Aversive conditioning, also referred to as aversion therapy when applied in clinical settings,

involves the systematic pairing of an aversive stimulus with some undesired behavior. For
example, taste-aversion conditioning involves the pairing of food ingestion with the
subsequent onset of nausea or sickness. As a result of the pairing, the food item is avoided in
the future. Similarly, shock may be systematically paired with sexual arousal that arises from
some prohibited stimulus (i.e., children), in the hopes that the fear elicited by the shock
interferes with the original emotion and behavior elicited by the prohibited stimulus.
Aversive conditioning, a technique arising out of the classical conditioning literature, is
typically distinguished from punishment, which is a technique arising out of the operant
conditioning literature. While both techniques involve the onset of an aversive stimulus
following the performance of some behavior, in the case of aversive conditioning, the
therapist does not directly modify the client's instrumental behavior by simply providing
punishment. Rather, some aspect of the stimulus is paired with aversive sensations such that
the resulting emotional state inhibits the instrumental behavior. Referring to the above
examples, the allure of the taste of a certain food, or the image of children, is modified as a
result of becoming associated with illness or shock, respectively.
Aversive conditioning is sometimes referred to as counterconditioning. That is because the
response one makes to a stimulus is reversed, or countered, as a result of a subsequent
pairing. That is, via a process of classical conditioning, a stimulus that initially elicits
approach behavior may come to elicit withdrawal. In a classic example, a child who originally
approached small furry animals became fearful and avoidant of them as a result of their being
repeatedly paired with an aversive noise. When used clinically, the goal of aversive
conditioning is to establish (through classical conditioning) an emotional state that will inhibit
or counter the initial response.

RESEARCH BASIS
Aversive conditioning derives from laboratory studies in classical conditioning dating back to
Pavlov. The most fundamental empirical base for aversive conditioning concerns research on
food aversion. This research illustrates several important parameters of aversive conditioning.
For instance, the pairing of food and illness may result in subsequent avoidance of the food
even if the onset of illness is delayed by several hours. On the other hand, the pairing
procedure is ineffective if stimuli such as sounds or lights are substituted for food. Therefore,
animals appear to have a biological preparedness to respond to pairings between illness and
the taste or smell of stimuli, but not between illness and the sight or sound of stimuli.
Consistent with these laboratory findings, the clinical effectiveness of aversive conditioning
procedures depends, in part, on the relevance or belongingness between the conditioned
stimulus (e.g., food or shock) and the unconditioned stimulus (e.g., illness).
In addition to being grounded in basic laboratory research, aversive conditioning also has an
applied legacy. As will be discussed in the following section, aversive conditioning is a
procedure that has been utilized in an attempt to reduce a wide range of undesired behaviors
in both adults and children. The procedure has proved to be more effective for certain childspecific problems such as thumb-sucking and bed-wetting, and less effective for many adultspecific problems such as addictive and fetishistic behavior. With respect to adults, the results
of early studies were frequently interpreted as supportive of the effectiveness of aversive
conditioning procedures. However, longer-term follow-up studies often proved less
encouraging. Those studies illustrated that the behavior changes resulting from aversive

conditioning procedures in adults frequently do not generalize to nontraining settings and are
short-lived when they do. Enthusiasm for aversive conditioning has also been reduced due to
ethical concerns about deliberately exposing individuals to aversive stimuli.

RELEVANT TARGET POPULATIONS AND

EXCEPTIONS
Aversive conditioning techniques have been used with respect to bed-wetting, thumb-sucking,
alcohol consumption, cigarette smoking, fetishistic sexual behaviors, pedophilia, changing
sexual orientation, and other unwanted behaviors. A characteristic aversive conditioning
technique for a shoe fetish would be to give a shock to the hands or feet or to ingest an emetic
drug that produces nausea, upon the presentation of a shoe. In theory, subsequent fetishistic
behavior should be reduced owing to the reciprocal inhibition derived from the new learning.
Similarly, in the case of children, thumb-sucking has been paired with an aversive stimulus by
placing a foul-tasting substance on the child's thumb. The aversive stimulus is administered
each time the child places the thumb in the mouth. Via this pairing, the aversive experience
comes to compete with the previously positive experience of thumb-sucking, generating an
avoidance of the behavior. Finally, an aversive conditioning technique for quitting smoking is
rapid smoking. In this procedure, participants smoke cigarettes as fast as they can, one after
the other or multiply, to the point of becoming nauseous or sick. They are encouraged and
facilitated to continue smoking in this manner until it is no longer physically possible to do so.
In this way, the act of smoking, along with the substances to which one is exposed as a result
(e.g., nicotine), are paired with the aversive physical sensations of becoming sick. The pairing
of smoking with nausea should reduce the appeal of smoking.
Aversive conditioning techniques have been shown to reduce undesired habitual behavior in
ways predicted by theory, and thereby provide patients with a greater degree of control.
However, the effects of such procedures are sometimes highly context-specific, meaning that
although behavior change occurs in the setting in which training occurred, it may not
generalize to other settings. Therefore, an individual exposed to a rapid smoking intervention
may avoid smoking in the clinic in which training occurred or in the presence of the therapist,
but will show little or no differences in smoking behavior elsewhere. Similarly, an individual
may avoid alcohol after having ingested anabusea drug that induces nausea and vomiting
when paired with alcoholbut only for the time period during which the drug is thought to be
in effect. Moreover, alcoholics sometimes refuse to take anabuse in anticipation of
subsequently drinking alcohol.
Limited generalization of the conditioned behavior seriously reduces the utility of avoidance
conditioning techniques as methods for effective and long-lasting behavior change.

