Habit Formation in the Adjustment to Blindness

By Justin M. H. Salisbury, MA, NOMC, NCRTB, NCUEB

Justin Mark Hideaki Salisbury is Coordinator of Educational Programs at Associated Services for the Blind, Incorporated, located in Philadelphia, Pennsylvania.

Abstract

For blind people, just like anyone else, what they do becomes a habit. If they practice productive thoughts or behaviors, they will become habits. If they practice unproductive ones, they, too, will become habits. Certain techniques for accomplishing life’s daily tasks and the attitudes and beliefs associated with them can have lasting impacts on the adjustment-to-blindness process. Constructs of behavioral change and self-talk are discussed, as well as certain alternative techniques and common behaviors that can occur in response to negative attitudes about blindness. Practitioners are advised to be cognizant of their opportunity to help blind people develop productive habits or break unproductive habits.

Keywords

Blindness, adjustment, rehabilitation, habits, self-talk, behavioral change

Introduction

Adjustment-to-blindness training in a residential program is an essential part of the empowerment and rehabilitation of a blind person (Omvig, 2002, Tigges, 2004). Levine and Blackburn (1946) wrote that the restoration of self-confidence was at the forefront of rehabilitation after vision loss. One model of training, developed in accordance with the collective voice of the organized blind, is known as Structured Discovery (Altman & Cutter, 2004; Dodds, 1984). The status quo model of blindness rehabilitation can also be called the vision-centered approach because it treats visual means of accessing the world as superior to nonvisual means (Riccobono, 2017). Training under the Structured Discovery model produces better outcomes than the status quo model (Bell & Silverman, 2018; Bell & Mino, 2013, 2015). Hill (1997a, 1997b) explained that the Structured Discovery model emphasizes a common-sense approach to blindness rehabilitation and involves one person teaching and mentoring another person.

In a residential Structured Discovery training program, students begin by putting on a pair of sleepshades. Sleepshades open the door for perceptual learning, and students learn how to better use their existing nonvisual senses, such as hearing and touch. They begin to learn how to use certain alternative techniques that enable them to nonvisually perform tasks more efficiently. These techniques are practiced to the point of automaticity, which frees up a blind person’s attention to focus on problem-solving (Maurer et al., 2006; Mettler, 1995/2008). Problem-solving is an important part of daily functioning as a blind person (Mino, 2011). Eventually, even the problem-solving algorithms can become automatic so that they can be called up and used with nominal effort (Maurer, 2011). As students continue to be active in their free moments outside of standard training hours, they eventually begin to employ nonvisual techniques instead of old visual ones as they gradually realize and prove to themselves that these nonvisual techniques are more efficient (Altman, 2012). Over the course of training, students gradually require less attention on the nuts and bolts of how to perform a task nonvisually. This allows the instructor and student to focus on other parts of the emotional adjustment to blindness, which is the keystone of the adjustment process and the primary reason that training typically requires six to nine months (Salisbury, 2017). Students must develop a sense of self-efficacy, meaning that they must develop confidence in their own ability to achieve their goals (Bandura, 1977, 1997). They must learn how to decline unwanted help while also serving as good ambassadors for the blind community (Jernigan, 1993, 1997; Wang et al., 2015). More broadly, students need to learn how to deal with various forms of social discrimination and accessibility barriers. Students must learn to think of themselves as first-class members of society (Salisbury, 2018a; Schroeder, 1996. A new student has many role models, but, over the course of training, a student gradually climbs the social ladder and begins to realize that he or she, too, is serving as a role model for other blind people (Omvig, 2002; Salisbury, 2017). This is a form of giving back, which is a major part of the path to full equality and integration of the blind in society (Omvig, 2009).

Jager (2003) described habits as behaviors that are performed with a minimum of cognitive effort, allowing for an effective use of our limited cognitive capacities. The automatizing of behavior makes habits less susceptible to change than reasoned behavior. Bad habits are habits that provide positive outcomes in the short run but detrimental outcomes in the long run. Bad habits are difficult to change because cognitive information about negative outcomes struggle to influence automatic behavioral scripts. People usually continue to engage in a habit because the direct personal outcomes are satisfying. Reasons to quit a bad habit usually focus on negative long-term consequences of the habit and/or on the social/physical environment. Because habits occur without processing new information, it is often difficult for a persuasive message to change habits. People receiving information promoting an alternative behavior to their bad habits also tend not to recognize that information as relevant for their own personal circumstances. Mettler (1995/2008) explained that adjustment-to-blindness training, which is perceptually-oriented with certain important habitually-oriented tasks, helps a blind person to refine and correct bad habits. Here begins the discussion of some components of habit formation in adjustment-to-blindness training.

