How to Use Aversion Therapy Effectively

Like many hypnotherapy techniques, aversion therapy comes with both strong supporters and equally strong reservations. Understanding where it fits, and where it doesn’t, is an important part of developing your own approach as a therapist.

What is Aversion Therapy?

It is combining an unwanted behaviour (like smoking) with an unpleasant experience. The result is that the client comes to associate the unpleasantness with the behaviour, and that this makes it easier to stop.

Why is Aversion Therapy Controversial?

It seems ethically questionable for a therapist to deliberately upset or scare a client unless there’s strong evidence to prove it’s helping them.

It can feel uncomfortable using an approach that can be misapplied or abused. For example, practitioners historically used aversion in situations we would no longer consider a problem, such as to “treat” or “recondition” homosexuality or gender non-conformity. Called “conversion therapy”, it caused trauma and depression in many patients.

How Does Aversion Therapy Work?

Behavioural psychology tells us that if we do something and the consequences are pleasant, we’ll probably want to do it again. If we do something and the consequences are unpleasant, we’ll probably try to avoid a repeat. Of course, there is a lot more complexity to behaviourism, but I’m sure you get a general idea.

Butler (2015) says that nicotine increases the release of dopamine, a neurotransmitter that makes you feel good. Smokers also associate smoking with specific activities: relaxing, socialising, ‘me time’ and so on, which make it a pleasant experience for them. These create positive associations with smoking which helps make it hard to quit.

(Before you head for the comments box, I appreciate that there are many factors involved. And that the ‘enjoyment’ may only be perceptual. As with behaviourism, space here demands a fairly reductionist argument. And in the end, isn’t it the client’s perception that matters?)

Hypnotherapy and Aversion Techniques

Firstly, I have to admit I couldn’t find any studies comparing hypnotherapy that included aversion and hypnotherapy that didn’t. That’s an idea for someone who fancies doing some research, I suppose. However, there are some studies on aversion therapy in other therapeutic modalities., primarily used with smokers. Studies tend to involve either rapid smoking until the client feels unwell, or pairing smoking with mild electric shocks, nausea or both.

Aversion Therapy Research

In 2004, Hajek and Stead searched the Cochrane Tobacco Addiction Group specialised register for studies that looked at aversive smoking cessation methodologies. Unfortunately, they concluded that there was a “relative absence of small studies with negative results. … Most trials had serious methodological problems likely to lead to spurious positive results” (pp. 3–4). In short, most studies were biased or too poorly designed to be reliable. However, outside of that particular resource, there are a few studies that show more useful results.

• According to Nigel Barber in Psychology Today (2010), “after the Shick-Shadel aversion therapy (Ed: which used a combination of electric shocks and nausea), 52.5 per cent of 327 people were still off tobacco after a year … Other studies of aversion therapy produced more modest results.”
   
• In June 2012 a meta-analysis study published in The American Journal of Medicine (Carol, 2012). It compared smokers attempting to quit without any therapeutic or chemical assistance, and those who used alternative therapies. The quit-smoking therapies improved the success rate by factors of:
  • Acupuncture 3.53
  • Hypnotherapy 4.26
  • Aversion therapy 4.55

The researchers didn’t record the use of aversion techniques combined with hypnotherapy. However, the findings do lend some credibility to the idea that this approach can help our clients.

How Effective is Aversion Therapy?

I’ve always felt that, if you are going to use aversion based hypnotherapy, you really have to go for it. Don’t pussyfoot around but make it as strong as you can. This is based on my feeling that smokers especially must be pretty good at ignoring negative messages. They’re on every pack and most of the TV ads. I am gratified to say that I found some evidence to support this.

• Research found an efficacy figure of 14% for rapid smoking and 7% for “milder versions of aversion smoking”. (Hajek and Stead, 2004, p 6). The difference is big enough that it probably does indicate that stronger methods have more effect.
   
• Dinh-Williams et al. (2014) looked at MRI scans of smokers’ brains while they viewed aversive images about smoking, aversive images about other topics, and images designed to trigger the urge to smoke. They found that their brains were less stimulated by the aversive smoking images than by the other two types.

Aversion Hypnotherapy

Hajek and Stead seem to support my theory that you are better using strong aversive stimuli than milder ones. The Dinh-Williams study offers one explanation of why this might be. Smokers react less to smoking-related aversion than to other kinds of aversion or the triggers that encourage them to smoke. It makes sense that it would also be easier to ignore milder forms of aversion therapy than stronger ones.

As hypnotherapists, we, therefore, need to consider our aversion approach carefully.

