Behavioural Intervention Therapies (AQA A-Level Psychology): Revision Notes

Behavioural Intervention Therapies

Behavioural intervention therapies for addiction are treatment approaches grounded in learning theory principles, particularly classical conditioning. These therapies aim to reduce addictive behaviours by creating new associations between substances or addictive activities and unpleasant experiences. The core idea is to reduce the time delay between engaging in addictive behaviour and experiencing negative consequences, making these consequences more immediate and therefore more effective in discouraging the behaviour.

Understanding the theoretical basis

Behavioural interventions are treatments that apply behaviourist learning principles, especially classical and operant conditioning, to modify problematic behaviours. These approaches work on the principle that addiction involves learned associations between environmental cues and pleasurable experiences. By creating competing negative associations, these therapies attempt to weaken the appeal of addictive substances or behaviours.

The treatments operate through counterconditioning, where a maladaptive behaviour becomes linked with an unpleasant experience rather than a pleasurable one. This process relies on the principle of contiguity from classical conditioning theory, which states that stimuli occurring close together in time become associated with each other.

Aversion therapy

Aversion therapy represents a direct application of classical conditioning principles to addiction treatment. In this approach, the addictive substance or behaviour is repeatedly paired with genuinely unpleasant stimuli, such as nausea-inducing drugs or mild electric shocks. The goal is to establish a conditioned response where the person automatically associates the addiction trigger with discomfort rather than pleasure.

Treatment for alcohol addiction

For treating alcohol dependency, aversion therapy typically involves administering an emetic drug (such as one that causes vomiting) to clients before they consume alcohol. The client experiences severe nausea and vomiting shortly after drinking, creating a powerful negative association with alcohol consumption. This process requires multiple sessions using varying doses of the aversive agent and different types of alcoholic drinks to ensure the conditioning generalises across different drinking situations.

An alternative pharmaceutical approach uses drugs like disulfiram (Antabuse), which interferes with alcohol metabolism. When someone drinks alcohol while taking this medication, they experience immediate and intense nausea and vomiting, creating an instant negative consequence for alcohol consumption. However, the effectiveness of this approach depends on the client's willingness to continue taking the medication, and there are potential risks if someone drinks heavily while on the drug.

Treatment for gambling addiction

Electric shock aversion therapy has been used for behavioural addictions like gambling, particularly for individuals whose medical conditions make drug-induced nausea unsuitable. In this treatment, clients read cards containing both gambling-related phrases and neutral content. When they encounter gambling-related material, they receive a brief, uncomfortable but harmless electric shock. The intensity is pre-selected by participants themselves to ensure it remains unpleasant without being traumatic. This approach helps create negative associations with gambling-related thoughts and cues.

Covert sensitisation

Covert sensitisation emerged as a more acceptable alternative to traditional aversion therapy. This technique is in vitro, meaning it takes place through imagination rather than actual physical experience. Instead of experiencing real unpleasant stimuli, clients are guided to vividly imagine how negative consequences would feel, creating similar conditioning effects without the trauma of actual aversive experiences.

Application to nicotine addiction

In treating smoking addiction through covert sensitisation, therapists first help clients achieve a relaxed state. Clients then create detailed mental images of themselves smoking, followed by imagining extremely unpleasant consequences such as severe nausea, vomiting, or other distressing physical sensations. The more vivid and detailed these imaginary scenarios become, the more effective the conditioning process.

Therapists often enhance this technique by incorporating personally relevant aversive stimuli. For example, if a client has a specific phobia, the therapy might combine smoking imagery with that feared object or situation. Additionally, the process includes imagining the relief and positive feelings associated with avoiding cigarettes, reinforcing the benefits of abstinence.

Evaluation

Research support

Nathaniel McConaghy and colleagues (1983) conducted a direct comparison between traditional electric shock aversion therapy and covert sensitisation for treating gambling addiction. Their findings strongly favoured covert sensitisation: at a one-year follow-up, 90% of participants who received covert sensitisation had reduced their gambling activities, compared to only 30% of those who underwent traditional aversion therapy. The covert sensitisation group also reported experiencing less intense gambling urges and fewer cravings overall.

This study represents part of broader research evidence suggesting that covert sensitisation offers a promising approach for treating various addictions, including alcohol, nicotine, and gambling dependencies. The technique appears to achieve similar conditioning effects to traditional aversion therapy while avoiding many of the associated problems.

Methodological concerns

Peter Hajek and Lindsay Stead (2001) reviewed 25 studies examining aversion therapies for nicotine addiction and concluded that the research quality was too poor to draw reliable conclusions about effectiveness. Most studies suffered from significant methodological flaws, with the most problematic being the failure to use proper blinding procedures.

When researchers evaluating treatment outcomes know which participants received active therapy versus placebo treatments, this knowledge introduces bias that typically makes therapies appear more effective than they actually are. The fact that much aversion therapy research is quite dated reflects the declining popularity of these approaches in favour of less controversial alternatives like covert sensitisation.

Treatment adherence problems

Aversion therapy faces inherent challenges with client compliance due to its deliberately unpleasant nature. The use of stimuli that cause vomiting, pain, or distress naturally leads many clients to discontinue treatment before completion. This high dropout rate creates problems for both clinical practice and research evaluation, as it becomes difficult to assess the true effectiveness of interventions when many participants leave early.

This compliance issue represents a clear advantage for covert sensitisation, which involves much less distress and trauma for clients.

Short-term versus long-term effectiveness

Evidence suggests that benefits from aversion therapy tend to be temporary rather than permanent. McConaghy's research found that aversion therapy showed much stronger effects after one month compared to one year later. In longer-term follow-up studies spanning two to nine years, aversion therapy proved no more effective than placebo treatments, while covert sensitisation maintained its advantages over longer periods.

This pattern of diminishing returns over time raises questions about the lasting value of aversion-based approaches and supports the argument for less traumatic alternatives that may offer more durable benefits.

Ethical considerations

Professional psychology organisations require practitioners to follow strict ethical codes governing how clients and research participants are treated. Aversion therapy struggles to meet these ethical standards because it inherently involves causing suffering.

The approach has been criticised for potentially damaging client dignity and self-esteem, even when participants consent to treatment and can control aspects like shock intensity. These ethical objections contributed to the preference shift towards covert sensitisation, which achieves similar therapeutic goals without compromising client wellbeing or professional ethical standards.