Commitment to Leaving Home

Omvig (2002) explained that a new student should begin training when they know that they can stay at the training center without going home on weekends for at least one month. This gives the blind person enough practice and enough rhythm at functioning on his or her own that he or she is able to resist the offerings of well-intended help from friends or family. If a student lives at home during training, even without that help, they are unable to benefit from the full 24/7 attitude-factory-effect described by Omvig (2002), where the training center acts as an incubator for self-reliance. Tigges (2004) explained that many blind people, especially those who still have residual vision, are living limited lifestyles and having family members take care of them prior to seeking rehabilitation services. Thus, it is necessary that the training center break that cycle of dependency and artificial limitation.

Altman (2012) wrote that the time at the apartments outside of normal training hours creates opportunities for students to practice what they are learning and further grow in their confidence. Since students have to perform the normal tasks of managing a home and caring for themselves, they are forced to practice their skills. When they travel, they are practicing. The same is true for any other content area. The time outside normal training hours does not have an enforced sleepshade policy, so students often are functioning without their sleepshades on. As they continue to advance through training, they gradually start to realize that they are shifting different tasks over to nonvisual methods of functioning and making permanent the priority of nonvisual techniques. This demonstrates that nonvisual means of functioning are now truly more efficient for them, and they are realizing it at the intuitive level. The instinct to use nonvisual means of functioning replaces the instinct to use visual means of functioning. This also helps students to maximize the use of their residual vision because they are reserving it for ready use by not using it in all the situations that are now being handled nonvisually. This important experience would not be likely if the student were to remain in the home environment with friends and family members as helpers and caretakers.

Abandoning Pre-Cane Techniques

Pre-cane skills, such as trailing, squaring off, sighted guide, and protective techniques, have negative side-effects that can limit the effectiveness of adjustment-to-blindness training. If students enter training using pre-cane skills, the instructors will attempt to lead the students to discontinue using them because they can produce bad habits. Schroeder (1986) explained that pre-cane skills have very little relevance to eventual effective use of the cane. Using pre-cane skills makes students stand out in society in negative ways, which contradicts the goal of helping students blend into the broader society dominated by sighted people (Omvig, 2002, 2009; Salisbury, 2018a). Pre-cane skills can be socially isolating and even produce blindisms—behaviors “commonly exhibited by the blind which are not socially acceptable” (Abang, 1988, p. 91). Pre-cane skills generally lead a person to focus too close to themselves rather than focusing further away from themselves, like a human is meant to do. McNevin, Shea, and Wulf (2003) found that people performed and learned better with an external focus of attention because focusing too close constrained their balance and other processes that would be more automatic with a more external focus of attention. In general, when students use pre-cane techniques, they tend to absorb the notion that they are only safe moving through familiar environments that have been specifically and carefully selected by rehabilitation specialists, using only the techniques that were scripted by those rehabilitation specialists. Such an idea limits a blind person’s ability to imagine having full control and individual agency in travel or, more broadly, life decisions. Instead, cane travel instructors can produce better outcomes by helping the student understand that blindness itself does not prevent anyone from devising his or her own strategies for navigating familiar or unfamiliar environments.

Sighted Guide or Human Guide

Anderson (1965) defined the following technique as "a blind person lightly grasping a sighted guide's elbow in taking a walk." Jernigan (1993) pointed out that this technique has gradually become colloquially known as sighted guide or, less often, human guide. If sighted guide is taught at the beginning of cane travel instruction, it promotes an alternative to using the cane before teaching the student how to use the cane. Students need to develop the habit of moving through space with the cane as an obstacle detector and themselves as the intelligent decision-maker. Students need to be in the habit of being responsible for themselves and monitoring their own safety, knowing where they are and where they are going, and metaphorically acting as the drivers in their own lives rather than the passengers (Riccobono, 2011, 2014a, 2014b). Sighted guide relegates a blind person to the status of a passenger rather than a driver when it comes to one’s own movement. When a student is new in training, it is perfectly normal for sighted guide to be easier than using a cane, and people naturally gravitate toward techniques that are easier. Adjustment-to-blindness training is not always about what is easiest because empowerment and freedom are not free. Students who use sighted guide to travel from place to place develop a habit of depending on sighted people or people other than themselves. This externalizes their locus of control, which is the exact opposite of the aim of adjustment-to-blindness training. Jernigan (1993) explained that students need to practice in good faith during training the kinds of techniques that will build a greater sense of self-respect and confidence. A technique like sighted guide may be used at some point after training, but students who are in training should be making every effort to focus on developing the skill sets that will help them to be judged as competent human beings and to confidently blend into the broader society.

