The proposed relationship between the mind and the body has been around since the very inception of medicine. Throughout the development of medicine in the western world a division between the mind and the body was facilitated by changes in philosophy and developments in medications and technology. More recent years has seen the western world return to a more traditional approach to the mind-body link. Research in this field has focussed on a range of issues and in this study, on people’s perceptions and attitudes towards their vision.
The current research project involved analysing the attitudes and perceptions of people who were attending a Natural Vision Improvement Course. Three hypothesis were derived from the previous research findings and theoretical perspectives within the field. Each of these were tested empirically through a statistical analysis on the questionnaire responses of the participants before and after attending the Natural Vision Improvement Course.
The first hypothesis predicted that people's attitudes towards vision would be significantly more positive at the end of the course in comparison to the base-line measures which were given at the start of the course. The second hypothesis proposed that a significant increase would be seen in the participants' perceptions of their level of vision. The third and final hypothesis proposed that there would be a positive relationship between a participants' attitudes towards vision and their subjective ratings of their level of vision. The data provided support for the acceptance of each of these three hypotheses. These findings are discussed with reference to previous research and a consideration is provided of the different areas which future research in this field should focus on.
Everyone has a wide range of attitudes regarding a variety of issues. Such attitudes are based on various factors such as a person's beliefs, values and knowledge. A great deal of research has been conducted over the past century which has investigated the numerous aspects of attitudes. Indeed the study of attitudes was at the very heart of the development of psychology as a science.
A significant element of the drive to understand attitudes has come from different groups of people who are interested in how these attitudes can be changed. Clearly marketing managers are keen to change peoples' attitudes towards their brands through techniques such as advertising with the aim of improving the reputation and sales of their products. Politicians are keen to change peoples' attitudes towards the key political issues of the time and towards their political party. Such a move is aimed at improving a given political party's performance within elections.
Recent years have seen an increase in the health profession's interest in people's attitudes towards various health issues. Understanding these attitudes and the way in which attitudes can be changed can ultimately help to improve people's health. This interest has led to the rise of the mind-body link debate. Through history approaches such as those involved in Chinese medicine have emphasised the importance of treating the soul as well as the body. However, until the middle of the 20th century, the western world had focussed on the division between the mind and the physical body. After the second World War, researchers and theorists in the western world began to re-affirm the mind-body link and to begin to develop techniques which are aimed at using the mind to facilitate positive changes in the body.
Research has indicated that the use of positive thinking can influence people's perceptions of their body and promote more positive feelings of being healthy. From the common cold, through basic medical procedures to more serious diseases such as cancer, they have all been the focus of research which has aimed at testing and emphasising the role played by the mind in the treatment of each of these issues. By understanding the nature and magnitude of such a role, attempts can be made to benefit from this understanding and to create treatments which are comprehensive and as effective as possible.
Mind-body interventions have taken a range of different forms. They have included self instructed techniques such as self-hypnosis or the use of audio tapes. Information has also been provided for people to read and educate themselves in the techniques available. Alternatively, these techniques can be directly taught by an instructor through a one to one or a group interaction over a short lecture or over a longer period of time through a training course.
One of the most recent subjects of the attention of the mind-body link is a person's vision. Clearly a person's vision is a crucial sense with a significant portion of the information that an individual receives arriving via the visual channel. The question has been raised regarding whether or not by facilitating changes in a person's attitudes and mind it is possible to significantly change their perceptions regarding their own level of eye sight. Most of the debate in this field has predominantly been theoretical with only a limited amount of research evidence being available. The evidence which has been offered is based on training courses which have reported an increase taking place between a participants' perception of their own vision prior to and after attending the training course. It has been concluded from this that such training courses can promote significant improvement in participants' perceived level of vision. However, such research has yet to address the participants' relevant attitudes and to investigate whether changes in such attitudes are associated with the improvements in perceived vision. This need has led to the current research project.
The following discussion will consider the study of attitudes and provide a definition of what the term has been taken to mean for the purposes of this research project. The different aspects of attitudes will be addressed along with the different functions which attitudes perform. Then the topic of attitude change will be discussed. The major theory proposed for explaining attitude change will be provided and analysed. The process of attitude change will also be outlined along with other relevant factors such as expectancy, involvement and whether or not the participant is voluntarily involved in a situation to which the attitudes relate.
