-clinical populations, and within the general population between those concerned, and those not concerned, about their appearance."
was carried out with participants allocated to one of four conditions (guided imagery, implementation intention, relaxation, or control). METHOD: Outcome variables (exercise behaviour, exercise selfefficacy and exercise motivation), were measured pre- and post intervention. Imagery ability was
measured as a potential confounding variable of intervention efficiency. Using provided exercise diaries, fifty sedentary participants (34F, 16M) monitored their physical activity for two weeks. Average of the participants was 29 years (range 19 to 56). RESULTS: A one-way MANCOVA suggested
that 13% of the variation in the linear combination of the dependent variables was accounted for by group allocation. Univariate tests confirmed that significant differences existed between both intervention groups and control group (Implementation Intention - Control (p = 0.048; effect size (d) = 0.92), Guided Imagery- Control (p = 0.012; effect size (d) = 1.46). CONCLUSIONS: This study succeeded in increasing exercise behaviour using guided imagery and implementation intention interventions. These are self-managed, economic and practical interventions which may be further developed for
particular populations or behaviours. The results may challenge the subjective expected utility basis of social cognition models of health behaviour, as it highlights the importance of considering both conscious and pre-conscious processes antecedent to behaviour change.
Greater objective scar severity and visibility should intuitively cause greater psychosocial distress for patients. Previous research is contradictory and has often employed non-validated scar severity measures whilst neglecting patient-rated severity. The aim of this study was to assess the effects of objective and patient-rated scar severity, scar type and location on psychosocial distress.
Methods
Patients were recruited from a specialist scar service at a plastic surgery clinic. Skin scars were quantitatively assessed using the “Manchester Scar Scale” (MSS) – a validated measure with high inter-rater reliability and correlation with histological and clinical findings. Scars were scored twice independently: first at consultation and later from photographs – their mean provided a final score. Patients also rated their scars as ‘very good’; ‘good’; ‘neutral’; ‘fair’; or ‘poor’ and completed the Derriford Appearance Scale (DAS24) and Dermatology Life Quality Index (DLQI).
Results
Eighty-three patients (57 women, 69%), with an average age of 34 +/- 15 (16 – 65) years were recruited. Mean psychosocial questionnaire scores were: DAS24 45.8 +/- 17.9 (15 – 91); DLQI 7.5 +/- 6.6 (0 – 26). Participants had on average 2.4 +/- 4.3 (1 – 30) scars with an MSS score of 33.4 +/- 53.3 (5.4 – 480) and subjective score of 2.6 +/- 1.2 (0 – 4). Correlation between psychosocial distress and objective severity was not significant (Kendall’s tau: DAS24 0.16 p=0.07; DLQI 0.16 p=0.06), though was for psychosocial distress and subjective severity (Kendall’s tau: DAS24 0.47 p<0.0001; DLQI 0.58 p<0.0001). Patients with non-visible scars experienced greater psychosocial distress than patients with visible scars (mean difference: DAS24 10.4 p=0.030; DLQI 4.1 p=0.013). Scar type was unrelated to psychosocial distress.
Conclusions
Patient-rated scar severity and scar visibility are correlated with patient psychosocial distress rather than clinician’s objective severity rating or scar type. Although counter-intuitive, results are consistent with research into other disfiguring conditions and should therefore form an integral part of clinical assessment. In addition to improving objective scar severity we recommend that treatment should address patient factors to improve self-perception and quality of life (QoL). Currently there are no measures that directly measure scar-related QoL, which should be developed in order to improve future management of scar patients.
KEY WORDS: appearance, plastic surgery, surgical outcome, prospective controlled trial
identified shared subjective
explanations of smoking among
non-smokers, current smokers and
ex-smokers, to consider whether some
representations were protective or
facilitated quitting. Four factors were
identified: named independent
addiction; independent non-addiction;
anti-smoking; and social addiction.
The first two factors were dominated
by current and ex-smokers, and the
last two by non-smokers. Differences
emerged on the use of the ‘addiction’
concept, the use of smoking as a tool
for affect management, the role of
image manipulation and the general
positive and negative perceptions of
smoking. The functional use of the
different shared smoking
representations is discussed.
surgeon contacted the Centre
for Appearance Research with
a problem. Why was it, he wanted
to know, that although there was
great diversity in the extent of
physically disfiguring conditions in
his outpatient clinics, and a similar
diversity in the degree of distress
and behavioural avoidance in his
patients, he could identify no
pattern relating the two? An
examination of what was then the
best available literature revealed
a lack of clarity in outcomes,
processes, and relevant models
to investigate this relationship.
Thus began a long-term
research programme to explain
the antecedents of good and poor
psychosocial outcome in relation
to visible differences.
psychosocial intervention programmes for adults with visible differences. Twelve papers met the inclusion criteria. None of the
papers demonstrated adequately the clinical effectiveness of the interventions. The review concluded that further research was
needed to demonstrate adequately the effectiveness of existing interventions, and a greater number of Randomised Controlled Trials
and experimental studies were required to increase the methodological validity of intervention studies.
severity upon psychological adjustment has yet to be explored fully. In this study, 400 patients with a range of physical
differences in appearance were recruited through general plastic surgery outpatient clinics and waiting lists. Patients completed
the Derriford Appearance Scale 24 (DAS24), a measure of psychological distress and behavioural dysfunction related to selfconsciousness
of appearance. Severity in the outpatient group was objectively rated by plastic surgeons, and severity amongst
the waiting-list group was subjectively rated by the patients themselves. Multiple regression modelling demonstrated a linear
relationship between subjective adjustment and severity, with greater perceived severity associated with poorer adjustment.
Similar modelling demonstrated a weak but statistically significant quadratic relationship between objectively rated severity and
adjustment for normally visible, but not for normally non-visible differences of appearance. Moderate, rather than mild or severe
objective severity was most related to poor adjustment.
disfiguring conditions is related to organisation of the content of appearance-related information in the
self-concept. A cross-sectional design was employed, using 70 participants with a range of appearance
problems recruited from support groups and the NHS. A postal paper and pencil task was completed by
participants which assessed the level of their adjustment using the Derriford Appearance Scale, and measured
the three self-concept variables – differential importance, compartmentalisation and complexity. Regression
analyses showed that poor adjustment to disfigurement is related to greater differential importance
of appearance-related self-aspects, greater compartmentalisation of appearance-related information and
greater self-concept complexity. No moderating effects were found between these independent variables.
The results have implications for psychological treatment strategies, particularly cognitive behavioural
therapeutic interventions.