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ICQ

Anxiety is undoubtedly the dominant emotion present during a course of mobility training. Other feelings such as devaluation or depression may be present but they usually stem from causes other than the process of learning to travel without sight. The visually impaired person may be depressed because he is dependent on others; but the feelings are stimulated by the event of his visual loss. They are an outcome of the condition of visual impairment.

Anxiety, however, during the course of travel training is usually a direct function of the learning experience. With little or no sight the individual must often travel in unfamiliar surroundings. Even if the surroundings are his home or his neighborhood, they are only visually familiar. He is not acquainted with them through his sense of hearing or through the touch of a cane. In addition, he is learning new techniques for finding his way about. And the process of acquiring this skill, because it is a new learning experience, may in itself stimulate his anxiety. Further, he must do all this with what seems to him a real possibility of falling and injuring himself. He must move about in an unfamiliar and threatening environment without his sight on which he formerly relied for self protection. It is thus entirely understandable that the experience of travel training stimulates anxiety.

Predictability of the Anxiety Reaction

It is not possible to predict the presence or absence of anxiety in a particular visually impaired person who is undertaking a course of mobility training. Even the intensity of whatever anxiety is present varies from one individual to another. One person who is totally blind may feel little or no anxiety as he learns to travel.

Another person with a considerable useful vision may be almost incapacitated by anxiety in the same situation. On the other hand, a person with minimal sight may experience much anxiety but is able to keep it within manageable limits. Conversely, the totally blind person may be incapacitated by anxiety, while the person with good travel vision takes the training experience in stride.

Thus, the presence or absence of anxiety during travel training is an individual matter. The instructor must consider each case separately and watch for anxiety and be ready to deal with its effects when it is present.

Manifestations of Anxiety

A perceptive observer can usually determine the presence of anxiety by cues that are familiar to most of us. If we have not personally experienced sweating hands, shortness of breath, trembling limbs or quavering voices, we have observed them in others. There are other symptoms of anxiety that may be less familiar to us. The person who is attempting to function under the stress of strong anxiety may find that his thought processes are disturbed. He may misunderstand verbal directions; his responses to instructions may be confused or inappropriate. If the anxiety is strong enough, he will totally block out cues that are essential to his safety. His locomotor responses are affected and he takes short, rapid steps, veers or stops when he should continue to move. As a result, his anxiety brings about the very thing he fears. He is injured, or at least runs the risk of being injured.

Anxiety may be, and probably is, the explanation for many of the difficulties experienced by some mobility students. They are not necessarily dull normal in intelligence because they cannot coordinate the swing of their cane with their steps. Rather, their thought processes have been short-circuited because they are afraid they will fall into a hole. When they veer, it may not be due to a mental inability to walk a straight line; it is quite possible that tension produced by anxiety causes them to miss available kinesthetic or auditory cues.

Even veering dangerously into moving traffic may be caused by anxiety. One may reasonably expect the person to veer away from what he fears. But, if anxiety blocks his rational thought processes, an unconscious self-destructive tendency may take control, and he veers into danger.

There are, then, the obvious symptoms of anxiety such as excessive sweating, shortness of breath, and muscle tension. Less obvious symptoms include the inability to grasp simple directions, or poor orientation that cannot be explained by low intelligence or lack of experience. The latter are as certainly related to anxiety as are the more obvious symptoms. But because they are not familiar to most observers, they may be overlooked as a possible explanation for the repeated mistakes of the student.

If the instructor overlooks anxiety as a possible explanation for specific behavior, he will not be able to take appropriate remedial action. He will then miss an opportunity to expedite the progress of the mobility student.

Some Causes of Anxiety

Anxiety stems from many causes, but the ultimate or overriding cause is, of course, the desire for survival. Without a reasonable degree of anxiety the person or organism would undoubtedly move into potentially harmful situations and either be injured or destroyed. There are, however, causes for anxiety that are only secondarily related to the drive for survival. These stimulate anxiety when there is no real possibility of injury or destruction. In either case, anxiety is present. And whether the basis for anxiety is one of potential harm or of possible embarrassment it should be considered, because it will affect the ability of the student to perform in his mobility training.

Situational Anxiety

Some situations are obviously more dangerous. Or they may seem potentially more dangerous to the new mobility student. One student may work quite well in a quiet neighborhood but seems to be afraid when he is asked to travel on busy streets. Another student works well in his own neighborhood but goes to pieces when he is taken to another location. Even the assurance of the instructor that there is no great difference between the two neighborhoods does not seem to help.

Superficially, these two students might only seem to be inconsistent in their performance. However, a more critical analysis of the student's behavior and a careful questioning of what he feels might uncover the fact that in certain situations he is terribly anxious. He does not experience anxiety in familiar situations or in quiet neighborhoods. However, on busy streets or in unfamiliar surroundings he experiences a surge of anxiety.

The cause of the anxiety in a specific situation will differ among individuals. One person is afraid of loud traffic noises while another feels reassured by sounds to which he can orient himself. Another student may work well on quiet streets but experiences anxiety in crowds because he feels people are watching him and associating him with a negative image of a blind person. Whatever the cause for anxiety in a given situation, it is imperative first to determine if a pattern exists in the performance of a particular student. If so, there is a bases for exploring the specific cause.

