Search

Covert sensitization is the first of a family of behavior therapy procedures called covert conditioning initially developed by Joseph Cautela in the 1960s and 1970s. The covert conditioning procedures involve the use of visualized imagery and are designed to work according to operant conditioning principles. When working with cooperative clients to treat maladaptive approach behaviors, covert sensitization has been found to be a humane and effective alternative to in vivo aversion therapy procedures that employ aversive stimuli such as chemicals and electric shock. This primer describes covert sensitization, provides examples and notes representative research. Guidelines for use and suggestions for further readings are also included.

Over the past few years, methamphetamine has appeared in mass quantities, in part, because of the ease and cost efficiency of manufacturing. With this increase in availability, the use of methamphetamine has increased significantly. The purpose of this article is to describe the existing treatment options for methamphetamine abuse and provide recommendations for practitioners and researchers. Methamphetamine abuse adversely impacts physical functioning, brain functioning and cognition, social support and social networks, and behavioral functioning. Negative consequences have also been documented to the environment and communities. In the studies reviewed on effective treatments, interventions consisted of aversion therapy, medication, psychosocial treatment, and case management. Each specific treatment is described as connected with an overall drug treatment program. If methamphetamine abuse continues to increase and the consequences continue to be so devastating, researchers and clinicians could advance the field by particular focus on the treatment of this type of drug use.

Four self-referred adult male homosexuals were provided with therapy to increase their level of heterosexual responsiveness. Three underwent 40 sessions of orgasmic reconditioning using both visual and fantasied stimuli, in counterbalanced treatment sequences; one underwent 19 sessions of orgasmic reconditioning with visual stimuli and 17 sessions of shock aversion therapy. Assessment included measurement of physiological and behavioral sexual arousal patterns throughout the study. Subjects reported that their sexual adjustment had improved, but objective physiological and behavioral measures of arousal were not changed. This fails to support many previous case reports of success with the technique. The aversion therapy procedure produced no change in arousal to deviant stimuli and only slight increases in arousal to heterosexual stimuli. The lack of objective data to corroborate the subject's allegations of improved condition following treatment with orgasmic reconditioning is discussed, and the implications for the use of subjective measures of improvement in therapy outcome research examined.

Seventy dependent heavy smokers (32 cigarettes per day) were randomly assigned to one of five treatment and control procedures: (1) electric aversion therapy, involving ten 20-trial sessions of shocks contiguous with the smoking act. (2) simulated electric aversion. with non-contiguous shocks, (3) non-shock smoking sessions, to control for stimulus satiation and negative practice effects. (4) simple support and attention from therapist, (5) no-treatment. Before treatment, simple ‘self-monitoring’ and ‘self-control’ reduced cigarette consumption by an average of 12% (p

In the first study, 30 child molesters who had received behavioral treatment designed to modify inappropriate sexual age preferences were followed after their discharge or transfer from a psychiatric institution for an average of 29 months. Posttreatment penile response data in the form of ratio of response to adult stimuli divided by response to child stimuli significantly differentiated the six recidivists from the nonrecidivists, providing support for the external validity of the assessment technique. In the second study, 18 hospitalized child molesters received biofeedback alone or in combination with signaled punishment aversion therapy as methods designed to modify inappropriate sexual age preferences. The biofeedback procedure involved signaling the patient by different colored lights when his penile response to a child or adult slide was above a preset criterion. Signaled punishment was superimposed on the biofeedback procedure and involved programming a mild shock to the arm to occur at intervals when the patient was above criterion during a child slide. The punishment plus biofeedback procedure was more effective in modifying inappropriate sexual arousal both as a first and second treatment type.

A procedure which uses the inhalation of cigarette smoke as an aversive stimulus is described and illustrated in the successful treatment of an obese compulsive eater. Usinga multiple baseline design, three problematic foods were sequentially eliminated by a self-managed aversion, procedure in which cigarette smoke served as a noxious stimulus. After dramatic reductions in compulsive eating, the client reported a generalized self-regulatory, optimism and initiated substantial changes in her overall diet. Corroborating selfreport data on food intake, a weight reduction of 41 lb was observed during 18 weeks of treatment. Additional losses were reported at follow-up. The clinical promise of this aversion procedure and its advantages over alternative treatments are briefly discussed.

