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Aversion therapy works by pairing together the stimulus that can causes deviant behavior (such as an acholic drink or cigarette) with some form of unpleasant (aversive) stimulus such as an electric show or nausea-inducing drug.
With repeated presentations, the two stimuli become associated, and the person develops an aversion towards the stimuli which initially caused the deviant behavior.
Aversion therapy has been used effectively for years in the treatment of alcoholism (Davidson, 1974; Elkins, 1991; Streeton & Whelan, 2001).
Patients are given an aversive drug which causes vomiting-emetic drug. They start experiencing nausea. At this point, they are given a drink smelling strongly of alcohol, they start vomiting almost immediately. The treatment is repeated with a higher dose of the drug.
Another treatment involves the use of disulfiram (e.g., Antabuse). This drug interferes with the metabolism of alcohol. Normally alcohol is broken down into acetaldehyde and then into acetic acid (vinegar).
Disulfiram prevents the second stage from occurring, leading to a very high level of acetaldehyde which is the main component of hangovers. This results in severe throbbing headaches, increased heart rate, palpitations, nausea, and vomiting.
For behavioral addiction such as gambling aversion therapy involves associating such stimuli and behavior with a very unpleasant unconditioned stimulus, such as an electric shock. These shocks are painful but do not cause damage.
The gambler creates cue cards with key phrases they associate with their gambling and then similar cards for neutral statements.
As they read through the statements, they administer a two-second electric shock for each gambling-related statement. The patient set the intensity of the shock themselves, aiming to make the shock painful but distressing.
The client thus learns to associate the undesirable behavior with the electric shock, and a link is formed between the undesirable behavior and the reflex response to an electric shock.
Apart from ethical considerations, there are two other issues relating to the use of aversion therapy.
First, it is not very clear how the shocks or drugs have their effects. It may be that they make the previously attractive stimulus (e.g., sight/smell/taste of alcohol) aversive, or it may be that they inhibit (i.e., reduce) the drinking behavior.
Second, there are doubts about the long-term effectiveness of aversion therapy. It can have dramatic effects in the therapist’s office.
However, it is often much less effective in the outside world, where no nausea-inducing drug has been taken, and it is obvious that no shocks will be given.
Also, relapse rates are very high – the success of the therapy depends on whether the patient can avoid the stimulus they have been conditioned against.
Flooding (also known as implosion therapy) is a type of exposure therapy that works by exposing the patient directly to their worst fears. (S)he is thrown in at the deep end.
For example, a claustrophobic will be locked in a closet for 4 hours, or an individual with a fear of flying will be sent up in a light aircraft.
Flooding aims to expose the sufferer to the phobic object or situation for an extended period in a safe and controlled environment. Unlike systematic desensitization, which might use in vitro or virtual exposure, flooding generally involves vivo exposure.
Fear is a time-limited response. At first, the person is in a state of extreme anxiety, perhaps even panic, but eventually, exhaustion sets in, and the anxiety level begins to go down.
Of course, normally, the person would do everything possible to avoid such a situation. Now they have no choice but to confront their fears, and when the panic subsides and they find they have come to no harm. The fear (which, to a large degree, was anticipatory) is extinguished.
Prolonged intense exposure eventually creates a new association between the feared object and something positive (e.g., a sense of calm and lack of anxiety). It also prevents the reinforcement of phobia through escape or avoidance behaviors.
Flooding is rarely used, and if you are not careful, it can be dangerous. It is not an appropriate treatment for every phobia.
It should be used with caution as some people can actually increase their fear after therapy, and it is not possible to predict when this will occur.
Wolpe (1969) reported the case of a client whose anxiety intensified to such as degree that flooding therapy resulted in her being hospitalized.
Also, some people will not be able to tolerate the high levels of anxiety induced by the therapy and are, therefore, at risk of exiting the therapy before they are calm and relaxed.
This is a problem, as an existing treatment before completion is likely to strengthen rather than weaken the phobia.
However, one application is for people who have a fear of water (they are forced to swim out of their depth). It is also sometimes used with agoraphobia.
In general, flooding produces results as effective (sometimes even more so) as systematic desensitization.
The success of the method confirms the hypothesis that phobias are so persistent because the object is avoided in real life and is therefore not extinguished by the discovery that it is harmless.
For example, Wolpe (1960) forced an adolescent girl with a fear of cars into the back of a car and drove her around continuously for four hours: her fear reached hysterical heights but then receded and, by the end of the journey, had completely disappeared.
Operant ConditioningOperant conditioning is a method of learning that occurs through rewards and punishments for behavior. Through operant conditioning, an individual makes an association between a particular behavior and a consequence (Skinner, 1938). Examples of therapies using the principles of operant conditioning include:
Token economy is a system in which targeted behaviors are reinforced with tokens (secondary reinforcers) and later exchanged for rewards (primary reinforcers).
Tokens can be in the form of fake money, buttons, poker chips, stickers, etc. In contrast, the rewards can range anywhere from snacks to privileges or activities. For example, teachers use token economy at primary school by giving young children stickers to reward good behavior.
ReferencesSkinner, B. F. (1938). The Behavior of organisms: An experimental analysis. New York: Appleton-Century.
Wolpe, J. (1958). Psychotherapy by reciprocal inhibition. Stanford, CA: Stanford University Press.
Wolpe, J. (1960). In behavior therapy and the neuroses.
Wolpe, J. (1969). Basic principles and practices of behavior therapy of neuroses. American Journal of Psychiatry, 125(9), 1242-1247.
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Wolpe, J., & Plaud, J. J. (1997). Pavlov’s contributions to behavior therapy: The obvious and the not so obvious. American Psychologist, 52(9), 966.