Running head: COPING MECHANISMS FOR VISUALLY IMPAIRED

Coping Mechanisms for the Blind

Student’s Name

Institutional Affiliation
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Abstract

The loss of vision has significant impacts on the lives of the individuals, families,

acquaintances, and the society at large. This paper focuses on a population segment

consisting of adults who have been confirmed legally blind for less than one year with the

condition and enrolled at the Bureau of Services for Blind Persons (BSBP). It aims to reduce

the symptoms of depression, anxiety, and social isolation for adults recently diagnosed with

legal blindness in the past one year. Adults who lost their eyesight less than a year ago are

highly likely to be depressed due to the effects of visual impairment on their careers, social

support systems, and mobility. With the increasing number of the visual impaired population

in the U.S., there is a need for a theoretical and institutional response to reduce the negative

effects caused by depression. More focus is needed for young adults who are in a transitional

stage where the majority are concentrating on join post-high school institution, getting the

first dream job, and starting serious relationship as well as the elderly who have lost the

social ties duet to age and visual impairment.

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Coping Mechanisms for the Visually Impaired

The loss of vision has significant impacts on the lives of the individuals, families,

acquaintances, and the society at large. According to Welp, Woodbury, McCoy, Teutsch &

National Academies (2016), adults who completely lose their eyesight get frightened and

overwhelmed. They are left to wonder about their ability to remain independent, cater for the

needed medical costs, keep their places at work, and fend for themselves as well as their

families. The health consequences coming with the untimely loss of eyesight is beyond eye

and visual system. It affects the quality of life, leading to other effects such as injuries due to

falls, mental problems, and general deterioration in social and economic aspects. In the

United States, there are organizations which help the blind to cope. This paper focuses on a

population segment consisting of adults who have been confirmed legally blind for less than

one year with the condition and enrolled at the Bureau of Services for Blind Persons (BSBP).

The group recognizes that adults undergo depression, anxiety, and social isolation. Therefore,

this group takes the initiative to design mechanisms to assist the newly blind adults to cope in

the society.

Statement of Purpose

According to the latest statistics by the World Health Organization (2018), it is

estimated that about 1.3 billion people are a given form of vision impairment. In this

category, WHO (2018) says that 80% of vision loss can be avoided. Loss of eyesight is

majorly caused by the failure to correct refractive errors, cataract, diabetic retinopathy, and

corneal opacity (WHO, 2018). The effects of the loss are traumatizing for individuals who

had not experience until in adulthood. The become stressed due to the realities of losing their

positions at the workplace to take care of themselves and families, loss the social connection

and must now depend on others or visuals aids for movement. According to Coker et al.
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(2018), the number of cases of losing eyesight is expected to increase by 2050. Varma et al.

(2016) state that the 1.02 million figure in 2015 is expected to reach 2.0 million by 2050. As

such, the need for centers where individuals who have lost their vision can be rehabilitated is

necessary for response to the side effects of baring the loss of vision. It is against this

backdrop that our group, in collaboration with the Bureau of Services for Blind Persons,

purpose to conduct a group therapy for the visually impaired adults. The therapy aims to

reduce the symptoms of depression, anxiety, and social isolation for adults recently diagnosed

with legal blindness in the past one year.

Theoretical Orientation

The study will be based on the theoretical postulations of Erik Erikson (Erikson, Paul,

Heider, & Gardner, 1959). According to Erikson’s theory of psychosocial development,

humans go through eight states of personality growth (Erikson, Paul, Heider, & Gardner,

1959). The process of development through the stages of life is marked by various challenges

that are can be upheld to assist in the future or cause difficulties. Though Erikson believed

that the stages build on the preceding ones, one does not need to master the previous stage to

move to the next. In the current study, the onset of visual impairment on the developmental

life of adults presents varying levels of psychological effects. Erikson’s theory will help in

understanding the depressive implications in relation to the variables of social support, career,

and mobility.

Setting

The Bureau of Services for Blind Persons (BSBP). BSBP holds that the individuals

who have lost their eyesight possess the capacity to achieve employment and independence.

The organization trains the blind and offer other empowering services that assist the visually

impaired to realize their personal goals.

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Target Population

Our groups selected adults who are between 18 and 65 years who lost their vision

within the last year. The individuals were already enrolled at BSBP. Lastly, the segment

selected have their depressive level at a Becks Inventory score of 21. The target group is

greatly affected in key areas such as mobility, careers and social support. However, given the

wide range of age variation in this study, it is imperative to consider the importance of the

age demographic at various stages.

How Adult Visual Impairment Influence Depression

Aspects of Social Support, Career, and Mobility

Permanent loss of eyesight is a traumatizing experience to adults. The change upsets

the psychosocial condition of the adult as well as the economic goals in terms of career.

According to Choi, Lee, & Lee (2018), visual impairment increases the risk of depression,

which varies with age and socio-economic status. Using a sample of 1, 025, 340 participants

in Korea, with a longitudinal design, the three researchers studied the level of depression in

the visually impaired and compared it with the depression level of the control group. The

study was conducted from 2002 to 2013. In another study based in the U.S., Chou, Beckles,

Zhang, & Saaddine (2015) explored how the socio-economic status was associated with

sensory impairment to explore the depressive effect of the loss of vision. There was no

association between economic status and visual impairment. Using content analysis to link

the two variable, the researcher indicated that economic stability reduced the stress due to

visual impairment.