Protective Techniques

Martinez (1998) defined protective techniques as “specific skills which provide added protection in unfamiliar areas.” Protective techniques frequently involve walking with the hands outstretched, with at least one in front of the face (Schroeder, 1986) and possibly one in front of the genitalia. This technique is often accompanied by foot shuffling or another defensive way of walking. Walking like this is socially isolating. Altman and Cutter (2004) explain that proponents of the Structured Discovery model understand that teaching cane travel is inseparable from addressing the misperceptions and low expectations of and for blind people that exist in society and understand themselves to be a part of the movement toward full integration and equality. Since protective arm techniques create major barriers to full integration and equality, it is not advisable to promote protective arm techniques. Furthermore, walking with these techniques create a safety hazard because the blind person is not receiving much of the environmental information that would be available through proper use of a long white cane.

Trailing

Anderson (1965) defined trailing as "the act of using the back of the fingers to follow lightly over a straight surface (e.g. wall, lockers, desks, tables, etc.) for one of the following reasons: a. to determine one's place in space; b. to locate specific objectives; c. to get a parallel line of travel." People who trail tend to struggle with walking straight. When delegating their orientation to an inanimate object becomes a habit, then they externalize their locus of control. On the contrary, adjustment-to-blindness training aims to internalize locus of control. Trailing keeps one’s attention focused only as far as the point of contact with the object being used for orientation. It is more effective to focus one’s attention more broadly to remain open to environmental information.

Squaring Off

Anderson (1965) defined squaring off as "the act of aligning and positioning one's body in relation to an object, for the purpose of getting a line of direction and establishing a definite position in the environment.” Squaring off can be executed by putting one's back flat against a wall (Cratty & Sams, 1968) and subsequently walking away from that wall. A person may also use other straight-edged objects, such as couches or tables, for this purpose. Squaring off requires a person to focus their attention backwards instead of focusing in the direction they want to go, which can be disorienting. Squaring off from curbs for street crossings is much less dependable than aiming toward a desired location based on traffic sounds and other environmental cues, but some blind people learn to do this. Squaring off is not an ideal technique and students should learn not to default to it as a primary means of getting alignment.

Breaking Bad Habits

Sometimes, a blind person comes to training with bad habits developed prior to training. Training at a residential adjustment-to-blindness training center is an excellent time to focus on cleaning up those bad habits. Bad habits could hinder the acquisition of environmental information, make the pursuit of a goal less efficient, or counteract the emotional adjustment to blindness. When bad habits are ingrained in the way a blind person functions, it can be more difficult, though certainly not impossible, to excel in adjustment-to-blindness training. In this way, adjustment-to-blindness training can also be viewed as a behavioral-change intervention.