The topic of the mind-body link will then be critically reviewed in terms of its historical development. The different interventions which have been developed to utilise the mind-body link will be considered along with the research which has addressed their efficacy and effectiveness. The case of people's vision in particular will then be discussed along with the theory and research which has been proposed to address the relevant research questions. The methodology employed within the current study will then be reported in terms of the design of the investigation, the materials used, the participants involved and the procedure which was used in order to collect the data required. Then the results will be presented and analysed in terms of how they relate to the three main hypotheses of the research project. These findings will be related back to the previous research in this field and their contribution to the debate will be demonstrated. Finally the areas which should be address by future investigations in this research area will be outlined before the conclusions of the current study are provided. 3.0 LITERATURE REVIEW
The following review of the relevant literature will be discussed within four key areas. Firstly,, attitudes in general will be considered in terms of a definitions, its relationship with belief and values and the function which attitudes fulfil. The second area of the literature review will cover the concept of attitude change. A major theory in this field will be provided and the various factors which can influence attitude change will also be analysed. The third section will address the research and theories which have focussed on the mind-body link. The potential positive effects of this relationship will be outlined along with the different interventions which have been designed to utilise it. The potential negative effects will also be considered before the research which is related to the specific relationship between the mind and a person's vision is considered. 3.1 ATTITUDES
Before discussing the concept of attitude change, it is important to first determine how the term 'attitude' has been defined for the purposes of this research project. The study of 'attitude' was one of the fundamental topics of concern at the very birth of psychology as a science. Allport (1935) stated that the concept of attitudes is the most distinctive and indispensable topic within the field of social psychology. Even in more recent years, the study of attitudes has continued to fascinate researchers and to be an integral part of social psychology (Hogg and Vaughan 1995). Attitudes as a research field is relatively broad and contains many different aspects and issues. Some attempts have been made to highlight the key areas of attitude research.
For instance, Stainton-Rogers (1995) suggested that there are four key questions to be asked and answered regarding the study of attitudes. These areas are:
* Where do our attitudes come from? * How can attitudes be measured? * How and why do attitudes change? * How do attitudes relate to behaviour?
These questions help to demonstrate the range of issues and debates which are relevant to the study of attitudes. The remainder of this section on attitudes will provide a definition of what is meant by the term attitude. It will then move on to briefly consider the difference between attitudes, beliefs and values before discussing the different functions that are fulfilled by attitudes. 3.1.1 A DEFINITION OF ATTITUDES
As a result of the range of aspects which are associated with attitudes, and the variety of situations to which the term attitudes is applied, defining it is not a straight forward task. Perhaps the most comprehensive definition of attitudes was proposed by Rosenberg and Hovland (1960). They define attitudes as follows:
"Attitudes are predispositions to respond to some class of stimuli with certain classes of response" (Rosenberg and Hovland 1960).
Rosenberg and Hovland (1960) went on to expand upon what they meant by 'classes of response'. They suggest that the responses come in three main forms. The first of these is defined as Affective. This refers to the feelings that an individual has towards a given object of their attitudes and the way in which they evaluate it. The second class of response is Cognitive. This concerns what the individual believes about a given object of their attitudes and what they think it is like. The third and final class response relates to Behaviour. Specifically it concerns how they would behave, or would intend to behave, regarding a given attitude. It could be argued that this approach is perhaps more accurately described as a model of the structure underlying attitudes rather than a direct definition of attitudes. However, the complexity of the concept of attitudes ensures that this model approach provides a more comprehensive and appropriate conceptualisation of attitudes rather than a simple sentence describing what the term attitudes means.
3.1.2 ATTITUDES, BELIEFS AND VALUES
Whenever one is discussing attitudes, it is important to draw distinctions between attitudes and other terms which are often used in order to convey the same meaning. This helps to ensure that correct concepts are being analysed and researchers are clear regarding the semantics of the topic within which their research is being conducted.
Attitudes are often a blend or integration of other similar terms such as beliefs or values. Beliefs are knowledge or information which we have about the world around us. Whether or not such knowledge or information is factually accurate is somewhat irrelevant. The fact that an individual believes it is the important issue as it is their beliefs which will help form, influence and change an individual's attitudes. Fishbein and Ajzen (1975) suggest that a belief involves an individual associating an attribute with the object of an attitude. One can illustrate this by using the example of smoking behaviour. An individual may hold the belief that smoking (which is the attitude object) damages your health (which is the belief). Therefore they will associate the attribute of negative health consequences with smoking behaviour. Obviously such a belief is likely to influence the individual's attitudes towards smoking behaviour. However, in order that such a belief is converted into an attitude, researchers have argued that the concept of 'value' also needs to be considered.
A 'value' is what an individual perceives as being desirable or worthwhile. Roqeach (1968) suggested that a value is an enduring belief that a specific mode of conduct is either socially or personally preferable relative to alternative modes of conduct. In other words, to continue with the smoking behaviour example, the extent to which an individual perceives smoking to be personally or socially desirable is a question which merits consideration when one is attempting to determine and understand the individual's relevant attitudes towards smoking.
In extending this concept a stage further, Fishbein and Ajzen (1975) suggested that 'expectancy' is also important. Within their Expectancy Value model, they propose that the desirability of a given possible outcome must be considered alongside an individual's expectation of the likelihood of such an outcome actually happening Therefore, although a person may have the value that smoking does have negative health consequences, they may also perceive that 'it will not happen to them' and hence this is also likely to effect their attitudes towards their own smoking behaviour.
Jonas et al (1995) argued that all of these relevant concepts have a part to play in determining an individual's attitudes and thus they all need to be taken into account. People form their attitudes based on beliefs, values, expectancy, knowledge and behaviour. In order to understand attitudes further, one must consider the function which they perform.
