Question: How does aversion therapy performed at BYU in the 1970s relate to medical and psychological science as understood at that time?

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Question: How does aversion therapy performed at BYU in the 1970s relate to medical and psychological science as understood at that time?

Aversion therapy is a standard technique that is still used today for a variety of treatments

Aversion therapy is still used today for a variety of treatments, such as gambling, smoking, alcoholism, and violence. A 2010 article in Psychology Today states "To date, aversion therapy using shock and nausea is the only technique of quitting [smoking] that offers decent gambling odds." [1] The Encyclopedia of Mental Disorders has this entry for aversion therapy:

A patient who consults a behavior therapist for aversion therapy can expect a fairly standard set of procedures. The therapist begins by assessing the problem, most likely measuring its frequency, severity, and the environment in which the undesirable behavior occurs. Although the therapeutic relationship is not the focus of treatment for the behavior therapist, therapists in this tradition believe that good rapport will facilitate a successful outcome. A positive relationship is also necessary to establish the patient's confidence in the rationale for exposing him or her to an uncomfortable stimulus. The therapist will design a treatment protocol and explain it to the patient. The most important choice the therapist makes is the type of aversive stimulus to employ. Depending upon the behavior to be changed, the preferred aversive stimulus is often electric stimulation delivered to the forearm or leg. [2]

Over the years, the methods have been refined and approved. Today, we have decades of research that were not available in the 1970s

Over the years, the methods have been refined and approved. Today, we have decades of research that were not available in the 1970s, giving us a better understanding of where aversion therapy would be effective and where it would not be effective. The methods of the 1970s may seem crude compared to today's standards, but today's standards will probably seem crude in another 40 years. Forms of aversion therapy are still used today by mainstream psychologists to treat a variety of conditions.

History of therapy and homosexuality

Homosexuality was once illegal in many countries, and those convicted were forced into various therapies against their wills.[1]

In 1966, Martin E.P. Seligman conducted a study at the University of Pennsylvania which showed positive results in applying aversion therapy to help people stop engaging in homosexual behavior. According to Seligman, this led to "a great burst of enthusiasm about changing homosexuality [that] swept over the therapeutic community." [3] Research was conducted by researchers at many institutions, including universities like Harvard and King's College in London.

Historically, there were two types of homosexuality that were treated, ego-dystonic homosexuality and ego-syntonic homosexuality. Ego-dystonic homosexuality is a condition where an individual's same-sex attraction is in conflict with his idealized self-image, creating anxiety and a desire to change. Ego-syntonic homosexuality describes a situation where the subject is content with his or her sexual orientation. Ego-dystonic homosexuality was considered a mental illness by the American Psychological Association (APA) until 1987, and an ego-dystonic sexual orientation is still considered a mental illness by the World Health Organization (F66.1). [4]

Even after the APA declassified ego-dystonic homosexuality as mental illness, aversion therapy could still be used to treat distress over sexual orientation, though not the sexual orientation itself. Persistent and marked distress about sexual orientation is still classified as a sexual disorder in the DSM-IV under Sexual Disorder Not Otherwise Specified (302.9). It was not until 1994, that the American Medical Association issued a report that stated "aversion therapy is no longer recommended for gay men and lesbians" [5] and it was not until 2006 that using aversion therapy to treat homosexuality became a violation of the codes of conduct and professional guidelines of the American Psychological Association and American Psychiatric Association.

In 2009, a task force was commissioned by the American Psychological Association to investigate therapies used to treat homosexuality, including aversion therapy. They reported:

Early research on efforts to change sexual orientation focused heavily on interventions that include aversion techniques. Many of these studies did not set out to investigate harm. Nonetheless, these studies provide some suggestion that harm can occur from aversive efforts to change sexual orientation...

We conclude that there is a dearth of scientifically sound research on the safety of SOCE [sexual orientation change efforts]. Early and recent research studies provide no clear indication of the prevalence of harmful outcomes among people who have undergone efforts to change their sexual orientation or the frequency of occurrence of harm because no study to date of adequate scientific rigor has been explicitly designed to do so. Thus, we cannot conclude how likely it is that harm will occur from SOCE. However, studies from both periods indicate that attempts to change sexual orientation may cause or exacerbate distress and poor mental health in some individuals, including depression and suicidal thoughts. The lack of rigorous research on the safety of SOCE represents a serious concern, as do studies that report perceptions of harm (cf. Lilienfeld, 2007). [6]

Ego-syntonic homosexuality was not addressed in the BYU studies, though it was a subject of research performed at other institutions. Furthermore, BYU only treated adults. Other institutions, such as UCLA, treated children as young as 6.[2]

Aversion therapy at other institutions

A significant number of hospitals and universities historically offered aversion therapy as a way to treat homosexuality. It would be impossible to list all of them, but here are a few of the major places where people were involved in research using aversion therapy to treat homosexuality:

Author Year Number Institution Type Publication References and Notes
Max

1935

?

