Aversion Therapy
Aversion Therapy
Definition
Aversion therapy is a form of behavior therapy in which an aversive stimulus (causing a strong feeling of dislike or disgust) is paired with an undesirable behavior in order to reduce or eliminate that behavior.
Purpose
As with other behavior therapies, aversion therapy is a treatment grounded in learning theory—one of its basic principles being that all behavior is learned and that undesirable behaviors can be unlearned under the right circumstances. Aversion therapy is an application of the branch of learning theory called classical conditioning. Within this model of learning, an undesirable behavior, such as a deviant sexual act, is matched with an unpleasant (aversive) stimulus. The unpleasant feelings or sensations become associated with that behavior, and the behavior will decrease in frequency or stop altogether. Aversion therapy differs from those types of behavior therapy based on principles of operant conditioning. In operant therapy, the aversive stimulus, usually called punishment, is presented after the behavior rather than together with it.
The goal of aversion therapy has been to decrease or eliminate undesirable behaviors. Treatment focuses on changing a specific behavior itself, unlike insight-oriented approaches that focus on uncovering unconscious motives in order to produce change. The behaviors for which aversion therapy has been tried as a treatment include such addictions as alcohol abuse, drug abuse, and smoking; pathological gambling; paraphilias ; and more benign habits—including writer’s cramp. Most controversially, this approach has been attempted as a way to “cure” homosexuality. Both the type of behavior to be changed and the characteristics of the aversive stimulus influence the treatment—which may be administered in either outpatient or inpatient settings as a self-sufficient intervention or as part of a multimodal program. Under some circumstances, aversion therapy may be self-administered.
Precautions
A variety of aversive stimuli have been used as part of this approach, including chemical and pharmacological stimulants, as well as electric shock. Foul odors, nasty tastes, and loud noises have been employed as aversive stimuli somewhat less frequently. The chemicals and medications generate very unpleasant and often physically painful responses. This type of aversive stimulation may be risky for people with heart or lung problems because of the possibility of making the medical conditions worse. Patients with these conditions should be cleared by their doctors first. Often, however, the more intrusive aversive stimuli are administered within inpatient settings under medical supervision. An uncomfortable but safe level of electric (sometimes called faradic) shock is often preferred to chemical and pharmacological aversants because of the risks that these substances involve.
In addition to the health precautions mentioned above, there are ethical concerns surrounding the use of aversive stimuli. There are additional problems with patient acceptance and negative public perception of procedures using aversants. Aversion treatment that makes use of powerful substances customarily (and intentionally) causes extremely uncomfortable consequences, including nausea and vomiting. These effects may lead to poor compliance with treatment, high dropout rates, potentially hostile and aggressive patients, and public relations problems. Social critics and members of the general public alike often consider this type of treatment punitive and morally objectionable. Although the scenes were exaggerated in the disturbing parts of the Stanley Kubrick film A Clockwork Orange, they depicted the use of aversion therapy to reform the criminal protagonist and provide a powerful example of society’s perception of this treatment.
Parents and other advocates for people with mental retardation and developmental disabilities have been particularly vocal in their condemnation of behavior therapy that uses aversive procedures in general. Aversive procedures are used within a variety of behavior modification strategies and the term is sometimes confused with the more specific technique of aversion therapy. Aversive procedures are usually based on an operant conditioning model that involves punishment. Advocates for special patient populations believe that all aversive procedures are punitive, coercive, and use unnecessary amounts of control and manipulation to modify behavior. They call for therapists to stop using aversive stimuli, noting that positive, nonaversive, behavioral-change strategies are available. These strategies are at least as, if not more, effective than aversive procedures.
In general, there are not very many studies in the scientific literature that produce strong evidence of the effectiveness of aversion therapy. Some studies indicate that aversion therapy for smokers may be somewhat effective, but a significant problem with the approach in smokers is compliance with the therapy, as is the case with most attempts at aversion therapy. Overall, in programs addressing substance use disorders, the results with aversion therapy do not compare favorably with therapies focusing on positive reward.
