# Pre- and postsurgical anxiety and body perception: the significance of cognitive-behavioral therapy in scoliosis adolescents

## TL;DR

This study examines how anxiety and body perception change in scoliosis patients before and after surgery, with and without cognitive-behavioral therapy.

## Contribution

The study is the first to longitudinally analyze anxiety and body image in scoliosis patients with and without CBT across three time points.

## Key findings

- Patients who received CBT showed sustained improvement in body shape perception after surgery.
- Anxiety levels remained stable regardless of therapeutic support.
- Patient and doctor assessments of trunk aesthetics did not align significantly.

## Abstract

Background. Spinal disfigurement is one of AIS patients’ greatest concerns and the primary objective of treatment. No group has ever evaluated the anxiety and body image disturbances longitudinally in three time points in the course of scoliosis surgical treatment, following the cognitive-behavioral therapy (CBT). The aim of this study was a longitudinal analysis of changes in anxiety levels and to determine their associations with a perception of trunk deformity in females with adolescent idiopathic scoliosis (AIS) who either did or did not undergo CBT. Methods. The study design comprised of three questionnaire assessments, with the evaluations taking place before and after surgical treatment during the hospital stay and in a minimum 6-months follow-up postsurgery. A sample of healthy females was also included in the analyses for comparative purposes. Thirty-six AIS females in total (18 received CBT and 18 did not) filled in the Polish trait version of the Spielberger’s Anxiety Inventory for Children (STAIC-trait), Trunk Appearance Perception Scale (TAPS). The Trunk Aesthetic Clinical Evaluation (TRACE) was completed by the doctors involved and patients pre-and postsurgery. Results. In regard to TAPS, the differences between all assessments were significant for both scoliosis groups, in favor, as expected, of postsurgical results. However, the improvement of the perception of patients’ body shape remained significant in the follow-up only in the CBT scoliosis sample (p = 0.018). Referring to TRACE-patients’ and TRACE-doctors’ results agreement, there was no concurrence between them (results of Kendall’s coefficients of concordance appeared insignificant). Conclusions. AIS patients’ anxiety levels are stable, independent of received therapeutic support. Clinicians need to be aware of how patients’ appearance-specific cognitions might be associated with levels of anxiety and the supporting role of psychotherapy in the further stabilization of patients’ improvement of body shape perception following scoliosis surgical treatment.