Aversion Relief

Description of Strategy

Aversive conditioning is intended to produce a conditioned aversion to the target dysfunctional behavior. Aversion therapy includes a variety of specific techniques based on both classical and operant conditioning paradigms. An array of aversive stimuli have been used, the most popular of which were electric shock and nauseaor apnea-inducing substances. Covert sensitization also relies on aversive conditioning and is called “covert” because neither the undesirable stimulus nor the aversive stimulus is physically present; they are presented in imagination only. “Sensitization” refers to the intention to build up an avoidance response to the undesirable stimulus.

In aversion relief, the subject is enabled to stop the aversive stimulus by performing more appropriate behavior. This cessation, in turn, leads to relief. For example, deviant sexual stimuli (e.g., pictures of nude children) may be the unconditioned stimulus (UCS), followed by onset of shock, the conditioned stimulus (CS), while cessation of shock is preceded by the appearance of pictures of nude adult women. The procedure is intended to condition the pleasant experiences associated with the cessation of shock (aversion relief) to adult females, while the unpleasant experiences associated with the onset of shock are conditioned to children. A typical example of aversion relief therapy is the application of bitter-tasting substances on the thumbs of children who engage in thumb-sucking activity. Thumb sucking will then lead to a bad taste, which will cease as soon as the child withdraws the thumb out of the mouth (aversion relief).

Covert sensitization is also referred to as aversive imagery. Before starting the formal covert sensitization procedures, the therapist gathers detailed information of the idiosyncratic characteristics associated with the target maladaptive-approach behavior. This information is essential in order to construe realistic scenes for the patient. Next, the patient is provided with the rationale that his or her problem (e.g., drinking) is a strongly learned habit that must be unlearned by establishing a conditioned link between the pleasurable situation (e.g., drinking) and the unpleasant stimulus (feelings of nausea and vomiting).

To illustrate the covert sensitization procedures, consider the case of a male alcohol-dependent patient. First, the patient is trained to relax. When relaxed, he is asked to close his eyes and to clearly visualize a critical drinking situation. For example, he may be asked to visualize himself in a pub, looking at a glass full of beer, holding the glass in his hand, and having the glass touch his lips. Next, he is asked to imagine that he begins to feel sick to his stomach and that he starts vomiting all over himself and the female bartender; it is important to include as many aversive details as possible. He is told to imagine that he rushes outside or that whenever he is tempted to drink but refuses to do so, the feeling of nausea will remit and that he will feel relieved and relaxed (aversion relief). As a homework assignment, he is asked to repeat these scenarios a number of times per day. Key scenarios can be written on pocket-sized cards, which the patient is instructed to carry with him and to use immediately upon noticing an urge to drink. As a result, much in vivo conditioning occurs in critical temptation situations, during which the patient self-applies the prescribed procedure outside the therapist's office.

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