Aversion therapy

Aversion therapy
ICD-9-CM	94.33
MeSH	D001348

Aversion therapy is a form of psychological treatment in which the patient is exposed to a stimulus while simultaneously being subjected to some form of discomfort. This conditioning is intended to cause the patient to associate the stimulus with unpleasant sensations with the intention of quelling the targeted (sometimes compulsive) behavior.

Aversion therapies can take many forms, for example: placing unpleasant-tasting substances on the fingernails to discourage nail-chewing; pairing the use of an emetic with the experience of alcohol; or pairing behavior with electric shocks of mild to higher intensities.

In addictions

The major use of aversion therapy is for the treatment of addiction to alcohol and other drugs. This form of treatment has been applied since 1932. The treatment is discussed in the Principles of Addiction Medicine, Chapter 8, published by the American Society of Addiction Medicine in 2003.

Alcohol addiction

Disulfiram is used to treat alcohol dependence; it causes negative effects when a person drinks alcohol while the drug is in their system. It has been described as an aversion therapy, but it appears that it has more of a deterrent effect, since people who take it generally don't drink and therefore don't experience the negative effects.^[1]^[2]

Cigarette addiction

Specifically, electrical aversion techniques have been demonstrated to significantly improve success rates among cigarette smokers.^[3] Additional longitudinal studies have repeated this effect, and showed cessation periods lasting at least 15 months post-trial. The examined trial involved 5 days of aversion therapy using an electric stimulus.^[4]

Cocaine dependency

Emetic therapy and faradic aversion therapy is used to induce aversion for cocaine dependency.^[5]

In compulsive habits

Many individuals struggle with subconscious or compulsive habits, such as chronic nailbiting, hair-pulling (Trichotillomania), or skin-picking (commonly associated with forms of Obsessive Compulsive Disorder as well as Trichotillomania). The effects of these habits are compounded by a lack of awareness, as the individual often does not make the conscious decision to engage in the particular behavior, in contrast to disorders of drug or alcohol addiction.

Nail biting

A relevant study of chronic nail-biters examined effects of electric stimulus, bitter substance (as applied to the nails), and placebo in biting reduction. Associating nail-biting with an electric stimulus or bitter substance showed similar levels of habit reduction as a result of aversion therapy, with over 80% of subjects exhibiting significant cessation rates up to 3 months post-trial.^[6] A similar study on the UCLA campus, examining electric stimulus conditioning on nail-biting alone, shared similar rapid and lasting results, with almost half of subjects ceasing entirely on the first day of treatment, and the majority having quit within 5 days.^[7]

Trichotillomania

More research is needed in cases of Trichotillomania (obsessive hair-pulling), but preliminary case-based data have demonstrated promising results for aversion therapy, specifically that of electric aversion.^[8]^[9]^[10]

Obsessive compulsive disorder

As well, in cases specific to the rituals of obsessive compulsive disorder, using an electric stimulus to pair an unpleasant association with the undesired behavior has been successful in individual studies.^[11]^[12]^[13]

In popular culture

In A Clockwork Orange and its film adaptation, the main character Alex is subjected to a form of experimental aversion therapy (the "Ludovico technique") aiming to stop his violent behavior.
In the episode "There's No Disgrace Like Home" from The Simpsons, the Simpsons family goes through shock aversion therapy in order to improve their overall behavior.
In the TV show Lost, the episode "Not in Portland" featured a room named 'Room 23' where people were brainwashed with the Ludovico technique.
In the movie South Park: Bigger, Longer and Uncut, Cartman is exposed to this when an electronic chip is inserted into his brain, such that if he swears he’s punished by an electric shock.
In the episode "Space Camp Was A Hoax" from Camp Camp, Max, Neil, and Nikki attempt to make Space Kid hate outer space by use of aversion therapy. The phrase "aversion therapy" is used in the episode to describe their actions.
In the episode "I Am Anne Frank (Part 1)" of American Horror Story: Asylum, the character Lana Winters is subjected to aversion therapy. She is administered a substance that makes her vomit while simultaneously being shown suggestive photographs of women as a form of conversion therapy.

