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When is Aversion Therapy Appropriate?

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Emily A. Ludwig, PsyD

Aversion Therapy is a form of behavior modification used to help individuals reduce or stop detrimental behaviors, by associating those behaviors with discomfort or punishment, such as a pain sensation, a bad taste, smell; or an electric shock.  Over time, the individual is conditioned to believe that doing the disagreeable behavior is not worth the resulting distress. 

You may or may not realize it, but examples of aversion therapy are easily found in our everyday lives, in pop culture and in the world of entertainment.  If you’ve ever seen the movie A Clockwork Orange, you’ve seen an extreme portrayal of the use of Aversion Therapy.  In the movie, Alex, the character played by Malcolm McDowell, is an extremely violent juvenile delinquent.  After being sent to prison for his crimes, he’s forced to watch films of Nazi atrocities, over and over, in an attempt to permanently modify his horrific behavior patterns.  It works, and as a result, he becomes physically ill if he even thinks about committing acts of violence.  He’s later released from prison and becomes a target for those persons he previously preyed upon, unable to defend himself against their rage and thirst for justice.

Aversion Therapy has been used to treat addictions, substance abuse, smoking, and those persons with angry, violent tendencies.  Many therapists find its use controversial and/or unethical and use other therapeutic modalities instead.  Individuals who have been subjected to severe aversion therapy may run a much higher risk of anxiety, depression and suicide after treatment.  Aversion Therapy was often used in the past to “treat” and “convert” those who identified as homosexual or those with gender dysphoria, usually with disastrous results. 

Aversion Therapy methods run the gamut from simple to complex, to those that can be self-administered, i.e., snapping a rubber band on your wrist when you feel the urge to smoke, or to those that require a medical doctor to administer pharmaceutical agents that cause a person to immediately vomit when they drink alcohol or inject illicit substances. 

While Aversion Therapy can be effective during treatment, relapse is a significant issue after treatment ends.  Being in the “real world” after treatment presents many challenges for those who have undergone Aversion Therapy. When the deterrent to the objectionable behavior is removed and the patient isn’t being held accountable by their therapist on a regular basis, the behavior is much more likely to recur.  Aversion Therapy tends to work best when the patient is highly motivated to change and under the regular care of a skilled therapist who establishes strict boundaries around its use.

In my Pain Psychology practice, I don’t use Aversion Therapy, nor do I recommend it for my patients. I would also caution anyone who is considering it as a form of treatment. I believe there are therapeutic modalities much more attuned to the needs of chronic pain patients than an authoritative, even cruel system of retribution for “bad” behavior.   An experienced counselor doesn’t need punishment to become the focus of treatment, but instead relies on other, more positive tools for patient care which facilitate emotional wellness. 

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