Jager (2003) discussed techniques for breaking bad habits and the challenges therein. The most effective method to change a habit is to literally make it impossible. This method cannot be used in many situations, since it interferes with people’s freedom of choice, an important part of the adjustment-to-blindness process (Salisbury, 2018a), and may draw resistance. One example of using this strategy would be when a home management teacher blacks out her classroom and turns off all the lights, operating in total darkness, to prevent a student from peeking around his sleepshades and trying to use residual vision. A second effective strategy involves changing the stimulus so that the script is not automatically activated. For example, people trying to overcome blindness-related dependency on a family member should avoid the circumstances in which they engaged in dependent and passive behavior, such as staying at the training center for at least the first month. After breaking that habit of dependency, it can then be healthy to re-enter the family environment. A third strategy is to change the direct-experienced outcomes when the habit is being performed. A training program may fine students for tardiness, such as issuing a daily fee to come out of the student’s stipend. This strategy can be self-imposed or imposed by others. It is possible to shift the balances by making the bad habit less rewarding or making the good habit more rewarding. For example, an instructor may praise a student who began training with much self-doubt for demonstrating confident behaviors rather than doubtful ones. No matter how effective it is to change the short-term outcomes of a bad habit, it is often unachievable due to legal or financial barriers. For example, making smoking impossible inside a building (such as taking the oxygen out of the building) also makes the building uninhabitable. Therefore, the outcomes of a bad habit are often changed less directly using rules with punishment for breaking the rules. For example, there are fines for smoking in a non-smoking area. For a rule like this to be effective, it is important that people are aware of the rule, the probability of enforcement, and the amount of the fine. Higher amounts of the fine and probability of enforcement make people more responsive to it. If information is supposed to make a person avoid engaging in a bad habit, it is helpful if that information is delivered at the exact moment that the habit is being practiced, such as how warning labels are put on cigarette packages. The same is true for incentivizing good behaviors. For example, a student who is converting from using screen-magnification software to screen-reading software might put a braille note-to-self inside his laptop between the screen and keyboard to remind him of the benefits of using a screen reader before he uses his computer each time. He could also tape a sheet of paper over his monitor with a reminder.  Lastly, it can help to align the need for habit development with an emerging social trend or fashion. In the case of blindness rehabilitation, this may be possible by branding the good habits as fashionable within the blind community.

For any of these bad habits, it can be helpful for students if staff at the training center, as well as any outside friends and family, can alert the student when they are engaging in the bad habit. For some, like sighted guide or squaring off, these habits require a conscious decision, so the student needs to make a conscious decision not to do it. When students come to training with a desire to trail, it can help them to use techniques to help them become more conscious of what they are doing with the hand that is not holding the cane as they walk. For example, a student may choose to wear a glove so that they will notice their hand more when it touches something. It makes it more difficult to absentmindedly begin trailing and not notice it. Students with this problem may also elect to carry a lightweight object in their hand just to keep that hand busy in a way that requires nominal concentration. Techniques for dealing with protective techniques can be similar, though it may help to have a somewhat heavier object to carry so that it requires some muscle engagement in order to reach forward. Whatever they choose to do, it helps to make sure that the free hand cannot slip into its old habit of trailing or groping protectively, encouraging the student to have more control and focus on the travel techniques emphasized by the program.

Eye Contact

In some cultures, eye contact is a symbol of respect, authenticity, and honesty. In other cultures, eye contact is often interpreted as a challenge or threat, and people in those cultures are taught to avoid eye contact with someone they respect. Some blind people get into a habit of grossly avoiding eye contact in order to avoid accidentally pointing their eyes in an inappropriate or otherwise inadvertent place. This can be done by turning one’s head away from the person being addressed. Such a behavior is often interpreted as a sign that the person is not interested or not paying attention, and it is socially inappropriate in some cultures. Students in adjustment-to-blindness training with this problem should be encouraged to turn their heads in the direction of the person to whom they are speaking. Instructors should have no discomfort in speaking up when a blind person needs reminding about this habit.

Pourmollaabasi (2013) discussed eye contact and its alternatives for blind people. In general, sighted people use their eyes to sense the world and to express themselves. Eye contact occurs when two people look into each other’s eyes (Chen, 2002). Most of the meaning communicated between sighted people is nonverbal, including posture and stance, facial expressions, gestures, proximity, appearance, and eye contact. Wainwright (1985) described body language as an unspoken language that is used unconsciously every time two people communicate. Babies begin to learn and practice eye contact in the first few months of their lives, particularly by making eye contact with their mothers (Argyle & Dean, 1965). Nonverbal cues, such as eye contact, are not always accessible to blind interlocutors, which can create access barriers in face-to-face communication. Sighted people are not always aware of their own use of nonverbal cues, and they do not consider it when communicating with blind people (Krishna et al., 2008). Franco (2008) wrote that blind people were not very successful in conversational turn-taking, sometimes interrupting other interlocutors in group conversations. Eye contact can have various functions throughout the communication process, including “showing attention,” “determining direct addressee,” “signaling readiness,” and “turn-taking.” Instead of using eye contact and smiles, blind people may use alternatives, such as hand movements and other body cues, to indicate where their attention is focused.

