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Chapter 4: Anxiety Disorders
Chapter Overview
In Chapter 4, we will discuss matters related to anxiety disorders including their clinical presentation, epidemiology, comorbidity, treatment options, and etiology. Our discussion will include Panic Disorder, Generalized Anxiety Disorder, Specific Phobias, Social Anxiety Disorder, and Agoraphobia. Be sure you refer to Chapters 1-3 for explanations of key terms (Chapter 1), an overview of the various models to explain psychopathology (Chapter 2), and descriptions of the various therapies (Chapter 3).
Chapter Outline
4.1. Panic Disorder
4.2. Generalized Anxiety Disorder
4.3. Specific Phobia
4.4. Social Anxiety Disorder
4.5. Agoraphobia
4.6 EtiologyChapter Learning Outcomes
Describe the various anxiety disorders and their symptoms.
Describe the epidemiology of anxiety disorders.
Describe comorbidity in relation to anxiety disorders.
Describe treatment options for anxiety disorders.
Describe the etiology of anxiety disorders.
4.1 Panic Disorder
Section Learning Objectives
Describe how panic disorder presents itself.
Describe the epidemiology of panic disorder.
Indicate which disorders are commonly comorbid with panic disorder.
Describe the treatment options for panic disorder.
4.1.1 Clinical Description
Panic disorder consists of a series of recurrent, unexpected panic attacks coupled with the fear of future panic attacks. A panic attack is defined as a sudden or abrupt surge or fear or impending doom along with at least four physical or cognitive symptoms (listed below). The symptoms generally peak within a few minutes, although it seems much longer for the individual experiencing the panic attack.
There are two key components to panic disorder—the attacks are unexpected meaning there is nothing that triggers them, and they are recurrent meaning they occur multiple times. Because these panic attacks occur frequently and essentially “out of the blue,” they cause significant worry or anxiety in the individual as they are unsure of when the next attack will occur. In some individuals, significant behavioral changes such as fear of leaving their home or attending large events occur as the individual is fearful an attack will happen in one of these situations, causing embarrassment. Additionally, individuals report worry that other’s will think they are “going crazy” or losing control if they were to observe an individual experiencing a panic attack. Occasionally, an additional diagnosis of agoraphobia is given to an individual with panic disorder if their behaviors meet diagnostic criteria for this disorder as well (see more below).
The frequency and intensity of these panic attacks vary widely among individuals. Some people report panic attacks occurring once a week for months on end, others report more frequent attacks multiple times a day, but then experience weeks or months without any attacks. The intensity of symptoms also varies among individuals, with some individuals reporting experiencing nearly all 14 symptoms and others only reporting the minimum 4 required for the diagnosis. Furthermore, individuals report variability within their own panic attack symptoms, with some panic attacks presenting with more symptoms than others. It should be noted that at this time, there is no identifying information (i.e. demographic information) to suggest why some individuals experience panic attacks more frequently or more severe than others.
4.1.2 Epidemiology
Prevalence rates for panic disorder are estimated at around 2-3% in adults and adolescents. Higher rates of panic disorder are found in American Indians and non-Latino whites. Females are more commonly diagnosed than males with a 2:1 diagnosis rate—this gender discrepancy is seen throughout the lifespan. Although panic disorder can occur in young children, it is generally not observed in individuals younger than 14 years of age.
4.1.3 Comorbidity
Panic disorder rarely occurs in isolation, as many individuals also report symptoms of other anxiety disorders, major depression, and substance abuse. There is mixed evidence as to whether panic disorder precedes other comorbid psychological disorders—estimates suggest that 1/3 of individuals with panic disorder will experience depressive symptoms prior to panic symptoms whereas the remaining 2/3 will experience depressive symptoms concurrently or after the onset of panic disorder (APA, 2013).
Unlike some of the other anxiety disorders, there is a high comorbid diagnosis with general medical symptoms. More specifically, individuals with panic disorder are more likely to report somatic symptoms such as dizziness, cardiac arrhythmias, asthma, irritable bowel syndrome, and hyperthyroidism (APA, 2013). The relationship between panic symptoms and somatic symptoms is unclear; however, there does not appear to be a direct medical cause between the two.
.1.4 Treatment
4.1.4.1 Cognitive Behavioral Therapy (CBT)
CBT is the most effective treatment option for individuals with panic disorder as the focus is on correcting misinterpretations of bodily sensations (Craske & Barlow, 2014). Nearly 80 percent of people with panic disorder report complete remission of symptoms after mastering the following five components of CBT for panic disorder (Craske & Barlow, 2014).
Psychoeducation. Treatment begins by educating the client on the nature of panic disorder, the underlying causes of panic disorder, as well as the mechanisms that maintain the disorder such as the physical, cognitive, and behavioral response systems (Craske & Barlow, 2014). This part of treatment is fundamental in correcting any myths or misconceptions about panic symptoms, as they often contribute to the exacerbation of panic symptoms.
Self-monitoring. Self-monitoring, or the awareness of self-observation, is essential to the CBT treatment process for panic disorder. In this part of treatment, the individual is taught to identify the physiological cues immediately leading up to and during a panic attack. The client is then encouraged to identify and document/record the thoughts and behaviors associated with these physiological symptoms. By bringing awareness to the symptoms, as well as the relationship between physical arousal and cognitive/behavioral responses, the client is learning the fundamental processes in which they can manage their panic symptoms (Craske & Barlow, 2014).