The discourse of visual impairment has been dominated by the need for care for the

older population (Garcia, 2017). Research has also concentrated on the elderly, yet young

adults are worth a significant share of attention. According to Elsman, van Rens, & van
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Nispen (2017), over 200 million people are affected by visual impairment. Although

majority of the visual disability goes to the elderly, over 80 million are between 14 and 49

years (Elsman, van Rens, & van Nispen, 2017). At all the stages, visual impairment comes

with a myriad of challenges both socially, economically, and psychologically.

Elsman, van Rens, & van Nispen (2017) studied young adults between 18 and 25

years to explore the aspect of their lives affected by the loss of eyesight. A sample of 22

visually impaired adults and 16 rehabilitation professionals were enrolled for the study. The

participants were involved in an online concept mapping workshop based on the objectives of

the study. The resulting concepts after multidimensional scaling summed up 11 clusters.

Young adults were found to be affected in their social life, work, mobility, and independence

(Elsman, van Rens, & van Nispen, 2017). The current study concentrates on mobility, work,

and social aspect.

Young adults are in a transitional stage where the majority are concentrating on join

post-high school institution, getting the first dream job, and starting serious relationships. The

stage itself is stressing because of the inexperience of managing these important life aspects

Cherry (2014). For our study population, it is a double tragedy. Imagine a normal high school

graduate who is has received an invitation to join the prestigious Harvard, or the ambitious

young lady who received secured her first recruitment letter. The two are diagnosed with

legal blindness months after achieving such important milestones. The feeling can never be

clearer: it I stressful and humbling, and the outcome is a great depression. Elsman, van Rens,

& van Nispen (2017) notes that regrets that the stage is accompanied by serious challenges

and regrets that the complications are more pronounced for those entering the period with

disabilities.
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Socially, the loss of eyesight presents the risk of reduced participation and social

exclusion. Garcia et al. (2017) argue that visual impairment has significant negative

psychological and psychosocial effects in young, middle-aged and older adults. For young

adults, it brings the problem of initiating and sustaining romantic relations. In the worst case

scenario, young adults with visual impairment may be shunned by their peers. Living with the

reality that one can longer make as many friends and that the few are not interested after

learning of the eyesight loss. Garcia et al. (2017) studied the effects of visual impairment on

the psychological well-being of young and middle-aged adults. The study looked at the

mood, career and interpersonal interactions. Results showed that 49.5% of the 103

participants met the depression criteria after losing their vision. The researchers also found

that participants showed negative interpersonal interaction and work goals.

Career

The depressive levels due to visual impairment vary with age. According to Elsman,

van Rens, & van Nispen (2017), young adults are a special group in terms of psychological

adaptation to the problems brought by the loss of vision. Young adults consider education

important for future socioeconomic status as they are normative social roles to the young

adults. When they lose their eyesight, the dreams of furthering their studies to achieve career

dreams fade and youths become stressed. Older adults are the least affected in career aspects

according to the Erikson’s psychosocial development theory because they worked to achieve

their career goals (Cherry, 2014). Garcia (2017) found that younger adults were affected by

psychological adaptation and coping while the elderly have difficulties in handling social

exclusion since they have reduced social network size. On the other hand, middle-aged adults

are adversely affected by the disruption in their career. At mid-age, adults have spent a good

fortune in establishing a career (Welp et al., 2016). They are keen to keep their positive work

trajectory to help in fulfilling life ambitions and responsibilities. The loss of vision throws
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everything in disarray. Mid-aged adults get depressed because of the fear of losing workplace

positions and career network, leading to dependency.

Mobility

Gleeson, Sherrington, Borkowski, & Keay (2014) posit that posture relies on eye

vision. Loss of visual impairment increase the risk of falls with the increase in age (Gleeson,

Sherrington, Borkowski, & Keay, 2014). According to Welp et al. (2016), the individuals

(adults) who have lost their eyesight recently were enjoying the primary sense that helped in

three-dimensional movement. Loss of vision makes the adults highly vulnerable to falls and

subsequent injury. The relationship between vision loss and mobility problems are

documented in research. Welp et al. (2016), found that 46.7% of individuals with serious

vision problems were found to have fallen within during the past year. The participants for

the study were obtained from the 2014 BRFSS data. The aim of the study was to determine

how prevalent adults who are 65 years or older are to falls or injuries as caused by falls. The

results were compared to the fall rate in adults of the same age but with no visual impairment.

Only 27.7% fell in the past year.

Crews (2016) asserts that adults who have lost their visions are at high risk of falling.