Distance Between the Face and an Object

Some blind people develop a habit of putting their faces close to an object that is the focus of their attention. Perhaps it is a sandwich on which condiments are being applied. Perhaps it is a faucet fixture being changed. This habit can come from realistically trying to see something with one’s residual vision or responding to an instinct to try to see it even though the person is now blind and wearing sleepshades. Additionally, if the person struggled with vision loss over an extended period of time, he or she might have gotten into such a habit of having to lean forward in order to see it at a close range that the motion has become automatic. The construct of automaticity described by Maurer et al. (2006), as well as Maurer (2011) can also have a negative impact in this way. Students may end up accidentally dipping their long hair into a sauce in the kitchen or pile of sawdust in the woodshop. Bad posture can hinder the development of good self-esteem and confidence. It can also make it more difficult for students to focus up ahead of them while walking instead of focusing on the ground in front of them. This habitual behavior can create an additional burden to overcome before the helpful habits can develop.

Learned Helplessness

Learned helplessness was described by Seligman (1972) within the context of animal research on rewards and punishments that the subjects could control. In an experimental setting, subjects could either make a response or avoid making that response in order to influence the reward or punishment that would be received. Through avoidance training, it was possible for dogs to learn how to avoid painful electric shocks by running and jumping over a barrier. For those dogs who had experienced unescapable electric shock prior to avoidance training, they simply gave up and accepted the punishment of electric shock, making no effort to influence their own experiences of pain, until the researcher discontinued the shock. These dogs demonstrated learned helplessness, and this study opened the door for later experiments with human subjects.

Hiroto and Seligman (1975) applied the construct of learned helplessness to humans in a study involving discrimination problems. In this experiment, unsolvable discrimination problems were just as uncontrollable as the unescapable shock that the dogs had received in the Seligman (1972) experiment. Three groups of college students were given four sets of solvable, unsolvable, or no-discrimination problems. Next, all three groups were given a hand shuttlebox with uncomfortably loud noise that they would be compelled to escape. Participants whose first-round treatment involved solvable discrimination problems or no problems escaped the noise quickly. The group who had experienced unsolvable discrimination problems failed to escape and listened passively to the noise.

Abramson et al. (1978) reformulated the model of learned helplessness in more detail. Developing an attributional framework requires refining attribution theory as portrayed by Heider (1958) and Weiner (1972, 1974). The previous helplessness model did not differentiate personal helplessness versus universal helplessness. It is possible for people to conclude that a problem is unsolvable by anyone, thus creating universal helplessness, or that it is unsolvable only by them personally, thus creating personal helplessness. Bandura (1977) addressed the conceptual distinction between efficacy and outcome expectations. People can give up trying because they lack a sense of efficacy in succeeding, or they may be confident in their own capabilities but give up trying because they determine that nobody could succeed in that impossible situation. These two separable expectancy-based senses of futility have quite different causes and remedies. To gain a sense of efficacy, a person must build competencies and expectations that they can be effective. On the other hand, if the situation is deemed universally impossible, the conditions making it universally impossible must be changed in order to restore the instrumental value of the competencies that people have already developed. Rotter's (1966) concept of external locus of control is similar to the learned helplessness construct. People's beliefs about causality vary along the linear dimension of locus of control, where people with an internal locus of control tend to believe that outcomes are caused by their own actions and people with an external locus of control tend to believe that outcomes are not caused by their own actions but instead caused by luck, chance, or fate. Those who have a greater sense of helplessness tend to have a more external locus of control. When people believe that outcomes are more or less likely for themselves than relevant others, they tend to attribute the outcomes to internal factors. When they believe that they are equally likely to experience these outcomes as relevant others, they tend to attribute the outcomes to external factors. In the case of blindness rehabilitation, both situations can create barriers that a blind person must overcome. There is the sense that something is impossible for all blind people versus the idea that something is impossible for that individual blind person. Blind role models can help break the idea that something is impossible for all blind people, but the development of Bandura’s (1977, 1997) construct of self-efficacy, upon which Structured Discovery training is heavily based, is necessary to overcome the attribution to internal factors and personal helplessness.

