Alopecia areata (AA) affects men at similar rates to women, yet comparatively little is known about men’s experience of the condition. We interviewed a demographically diverse group of 18 men with AA ...to explore this gap. From qualitative thematic analysis, participants’ accounts described a profound yet often-minimised impact of AA on their lives, in the context of poor public awareness and misguided assumptions about AA in men. Conversely, this adversity appeared to facilitate personal growth for many. These findings can help health professionals better understand men’s gendered experience of AA, which we discuss through the lens of masculinities theory.
Background
Alopecia describes a group of dermatological conditions characterised by hair loss, which are either non‐scarring or scarring in nature, and range from bald patches to complete body hair ...loss, to general thinning. In the UK, the General Practitioner (GP) is typically the first point of contact, and some patients are referred for specialist dermatology consultation. However, little is known about how individuals with alopecia in the UK experience the care provided by the National Health Service.
Objectives
We aimed to understand patients' perceptions of primary healthcare and dermatology provision. Further, we aimed to investigate how care provision and patients' overall patient journey might be improved in the UK, and how these lessons may apply internationally.
Methods
An online mixed methods survey was distributed by Alopecia UK to UK‐based individuals with alopecia. Open‐ended text responses were analysed using qualitative content analysis. Quantitative data were analysed using descriptive analyses and dependent measures t‐tests.
Results
A total of 291 participants completed the survey. They reported neutral‐to‐partial dissatisfaction with their GP appointments, with greater satisfaction in their most recent compared to their first appointment. Participants highlighted positive experiences with GPs and dermatologists as well as areas for improvement. Participants also expressed a desire for a greater degree of support and understanding about the psychological impact of alopecia.
Conclusions
Results highlight the importance of being empathic and caring healthcare professionals for patients with alopecia, the need for training for GPs on alopecia, as well as a simplified and joined up pathway between primary and secondary healthcare.
This study sought the subjective experiences of patients with alopecia in their healthcare consultations. Findings suggest health professionals' empathy for the psychosocial impact of alopecia is a crucial element in patients' experience.
Abstract Background The most common forms of hair loss in men, alopecia areata (AA) (an autoimmune condition) and androgenetic alopecia (AGA) (pattern baldness), alter individuals' appearance in ways ...that may impact psychological and social wellbeing. We currently have a limited understanding about this impact of alopecia in men, their support needs, and preferences. Objectives We sought to investigate and explore the psychosocial impact of alopecia on men, alongside their experiences of treatment and support. Methods The study used a mixed methods cross‐sectional online survey with 177 men aged 17–79: 83 with AGA and 94 with AA. Quantitative questions included purpose‐made rating scales of men's support experiences, and standardised measures of wellbeing and appearance‐focused anxiety. Qualitative data comprised participants' answers to an open‐ended question asking about their subjectively salient experiences related to their alopecia. Results The combined findings indicate that while participants in both subsamples had sought minimal support for psychosocial concerns, such concerns were in fact commonplace. Over half of participants (56%–57%) shared qualitative accounts of depleted confidence, while wellbeing scores were on average lower than matched norms. Participants identifying as sexual minority also reported greater appearance‐focused anxiety compared to those identifying as straight. Conclusions The apparent contrast between participants' minimal help‐seeking and accounts of affected wellbeing suggests an unmet support need for men with alopecia. Masculine norms may impede men from accessing psychosocial support, both by discouraging help‐seeking behaviours and by encouraging minimisation of appearance concerns. The findings also suggest sexual minority status may pose a greater risk of distress in affected men.
Some individuals with appearance-affecting conditions experience psychosocial challenges such as social anxiety and avoidance. Acceptance and Commitment Therapy (ACT) may offer a suitable approach ...for these challenges. This qualitative study investigated the lived experiences of patients with such appearance related concerns, who had been through a one to-one ACT-based intervention. It was expected that this would offer insights into the processes underpinning any positive impacts of therapy, potentially including ACT-specific elements. Semi structured interviews were conducted with six female patients of a specialist clinical psychology service, where an appearance focused ACT-based intervention was delivered. Participants described their experiences of therapy, any impact it had on their lives, and to what they attributed any changes. Interpretative Phenomenological Analysis, a qualitative method suited to exploring individuals’ lived experiences, was used. Four superordinate themes included: Progress in body confidence, developing ways to take control over (re)action, developing acceptance of appearance, and compassion. These processes emanated from the participants’ relationship with the treating psychologist, as well as specific skills used in sessions, and were enacted through participants’ engagement in life-fulfilling activities. One-to-one ACT-based therapy appeared to help expedite the process of accepting a changed appearance, which participants highlighted as an important step in adjusting to their appearance. Participants’ account of their improved body confidence can be understood in terms of an existing model of body image coping, offering a theoretical framework worthy of exploration in relation to ACT processes for this population. Participants’ accounts also convey the centrality of therapists expressing compassion and helping patients to cultivate self-compassion.
Some individuals with appearance-affecting conditions experience psychosocial challenges such as social anxiety and avoidance. Acceptance and Commitment Therapy (ACT) may offer a suitable approach ...for these challenges. This qualitative study investigated the lived experiences of patients with such appearance-related concerns, who had been through a one-to-one ACT-based intervention. It was expected that this would offer insights into the processes underpinning any positive impacts of therapy, potentially including ACT-specific elements. Semi-structured interviews were conducted with six female patients of a specialist clinical psychology service, where an appearance-focused ACT-based intervention was delivered. Participants described their experiences of therapy, any impact it had on their lives, and to what they attributed any changes. Interpretative Phenomenological Analysis, a qualitative method suited to exploring individuals' lived experiences, was used. Four superordinate themes included: Progress in body confidence, developing ways to take control over (re)action, developing acceptance of appearance, and compassion. These processes emanated from the participants' relationship with the treating psychologist, as well as specific skills used in sessions, and were enacted through participants engagement in life-fulfilling activities. One-to-one ACT-based therapy appeared to help expedite the process of accepting a changed appearance, which participants highlighted as an important step in adjusting to their appearance. Participants account of their improved body confidence can be understood in terms of an existing model of body image coping, offering a theoretical framework worthy of exploration in relation to ACT processes for this population. Participants' accounts also convey the centrality of therapists expressing compassion and helping patients to cultivate self-compassion.
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.
PDF
