Aversion therapy is a form of 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 with the intention of quelling the targeted (sometimes compulsive) 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 mild to higher intensities.
The major use of aversion therapy is 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.
Among more-casual members of the self-help community, minor behavioral issues have been treated with the aid of an elastic band; the user snaps the band against his/her wrist while performing the undesirable behavior, seeking to create an unpleasant association and, ultimately, stop or the behavior pattern.
A strong precedent of the successful effects of aversion therapy is Disulfiram, or Antabuse,is an acetaldehyde dehydrogenase inhibitor. This enzyme is responsible for a portion of the metabolism of alcohol and, when inhibited, causes hangover-like effects almost immediately after consuming alcohol, thus promoting an unpleasant association with a chemical dependence. However, most patients never drink on it because they are aware of the negative effect, and instead, use it to help counter urges to drink while they are developing other coping skills and hope that over time the craving for alcohol will be extinguished from not being reinforced. Prior studies have shown Antabuse brings relief to the majority of its users, describing, "Patients who could not remain sober from one visit to the next achieved many months of continuous sobriety." More recent studies have compared aversion to "Minnesota Model" programs and have found patients matched on 17 baseline characteristics, to have higher abstinence rates at 6 and 12 months with the aversion. Traditional aversion therapy, which employed either chemical aversion or electrical aversion while effective, is commonly replaced with aversion imagery, a technique which is known as covert sensitization. Covert sensitization, or covert conditioning, involves provoking mental imagery to create associations with undesirable habits. While the efficacy of covert conditioning may be comparable to that of more-prevalent techniques in aversion therapy, these treatments may be combined to enhance an individual's likelihood for success in ending an unwanted habit.
Specifically, electrical aversion techniques have been demonstrated to significantly improve success rates among cigarette smokers. Additional longitudinal studies have repeated this effect, and showed cessation periods lasting at least 15 months post-trial. The examined trial involved 5 days of aversion therapy using an electric stimulus.
As an addictive substance, nicotine shows particular responsiveness to electric-stimulus-associated aversion therapy, especially when compared to traditional cessation methods. In addition, similar trials surveying chronic marijuana smokers yield higher cessation rates with only 5 days of treatment, with majorities of up to 85% remaining abstinent 15 months post-trial.
In compulsive habits
Many individuals struggle with unconscious or compulsive habits, such as chronic nailbiting, hair-pulling (Trichotillomania), or skin-picking (commonly associated with forms of Obsessive Compulsive Disorder as well as Trichotillomania). The effects of these habits are compounded by a lack of awareness, as the individual often does not make the conscious decision to engage in the particular behavior, in contrast to disorders of drug or alcohol addiction.
A relevant study of chronic nail-biters examined effects of electric stimulus, bitter substance (as applied to the nails), and placebo in biting reduction. Associating nail-biting with an electric stimulus or bitter substance showed similar levels of habit reduction as a result of aversion therapy, with over 80% of subjects exhibiting significant cessation rates up to 3 months post-trial. A similar study on the UCLA campus, examining electric stimulus conditioning on nail-biting alone, shared similar rapid and lasting results, with almost half of subjects ceasing entirely on the first day of treatment, and the majority having quit within 5 days.
More research is needed in cases of Trichotillomania, but preliminary case-based data have demonstrated promising results for aversion therapy, specifically that of electric aversion.
Obsessive compulsive disorder
As well, in cases specific to the rituals of obsessive compulsive disorder, using an electric stimulus to pair an unpleasant association with the undesired behavior has been successful in individual studies.
In popular culture
- In A Clockwork Orange and its film adaptation, the main character Alex is subjected to a form of experimental aversion therapy (the "Ludovico technique") aiming to stop his violent behavior.
- In the episode "There's No Disgrace Like Home" from The Simpsons, the Simpsons family goes through shock aversion therapy in order to improve their overall behavior.
- In the TV show Lost, there was a room 23 where people were brainwashed with the Ludovico technique. Episode 7 of season 3 "Not in Portland" was a specific episode.