• Aversion therapy seeks to create negative associations which are more powerful than any positive ones clients already have with their unwanted habit.
• Strong aversion is probably more effective than milder forms for smokers because they are insensitive to negative messages about smoking.
• Combine it with other, non-aversive ways of dissociating smoking from pleasure. This may avoid the barriers which protect smokers from taking in negative information about smoking.

Aversion Therapy Techniques

• Milder options tend to be based around choice metaphors like Fork in the Road, which compare the future if the habit continues with the future if it is discarded.
• A stronger option would be physical revulsion brought about by associating the habit with something the client finds disgusting. An example is imagining a cigarette tastes or smells like faeces.
• Some hypnotherapy scripts contain a “deathbed scene”. The client is asked to imagine seeing or experiencing their own death, caused by their habit. Some versions also introduce the effect on their families. This often brings about abreaction, and is perhaps one of the stronger methods available to hypnotherapists.
• Personal trigger points and those related to the client’s reasons for stopping their habit are possibly the most effective approach. For example, my tutor in hypnotherapy used to ask fathers to imagine telling their young daughters that “I won’t be here to walk you down the aisle because I love the cigarettes more”.

Aversion Therapy Strengths and Weaknesses

Strengths

• When used ethically, it often leads to rapid results, by causing the client to avoid their unwanted or unhealthy habit.
• In the short term at least, it tends to reduce cravings in cases for smokers and alcohol drinkers who wish to reduce or stop their habits.
• The benefits gained arguably offset any short term discomfort when people stop self destructive habits such as smoking or drinking to excess.
• It is very targeted to the sights, sounds, smells, or other stimuli that act as triggers to the unwanted behaviour.
• It can be effective when other methods have failed.
• It combines well with many different therapy modalities.

Weaknesses

• The 2004 Hajek and Stead research, and the study by Dinh-Williams et al (2014) indicate that aversion for smokers in particular works best when it is vivid and strong. Not all therapists want to expose their clients (or themselves) to high levels of distress.
• The historical abuse associated with the technique, and the potential for psychological or physical harm to the client.
• Ethical issues around client consent, autonomy and choice.
• It does not address the root cause of why people continue to use maladaptive habits.
• The research around the long term effects is uncertain.

Conclusion

So, will I be changing my policy and using strong aversion for everyone?

I have to say it, no. I don’t think there is any technique which suits literally every client. Each session should be geared to the client you are working with. This should include as many elements of their lives as possible: their hopes and dreams as well as their fears. But I now have some facts on which to base what was, before, only an intuitive decision.

Some therapists use aversion techniques regularly, others prefer different approaches altogether. I use it now and then, especially with clients who tell me that scaring them out of smoking is the only thing that will work (yes, that happens). Or if their motivation is not very strong, or other approaches have been tried and failed. But, as with most things in therapy, there’s rarely just one right answer.

The important thing is understanding the range of options available, and choosing the methods that best fit both your client and your own way of working.

References:

Butler, Alia. (2015) ‘Aversion Therapy and Smoking’. Livestrong.com http://www.livestrong.com/article/131926-aversion-therapy-smoking, [accessed Mar 2026]
Hajek, P. and Stead, L.F. (2004). Aversive smoking for smoking cessation. The Cochrane database of systematic reviews, [online] (3), p.CD000546. doi:https://doi.org/10.1002/14651858.CD000546.pub2. [accessed Mar 2026]‌
Barber, Nigel (2010) ‘Smoking: Most effective quitting technique little known.’ Psychology Today Blog https://www.psychologytoday.com/blog/the-human-beast/201002/smoking-most-effective-quitting-technique-little-known, [accessed Mar 2026]
Carol (2012). Alternative Acupuncture & Hypnosis Can Help You Quit Smoking. [online] Addiction Rehab Now. Available at: https://web.archive.org/web/20230319052834/http://addictionrehabnow.com/acupuncture-hypnosis-helps-quitting/ [Accessed Mar. 2026].
Dinh-Williams Laurence, Mendrek, Adrianna, Bourque, Josiane, & Potvin, Stéphane (2014) “Where there’s smoke, there’s fire: The brain reactivity of chronic smokers when exposed to the negative value of smoking.” Progress in Neuro-Psychopharmacology and Biological Psychiatry Volume 50, 3 April 2014, Pages 66–73 http://www.sciencedirect.com/science/article/pii/S0278584613002881 [accessed Mar 2026]

Disclaimer
The information and ideas shared on this blog are based on the author’s professional experience, research, and training. They are intended for educational purposes and to support reflection and professional development. Therapists should always apply their own professional judgment and consider the needs of individual clients when using any techniques or suggestions discussed here.
While every effort is made to ensure the information is accurate and helpful, no responsibility can be accepted for any loss, damage, or difficulties arising from the use or misuse of material contained in these articles.