New York University

Aversion therapy

Psychological bulletin

  • Max, Louis William. "Breaking Up a Homosexual Fixation by the Conditioned Reaction Technique: A Case Study," Psychological Bulletin (Washington, D.C.), Vol. 32 (1935): p. 734·
Freund

1960

67

University of Toronto

Aversion apomorphine therapy

Adult sexual interest in children

  • Kurt Freund, "Assessment of pedophilia," in Cook, M. & Howells, K. (eds.), Adult sexual interest in children, London: Academic Press, 1981, pp. 139-179.
James

1962

1

Glenside Hospital (Bristol, U.K.)

Aversion apomorphine therapy

British Medical Journal

Miller

1963

4

Howard University

Hypnotic-Aversion

Journal of the National Medical Association

Thorpe, Schmidt, Brown, Castell

1964

-

Banstead Hospital

Imaginary aversive therapy

Behavior Research Therapy

Golda, Neufelda

1964

39

Guy's Hospital

Imaginary aversive therapy

Behavior Research Therapy

McGuire, Vallance

1965

39

Southern General Hospital

Aversive shock therapy

British Medical Journal

MacCulloch, Pinschof & Feldman

1965

4

Crumpsall Hospital, Manchester, UK

Anticipatory avoidance with aversion shock therapy

Behavior Research and Therapy

  • MacCulloch, M. J., Feldman, M. P. and Pinschof, J. M., “The application of anticipatory avoidance learning to the treatment of homosexuality—III : The sexual orientation method,"] Behaviour Research and Therapy Volume 4, Issue 4, November 1966, Pages 289-299
Solyom & Miller

1965

6

Allan Memorial Institute

Aversion shock therapy

Behavior Research and Therapy

  • Solyom, L., & Miller, S. (1965) A differential conditioning procedure as the initial phase of the behavior therapy of homosexuality. Behavior Research and Therapy, 3, 147-160.
MacCulloch & Feldman

1967

43

Crumpsall Hospital (Manchester, U.K.)

Anticipatory avoidance with aversion shock therapy

British Medical Journal

Bancroft & Marks

1968

-

Institute of Psychiatry and Maudsley Hospital

Electric aversion therapy

Proceedings of the Royal Society of Medicine

Fookes

1969

27

?

aversion shock therapy

British Journal of Psychiatry

Bancroft

1969

16

?

aversive shock therapy

The British Journal of Psychiatry

McConaghy

1969

40

The University of New South Wales

aversion apomorphine therapy

The British Journal of Psychiatry

Barlow

1973

-

The University of Mississippi

Variety

Behavior Therapy

Birk, Huddleston, Miller, & Cohler

1971

18

Joint project from Harvard and University of Chicago

Aversive shock therapy vs. associative conditioning

Archives of General Psychiatry

  • Lee Birk, MD; William Huddleston, JD; Elizabeth Miller; Bertram Cohler, PhD, "Avoidance Conditioning for Homosexuality," Archives of General Psychiatry. 1971;25(4):314-323. This study, published in 1971, involved eight treated subjects and eight placebo subjects. A follow-up study was conducted two years after the original treatment. The study was published in the Archives of General Psychiatry.
Feldman, MacCulloch, & Orford

1971

63

Crumpsall Hospital

Aversive therapy

-

  • Feldman, M. P., MacCulloch, M. J., & Orford, J. E (1971) Conclusions and speculations. In M. P. Feldman & M. J. MacCulloch, Homosexual behaviour: Therapy and assessment (pp. 156-188), New York: Pergamon Press.
Colson

1972

1

Illinois State University

Olfactory aversion therapy

Journal of Behavior Therapy and Experimental Psychiatry

  • Charles E. Colson, "Olfactory aversion therapy for homosexual behavior," Journal of Behavior Therapy and Experimental Psychiatry Volume 3, Issue 3, September 1972, Pages 185-187. Concluded that olfactory aversion therapy provides many advantages over more traditional forms.
Segal & Sims

