Aversion Therapy: Definition, Examples, & Techniques

Aversion therapy is a type of behavior therapy. Behavior therapy focuses on changing behaviors by looking at things in the environment that reward the behavior (APA, 2023). 

Aversion therapy takes advantage of our innate desire to avoid unpleasant experiences by training people to develop a repulsion to unwanted, harmful, or addictive behavior (Arlinghaus et al., 2017). It works by pairing an unwanted behavior with something unpleasant or even painful. The idea is that our brain creates a connection between the two, which creates an aversion, or intense dislike or disgust, to an unwanted craving or habit. Essentially, a behavior is punished as a way to discourage you from doing it. 

The research here is mixed. Some studies indicate that aversion therapy doesn’t work for changing lifestyle habits (Arlinghous et al., 2017). In addition, other studies suggest that while aversion therapy can be effective for some behaviors in the short term, the benefit fades over time with many people returning to their original behavior patterns (Arlinghaus et al., 2017).

However, several other studies have found that some aversion therapy techniques can help alcohol and drug misuse, especially when combined with other therapies and follow-up visits. One study even showed a reduction in brain activity related to craving (Elkins et al., 2017).

A major criticism of aversion therapy is that while it may help stop unwanted behavior, at least temporarily, it doesn’t do anything to address the underlying cause of the behavior. This is why relapse rates can be high, and sometimes one addiction is simply replaced by another. 

​The effectiveness of aversion therapy depends on several factors:

• The behavior you’re trying to change 
• The type or method of aversion therapy
• Whether it’s combined with other psychotherapies or treatment
• Availability of follow-up programs after aversion therapy has been completed

A well-known example in popular culture is from the movie A Clockwork Orange. The main character, Alex, is forced to undergo a brutal form of aversion therapy to stop his extremely violent behavior. To accomplish this, doctors give him a drug that makes him sick and causes intense anxiety while forcing him to watch violent films. After the treatment, he associates violence with the traumatic experience and is no longer able to act violently.

I have a slightly less dramatic personal example. Years ago I had a cat that bit all the fur off her tail, to the point that it looked like a rat’s tail. This started after we moved to a new apartment, which I assume was stressful for her. After numerous tests at the vet’s office and hundreds of dollars later, the vet determined that there was nothing physically wrong. She said it was “psychoneurotic”. My cat had developed a compulsive habit, like nail-biting. 

Desperate to get her to stop, I tried the old squirt bottle method—every time I caught her nibbling at her tail, I squirted her with a little water, which she definitely didn’t like. It worked. She stopped the biting habit and her fur grew back. Little did I know, I was using aversion therapy. She associated an unpleasant experience (the water), with her tail-biting habit, and no longer found it rewarding. But unlike Alex from A Clockwork Orange, her unwanted behavior didn’t return.

• Overeating
• Alcohol misuse
• Substance misuse
• Overcoming phobias 
• Smoking cessation
• Gambling
• Aggression/anger issues
• Self-harm behaviors
• Compulsive behaviors such as nail-biting, hair-pulling, or skin-picking
• Inappropriate sexual behavior

Aversion therapy was started in the 1930s to treat alcoholism. It grew out of the work of behavioral psychologist Ivan Pavlov whose work showed that we (and other animals) can be conditioned to repeat or avoid behaviors depending on whether they’re rewarded or punished. Centers were established for treating alcoholism that paired electric shocks with drinking—a practice now largely considered inhumane.  

By the 1950s, aversion therapy grew from treating alcoholism to becoming a popular way to  “cure” homosexuality. It also incorporated the use of electric shocks, as well as drugs that made the person violently ill. Not only did this do nothing to change a person’s sexual orientation, but it was also found to be harmful both physically and mentally. 

Unfortunately, this practice was accepted in the United States until 1973 when the American Psychiatric Association issued a resolution stating that homosexuality is not a mental illness. Using aversion therapy in an attempt to change a person’s sexual orientation is now considered an ethical violation by the American Psychological Association (APA) (Drescher, 2015). It’s also now illegal to use aversion therapy on minors for sexual reorientation in many states.

