Aversion therapy refers to a type of conditioning that causes the patient to associate an undesirable urge with a negative response. Like many forms of therapy, it originated decades ago and has developed and evolved to become quite different from its original form. Nonetheless, misperceptions persist about aversion therapy. This is not helped by the barbaric portrayal of it in films like A Clockwork Orange, or its controversial and dangerous use in conversion therapy (discussed below).
We hope to give you a more nuanced understanding of aversion therapy and whether it can help you or your loved one.
Aversion Therapy: What is it?
Aversion therapy is a therapy technique that works by conditioning the mind to associate undesirable behaviors with negative stimuli. It aims to do this by exposing the patient to the negative stimulus when s/he feels an undesirable urge.
Aversion Therapy Theory
How Does Aversion Therapy Suggest the Mind Works?
Aversion therapy is anchored in the approach to psychology known as behaviorism. Behaviorists consider human behavior to be something learned from the external environment. The person learns to behave in certain ways based on two types of conditioning. Classical conditioning refers to learning by association. Operant conditioning refers to learning by positive reinforcement (reward) or negative reinforcement (punishment).
While it is generally accepted that certain behaviors are inherent in the physical makeup of the species, behaviorism asserts that even these behaviors can be changed, or at least averted, through external forms of conditioning.
How Does Aversion Therapy Cause Change?
Aversion therapy causes change by replacing positive associations with a behavior with negative associations. Aversion therapy mainly uses operant conditioning, averting the undesired behavior by engineering negative reinforcement.
In the past, this was mainly done using physically harmful stimuli, such as shock therapy and medication. These days, it is becoming more common for therapists to guide patients in visualizing negative consequences in association with the behavior.
Another type of aversion therapy is used to relieve symptoms of certain phobias. Instead of associating the behavior with negative consequences, the behavior is shown to have none of the negative consequences expected (see “Flooding” below).
What Happens in an Aversion Therapy Session?
The structure of an aversion therapy session is very different today than it was in the past. In addition to physical reinforcements, visualization is becoming more common. Some more extreme forms of physical reinforcement are no longer used.
Techniques Used in Aversion Therapy
Modern aversion therapy sessions include both physical and non-physical techniques. Electric shock therapy is still commonly used in treating addictions. It works particularly well in helping people to stop smoking. Drugs such as disulfiram are used to prevent drinking, by causing the patient to feel nauseous when s/he consumes alcohol.
The therapist might also help a patient visualize negative consequences, such as vomiting related to alcohol consumption, or severe illness connected to smoking. This is called covert sensitization. In order for covert sensitization to be effective, the patient needs to be particularly motivated.
Flooding is a form of aversion therapy that helps patients with phobias negate the negative consequences they associate with the subject of their fear. For example, a person suffering from claustrophobia may be locked in a small space for an extended period of time. People suffering from PTSD may be taken to the location where the trauma occurred, or guided to visualize the situation over and over again. Flooding is always done in a controlled environment, to avoid the possibility that the subject may hurt him or herself when s/he feels unable to manage the situation.
Does Aversion Therapy Work?
There is evidence that aversion therapy works, but it is often called into question or criticized. This is for a number of reasons, the first being that studies done on its efficacy have not been entirely rigorous.
But the problem with measuring the efficacy of aversion therapy goes beyond questions about methodology. One of the fundamental difficulties comes from differences in opinions as to what to measure. Critics assert that measuring whether aversion therapy stops a certain behavior is moot as long as the underlying motivations still exist. Those motivations might simply be expressed through other unhealthy behaviors, or lead to deeper problems. Measuring whether aversion therapy has an effect on these motivations is difficult, if not impossible. We will discuss the possible negative consequences of not dealing with these motivations below.
Even if we gauge its effectiveness by the simple measure of whether it stops the behavior, risks of relapse bring these measurements into question. Because aversion therapy is used most commonly in treating addiction, relapse remains a possibility long after the behavior is stopped. The question becomes how many subjects relapse, and over how long a time period we measure this. All addiction treatments share this problem and it is not just aversion therapy which is subject to this criticism.
On a very basic level, there is evidence that aversion therapy can prevent undesirable behaviors, including addiction, and that it has positive results even when taking relapse into account. Because aversion therapy is less common these days, much of the evidence dates back to the mid to late twentieth century.
What Kinds of Concerns is Aversion Therapy Best For?
Aversion therapy can be used to stop certain compulsive behaviors like nail-biting, skin-picking, and hair-pulling. In these cases, the therapy can comprise simple techniques, such as putting unpleasant tasting substances on the fingernails. Alternatively, electric shock treatment is used, and while evidence for its effectiveness is scarce, what evidence there is shows positive results for these behaviors.
People who wish to stop smoking may try aversion therapy. One study shows that over 50% of smokers who used aversion therapy to quit smoking, were still not smoking a year later. This is much higher than the success rates of other methods of quitting smoking.
