Aversion therapy

Hypnosis / Self Hypnosis - discuss this most useful, and misunderstood, of therapeutic tools.

Postby Louise McDermott » Tue Oct 14, 2003 1:46 pm

I was talking to a fellow diploma student about some different techniques for smoking.

He said he'd come across this idea of telling the story of a man who, when he put a cigarette to his lips, found that there was blood on his lips and the cigarette (yes, gross I know!). And it can be embellished, extended and so on . . .

I instinctively didn't really agree with doing this sort of thing, as there are just so many ways of breaking habits more comfortably (and said so :) ).

But I was recounting this to another friend, and he made the highly salient point that clients may find this (and other ideas in a similar vein, no pun intended :) ) at best squeamish and at worst actually frightening.

And of course, surely he's so right - well trained therapists spend much of their time looking out for and deconditioning states of high emotional arousal. Why on earth would we want to (possibly) create these states which we know have no place in therapy (unless we're talking getting excited about something positive, or building up motivation, etc).

So I guess it might seem simple to others, but it really clarified the reasons why I personally would avoid using aversion-type techniques:

a) there are more comfortable ways of achieving the goal, and

b) (more importantly in my mind) it's possible to create states of high emotional arousal, (maybe even create phobic pattern matches in some people) which is the opposite of what we're trying to achieve in therapy.

Louise
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Postby andy » Tue Oct 14, 2003 7:50 pm

I was the one who told Louise that little gem! - and it has a happy ending, it's was a false alarm - not some deadly disease!

While it's all very nice to use gentle therapy on the client I wonder whether sometimes they need the stick as well as the carrot so to speak.

If they can imagine these horrific experiences, then I'm sure they'd be forever grateful to you for helping them to avoid them for real.. Surely actually living through that experience is the worse of two evils. :twisted: or :evil:

Besides, their reasons for wanting to quit stem from similar ideas about health - it's just an extension on what they know already.

This would not be something to decondition. Just like you don't need to decondition the fear when you are in severe danger. It's only faulty pattern matching, fears that serve no purpose, which need to be deconditioned.

Therapy doesn't always have to be about relaxing and being calm, it's about finding the right tool that best solves the problem.

What do others think?

Andy.

(I'd like to make it clear that I'm just keeping my mind open to the possibility - for the purpose of the debate)
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Postby Anthony Jacquin » Tue Oct 14, 2003 10:22 pm

My experience with quite classic aversion with smokers is that immediately everyone quit - - but long term it was not effective for many of them.

By classic aversion I mean buiding up some disgusting thought/image/tast and snapping this to the act of putting a cigarette to the lips.

Some quit and remained non smokers - I feel they were and continue to sail on the success of those first few days of not having a cigarette because any suggestion I give that they will taste disgusitng can only realy last a few days.

Too many went back to smoking and after quite a few years of pondering I feel the reason is quite straightforward. Aversion in isolation of other techniques does not deal with either the reasons why people smoke or the 'little voice' in their head that says 'have a cigarette'. It is stil there but when they try to smoke they find they cannot. In other words they are still smokers, just frustrated ones. It is about as effective (maybe a bit more) as painting a childs fingers with mustard and hoping they will stop biting their nails - either they develop a taste for it or find a way through it. So even if they do not smoke they do not really have a choice. Much more effective is to give them a choice back or at least enable them to get in a position where they can exercise their right to choose is it not?

It also sets up a bit of a battle between the therapsit and the client. You say they will taste disgusting or in this case have something to do with blood :evil: ?? and wil not be able to smoke. They want to but find it difficult. So your client starts using willpower to move toward smoking rather than away from it.

This weekI had a client who had previously seen a therapist who had used an aversion technique where the client had a choice of two paths. one of which ensured happiness for her mother and the other unhappiness. When the client went back to smkoing they found they felt incredibly guilty about it for a year. If aversion works great. If it does not then there may be the potential for causing suffering. Same with 'flood therapy' for a phobia. Just because it might work does not mean it is the best way to proceed.

I am very interested to know other therapists views on aversion as i appreciate it can be used at many levels. My approach is to use it very indirectly, such as ' I dont need to say cigarettes are a poor substitute for your life, health....and i know i do not need to say they are a poor substitute for being there for so and so etc etc...' yeah its stil aversion but it s a minor bump....

That all said, when i first started working as a hypnotherapist i was a big user of aversion and did get some great results - just not enough to call this an effective approach.
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Postby guyb » Tue Oct 14, 2003 10:24 pm

I think a little aversion can be a good thing.

I use a similar story to Andy's sometimes (man smoking alone late one night, coughs up blood, thinks he has had one cigarette too many, goes into shock, horrific thoughts, comes round a few minutes later, throws cigarettes away and never smokes again. Later finds it was from a bleeding gum).