With a few exceptions, aversion was not used much from 1980 to 2000 because of the controversy around the use of electric shock. However, in recent years, it has reemerged as a treatment for alcohol and drug misuse. Although some clinicians still consider it unethical, recent studies show that it can be effective, especially when combined with other treatments and supports. 

The most common use of aversion therapy is for alcohol misuse.  As mentioned above, a drug is given that triggers nausea or vomiting if even a small amount of alcohol is consumed. The idea is that this highly unpleasant reaction reduces alcohol cravings, and can even make the person feel a repulsion toward alcohol. While intentionally making someone sick may be considered unethical, studies have shown that it can be effective, especially when combined with other therapies and a follow-up program. And of course, the patient must be a willing and informed participant.

In 2017, Schick Shadel Hospital in Seattle combined this type of aversion therapy with magnetic resonance imaging (MRI) scans of the brain. The researchers found that not only did many participants reduce or eliminate their alcohol cravings, but there were actual changes in craving pathways in the brain (Elkins et al., 2017). This video explains further and shows the experience of one of the participants.

Years ago, studies were conducted using electric shock to help people quit smoking without much success. While people did stop smoking during the study, most returned to it eventually, and some experienced the “troublesome side-effect” of depression (Russell, 1970). 

More recently, smoking itself has been used to help people quit smoking. The procedure is that smokers are made to smoke a lot of cigarettes rapidly—taking a puff every few seconds and smoking as many cigarettes in a row until they can’t take it anymore. While this also seems to work short-term, they usually started up again (Arlinghaus et al., 2017).

In this technique, a rubber band or rubber bracelet is placed on your wrist and you self-administer a light sting by pulling it back and releasing it whenever you do or think about the unwanted behavior. Since we’re wired to seek pleasure and avoid pain, the idea is to pair the pain with the unwanted behavior so that you instinctively want to avoid it. It also serves as a kind of wake-up that disrupts habitual behavior or thought patterns.

This technique has been used to curb habits like eating junk food or procrastination. Some people find it especially helpful to help control self-critical thinking. When you catch yourself in a negative thought pattern…SNAP! The thought pattern is broken, at least for the moment, allowing you the chance to redirect. While it may be impossible to prevent the thought from arising altogether, this technique can prevent you from getting completely sucked into a vortex of self-criticism. I think of the rubber band as a giant stop sign.

An obvious advantage to this technique is that you don’t need a therapist to try it. However, some studies showed that this technique was not only ineffective but even lead to more obsessive thinking (Blue, 2016).

Punishment
Many therapists consider aversion therapy unethical primarily because of its use of punishment which can trigger feelings of shame or guilt. In addition, shame or guilt may actually contribute to an increase in the unwanted behavior (Baghchechi et al., 2021). And it seems to me that an increase in unwanted behavior could bring on even more shame and guilt, creating a distressing downward spiral.

Electric Shock
The use of electrical shock is now considered inhumane in most circumstances as it can cause not only extreme pain but also emotional and psychological harm. Until recently, electric shock was still used as an aversive technique on people with developmental disabilities to prevent them from causing harm to themselves or others. 

A notorious example is the Judge Rotenberg Educational Center. This is a center for people with emotional or developmental issues. Personnel used a device called a graduated electronic decelerator (GED) on residents at risk of harming themselves or others. These residents were forced to wear the GED continuously so that shocks could be delivered at any time. Many suffered physical and emotional harm as a result. In an unusual step by the Food and Drug Administration, this device was banned in the United States in March 2020.

Conversion Therapy
Perhaps the biggest ethical issue was the use of aversion techniques in conversion therapy. Conversion therapy attempts to change a person’s sexual orientation or gender identity. This practice was started in the United States in the 1930s and continues in some places today even though the American Psychological Association (APA) declared it an ethical violation in 1974. The APA now considers sexual orientation diversity normal and healthy (APA, 2021). Furthermore, in 2015, the Obama administration called for an end to conversion therapy, regardless of whether aversion techniques are used or not (Drescher et al., 2016).