References

↑ Brewer, C; Streel, E; Skinner, M (9 March 2017). "Supervised Disulfiram's Superior Effectiveness in Alcoholism Treatment: Ethical, Methodological, and Psychological Aspects". Alcohol and alcoholism (Oxford, Oxfordshire). 52 (2): 213–219. doi:10.1093/alcalc/agw093. PMID 28064151.
↑ Fralwey, P. Joseph; Howard, Matthew O. (2009). "Aversion Therapies". In Ries, Richard K.; Fiellin, David A.; Miller, Shannon C.; Saitz, Richard. Principles of Addiction Medicine (4th ed.). Philadelphia: Lippincott, Williams and Wilkins. pp. 843–844. ISBN 978-0-7817-7477-2.
↑ Russell, M. A. Hamilton (January 1970). "Effect Of Electric Aversion On Cigarette Smoking". British Medical Journal. 1 (5688): 82–86. JSTOR 20379143. PMC 1699162. PMID 5411450.
↑ Smith, J. Journal of Substance Abuse Treatment, Vol. 5. pp. 33-36, 1988.)
↑ Jerome J. Platt (2000). Cocaine Addiction: Theory, Research, and Treatment. Harvard University Press. pp. 241–. ISBN 978-0-674-00178-7.
↑ Vargas, John M., and Vincent J. Adesso. ‘A Comparison Of Aversion Therapies For Nailbiting Behavior’. Behavior Therapy 7.3. 322-329. (1976)
↑ Bucher, Bradley D. ‘A Pocket-Portable Shock Device With Application To Nailbiting’. Behaviour Research and Therapy 6.3 (1968)
↑ BAR, LOUIS H. J., and BEN R. M. KUYPERS. ‘Behaviour Therapy In Dermatological Practice’.Br J Dermatol 88.6 (1973): 591-598.
↑ Aversion Therapy in the Treatment of Trichotillomania: A Case Study__Crawford, David A. ‘Aversion Therapy In The Treatment Of Trichotillomania: A Case Study’. Behav. Psychother. 16.01 (1988)
↑ Rapp, J T, R G Miltenberger, and E S Long. ‘Augmenting Simplified Habit Reversal With An Awareness Enhancement Device: Preliminary Findings.’. Journal of Applied Behavior Analysis 31.4 (1998): 665-668.
↑ ‘The Elimination Of Chronic Cough By Response Suppression Shaping’. Journal of Behavior Therapy and Experimental Psychiatry 4.1 (1973)
↑ Le Boeuf, Alan. ‘An Automated Aversion Device In The Treatment Of A Compulsive Handwashing Ritual’. Journal of Behavior Therapy and Experimental Psychiatry 5.3-4 (1974): 267-270.
↑ Kenny, F.T., L. Solyom, and C. Solyom. ‘Faradic Disruption Of Obsessive Ideation In The Treatment Of Obsessive Neurosis’. Behavior Therapy 4.3 (1973): 448-457.

Sources

Lancaster, T., Stead, L., Silagy, C., & Sowden, A. (2000). Effectiveness of interventions to help people stop smoking: findings from the Cochrane Library. BMJ : British Medical Journal, 321(7257), 355–358.

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[1] Brewer, C; Streel, E; Skinner, M (9 March 2017). "Supervised Disulfiram's Superior Effectiveness in Alcoholism Treatment: Ethical, Methodological, and Psychological Aspects". Alcohol and alcoholism (Oxford, Oxfordshire). 52 (2): 213–219. doi:10.1093/alcalc/agw093. PMID 28064151.

[2] Fralwey, P. Joseph; Howard, Matthew O. (2009). "Aversion Therapies". In Ries, Richard K.; Fiellin, David A.; Miller, Shannon C.; Saitz, Richard. Principles of Addiction Medicine (4th ed.). Philadelphia: Lippincott, Williams and Wilkins. pp. 843–844. ISBN 978-0-7817-7477-2.

[3] Russell, M. A. Hamilton (January 1970). "Effect Of Electric Aversion On Cigarette Smoking". British Medical Journal. 1 (5688): 82–86. JSTOR 20379143. PMC 1699162. PMID 5411450.

[4] Smith, J. Journal of Substance Abuse Treatment, Vol. 5. pp. 33-36, 1988.)

[5] Jerome J. Platt (2000). Cocaine Addiction: Theory, Research, and Treatment. Harvard University Press. pp. 241–. ISBN 978-0-674-00178-7.

[6] Vargas, John M., and Vincent J. Adesso. ‘A Comparison Of Aversion Therapies For Nailbiting Behavior’. Behavior Therapy 7.3. 322-329. (1976)

[7] Bucher, Bradley D. ‘A Pocket-Portable Shock Device With Application To Nailbiting’. Behaviour Research and Therapy 6.3 (1968)

[8] BAR, LOUIS H. J., and BEN R. M. KUYPERS. ‘Behaviour Therapy In Dermatological Practice’.Br J Dermatol 88.6 (1973): 591-598.

[9] Aversion Therapy in the Treatment of Trichotillomania: A Case Study__Crawford, David A. ‘Aversion Therapy In The Treatment Of Trichotillomania: A Case Study’. Behav. Psychother. 16.01 (1988)

[10] Rapp, J T, R G Miltenberger, and E S Long. ‘Augmenting Simplified Habit Reversal With An Awareness Enhancement Device: Preliminary Findings.’. Journal of Applied Behavior Analysis 31.4 (1998): 665-668.

[11] ‘The Elimination Of Chronic Cough By Response Suppression Shaping’. Journal of Behavior Therapy and Experimental Psychiatry 4.1 (1973)

[12] Le Boeuf, Alan. ‘An Automated Aversion Device In The Treatment Of A Compulsive Handwashing Ritual’. Journal of Behavior Therapy and Experimental Psychiatry 5.3-4 (1974): 267-270.

[13] Kenny, F.T., L. Solyom, and C. Solyom. ‘Faradic Disruption Of Obsessive Ideation In The Treatment Of Obsessive Neurosis’. Behavior Therapy 4.3 (1973): 448-457.