Relaxation training. Prior to engaging in exposure training, the individual must learn a relaxation technique to apply during the onset of panic attacks. While breathing training was once included as the relaxation training technique of choice for panic disorder, due to the high report of hyperventilation during panic attacks more recent research has failed to support this technique as effective in the use of panic disorder (Schmidt et al., 2000). Findings suggest that breathing retraining is more commonly misused as a means for avoiding physical symptoms as opposed to an effective physiological response to stress (Craske & Barlow, 2014). To replace the breathing retraining, Craske & Barlow (2014) suggest progressive muscle relaxation (PMR). In PMR, the client learns to tense and relax various large muscle groups throughout the body. Generally speaking, the client is encouraged to start at either the head or the feet, and gradually work their way up through the entire body, holding the tension for roughly 10 seconds before relaxing. The theory behind PMR is that in tensing the muscles for a prolonged period of time, the individual exhausts those muscles, forcing them (and eventually) the entire body to engage in relaxation (McCallie, Blum, & Hood, 2006).
Cognitive restructuring. Cognitive restructuring, or the ability to recognize cognitive errors and replace them with alternate, more appropriate thoughts, is likely the most powerful part of CBT treatment for panic disorder, aside from the exposure part. Cognitive restructuring involves identifying the role of thoughts in generating and maintaining emotions. The clinician encourages the individual to view these thoughts as “hypotheses” as opposed to facts, which allows the thoughts to be questioned and challenged. This is where the detailed recordings in the self-monitoring section of treatment are helpful. By discussing specifically what the client has recorded for the relationship between physiological arousal and thoughts/behaviors, the clinician is able to help the individual restructure the maladaptive thought processes to more positive thought processes which in return, helps to reduce fear and anxiety.
Exposure. Next, the client is encouraged to engage in a variety of exposure techniques such as in vivo exposure and interoceptive exposure, while also incorporating the cognitive restructuring and relaxation techniques previously learned in efforts to reduce and eliminate ongoing distress. Interoceptive exposure involves inducing panic specific symptoms to the individual repeatedly, for a prolonged time period, so that maladaptive thoughts about the sensations can be disconfirmed and conditional anxiety responses are extinguished (Craske & Barlow, 2014). Some examples of these exposure techniques are spinning a client repeatedly in a chair to induce dizziness and breathing in a paper bag to induce hyperventilation. These treatment approaches can be presented in a gradual manner; however, the client must endure the physiological sensations for at least 30 seconds to 1 minute to ensure adequate time for applying cognitive strategies to misappraisal of cognitive symptoms (Craske & Barlow, 2014). Interoceptive exposure is continued both in and outside of treatment until panic symptoms remit. Over time, the habituation of fear within an exposure session will ultimately lead to habituation across treatment, which leads to long-term remission of panic symptoms (Foa & McNally, 1996). Occasionally, panic symptoms will return in individuals who report complete remission of panic disorder. Follow-up booster sessions reviewing the steps above is generally effective in eliminating symptoms again.
4.1.4.2 Pharmacological Interventions
According to Craske & Barlow (2014), nearly half of people with panic disorder present to psychotherapy already on medication, likely prescribed by their primary care physician. Some researchers argue that anti-anxiety medications impede the progress of CBT treatment as the individual is not able to fully experience the physiological sensations during exposure sessions, thus limiting their ability to modify maladaptive thoughts maintaining the panic symptoms. Results from large clinical trials suggest no advantage during or immediately after treatment of combining CBT and medication (Craske & Barlow, 2014). Additionally, when medications were discontinued post-treatment, the CBT+ medication groups fared worse than the CBT treatment alone groups, thus supporting the theory that immersion in interoceptive exposure is limited by the use of medication. Therefore, it is suggested that medications are reserved for those who do not respond to CBT therapy alone (Kampman, Keijers, Hoogduin & Hendriks, 2002).
4.2 Generalized Anxiety Disorder
Section Learning Objectives
Describe how generalized anxiety disorder presents itself.
Describe the epidemiology of generalized anxiety disorder.
Indicate which disorders are commonly comorbid with generalized anxiety disorder.
Describe the treatment options for generalized anxiety disorder.
4.2.1 Clinical Description
Generalized anxiety disorder, commonly referred to as GAD, is a disorder characterized by an underlying excessive worry related to a wide range of events or activities. While many individuals experience some levels of worry throughout the day, individuals with GAD experience worry of a greater intensity and for longer periods of times than the average person. Additionally, they are often unable to control their worry through various coping strategies, which directly interferes with their ability to engage in daily social and occupational tasks. There are six characteristic symptoms of generalized anxiety disorder and in order to be diagnosed with the disorder, individuals must experience at least three of them. These symptoms are: feeling restless, being easily fatigued, having difficulty concentrating, feeling irritable, having muscle tension, experiencing problems with sleep.
4.2.2 Epidemiology
The prevalence rate for generalized anxiety disorder is estimated to be 3% of the general population, with nearly 6% of individuals experiencing GAD sometime during their lives. While it can present at any age, it generally appears first in childhood or adolescence. Similar to most anxiety-related disorders, females are twice as likely to be diagnosed with GAD as males (APA, 2013).
4.2.3 Comorbidity
There is a high comorbidity between generalized anxiety disorder and the other anxiety-related disorders, as well as major depressive disorder, suggesting they all share common vulnerabilities, both biological and psychological.
4.2.4 Treatment
4.2.4.1 Psychopharmacology
Benzodiazepines, a class of sedative-hypnotic drugs, originally replaced barbiturates as the leading anti-anxiety medication due to their less addictive nature, yet equally effective ability to calm individuals at low dosages. Unfortunately, as more research was conducted on benzodiazepines, serious side effects, as well as physical dependence have routinely been documented (NIMH, 2013). Due to these negative effects, selective serotonin-reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are generally considered to be first-line medication options for those with GAD. Findings indicate a 30-50% positive response rate to these psychopharmacological interventions (Reinhold & Rickels, 2015). Unfortunately, none of these medications continue to provide any benefit once they are stopped; therefore, other more effective treatment options such as CBT, relaxation training, and biofeedback are often encouraged before the use of pharmacological interventions.
4.2.4.2 Rational-Emotive Therapy
Rational emotive therapy was developed by Albert Ellis in the mid-1950s as one of the first forms of cognitive-behavioral therapy. Ellis proposed that individuals were not aware of the effect their negative thoughts had on their behaviors and various relationships and thus, identified a treatment aimed to address these thoughts in an effort to provide relief to those experiencing anxiety and depression. The goal of rational emotive therapy is to identify irrational, self-defeating assumptions, challenge the rationality of those assumptions, and to replace them with new more productive thoughts and feelings. It is proposed that through identifying and replacing these assumptions that one will experience relief of GAD symptoms (Ellis, 2014).
4.2.4.3 Cognitive Behavioral Therapy (CBT)
CBT is among the most effective treatment options for a variety of anxiety disorders, including GAD. In fact, findings suggest 60% of individuals report a significant reduction/elimination in anxious thoughts one-year post-treatment (Hanrahan, Field, Jones, & Davy, 2013). The fundamental goal of CBT is a combination of cognitive and behavioral strategies aimed to identify and restructure maladaptive thoughts while also providing opportunities to utilize these more effective thought patterns through exposure based experiences. Through repetition, the individual will be able to identify and replace anxious thoughts outside of therapy sessions, ultimately reducing their overall anxiety levels (Borkovec, & Ruscio, 2001).
4.2.4.4 Biofeedback
Biofeedback provides a visual representation of a clients’s physiological arousal. To achieve this feedback, a client is connected to a computer that provides continuous information on their physiological states. There are several ways a client can be connected to the computer. Among the most common is electromyography (EMG). EMG measures the amount of muscle activity currently experienced by the individual. An electrode is placed on a individuals’s skin just above a major muscle group- commonly the forearm or the forehead. Other common types of measurement are electroencephalography (EEG) which measures the neurofeedback or brain activity; heart rate variability (HRV) which measures autonomic activity such as heart rate or blood pressure; and galvanic skin response (GSR) which measures sweat.
Once the client is connected to the biofeedback machine, the clinician is able to walk the client through a series of relaxation scripts or techniques as the computer simultaneously measures the changes in muscle tension. The theory behind biofeedback is that in providing a client with a visual representation of changes in their physiological state, they become more skilled at voluntarily reducing their physiological arousal, and thus, their overall sense of anxiety or stress. While research has identified only a modest effect of biofeedback on anxiety levels, clients do report a positive experience with the treatment due to the visual feedback of their physiological arousal (Brambrink, 2004).
4.3 Specific Phobia
Section Learning Objectives
Describe how specific phobia presents itself.
Describe the epidemiology of specific phobia.
Indicate which disorders are commonly comorbid with specific phobia.
Describe the treatment options for specific phobia.
4.3.1 Clinical Description
Specific phobia is distinguished by an individual’s fear or anxiety specific to an object or a situation. While the amount of fear or anxiety related to the specific object or situation varies among individuals, it also varies related to the proximity of the object/situation. When individuals are face-to-face with their specific phobia, immediate fear is present. It should also be noted that these fears are more excessive and more persistent than a “normal” fear, often severely impacting one’s daily functioning (APA, 2013).
Individuals can experience multiple specific phobias at one time. In fact, nearly 75% of individuals with a specific phobia report fear in more than one object (APA, 2013). When making a diagnosis of specific phobia, it is important to identify the specific phobic stimulus. Among the most commonly diagnosed specific phobias are animals, natural environments (height, storms, water), blood-injection-injury (needles, invasive medical procedures), or situational (airplanes, elevators, enclosed places; APA, 2013). Given the high percentage of individuals who experience more than one specific phobia, all specific phobias should be listed as a diagnosis in efforts to identify an appropriate treatment plan.
4.3.2 Epidemiology
The prevalence rate for specific phobias is 7-9% within the united states. While young children have a prevalence rate of approximately 5%, teens have nearly a double prevalence rate than that of the general public at 16%. There is a 2:1 ratio of females to males diagnosed with specific phobia; however, this rate changes depending on the different phobic stimuli. More specifically, animal, natural environment, and situational specific phobias are more commonly diagnosed in females, whereas blood-injection-injury phobia is reportedly diagnosed equally between genders.
4.3.3. Comorbidity
Seeing as the onset of specific phobias occurs at a younger age than most other anxiety disorders, it is generally the primary diagnosis with generalized anxiety disorder as an occasional comorbid diagnosis. It should be noted that children/teens diagnosed with a specific phobia are at an increased risk for additional psychopathology later in life. More specifically, other anxiety disorders, depressive disorders, substance-related disorders and somatic symptom disorders.
4.3.4 Treatment
4.3.4.1 Exposure Treatments
While there are many treatment options for specific phobias, research routinely supports the behavioral techniques as the most effective treatment strategies. Seeing as the behavioral theory suggests phobias are developed via classical conditioning, the treatment approach revolves around breaking the maladaptive association developed between the object and fear. This is generally accomplished through exposure treatments. As the name implies, the individual is exposed to their feared stimuli. This can be done using several different approaches: systematic desensitization, flooding, and modeling.
Systematic desensitization is an exposure technique that utilizes relaxation strategies to help calm the individual as they are presented with the fearful object. The notion behind this technique is that both fear and relaxation cannot exist at the same time; therefore, the individual is taught how to replace their fearful reaction with a calm, relaxing reaction. To begin, the client, with assistance from the clinician, will identify a fear hierarchy, or a list of feared objects/situations ordered from least fearful to most fearful. After learning intensive relaxation techniques, the clinician will present items from the fear hierarchy- starting from the least fearful object/subject- while the patient practices using the learned relaxation techniques. The presentation of the feared object/situation can be in person (in vivo exposure) or it can be imagined (imaginal exposure). Imaginal exposure tends to be less intensive than in vivo exposure; however, it is less effective than in vivo exposure in eliminating the phobia. Depending on the phobia, in vivo exposure may not be an option, such as with a fear of a tornado. Once the patient is able to effectively employ relaxation techniques to reduce their fear/anxiety to a manageable level, the clinician will slowly move up the fear hierarchy until the individual does not experience excessive fear of any objects on the list.
Another exposure technique is flooding. In flooding, the clinician does not utilize a fear hierarchy, but rather repeatedly exposes the individual to their most feared object/subject. Similar to systematic desensitization, flooding can be done in either in vivo or imaginal exposure. Clearly, this technique is more intensive than the systematic or gradual exposure to feared objects. Because of this, patients are at a greater likelihood of dropping out of treatment, thus not successfully overcoming their phobias.
Finally, modeling is a common technique that is used to treat specific phobias (Kelly, Barker, Field, Wilson, & Reynolds, 2010). In this technique, the clinician approaches the feared object/subject while the patient observes. Like the name implies, the clinician models appropriate behaviors when exposed to the feared stimulus, implying that the phobia is irrational. After modeling several times, the clinician encourages the patient to confront the feared stimulus with the clinician, and then ultimately, without the clinician.
4.4 Social Anxiety Disorder
Section Learning Objectives
Describe how social anxiety disorder presents itself.
Describe the epidemiology of social anxiety disorder.
Indicate which disorders are commonly comorbid with social anxiety disorder.
Describe the treatment options for social anxiety disorder.
4.4.1 Clinical Description
For social anxiety disorder (formerly known as social phobia), the anxiety is directed toward the fear of social situations, particularly those in which an individual can be evaluated by others. More specifically, the individual is worried that they will be judged negatively and viewed as stupid, anxious, crazy, boring, unlikeable, or boring to name a few. Some individuals report feeling concerned that their anxiety symptoms will be obvious to others via blushing, stuttering, sweating, trembling, etc. These fears severely limit an individual’s behavior in social settings. For example, an individual may avoid holding drinks or plates if they know they will tremble in fear of dropping or spilling food/water. Additionally, if one is known to sweat a lot in social situations, they may limit physical contact with others, refusing to shake hands.
Unfortunately, for those with social anxiety disorder, all or nearly all social situations provoke this intense fear. Some individuals even report significant anticipatory fear days or weeks before a social event is to occur. This anticipatory fear often leads to avoidance of social events in some individuals; others will attend social events with a marked fear of possible threats. Because of these fears, there is a significant impact on one’s social and occupational functioning.
It is important to note that the cognitive interpretation of these social events is often excessive and out of proportion to the actual risk of being negatively evaluated. There are instances where one may experience anxiety toward a real threat such as bullying or ostracizing. In this instance, social anxiety disorder would not be diagnosed as the negative evaluation and threat are real.
4.4.2 Epidemiology
The overall prevalence rate of social anxiety disorder is significantly higher in the United States than in other countries worldwide, with an estimated 7% of the US population diagnosed with social anxiety disorder. Within the US, the prevalence rate remains the same among children through adults; however, there appears to a significant decrease in the diagnosis of social anxiety disorder among older individuals. With regards to gender, there is a higher diagnosis rate in females than males. This gender discrepancy appears to be larger in children/adolescents than adults.
4.4.3 Comorbidity
Among the most common comorbid diagnoses with social anxiety disorder are other anxiety-related disorders, major depressive disorder, and substance-related disorders. Generally speaking, social anxiety disorders will precede that of other mental health disorders, with the exception of separation anxiety disorder and specific phobia, seeing as these two disorders are more commonly diagnosed in childhood (APA, 2013). The high comorbidity rate among anxiety-related disorders and substance-related disorders is likely related to the efforts of self-medicating. For example, an individual with social anxiety disorder may consume larger amounts of alcohol in social settings in efforts to alleviate the anxiety of the social situation.
4.4.4 Treatment
4.4.4.1 Exposure
A hallmark treatment approach for all anxiety disorders is exposure. Specific to social anxiety disorder, the individual is encouraged to engage in social situations where they are likely to experience increased anxiety. Initially, the clinician will engage in role-playing of various social situations with the client so that he/she can practice social interactions in a safe, controlled environment (Rodebaugh, Holaway, & Heimberg, 2004). As the client becomes habituated to the interaction with the clinician, the clinician and client may venture outside of the treatment room and engage in social settings with random strangers at various locations such as fast food restaurants, local stores, libraries, etc. The client is encouraged to continue with these exposure based social interactions outside of treatment to help reduce anxiety related to social situations.
4.4.4.2 Social Skills Training
This treatment is specific to social anxiety disorder as it focuses on skill deficits or inadequate social interactions displayed by the client that contributes to the negative social experiences and anxiety. The clinician may use a combination of skills such as modeling, corrective feedback, and positive reinforcement to provide feedback and encouragement to the client regarding his/her behavioral interactions (Rodebaugh, Holaway, & Heimberg, 2004). By incorporating the clinician’s feedback into their social repertoire, the client can engage in positive social behaviors outside of the treatment room in hopes to improve overall social interactions and reduce ongoing social anxiety.
4.4.4.3 Cognitive Restructuring
While exposure and social skills training are helpful treatment options, research routinely supports the need to incorporate cognitive restructuring as an additive component in treatment to provide substantial symptom reduction. Here the client will work with the therapist to identify negative, automatic thoughts that contribute to the distress in social situations. The clinician can then help the client establish new, positive thoughts to replace these negative thoughts. Research indicates that implementing cognitive restructuring techniques before, during, and after exposure sessions enhances the overall effects of treatment of social anxiety disorder (Heimberg & Becker, 2002).
4.5 Agoraphobia
Section Learning Objectives
Describe how agoraphobia presents itself.
Describe the epidemiology of agoraphobia.
Indicate which disorders are commonly comorbid with agoraphobia.
Describe the treatment options for agoraphobia.
4.5.1 Clinical Description
Similar to GAD, agoraphobia is defined as an intense fear triggered by a wide range of situations; however, unlike GAD, agoraphobia’s fears are related to situations in which the individual is in public situations where escape may be difficult. In order to receive a diagnosis of agoraphobia, there must be a presence of fear in at least two of the following situations: using public transportation such as planes, trains, ships, buses; being in large, open spaces such as parking lots or on bridges; being in enclosed spaces like stores or movie theaters; being in a large crowd similar to those at a concert; or being outside of the home in general (APA, 2013). When an individual is in one (or more) of these situations, they experience significant fear, often reporting panic-like symptoms (see Panic Disorder). It should be noted that fear and anxiety related symptoms are present every time the individual is presented with these situations. Should symptoms only occur occasionally, a diagnosis of agoraphobia is not warranted.
Due to the intense fear and somatic symptoms, individuals will go to great lengths to avoid these situations, often preferring to remain within their home where they feel safe, thus causing significant impairment in one’s daily functioning. They may also engage in active avoidance, where the individual will intentionally avoid agoraphobic situations. These avoidance behaviors may be behavioral, including having food delivery to avoid going to grocery store or only taking a job that does not require the use of public transportation, or cognitive, by using distraction and various other cognitive techniques to successfully get through the agoraphobic situation.
4.5.2 Epidemiology
The yearly prevalence rate for agoraphobia across the lifespan is roughly 1.7%. Females are twice as likely as males to be diagnosed with agoraphobia (notice the trend…). While it can occur in childhood, agoraphobia typically does not develop until late adolescence/early adulthood and typically tapers off in later adulthood.
4.5.3 Comorbidity
Similar to the other anxiety disorders, comorbid diagnoses include other anxiety disorders, depr
Home, a place where you feel the warmth
Home
Name
Institutional Affiliation
Home is a place where you feel the warmth of people you are familiar with and can relax after a long day work or absence. It is where we relax with our parents, siblings and other blood relatives who continuously condemn and praise us whenever we make mistakes. Home is absolutely one of the most favorite places to be and feel loved. It is where people around you are so much concerned with your wellbeing. Moreover, home is where one experiences security, safety, freedom, and comfort. It is a feeling in a more personal sense that prompts happiness, peace and is warmer than a house (Sanders, 1993). Home is where an individual has lived for a long enough time and are attached to the area and everything including the streets and people look familiar. It is therefore significant to note that home creates a warmly and familiar feelings.
Generally, home is such a good place and it is where I would take most of my time because of the great feeling. Home provides the best feelings and familiarity that no other place can offer. Individuals may freely release their stresses by the home feelings. Being at home is simply feeling very comfortable and free in terms of thoughts, feelings, emotional relationships, and high level of freedom that cannot be felt in any other place (Sanders, 1993). As a student, home is where parents provide everything deemed significant in education and life. Parents, siblings, relatives, and friends provide warmly feelings both at home and at school.
Home is a very important place to be everyone is passionate about it. Feeling and staying at home is a right for everyone because all individuals need comfort, peace, and a place to feel happy. Failure of being at home may lead to stress or sickness. People should benefit from the advantages offered by home. Failure of being at home may taint the relationship between the citizens and the government because it undermines the basis of the citizens’ freedom. Home is like a God given right that must be enjoyed by absolutely everyone because it is a divine authority (Sanders, 1993). Home is a basic right that is unalienable and no individual or authority is justified to trespassing except through the process of law as a penalty for having harmed or violated another person’s life, property, or liberty. Although having a home is not an absolute right, being at home is critical to every person (Sanders, 1993). People cannot be denied to stay at home without any good reason because of the rights bestowed upon them. Although critics may argue that claiming to be at home is being too “right centered” and that staying at home should be treated as a responsibility, it is still worth noting being at home is a right of everyone.
Home may sometimes change depending on the treat an individual gets. Although homes are always permanent, the permanency may be destroyed by a few factors and incidences that affect individuals both emotionally and physically (Mukherjee, 1999). Because home is more about emotions and feelings, all these may be changed in case any of the factors changes. It is therefore apparent that a home may change as long as what forms a home is taken away from an individual. For people who consider that home is a place to live they may change their home if they buy another place to stay or live in. They would make new friends and familiarize themselves with the area until they feel the warmth. However, this may not be a satisfactory feeling compared to the previous home. It may only be okay if one had a few challenges with the old home. It is therefore apparent that home can change although it is not very easy to change the feelings and warmth towards a place or something. In most cases, people are so reluctant to change their homes because of a number of reasons. In case individuals’ are hurt from what they call their homes, they may have the courage to forgive people who hurt them because of the long and warm relationship they have had together (Mukherjee, 1999).
Being homeless means lacking a place to relax and feel the warmth of the family members, friends. Homelessness greatly affects the victims in several ways especially because individuals do not have shelter and people around them who can comfort and show them love (Mukherjee, 1999). Homelessness may be characterized by different negative things such as sickness and failure to get emotional and material support from the loved ones that may be a dangerous situation to human life. Homelessness is a very unfortunate and emotional situation because individuals do not get the most precious thing in life, love. Homeless people are people who rarely get comfort and do not have people who may fully understand their situations well. Some of the homeless people are the orphans who do not have even guardians to lean on and place to sleep like a house. They are people who do their activities throughout the day without the hope of retiring in a more comforting place with good people to who understand them.
Community is a group of individuals with common interest and share things such as culture, information, and exchange ideas and further provides a way of connecting to members. A community is normally a social group residing in a specific locality and shares a common administration as well as a historical heritage. It is possible to return to homes but can always be identified by a certain community (Mukherjee, 1999). People normally feel closer to their homes than their community does. This closeness may enable an individual to return to their homes where they get love and warmth that they really need. However, a community is only important and relevant to people who strongly love their cultures and would not want to separate themselves from the culture. With the current cultural distortion, very few people are concerned with their cultures because majority of individuals adopt the cosmopolitan culture that do not identify itself with any original culture. In fact, with the current urban-rural migration, most people cannot even identify themselves with a particular community especially the young people who grow up in a mixed up culture and interact with people from different communities. It is therefore easy for an individual to return to home than to return to their community.
We should always stay at home because it is where we are familiar with many things and always have a sense of feelings and comfort. Staying at home has several benefits that hugely influence people’s attitudes in a positive manner. Staying at home also includes being around the most adorable and caring people in one’s life. Changing home may be accompanied with various disorienting things such as loneliness. Moreover, changing home may force individuals to lose family relationship as well as friends who are the most important people who make home what it actually is. By moving to another home, people tend to move to unfamiliar places and meet unfamiliar people who do not care about their new neighbors. Staying at home strengthens the family and friends bond and individuals normally feel satisfaction because of various available chances of helping each other emotionally. The better feelings one undergoes when hanging around with friends at home especially the old home may possibly bring the memories that can be cherished forever. Staying at an initial home is generally an opportunity to share a few memories with friends and relatives. It is therefore apparent that it is better to stay home to get the same feelings and positive emotions as usual instead of looking for home elsewhere (Mukherjee, 1999).
A home can be either a small town or a whole depending on the emotional attachment someone has with the place. There are people who are even so much attached to their country especially when they are in a foreign land simply because they have friends and relatives in their home country. However, a small town, because of the geographical size may act as a home better than the bigger town. This is because a small town accommodates a few people and features that an individual is more familiar with than a big town. A home therefore depends on an individual’s perception of the place he stays and feels comfortable and familiar with. The smaller the size the better the home because of the closeness and familiarity involved. Home is more of a memory but not a location. It is where an individual is emotionally attached and feels the warmth of people around them.
References
Mukherjee, Bharati. (1999). “Imagining Homelands” in A. Aciman (ed) Letters of Transit. Reflections on Exile, Identity, language, and Loss. New York: the New York Press.
