Aversion Therapy - 1
Title: Aversion Therapy
Author: Rodger K. Bufford
Aversion therapy uses a number of techniques and stimuli to weaken or eliminate
undesirable responses such as deviant sexual behavior and substance abuse. Theoretically,
punishment is used to directly reduce the frequency of undesired behaviors through contingent
presentation or removal of a stimulus (see Punishment), while aversion--or aversive
counterconditioning--seeks to change the undesirable response indirectly by altering the
functions of the discriminative and reinforcing stimuli. In practice this distinction is somewhat
blurred since many aversion procedures have both punishing and stimulus altering effects.
In some forms of aversion, no behavior need occur. Rather, the discriminative and
reinforcing stimuli which maintain the problem behavior (e.g., sight or smell of alcohol, deviant
sexual stimuli) are presented to the person, and an unpleasant stimulus (e.g. electric shock) is
presented simultaneously. The discriminative and reinforcing stimuli acquire the properties of
the aversive stimulus through association. The goal is to weaken the link between the controlling
conditioned stimulus (e.g., children) and undesired response (e.g., sexual arousal). Wolpe’s
theory of “reciprocal inhibition” provides one explanation for this process. Wolpe theorizes that
arousing a strong competing response such as nausea or fear inhibits the undesired response.
Aversion uses electrical shock; chemical and olfactory stimuli such as emetine
hydrochloride (which causes nausea and vomiting); valeric acid (smells like rotten eggs) and
ammonia; covert sensitization by aversive imagery; and shame induction (McAnulty & Adams,
1992). The ideal stimulus is one which permits rapid onset, prompt termination, controlled
intensity, and quick recovery so that repeated trials may be administered in a brief time. Electric
shock and noxious smells are readily controlled in these ways, but drugs are not. Drug
administration also requires medical personnel, sometimes hospitalization, is medically contra-
indicated for many individuals, and may have side effects which impair conditioning. Shock is
widely applicable except for persons with heart conditions. For all these reasons, shock replaced
drugs as the principal aversion technique in the 1970’s. More recently, covert sensitization has
Aversion Therapy - 2
Aversion takes three basic forms: escape training, avoidance training, and presenting the
unpleasant stimulus without permitting either escape or avoidance. Often escape training is used
initially, then modified into avoidance training.
In escape training, the target stimulus is presented, then an unpleasant stimulus such as
electric shock occurs. After brief exposure to the two stimuli, the individual escapes from the
stimuli by making some specified response. For example, a transvestite is given an article of
women's clothing to put on, then administered electric shock. Once the clothing is removed,
shock is terminated.
In avoidance training, the individual is presented with the stimulus that elicits the
problem behavior. If an avoidance response is made quickly enough, the aversion stimulus is
avoided entirely. Typically, the avoidance response removes the stimulus for the undesired
response. For example, turning off pictures of women’s clothing quickly enough may avoid
shock for a fetishist. An advantage of the avoidance procedure is that the client learns to be
anxious in the presence of the target stimulus, and is negatively reinforced for actively avoiding
Covert sensitization is a form of aversive counterconditioning developed by Cautela in
which the client imagines an unpleasant event following the undesired stimulus response
complex rather than experiencing overt aversive stimulation. For example, persons may imagine
taking a large bite of hot fudge sundae topped with whipped cream and nuts, then imagine
becoming grossly fat, unable to fit into their clothes, and socially ostracized. In the avoidance
phase, they imagine becoming increasingly anxious as they approach the ice cream shop. They
then imagine turning away and experiencing immediate relief.
Effectiveness of Aversion
Research on the outcomes of aversion treatments have produced mixed results. Aversion is quite
effective with transvestism and fetishism. Aversion techniques are the most common approach
to treatment of pedophilia. Aversion with sexual reconditioning has shown favorable short-term
effects with pedophiliacs, but reductions of long term recidivism have not been demonstrated.
Results with homosexuality are modest; they are better for homosexuals voluntarily seeking
Aversion Therapy - 3
treatment, and for those with prior heterosexual experience. Aversion has been found effective
with homosexuals who have prior heterosexual experience; transvestites and fetishists with prior
heterosexual experience and few gender identity problems also show favorable outcomes
(McAnulty & Adams, 1992).
