Social Interaction after Burn Injury (MSKTC)

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Copyright © 2011 Model Systems Knowledge Translation Center (MSKTC). 
Based on research by Burn Injury Model Systems

Many burn injury survivors who have had a change in their physical appearance feel anxious about how people will react to them when they leave the hospital and go back into public places. Some of the social challenges burn survivors experience during the transition from the safe zone of the hospital back into the community include:

  • Stares or double-takes.
  • Questions and comments about their injury.
  • Bullying and teasing.

If your burns are visible, simple everyday activities such as going shopping or taking public transportation can involve being stared at and having to deal with curiosity. If your burns are more hidden, you may be concerned about how people will react when your burns are uncovered, such as when you take your shirt off at the beach.

The way people react (verbally and non-verbally) can make it more difficult to feel confident during social interactions. While some burn survivors are not bothered by the reactions of others, you may find it helpful to learn social skills to face these challenges successfully.

Understanding challenges with social interactions

Social interaction can go wrong between a person with physical differences and someone meeting them for the first time. This table, developed by Changing Faces, uses the acronym "SCARED" to illustrate how reactions on both sides can be misunderstood or cause discomfort.

Resource from Changing Faces




Do you have social anxiety?

You may be suffering from social interaction anxiety if you experience any of the following symptoms in social situations, based on how you think others will react or are reacting to your appearance:

  • Feeling nervous or on edge when meeting new people or among strangers.
  • Avoiding social situations.
  • Feeling isolated and alone.
  • Feeling emotional distress, including depression.

Finding help

If you have any of the symptoms listed above, please seek help from your local burn center or the Phoenix Society for Burn Survivors (

  • Your burn center health care providers (physicians and psychologists) will be able to discuss appropriate treatment options for social anxiety.
  • The Phoenix Society offers a peer support program where burn survivors assist you in recovery by sharing their experiences. You may participate in the on-line Burn Recovery Peer Support Chat sessions by becoming a member of the Phoenix Society.
  • The Phoenix Society also provides the Image Enhancement for Burn Survivors book and video, a common sense guide to creating your best image, including the application of corrective cosmetics. To order, contact the Phoenix Society (see Resources at end of article).

How to improve your social interactions

It is okay to feel apprehensive when interacting with people after a burn injury. Here are some strategies you can use when meeting strangers, entering new social, work or school situations or going into public places.

In all social interactions, it is helpful to act positively and use confident body language.

The "STEPS" strategy developed by Barbara Kammerer Quayle may help you feel confident when entering new social situations.

  • Self Talk—What you say to yourself and believe, such as "I love and accept myself the way I am and the way I am not," "I meet people easily and feel comfortable with them," and "I can do it!"
  • Tone of Voice—Use a friendly, warm and enthusiastic tone of voice.
  • Eye Contact—Look people in the eye, even if just for a few seconds.
  • Posture—Have a confident posture with head raised, rib cage lifted and shoulders back.
  • Smile—A smile makes you look confident and approachable.

Ways you can respond when others react to you

If someone stares at you:

  • Say "Hi, how are you doing? Can I help you with something?"
  • If staring continues, look back at them firmly and frown to show your displeasure.

If someone asks what happened:

  • Respond in a positive manner.
  • Change the subject if you do not wish to continue to talk about your burn.
  • Use sense of humor when appropriate to lighten the moment.
  • An example of a resonse could be: "I was in a house fire, but I'm okay now."
  • You may find it helpful to write down and memorize your responses.

If someone turns away:

  • Think positively. For example, "They are just trying not to stare," or "They don't know what to do either."

If someone teases you:

  • Stand up for yourself and be assertive when someone is teasing you.
  • Count to 10 slowly so you don't become aggressive or lose your cool.
  • Use the power of the "I statement," such as, "I don't like what you are saying, or "I want you to stop doing that ."
  • Use the "shrug" that says "that's so boring." Smile, act bored and walk away with a shrug
  • SILENCE the teaser, such as "So what's your problem?" or "What's so perfect about you?" or "I'm wondering why you would say something like that?"

Social Interaction Skills Training

There are also social interaction skills training programs that can help you:

  • Prepare for social situations after leaving the hospital.
  • Understand what goes on in social interactions.
  • Practice effective strategies for managing social interactions.

Two well-known social interaction skills training programs are:

  • The 3-2-1-GO! Strategy developed by James Partridge ( This strategy includes:
    • 3 things to do if someone stares at you.
    • 2 things to say if someone asks what happened.
    • 1 thing to think if someone turns away.
  • The Beyond Surviving: Tools for Thriving developed by Barbara Kammerer Quayle


Copyright © 2011

Model Systems Knowledge Translation Center (MSKTC).


The Phoenix Society for Burn Survivors Inc.
1835 R W Berends Dr. SW
Grand Rapids, MI 49519-4955
.(JavaScript must be enabled to view this email address)

Changing Faces
The Squire Centre
33-37 University Street
London, WCIE6JN


Blakeney P, Partridge J, Rumsey N. (2007). Community Integration. Journal of Burn Care and Research, 28(4): 598-601

Blakeney P, Thomas C, Holzer C, 3rd, et al. (2005). Efficacy of a short-term, intensive social skills training program for burned adolescents. Journal of Burn Care & Rehabilitation. 26(6): 546-555.

Kammerer Quayle, B. (2006). Behavioral Skills and Image Enhancement Training for Burn Survivors: Essential Interventions for Improving Quality of Life and Community Integration." In R Snood, B Achauer, (Eds.), Achauer and Soods's Burn Surgery: Reconstruction and Rehabilitation. Elsevier Inc.


Our health information content is based on research evidence whenever available and represents the consensus of expert opinion of the Burn Model System directors.


Social Interaction after Burn Injury was developed by Radha Holavanahalli, Ph.D. and Karen Kowalske, M.D., in collaboration with the University of Washington Model Systems Knowledge Translation Center.


This information is not meant to replace the advice from a medical professional. You should consult your health care provider regarding specific medical concerns or treatment.


This publication was produced by the Burn Injury Model Systems in collaboration with the University of Washington Model Systems Knowledge Translations Center with funding from the National Institute on Disability and Rehabilitation Research in the U.S. Department of Education, grant no. HI33A060070.
For more information, contact your nearest Burn Model Systems. For a list of Burn Model Systems, go to: