Aversion therapy - Dr. Axe

Aversion therapy is based on the theory of conditioning, which states that a response becomes more frequent and predictable as a result of reinforcement. In other words, when you’re rewarded for a behavior by feeling good, this reinforces the behavior and makes it more likely that you’ll repeat it in the future.

If we assume that human behavior is learned, we can conclude that certain behaviors can also become unlearned and intentionally avoided.

This is the purpose of aversion therapy, an intervention that can help to treat problems including drug or alcohol dependence, cigarette or electronic cigarette smoking, violent behaviors, and overeating. It works by making self-destructive and unhealthy habits less desirable because they stop feeling good and producing a “reward.”

What Is Aversion Therapy? How Does It Work?

The definition of aversion therapy is “psychotherapy designed to cause a patient to reduce or avoid an undesirable behavior pattern by conditioning the person to associate the behavior with an undesirable stimulus.” Another name for this type of therapy is “aversive conditioning.”

The history of aversion therapy dates back to the 1930s, when it first began being used to treat alcohol addiction.

An “aversion” is a strong dislike or feeling of disgust, which usually causes someone to avoid or turn away from the thing causing the aversion.

An example of an aversion that many people are familiar with is any food that has made them feel sick in the past. Even if they once the enjoyed the food, chances are they no longer enjoy it because it’s become associated with feeling unwell.

How is aversion therapy done?

According to an article published in Frontiers in Behavioral Neuroscience, this type of therapy was designed to reduce positive cues and “pleasure center activation” that is associated with destructive behaviors. According to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, activation of the brain’s reward (pleasure) system is a major source of problems for drug and alcohol users, as well as those “addicted” to other substances and habits.

The unwanted behavior is paired with a stimulus — such as electrical shocks, use of chemical substances or frightening imagined situations — that evokes unpleasant feelings. These stimuli are given following an undesirable behavior so a mental link is formed between doing the behavior and feeling badly afterward.

What is an example of aversive conditioning? One example is the use of drugs in the treatment of alcoholism.

The drug given to the alcoholic produces unpleasant effects, such as nausea, when alcohol is consumed.

In this case, the therapeutic drug and the alcohol together cause an upset stomach, making it less desirable to continue to drink. In addition to administering the stimulus (drug), therapy is also often used.

Together, this type of intervention can specifically target unconscious/habit memory associations that lead to cravings and then undesirable actions.

Note: Aversion therapy is not to be confused with inversion therapy, a nonsurgical treatment designed to remove gravitational pressure off the spine and create more space between the spine’s vertebrae.

Benefits/Uses (Who Is It For?)

What is aversion therapy used for? Some of the habits and conditions that this method is intended to treat include:

  • Alcohol abuse
  • Smoking
  • Sexual offenses and inappropriate behaviors
  • Drug use
  • Less serious but unwanted habits like nail biting, skin picking and hair pulling
  • Gambling
  • Violent behavior
  • Anger problems
  • Overeating
  • Overusing technology, such as someone being “addicted to their phone” (aka nomophobia)

Types of aversion therapy include:

  • Olfactory aversion therapy, which uses chemicals that are inhaled to produce negative responses. These chemicals usually have a strong odor and can cause nausea and loss of appetite.
  • Gustatory stimuli, which uses chemicals/drugs that are swallowed to produce negative responses. The chemicals used normally have a foul taste. One example is spraying someone’s hands/nails with a chemical that makes them taste bad in order to reduce nail biting.
  • Aversion therapy for alcohol. Disulfiram (or Antabuse) is one drug given to those who abuse alcohol because it causes side effects when someone drinks by changing the way alcohol is normally metabolized. Side effects can include nausea, vomiting, heart palpitations, intense headache, flushing, shortness of breath and dizziness. Another term for this approach is emetic therapy, the use of drugs that produce aversive states.
  • Use of electric shocks. This is considered the most controversial form. It’s often used to help someone quit smoking. It involves administering an electrical shock to the patient’s arm, leg or even genitals every time the person engages in the unwanted behavior. Faradic therapy is one form in which shocks are administered to muscles.
  • Covert sensitization (or verbal imagery/visual aversion therapy), which uses an individual’s imagination to produce the unpleasant “covert” stimuli. This type relies on the patient’s thoughts, rather than use of a drug, shock, etc.

According to Addiction.com, some advantages of this type of therapy include:

  • Fewer potential adverse or unexpected side effects compared to taking drugs long term
  • The therapist having complete control over the negative stimulus
  • Can be less expensive than other types of therapy
  • Ease of administration, depending on the specific type of stimuli used
  • In the case of covert sensitization, there are no actual consequences or suffering, since stimuli is only imagined

Is It Effective?

There’s good evidence that aversion therapy can be effective in some situations, depending on the condition being treated, because it creates an association with something negative, rather than positive, every time someone engages in a habit she or he wants to quit.

In one study published in published in Frontiers in Behavioral Neuroscience mentioned above, the majority of patients with alcohol dependence reported that after four chemical aversion treatments, they experienced strong aversions/repulsion to alcohol. This strong aversion was still evident 30 and 90 days post-treatment, with 69 percent of the participants reporting being abstinent 12 months post-treatment.