I use this as aversion and also to show the power of hypnosis - the shock was a trance state etc.

There is good arousal and bad arousal. But there has to be some emotional arousal in what we do. For example, I know when my clients let go of smoking because I get a strong emotional response (eyes water, voice changes etc). It has to be there because the smoking pattern has been held in the emotional brain.

I agree that you can't scare a smoker into stopping. That's why the health warnings don't work. But a little bit of aversion can get their emotions engaged and also reaffirm what they are doing in seeking help. Rather than being frightened they feel relief that they can escape the consequences of smoking.

You don't have to do the scaring though. I usually disassociate from it by saying something like "and, would you believe, there are still some therapists out there who will try and scare you into stopping by telling you exactly what happens when ......." .

That way you can really scare them and they feel good about it because they have come to an nice enlightened therapist who won't scare them. :!:
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Postby Louise McDermott » Wed Oct 15, 2003 10:01 am

'I know when my clients let go of smoking because I get a strong emotional response (eyes water, voice changes etc). It has to be there because the smoking pattern has been held in the emotional brain.'

Is this really true that smoking is held in the emotional part of the brain? I am under the impression that things like phobic, panic & PTSD responses were processed by the emotional brain, and hadn't passed to the narrative memory.

My thoughts on smoking are that the action has passed from conscious to unconscious behaviour, ie it's become a habit. Not that the act or thoughts about the act of smoking are held on 'high alert' in a different part of the brain.

If this were the case, surely there'd be a lot more high anxiety around smoking :?:

What does anyone else think on this?

Louise
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Postby Louise McDermott » Wed Oct 15, 2003 10:14 am

It's only faulty pattern matching, fears that serve no purpose, which need to be deconditioned.


This is exactly my point, Andy. A therapist who uses these sorts of scare tactics may well create a faulty pattern match, a fear that serves no purpose, which needs to be deconditioned.

For example, a fear of blood (if they don't have already, which would be highly uncomfortable for them, and what are you going to do? Ask them before you tell the story whether or not they have a blood phobia :shock: )

Just like you don't need to decondition the fear when you are in severe danger.


Also, I don't quite understand what the above quote means? Do you mean you don't need to decondition the fear when you're actually in a dangerous situation? If so, I don't really get the point. It would be good if you could clarify that for me :?

And I agree that not all therapy should be nicey nicey. That was not the point I was making. Yes, as I've said, I do believe we should engage certain emotions, and what is anchoring if not trying to establish an emotional link to a particular object or action? I'm all for that, especially seeing as much learning happens on an emotional, unconscious level.

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Postby andy » Wed Oct 15, 2003 11:24 am

Hi Louise. Let me first clarify a few things that I said.

Nature has made us so that in dangerous situations we have an emotional hijack, which serves a very useful purpose. See a lion, freeze or run away.

Smoking is a man made artificial cancer stick and so does not have a biological response, even though the risks are very real. In order to overcome an artificial danger we need an artificial anchor. And this anchor would most definitely serve a purpose - stopping them killing themselves all the more! A faulty pattern match is one that does not serve a purpose.

I see your point about this anchor spreading to other areas, like a fear of blood. That's where it could create a faulty pattern match. And that is the crucial aspect that needs to be taken into consideration. That's why this tactic should only be used mildly, if at all.

It's very hard to know what fears clients may have and we may inadvertently stumble across them by accident at any time. I often get them to fly around in the sky to feel freedom, breath in fresh air etc - but what about if they had a flying phobia? (for this I ask them how they manage to not smoke on long flights and gage it from their response).

But the point is we always run the risk of creating a pattern match which serves no purpose and could even cause them despair without even being aware of it.

Andy.
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Postby Roger Elliott » Wed Oct 15, 2003 11:29 am

Interesting thread folks. For my own part, if all I can think of is using an aversion technique, I assume I'm missing something. I'm averse to them I suppose.
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Postby guyb » Wed Oct 15, 2003 12:37 pm

Louise

I think we are talking about the same thing here. Smoking, like a phobia, is held in the emotional brain. At least that is where the pattern is that says "feel bad, have a cigarette, feel better". If it was just a function of the rational mind no-one would smoke because there is nothing reasonable about smoking.

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Postby Louise McDermott » Wed Oct 15, 2003 1:42 pm

It does seem we're talking about the same thing here.

Although, I would say that smoking is something that has become unconscious, therefore as you said, rational thinking no longer comes into it.

What I think of as the emotional brain is the part that holds/processes important pieces of incoming stimuli, ready for us to pattern match in case the stimuli is of threat to us. I personally don't really think smoking comes under that.

Just my thoughts . . .

Louise
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Postby Roger Elliott » Thu Oct 16, 2003 8:31 am

'Smoking and pattern matching' moved to here so we don't get off-topic on this thread.

Please continue with discussions on Aversion Therapy here.
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