Academic journal article The Behavior Analyst Today

Behavior Analysis of Epilepsy: Conditioning Mechanisms, Behavior Technology and the Contribution of Act

Academic journal article The Behavior Analyst Today

Behavior Analysis of Epilepsy: Conditioning Mechanisms, Behavior Technology and the Contribution of Act

Article excerpt

The conditioning mechanisms involved in the epileptic seizure behavior along with subsequent effective behavioral treatment have been known for more than a half a century. The behavior technology of seizure control provides low-cost, drug free treatment alternative for individual already suffering from seizures and the stigmatization of epilepsy. Despite this substantial amount of research, behavior therapy for seizures is not available to most people. This aim of this paper is to present the history of the behavior analysis and therapy developed in the last century. In addition to the established behavioral technology, a third wave contextual behavior therapy, Acceptance and Commitment therapy is shown in a recent study to contribute to new dimensions of treatment. Whereas, previous behavioral treatment regimens have aimed at seizure control, ACT aims at creating psychological flexibility around all of the experiential avoidance patterns associated with epilepsy and builds repertoire towards the individuals valued life. A treatment model that includes both the behavioral analysis and seizure control techniques along with ACT components: acceptance, defusion skills, mindfulness, and committed action in valued direction may have greater success than behavioral treatments alone. While behavioral control strategies may be used for preventing, predicting and actually interrupting seizure behavior, acceptance-based skills are used for creating flexibility around "resistance" to having seizures. While more research is needed, this combination represents a viable alternative and or compliment to drug and surgical therapy.

Key words: Epilepsy, applied behavior analysis, Acceptance and Commitment Therapy, third wave contextual behavior therapy

EARLY DOCUMENTATION OF CONDITIONING USED TO STOP SEIZURES

Among the earliest medical documentations of epileptic seizures we find stories of conditioning mechanisms and how they can be used to control seizures. Already in ancient Greek medicine, Galen, describes seizures as a process or predicable chain of behavior that can be interrupted by different stimulation to the body (Temkin, 1945). Much later, the British Neurologist Gowers (1881) is the first to classify epilepsy: grand mal, petit mal, and hysteroid and he publishes case studies where behavioral techniques are applied and successfully stop seizures. Epileptic seizure behavior is carefully documented and treatment interventions entail different ways of stimulating around the area of the seizure start. Both specific and general stimulation are described. In one example a specific stimuli like pressure is put on the hand where the seizure starts and in other more general, strong smells are used to evoke a general arousal contingent on seizure start. A French physician/physiologist presents a review of cases studies (Brown-Sequard, 1858) also demonstrating how seizures can be successfully aborted by the use of stimulating contingent on seizure start. Documentation of these behavioral interventions continues into the 19th century with a renown epileptologist, Jackson, who describes certain seizures as a "march" throughout the body and how it is brought to a halt by vigorous rubbing of that affect limb (Jackson, 1931).

From these early studies the principle of competitive recruitment evolves. At this point, based on clinical observations, the assumption is that by localizing hyper excitable brain areas, competitive recruitment stimulated in relatively normal brain areas will increase normal activity and reduce synchronization and prevent seizures. In other words, if you can identify an early link in the chain of seizure behavior, and either apply stimulation around that area or initiate a "general arousal" you are likely to stop the seizure.

Drug industry: conditioning and behavioral know-how gets lost by the wayside

At the turn of the century, the drug industry enters the scene with the promise of a chemical solution to stop seizures. …

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