That said, aversion therapy isn’t always effective. Research studies overall have shown mixed results.

How well aversion therapy works depends on factors including;

  • How motivated the patient is to change the habit/behaviors
  • Whether or not the program is geared toward relapse prevention — for example if there’s follow-up meetings scheduled
  • The exact method used in therapy and type of stimulus
  • The type of behavior being modified

This type of therapy is also controversial, sometimes even described as unethical.

For example, historically some people have used this approach to try to “treat” sexuality (this is called reparative therapy or conversion therapy), often without success. In this case, pictures or imagined situations have been paired with electrical shocks or other unpleasant stimuli in order for the individual to eventually stop associating certain situations with pleasure.

A major criticism of aversion therapy is that it focuses exclusively on behaviors without addressing the patient’s underlying motivation, thoughts and other psychological factors that contribute to the unhealthy habits. There’s concern that if the underlying issues that led to the addiction/destructive habit are never addressed, then any intervention won’t work long term.

This is believed to contribute to high rates of relapse and even development of other addictions.

Issues and Concerns with This Type of Therapy

While it’s an effective approach for some people, aversion therapy also has some disadvantages.

  • Some of the stimuli used can cause negative side effects and suffering, at times making people feel very sick. It remains controversial whether someone should have to suffer, even if that person eventually gets better.
  • In some situations the patient may have control of the stimuli and fail to use it appropriately. For example, patients may not take the drugs they are prescribed as intended or misuse the drugs.
  • Some types of chemical aversion stimuli can be expensive, especially if they need to be administered by a doctor or in a hospital or residential treatment setting (such as electrical chocks).
  • Patients may experience significant anxiety symptoms, signs of depression, hostility and anger in response to some stimuli. Some report feeling traumatized, which may lead to other psychological problems.
  • Most therapists believe that children should not be subjected to aversion therapy, since they may not fully understand the risks involved and may develop anxiety.

The American Psychiatric Association and the American Psychological Association consider some forms of aversion therapy to be unethical and strongly argue against their use. This especially applies to the desire to inhibit or eliminate sexual urges or desires.

According to experts, there are some precautions that can be taken in order to make aversion therapy as safe and helpful as possible:

  • The patient should have a medical exam performed and/or obtain medical clearance from his or her doctor.
  • Electrical stimuli should be avoided by anyone with a heart condition.
  • Patients should be educated about what to expect and serious side effects to look out for.

Other Options

Most therapists believe that aversion therapy shouldn’t be used as a first-line treatment approach, as other forms of psychotherapy may be safer and more effective long term. However, some techniques involved in this method may successfully be coupled with other forms of therapy or interventions.

What is the opposite of aversion therapy? While it’s not exactly the opposite type of approach, systematic desensitization is one therapeutic technique that has a similar goal but works differently.

The purpose of systematic desensitization is for a patient with anxiety or a phobia disorder to practice a set of relaxation techniques in order to reduce the response that he or she feels when exposed to a fearful stimuli.

Depending on the situation, other types of therapy that may be better options than aversion therapy include:

  • Cognitive behavioral therapy (CBT) — This approach, considered one of the best therapies for overcoming alcohol and substance abuse, anxiety, and for smoking cessation, aims to change destructive patterns of thinking that lead to unwanted behaviors. With CBT, addictions are viewed as over-learned behaviors, but more effective behaviors can be practiced until they take their place.
  • Visualization/guided imagery — Using your imagination to visualize scenarios and figuring out how to handle them more productively can lead to positive changes in behavior, as well as a decrease in stress and anxiety.
  • Exposure therapy — This works by exposing a person to something she or he fears repeatedly, helping to desensitize the patient. Over time people can learn to better tolerate the thing that scares them rather than numbing with drugs/alcohol or engaging in other harmful habits.
  • Mindfulness practices —  Guided meditation, mind-body practices like yoga and breathing exercises can all help to manage someone’s response to triggers in the environment. These practices are also now used to help people deal with substance abuse, quit smoking and overeating, and overcome anxiety. For example, recent research focused on mindfulness for smoking cessation has found that training smokers to learn how to notice the sensation of craving and letting thoughts and cravings pass can help them to quit.
  • Emotional freedom technique (EFT) — Also called tapping or psychological acupressure, this involves tapping certain points on the body to focus one’s attention, reduce stress and improve the body’s flow of energy.
  • Social accountability and support — One example is committing to pay a charity every time you gamble or engage in another unwanted behavior, such as eating a “forbidden food.” There are even apps now, such as HabitShare, that allow you to “share habits with friends for extra motivation & accountability.”

Conclusion

  • What is aversion therapy? It’s a form of psychological treatment in which an unpleasant stimulus is paired with an undesirable behavior. This leads to discomfort and a negative association, making it less likely that the unwanted behavior will be repeated.
  • Examples of stimuli used in aversion therapy include electric shock, chemicals/drugs (used in olfactory and gustatory therapy) and imagined scenarios (used in covert sensitization).
  • Although it’s controversial and at times considered unethical, conditions that this method may help treat include alcohol abuse, drug use, smoking, sexual deviations/offenses, nail biting, gambling and overeating.

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