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The use of negative practice to eliminate nocturnal headbanging
J. Behav. Ther. & Exp. Psychiat.
THE
Vol. 5, pp. 81-82. Pergamon Press, 1974. Printed in Great Britain.
USE OF NEGATIVE NOCTURNAL
PRACTICE
TO ELIMINATE
HEADBANGING
HOWARD E . WOODEN* Katherine Hamilton Mental Health Center Inc. Summary---Negative practice was utilized to eliminate longstanding headbanging during sleep in a 26-yr-old male. The problem behavior had seemed to increase during periods of stress and anxiety. The generalization of the effects of negative practice from waking to sleeping is discussed. BEHAVIOR therapy
today encompasses numerous techniques. One technique that appears to have received only limited attention in the literature is negative practice. Negative practice was described in the early literature dealing with the acquisition of habits (Dunlap, 1932), and was later refined in the work of Yates (1958) who explained it in terms of Hullian reactive inhibition. Negative practice has recently been used successfully to extinguish the motor compulsion of chewing, biting, and tearing materials by a young boy (Humphrey and Rachman, 1963). THE PATIENT R.S. was a 26-yr-old married man who entered out-patient treatment with complaints of headache, fatigue, and generalized anxiety. According to the patient and his wife, he was awakened periodically each night, the result of banging his head into his pillow while asleep. This habit had persisted for approximately 25 yr and caused the patient a good deal of distress. When the patient was approximately 1-yr-old he was adopted by an aunt and uncle who related to him that as an infant, while sleeping, he would lie on his stomach, pull his knees up to his chest, and rock back and forth while grinding and banging his head into his pillow. He carried out this behavior width such
force that he was able to propel his crib a few feet across the room. Essentially this same behavior occurred nightly up until the time the patient commenced treatment with me. As a result of this habit, the patient had experienced only a few nights of restful sleep which in turn possibly contributed to the patient's anxiety and displeasure concerning his symptoms. Furthermore, a portion of the skin on his forehead was noticably discolored and slightly calloused. PHASE I The patient and his wife were interviewed conjointly. It was learned that ,the patient's wife was a light sleeper and that she observed her husband's headbanging nightly. She was advised to photograph one of her husband's nightly episodes in order that the patient might also observe the exact posi'tion of his body during his nightly ordeal. The assumptions underlying negative practice were then explained to the patient and he was instructed to assume, as closely as possible, the position ~n the photograph and was asked to grind his head in'to the pillow until he developed a combination of physical fatigue and pain in his forehead, neck, and shoulder nmscles. The patient was advised to carry out this activity nightly immediately prior to going to sleep, and was instructed 'to perform this procedure
*Requests for reprints should be addressed to Howard E. Wooden, Katherine Hamilton Mental Health Center. Inc., 620 Eighth Avenue, Terre Haute, Indianna 47804. 81
82
HOWARD E. WOODEN
until he could no longer tolerate the grinding and banging sensation. RESULTS The patient and his wife were seen 2 weeks after the initial instructions were presented. The patient's wife reported that after four successive nightly sessions of negative practice that she no longer observed any episodes of headbanging. Furthermore, the patient himself reported that he was resting peacefully at night, and that he was feeling less fatigued, irritable, and anxious during the day. The patient was seen for a follow-up examination 6 months later at which time he reported only two episodes of headbanging, one occurring the night before he was to be best man at a wedding, and the other instance occurring the night after he was involved in a minor traffic accident. DISCUSSION This case study indicates that the effects of negative practice carried out in a waking state can be successfully generalized in eliminating habits occurring during sleep. The results of the specific treatment lend further support to the assumption that one of the crucial variables involved in negative practice may be the aversive property of the fatigue and discomfort (i.e. pain and fatigue in forehead, neck and shoulders) associated with having carried out the headbanging habit in excess. Furthermore, these results 'lend support to Mowrer's (1960) two factor theory in that by not performing this habit, the patient avoided an aversive stimulus which in turn resulted in positively reinforced behavior, i.e. no headbanging. While it was initially assumed that this habit was anxiety inhibiting, it is interesting to note that the patient reportedly suffered from less anxiety
subsequent to the treatment and continued to maintain his adjustment up to the time that he was seen for follow-up. Examination of the technique of negative practice and attempts to explain its generalizing effects from a waking state to a sleeping state have led this author to assume that learning actually did occur in this instance. While some will argue that physical fatigue in itself may have acted as the variable allowing this patient to have restful sleep, it is necessary to emphasize that the technique (and the fatigue associated with it) was carried out on four occasions only. It is also interesting to note that this study tends to support nmch of the literature pertaining to anxiety reduction after the disappearance of the initial symptom (in this case nocturnal headbanging). It would appear that if learning 'through negative practice in a waking state can result in behavior change during sleep, then possibly this technique may be useful in dealing with other selected sleeping difficulties such as nightmares, whereby the patient would be requested to dwell thoroughly on various upsetting themes or specific scenes prior to falling asleep. It would seem, then, that additional research is warranted in studying the effects of negative practice not only Jn patients suffering from nightmares but also in those suffering from other selected disturbed sleep patterns.
REFERENCES
DUNLAPK. (1932) Habits: Their M a k i n g and Unmaking, Liveright, New York. HIJMI'm~EYJ. and RACHMANS. (1963) The Causes and Cures o[ Neurosis (Edited by EYSENCKH. J, and RAeHMAN S.), Routledge and Kegan Paul, London. MOWRER O. H. (1960) Learning Theory and Behavior, Wiley, New York. YATES A. J. (1958) The application of learning theory to the treatment of t~ics,J. abnorm soc. Psychol. 56, 175-182.
