Behavioural Interventions

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

Moreover, it has been widely criticised for ethical violations. During therapy, there should be no harm physically or psychologically caused to the patient.

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.