A well-known example of using aversion therapy techniques for sexual reorientation existed in the United Kingdom. Until 1967, homosexuality was illegal in the U.K. In the 1950s and 60s, some people were either coerced to undergo aversion therapy to avoid prison, or were driven to it by shame or guilt, resulting in long-term negative impacts (Smith et al., 2004). This poignant video shows the perspectives of both a patient and a psychiatric nurse from that time.

​Want to learn more? Check out these articles:

• Behavioral Psychology: Definition, Theories, & Examples
• Somatic Therapy: Definition, Examples, & Exercises
• ​​​Therapy: Definition, Types, & Tips
• ​Acceptance and Commitment Therapy: Definition & Exercises
• ​Narrative Therapy: Definition, Techniques, & Exercises
• ​Family Therapy: Definition, Activities, & Techniques
• ​EMDR Therapy: Definition & Examples
• Substance Abuse Counseling: Techniques, Theories, & Skills​​​​​​​​​

Although not recommended as the first line of treatment, aversion therapy may be useful to help with some unwanted or harmful behaviors, especially alcohol and drug misuse. Despite a controversial past, recent studies using MRI scans show that it can change pathways in the brain that contribute to cravings.

So if a behavior is damaging health or well-being, and other treatments haven’t been successful, aversion therapy could be a viable alternative, especially if combined with a follow-up program. However, it should be approached with caution and only after careful consideration because it can have harmful side effects such as depression and anxiety. Overall, more research is needed regarding the future direction of aversion therapy and its long-term effectiveness.

• ​APA. (2021). APA resolution on sexual orientation change efforts. PsycEXTRA Dataset. https://doi.org/10.1037/e502302021-001 
• APA. (2023). APA Dictionary of Psychology. American Psychological Association. Retrieved February 18, 2023, from https://dictionary.apa.org/behavior-therapy 
• Arlinghaus, K. R., Foreyt, J. P., & Johnston, C. A. (2017). The issue of aversion in lifestyle treatments. American Journal of Lifestyle Medicine, 11(2), 119–121. https://doi.org/10.1177/1559827616680554
• Baghchechi, M., Pelletier, J. L., & Jacob, S. E. (2021). Art of prevention: The importance of tackling the nail biting habit. International Journal of Women’s Dermatology, 7(3), 309–313. https://doi.org/10.1016/j.ijwd.2020.09.008 
• Berridge, K. C., & Kringelbach, M. L. (2015). Pleasure systems in the brain. Neuron, 86(3), 646. https://doi.org/10.1016/j.neuron.2015.02.018
• Blue, R. (2016). Ineffectiveness of an Aversion Therapy Technique in Treatment of Obsessional Thinking. Psychological Reports. https://doi.org/10.2466/pr0.1978.43.1.181 
• Drescher, J. (2015). Out of DSM: Depathologizing Homosexuality. Behavioral Sciences, 5(4), 565-575. https://doi.org/10.3390/bs5040565
• Drescher, J., Schwartz, A., Casoy, F., McIntosh, C. A., Hurley, B., Ashley, K., Barber, M., Goldenberg, D., Herbert, S. E., Lothwell, L. E., Mattson, M. R., McAfee, S. G., Pula, J., Rosario, V., & Tompkins, D. A. (2016). The growing regulation of Conversion Therapy. Journal of Medical Regulation, 102(2), 7–12. https://doi.org/10.30770/2572-1852-102.2.7 
• Elkins, R. L., Richards, T. L., Nielsen, R., Repass, R., Stahlbrandt, H., & Hoffman, H. G. (2017). The neurobiological mechanism of chemical aversion (emetic) therapy for alcohol use disorder: An fmri study. Frontiers in Behavioral Neuroscience, 11. https://doi.org/10.3389/fnbeh.2017.00182 
• Russell, M. A. (1970). Effect of Electric Aversion on Cigarette Smoking. British Medical Journal, 1(5688), 82-86. https://doi.org/10.1136/bmj.1.5688.82
• Smith, G., Bartlett, A., & King, M. (2004). Treatments of homosexuality in Britain since the 1950s—An oral history: The experience of patients. BMJ : British Medical Journal, 328(7437), 427. https://doi.org/10.1136/bmj.37984.442419.EE