THE
Vol. 5, pp. 81-82. Pergamon Press, 1974. Printed in Great Britain.
USE OF NEGATIVE NOCTURNAL
PRACTICE
TO ELIMINATE
HEADBANGING
HOWARD E . WOODEN* Katherine Hamilton Mental Health Center Inc. Summary---Negative practice was utilized to eliminate longstanding headbanging during sleep in a 26-yr-old male. The problem behavior had seemed to increase during periods of stress and anxiety. The generalization of the effects of negative practice from waking to sleeping is discussed. BEHAVIOR therapy
today encompasses numerous techniques. One technique that appears to have received only limited attention in the literature is negative practice. Negative practice was described in the early literature dealing with the acquisition of habits (Dunlap, 1932), and was later refined in the work of Yates (1958) who explained it in terms of Hullian reactive inhibition. Negative practice has recently been used successfully to extinguish the motor compulsion of chewing, biting, and tearing materials by a young boy (Humphrey and Rachman, 1963). THE PATIENT R.S. was a 26-yr-old married man who entered out-patient treatment with complaints of headache, fatigue, and generalized anxiety. According to the patient and his wife, he was awakened periodically each night, the result of banging his head into his pillow while asleep. This habit had persisted for approximately 25 yr and caused the patient a good deal of distress. When the patient was approximately 1-yr-old he was adopted by an aunt and uncle who related to him that as an infant, while sleeping, he would lie on his stomach, pull his knees up to his chest, and rock back and forth while grinding and banging his head into his pillow. He carried out this behavior width such
force that he was able to propel his crib a few feet across the room. Essentially this same behavior occurred nightly up until the time the patient commenced treatment with me. As a result of this habit, the patient had experienced only a few nights of restful sleep which in turn possibly contributed to the patient's anxiety and displeasure concerning his symptoms. Furthermore, a portion of the skin on his forehead was noticably discolored and slightly calloused. PHASE I The patient and his wife were interviewed conjointly. It was learned that ,the patient's wife was a light sleeper and that she observed her husband's headbanging nightly. She was advised to photograph one of her husband's nightly episodes in order that the patient might also observe the exact posi'tion of his body during his nightly ordeal. The assumptions underlying negative practice were then explained to the patient and he was instructed to assume, as closely as possible, the position ~n the photograph and was asked to grind his head in'to the pillow until he developed a combination of physical fatigue and pain in his forehead, neck, and shoulder nmscles. The patient was advised to carry out this activity nightly immediately prior to going to sleep, and was instructed 'to perform this procedure
*Requests for reprints should be addressed to Howard E. Wooden, Katherine Hamilton Mental Health Center. Inc., 620 Eighth Avenue, Terre Haute, Indianna 47804. 81
82
HOWARD E. WOODEN
until he could no longer tolerate the grinding and banging sensation. RESULTS The patient and his wife were seen 2 weeks after the initial instructions were presented. The patient's wife reported that after four successive nightly sessions of negative practice that she no longer observed any episodes of headbanging. Furthermore, the patient himself reported that he was resting peacefully at night, and that he was feeling less fatigued, irritable, and anxious during the day. The patient was seen for a follow-up examination 6 months later at which time he reported only two episodes of headbanging, one occurring the night before he was to be best man at a wedding, and the other instance occurring the night after he was involved in a minor traffic accident. DISCUSSION This case study indicates that the effects of negative practice carried out in a waking state can be successfully generalized in eliminating habits occurring during sleep. The results of the specific treatment lend further support to the assumption that one of the crucial variables involved in negative practice may be the aversive property of the fatigue and discomfort (i.e. pain and fatigue in forehead, neck and shoulders) associated with having carried out the headbanging habit in excess. Furthermore, these results 'lend support to Mowrer's (1960) two factor theory in that by not performing this habit, the patient avoided an aversive stimulus which in turn resulted in positively reinforced behavior, i.e. no headbanging. While it was initially assumed that this habit was anxiety inhibiting, it is interesting to note that the patient reportedly suffered from less anxiety
subsequent to the treatment and continued to maintain his adjustment up to the time that he was seen for follow-up. Examination of the technique of negative practice and attempts to explain its generalizing effects from a waking state to a sleeping state have led this author to assume that learning actually did occur in this instance. While some will argue that physical fatigue in itself may have acted as the variable allowing this patient to have restful sleep, it is necessary to emphasize that the technique (and the fatigue associated with it) was carried out on four occasions only. It is also interesting to note that this study tends to support nmch of the literature pertaining to anxiety reduction after the disappearance of the initial symptom (in this case nocturnal headbanging). It would appear that if learning 'through negative practice in a waking state can result in behavior change during sleep, then possibly this technique may be useful in dealing with other selected sleeping difficulties such as nightmares, whereby the patient would be requested to dwell thoroughly on various upsetting themes or specific scenes prior to falling asleep. It would seem, then, that additional research is warranted in studying the effects of negative practice not only Jn patients suffering from nightmares but also in those suffering from other selected disturbed sleep patterns.
REFERENCES
DUNLAPK. (1932) Habits: Their M a k i n g and Unmaking, Liveright, New York. HIJMI'm~EYJ. and RACHMANS. (1963) The Causes and Cures o[ Neurosis (Edited by EYSENCKH. J, and RAeHMAN S.), Routledge and Kegan Paul, London. MOWRER O. H. (1960) Learning Theory and Behavior, Wiley, New York. YATES A. J. (1958) The application of learning theory to the treatment of t~ics,J. abnorm soc. Psychol. 56, 175-182.