Attribution styles are relevant to the stability of a factor. People who attribute negative outcomes to global factors will show helplessness problems in all new situations. By contrast, people whose attribution styles involve attributing their helplessness to specific situational factors will show helplessness deficits only in situations that are relevantly similar to the original situation in which they were helpless. In the case of adjustment-to-blindness training, if a student attributes helplessness to blindness, which is a global factor because the student is always blind, that student will exhibit helplessness deficits in all new situations. If the student attributes the helplessness to a specific factor, then the student can succeed in situations when that factor is not an obstacle. To the extent that it is necessary for any given student in adjustment-to-blindness training, there is a process of learning how to shift the students’ own attribution style from being more global to being more specific. If they stop blaming helplessness on their blindness and start attributing helplessness to specific factors, especially ones that they can change, then they can be more empowered. If a blind person accepts the idea that he cannot get a job because he is blind, then he will be unable to get a job as long as he remains blind. If he attributes the difficulty in getting a job to a lack of understanding or low expectations about blindness in the mind of the employer, then he can begin to address those particular issues to move closer to his goal of employment. If the blind person attributes the problems he or she is facing to be consequences of blindness, that person will come to believe that the problems will not go away and will develop learned helplessness as long as they retain their condition of blindness. If they attribute the problems to social construction, this gives them the opportunity to change the socially constructed barriers to make the world more accessible and thus inclusive to the blind.

One student was too short to reach a cabinet from which she needed cooking ingredients in her home management classroom. She initially said that the problem was that she was short, which could be considered a global factor. Her instructor asked her to explain what it was that she needed to be able to do to access the materials in that cabinet. She said that she needed to be able to reach the cabinet. Not being able to reach the cabinet is a specific factor. Then, the instructor asked her what she could do to change the fact that she could not reach. She decided to find a small stepladder and used it to help herself reach the cabinet, thus having the experience of problem-solving that barrier and attributing helplessness to a more specific situational factor that she could change. This helps her to get into a habit of looking for specific factors rather than global ones, which carries over into situations where blindness could be the global factor.

Blind people who go too long without training can develop a sense of learned helplessness. This can lead them to give up too quickly when a task seems difficult. It also leads to a habit of not attempting new things and not stepping outside of one’s comfort zone. Stepping out of one’s comfort zone is an important part of building self-efficacy (Hart & Silka, 1994). Field class experiences in adjustment-to-blindness training emphasize stepping out of one’s comfort zone, which is an important part of Structured Discovery training (Salisbury, 2018b). Students who learn how to attribute experiences of failure or helplessness to specific situational factors can change those factors in order to change their outcomes.

Self-Talk

Neck and Manz (1992) proposed the construct of thought self-leadership. Its underlying premise holds that people can employ specific cognitive strategies to influence or control their own thoughts, which ultimately impact individual and organizational performance (Manz and Neck, 1991). Self-talk and mental imagery have been studied in fields such as sports psychology (Andre & Means, 1986; Clark, 1960; Feltz & Landers, 1983; Kendall, Hrycaiko, Martin & Kendall, 1990; Lee, 1990; Mahoney & Avener, 1977; Meyers et al., 1979; Ryan & Simons, 1981; Wrisberg & Anshel, 1989; Zecker, 1982; Ziegler, 1987), clinical psychology (Bonadies & Bass, 1984; Crowder, 1989; Harrell et al., 1981; Meichenbaum & Goodman, 1971; Rosin & Nelson, 1983; Schill et al., 1978; Steffy et al., 1970; Turner et al., 1982; Velten, 1968), counseling psychology (Baker et al., 1985; Hazler & Hipple, 1981; Kurpius et al., 1985; Morran, 1986; Richardson & Stone, 1981), education (Swanson & Kozleski, 1985), and communication (Boice, 1985). This literature supports the relationship between self-talk and performance enhancement. Individuals can choose the way that they think (Seligman, 1991, 2006). Management literature has discussed the importance of empowering people to be more autonomous (Hackman, 1986; Lawler. 1986; Manz & Sims, 1989; Walton, 1985). Individuals must learn self-leadership skills to support increased autonomy; therefore, management must help employees to manage their own thinking. Manz (1983, 1986, 1992) introduced the process of self-leadership, the process of influencing oneself to establish the self-direction and self-motivation needed to perform. This management construct has been derived primarily from literature on social learning (Bandura, 1977, 1986) and related literature on self-control (Bandura, 1969; Cautela, 1969; Goldfried & Merbaum, 1973; Kanfer, 1970; Mahoney & Arnkoff, 1978, 1979; Mahoney & Thoresen, 1974; Thoresen & Mahoney, 1974). Organizational literature has focused on the related construct of self-management (Andrasik & Heimberg, 1982; Manz & Sims, 1980; Marx, 1982; Mills, 1983; Hackman, 1986).

