Aversion therapy Health Article

Definition

Aversion therapy is a form of behavior therapy in which an aversive (causing a strong feeling of dislike or disgust) stimulus 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 is 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 that have been treated with aversion therapy include such addictions as alcohol abuse, drug abuse, and smoking; pathological gambling; sexual deviations; and more benign habits—including writer's cramp. 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 persons with heart or lung problems because of the possibility of making the medical conditions worse. Patients with these conditions should be cleared by their doctor 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 utilizing 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, the disturbing parts of the Stanley Kubrick film A Clockwork Orange that depicted the use of aversion therapy to reform the criminal protagonist, provide a powerful example of society's perception of this treatment.

Parents and other advocates for the mentally retarded and developmentally disabled 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 that 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, non-aversive, behavioral-change strategies are available. These strategies are at least as, if not more, effective than aversive procedures.