J. Behav. Ther. & Exp. Psychiat. Vol. 6. pp. 343-344. Pergamon Press, 1975. Printed in Great Britain.

THOUGHT-STOPPING TREATMENT OF ANXIETY ATTACKS DUE TO SEIZURE-RELATED OBSESSIVE RUMINATIONS

JOHN ANTHONY a n d BARRY A. EDELSTEIN*

West Virginia University and West Virginia University Medical Center

Summary~A 24-yr-old woman with a 3-yr history of seizure-related obsessive ruminations that provoked anxiety attacks was treated by a thought-stopping procedure. The anxiety attacks were eliminated after 3 weeks of thought-stopping at home, and at no stage recurred during a 6-month follow-up.

RELATIVELY few case reports have dealt with the anxieties and ruminations associated with physical illnesses. Gentry (1970) utilized in vivo desensitization to treat an obsessive fear of cancer. The technique of " thought stopping" has reportedly been quite effective in the treatment of a variety of obsessive problems, e.g. pre- occupations and fears (Stern, 1970) and obsessive color labeling (Yamagami, 1971).

In the present study, thought-stopping was applied to a patient who had obsessive fears of experiencing a seizure, even though anti-seizure medications had satis- factorily eliminated all seizure activity for over a 2-yr period.

The subject was a 24-yr-old married woman who was referred to the out-patient clinic of the West Virginia University Medical Center with the presenting problem of fear of experiencing epileptic seizures. She reported having had five to seven seizures during a 2-yr period beginning in 1970. In 1972 an EEG evaluation had sug- gested sleep-related seizure activity. She was then placed on anti-seizure medications that completely controlled the seizure activity.

Though the patient had not experienced another seizure in 2 yr she had obsessive ruminations that often resulted in severe anxiety attacks characterized by pal- pitations, nausea and vomiting. The first time a seizure had followed an anxiety attack was while she was em- ployed in a hospital where she was exposed to seizure patients. She had terminated her job there about 6 months previously because of increasing anxiety at work occasioned by these ruminations about seizures. Recently the attacks had been occurring four to five times per week.

T R E A T M E N T

The patient was instructed to record each anxiety attack to provide a baseline. Standardized data sheets were given to her and she was asked to complete one after

each anxiety attack, regardless of its severity. Informa- tion to be recorded included the time of day, place, duration, severity of attack (mild, moderate, or severe), thoughts and behavior before, during and after each attack, and whether she was alone or with others at the time.

After 2 weeks of baseline recording, the technique of thought-stopping was explained to the patient, and training divided into four phases as described by Rimm and Masters (1974): (1) therapist interruption of patient's overt thoughts of having a seizure in a public place, (2) therapist interruption of patient's covert thoughts of having a seizure in a public place, (3) patient's overt interruption of covert thoughts and (4) patient's covert interruption of covert thoughts. When the patient ex- pressed confidence in the thought-stopping technique, she was told to focus on pleasant imagery immediately following each thought-stopping. She was also instructed to practice the thought-stopping procedure at home at least twice a day, and to initiate it at the onset of any obsessive ruminations.

R E S U L T S

The dependent measures were frequency and severity of anxiety attacks. The patient's data revealed anxiety attacks at a frequency of two per week during the 2 weeks of baseline, remained at that frequency during the first 2 weeks of treatment and then dropped to zero in the third week. It remained at zero throughout a 6-month follow-up conducted by telephone.

The severity of the attacks ranged from mild to severe during the baseline period, decreased to mild to moderate during the first 2 weeks of treatment, and then there were no attacks. The decrease in severity of attacks was the first apparent effect of the thought-stopping pro- eedure. The patient reported that by the fifth week, continued practice of the thought-stopping had sensitized

*Requests for reprints should be addressed to Barry A. Edelstein, Department of Psychology, West Virginia University, Morgantown, West Virginia 26506.

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her to the discriminative stimuli which occasioned the ruminations about having a seizure. Through continuing the thought-stopping, she could eliminate those thoughts before they could reach obsessive proportions.

REFERENCES

GENTRY W. (1970) In vivo desensitization of an obsessive cancer fear, J. Behav. Ther. and Exp. Psychiat. 1, 315-318.

RIMM D. D. and MASTERS J. C. (1974) Behavior Therapy: Techniques and Empirical Findings, pp. 429-443, Academic Press, New York.

STERN R. (1970) Treatment of a case of obsessional neurosis using thought-stopping technique, Brit. J. Psychiat. 117, 441-442.

YAMAGAMI T. (1971) The treatment of an obsession by thought stopping, J. Behav. Ther. & Exp. Psychiat. 2, 133-135.