Sometimes, students in adjustment-to-blindness training have gotten into a habit of negative self-talk. For example, one student, who attended a training center during a gap year between high school and college, had been told her whole life that she was a bad traveler. She had internalized these messages, direct or implied, and continued to think of herself as a bad traveler. When she began cane travel lessons at the training center, she struggled emotionally because of that negative self-talk and self-concept. When she faced what should have been an ordinary challenge in training, she also faced all those doubtful words that had been used on her and that she had been using on herself. Part of building self-efficacy involves mastery experiences and managing stress, or physiological arousal (Bandura, 1977, 1997), which was heightened for this student by her own negative self-talk. In her frustrated moments of tears, she would say “I have it stuck in my head that I’m a bad traveler.” More positive self-talk can help such a student and specifically appeared to help her. She agreed that with each coming day she was learning new things and becoming better. Instead of self-talk that focused on her existing skill set, she began using self-talk that focused on the growth in her skill set. Her new mantra became, “I’m getting better at cane travel.” Whether or not it was because of this newer and more positive mantra, she did continue to advance in training and reach a much greater level of independence and self-efficacy.

Hiding

Some blind people have a desire to hide their blindness, and some have a desire to hide themselves from public view. Neither habit is productive. Part of why students use a straight, non-collapsible cane during training is so that they cannot hide it (Jernigan, 1993; Omvig, 2002). A folding, telescoping, or otherwise collapsible cane can be easily hidden, which contradicts this sense of identity with the cane. Some blind people are ashamed or afraid to go out in public. A major remedy for these inhibitions is to spend time traveling in the public view. Facing the fear and shame are part of what makes cane travel class the most emotional class for many students. They cannot avoid the public while traveling in public spaces. They cannot avoid crossing busy streets while crossing busy streets. Nobody is afraid of dying while reading braille, but being hit by a car is a normal and realistic fear. If a blind person does not have proper adjustment-to-blindness training, it is common to stay at home instead of going outside. This habit becomes confining and makes a person increasingly less comfortable venturing outside the home. Bickford (1993) wrote that, for people who allow blindness to create limitations in their lives, it does, and it can affect every area of their lives. Training can break this habit and set blind people on more productive and healthy paths.

Omvig (2002) wrote that a residential adjustment-to-blindness training center should be located in an active, urban area—truly in society—so that it compels students to function within society. Salisbury (2018a) wrote that, if a training center is to be located in a rural or small-town area, it should be positioned in a vibrant part of town, and training should involve trips to nearby urban areas often enough to help students become comfortable in such settings. In a previous era with a different way of thinking about the education and rehabilitation of the blind, many training centers and schools for the blind were established in secluded areas to protect the blind students from the dangers of society while excusing the mainstream public from the burden of interacting with the blind (Crockett & Dease, 1990; Shackel, 2008). Ideally, a training center should be located close to public places, like restaurants, bowling alleys, concert halls, or any other place that ordinary people seek entertainment. Lipscomb (2004) explained that the location of a household imposes constraints on retail purchases, recreation, and available groceries, and the residents of their neighborhood tend to be people who live according to those constraints. Thus, students in training who live in vibrant and active neighborhoods will also be surrounded by neighbors and community members who actively get out into the community to take advantage of the resources around them. As part of the adjustment process, students should be actively embracing community resources in the process of living their daily lives and interacting with the rest of the public. To be even more specific, the training center and its student apartments should be located in a decent part of town—not a depressed slum—because those environments do not invite people to spend time in productive spaces outside the home. A training center should never be housed with a sheltered workshop because the segregation specifically hides the workers from society. As part of being located in a busy area, the training center should play a role in the local community, opening its doors to offer tours and participating in local activities (Salisbury, 2018a). When the training center is rented by local community organizations or clubs to host events or activities, members of the public are coming into the training center, thus preventing the training center itself from being an isolated or segregated space and preventing students from feeling as if they are hidden while in it.

