aversion therapy

Aversion therapy is a form of psychiatric, mental health or psychological treatment in which the patient is exposed to a stimulus while simultaneously being subjected to some form of discomfort. This conditioning is intended to cause the patient to associate the stimulus with unpleasant sensations in order to stop the specific behavior.

Aversion therapies can take many forms, for example: placing unpleasant-tasting substances on the fingernails to discourage nail-chewing; pairing the use of an emetic with the experience of alcohol; or pairing behavior with electric shocks of various intensities.

Aversion therapy for addiction

The major use of aversion therapy is currently for the treatment of addiction to alcohol and other drugs. This form of treatment has been in continuous operation since 1932. The treatment is discussed in the Principles of Addiction Medicine, Chapter 8, published by the American Society of Addiction Medicine in 2003. Their website is www.asam.org.

Aversion therapy works on changing positive emotional associations with the sight, smell and taste of alcohol or other drugs. Follow up studies done at 6 and 12 months on populations matched on 17 baseline variables shows that aversion therapy resulted in significantly better abstinence rates. There was no increase in leaving the hospital against medical advice in patients seeking aversion therapy compared to patients in non-aversion programs.

The results of Antabuse combined with behavioral marital therapy for treating alcoholism has growing research support ^[1][2]

Traditional Aversion therapy, which employed either chemical aversion (Watson and Reyner, 1920) or electrical aversion (Maguire and Vallance, 1964) has now, since Cautela, been replaced by aversion in the imagination, a technique which is known as covert sensitization (Cautela, 1967).

Covert sensitisation is a powerful and effective form of treatment and it has been used successfully in the treatment of alcoholism, compulsive gambling and juvenile delinquency. This treatment approach can also be used in the treatment of cigarette smokers, and there are favorable results here especially when being compared to other techniques.

Kraft & Kraft (2005) assessed the value of covert sensitization in six case studies—a fingernail bitter, a cannabis smoker, an obese lady, a cigarette smoker, an individual with a chocolate addiction and an alcoholic. The study showed that covert sensitization was a rapid and cost effective form of treatment. All the individuals in the study eliminated their maladaptive behavior pattern, and this was maintained at the follow up.

Legal and ethical challenges to the use of aversive procedures

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The use of aversive procedures by applied behavior analysis, behavior modification, and behavior therapy is always under scrutiny. These issues are discussed in regards to the ethics of such practices (see Professional practice of behavior analysis) However, it is important for regulatory bodies to discuss the use of aversives and punishment techniques. For example, in Massachusetts in the U.S. Judge Rotenberg Educational Center has led to several bills (e.g., H109) to be developed limiting the use of aversives to licensed psychologists and/or board certified behavior analysts. Other states have begun to push for licensing of behavior analysts to ensure regulatory control over such processes. While in some cases the means is justified by the end effect, behavior analysts need to remember that their overaching goal is to do no harm.^[3]

Aversion therapy and homosexuality

Since 1994, the American Psychological Association has declared that aversion therapy is a dangerous practice that does not work.^{[citation needed]} Since 2006, the use of aversion therapy to treat homosexuality has been in violation of the codes of conduct and professional guidelines of the American Psychological Association and American Psychiatric Association. The use of aversion therapy to treat homosexuality is illegal in some countries. The standard in psychotherapy in America and Europe is currently Gay Affirmative Psychotherapy. Guidelines for Gay Affirmative Psychotherapy can be found by APA. ^[4]

Psychologist Martin E.P. Seligman^[5] reported that using aversion therapy to try to change homosexual men's sexual orientation to heterosexual was controversial. In some instances, notably a series of 1966 experiments, the process was initially judged to have worked surprisingly well, with up to 50% of men subjected to such therapy not acting on their homosexual urges. These results produced what Seligman described^[5] as "a great burst of enthusiasm about changing homosexuality [that] swept over the therapeutic community" after the results were reported in 1966. However, Seligman notes^[6] that the findings were later shown to be flawed: most of the men treated with aversion therapy who stopped homosexual behavior were actually bisexual; among men with an exclusive or near-exclusive homosexual orientation, aversion therapy was far less successful.

Popular culture

• Both Ken Kesey and Anthony Burgess explored the concept, and its moral implications, in their respective 1962 novels One Flew Over the Cuckoo's Nest and A Clockwork Orange.
• An Aversion Therapy is used in A Change of Mind, an episode of the 1967 television series The Prisoner. The room where this is performed has a securely locked door with the words "Aversion therapy" written on it.
• A radio commercial in Grand Theft Auto: San Andreas refers to the practice of aversion therapy.
• The television show Robot Chicken opening has a scientist torturing a robotic chicken in the same manner.
• The movie Latter Days includes a scene in which a character is subjected to aversion therapy in an attempt to change his sexual orientation.
• In the movie But I'm a Cheerleader, the character Sinead, an inmate at True Directions, more than likely a self-harmer, gives herself aversion therapy and explains to the main character, Megan, why she does so. In another scene, Megan gives herself aversion therapy for a period of time.
• In season 1, episode 4 of The Simpsons, "There's No Disgrace Like Home" - the family are strapped to electric chairs and are given the opportunity to give electric shocks to each other. The therapy is unsuccessful as no such aversion is attained, and the family does not stop shocking each other until Dr. Monroe pulls the plug.
• In the comic book series Y: The Last Man, Agent 711 uses a form of aversion therapy (referred to as Le précedé d'enfer - 'the hellish procedure') said to be developed by Benjamin Franklin and the Marquis de Sade to help Yorick overcome his deathwish.
• In the novel Brave New World, aversion therapy is used to teach the lower classes to fear intellect and the upper classes to despise monogamy and the notion of family.
• In the fifth season of Law and Order, the episode Cruel and Unusual
• In the film A Beautiful Mind, the character of Russell Crowe is treated with aversion because of schizophrenia

See also

• Conversion therapy
• Behavior modification
• Ludovico technique
• Shock collar

References

• "The Aversion Project: Human rights abuses of gays and lesbians in the SADF by health workers during the apartheid era"by Mikki van Zyl, Jeanelle de Gruchy, Sheila Lapinsky, Simon Lewin, and Graeme Reid, Simply Said and Done, Cape Town, October 1999.
• Ethical Treatment for All Youth
• Houser, Ward Aversion Therapy. Encyclopedia of Homosexuality. Dynes, Wayne R. (ed.), Garland Publishing, 1990. p. 101
• Cautela JR (1967) Covert Sensitization. Psychological Reports 20: 259-468.
• Kraft T & Kraft D (2005) Covert Sensitization Revisited: Six Case Studies’ Contemporary Hypnosis, 22, (4): 202-209
• Maguire RJ and Vallance M (1964) Aversion therapy by electric shock: a simple technique. British Medical Journal 1: 151-153.
• Seligman, Martin E.P., What You Can Change and What You Can't: The Complete Guide to Self Improvement Knopf, 1993; ISBN 0-679-41024-4
• Watson JB and Reyner R (1920) Conditioned emotional reactions. Journal of Experimental Psychology 3: 1-14.