3.1.3 THE FUNCTION OF ATTITUDES
Researchers in this field have attempted to conceptualise the function of attitudes for years. Perhaps the most comprehensive framework was provided by Kats (1960). Four key functions of attitudes were highlighted. The first of these was related to Knowledge. It is suggested that attitudes are used to provide a meaning for experiences and to offer a frame of reference for making judgements. The second function of attitudes is labelled Adjustive. This area highlights the significance played by the social group to which an individual belongs. In order to gain acceptance to a given social group an individual may adapt their attitudes and hence they perform the function of enabling social inclusion. Value Expression is said to be another key function of attitudes. They afford a form of self expression and allow the individual to gain confirmation regarding positive aspects of the self. They also enable the individual to experience a sense of integrity. The fourth and final function of attitudes is based on the psycho-dynamic approach and concerns Ego-Defences This means that an individual can use their attitudes to protect themselves from having to admit their own deficiencies. Therefore an individual may have negative attitudes towards people who regularly attend a gym. Such attitudes may in fact be based on the individual's lack of motivation to go to the gym themselves and hence they adopt the negative attitude to overcome a personal deficiency.
This section has provided a definition of what the term attitude was taken to mean for the purposes of this research project. Beliefs and values has also been discussed in order to clarify there link with attitudes. Finally the different functions that an attitude can fulfil were also considered. The next section will now consider how attitudes can be changed.
3.2 ATTITUDE CHANGE
Based upon the different aspects of attitudes which have been discussed above, one can form an understanding of how attitudes can be changed. Laswell (1948) suggested that in order to understand or predict attitude change one needs to consider who says what, to whom it was said, the channel through which the communication took place and the effect of the communication. Other researchers have highlighted the need to address all of the different aspects which are involved in the process of attitude change (Hovland and Janis 1959). In order for a person to change their attitude towards a given issue, McGuire (1969) suggested that there are five key stages, all of which must be involved if the attitude is to change. The individual needs to receive the message, comprehend the message, yield to the information provided, retain the information and act differently as a result.
As well as considering the process of attitude change, it is important to identify models which have focussed on how people can be persuaded to change their attitudes. An example of this is the Heuristic Model which was proposed by Chaikan (1987). It theorises that if a person is highly involved in the topic then they will be persuaded by the strength of the argument which is provided. However, if the person has a low involvement then factors such as the expertise and the level of favouritism shown towards the information source, the number of supporting arguments, the presence of statistics and whether other significant people hold the attitude. As well as these factors, the function of the argument is also said to be important. Shavitt (1990) provides the example of the sales technique used to sell air conditioning units. People's attitudes towards the products were more significantly changed when the message focussed on the health benefits rather than those associated with the social identity linked with air conditioning. One of the major theories of attitude change will now be discussed.
3.2.1 THEORIES OF ATTITUDE CHANGE
Many of the approaches which have been proposed to help understand attitude change are fundamentally based on the concept of cognitive consistency. Humans are seen as information processors which attempt to achieve a level of consistency in their cognition. The major theory proposed in this field is the Cognitive Dissonance Theory (Festinger 1957). The theory suggests that when an individual holds two different attitudes which are psychologically inconsistent, this causes them dissonance. They then need to change one of the attitudes in order to remove the dissonance and achieve cognitive consistency. Through this, the human is seen as rationalising rather than rational. Dissonance can take two forms.
Dissonance can occur as a result of a decision. When a decision is made, an individual can change their attitudes towards the rejected options so that they can justify their choice and remove any associated dissonance (Brehm 1956). Dissonance is also associated with effort. Aronson and Mills (1959) suggested that the more effort a person puts into a task, the more motivated they will be to have positive attitudes towards the experience and the outcomes.
Therefore this theory highlights how people's attitudes can be changed. Other factors have also been shown to play a part. For example, the presence of threats (Aronson and Carlsmith 1963, Freedman 1965), rewards (Carlsmith et al 1966) and whether an individual's participation in an event is voluntary (Freeman 1963) all have the potential to significantly effect an individual's related attitudes. This section has provided an understanding of the research and theoretical perspectives which have addressed the process involved in attitude change. Based on this information, it should be possible to design information, interventions and training courses which have a significant impact on people's attitudes. The next section will now consider the mind-body link along with the research and theories which have been proposed to investigate and understand it.
3.3 THE MIND-BODY LINK The Mind-body link focuses on the interactions among the brain, mind, body, and behaviour, and the powerful ways in which emotional, mental, social, spiritual,, behavioural and attitudinal factors can directly affect health (Wolsko et al 2004) It regards as fundamental an approach that respects and enhances each person's capacity for self-knowledge and self-care, and it emphasizes techniques that are grounded in this approach. There are a range of mind-body intervention strategies that are thought to promote health, such as relaxation, hypnosis, visual imagery, meditation, yoga, biofeedback, tai chi, cognitive-behavioural therapies, group support, autogenic training, spirituality, and specifically designed training courses Illnesses are viewed as an opportunity for personal growth and the role of a health professional or service provider is to facilitate these positive changes. The idea that the mind has an important part to play in the healing process was advocated more than 2000 years ago within traditional Chinese medicine. Even earlier than this, Hippocrates in 400BC recognise the moral and spiritual aspects of healing and that effective healing can only occur if relevant attitudinal, environmental and natural remedies are considered. Although such approaches were maintained in the East, subsequent, changes in the West saw a separation between the spiritual and emotional aspects of health and the physical body. Western developments regarding medical technology, such as the blood pressure cuff, facilitated the division between the body and the mind within health care philosophy. The physical 'cellular' world was viewed as being far removed from beliefs and emotions. Further developments such as the discovery of bacteria and the use of anti-biotic medication aided the separation of beliefs and the health of an individual. The focus of those attempting to cure an individual was predominantly based on the use of science through medication and technology rather than on 'the healing of the soul'.
It was not until the 1920s that the direct relationship between stress and neuroendocrine responses in animals was identified (Cannon 1932). Through using the phrase 'fight or flight', Cannon (1932) highlighted the link between sympathetic or adrenal activation in response to perceived dangers or environmental factors such as the cold or heat. Selye (1956) also identified the significant effects that stress has on an individual's health which further demonstrated a biological emphasis in terms of the conceptualisation of health. The development of technological and pharmacological approaches continued to increase at an ever growing rate. Within medicine in general, and even in psychiatry, there was a focus on the disease disease-based model, the search for a specific pathology and on finding an external cure.
Despite this focus on the physical body in the western world, some researchers did begin to investigate the role played by the mind. During World War 2 there were clearly a large number of people who were in pain and there was not always appropriate medication available to alleviate their distress. However, Beecher (1959)found that sufferers did report feeling less pain after they had been injected with saline. Beecher (1959) suggested that the improvement was not actually related to a physical change caused by the saline but rather through a 'placebo' effect. It was the experience of being injected and believing that it would alleviate the pain which had caused the positive change. Beecher (1959) then went on to suggest that up to 35% of the response to any medical treatment could be due to the placebo effect. Such evidence lends support to the view that the mind has a significant part to play in terms of an individual's health. From the 1960s onwards, research in this field steadily increased. Some of the findings of this research will now be discussed to demonstrate the positive effect of the mind and a positive attitude on the body.
3.3.1 POSITIVE MIND-BODY EFFECTS
Over the past twenty years, research has indicated that the mind can have an important role to play in the treatment of a range of different illnesses and diseases. For instance, Rutledge et al (1999) found that when used alongside traditional treatment, a mind-body intervention for coronary artery disease can help to reduce all-cause mortality rates and the occurrence of cardiac events for up to two years. Clinical trials have also shown that mind-body interventions can be used in the treatment of Arthritis. Luskin et al (2000) found that the pain associated with Arthritis can be reduced for up to four years via these techniques whilst also significantly reducing the number of visits from a physician which were required. These interventions have also been used to some effect with more general pain such as that suffered in the form of headaches or lower back pain. Astin et al (2003) demonstrated this positive effect empirically, but the extent to which this effect is significant depends on the target population and the specifics of the intervention used.
A range of studies focussing on different types of cancer have shown that mind-body interventions can improve mood, quality of life and coping skills (Mundy et al 2003). It can also help with treatment-related symptoms such as the nausea, vomiting and pain which can be associated with chemotherapy (Mundy et al 2003). Although such research evidence has indicated that mind-body interventions can help with the specific disease parameters, it is still unclear whether such effects have a significant impact on the prognosis of the disease (Irwin et al 2003, Kiecolt-Glaser et al 2003) Having said this, research evidence has leant some support to the view that psychological factors have a significant impact on the development and exacerbation of complaints such as the common cold (Cohen et al 2003) and Asthma (Smith AND Nicholson 2001). Some of the interventions which have been specifically designed to facilitate the positive effects of the mind on the body will now be considered. 3.3.2 MIND-BODY INTERVENTIONS Research has been conducted in order to assess the efficacy and effectiveness of different mind-body interventions. For example, Meditation is an approach which aims to facilitate physical changes via relaxation exercises (Lazar et al 2000). Meditation was shown by Davidson et al (2003) to be associated with increases in left-sided anterior brain activity which Is an area of the brain that is linked with positive emotional states. Davidson et al (2003) also found that meditation was linked with an increase in antibody titers to influenza and it led them to conclude that there is an association between meditation, positive emotional states, local brain activity and improved immune function. Techniques have also been developed which are aimed at reducing the stress associated with surgery.
Tusek et al (1997) conducted a study with patients who were undergoing elective colorectal surgery. In an experiment, half of the participants were given audio tapes which contained mind-body information and they were also instructed in terms of guided imagery techniques. It was found that these patients recovered more quickly and spent fewer days in hospital relative to a group of patients who had been given control tapes. Lang et al (2000) conducted research regarding the pain suffered by people undergoing vascular and renal procedures. In the control group and a second group using selection attention, pain was seen to steadily increase as the length of the procedure increased. However, for a group of patients who were using self hypnosis techniques, the pain was seen to remain constant. Thus far this discussion has demonstrated that the link between the mind and the body can be used to promote positive effects. However, other investigations have indicated that the potential may also be there for negative effects to occur.
3.3.3 NEGATIVE MIND-BODY EFFECTS The mind has the potential to have both positive effects (through mind-body interventions) and negative effects (through stress and depression) on an individual's physical health. The effects of the mind on the body have also been found to be negative in some circumstances. For instance, Braswell (2000) found that thinking negatively can be associated with a reduction in immune response as well as an increased susceptibility to the effects of stress, fatigue and higher blood pressure. Therefore, whenever one is designing, implementing and evaluating a mind-body intervention, one must be conscious of the potential for negative as well as positive effects to be occurring. By keeping this potential in mind it should be possible to monitor for it and take steps to ensure that its prevalence is minimised. The specific case of the link between the mind and a person's vision will be the focus of the next stage of this discussion.
This discussion has shown that a range of interventions have been developed to target different aspects of the body. One of the more recent growth areas is that which has focussed on whether the mind and positive attitudes can effect vision. Leviton (1992) highlights the importance of vision with approximately 90% of the information which we receive coming via this communication channel. Some 'Natural Vision Improvement Workshops' have been developed in order to promote positive attitudes towards vision and therefore an improvement in an individual's subjective vision. Some empirical research has provided support for the view that such positive changes can be made (Lieberman 1993). However, further research is require to assess attitude change regarding vision and the association between this and a person's subjective vision. This need gave rise to the current research project. The three hypotheses which were central to the current research project are listed below.
The hypotheses for the current research investigation are:
A) There will be a positive change in participant's attitude towards vision from the beginning to the end of the Natural Vision Improvement Workshop.
(B) There will be a positive improvement in participant's subjective vision scores from the beginning to the end of the Natural Vision Improvement Workshop.
(C) There will be a positive relationship between participant's attitude towards vision and their reported visual acuity.
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The reported research investigated the potential link between positive attitudes towards vision and a person's subjective opinions regarding their vision. The research involved 29 participants completing a two-day Natural Vision Improvement Course. Participants completed questionnaires before and after the course in order that the effects of attending the course could be recorded and analysed. Based upon the previous research in this field, three hypotheses were derived for this investigation. Each of these will now be discussed in turn with regards to whether they can be accepted or rejected and how the findings relate to other research.
6.1 HYPOTHESIS A
The first hypothesis concerned the participants' attitudes towards their vision. It was hypothesised that:
A) There will be a positive change in participant's attitude towards vision from the beginning to the end of the Natural Vision Improvement Workshop.
The ratings provided by the participants regarding their attitudes towards vision were found to be significantly higher after the Natural Vision Improvement Course relative to those ratings which were given before the course. Therefore, this finding would lead one to conclude that the course did promote a positive change in the participants' attitudes towards vision and hence Hypothesis A can be accepted. This presents an interesting finding and one which would advocate people attending the course.
It does appear from the statistical analysis that a positive change in the participants' attitudes did take place. In order for this to occur, McGuire (1969) would argue that five key stages had been present. Firstly, the participants will have needed to have been given the message. They would then have needed to comprehend it, yield to it and then retain it. The fifth and final stage theorizes that the participants would then need to act on it and hence change their attitudes towards the object, or in this case, towards their own vision. This theory would lead one to conclude that as a positive change was identified, then all of these requirements had been met. Therefore the Natural Vision Improvement Course can be recommended as being effective in this regard.
An important point which needs to be made here concerns the 'involvement' of the participants. Chaikan (1987) argued that if a person is strongly involved in an issue then it is the strength of the argument which determines attitude change. One may argue that in the case of the participants on the Natural Vision Improvement Course were relatively involved in the issue as they have paid to attend the course and hence were presumably interested in the field. The strength of the argument given by the course provider was then strong enough to change the participants' attitudes.
A situation in which participants had a lower level of involvement would be an interesting one and should perhaps be an area that future research should focus on. Chaikan (1987) argued that when the receivers of an argument have a 'low involvement' it is factors such as the perceived expertise of the course provider, the extent to which they are liked, the number of arguments used, the statistics provided to support these arguments and the attitudes held by significant others which have the most significant parts to play. Therefore by investigating the effectiveness of the Natural Vision Improvement Course on people who were relatively more skeptical to the topic should theoretically mean that these other heuristic factors have a more significant part to play and this merits further research.
Therefore this research has shown that attending the Natural Vision Improvement Course resulted in the participants having significantly more positive attitudes towards their vision. Such attitudes are important as they can fulfill the function of helping the individual to understand and give meaning to the world around them (Kats 1960). Based upon this evidence, and the theoretical perspectives which have been discussed, one can conclude that a positive attitude change towards vision had occurred as a result of attending the Natural Vision Improvement Course and hence the acceptance of Hypothesis A can be supported. The second hypothesis of the reported research will now be considered.
6.2 HYPOTHESIS B
The research also investigated the effect of attending the Natural Vision Improvement Course on the participants' subjective ratings of their own vision The people who took part in the research were required to subjectively measure their own perceived eye sight on eye charts before and after completing the two-day workshop. It was anticipated that the participants would report experiencing an improvement in their eye sight after the course and hence the following hypothesis was proposed:
(B) There will be a positive improvement in participant's subjective vision scores from the beginning to the end of the Natural Vision Improvement Workshop.
The statistical analysis found that a significant subjective improvement was revealed both with reference to the right eye, the left eye and when using both eyes simultaneously. Based on this evidence, the second hypothesis of this research can be accepted in that a significant improvement was found in the participants' subjective opinions of their eye sight. Clearly this provides further support for the effectiveness of the Natural Vision Improvement Course in that it has been shown to achieve an improvement which is likely to be at the centre of its objectives.
Having said this, it is necessary to outline a number of caveats to accompany this finding. Firstly, the issue of expectancy is of relevance to this research. Fishbein and Ajzen (1975) suggested that a person's attitude, and the extent to which it is changed, depends to a large extent on their expectations regarding the situation. Clearly when the participants signed up to take part in the Natural Vision Improvement Course they will have probably done so with the expectation of them experiencing an improvement in their eye sight. This is likely to have had an impact on their subjective ratings of their own eye sight. When they were measuring their eye sight after the completion of the course, they would presumably have been looking for an improvement and this could potentially have led to them reporting an improvement which was partially based on expectations rather than a true measure. Therefore, when one is considering the improvement seen in this research, one must keep in mind that the participants were expecting such an improvement and may have been looking for it in a way which influenced their perceptions.
Another point which needs to be made here is that people's perceptions and attitudes can depend upon the presence of rewards (Carlsmith et al 1966). This reward can take a number of different forms. For example, by reporting an improvement the participant rewards themselves by believing that they can now see better. Clearly sight is an important sense (Leviton 1992), and if one believes that their sight has improved then they are likely to feel happier as a result. A second reward is present which is related to the participant. By perceiving an improvement in their eye sight as a result of attending the Natural Vision Improvement Course, the participant rewards themselves for attending the course and hence justifies their choice to attend the workshop. This justification will again reward the participants. In contrast, if they had not seen an improvement then this would have been likely to disappoint the participants and hence this in turn could have created a motivation to perceive an improvement. A third and final form of reward relates to the demand characteristics which are associated with the situation and to the research team. Whenever a person takes part in research there are some demand characteristics on their participation which have the potential to influence their attitudes, beliefs and the data which they provide during the research. Participants may have felt a demand being placed upon them by the researcher and the course provider to report an improvement in their eye sight. If any such demand was present then it is not necessarily a criticism of the research as an attempt was made at all times to ensure that the participants gave truthful responses. However, the participants may have wanted to please the researcher and course provider by reporting positive results. The reaction created by an improvement could have provided another form of reward for the participants which could have influenced the data which they provided.
A final factor which could present a limitation to the methodology employed within this research is that the participants had paid to come on the workshop. It could be stated that the people contained within this sample were more likely to report significant differences than the general population as the fact that they have enrolled on the course indicates that they are unlikely to be skeptical towards such mind-body interventions. Previous research has shown that whether or not a person is voluntarily taking part in a task has a significant impact on their attitudes towards it (Freedman 1963). Clearly this is a limitation which would be difficult to overcome. One cannot force people to attend a course if they are not willing to do so. However, if a given organization was running such courses for its employees, for example, then the sample involved would be randomly taken for all of the employees who worked for that organization. This could provide a more representative sample of the general population and hence allow results which could more confidently be generalized.
Therefore this research project found that attending the Natural Vision Improvement Course did result in a significant increase in the participants' subjective ratings of their own eye sight. However, a number of potential limitations have been highlighted which ensure that it is difficult to confidently accept the findings and generalize them to the general population. Due to factors such as the participants' expectations, the various rewards available to them regarding positive results and the fact that the participants paid to take part all mean that further research would be required to clarify the magnitude and cause of any positive changes in perceived eye sight as a consequence of attending Natural Vision Improvement Course. The research will now be discussed in terms of the third and final hypothesis.
6.3 HYPOTHESIS C
The third and final hypothesis of this research concerned the relationship between the two variables which were discussed within the other two hypotheses. It was proposed that as a participants' attitudes towards their own vision became more positive, their subjective ratings of their own eye sight would also positively increase. Therefore the following hypothesis was proposed:
(C) There will be a positive relationship between participant's attitude towards vision and their reported visual acuity.
It was concluded based on the data collected within this research that a positive relationship did exist between participants' attitudes towards vision and the subjective ratings of their eye sight. Therefore Hypothesis C was also accepted. This is a correlational relationship and hence it is difficult to conclude the direction of the relationship. Whether positive attitudes lead to improvements in perceived vision or vice versa is not possible to determine, but a positive correlation was seen to exist. The Cognitive Dissonance Theory, proposed by Festinger (1959), can be used to help explain this finding. As proposed by the Cognitive Dissonance Theory, when an individual has two different cognitions which are psychologically inconsistent, this can cause dissonance. As a result the individual has to change one of their cognitions in order to return to a state of cognitive consistency. In the specific case of this research, a negative attitude towards vision and a positive perceptions of the quality of an individual's vision may cause dissonance and hence lead to the individual changing one of their cognitions. In this case the individual may change to have a more positive attitude towards vision such that this attitude is consistent with their positive perceptions of their own level of vision. This could also work in the other direction in that a positive attitude towards vision may not be consistent with a negative perception of an individual's level of vision. Therefore the theory would suggest that the individual could change their perception of their subjective level of eye sight such that it is more consistent with their other cognition.
An issue which is relevant here is the Placebo effect. Beecher (1959) showed during the second World War with soldiers that treatments can be given to promote significant reductions in the level of pain experienced that are predominantly based on the belief that the treatment would cause such an improvement. As Beecher (1959) went on to claim, up to 35% of any treatment is likely to be based on the placebo effect. With reference to the present study, it may be the case that the positive attitude led to the participants believing that a positive change in their vision would occur. Therefore, the placebo effect has contributed to a subjective improvement rather than an actual improvement. However, this is not necessarily a negative point. Whether or not an actual improvement has taken place is somewhat irrelevant. If the participant believes that a significant improvement in their eye sight has taken place then they are going to be happy with the results of the course and the course can be said to have achieved its main objective. It would therefore be concluded that the Natural Vision Improvement Course facilitated a significant increase in both the participant's positive attitudes towards vision and in their subjective ratings of their own vision, which would ultimately be its aim.
Therefore the extent to which the improvement is based on the placebo effect or on actual physiological changes can be questioned. However, one can conclude from the data collected within this research that when a person's attitude towards vision became more positive, an associated significant increase in their perceptions regarding their own eye sight was observed. As a result of this finding, Hypothesis C can be accepted and a positive relationship can be said to have been shown to exist.
This finding has a contribution to make to the wider arguments in this field of research. It supports the findings reported by Lieberman (1993) in that a Natural Vision Improvement Course can have positive effects on a person's subjective vision. This current research actually went a stage further to include attitude change. It has provided evidence that attitudes regarding vision can be changed through a course and that this change appears to be linked with the improvements in perceived vision.
These findings also have wider implications for the mind-body link debate. It builds upon the findings of researchers like Lang et al (2000) who found that mind-body techniques can be used to reduce pain experienced during a specific medical procedure. It demonstrates that longer term mind-body interventions can be used to have positive effects. Therefore the potential for mind-body interventions can be said to go beyond short term effects to help promote more permanent changes in a client or patient's attitudes and perceptions. However, the ratings given during this research were at the start and the end of a weekend course. It would have been interesting to obtain some follow-up data in order to test the extent to which any changes remained significant. It may be that, due to a variety of reasons, the significant improvements found in this research were short term and that if the participants were questioned a few days, weeks or months later, then their attitudes and perceptions may have fallen back to the base-line levels. Further research in this field should be conducted in order to assess the longer term changes in attitude and perception which are facilitated by the Natural Vision Improvement Course and other mind-body interventions in general.
The findings of this research also have implications for the formats via which mind-body interventions are delivered. Research such as that conducted by Tusek et al (1997) with patients undergoing elective colorectal surgery, showed that mind-body techniques can be delivered via audio tapes and other information. Through this method the patient studies the information about the mind-body link and this in turn has positive effects. The present study has shown that this information can be provided through a personal interaction with an expert in the field. These findings would advocate the establishment of more courses to deliver mind-body techniques. More research is required in this field to test the efficacy of different possible methodologies for the delivery of mind-body interventions. The efficacy of a range of techniques have been demonstrated within this and previous research. However, more investigations are needed to clarify which mind-body interventions are more effective and whether different approaches are more effective when working with different clients or patients or when focussing on different aspects of the mind or body.
Finally, the positive relationship between attitudes towards vision and subjective ratings of eye sight lends more support to the mind-body relationship. Many researchers have advocated the range of ways in which an individual's mind and body are linked and on how this relationship can be used to have positive effects (Wolsko 2004). By understanding such a relationship, interventions can be designed, implemented and evaluated which aim to educate and influence the mind such that positive effects on the body can be caused.
This also lends further support against the view that there is a clear division between an individual's psychology and physiology. Early research, such as that conducted by Cannon (1932) and Selye (1956) demonstrated specific physiological processes which were thought to occur independently from the mind. However, the findings of the current research suggest that by attending a Natural Vision Improvement Course, a person can change their attitudes and this in turn can help change their perceptions of their body. It is unclear whether or not any physiological changes have actually taken place and this is a question which merits further investigation. 6.4 FUTURE RESEARCH
The mind-body link has been the subject of an increasing amount of research over the past twenty years and this growth is likely to continue into the future. It is important to consider the different areas which this further research should address and investigate. It would be interesting to conduct this form of research focussing on other senses. For instance, an investigation on whether positive attitudes towards hearing could promote an increase in a person's perceived hearing ability could provide some interesting findings. Research is also required to investigate the efficacy and effectiveness of different delivery options It may be that delivering the Natural Vision Improvement Course via audio or video tape may have provided significantly different results. It may also be the case that different techniques are more appropriate depending on the aspects of the mind and body that are of interest. Further research would help to clarify this situation.
Another important issue for researchers in this field to address in the future concerns the target population of the research. Within this research the participants had all paid to attend the course. It would be interesting to investigate whether the same findings could be replicated with people who are less involved in the topic. It would be in these circumstances that other factors such as the perceived expertise of the course provider, the extent to which they are liked, the number of arguments that are used, the statistics provided to support these arguments and the beliefs of significant others which may have significant roles to play (Chaikan 1987). Clearly research would need to control for, and assess the influence of, these other relevant factors.
Other factors regarding the target population of any research need to be considered. Various demographic factors all have the potential to have a significant impact on any changes in attitudes or perceptions. The participants included within this study were of both genders and had a range of ages. However, the influence of these factors was not assessed. Future research could investigate whether different approaches are more effective based on gender or age. Such research would help to ensure that the mind-body intervention used and selected based on the personal characteristics of the client and patient with the aim of it being the most feasible and effective approach.
One area of this field of research which has witnessed relatively little attention concerns the long term effects of any mind-body interventions. Both in this research project and in other research within this field, has focussed on the short term and initial effects of any technique. It would be interesting to follow-up the participants in this research and re-test their eye sight in order to determine whether the significant improvements which had been seen after the course were still present. It would also be interesting to assess whether or not their positive attitudes towards vision were still evident or whether they had returned to their base-line level.
Although much theory has been proposed regarding the mind-body link, it is still not clear what changes actually take place as a result of mind-body interventions. Whether it is subjective changes which are partially based on the placebo effect or on actual physiological changes It would be interesting to conduct further analysis of the participants within the study to investigate whether measurable changes in the participants' eye sight had taken place. By an potation conducting an eye sight on the participants, a more objective measure could be obtained and the nature of any changes could be further clarified. Research would also be interesting regarding the negative aspects of the mind-body link such that they can be avoided where possible (Braswell 2000).
Therefore a wide range of research questions and issues are still prevalent and merit the attention of researchers in this field in the near future. Traditionally an experimental and quantitative approach has been employed. Data could also be obtained using qualitative methods in order to gain a deeper understanding of the participants' experience of a mind-body intervention. Within the reported research, focus groups could have been conducted after the Natural Vision Improvement Course in order that the participants experience and perception of the course could be investigated. 7.0 SUMMARY AND CONCLUSIONS
The present study involved investigating the effects of attending a Natural Vision Improvement Course on participants' attitudes towards vision and their subjective ratings of their vision. By using questionnaires before and after the two-day course it was possible to statistically analyse the data to determine whether or not any significant changes had taken place. Three different hypotheses were proposed for the current research and data collected supported the acceptance of each of them.
The first hypothesis proposed that attending the Natural Vision Improvement Course would lead to a significant increase in the participants' attitudes towards vision. The increase found between the participants' ratings of their attitudes towards vision were found to significantly increase from before to after the course and hence the first hypothesis can be accepted. Therefore, this research has illustrated that the use of a specifically designed training course can promote peoples' attitudes towards their body and its functioning.
The second hypothesis for this research project was that attending the Natural Vision Improvement Course would cause a significant increase in the participants' perceptions of the level of vision. The subjective ratings given by the participants before and after the training workshop were found to significantly increase. It was concluded from this that such courses have the potential to significantly improve people's perceptions of their body's functioning regarding vision. The second hypothesis was therefore accepted. It could be the case that such a finding could be replicated with people's perceptions of other parts of their body.
The third and final hypothesis of this research was that there would be a positive relationship between people's attitudes towards vision and their subjective ratings of their level of vision. Both of these statistics were found to increase and it was concluded from this that a positive relationship was found to exist. Based on this the third hypothesis of the research was accepted. Therefore by encouraging people to have more positive attitudes towards vision, one can help to increase a person's perceived level of vision. This finding encourages further investigations both in this field and in other related fields.
This research has provided evidence to support the growing movement of researchers and theorists who advocate the relationship between the mind and the body. By making alterations to the mind it seems that it is possible to make perceived changes to the body. By continuing this move back towards the mind-body link, the western world can complete the full circle and return to the traditional approach of Chinese medicine. The mind and soul can be viewed as crucial elements in the treatment of humans and they need to be addressed if a comprehensive treatment program is to be achieved. Over 2000 years ago, Hippocrates emphasised that the moral and spiritual aspects of the human being need to be considered when treatments are being designed, implemented and evaluated. By focussing on people's attitudes, environmental factors and natural forms of medicine, Hippocrates in 400BC suggested that the soul can be treated which can in turn have significant benefits for the body. It would appear that the recent growth of interest in this research field and in mind-body interventions is only likely to continue to grow into the near future such that a move towards the optimal treatment program can be achieved and that people's attitudes towards their vision, and other aspects of their body, can be maximised. This in turn should help facilitate significant increases in people's perceptions of their body's abilities which should help maximise their own positive outlook on life.
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