Masking of Cues

The value of any cue in the performance of a task is its distinctiveness. If a person is to make an appropriate response in a training situation, he must be able to distinguish whatever cue he needs for the performance of the task.

Auditory cues are, of course, very important to the visually impaired traveler. He must be able to hear certain sounds and correctly interpret them if they are to be useful to him. How clearly he hears the sounds he needs is often dependent on the background noise level. If the background noise is the low hum of ordinary city sounds the visually impaired traveler should have no difficulty in identifying the sounds he needs for direction and location. If, however he must cross at an intersection where a road crew is working with a jackhammer, or if he is passing a parking lot just as a jet screams overhead, essential cues are masked. The result in either case may be that the band traveler feels a tremendous surge of anxiety. If the anxiety is sufficiently strong, he forgets about other cues that are available. He tenses up, begins to veer, and becomes disoriented.

In other cases the masking of necessary auditory cues may not be as dramatic as the two previous examples. The interfering noise might be sufficiently loud only to blur auditory cues without blotting it out completely. The sighted person in such a situation, because he can rely on his sight, would feel no anxiety because of the visual cues that are available to him. But the visually impaired person would immediately be aware of a difficulty in hearing and interpreting the cues he needs, and would be subject to the onset of anxiety.

Ambiguous Cues

Another cause for anxiety in the blind mobility student is the presence of ambiguous cues. He can hear something, but is not sure what to make of it. Because of this anxiety, he makes a wrong decision. For example while preparing to cross a busy intersection the student hears someone call out. He is not sure if he has just been told to go, or warned not to go. The ambiguity of this communication stimulates anxiety which in turn, interferes with what he has learned in training. For a time he stands, unable to make a decision. However, he might make the wrong choice, rush the intersection, and risk being hit by a car.

The poor crossing could be attributed to carelessness. The student might even insist that this is the case, because he would rather admit to being careless than to being afraid.

In fact, the poor crossing is the result of anxiety triggered by an ambiguous cue that the traveler received as he reached the intersection. If the instructor accepts the statement of the student and attributes the poor crossing to carelessness, he is misinterpreting the cause of the behavior. He cannot then help the student with the real problem, which is his anxiety.

Remedial Action

In most cases the student's anxiety dissipates during the normal process of travel training. He gains confidence in his newly acquired skill and no longer needs to feel apprehensive. The instructor need only by aware that the student is experiencing anxiety, and take care not to stimulate greater anxiety by moving the student ahead too rapidly in his assignments.

The purpose of this chapter is to point out those special cases in which anxiety is so extreme that it interferes with the normal course of mobility training. Where the instructor suspects the existence of such extreme anxiety, it is important that he discuss it with the student. The student may deny his anxiety; but the instructor can help him to face it by pointing out that it is a natural reaction of which he need not be ashamed.

At the very least, the instructor can help the student control the behavioral effects of the anxiety. For example, the student can stop to consider everything he needs to remember before crossing at a busy intersection, rather than allowing his anxiety to force him into a precipitous crossing. Or, if extreme anxiety causes him to hesitate too long before attempting a crossing he can concentrate on remembering the various techniques that will insure a safe crossing. Knowing that the instructor is aware of his anxiety and does not condemn him for it often reduces the intensity of the feelings. When he confides in the instructor, he shares the burden of the feelings. He no longer needs to feel that he is trying to cope with the feelings by himself.

Where the student feels extreme anxiety concerning unfamiliar situations, the instructor can simply make the transition more gradual. For example, the instructor begins each lesson in a familiar area and little by little extends the route. Sudden changes, such as beginning the student in a completely new neighborhood, might stimulate too much anxiety. The degree of change the student can handle must, of course, be left to the discretion of the instructor. Only he can know how well the student is performing and how much the anxiety interferes with performance. As long as he is aware of how much the student's anxiety interferes with performance, he can use his judgment as to what he can expect from the student.

The same principle of graduating or extending the student's area by very discrete steps applies when the student is extremely anxious about busy or noisy intersections. Allowing him to approach a busy intersection from a familiar and quiet area without actually making the crossing can help him become accustomed to the noise and confusion.

When traffic or street repair sounds mask normal auditory cues it is important for the instructor to verbally emphasize other cues available to the student. Obviously this would have to be done before the approach to the intersection. And because there is no magic in saying something once, the message may have to be repeated frequently. This is particularly true when the anxiety of the student may be so severe that he blocks out much of what the instructor says. At the intersection the instructor may stand with him for a time to allow him to adapt to the noises. Occasionally touching the student on the arm assures him that he is not alone. This is especially effective, because the visually impaired person can feel totally isolated when noise is so extreme that it blocks out the normal auditory cues. He is wrapped in a blanket of sound that separates him from all human contact. In such a situation he needs to know that the person he depends on for safely is still with him.

A special case of anxiety may be that of the partially sighted student who is asked to work under a blindfold. He feels apprehensive about his safety when he is temporarily deprived of his useful vision. But he may not readily admit that what he also feels is anxiety about total loss of sight. In one case a student commented that the whole time he was working under a blindfold he felt that this was what things would be like when he lost his sight completely. This would be especially true when the student's visual condition is not stable. He might already be feeling anxiety over future total blindness. Putting him under a blindfold would give him the immediate sensation of what he fears. His anxiety would then be tremendously increased. In such a case, caution should be taken before asking a student to work under a blindfold.

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