COMPLICATIONS
In addition to problems of generalization discussed above, aversive conditioning techniques
raise ethical questions related to the appropriateness of inflicting pain and discomfort on
peopleeven if they consent to it. Because of these concerns, such procedures are often used
as a last resort or as default treatments to temporarily reduce some aberrant behavior while
other methods are used to generate new ways of coping.

When aversive conditioning techniques are used, it is usually within the context of a larger
program that incorporates other interventions as well. This is illustrated in a program for
eliminating thumb-sucking in children. The application of an aversive-tasting substance to the
thumb of the youngster is only one element of a comprehensive intervention that involves (a)
educating parents about the habitual rather than purposeful nature of the behavior, (b)
increasing the number of brief, positive, nonverbal contacts with the child (i.e., pats on the
head, brief back rubs, mussing the hair, etc.) prior to and during the treatment, (c) informing
the child of the age inappropriateness of the thumb-sucking and the negative effects on one's
teeth and peer relationships that may result from it, and (d) eliminating lectures, reprimands,
and reasoning about the issue.

CASE ILLUSTRATION
Jack, age 7, was taken by his parents to see a psychologist because of nightly bed-wetting.
The psychological consultation was prompted by the inconvenience of this behavior and also
because of embarrassment experienced by Jack at a recent sleepover with friends. It was clear
from the initial consultation that both Jack and his parents were highly motivated to rectify
Jack's nighttime enuresis.
Following up on the advice of the psychologist, Jack's parents purchased a battery-operated
bell and pad device. When installed, this device produces a loud and aversive sound as soon
as a child urinates into the bed, due to the closing of an electrical circuit by the liquid.
Consistent with aversive conditioning principles, the bell and pad device results in the pairing
of an aversive stimulus (i.e., loud sound) and the onset of urination. In addition to being
startled by the loud noise, the procedure also calls for the child to get out of bed, change the
sheets, and reset the alarm, following a bed-wetting incident. Within 4 to 12 weeks, children
generally become more aware of the sensation of a full bladder and begin to preempt the
aversive stimulus by getting up and urinating in the toilet.
In Jack's case, the introduction of the bell and pad system into his bed was welcomed due to
his motivation to quit wetting the bed. Initially, however, Jack required help from his parents
to fully awaken and get out of bed and change the sheets when the alarm sounded. This ritual
was resisted by Jack and taxing to his parents. After 2 weeks with no noticeable change, the
family was less enthusiastic about the treatment.
However, after the 5th week, the frequency of Jack's bed-wetting began to decline. On several
occasions, Jack was heard by his parents getting up at night to use the toilet and then returning
to bed. By the 10th week, Jack had put together a string of 2 weeks of nights in which he did
not urinate in the bed. It was then decided that the bell and pad would be removed.
Within 3 days, Jack and his parents were disappointed to find that Jack had urinated in his bed
again. Bed-wetting, once again, became frequent. The family was alerted by the psychologist
that such a relapse is common, and may be tied to the change in the stimulus condition arising
from the removal of the system. That is, Jack's learning had not generalized to an environment
in which the bell and pad was not hooked up. Therefore, the alarm system was reinstalled, and
within 2 weeks Jack was consistently making it through the night without urinating in his bed.
Although upset with the reintroduction of the device, Jack was motivated to be dry, and
consented to an agreement that the system would be removed after 8 consecutive dry nights.
At the same time, Jack became less insistent about drinking water or soda after dinner.

After 8 dry days, the bell and pad was removed. Over the next 4 months, Jack had only 2
instances of bed-wetting, and was consistently asking to have sleepovers with friends.
Paul S. Strand
Further Reading

Entry Citation:
Strand, Paul S. "Aversive Conditioning." Encyclopedia of Behavior Modification and
Cognitive Behavior Therapy. 2007. SAGE Publications. 15 Apr. 2008. <http://sageereference.com/cbt/Article_n2008.html>.