Description
According to the American Psychiatric Association, aversion therapy should be practiced only in very specialized centers.
KEY TERMS
Aversion —A strong feeling of dislike or disgust. Aversion therapy makes use of this feeling to reduce or eliminate an undesirable behavior. Chemicals or medications used to produce unpleasant effects are called aversants.
Classical conditioning —A process used in psychology in which a previously neutral stimulus eventually produces a specific response by being paired repeatedly with another stimulus that produces that response. The best-known example of classical conditioning is Pavlov’s dogs, who were conditioned to salivate when they heard a bell ring (the previously neutral stimulus) because the sound had been paired repeatedly with their feeding time.
Compliance —In medicine or psychiatry, cooperation with a treatment plan or schedule of medications.
Detoxification —A process in which the body is allowed to free itself of a drug while the symptoms of withdrawal are treated. It is the primary step in any treatment program for drug or alcohol abuse.
Emetic —A medication intended to cause vomiting. Emetics are sometimes used in aversion therapy in place of electric shock. Their most common use in mainstream medicine is in treating accidental poisoning.
Faradic —A type of discontinuous alternating electric current sometimes used in aversion therapy. It is named for Michael Faraday, an eminent British physicist.
Stimulus —Something that incites or moves a person to thought, emotion, or action. In mainstream psychotherapy, a stimulus can be anything from a certain picture or image to smell, sound, word, or idea. In aversion therapy, the stimulus is typically a mild electric shock or a medication that produces unpleasant results.
Risks
Patients with cardiac, pulmonary, or gastrointestinal problems may experience a worsening of their symptoms, depending upon the characteristics and strength of the aversive stimuli. Some therapists have reported that patients undergoing aversion therapy, especially treatment that uses powerful chemical or pharmacological aversive stimuli, have become negative and aggressive.
Outcomes
Depending upon the objectives established at the beginning of treatment, patients successfully completing a course of aversion therapy may see a reduction or cessation of the undesirable behavior.
Some clinicians have reported that patients undergoing aversive treatment using electric shocks have experienced increased anxiety and anxiety-related symptoms that may interfere with the conditioning process, as well as lead to decreased acceptance of the treatment. As indicated above, a few clinicians have reported a worrisome increase in hostility among patients receiving aversion therapy, especially those undergoing treatment using chemical aversants. Although aversion therapy has some adherents, lack of rigorous outcome studies demonstrating its effectiveness, along with the ethical objections mentioned earlier, have generated numerous opponents among clinicians as well as the general public. These opponents point out that less intrusive alternative treatments, such as covert sensitization, are available.
Resources
BOOKS
American Psychiatric Association. Practice Guidelines for the Treatment of Psychiatric Disorders. Washington, D.C.: American Psychiatric Association, 2000.
Colman, Andrew. A Dictionary of Psychology. New York: Oxford University, 2001.
Committee on the Social and Economic Impact of Gambling. Pathological Gambling: A Critical Review. Washington, D.C.: Committee on the Social and Economic Impact of Gambling, 1999.
Kaplan, Harold, and Benjamin Sadock, eds. Synopsis of Psychiatry. 8th ed. Baltimore: Williams and Wilkins, 1998.
Plaud, Joseph, and Georg Eifert, eds. From Behavior Theory to Behavior Therapy. Boston: Allyn and Bacon, 1998.
PERIODICALS
Howard, M. “Pharmacological Aversion Treatment of Alcohol Abuse.” American Journal of Drug and Alcohol Abuse 27. 3 (2001): 561–85.
ORGANIZATIONS
Association for Advancement of Behavior Therapy. 305 Seventh Avenue, 16th Floor, New York, NY 10001-6008. <http://www.aabt.org>.
OTHER
Kleber, Herbert D., et al. Practice Guideline for Treatment of Patients with Substance Use Disorders, 2nd ed. (2006). Available online through the American Psychiatric Association: <http://www.psych.org/psych_pract/treatg/pg/SUD2ePG_04-28-06.pdf>.
John Garrison, PhD
Emily Jane Willingham, PhD