Cannabis dependence is fast becoming a public health problem in Nigeria. Prevalent studies indicate that up to 9% of secondary school students and 33% of University undergraduates (i.e., one in every three students) abuse cannabis. Cases of cannabis dependence seen in hospital practise in Nigeria are usually associated with psychotic illness and there is a strong feeling among psychiatrists in the country that the cannabis abuse is contributory to the precipitation of the psychosis. If this is true, then abstinence from cannabis abuse is necessary in order to reduce the possibility of relapse of the psychotic illness when this has been treated. The paper to be presented describes a method of treatment which has been developed and tried in an Ife University Teaching Hospital, Ile-Ife, Nigeria. This treatment is a form of behaviour therapy and its cost has been estimated at about US$12, which was found to be within reach of most patients. Patients who have undergone a course of this treatment (one course of 3 treatments) have abstained from cannabis for an average period of 9 months. A single treatment administered within this period further prolongs the period of abstinence. Further work is recommended to explore the range of application of this method of treatment, for example, the personality types for whom it is most suitable and those in whom it would contraindicated.

Auditory hallucinations were temporarily stopped by conversation and lastingly stopped by faradic aversive conditioning. A 1-yr follow-up of the patient revealed no evidence of recurrence.

Anticipatory avoidance aversion therapy (AA) was conceived in an attempt to gain efficient control of unwanted approach behavior; this aim has been achieved in the hands of only relatively few workers. paradoxically other, seemingly more simple, techniques have produced comparable results. This paper presents in detail psychometric attitudinal data on changes in sexual orientation measured immediately before and after sessions of AA aversion therapy in two cases of homosexual behavior. The findings suggest that the crucial reduction in sexual interest in men occurred in the between-treatment time. It was also found that male scores tended to increase during the later treatment sessions. Three points emeerge: first, these data appear to demonstrate incubation. Second, this experimental design could be applied to other dependent variables with the prediction that they will show response increment in the absence of the experimentally presented CS. Finally, if the theoretical argument presented here approximates to the truth then the effectiveness of apparently dissimilar techniques can be explained.

Participants in the aversion treatment were instructed to focus vividly on the triggering thoughts leading to smoking each time the urge to smoke occurred. Subjects then were to self-administer a painful snap immediately using the rubber band they were wearing around their wrist and to engage in alternate behaviors such as chewing gum. Participants in a placebo treatment were instructed to wear the wrist band as a “reminder” and to engage in alternate behaviors such as chewing gum, etc. About a third of the participants never wore the wrist band either as an aversive stimulus dispenser or as a “reminder”. These people were assigned to a nonuser group in the statistical analysis. At a 1-year follow-up, a treatment effect was shown for males but not for females. One year after treatment five of the seven males in the aversion group were still abstinent, as compared to one out of seven abstinent in the placebo group and none in the nonuser group.

Summary Aversion therapy for alcoholism is based on the notion that aversion conditioning produces a conditioned response (CR) to alcohol that is antagonistic to subsequent alcohol ingestion. This study reports the first experimental evidence that aversion conditioning produces a CR to the taste and smell of alcohol. Two patients were given taste aversion therapy for alcoholism. While medically conservative, the taste-aversion procedures produced profound malaise and reliable emesis shortly after patients began drinking alcoholic beverages. Behavioral. attitudinal and psychophysiological indices all reflected the acquisition of an alcohol aversion as a function of conditioning.

A comparative trial of two therapies for treatment-seeking homosexuals was undertaken. It was hypothesized that heterophobic homosexuals would be more likely to respond to a treatment based on desensitization (to social and heterosexual anxiety) than to aversion therapy and that the latter would be more suitable for nonheterophobic homosexuals. From their history and also their scores on a sociosexual anxiety rating scale, patients were classified as heterophobic or nonheterophobic; within each of these two main groups they were then allocated at random to receive either an automated anticipatory avoidance therapy or a desensitization program which included provision for the development of heterosexual arousal. A simple factorial design was employed to allow analysis of interaction between type of patient and type of treatment. Thus, there were four subgroups: (a) heterophobes receiving desensitization, (b) heterophobes receiving aversion, (c) nonheterophobes receiving desensitization, and (d) nonheterophobes receiving aversion. There were 10 patients in each subgroup. A female therapist gave the desensitization to subgroups (a) and (c) and gave simple social skills training to all patients. A 2-year follow-up showed that both heterophobes and nonheterophobes responded better to desensitization than to aversion therapy.

Sixty alcoholics were treated with one of three treatment conditions: (1) aversion plus self-regulation which included blood alcohol concentration feedback training, discriminated aversive conditioning, training in self-regulation, education, and psychotherapy; (2) self-regulation which was identical to the aversion plus self-regulation condition, except that no shock was used; and (3) aversion which was identical to the aversion plus self-regulation group, except that no emphasis was given to the self-regulatory processes. Patients were evaluated in their homes at the end of treatment and at 6 and 12 months with additional information from a confederate of the patient. The group receiving both aversion training and self-regulation performed at the highest level throughout, with the self-regulation alone group responding better than the aversion group. This latter difference was not statistically significant. Relapse rates did not differ significantly. The study reflected the importance of individual responsibility and aversion therapy combined.

The present investigation initiated a dismantling strategy in which subjects were assigned to treatment stages (preparation, aversion, maintenance) or to combinations of stages in a factorial design. It was hypothesized that multistage conditions would be superior to single stage conditions and that maintenance would retard relapse. Forty men and 33 women were randomly assigned to one of seven conditions. Results supported both hypotheses although significant effects were no longer evident at 12-month follow-up. Considerable relapse occurred in all conditions. Specific treatment components appeared to be of limited importance as indicated by generally very similar results for preparation and aversion. Booster sessions appeared to be ineffective. Interpretation of the findings is limited, however, by a relatively small subject enrollment in each condition. It was concluded that attempts to isolate extremely precise treatment elements are unlikely to be successful. Suggestions for further research included adoption of more structured maintenance strategies emphasizing coping skills and a more systematic focus upon potentially important process variables, notably group cohesiveness.

To compare the relative effectiveness of three alternative models of aversion therapy in modifying the biting behavior of chronic naibiters, subjects ( N =61) were randomly assigned to one of four groups: (1) shock, (2) negative practice, (3) bitter substance, and (4) attention-placebo control. Half of the subjects from each treatment condition were instructed to self-monitor their nailbiting throughout treatment. All groups experienced an increase in nail growth, with no significant difference among groups. However, self-monitoring subjects exhibited significantly greater increases in nail growth than non-self-monitoring subjects ( p p p

A treatment program was designed to compare the therapeutic efficacy of four behavior therapy approaches to the treatment of alcoholism. Forty-nine alcoholics were administered either a behavioral family counseling, systematic desensitization, covert sensitization or a shock presentation treatment program. The treatment program was conducted in an out-patient setting using both professional and para-professional therapists. Each patient's therapy regime adhered to a standardized sequence of treatment sessions over a 1-yr period. Additionally, each program participant was offered the opportunity to establish a treatment goal of either controlled drinking or complete abstinence. Program data indicated that behavioral family counseling was the most effective alcoholism treatment method of the four procedures studied. Systematic desensitization was highly effective in modifying excessive alcohol consumption with covert sensitization being only moderately effective. Presentation of shock resulted in little behavior change, suggesting that the procedure may have only limited utility for alcoholism treatment in an out-patient facility. Controlled drinking appeared to be an appropriate and practical treatment alternative to the traditional treatment program requirement of complete abstinence. Implications for the operation of behavioral alcoholism treatment programs in out-patient facilities are summarized and discussed.

After detoxification has been completed (if needed), a comprehensive assessment of the individual patient's drinking and other problems is the first step in inpatient behavioral treatment of alcoholism. On the basis of the assessment results, treatment is planned and delivered in an individualized manner to achieve three major goals. The first goal of treatment is to facilitate and consolidate the patient's commitment to change by carefully reviewing the evidence from the assessment of negative consequences of the patient's drinking. Alcohol education about the long-term negative consequences of drinking and the use of a decision matrix to clarify the patient's reasons for not drinking also are useful in this regard. The second goal is to stabilize the change in the drinking that occurred when the patient decided to enter the inpatient treatment program. Aversion therapy to decrease desire for alcohol, teaching alternative skills to deal with likely precipitants of renewed alcohol use, and strengthening behaviors incompatible with alcohol abuse all can be used to help maintain abstinence. Antabuse (including behavioral contracting procedures to increase compliance with this drug), along with psychotropic medication for additional psychopathology, are pharmacological interventions that often can be used to stabilize change. A final very important goal is the careful planning of aftercare and post-discharge life to help maintain the changes started during inpatient treatment. A case is presented to illustrate the above notions.

This case study examines the response-response relationships between three distinct patterns of sexual arousal—exhibitionism, sadism, and heterosexual arousal—in the treatment of a 25-year-old male arrested for exhibitionism and attempted rape. Physiological and self-report measures of appropriate and deviant arousal were obtained in a baseline phase. Subsequently, a modification of covert sensitization involving the use of realistic aversive scenes and self-administration was successively employed with the two deviant arousal patterns in multiple-baseline fashion. Implementation of the treatment program led to rapid and stable reductions in both physiological and self-report measures of the specific arousal patterns being treated, while the other patterns of sexual arousal remained unchanged. At the end of treatment the client displayed low levels of arousal to exhibitionistic and sadistic stimuli, while maintaining appropriate heterosexual arousal. These treatment gains were sustained during a 2-month follow-up period. The data support the view that patterns of sexual arousal are independent entities which require individual assessment and treatment. The theoretical advantages of self-administered covert sensitization are discussed.

A male-to-female transsexual underwent a series of behavior therapy procedures consisting of motor training, social skills training, fantasy training, aversion therapy, supportive psychotherapy, and occupational therapy in an inpatient setting. Therapy lasted for six months, after which the patient showed marked improvement in gender role and identity. The patient remained symptom-free two years after termination of therapy, suggesting the clinical utility of this package. Issues in the diagnosis and behavior therapy of such cases are discussed from a cross-cultural perspective.

Homosexual and exhibitionist patients were treated with “assisted” covert sensitization for a 6-month period. Subjects were then provided 12 months of follow-up care, with no active conditioning treatment. A further 12 months was devoted to “booster” sessions of active conditioning on a tapering basis. Although averaged data demonstrated the value of providing continuing, albeit infrequent, active conditioning sessions, not all subjects appeared to require such “boosters.” Those who could adequately change life-style and avoid especially provocative situations seemed able to derive continuing benefit from aversive conditioning without “booster” sessions.

The effectiveness of social isolation, aversion-relief treatment, one-to-one monitoring with point earning and point loss contingencies, and no-programmed contingencies were compared in treating a 22-year-old mildly retarded woman with Prader-Willi Syndrome for obesity. While the patient lost some weight during contingent social isolation and aversion therapy, her weight increased rapidly on discontinuing these procedures. The patient lost 44 lb. over 5 months of 1:1 monitoring with immediate point-gain and point-loss contingencies and dropped 8 more pounds over 3 succeeding months in a less rigorously controlled setting.

Summary Ethnographic data are presented on the use of a seed, haba de San Ignacio ( Hura polyandra L. and Hura crepitans L.) to promote an aversion to the consumption of alcohol by problem drinkers in Mexican American and Mexican national populations on the United States-Mexico border.

Work on the analysis and significance of avoidance latencies gathered during anticipatory avoidance (A.A.) aversion therapy for homosexual behavior is reviewed. An analysis of automatically collected data showed two types of sessional avoidance latency behavior. These two types of latency behavior are shown to be related to differing degrees of clinical efficacy during treatment sessions in terms of reduced homoerotic interest measured on a psychometric test. One type of avoidance behavior is shown to be very closely associated with the incubation of decreasing homoerotic attitude between treatment sessions, the other with the absence of attitude change. A quantitative relationship between changes in avoidance latency behavior and changes in homoerotic interest has been derived. The relationship was then used to predict the overall attitude change in a number of patients by using the avoidance latency data alone. These predictions were in accordance with eventual clinical outcomes and were superior indicators of clinical success compared with psychometric assessment. It is suggested that the avoidance response itself may serve a positive therapeutic role as it can predict outcome. It also appears that A.A. aversion therapy produces or enhances response increment outside of therapy .

Two case studies of behavior therapy with transvestites are described. Aversive conditioning procedures with variations were employed along with programs for increasing appropriate gender-related behavior. While therapy was successful in the short term follow-up, long term follow-up revealed total relapse in both cases. The implications of this outcome are discussed with regard to therapy strategies with transvestism.

Danaher and Lichtenstein's (1973) comments on aversion therapy are briefly evaluated. It is suggested that they underestimate the importance of conditions of original training relative to the modification of smoking behavior using the “rapid smoking” method, confound the issues of endogenous cues and topographial similarity, blur important distinctions among various kinds of placebo control groups, incorrectly imply that attention to the qualitative aspects of aversive stimuli necessitates a psychophysiological methodology, and erroneously evaluate the clinical utility of parametric studies. It is emphasized that most of these issues can be empirically resolved if investigators utilize more precise experimental designs.