1972

1

Murray State University

Covert Sensitization

Journal of Consulting and Clinical Psychology

Hallam & Rachman

1972

7

King's College, London

aversion shock therapy

Behaviour Research and Therapy

Hanson & Adesso

1972

1

University of Wisconsin-Milwaukee

Desensitization and aversive counter-conditioning

Journal of Behavior Therapy and Experimental Psychiatry

  • Richard W. Hanson, and Vincent J. Adesso, "A multiple behavioral approach to male homosexual behavior: A case study", Journal of Behavior Therapy and Experimental Psychiatry Volume 3, Issue 4, December 1972, Pages 323-325. This study took place in 1972, involved a single male subject, and included a follow-up six months from the original treatment. The study was published in the Journal of Behavior Therapy and Experimental Psychiatry.
McConaghy, Proctor, & Barr

1972

40

Prince Henry Hospital (Sydney, Australia)

Apomorphine aversion conditioning

Archives of Sexual Behavior

Callahan & Leitenberg

1973

23

Carmarillo State Hosp., California

aversion shock therapy

The Journal of Abnormal Psychology

McConaghy & Barr

1973

46

University of New South Wales, Institute of Psychiatry of New South Wales

Classical conditioning, avoidance conditioning

The British Journal of Psychiatry

Tanner

1974

16

Center for Behavior Change

aversion shock therapy

Journal of Behavior Therapy and Experimental Psychiatry

McConaghy

1975

31

University of New South Wales

Aversion shock therapy

Behaviour Research and Therapy

  • N. McConaghy, "Aversive and positive conditioning treatments of homosexuality", Behaviour Research and Therapy Volume 13, Issue 4, October 1975, pages 309-319 This study used both aversive conditioning against homosexuality and also positive conditioning toward heterosexuality. It concluded that the positive conditioning was ineffective.
Tanner

1975

16

Northeast Guidance Center

Aversion shock therapy

Behavior Therapy

Freeman & Meyer

1975

9

University of Louisville

Aversion shock therapy

Behavior Therapy

McConaghy

1976

157

University of New South Wales

Aversion apomorphine therapy

The British Journal of Psychiatry

James

1978

40

Hollymoor Hospital, England

Anticipatory avoidance, desensitization, hypnosis, anticipatory avoidance

Behavior Therapy

McConaghy, Armstrong, & Blaszczynski

1981

20

University of New South Wales

Aversive therapy

Behavior Research and Therapy

Purpose of psychological therapy

The purpose of therapy is to help patients towards their desired goals. One of the fundamentals in the field is patient self-determination. It is the patient who sets the goals, not the therapist. Aversion therapy, which is still administered today to help smokers, is not administered as a way to torture the subjects for smoking, but to help them achieve their goal of being smoke-free. Similarly, the therapy at BYU was administered to people who felt distress about their sexual lives. The purpose of the therapy was to relieve that stress. The volunteers for the study sought help to change their homosexuality and medical associations of that time recommended this therapy as just one among several.

An analysis of similar aversion therapy studies indicate that they may have caused or exacerbated distress and poor mental health, especially depression and suicidal thoughts. (For more information on suicides, see Same-sex attraction/Suicide.) Whether or not these effects were experienced by the participants at the studies run at BYU could not be determined. There is an inherent risk in therapy for mental illnesses. As with many experiments, the risks were not fully understood at the time they were being run.

Notes

  1. Nigel Barber, Ph.D., "Smoking: Most effective quitting technique little known," February 17, 2010
  2. "Aversion Therapy," Encyclopedia of Mental Disorders
  3. Seligman, Martin E.P., What You Can Change and What You Can't: The Complete Guide to Self Improvement Knopf, 1993; ISBN 0-679-41024-4, p. 156
  4. "Mental and behavioural disorders," International Statistical Classification of Diseases and Related Health Problems, 10th Revision Version for 2007
  5. "Health Care Needs of Gay Men and Lesbians in the U.S.," American Medical Association Report, 1994
  6. "APA Task Force on Appropriate Therapeutic Responses to Sexual Orientation." (2009). Report of the Task Force on Appropriate Therapeutic Responses to Sexual Orientation. Washington, DC: American Psychological Association.