As we’ve mentioned, aversion therapy is most commonly used in treating addiction. There are certainly limitations to its effectiveness, but treatment centers which do use this therapy offer it as part of a more holistic treatment approach. Implemented in conjunction with other therapies, many of its limitations become moot, and the negative associations some have with it become less of a concern.
Another common use of aversion therapy in the past has been in treating sexual offenders or those who see themselves at risk of becoming sexual offenders. Convicted sex offenders may be given court-ordered aversion therapy, so as to associate sexual behaviors with negative stimuli. People who have not committed any crimes, on the other hand, but have strong urges to commit sexual assault or pedophilia, sometimes seek out aversion therapy to avoid succumbing to these urges.
Finally, aversion therapy has been used to treat obsessive-compulsive disorder. However, many psychologists reject this approach in treating OCD, criticizing it as causing more harm than good.
How Are Aversion Therapy Specialists Trained?
Modern psychology programs at most colleges around the world do not train therapists in aversion therapy. It is, after all, a technique used by few psychologists and practices. Those who do want to train in aversion therapy may seek out experienced therapists to guide them. Alternatively, therapists working for a treatment center that utilizes it will receive training from experts employed by the center. They’ll also be guided in electric shock treatment if necessary.
In order to prescribe disulfiram to alcoholics, one needs to be qualified as a medical doctor or psychiatrist.
Concerns/Limitations of Aversion Therapy
There are possibly more critics of aversion therapy than proponents of it. The idea of inflicting physical pain on a patient is immediately off-putting to many healthcare providers. Also, pop culture has not represented it in a flattering way, with many portrayals of the therapy taking place either in the distant past or in a dystopian future.
The most apparent concern regarding aversion therapy is the possibility that the painful physical treatments could cause problems for the patient unrelated to their undesirable behavior. It could cause excess anxiety related to pain and discomfort that remains with the patient long after the treatment is over. Some go so far as calling electric shock therapy as well as the effects of disulfiram a possible source of trauma.
Even if the treatment is superficially successful, critics point out that the underlying problems remain. Many addicts, for example, suffer from co-occurring mental health disorders. Often, their addiction began as a result of past difficulties. Aversion therapy runs the risk of eliminating a defective coping mechanism without replacing it with a healthy alternative.
Since the fundamental problems remain, they are likely to be expressed in other unhealthy forms or lead to a relapse. Alternatively, they may be suppressed for the present, only to cause significant damage in the future.
Therefore, aversion therapy on its own is unlikely to yield lasting positive results when treating serious conditions. However, as part of a more holistic treatment regimen, it can play an important role, diverting the urges effectively enough to give the patient the opportunity to deal with the source of the problems.
Important Practitioners in Aversion Therapy
Since the practice of aversion therapy is relatively rare today, and since it is one offshoot of the behavioral approach to psychology, there are few “big names” remaining in the field. One such example is Joseph Cautela, credited with developing covert sensitization. Most practitioners are connected to larger practices or treatment centers.
Controversies with Aversion Therapy
Aversion therapy has been very controversial, particularly due to the questionable ethics in administering painful shocks to a patient. This is especially true in cases in which it has been used to treat minors, who had little to no say in consenting to the treatment.
Today, the biggest controversy regarding aversion therapy is around so-called conversion therapy.
Conversion therapy is a form of aversion therapy that claims to “cure” homosexuality. It is most commonly carried out by religious practitioners, who believe that homosexuality is a perversion or sin. The very basis of conversion therapy is grounded in pathologizing homosexuality. Modern psychology stopped regarding homosexuality as pathology decades ago. Practitioners who do so are therefore putting personal or cultural beliefs above the scientific foundation of the field of psychology.
For those who do wish to eliminate their homosexuality and replace it with heterosexuality, conversion therapy is unlikely to have the desired effect. While aversion therapy aims to prevent a person from acting on an urge, homosexuality cannot be reduced to urges alone. Regardless of one’s perspective on the morality of homosexuality, sexuality is an important part of a person’s identity. It cannot be changed simply by changing one’s behavior.
At most, conversion therapy pathologizes a person’s sexuality, preventing them from acting on their sexual urges. There is no evidence that it can cause a person to become attracted to the opposite sex. There is, however, evidence that it causes people to experience an excess of shame in themselves, which can lead to severe depression. There are documented cases of people who have undergone conversion therapy turning to drugs or committing suicide.
For this reason, it has been banned in multiple states, with many human rights organizations calling for wider bans on the practice throughout the world.
Final Thoughts on Aversion Therapy
Aversion therapy has garnered plenty of controversy and criticism over the past few decades. It has certainly been used in damaging ways. However, there is evidence that it works, particularly in helping people quit smoking and averting habits such as nail-biting and hair-pulling. It can help addicts stop using substances and prevent relapse, but is most likely to be effective when implemented as part of a holistic treatment program. Aversion therapy