College women volunteers for a weight reduction program were assigned to one of three treatment conditions. Twelve subjects received olfactory aversion therapy, while another group of 12 received attention-placebo treatment. A third group of 14 served as waiting-list controls. Weight losses over time were statistically significant, but there were no differences among groups. The losses were clinically trivial, and both aversion therapy and placebo treatments were considered to be ineffective in the treatment of obesity. The aversion therapy and attention-placebo groups both downrated the palatability of favorite (target) foods, found the experiment to be helpful and sensible, and claimed reduced food intake. These subjective reports were discussed in terms of demand characteristics and suggestion effects.

A brief reply to Berecz's (1973) note on aversion therapy is presented.Several key arguments are evaluated and alternative views are proposed. It is suggested that rapid smoking is not contraindicated by punishment theory, that Berecz's discussion of aversion therapy overemphasizes the punishment paradigm, and that Wilson and Divison's (1969) argument in favor of the topographical similarity between target response and aversive stimulus requires consideration. That research must include independent assessment of aversive stimuli is acknowledged, but the citations Berecz provides to illustrate this point are found to be inappropriate. Finally, the clinical utility of parametric studies on the psychophysiological nature of aversiveness is questioned.

A successful case study of behavior therapy with a pedophile is described, in which pedophilia is viewed as a multifaceted pattern of aberrant sexual arousal with accompanying excesses and deficits in other significant social and sexual areas. Aversive deconditioning procedures and graded social skills training were employed. The implications of this study are discussed with regard to therapy strategies and generalization effects.

A series of single-subject experiments were performed to evaluate the utility of a new technique for assessing the differential effects of electrical aversion on human operant behavior. The subjects were eight college males classified as either high ( N =3) or low ( N =5) in “fear” of physical pain according to their T-scores on Factor 5 ( Tasto, Hickson, & Rubin, 1971 ) of the Fear Survey Schedule ( Wolpe & Lang, 1969 ). Each subject was instructed to press a response key on a differential-reinforcement-of-low-rates (DRL) schedule, while during certain periods electric shock was introduced conjointly on a modified free operant avoidance schedule. The results indicated that whereas 100% of the “high fear” subjects emitted a considerable number of response “bursts” during at least some of the electrical aversion periods, only 20% of the “low fear” subjects showed the effect at the highest shock level (4.5 mA). For those subjects who demonstrated the effect, a positive relationship between shock intensity and frequency of “bursts” was established by means of systematic replications with different levels of shock. The findings suggest that the rate of response “bursts” under the present schedule might serve as an index of the relative aversiveness of electric shock during aversion therapy.

A brief overview is given of the techniques and results to date of the treatment of homosexuality by anticipatory avoidance learning (AA), including the outcome of a controlled trial of AA, classical conditioning (CC), and psychotherapy. Findings discussed include: the delineation of two major types of homosexuals and their differential prognosis; the need for research into heterosexual social skills; the superiority of aversive techniques over psychotherapy; and the lack of difference in efficacy between AA and CC. Despite this last finding, the greater efficiency of AA is strongly argued. Results are presented which indicate the predictive value of such data for treatment outcome, and the necessity is argued for the automation of both data logging and of the total treatment system. A design study of such a system is fully described. The system is simple, compact, highly flexible, yields computer compatible data, saves therapist time, and provides immediate information about treatment response.

The study presents a case in which aversion therapy was successfully used to eliminate a chronic cough in a 15-yr-old boy. Treatment included electric shock aversion therapy employing a response suppression shaping paradigm to remove the cough, and ancillary family treatment to alter the reinforcement pattern which maintained the inappropriate behavior. The S has been free of cough for 1 1 2 yr since treatment. Significant aspects of the case relating to the use of aversion techniques are discussed.

