Have you ever eaten at a restaurant and got sick immediately afterwards? How did you feel about returning to that restaurant? Most likely, you felt nauseous just thinking about it! This is an example of how unpleasant experiences influence our behaviour in everyday life. Similar mechanisms are also used in aversion therapy to help people get rid of unhelpful behaviours. Let's explore what aversion therapy looks like and how effective the intervention is.
- First, we'll look at the aversion therapy psychology definition.
Next, we'll outline the types of aversion therapy in addiction treatment.
- Then, we'll use an aversion therapy example to understand this treatment approach's principles better.
Finally, we'll highlight the advantages of aversion therapy and discuss the aversion therapy effectiveness.
Aversion Therapy Psychology Definition
Aversion therapy focuses on changing unhelpful behavioural patterns through sensory experiences that create discomfort. The treatment is based on behaviourism principles, which emphasise that humans learn through interactions with their environment. Therefore, we can unlearn any behaviour by manipulating the character of this interaction.
If you feel happy and proud of yourself after your first time at the gym, you learn it's a good idea to go there again.
However, if you feel ashamed because others laughed at you while trying to figure out how to use the equipment, you can feel discouraged about returning.
Whether the experience was pleasant or not will influence your future behaviour.
According to behaviourism, all behaviour is learned through either classical or operant conditioning. These processes explain how the environment (stimulus) influences our behaviour (response).
Aversion therapy utilises the first mechanism – classical conditioning. As part of the treatment, clients are exposed to unpleasant experiences that can help them unlearn problematic behaviours such as addictions.
Classical conditioning occurs when we strongly dislike something because it becomes associated with an unpleasant experience.
On the other hand, learning through operant conditioning occurs through reward and punishment. When we are rewarded for doing something, this reinforces the behaviour and makes the behaviour likely to be continued. Whilst punished behaviours are less likely to be repeated.
Types of Aversion Therapy
Aversion therapy can treat addictions to drugs, smoking, or alcohol. It can also be used to help with behavioural addictions (e.g. internet or gambling addictions) or compulsive behaviours such as aggression or nail-biting.
For example, those who excessively bite their nails can use nail polish that produces a horrible, bitter taste in their mouth whenever they bite their nails.
The nail-biting urges will eventually stop according to the aversion therapy principles because the individual will form an association between the nail polish (conditional stimuli) and disgust from the horrible taste (conditional response).
To better understand how aversion therapy uses the principles of classical conditioning, we'll examine the examples of aversion therapy for alcohol and gambling addiction in detail.
Aversion Therapy Example: Alcohol Addiction
Aversion therapy uses unconditioned stimuli to create an unpleasant sensory experience. Unconditioned stimuli refer to anything that naturally evokes unpleasant sensations like fear, disgust, pain, or nausea. Unconditioned stimuli include loud noises, unpleasant tastes or smells, mild electric shocks or nausea-inducing drugs.
The unconditioned stimulus is then paired with a neutral stimulus – something that doesn't typically evoke dislike. The neutral stimuli in aversion therapy are related to the problematic behaviour you want to eliminate.
Patients with alcohol addiction can be treated with medications like disulfiram (unconditioned stimulus). When the medication and alcohol (the neutral stimulus) are consumed together, they usually cause unpleasant side effects, such as nausea or vomiting (unconditioned response).
By giving the patient alcohol right after the nausea-inducing drug, their unpleasant response to the medicine becomes associated with alcohol. When this process occurs, the patient learns to respond negatively to alcohol even when the drug no longer accompanies it. The alcohol now becomes a conditioned stimulus.
The patient learns to dislike alcohol due to the previous unpleasant experience. This newly learnt aversion to alcohol is called the conditioned response.
Unconditioned stimuli produce unpleasant sensory experiences, which involve an automatic negative response (unconditioned response).
Neutral stimuli are not associated with a negative response.
When the unconditioned stimuli are paired with the neutral stimuli, we learn to respond to the neutral stimuli negatively (conditioned response). Through this process, the neutral stimuli become the conditioned stimuli.
Due to the potential risks associated with using disulfiram and alcohol, this treatment is no longer used. However, disulfiram can be prescribed in low doses to people to prevent relapse. It reduces cravings and prevents people from drinking due to the severely unpleasant reaction it elicits when combined with alcohol.
Aversion Therapy Example: Gambling Addiction
Gambling addiction can also be treated using aversion therapy. During treatment, the patient may write gambling-related statements. Then the patient is asked to read from cards that either include statements related to gambling (neutral stimuli) or statements unrelated to gambling.
Anytime they read a gambling-related card, they are given a mild electric shock or are exposed to an unpleasant, loud noise (unconditioned stimuli). The patient's natural response to the unpleasant stimuli involves feelings of fear, pain or irritation; this is the unconditioned response.
After repeatedly experiencing this response in a context associated with gambling-related statements, the statements start to evoke the same unpleasant psychological response in the patient; this is the conditioned response. Now, the patient develops a dislike towards things that they associate with gambling behaviour, which can help them quit their addiction.
