Facially disfigured people with psychological difficulties resembled people with social phobia on Fear Questionnaire social phobia, agoraphobia and anxiety/depression sub-scores but were less agoraphobic and more socially phobic than were people with agoraphobia. Facially disfigured people thus appeared to be socially phobic and to deserve the cognitive--behavioural therapy that is effective for such phobias.

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This study supports the need for supplementary pharmacology education for nurses in clinical settings, focusing on common drugs they administer. This will increase nurses' knowledge and confidence in drug administration and safer medicines management.

Altered body image is a potential and actual source of considerable distress, particularly following facial disfigurement, and social functioning is reported as a major area of difficulty by sufferers. However, the area of facial disfigurement has received comparatively little attention from researchers in health care. Two current models of disturbed body image are examined, and it is contended that both require development in order to be of use in responding to the difficulties experienced by disfigured people. A fear-avoidance model of exaggerated pain perception, which has clear treatment implications, is described, and it is shown how this model may be modified to offer a framework for the understanding and treatment of the psycho-social difficulties of disfigured people. In particular, it is suggested that the avoidance present following disfigurement is phobic in nature, and special attention is given to the roles of avoidance and confrontation in mediating these difficulties. Implications for intervention and the shortcomings of the model are described.

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Reflection is a key concept in the development and maintenance of nursing expertise in theory and practice, yet commentators have rarely examined difficulties associated with it. This paper describes the role of reflection in nursing and relates it to information-processing accounts of human memory. The issues raised by the role of memory in mediating reflection are discussed, in the context of an examination of the importance of accuracy in reflection-on-practice. It is argued that anxiety is of particular importance in mediating accurate reflection. Whilst it is concluded that reflection is inherently flawed, a range of tactics to enhance it are explored, with particular emphasis on anxiety reduction and reduction of the burden of the memory task.

Psychosocial difficulties have been reported in head and neck cancer (HNC) patients, yet only few studies have assessed the impact of altered appearance following HNC treatment using theoretically selected measures of appearance-related distress. This study investigated appearance-related adjustment following HNC, and demographic and socio-cognitive predictors of adjustment. HNC patients (n=49) completed baseline questionnaires and a nine-month postal follow-up (n=20). Participants showed considerable variation in appearance-related adjustment, with females reporting higher levels of appearance-related distress (derriford appearance scale [DAS-24]) than females in the general population and male HNC survivors. Depression scores on the hospital anxiety and depression scale were higher than UK norms whilst anxiety was similar to UK norms. There were no significant differences between baseline and follow-up data. Fear of negative evaluation (a central feature of social anxiety) was a significant predictor of appearance-related adjustment at baseline, whilst dispositional optimism was a significant predictor of appearance-related adjustment at baseline and follow-up. Qualitative responses showed themes of appearance and disability, and coping strategies. Findings suggest that appearance-related adjustment post-HNC varies considerably and psychosocial services working with HNC patients should consider this broad pattern of response. Future research to examine the role of socio-cognitive predictors of appearance-related adjustment could progress development of effective psychological interventions.