Field classes occur when students and staff at a training center break from the normal routine of training to venture out into the community for a different kind of instructional activities (Salisbury, 2018b). Field classes often occur in the general area around the training center, depending on how far the program wants to travel. Field classes give students an opportunity to experience new settings, to feel a connection with the community, and engage in more experiential learning. While some people view labor and leisure as mutually exclusive, field classes blend the two as part of the emotional adjustment process. For any human being, traveling anywhere in the short term helps build confidence and open the mind to new possibilities and ways of thinking. Field classes should be sufficiently informal in their structure to enable the student to engage in the activities at hand, creating a more intrinsically motivated student. Since blind people must regularly engage in small acts of public education, one of the functions of field classes is to give students experiences to engage in public education. This self-advocacy and community advocacy pushes blind students in training to own their blindness and shamelessly communicate with the public about it.

Implications for Practitioners and Families

This article has offered some examples of different habits that are commonly developed and documents the importance of habit development, for better or worse. There exist many habits that could interact with a person’s emotional adjustment to blindness. It may be difficult for families to know what these habits are or could be, but competent blind role models and blindness rehabilitation professionals ought to be able to notice these habits as they spend time with a given blind person. Whatever a person routinely does after vision loss will become a habit. Blind people of all ages should be given proper adjustment-to-blindness training as soon as possible after vision loss in order to be sure that the right kinds of habits are formed. If a blind person has time to develop bad habits before receiving proper adjustment-to-blindness training, time and emphasis should be devoted to cleaning up those bad habits so that they do not undermine the person’s adjustment process and overall quality of life. Just as the emotional adjustment is the keystone of the adjustment-to-blindness process, habits that support or undermine the emotional adjustment are impactful in the adjustment process. Practitioners and families should think critically about the habits that blind people are developing and strive to promote productive habits and discourage counterproductive habits. Making the commitment to leave home in order to reside at the training center promotes habits of self-sufficiency rather than family dependency. Abandoning pre-cane skills helps students to internalize locus of control while externalizing locus of attention, in addition to promoting the habit of investigating their own new environments rather than waiting for instructors to orient them with a sequence of carefully selected techniques. Rules for eye contact vary from culture to culture, but blind people can learn to be conscious of how they are acting with respect to eye contact. Many blind people develop the habit of putting their face unusually close to an object, and this habit can be broken. If blind people get into a rhythm of learned helplessness, those behaviors can become habitual, and cleaning up those habits is part of building self-efficacy. Self-talk can be positive or negative, and practitioners can help train consumers to engage in positive self-talk. Adjustment-to-blindness training is designed to prevent blind people from hiding themselves and their blindness from the world and to help them greet the world with feelings of first-class status. Breaking bad habits can be difficult, but creativity, common sense, and a commitment to change can enable practitioners to help consumers develop the discipline to live the lives they want.

Implications for Future Research

More research could study the different types of habits that may be formed by blind people with onset at different points in the lifespan. There can be a tendency for blind babies to be extremely still as they listen to their environment, and parents of blind babies often allow them to stay still because they fear overstimulating them or simply do not want to do the wrong thing. This can lead to a lack of sense of exploration and tactile defensiveness, among other things, and more research could investigate and document the kinds of interventions used to form the right kinds of habits. Strategies to address any particular habit can be a full professional practice article of its own. Future research could also study the adjustment-to-blindness process for those adults who attend residential training programs, where they actually live away from home in facilities operated by the training center, versus those who still stay around their families during training. Past literature appears to indicate that family involvement during that first critical month of training is counterproductive in the adjustment to blindness, but a deeper dive could produce meaningful results. There may be ways that blind people who cannot leave home to attend training can stay around their families without family members encouraging counterproductive habits. Perhaps the director of the training program should hold a training session for the entire household in order to teach them how to avoid undermining the student’s progress in the training program. Also, if other supports are required because a student has multiple disabilities, these may impact the habit formation processes, which future literature can discuss. Since social rewards can incentivize good habits and help break bad habits, future research could investigate how this is most effectively done, perhaps through blind consumer organizations. Some blind people may wish to undertake self-directed efforts to break bad habits or form new good habits, and future literature could also discuss ways that blind people can work on their own habits outside of training. For each of the major topical areas of this article, future research could further explore the causes and appropriate proactive and reactive measures to make progress in these areas.

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