CAFETY takes the position that because of the existence of behavioral therapies that are in most cases more effective than ABI’s and in no case less effective than ABI’s, (such as cognitive-behavioral therapy and positive behavioral therapy) without creating an atmosphere of fear in a therapeutic environment, the use of aversive behavioral interventions should be eliminated from every school, residential center, and hospital in the State of New York and throughout the United States.
Aversive behavioral interventions (ABIs) are any form of therapy that is designed to work though “application of noxious, painful, intrusive stimuli or activities intended to induce pain” or discomfort (Cort 2006).
The link to the New York State report that defined such interventions can be found at the following webpage:
http://www.regents.nysed.gov/2006Meetings/June2006/ 0606emscvesida1.htm
Aversive behavioral interventions are modeled after Ivan Pavlov and B.F. Skinner’s work on classical and operant conditioning. The theory is that if you apply a negative response to an undesired behavior, then eventually that undesired behavior will cease. In this case the undesired behavior is the stimulus and the intervention is the response. Eventually, the subject becomes so attuned to the negative response that they anticipate the response, and preemptively stop themselves from conducting the undesired behavior. It is at this point that the aversive interventions can cease since the subject has been effectively conditioned.However, research has shown that once the threat of the negative response has been removed, the subject usually reverts back to his or her original undesired behaviors. The conditioning is only temporary.
While the term “aversive behavioral intervention”, is a term specific to the New York State Education Department, their definition encompasses a wide array of “therapies” widely being used at schools, hospitals, and residential treatment centers throughout the country.
There is no research available that documents the long-term success of aversive behavioral interventions. Advocates for such interventions claim that they can be successful in treating self-injurious or aggressive behaviors. We agree that there is anecdotal evidence to suggest that self-injurious behavior stops in the short-term with the application of ABI’s. But to what end? When dealing with the self-injurious student, is the solution to continue the administration of ABI’s for the rest of their life?
Where ABI’s have been effective in the short-term two long-term effects have been noted anecdotally; extinction defined as the eventual ineffectiveness of the conditioning, and institutionalization, defined as the continuing need of the institution to function. Institutionalization could mean anything from the continual reliance on the ABI or the need to be a part of the institution in some way such as an employee.
So far in our argument we have offered the concession that ABI’s may be acceptable if they are used clinically as they have designed to be used, in a manner as safely and humanely as possible and with the consent of the client after full disclosure of the nature of the procedures. However, the reality is that the people who usually administer these interventions are not clinicians, but staff and day workers usually with not much more than a high school diploma. The use of these interventions is often inconsistent and punitive rather than anything approaching therapeutic.
Because these interventions create an atmosphere of fear, anxiety, and loss of control there is the potential for residual trauma from what is supposed to be a therapeutic setting, especially when the student has no choice but to be there.
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