Walden University ScholarWorks Walden Dissertations and Doctoral Studies Walden Dissertations and Doctoral Studies Collection 2019 Efficacy, Risks, and Ethics of Aversive or Positive Therapy in Identical Twins Jacqueline Salerno Walden University Follow this and additional works at: https://scholarworks.waldenu.edu/dissertations Part of the Social and Behavioral Sciences Commons This Dissertation is brought to you for free and open access by the Walden Dissertations and Doctoral Studies Collection at ScholarWorks. It has been accepted for inclusion in Walden Dissertations and Doctoral Studies by an authorized administrator of ScholarWorks. For more information, please contact [email protected]. Walden University College of Social and Behavioral Sciences This is to certify that the doctoral dissertation by Jacqueline Salerno has been found to be complete and satisfactory in all respects, and that any and all revisions required by the review committee have been made. Review Committee Dr. Lisa Scharff, Committee Chairperson, Psychology Faculty Dr. Christos Constantinidis, Committee Member, Psychology Faculty Dr. Anne Morris, University Reviewer, Psychology Faculty Chief Academic Officer Eric Riedel, Ph.D. Walden University 2019 Abstract Efficacy, Risks, and Ethics of Aversive or Positive Therapy in Identical Twins by Jacqueline Salerno MA, Long Island University, 1999 BS, Mercy College, 1997 Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy Clinical Psychology Walden University May 2019 Abstract Aversion therapy has reemerged as a treatment for self-injurious behavior (SIB) but remains unpopular, as it is perceived to be unethical. The purpose of this mixed-methods sequential explanatory study was to investigate the effectiveness of positive therapy and aversion therapy in the treatment of twins with SIB as well as to understand the lived experiences of their caretakers regarding treatment ethics. The frameworks used included classical and operant conditioning as well as utilitarian ethics theory. Quantitative research questions focused on changes in SIB, aggressive and prosocial behaviors with treatment, while the qualitative research question focused on the perceptions of caretakers regarding treatment. The quantitative component used a case study design and archived data from 2 U.S.-based treatment centers. The qualitative component included essay-type questionnaires for family members and caretakers regarding perceptions of the different therapies. The quantitative data that was obtained measured different behaviors that were not comparable. The twin in aversion therapy demonstrated aggressive behaviors that decreased with treatment, while the twin in positive therapy demonstrated positive behaviors that showed little to no change. Caretaker and family reports were consistent with the quantitative data, and family members considered aversion therapy ethical because they perceived it to be effective in treating SIBs. They also perceived it as ethically preferable to the use of large amounts of medication. Findings suggest that aversion therapy may be effective and ethical. Implications for positive social include potential continued research on aversion therapy to enhance treatment outcomes for individuals with SIB, and possible changes in public perceptions of aversion therapies. Efficacy, Risks, and Ethics of Aversive or Positive Therapy in Identical Twins by Jacqueline Salerno MA, Long Island University, 1999 BS, Mercy College, 1993 Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy Clinical Psychology Walden University May 2019 Table of Contents List of Tables ..................................................................................................................... iv List of Figures ......................................................................................................................v Chapter 1: Introduction to the Study ....................................................................................1 Background ....................................................................................................................2 Classic Aversion Therapy ....................................................................................... 2 Contemporary Aversion Therapy ........................................................................... 3 Self-Injurious Behavior ........................................................................................... 8 Problem Statement .......................................................................................................13 Purpose of the Study ....................................................................................................15 Research Questions ......................................................................................................15 Quantitative Study ................................................................................................ 16 Qualitative Study .................................................................................................. 17 Theoretical Framework ................................................................................................17 Nature of the Study ......................................................................................................20 Definition of Terms and Abbreviations .......................................................................22 Assumptions .................................................................................................................30 Scope and Delimitations ..............................................................................................30 Limitations ...................................................................................................................31 Significance..................................................................................................................31 Summary ......................................................................................................................34 Chapter 2: Literature Review .............................................................................................35 i Literature Search Strategy............................................................................................37 Theoretical Framework ................................................................................................37 Theoretical Basis for Aversion Therapy ............................................................... 37 Aversion Therapy as Classical Conditioning ........................................................ 38 Aversion Therapy as Operant Conditioning or Punishment ................................. 39 Psychology and Neurobiology of Aversive States................................................ 43 Aversion Therapy, Clinical Practice, and Research .............................................. 49 Literature Review Related to Key Variables and/or Concepts ....................................65 Self-Injurious Behavior and Its Treatment ........................................................... 65 Treatment of Self-Injurious Behavior: Methods Other Than Aversion ................ 72 Reflections on the Aversion Therapy Literature ................................................... 97 Ethical Issues Related to the Use of Aversion Therapy ...................................... 102 Summary ....................................................................................................................109 Chapter 3: Research Method ............................................................................................116 Research Design and Rationale .................................................................................117 Role of the Researcher ...............................................................................................119 Methodology ..............................................................................................................121 Participant Selection Logic ................................................................................. 121 Procedures for Recruitment, Participation, and Data Collection ........................ 121 Data Analysis Plan .............................................................................................. 125 Issues of Trustworthiness ...........................................................................................130 Ethical Procedures .............................................................................................. 132 ii Summary ....................................................................................................................134 Chapter 4: Results ............................................................................................................135 Participants .................................................................................................................136 Quantitative Data Collection and Analysis ................................................................136 Qualitative Data Collection and Analysis ..................................................................139 Results ........................................................................................................................141 Quantitative Component – Data for M (Aversion Therapy) ............................... 141 Quantitative Component – Data