Psychosomatics 16: 65-67, 1975
Copyright
© 1975 Academy of Psychosomatic Medicine
Treatment of Grand Mal Epilepsy by Covert and Operant Conditioning Techniques
A Case Study
LLOYD K. DANIELS Ed.D.1
1 From the Department of Psychology, Central Connecticut State College, New Britain, Connecticut 06050
Grand mal seizures were aborted by thought stopping and covert reinforcement and then eliminated after training sheltered workshop personnel in operant conditioning principles. Although episodes reoccured following a series of unfavorable events, there is evidence that this disorder can be treated by covert and operant conditioning strategies.
An early report of the use of a behavioral control procedure using classical conditioning to abort epileptic seizures has been traced by Efron (1956) to a study by Gowers who, in 1881, described the use of a ligature, applied above the elbow, paired with a non-specific stimulus, which eventually inhibited seizures without the ligature. Efron's own study describes the use of an unpleasant odor as a specific sensory stimulus to abort the development of an aura that consisted of five sequentially elicited components. Efron refers to another earlier report by Lyons in which a tight garter was applied to the knee at seizure onset. In a later study, Efron (1957) established that a second order conditioned reflex could be established to prevent seizures if two stimuli (odor of jasmine and an inexpensive silver bracelet) were presented to the patient simultaneously. Eventually, the patient could arrest the seizure simply by staring at the bracelet. Of interest in these investigations, is that although conditioning arrested seizures following onset, they were not eliminated entirely.
Since antecedent events often elicit anxiety responses and may precipitate seizures, counter-conditioning procedures, such as systematic desensitization, may be the treatment of choice in reducing seizure frequency.
Parrino (1971) describes the effectiveness of systematic desensitization in treating a hospitalized patient exhibiting violent episodes of bizarre muscular movements which were elicited by antecedent stimulus events present in the environment. Adams, Klinge, and Keiser (1973) also succeeded in inadvertently decreasing seizure frequency for a 14-year-old-female whose major problem was self-injurious behavior caused by falling from a sitting position.
Operant strategies used to eliminate seizures have included the withholding of parental attention (Gardner, 1967), and the manipulation of a variety of environmental contingencies (Richardson, Lal and Karkalas, 1972). Flannery and Cautela (1972) instructed teacher-therapists employed in a community school for severely retarded adults to use a variety of primary reinforcers to control seizures for a 22-year-old-male retardate, and Sternab and Friar (1972) successfully treated a patient with nocturnal generalized motor seizures using electroencephalographic feedback.
Mostofsky's review of the classical and operant literature further supports the view that a wide variety of behavior therapy strategies may be successful in controlling epileptic seizures even when organic pathology is evident and appropriate medication has not been effective (1972).
The present study differs from the above in that covert conditioning techniques were used in conjunction with the manipulation of the environment to treat grand mal epilepsy as well as several other maladaptive approach and avoidance behaviors associated with seizure episodes.