Sanders, S. R. (1993). Staying put: Making a home in a restless world. Boston: Beacon Press.
home schooling
Home Schooling
(Author’s name)
(Institutional Affiliation)
Abstract
Home based education or what is commonly referred to as home schooling is a term used to describe the kind of education which children receive at home, especially by parents and at other times by tutors. These children do not have to go to formal settings of private or public schools. This kind of education has become an alternative in most western countries although it was the main kind of education practiced before the introduction of the present compulsory laws on school attendance. The paper, hence, is going to look at some of the main issues commonly associated with home schooling. The paper will use a number of resources to argue this issue comprehensively, some of them including books, chapters, and even database sources.
Introduction
Home based education is an option for parents, which is legal in most developed countries, to provide their children with education at a different environment than that offered by private and public schools. There are numerous reasons parents cite for wanting to provide their children with education at these alternate locations. Parents have, for example, indicated that they prefer to educate their children at home because there is no religious education a home as compared to public schools. Some parents fell that it is inappropriate to ‘shove’ religion at the throats of children. Rather it should be the choice of these children to associate or affiliate themselves with a religion of their choice. As a result, they feel that when they tutor and teach their children at home they are in less danger of being forced to affiliate themselves with a religion (Pfleger, 1998).
Parents who practice home schooling have cited the presence of gangs in public schools as a reason why they choose to tutor and educate their children at home rather than in these schools. Parents are afraid that if they take their children in such schools, their children might come to harm or become a part of those gangs. Gangs in schools and particularly, public schools have become a big concern for many parents. Other parents feel that most public schools have huge classes where they doubt whether their children get any attention. They feel that their children have a better chance of learning at home than in these schools where teachers and tutors hardly get any chance to interact in person with each student. As it follows, they opt to teach and educate their children at home because it is at home where their children get individual attention and, thus, a better chance of doing well in education (Pfleger, 1998).
All in all, it is clear from the above cited reasons that real issues are concerning parents at public and private schools to make them want to educate their children at home. This should say something to school teachers and tutors. Teachers must ask themselves what is it that they are doing wrong for a significant number of parents to opt to educate their children away from schools. Home schooling should, hence, be a real concern for teachers about the teaching methods used at school and the kind of environments they have created at schools, even though some parents just choose homeschooling for other reasons such as personal choice, parenting style, and an option for parents living abroad (Pfleger, 1998).
Home based education is legal in all 50 states, and each day, more parents are opting out of public school education to educate their children at home. As already seen, this is due to numerous reasons. There are also numerous issues cropping out from the debate of the success homeschooling. One of these issues surrounds the matter of home school teacher qualification. Today, when individuals talk about home based education, one question usually comes up. This is whether the parent or the home tutor has the required qualifications to tutor a child. Qualifications of these parents and home tutors has become a significant concern because opponents of this system of education believe and argue that parents do not possess the right qualifications to teach and educate children like a trained and certified teacher. Though it is true that teachers have higher teaching and tutoring accreditations when compared to parents, it is also true that parents have the ability to tutor and educate children in any class and especially those children in elementary classes (Moore & Moore, 1993).
When one is arguing this matter, they should realize that homeschooling gives certain benefits to the child when compared to public and private schools. For example, if a child has a question at home, they can ask it as many times as they want unlike in schools where the time might be inappropriate to ask or where the teacher might be too engaged to address the question. It is not possible for one to know answers, even when they are qualified teachers. It has been argued that parents have better abilities to shape the minds and futures of their children unlike teachers who only tutor the children for a year, and who care less for the children (Moore & Moore, 1993). However, it should be noted that parents need to sharpen their skills if they decide to tutor their children at home. For example, they can use online sources, co-ops, correspondent courses, as well as, community college classes so as to add on to the resources they have on homeschooling. With these additional classes, parents can become highly competent in teaching their children in different subjects, and they can also provide their children with the same benefits as they would get with a teacher in school (Law. Co-op, 1978).
Also parents should realize that end of term or year testing is essential. Testing has been made a requirement in all state schooling guidelines, and it should be utilized in home based education to prove that this kind of education is effective as school based education. Public and private schools undertake these tests and it would also be sensible to include them in home schooling. Like a number of states assert, all home schools must be registered and their end of year scores submitted so that the progress of these children can be ascertained. Studies show that regulations of testing by the state on the degree of qualification of the parent, which can range from certified teacher to no high school diploma to non- relational degrees, and laws on compulsory attendance, have not essential significance when it comes to the achieved scores on tests (Moore & Moore, 1993).
The subject of home schooling has also led to another issue of content knowledge and parents. For one to educate children appropriately, and according to the current standards, teachers, tutors and parents have to understand the subject matter flexibly and deeply so that they can help the learners create essential cognitive maps, address and solve misconceptions, and associate different ideas to each other. As it follows, tutors, teachers, as well as, parents who have undertaken home schooling have to understand and comprehend how ideas link across different fields and to each day’s life. This type of understanding helps them by proving them with a basis for pedagogical content knowledge that makes it possible for them to create ideas accessible to others (Shulman, 1987b).
