Aversion therapy

Aversion therapy is a form of psychiatric, mental health or 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 in order to stop the specific behaviour.

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 various intensities.

Aversion therapy for addiction

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

Aversion therapy works on changing positive emotional associations with the sight smell and taste of alcohol or other drug. Follow up studies done at 6 and 12 months on populations matched on 17 baseline variables shows that aversion therapy resulted in significantly better abstinence rates. There was no increase in leaving the hospital against medical advice in patients seeking aversion therapy compared to patients in non-aversion programs.

The results of Antabuse combined with behavioral marital therapy for treating alcoholism has growing research support [O'Farrell, T.J., Cutter, H.S.G., Choquette, K.A., Floyd, F.J. & Bayog, R.D.(1992). Behavior marital therapy for male alcoholics: Marital and drinking adjustment during the two years after treatment. "Behavior Therapy, 23," 529-549.] [O'Farrell, T.J., Cutter, H.G, & Floyd, F.J.(1985). Evaluating behavioral marital therapy for male alcoholics. "Behavior Therapy, 16," 147-167.]

Legal and ethical challenges to the use of aversive procedures

The use of aversive procedures by applied behavior analysis, behavior modification, and behavior therapy is always under scrutiny. These issues are discussed in regards to the ethics of such practices (see Professional practice of behavior analysis) However, it is important for regulatory bodies to discuss the use of aversives and punishment techniques. For example, in Massachusetts in the U.S. Judge Rotenberg Educational Center has led to several bills (e.g., H109)to be developed limiting the use of aversives to licensed psychologists and/or board certified behavior analysts. Other states have begun to push for licensing of behavior analysts to ensure regulatory control over such processes. While in some cases the means is jusified by the end effect, behavior analysts need to remember that their overaching goal is to do no harm [Hemingway (2003): Do No Harm. "The Behavior Analyst Today, 4 (2), " 151-154 [http://www.behavior-analyst-online.org] ]

Aversion therapy and homosexuality

Aversion therapy has been used in attempts to convert homosexuals to heterosexuality. While no longer common, it is still sometimes used.

Since 1994, the American Psychological Association has declared that aversion therapy is a dangerous practice that does not work. Since 2006, the use of aversion therapy to treat homosexuality has been in violation of the codes of conduct and professional guidelines of the American Psychological Association and American Psychiatric Association. The use of aversion therapy to treat homosexuality is illegal in some countries. The standard in psychotherapy in America and Europe is currently Gay Affirmative Psychotherapy. Guidelines for Gay Affirmative Psychotherapy can be found by APA. [http://www.apa.org/pi/lgbc/guidelines.htm APA:l ]

Psychologist Martin E.P. Seligman [Seligman, p. 156] reported that using aversion therapy to try to change homosexual men's sexual orientation to heterosexual was controversial. In some instances, notably a series of 1966 experiments, the process was initially judged to have worked surprisingly well, with up to 50% of men subjected to such therapy not acting on their homosexual urges. These results produced what Seligman described [Seligman, p. 156] as "a great burst of enthusiasm about changing homosexuality [that] swept over the therapeutic community" after the results were reported in 1966. However, Seligman notes [Seligman, p. 157] that the findings were later shown to be flawed: most of the men treated with aversion therapy who stopped homosexual behaviour were actually bisexual; among men with an exclusive or near-exclusive homosexual orientation, aversion therapy was far less successful.

A notorious case of aversion therapy occurred in the 1970s and 1980s, when suspected homosexuals of both sexes in the South African Defense Force underwent aversion therapy and chemical castration. Aversion therapy sometimes involved applying electric current, via electrodes, to men while they were shown pictures of naked men. The current would be turned off when photographs of naked women were shown. See the article in "external links" below for more information.

Injections of apomorphine were also reportedly used as part of aversion therapy for homosexuality, resulting in violent illness. At least one person has reportedly died from this treatment. Fact|date=February 2007

There is currently little published data available on conversion rates. However, four studies have reported success rates during conversion therapy of 0.4%, 0.0%, 0.5% and 0.04%. That is, conversion therapy has a failure rate in excess of 99.5% in each study. Furthermore, anecdotal data indicates a high percentage of extremely depressed and suicidal clients emerging from conversion therapy. Fact|date=February 2007

Aversion therapy and "sexually deviant" youth

Aversion therapy is still sometimes forced on children and teenagers who violate sex laws, and especially on individuals believed to have deviant sexual feelings. These youths have been forced to smell ammonia, describe humiliating scenarios, or engage in other uncomfortable acts, while looking at nude pictures, listening to audio tapes describing sexual situations, or describing their own fantasies. In order to measure sexual response, devices such as penile plethysmographs and vaginal photoplethysmographs are sometimes used, despite the controversies surrounding them.

In 1992, the Arizona Civil Liberties Union challenged the Phoenix Memorial Hospital for its use of these methods on children as young as 10. They were defended by the Association for the Treatment of Sexual Abusers. Since then, policies have usually discouraged the use of forced aversion therapy on children under 14.

Popular culture

*Both Ken Kesey and Anthony Burgess explored the concept, and its moral implications, in their respective 1962 novels "One Flew Over the Cuckoo's Nest" and "A Clockwork Orange".
*An Aversion Therapy is used in A Change of Mind, an episode of the 1967 television series The Prisoner. The room where this is performed has a securely locked door with the words "Aversion therapy" written on it.
*A radio commercial in "" refers to the practice of aversion therapy.
*The television show "Robot Chicken" opening has a scientist torturing a robotic chicken in the same matter.
*The movie "Latter Days" includes a scene in which a character is subjected to aversion therapy in an attempt to change his sexual orientation.
*In the movie "But I'm a Cheerleader", the character Sinead, an inmate at True Directions, more than likely a self-harmer, gives herself aversion therapy and explains to the main character, Megan, why she does so. In another scene, Megan gives herself aversion therapy for a period of time.
*In season 1, episode 4 of "The Simpsons", "There's No Disgrace Like Home" - the family are strapped to electric chairs and are given the opportunity to give electric shocks to each other. The therapy is unsuccessful as no such aversion is attained, and the family does not stop shocking each other until Dr. Monroe pulls the plug.
*In the comic book series agent 711 uses aversion therapy to help Yorick overcome his deathwish.

ee also

*Ex-gay
*Behavior modification
*Ludovico technique

References

* [http://www.mask.org.za/sections/AfricaPerCountry/southafrica/aversion.pdf "The Aversion Project: Human rights abuses of gays and lesbians in the SADF by health workers during the apartheid era"] by Mikki van Zyl, Jeanelle de Gruchy, Sheila Lapinsky, Simon Lewin, and Graeme Reid, Simply Said and Done, Cape Town, October 1999.
* [http://www.ethicaltreatment.org/reconditioning.htm Ethical Treatment for All Youth]
* Houser, Ward "Aversion Therapy." [http://www.williamapercy.com/wiki/images/Aversion.pdf "Encyclopedia of Homosexuality".] Dynes, Wayne R. (ed.), Garland Publishing, 1990. p. 101
*Seligman, Martin E.P., "What You Can Change and What You Can't: The Complete Guide to Self Improvement" Knopf, 1993; ISBN 0-679-41024-4