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." 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.

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." 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).

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" 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).

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	BASIL JAMES, M.B., B.Ch., B.Sc., D.P.M., "CASE OF HOMOSEXUALITY TREATED BY AVERSION THERAPY" British Medical Journal, MARCH 17, 1962, p. 768. This study, published in 1962, reported a on the treatment of a single 40-year-old male.
Miller	1963	4	Howard University	Hypnotic-Aversion	Journal of the National Medical Association	Miller, Michael M. "Hypnotic-Aversion Treatment of Homosexuality," Journal of the National Medical Association. Vol. 55, no. 5 (1963): p. 4II-15, 436. (P. 4II-13, 415.)
Thorpe, Schmidt, Brown, Castell	1964	-	Banstead Hospital	Imaginary aversive therapy	Behavior Research Therapy	J. G. Thorpe, E. Schmidt, P. T. Brown and D. Castell, "Aversion-relief therapy: A new method for general application," Behavior Research and Therapy, Volume 2, Issue 1, May 1964, Pages 71-82
Golda, Neufelda	1964	39	Guy's Hospital	Imaginary aversive therapy	Behavior Research Therapy	Golda and Neufelda, "A learning approach to the treatment of homosexuality," Behavior Research and Therapy, 1964 October 20.
McGuire, Vallance	1965	39	Southern General Hospital	Aversive shock therapy	British Medical Journal	R. J. McGuire and M. Vallance, "Aversion Therapy by Electric Shock: a Simple Technique," British Medical Journal, 1964 January 18; 1(5376): 151–153.
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	M. J. MacCulloch and M. P. Feldman, "Aversion therapy in management of 43 homosexuals.", British Medical Journal 1967 June 3; 2(5552): 594–597. This study was published in 1967, and involved 43 male test subjects.
Bancroft & Marks	1968	-	Institute of Psychiatry and Maudsley Hospital	Electric aversion therapy	Proceedings of the Royal Society of Medicine	Bancroft & Marks, "Electric aversion therapy of sexual deviations.", Proc R Soc Med. 1968 August; 61(8): 796–799
Fookes	1969	27	?	aversion shock therapy	British Journal of Psychiatry	B.H. Fookes, "Some Experiences in the Use of Aversion Therapy in Male Homosexuality, Exhibitionism and Fetishism-Transvestism," The British Journal of Psychiatry (1969) 115: 339-341.
Bancroft	1969	16	?	aversive shock therapy	The British Journal of Psychiatry	JOHN BANCROFT M.B., M.R.C.P., D.P.M. "Aversion Therapy of Homosexuality," The British Journal of Psychiatry (1969) 115: 1417-1431.
McConaghy	1969	40	The University of New South Wales	aversion apomorphine therapy	The British Journal of Psychiatry	N. McConaghy M.D., B.Sc., D.P.M., "Subjective and Penile Plethysmograph Responses Following Aversion-Relief and Apomorphine Aversion Therapy for Homosexual Impulses," The British Journal of Psychiatry (1969) 115: 723-730.
Barlow	1973	-	The University of Mississippi	Variety	Behavior Therapy	Barlow, David H, "Increasing heterosexual responsiveness in the treatment of sexual deviation: A review of the clinical and experimental evidence," Behavior Therapy Volume 4, Issue 5, October 1973, Pages 655-671
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	Segal, Bernard; Sims, Joseph, "Covert sensitization with a homosexual: A controlled replication," Journal of Consulting and Clinical Psychology, Vol 39(2), Oct 1972, 259-263.
Hallam & Rachman	1972	7	King's College, London	aversion shock therapy	Behaviour Research and Therapy	R.S. Hallam and S. Rachman, "Some effects of aversion therapy on patients with sexual disorders," Behaviour Research and Therapy Volume 10, Issue 2, 1972, Pages 171-180.
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	N. McConaghy, D. Proctor, and R. Barr, "Subjective and penile plethysmography responses to aversion therapy for homosexuality: A partial replication", Archives of Sexual Behavior, Volume 2, Number 1, 1972, Pages 65-78. This study used both aversion and positive conditioning toward heterosexuality. A six-month follow-up indicated some success in half the subjects.
Callahan & Leitenberg	1973	23	Carmarillo State Hosp., California	aversion shock therapy	The Journal of Abnormal Psychology	Callahan EJ, Leitenberg H., "Aversion therapy for sexual deviation: contingent shock and covert sensitization.," Journal of Abnormal Psychology, 1973 Feb;81(1):60-73.; "Aversion therapy for sexual deviation: Contingent shock and covert sensitization." This study, published in 1973, involved six test subjects. Follow-up study took place four to eighteen months later. The study was published in 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	N. McConaghy and R. F. Barr, "Classical, Avoidance and Backward Conditioning Treatments of Homosexuality," The British Journal of Psychiatry (1973) 122: 151-162. This study concluded that homosexual feelings decreased for half the subjects, and also that the aversive conditioning worked, but not by setting up conditioned reflexes.
Tanner	1974	16	Center for Behavior Change	aversion shock therapy	Journal of Behavior Therapy and Experimental Psychiatry	Barry A. Tanner, "Aversive shock issues: Physical danger, emotional harm, effectiveness and “dehumanization”," Journal of Behavior Therapy and Experimental Psychiatry Volume 4, Issue 2, June 1973, Pages 113-115 Concluded that aversion therapy was safe.
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	Barry A. Tanner, "Avoidance training with and without booster sessions to modify homosexual behavior in males," Behavior Therapy, Volume 6, Issue 5, October 1975, Pages 649-653.
Freeman & Meyer	1975	9	University of Louisville	Aversion shock therapy	Behavior Therapy	William Freeman, a and Robert G. Meyer, "A behavioral alteration of sexual preferences in the human male," Behavior Therapy Volume 6, Issue 2, March 1975, Pages 206-212.
McConaghy	1976	157	University of New South Wales	Aversion apomorphine therapy	The British Journal of Psychiatry	N McConaghy, "Is a homosexual orientation irreversible?", The British Journal of Psychiatry 129: 556-563 (1976)
James	1978	40	Hollymoor Hospital, England	Anticipatory avoidance, desensitization, hypnosis, anticipatory avoidance	Behavior Therapy	Sheelah James, "Treatment of homosexuality II. Superiority of desensitization/arousal as compared with anticipatory avoidance conditioning: Results of a controlled trial," Behavior Therapy Volume 9, Issue 1, January 1978, Pages 28-36
McConaghy, Armstrong, & Blaszczynski	1981	20	University of New South Wales	Aversive therapy	Behavior Research and Therapy	McConaghy, N., Armstrong, M. S., & Blaszczynski, A. "Controlled comparison of aversive therapy and covert sensitization in compulsive homosexuality," Behavior Research and Therapy, 19, 1981. 425-434.

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