Penile volume responses to moving pictures of female and male nudes were investigated in 11 heterosexual and 40 homosexual subjects. Responses to visual stimuli of a red circle which regularly preceded the female nude and a green triangle which regularly preceded the male were also measured. Ten of the 11 heterosexual and 15 of the 40 homosexual subjects showed statistically significant differences in response to the nudes of the two sexes. In addition to the penile volume increase occurring to the pictures of the sex to which they were attracted, these subjects showed a penile volume decrease to pictures of the other sex. It was suggested that this volume decrease indicated the presence of an inhibitory process preventing generalisation of the sexual response to the sex opposite to that to which the subject is attracted. Penile volume changes similar to those produced by the pictures of the nudes occurred as conditioned responses to the visual stimuli preceding the nudes. The strength of positive (volume increase) conditioned responses correlated highly with the strength of the corresponding unconditioned responses in both the heterosexual and homosexual groups. The negative (volume decrease) conditioned responses were of the same order of magnitude as the corresponding unconditioned responses, in the case of the heterosexual subjects, and significantly stronger in the case of the homosexuals. This unusual finding suggests that the negative conditioned response may have special features compared with the positive response. The magnitude of the negative response in the homosexual subjects correlated significantly with the degree of their reported response 2 weeks after 5 days of aversion therapy.

This study describes an aversive conditioning experiment in which favorite foods (CS) were paired with noxious odors (UCS) to help overweight Ss achieve and maintain a weight loss. After the nine-week conditioning period, a. significant (obtained p = 0.002, significant at p

Since aversion therapy is designed to reduce the probability of response frequency, such attempts can be best understood within a punishment framework. The punishment literature is surveyed for the purpose of isolating those conditions which enhance the probability of demonstrating a reduction in response frequency. Several case histories are presented which employ such procedures on a variety of behavior disorders.

The importance and also the lack of attention to assessment procedures in behaviour therapy has been stressed recently. The purpose of this study was to investigate whether differences exist in a number of subjective variables taken on two groups of exhibitionists, those successfully and those unsuccessfully treated by means of aversion therapy. Differences in age, education and marital status for the two groups were not significant. Significantly more of the subjects in the failure group were found to masturbate to deviant fantasy than in the success group. However, differences in the frequency of masturbation and sexual inter- course for the two groups were not significant. The failure group had been acting-out significantly longer and more frequently than had the success group. Further, the failure group took significantly more treatment trials to non-acting-out and no urges to act-out than did the success group. The importance of assessing cases for behaviour therapy on measures derived from learning experiments is stressed.

Some limitations of the conditioning theory are discussed and attention is drawn to significant pieces of evidence which are still lacking. The shortcomings of the associated 2-factor theory are also considered. Seven types of explanation are given in summary form and the evidence in favour and against each of the 7 is described. Finally, a partial theory based on changes in general state is adumbrated in an attempt to clarify some phenomena and to predict others.

A problem of paramount importance in the application of behaviour therapy concerns the relationship between personality parameters and the therapeutic outcome of such therapy, particularly in the case of aversion therapy. This report is concerned with a comparison between two patients with similar psychometric scores and similar complaints, one of whom responded well to aversion therapy while the other withdrew from treatment. It is argued that this differential response to treatment was due not to the amount of anxiety present but rather to a specific fear in the case of the latter patient that the treatment itself would precipitate cancer. Precautionary enquiries along these lines should, in future, be carried out prior to embarking on an aversion therapy programme.

It is suggested that intermittent reinforcement may be of value in retarding the tendency towards relapse in aversion therapy. An experiment with rats was conducted to examine the effects of intermittent shocks in approach-avoidance conflict learning. Intermittent reinforcement was shown to produce marked resistance to extinction in this type of avoidance learning. In a field-investigation of conditioning treatment of enuresis, intermittent reinforcement was found not to retard acquisition unduly and to give promise of reducing the relapse rate. A longer follow-up period is required to permit a final evaluation of the procedure.

The control of undesirable behaviors by aversive techniques under the label “aversion therapy” has become an increasingly prominent behavior therapy. The attention given to these techniques is a measure of resistance of disorders such as sexual deviations to more traditional therapies. Although effective in the animal laboratory, aversive control applied clinically may not be entirely appropriate. Some theoretical and practical draw-backs to aversion therapy are discussed, and an alternative is suggested in the use of positive behavioral control. In illustration, two cases of transvestism are presented.

