John Rey R.

Magsico

BSPSY4-4

HOW AVERSION THERAPY IS DONE AND WHAT ARE THE

TECHNIQUES USED IN THIS THERAPY

Preliminaries:

■ The therapist will assess the problem by measuring the severity, frequency, and the
environment of the undesirable behavior.

■ This will allow them to formulate a treatment program. Depending on the behavior to be
modified, the therapist will decide on which is the appropriate aversive stimulus to use.

Techniques used in Aversion Therapy

1. Physical Stimuli

Physical stimuli used in Aversion therapy can include pinches or smacks, and sometimes
the patient can administer his own aversive stimulus, for example by snapping an elastic band
which is on his wrist. The use of electric shocks as the aversive stimulus is perhaps the most
controversial in Aversive Therapy. These shocks, which are sometimes called Faradic shocks,
are unpleasantly painful but they are not dangerous. The patient can choose the level of shock
that they will receive, and they are usually applied to the arm or the leg.

Electric shocks are frequently used in cases of sexual deviations and can be applied
directly to the genital area. A pedophile may be shown photos of children or asked to think about
touching a child in an improper way. At the same time, the electric shock is applied. This is
repeated many times so that the person becomes conditioned to relate his desire to abuse a child
with a painful consequence.

While the use of electrical stimuli may be controversial, they do have the advantage that
it is a relatively cheap stimulus, which is easy to administer, with few adverse side effects, and
which gives the therapist complete control over the application. As therapy progresses the patient
may be given a portable shocking unit which he can use at home.
2. Chemical Stimuli

Sometimes, chemical or pharmacological aversants are used. The drug disulfiram

(Antabuse) is frequently used for treating alcohol abuse. It causes a desire to vomit and a very
unpleasant overall sensation when alcohol is ingested after administering it. The effects may
include headaches, heart palpitation, nausea and vomiting, dizziness, flushing, and shortness of
breath. Symptoms appear about 10-minutes after ingesting alcohol and are so unpleasant that
some alcoholics do restrain from drinking. Acamprosate and Naltrexone are also used to control
alcohol consumption.

Chemical stimuli can be quite effective, but they are quite expensive, and as they often
need to be administered in a hospital setting this can further elevate the cost. Additionally, they
can sometimes have unpredictable or excessive effects, and the therapist does not have such
control over the stimulus. Also, the very unpleasantness of the aversive substance can cause a
high drop-out rate and patients becoming aggressive and unwilling to continue the entire course
of treatment.

Aversion therapy for alcoholism is usually carried out in an inpatient setting and is
reinforced with other therapies and support groups. Sometimes, the person who is addicted to
alcohol will need to pass through a period of detoxification before treatment can begin. Often
family counseling sessions, stress management, and social skills training are also incorporated
into the recovery program.

3. Visual Imagery

Nowadays, visual imagery is often used, in a technique known as verbal aversion therapy
or covert sensitization. In this treatment method, the person is asked to think about the target
behavior and to imagine an undesirable consequence. For example, someone who cannot control
their eating of ice-cream may envisage a mound of ice-cream covered in maggots or
excrement. As no actual painful consequence is administered, it is only imagined, this is
considered to be a more acceptable form of aversion therapy. It does require the assistance of a
skilled therapist to guide the person to think of a sufficiently impacting image.

Examples

Case Example#1: What would a treatment protocol look like for a relatively well-adjusted
patient specifically requesting aversion therapy on an outpatient basis to reduce or
eliminate problem gambling behavior?

The therapist begins by asking the patient to keep a behavioral diary. The therapist uses
this information both to understand the seriousness of the problem and as a baseline to measure
whether or not change is occurring during the course of treatment. Because electric shock is easy
to use and is acceptable to the patient, the therapist chooses it as the aversive stimulus. The
patient has no medical problems that would preclude the use of this stimulus. He or she fully
understands the procedure and consents to treatment. The treatment is conducted on an outpatient
basis with the therapist administering the shocks on a daily basis for the first week in the office,
gradually tapering to once a week over a month. Sessions last about an hour. A small, battery-
powered electrical device is used. The electrodes are placed on the patient's wrist. The patient is
asked to preselect a level of shock that is uncomfortable but not too painful. This shock is then
briefly and repeatedly paired with stimuli (such as slides of the race track, betting sheets, written
descriptions of gambling) that the patient has chosen for their association with his or her problem
gambling. The timing, duration, and intensity of the shock are carefully planned by the therapist
to assure that the patient experiences a discomfort level that is aversive and that the conditioning
effect occurs.