- In the movieSouth Park Movie, Cartman is exposed to this when an electronic chip is inserted into his brain, such that if he swears he’s punished by an electric shock.
- Fralwey, P. Joseph; Howard, Matthew O. (2009). "Aversion Therapies". In Ries, Richard K.; Fiellin, David A.; Miller, Shannon C.; Saitz, Richard. Principles of Addiction Medicine (4th ed.). Philadelphia: Lippincott,Williams and Wilkins. pp. 843–844. ISBN 978-0-7817-7477-2.
- Sereny, G.; Sharma, V.; Holt, J.; Gordis, E. (May 1986). "Mandatory Supervised Antabuse Therapy in an Outpatient Alcoholism Program: A Pilot Study.". Alcoholism: Clinical and Experimental Research. 10 (3): 290–292. doi:10.1111/j.1530-0277.1986.tb05092.x. PMID 3526952.
- Smith, James W.; Frawley, P. Joseph; Polissar, Lincoln (October 1991). "Six- and Twelve-Month Abstinence Rates in Inpatient Alcoholics Treated with Aversion Therapy Compared with Matched Inpatients from a Treatment Registry". Alcohol Clinical and Experimental Research. 15 (5): 862–870. doi:10.1111/j.1530-0277.1991.tb00614.x. PMID 1755521.
- Watson, J.B. & Reyner, R. (1920). Conditioned emotional reactions. Journal of Experimental Psychology, 3: 1–14
- Maguire, R. J.; Vallance, M. (1964). "Aversion therapy by electric shock: a simple technique". British Medical Journal. 1 (5376): 151–153. PMC 1812608. PMID 14072635.
- Cautela, J.R. (1967). Covert Sensitization. Psychological Reports 20: 259–468.
- Russell, M. A. Hamilton (January 1970). "Effect Of Electric Aversion On Cigarette Smoking". British Medical Journal. 1 (5688): 82–86. JSTOR 20379143. PMC 1699162. PMID 5411450.
- Smith, J. Journal of Substance Abuse Treatment, Vol. 5. pp. 33-36, 1988.)
- Knowles, P.L, & Schmeling, G, & Smith, J.W. A marijuana smoking cessation clinical trial utilizing THC-free marijuana, aversion therapy, and self-management counseling. J Subst Abuse Treat. 1988
- Vargas, John M., and Vincent J. Adesso. ‘A Comparison Of Aversion Therapies For Nailbiting Behavior’. Behavior Therapy 7.3. 322-329. (1976)
- Bucher, Bradley D. ‘A Pocket-Portable Shock Device With Application To Nailbiting’. Behaviour Research and Therapy 6.3 (1968)
- BAR, LOUIS H. J., and BEN R. M. KUYPERS. ‘Behaviour Therapy In Dermatological Practice’.Br J Dermatol 88.6 (1973): 591-598.
- Aversion Therapy in the Treatment of Trichotillomania: A Case Study__Crawford, David A. ‘Aversion Therapy In The Treatment Of Trichotillomania: A Case Study’. Behav. Psychother. 16.01 (1988)
- Rapp, J T, R G Miltenberger, and E S Long. ‘Augmenting Simplified Habit Reversal With An Awareness Enhancement Device: Preliminary Findings.’. Journal of Applied Behavior Analysis 31.4 (1998): 665-668.
- ‘The Elimination Of Chronic Cough By Response Suppression Shaping’. Journal of Behavior Therapy and Experimental Psychiatry 4.1 (1973)
- Le Boeuf, Alan. ‘An Automated Aversion Device In The Treatment Of A Compulsive Handwashing Ritual’. Journal of Behavior Therapy and Experimental Psychiatry 5.3-4 (1974): 267-270.
- Kenny, F.T., L. Solyom, and C. Solyom. ‘Faradic Disruption Of Obsessive Ideation In The Treatment Of Obsessive Neurosis’. Behavior Therapy 4.3 (1973): 448-457.