Falling is influenced by factors such as the sensitivity of contrast and lost balance and poor

visual acuity. The adults also become week in their lower muscles, develop other chronic

complications and use numerous drugs. The risk factors increase the chances of fall for the

visually impaired (Crews, 2016). Wahl (2016) looked at the problem of mobility using the

perspective of the physical-spatial environment. The researcher argued that in order to

understand the mobility problem for the individuals who have lost their vision, it is important

to look at the person-environment fit models. Wahl (2013) points out that the person-

environment models have the assumption that environmental problems such as poor lighting
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or floor conditions are likely to reveal a certain strong negative impact when competence is

low. This implies that loss of vision interferes with a person’s vision competency, leading to

locomotion inabilities in troubled environments.

In middle-age, the depression that comes with the loss of eyesight is less compared to

adulthood (Elsman, van Rens, & van Nispen, 2017). However, the effects are still devastating

for a stage of human development characterized by high career ambitions. Chandrasekaran et

al. (2017) conducted a longitudinal study consisting of 483 women in Michigan. They wanted

to assess how the loss of eyesight influenced the future functioning in mid-age. The

participants’ ages ranged between 42 and 56 years. After following the physical functioning

of the participants for up to 10 years, it was found that visual impairment has a negative

effect on the physical functionality of middle-aged women. The effects are linked to mental

effects of poor physical functioning. If a middle-aged woman learns that the recent blind

status have future physical implications, they are likely to be stressed. As Chandrasekaran et

al. (2017) opine, the level of mood defects in mid-age adults are higher compared to older

adults. This implies that adults whose visual impairment are likely to cause future physical

function are more likely to be depressed. Therefore, the adults with new onset of blindness

need support to help in the attenuation of the current and predicted effects on their physical

functioning.

Social Support

Human beings are social, often using the environment for positive social interaction.

Vision, like other sensory aspects, plays a significant role to that effect. The onset of visual

impairment in adulthood upsets the existing social structures established by the adults.

According to Wahl (2013), the social environment influences the mental condition of adults.

The research uses the socio-emotional selectivity theory to explain the psychosocial effects of
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visual loss among older adults. The theory argues that older adults use a good proportion of

their time to maintain close and intimate relationships due to the limited time coming with

old age. With a lost vision, depression levels are likely to increase as it is added to the

inability to make new social ties. The adult gets more depressed when the psychological

insecurity sets in that they can no longer participate fully in maintaining the intimate

relationship.

The studies used in the literature discussion have limitations in proposing ways to

reduce the depressive effects of visual impairment. The purpose of the current study is to

design group therapies for adults recently found blind. Tolman, Hill, Kleinschmidt, & Gregg

(2005) conducted a study to examine the psychosocial adaptation for losing eyesight in

relation to the depressive symptoms. 144 legally blind participants had their levels of

depression observed using psychological screening tools. It was found that adults developed

adaptive factors such as accepting the loss of vision, negative effects of relationships, and

attitudinal response to compensation.

The therapeutic strategies for this group aim to mitigate the depressive effects of

visual impairment in relation to the social support, career, and mobility of the patient. The

study hypothesizes that supportive therapies will help legally blind adults accept the

conditions to reduce depression. The study can form the foundation for future research where

more investigation is done on a larger age segment. Based on the theoretical foundation,

understanding the relationship between a recent visual impairment across all ages helps in

formulating therapeutic strategies that are proactive.

Recruitment: Needs Assessment, Pre-screening Methods

The participants will be drawn from the BSBP program. The existence of the

participants at the facility will help us to conduct a purposive sampling as most of the criteria
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were used when the facility enrolled the visually impaired for their services. However, our

therapy will involve adults whose condition has lasted only one year. The group will consult

trained instructors on matters of sensory sensibility to screen the participants for legal blind

condition and the one-year taken since onset.

Additionally, the demographic data about the participants will be collected at the day

of selection before screening and assessment. The study will be specific aspects such as

mobility, social relationship, and career goals. The inclusion criteria will be as follows: visual

impairment (status <1 year); depressive level (Becks Inventory score of 21), and age (18-65

years). Being that the kind of study will take time, a longitudinal method will be used. The

sessions will be organized after consultation with the management at BSBP to ensure there

are no time-table clashes.

Leadership Skills

The research group offers leadership opportunity skill for the upcoming psychologist.

Although the group will work collectively, the position of a leader is inevitable. The first

skills is effective communication. The leader has to communicate in a clear, open, and

accountable manner. The skills have to be adjusted by multicultural skills due to group

diversity as well as the society which is a significant component of research. Secondly, the

leader should have administrative skills. Skills such as effective planning, delegation of

duties, managing conflicts, and empowering members are vital administrative skill-cum-roles

helpful for leadership. Thirdly, should have the ability to work under pressure to manage the

levels of anxiety that is implicit in the course of research work. Lastly, the leader should be

knowledgeable of the activities and the team members during the research process. The

leader is the reference point for everything, contentious or not. Bundy (2017) argues that the
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team leader can stay knowledgeable by engaging the team with technical questions and

appreciating the capabilities of every member.

Limitations

This study will be carried out among a population who are likely to be traumatized,

making it hard to administer the interventions. However, the researchers will be prepared to

take their time to establish a cordial relationship with the participants The process of data

collection will be tiresome due to the trauma among the participants. Researchers will solve

the issue by getting the consent of the families of the close social ties to the participant by

explaining the benefits of the program.

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