After the first or second week of treatment, the patient is provided with a portable
shocking device to use on a daily basis for practice at home to supplement office treatment. The
therapist calls the patient at home to monitor compliance as well as progress between office
sessions. The conditioning effect occurs, the discomfort from the electric shock becomes
associated with the gambling behavior, the patient reports loss of desire and stops gambling.
Booster sessions in the therapist's office are scheduled once a month for six months. A
minor relapse is dealt with through an extra office visit. The patient is asked to administer his or
her own booster sessions on an intermittent basis at home and to call in the future if needed.

Case Example#2 What would the treatment protocol look like for an alcohol-dependent
patient with an extensive treatment history including multiple prior life-threatening
relapses?

The patient who is motivated to change but has not experienced success in the past may
be considered a candidate for aversion therapy as part of a comprehensive inpatient treatment
program. The treating therapist assesses the extent of the patient's problem, including drinking
history, prior treatments and response, physical health, and present drinking pattern. Patients who
are physically addicted to alcohol and currently drinking may experience severe withdrawal
symptoms and may have to undergo detoxification before treatment starts. When
the detoxification is completed, the patient is assessed for aversion therapy. The therapist's first
decision is what type of noxious stimulus to use, whether electrical stimulation or an emetic (a
medication that causes vomiting). In this case, when the patient's problem is considered
treatment-resistant and a medically-monitored inpatient setting is available, an emetic may be
preferable to electric shock as the aversive stimulus. There is some research evidence that
chemical aversants lead to at least short-term avoidance of alcohol in some patients. An emetic is
"biologically appropriate" for the patient in that it affects him or her in the same organ systems
that excessive alcohol use does. The procedure is fully explained to the patient, who
gives informed consent.

During a ten-day hospitalization , the patient may receive aversion therapy sessions
every other day as part of a comprehensive treatment program. During the treatment sessions, the
patient is given an emetic intravenously under close medical supervision and with the help of
staff assistants who understand and accept the theory. Within a few minutes following
administration, the patient reports beginning to feel sick. To associate the emetic with the sight,
smell and taste of alcohol, the patient is then asked to take a sip of the alcoholic beverage of his
or her choice without swallowing. This process is repeated over a period of 30–60 minutes as
nausea and vomiting occur. As the unpleasant effects of the emetic drug become associated with
the alcoholic beverage, the patient begins to lose desire for drinking. Aversion therapy in an
inpatient program is usually embedded within a comprehensive treatment curriculum that
includes group therapy and such support groups as AA, couples/family counseling, social
skills training , stress management, instruction in problem solving and conflict resolution, health
education and other behavioral change and maintenance strategies. Discharge planning includes
an intensive outpatient program that may include aversive booster sessions administered over a
period of six to twelve months, or over the patient's lifetime.
Reflection

Psychological/Behavioral therapies have been an effective tool in helping patients from

their mental illness. It may not guarantee them a hundred percent effective results, it somehow
helps them improve different aspects of their lives. Among all the therapies we have discussed, I
think aversion therapy is one of the therapies that I can say would not totally help patients
improve their lives. Maybe, we can say that on paper, aversion therapy is effective because of its
success rate and the testimonies from patients who undergo the therapy. In my opinion, I still do
not recommend this therapy for the patients.

Aversion therapy is the type of therapy that uses unpleasant stimulus to associate it with
the unpleasant habit. It was conceptualized from the theory Behaviorism, which states that
everything we do is learned, and hence, everything we do can be unlearned. I have two reasons
why I do not recommend this therapy. First is the process in the therapy is unethical. All kinds of
stimulus to be used is considered unethical because the therapy focuses and uses negative
reinforcement only. The inflicting pain also is unethical. Painful stimuli will cause a lot of
distress on the patient. It will also result to PTSD and anxiety for the patient. Biological aspect is
also affected. The use of chemicals that cause patients to vomit and to feel an unpleasant
sensation will damage some of their internal organs. With these reasons, we can see that both
mental and physical health of a person is affected. Second reason is that aversion therapy
promotes suffering just to modify or change the behavior of a person. I cannnot recommend this
therapy also because there are a lot of therapy that is better and more useful than aversion. With
these reasons, I can say that aversion therapy would not help the overall situation of the patient.

As a psychology student and as a future therapist, we should promote therapy that provides
beneficial effects in all aspects. We should be mindful whether it is beneficial for the well being
of our patient and we should ensure that both the psychological and biological aspect are affected
by the therapy we will use. It should be a balance of physical and psychological aspect so we can
ensure an overall effective therapy.