It has been argued that parents who practice home schooling do not have the appropriate and the needed content knowledge to make the learning of their children successful. The concept of pedagogical content knowledge was introduced by Shulman in 1986. This concept argues teachers knowledge and understanding of their subject matter is essential for successful and effective teaching. In his theoretical framework, Shulman argues that there is a need for teachers to master two kinds of knowledge; one is the kind of knowledge usually referred to as deep knowledge of the subject the teachers and tutors have to teach, and second, the curricular development knowledge that these individuals must possess so as to effectively come up with a curricular effective in learning (Shulman, 1987b). Content knowledge includes what is referred to as structure of knowledge, which also encompasses a number of principles, theories, and concepts useful in a certain discipline. What us especially essential is the content knowledge that fosters in teachers the better methods of teaching processes, including the most effective forms of communicating and representing content and how best students learn certain topics and concepts of a subject. As it follows, it has been indicated that parents who have not received any training, as well as, beginning teachers do not have the required content knowledge to make education successful. They, therefore, have to struggle with, and must learn different pedagogical knowledge or content, in addition to, general pedagogy or generic principles of teaching (Shulman, 1987b).
Pedagogical content knowledge has also become another serious issue in home based education. Pedagogical content knowledge can be understood as integration or the combination of three different, essential aspects of learning; content or what is commonly referred to as subject matter, instructional methods, or pedagogy, and characteristics of a learner (Shulman, 1986a). What has fueled the issue is that opponents of home schooling believe that training teachers and tutors is essential in developing and sharpening skills in all the above aspects. They, therefore, do not see how home school tutors and parents, who are not trained can effectively educate children when they have not been trained on how to attain efficiency in these matters. They argue that pedagogical content knowledge relates directly with the quality of education and success of candidate in tests.
As a result, if a parent, a tutor, or even a teacher does not possess any of these qualities or education aspects, they cannot effectively teach their children. To counter these arguments, supporters of the home based education have indicated that experienced tutors and parents have better pedagogical content knowledge especially because they have better knowledge of the characteristics of their students, and they have better designed instructional methods that they have devised and designed according to the characteristics of their students, who they know better. All in all, it should be realized that pedagogical content knowledge is an essential aspect in effective and successful education that both parents and teachers can attain with the proper training and with time, through experience. Parents, though adequately equipped, must also consider attending some training or courses that can help them become better equipped tutors for their children (Shulman, 1986a).
One of the most important concerns of all concerns among the opponents of home based education is socialization and acquisition of socialization skills. Socialization can be defined in numerous different ways but one of the most obvious definitions is that socialization is the ability of an individual to adapt or to convert to the needs and wants of the society. Another essential definition in this case is the ability for individuals to make themselves fit for association with others, and make themselves sociable. It is a wide believe of many individuals that children need to socialize with others in order for them to become meaningful and productive society members. It has become the concern of many, therefore, that children who are homeschooled will not acquire the right and the appropriate socialization skills for use in the future since they spend most of their time in their houses and with their parents (Taylor, 1998).
However, it should be noted that socialization and fitting in are two extremely different concepts that people should not confuse. One, for example, cannot say that a child is not social enough when they do not fit in with other children who do not have the same moral values. Parents practicing home schooling argue that it is hard for children when they are impressionable and young to differentiate which children are bad influences and which children are not until it is too late and they have already been steered in the wrong direction. They argue that it is at this age where peer pressure becomes an issue, when children want to copy what their friends are doing and how they are acting in order for them to feel accepted and for them to fit in. for these parents, this is not socializing, and it is for this reason why these parents want to home school their children and protect them from bad influence (Taylor, 1998).
After the completion of primary education, most students opt to stop home based schooling in the favor of public higher institutions of learning at established universities and colleges. Though reservations still remain about the qualifications of these students and the quality of education they have received in the previous years, studies have indicated that most public and private universities and colleges are increasing the number of admissions of students who have been home schooled. To ensure that their children pass as candidates for these colleges and universities, parents must ensure that their students undertake standardized test scores that can be useful in helping these students enroll in college. One thing that is extremely essential is that students who have a home based education, must always keep their detailed portfolios and records, as they can be highly crucial in determining whether they get enrolled in college or not. Just like colleges, employers and most corporate are also increasingly becoming open to students who have attained home- based education. Though, the scene is changing to include more and more of students from home schools, these students must strive to have and keep their records as proof of education (Greene & Greene, 2007).
Conclusion
Home based education has become an increasingly common phenomenon in the current world. With this sort of education, however, several issues have arisen indicating that caution must be taken whenever a parent chooses to home school their children because a number of challenges can affect the quality of education a home- schooled child has. Such challenges might have more or less to do with socialization, quality of education, and admission to higher education institutes and employment.
References
Greene, H. & Greene, M. (2007). There’s no place like home: as the home school population grows, college and universities must increase enrollment efforts targeted to this group (Admissions). University Business, 25(2).
Law. Co-op. (1978). .Alternative Statutes Allowing for Home Schools: Mass. Ann. Laws ch. 76, I.
Moore, R. S. & Moore, D.N. (1993). Better late than early. New York: Seventh Printing.
Pfleger, K. (1998). School’s out. The New Republic. Washington 218 (14), 11-12.
Shulman, L. (1986a). Those who understand: Knowledge growth in teaching. Educational Researcher, 15 (2), 4-14.
Shulman, L. (1987b). Knowledge and teaching: Foundations of the new reform. Harvard Educational Review, 57 (1), 1-22.
Taylor, V. (1998). Self-Concept in home-schooling children. Berrien Springs, MI: Andrews University.