Barker and Miller (1966) described a case study of treating a man with a gambling addiction. The treatment lasted ten days and consisted of 30-minute sessions, one session each day. During these sessions, the man was given painful electric shocks while watching a video of himself in a betting shop and a video of his family talking about how his addiction affected them.
The participant did not relapse even two months post-treatment.
Fig 2 - Aversion therapy can be used to treat gambling addiction, Unsplah by Kaysha
Advantages of Aversion Therapy: Effectiveness of Aversion Therapy
One advantage of aversion therapy is that it is an evidence-based theory. For instance, the classical conditioning theory was derived based on animal research carried out on dogs by Pavlov.
The number of studies investigating the effectiveness of aversion therapy for treating addictions in humans remains limited.
One study, which supports the effectiveness of aversion therapy for alcoholism, was conducted by Elkins et al. (2017). In this study, 13 patients with alcohol use disorder received five sessions of chemical aversion therapy in addition to standard treatment, which involved individual and group counselling and psychoeducation. The patients also received booster aversion therapy sessions 30 and 90 days after treatment.
After a year, 69% of patients were still sober. In addition, fMRI scans in the patients showed reductions in craving-related brain activity in the occipital cortex. The patients also reported lower cravings for alcohol.
However, it's hard to tell whether it was due to the aversion therapy or the other treatment they received.
It's challenging to establish this as the study did not use a control group.
We have also seen positive results in earlier research that did use a control group. Smith et al. (1991) conducted a study in which 249 patients underwent aversion therapy. The outcomes were compared to matched controls who had received counselling treatment instead. After 6 and 12 months, the patients who received aversion therapy had higher alcohol abstinence rates than those who received counselling.
While these two studies show promising results, there hasn't been much more research in this domain, and aversion therapy remains an unpopular treatment choice, likely due to its unpleasant and potentially unethical nature.
Fig 3 - Many people rely on support groups or self-management programmes to prevent relapse, Unsplash by Adrianna geo
Limitations of Aversion Therapy
One limitation of aversion therapy is that it's unclear how effective it is in the long term and whether the outcomes would be negatively affected by the process of extinction.
Extinction is when a learned behaviour fades, meaning the association formed starts to disappear.
There is a concern about the long-term effectiveness of aversion therapy due to extinction. Extinction occurs when the conditioned stimulus is no longer accompanied by the aversive stimulus, which leads the learned negative response to disappear slowly. In the real world, where the undesired behaviour is no longer associated with unpleasant consequences, it becomes harder to avoid the behaviour.
After undergoing aversion therapy for addiction, many still rely on other resources like support groups or self-management programmes like alcoholics anonymous to prevent subsequent relapse.
Moreover, it has been widely criticised for ethical violations. During therapy, there should be no harm physically or psychologically caused to the patient.
Aversive stimuli may cause stress, anxiety, humiliation, or pain.
Another important criticism is that this type of treatment can be considered reductionistic. Aversion therapy focuses only on behaviour and dismisses the importance of internal mental processes or one's social circumstances. Aversion therapy may get rid of the behaviour, but it does not address the underlying causes of the behaviour. Thus, the original undesired behaviour may be treated but may very well show up as a different form of addiction or another dysfunctional side-effect.
Aversion therapy - Key takeaways
- Aversion therapy is based on the principles of classical conditioning; it focuses on changing unhelpful behavioural patterns through sensory experiences that create discomfort.
- Aversion therapy works by pairing an aversive, unconditioned stimulus with the target behaviour to create a dislike toward the behaviour.
- Unconditioned stimuli refer to anything that naturally evokes unpleasant sensations like fear, disgust, pain, or nausea. When the unconditioned stimuli are paired with the neutral stimuli, we learn to respond to them negatively. Through this process, the neutral stimuli become the conditioned stimuli.
- There isn't sufficient research that would demonstrate the effectiveness of aversion therapy. However, the existing research shows some promising results.
- It's difficult to tell whether aversion therapy alone is effective in the long term. Moreover, it is associated with significant psychological and physical harm to the patient. It can also be considered reductionistic as it fails to address the experiences, cognitions, or one's circumstances that could be related to behavioural problems.
References
- Elkins, R. L., Richards, T. L., Nielsen, R., Repass, R., Stahlbrandt, H., & Hoffman, H. G. (2017). The Neurobiological Mechanism of Chemical Aversion (Emetic) Therapy for Alcohol Use Disorder: An fMRI Study. Frontiers in behavioral neuroscience, 11, 182. https://doi.org/10.3389/fnbeh.2017.00182
- Barker, J. C., & Miller, M. (1966). Aversion Therapy for Compulsive Gambling. British Medical Journal, 2(5505), 115.
- Smith, J. W., Frawley, P. J., & Polissar, L. (1991). Six- and twelve-month abstinence rates in inpatient alcoholics treated with aversion therapy compared with matched inpatients from a treatment registry. Alcoholism: Clinical and Experimental Research, 15(5), 862–870. https://doi.org/10.1111/j.1530-0277.1991.tb00614.x
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