Case histories and shorter communications: Treatment of nocturnal headbanging by behavior modification techniques: a case report

Abstract

The application of behavior modification techniques to the alleviation of maladaptive behavior occurring during the waking state is well documented (Bandura, 1969; Franks, 1969). Recently, several case studies have been reported which demonstrate the successful extension of behavior modification techniques such as the desensitization procedure to the modification of sleep state maladaptive behavior, e.g. recurrent nightmares (Cautela, 1968; Geer and Silverman 1966; Silverman and Geer, 1968) and sleep walking (Clement, 1969). The present case study illustrates that other sleep state maladaptive behavior, in this case nocturnal headbanging, is amenable to the same behavior modification techniques which are used to modify maladaptive behavior during the waking state. Case background The S was a 16-year-old institutionalized female offender who had a repeated history of placement in foster homes and psychiatric units. At the time of the present treatment she had been in an operant-oriented treatment program at the Ontario Reception and Diagnostic Centre for one year. Prior to her involvemente in the treatment program she had been described as “a highly dependent, belligerent, manipulative girl whos explosive hostility has been released at staff or at other times directed at herself in the form of self-destructive behavior”. Although over the course of the year her overt anti-social behavior had significantly decreased another one of her maladaptive behaviors persisted and was brought to the attention of the authors. She reported that for several years she had had episodes of headbanging during the night. The night staff was asked to record the frequency, duration, and time of these headbanging episodes for a one-week baseline period. The headbanging episodes occurred nightly most often between the hours of 4 a.m. and 7 a.m. and consisted of her banging her head against the pillow or bed resulting in her awakening, often in a crying state. The headbangs were of a short intense nature with a duration ranging from 1 to 15 sec and each episode consisted of a number of headbangs ranging from 1 to 13. The S reported that she was asleep at the onset of these headbanging occurrences and the observations of the night staff seemed to confirm this. The S reported that she had had instances of headbanging for several years, usually at least two or three times a week.