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Therapeutic Abhorrence: Intent, Case Studies, and Dispute

Therapeutic Approach Based on Negative Conditioning: Goals, Examples, and Disputes

Images of Neleman, Winners Initiative Unveiled
Images of Neleman, Winners Initiative Unveiled

Therapeutic Abhorrence: Intent, Case Studies, and Dispute

Aversion therapy, also known as "deterrent therapy" or "aversive conditioning," is a contentious behavioral treatment that consistently links undesirable behaviors with uncomfortable experiences to discourage such actions (1). People most commonly receive this therapy as a means to tackle behaviors linked to addictions, such as smoking or alcohol use disorder (AUD). Despite its history, aversion therapy is less common compared to other treatment options for substance use disorders.

The primary aim of aversion therapy is to create an association between undesirable habits and unpleasant experiences, which ultimately discourages or eliminates these unwanted habits (2). Here, we explore various examples of aversion therapy and its potential effectiveness for several addictive behaviors.

Examples of Aversion Therapy

Emetic Counter Conditioning

One form of aversion therapy is emetic counter conditioning (ECC), which can help reduce alcohol cravings in those with AUD. During ECC sessions, a person consumes various alcoholic beverages while taking a medication to induce nausea and vomiting (3). The goal is for the individual to associate drinking alcohol with the unpleasant sensation of nausea or vomiting.

Graphic Warning Labels

Graphic warning labels on cigarette packages, mandated in 118 countries, typically feature photographs of severe health consequences associated with smoking, such as diseased lungs and cancerous tumors (3). These labels serve as a form of aversion therapy by linking the act of smoking with disturbing or distressing images.

Rapid Smoking

Rapid smoking entails puffing on a cigarette every few seconds to trigger uncomfortable sensations, thereby reducing nicotine dependence (4). A 2016 review, however, concluded that rapid smoking is not an effective long-term treatment for individuals trying to quit smoking.

Rubber Band Aversion Therapy

Known as rubber band aversion therapy (RBAT), this treatment method is used for obsessive-compulsive disorder (OCD). RBAT involves wearing a rubber band around the wrist and snapping the band every time the patient experiences an obsessive thought (5). The intention is for the individual to associate obsessive thoughts with physical pain, leading to a reduction in the number of obsessive thoughts over time. A 2010 review, however, found that RBAT is not an effective therapy for OCD.

Does Aversion Therapy Work?

Research suggests that aversion therapy can decrease addictive behaviors in the short term (6). For instance, a 2017 study investigated ECC's impact on alcohol-related brain activity in 13 individuals with AUD. Results showed that participants reported alcohol aversion or avoidance at 30 and 90 days post-treatment, and 69% of participants remained sober 12 months later (6). Brain scans also revealed significant reductions in craving-related brain activity before and after treatment, suggesting that ECC might be an effective treatment for AUD.

However, research into the effectiveness of aversion therapy as a treatment for other addiction-related behaviors is limited (6). A review of studies investigating rapid smoking's impact on smoking cessation found that while some studies reported initial success, the treatment's effectiveness waned over the longer term (6). Similarly, research indicates that aversion therapy might be less effective against nicotine addiction or overeating in the long term (6).

Controversy and Ethical Concerns

Some mental health professionals view aversion therapy as controversial due to its use of punishment as a form of therapy (7). Aversion therapy's history is marked by debates, with "conversion therapy," a type of aversion therapy used to treat homosexuality, being considered unethical (8).

Many people were coerced into conversion therapy, while others voluntarily participated out of shame, guilt, or societal discrimination (8). A 2022 review warns that some mental health practitioners still engage in conversion therapy, calling for it to be outlawed in all U.S. states (8).

The use of aversion therapy as a treatment for addiction-related behaviors remains contentious. Some mental health professionals consider the treatment unethical because it involves deliberately causing psychological or physical distress or discomfort (7).

In conclusion, while some studies suggest that aversion therapy may be effective in reducing harmful behaviors in the short term, its long-term effectiveness is unclear. Additionally, ethical concerns regarding aversion therapy's aversive nature and the potential for causing harm to individuals make it a debated treatment option within the mental health community (1). Alternative approaches often focus on positive reinforcement techniques or medication-assisted treatments, which prioritize reducing harm and promoting well-being.

  1. Aversion therapy, such as emetic counter conditioning (ECC), links alcohol consumption with feelings of nausea and vomiting to discourage drinking in individuals with alcohol use disorder (AUD).
  2. Graphic warning labels on cigarette packages, a common practice in 118 countries, create an association between smoking and severe health consequences like diseased lungs and cancerous tumors, serving as a form of aversion therapy.
  3. Rapid smoking, involving puffing a cigarette every few seconds to trigger unpleasant sensations, is a form of aversion therapy often used to reduce nicotine dependence, but its effectiveness as a long-term treatment is limited.
  4. Rubber band aversion therapy (RBAT) is used to treat obsessive-compulsive disorder (OCD) by associating obsessive thoughts with physical pain, but a 2010 review found it ineffective as a therapy for OCD.
  5. Research indicates that aversion therapy can decrease addictive behaviors temporarily, like reducing alcohol-related brain activity in individuals with AUD, but its long-term effectiveness is uncertain.
  6. The effectiveness of aversion therapy as a treatment for other addiction-related behaviors, such as nicotine addiction or overeating, is also limited, with findings suggesting decreased effectiveness over the longer term.
  7. Due to potential harm to individuals and concerns over ethicality due to the use of punishment in therapy, aversion therapy remains a debated treatment option within the mental health community, with many preferring alternative approaches like positive reinforcement techniques or medication-assisted treatments.

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