The effectiveness of aversion with sexual deviations is influenced by a number of factors. Most
studies have used electrical aversion; smell aversion shows promise and has been widely
adopted, but needs further study. Although drug aversion studies have sometimes yielded
promising results, due to the disadvantages mentioned above, shock and unpleasant smells are
more commonly used with sexual behaviors. A major concern with sexual disorders is the need
to assess sexual arousal to appropriate heterosexual stimuli. When appropriate sexual arousal
patterns are absent or weak, developing or strengthening them is essential to lasting effects of
For alcohol abuse, electrical aversion does not appear effective. Nausea aversion is generally
effective for several months, but as time passes an increasing percentage of clients resume
drinking. Compliance may be as low as 20 per cent when voluntary; thus administration in a
supervised setting is important. Additional treatment of psychosocial problems is widely
recommended, and may help to maintain gains. In a recent review, Emmelkamp concludes
“aversive therapy, if applied at all, should be part of a more comprehensive cognitive-behavioral
program” (Emmelkamp, 1994; p. 400).
Covert sensitization is appealing for both theoretical and practical reasons. Covert sensitization
appears promising for those who can visualize well and are well motivated. However, there
remains a lack of clear empirical evidence of treatment effectiveness for covert sensitization
when used alone. Thus it should be used as part of a more comprehensive approach which also
addresses the psychosocial aspects of the problem behavior. Interestingly, Adams notes that a
number of biblical teachings are consistent with the idea of replacing responses rather than
simply eliminating them (Adams, 1973).
Aversion Therapy - 4
Aversion therapy has often been opposed on ethical and moral grounds. However, aversive
consequences are a natural feature of the social and physical world. Typically, behaviors treated
by aversion produce immediate rewards followed by delayed pain. For example, the sexual
gratifications of paraphilias are immediate, but the costs of broken relationships and sexually
transmitted diseases are delayed. Aversion therapy helps persons forego immediate rewards so
they can avoid these delayed aversive events.
Guidelines for aversion emphasize informed consent and minimal exposure to painful stimuli.
Persons voluntarily seeking treatment respond better than those sent by the courts or family
members. For both these reasons, use of aversion on reluctant patients is questionable.
Practically, the individual will avoid treatment if the experience is sufficiently unpleasant.
Aversion to the target stimulus or elimination of the problem behavior must thus be
accomplished without causing aversion to treatment.
Research evidence indicates that problem behaviors are most effectively eliminated when
constructive alternatives are developed simultaneously. This raises two concerns. First, many
(especially laypersons) use aversion techniques without establishing suitable alternatives;
developing these is essential. Second, problems arise in selecting alternatives, especially for
sexual behaviors like homosexuality, voyeurism and transvestism. From a Christian perspective,
most sexual activity outside of marriage is unacceptable, and alternative goals have not been
clearly articulated. For many, sexual contact appears to have become a sole form of intimacy.
Erotic intimacy substitutes for familial, fraternal, and spiritual closeness. The biblical concept of
love suggests a direction for consideration. Learning to experience and express love, especially
God's love, may be the key.
Reorientation treatment of homosexual behavior is highly controversial today, and not widely
practiced. Since 1973 homosexuality has not been considered a mental disorder by the American
Psychiatric Association. Some contend that any sexual reorientation treatment is abusive, a
result of homophobia--fear of and hostility toward homosexuality. Others, such as Nicolosi
(1991), contend that reorientation treatment can be ethically conducted within the guidelines of
Aversion Therapy - 5
informed consent when it is consistent with the values and goals of the individual seeking
Aversion therapy uses aversive counterconditioning and covert sensitization to eliminate
undesired behaviors. Research indicates that aversion is effective for some problems and under
some conditions. Because of legal, ethical, and practical concerns, covert sensitization has
gradually become the preferred approach, at least for outpatient psychotherapy. Empirical
support is limited for covert sensitization alone, but indicates that more comprehensive treatment
packages which include covert sensitization along with strengthening of desired alternative
responses are quite effective. The precise contribution of covert sensitization in these treatment
approaches is not known. Finally, as applied to sexual behavior, aversion therapy poses a
number of unique problems from a Christian perspective.
Adams, J. E. (1973). The Christian counselor’s manual. Grand Rapids, MI: Baker.
Emmelkamp, P. M. G. (1994). Behavior therapy with adults. In A. E. Bergin & S. L. Garfield
(Eds.), Handbook of psychotherapy and behavior change (4th ed.). New York: Wiley.
McAnulty, R. D., & Adams, H. E. (1992). Behavior therapy with paraphilic disorders. In S. M.
Turner, K. M. Calhoun, & H. E. Adams, Handbook of clinical behavior therapy. New York:
Nicolosi, J. (1991). Reparative therapy of male homosexuality: a new clinical approach.
Northvale, N.J.: J. Aronson.