Covert sensitization: what is it and how is it used in therapy?

This therapeutic technique associated with the cognitive-behavioral paradigm is mainly used in addictions.

Covert conditioning consists of a type of conditioning in imagination, developed by Cautela. It is based on the fact that cognitive activity follows the same laws as observable responses, the only difference being the degree of accessibility.

In this article we will learn about covert sensitizationa technique typical of this type of conditioning, where the objective is to develop an aversive response to a stimulus that was previously a source of attraction.

Covert sensitization: characteristics

Covert sensitization is a type of technique characteristic of covert conditioning. It is an intervention strategy belonging to the behavioral and cognitive models, and consists in imagined repetitions of the problem-behavior paired with aversive symbolic events..

The aim of covert sensitization is to provoke in the patient some degree of inhibition in potentially harmful behaviors that the patient does not want, such as smoking, drinking alcohol, sexual deviance such as pedophilia or compulsive eating.

Thus, covert sensitization is analogous to positive punishment, in that it it aims to decrease the probability of occurrence of the behavior by presenting a stimulus to the patient.It is indicated to reduce the probability of occurrence of the behavior by presenting an imagined aversive stimulus immediately after the occurrence (also imagined) of the behavior we wish to eliminate. That is to say, it is indicated to modify maladaptive or dysfunctional behaviors.

How does it work?

It is a procedure that would consist of the "opposite" of Systematic Desensitization (SD), that is, it would act in reverse, since what it tries precisely is that the person experiences a certain degree of anxiety or discomfort (vs. the relaxation of SD) in the face of unwanted or pathological behaviors, so that the occurrence of these behaviors is inhibited.

But how does the technique work concretely? Covert sensitization is aimed at altering the symbolic representations or mediators of the undesired activity or behaviorTherefore, its effectiveness depends on the behavior possessing such symbolic representations; that is, it is important that we are not dealing with an automatic behavior.

Thus, the individual imagines himself/herself performing the behavior whose frequency he/she intends to reduce, going on to imagine, contingently and abruptly, some aversive event that this behavior could produce, or an event that, although unlikely, is very aversive for the subject.

Components

If we break down the term, we find that sensitization, as the name itself indicates, involves becoming sensitized to certain stimuli or situations (i.e., that end up generating aversion), and covert means that the technique is developed in the patient's imagination, which implies that the patient will have to imagine "X" scenes or situations linked to an unpleasant, disgusting, embarrassing, aversive, etc. sensation.

Aversive stimulus

It is important to choose aversive stimuli correctly, and that they are really aversive for the subject. You can even ask the subject directly about situations or images that are unpleasant to them.

Maciá and Méndez described 3 particularly repulsive scenes:

• The mouth of an old man expectorating.
• A dead animal in an advanced state of decomposition.
• An infected wound.

On the other hand, another author, Costa, in a change of sexual tendency, used a homosexual person who was discovered with another by the girl he was attracted to. Leitenberg, on the other hand, believes that for problems of paedophilia, one should choose the image that is most effective for the client..

Cautela uses as an aversive stimulus the sensation of vomiting adorned with all sensory modalities, and Mckay proposes a list of repulsive and frightening thoughts.

Applications

Covert sensitization is used especially in the field of addictions.The aim is for the patient to acquire a good degree of self-control in the face of environments, conditioning factors or people that could lead to a relapse.

For example, a patient suffering from alcoholism and following a covert sensitization procedure is induced to imagine situations where there are people drinking followed by others that he experiences as aversive, disgusting, degrading or embarrassing.

If this is applied consistently and systematically (together with other psychological techniques if required for treatment), it may be possible to weaken his craving for alcohol in contexts similar to those he has imagined.

Variants

Covert sensitization has two variants:

1. Assisted covert sensitization.

In this case, aversion to the stimulus is strengthened by means of the use of an electric shock or of an unpleasant odorous substance. That is, some type of actual stimulation is applied.

2. Vicarious covert sensitization

Here the subject imagines another person performing the behavior and receiving the punishment or aversive stimulus for it. receiving the punishment or aversive stimulus for it..

Disadvantages

The problem with covert sensitization (as well as with other aversive techniques) is the hostility, rejection, aggressiveness or lack of cooperation that the patient may show.. Therefore, it will always be necessary to reinforce the adaptive aspects of the behavior that we want to increase.