Despite wide agreement that avoidance of heterosexuality is a major component in the genesis and maintenance of sexual deviation, the development of therapeutic procedures to increase heterosexual responsiveness has been largely neglected in favor of aversion therapy to suppress deviant responsiveness. Therapeutic procedures that have been employed to increase heterosexual responsiveness include: aversion relief techniques in which relief from an aversive stimulus is paired with heterosexual stimuli; “Systematic Desensitization procedures” in which heterosexual avoidance is desensitized either in imagination or in the real situation; social retraining where heterosexual skills are directly encouraged and taught; or pairing techniques in which sexual arousal is elicited and associated with heterosexual stimuli. Clinical and experimental evidence for the effectiveness of these procedures, as well as some newly developed techniques which cannot be classified in the above categories, is evaluated and the relationship of these procedures to aversion therapy in the treatment of sexual deviation is discussed.

A brief survey of punishment theory is presented, and the inadequacy of many aversion therapy experiments is outlined. The experimental demonstration of the alleged aversiveness of proposed stimuli is seen as basic to making correct judgments regarding the usefulness of aversion therapy. This has not generally been done and most experimenters have simply defined aversion by fiat. Typical studies from the area of modification of smoking behavior are considered and suggestions are made for implementation of appropriate control groups.

It is argued that previous techniques of aversion therapy have paid too little attention to the general body of learning theory, and a summary is given of the relevant variables. It is pointed out that anticipatory avoidance learning appears to be the training method most resistant to extinction, and a full description is given of a technique designed to enable its clinical application to the treatment of homosexuality. Some preliminary results of treatment are described, and it is concluded that the technique is most promising. Further studies are in progress.

In three cases of exhibitionism, two of transvestism and one of masochism, tapes were made involving descriptions of each subject's individual deviant behavior divided into three sequential segments. Five of the six subjects were placed on a schedule on which, at first, the final segment of the tape was followed by shock, at later sessions the second segment and ultimately the first. At each session the shocked tape runs were followed by runs in which the patient avoided shock by verbalizing normal sexual behavior in the place of the shocked segment. The sixth subject was given shocks out of relation to taped material, as a control. Treatment was evaluated by measuring penile responses to sexually deviant and non-deviant tapes, and by clinical reports. In the experimental subjects there was reduction of erectile responses to deviant tapes but sustained responses to non-deviant tapes. These subjects reported weaker deviant responses, less frequent deviant behavior and fewer symptoms of psychopathology in general.

A 12-year-old male was referred to the clinic for treatment of exhibitionism. Preliminary treatment of his behaviour problem employed a conventional psychotherapeutic approach, but impending police action following a further act of exhibiting himself, called for a more rapid resolution. The method of anticipatory avoidance aversion therapy for homosexuality was modified for use in this case. There was a successful reduction in his exhibitionistic behaviour, in his deviant masturbatory phantasy and in his sexual orientation towards older women, following 18 20-minute treatment sessions. Follow-up at 5 months found recovery in all respects maintained.

A behavior therapy for alcoholism was designed based on the rationale that alcoholic drinking is a discriminated, operant response. Treatment emphasized determining setting events for each subject's drinking and training equally effective alternative responses to those situations. Seventy male, hospitalized, Gamma alcoholics were assigned to a treatment goal of either nondrinking ( N =30) or controlled drinking ( N =40). Subjects of each group were then randomly assigned to either an experimental group receiving 17 behavioral treatment sessions or a control group receiving only conventional treatment. Treatment of experimental groups differed only in drinking behaviors allowed during sessions and electric shock avoidance schedules. Nondrinker experimental subjects shaped to abstinence, while controlled drinker experimental subjects practiced appropriate drinking behaviors with little shaping, a result attributed to instructions. Follow-up measuring drinking and other behaviors found that experimental subjects functioned significantly better after discharge than control subjects, regardless of treatment goal. Successful experimental subjects could apply treatment principles to setting events not considered during treatment, suggesting the occurrence of rule learning. Results are discussed as evidence that some “alcoholics” can acquire and maintain controlled drinking behaviors. Tra ditional treatment of alcoholics may be handicapped by unvalidated beliefs concerning the nature of the disorder.

A reliable, readily assembled and inexpensive shock generator for aversion therapy in the clinic or laboratory is described.

The problems often associated with aversion therapy led the authors to make use of a classical conditioning paradigm in the treatment of a young pedophiliac. The therapy, initially employing pictures of young girls as the UCS and of mature women as the CS, was successful in effecting normal heterosexual responsiveness outside the clinic as well as in the laboratory situation. Surprisingly, as treatment progressed, there was an accompanying diminution in deviant sexuality.

A discussion of the special relevance of recent research on the arousal and reduction of cognitive dissonance to the practice and evaluation of aversion on therapy.