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STEP THREE: Arrange to use the methods daily; as with all
aversion techniques, learn better ways of handling the
situation.
To be effective these methods must be repeated over and over,
preferably 5 to 10 times twice a day. Covert reinforcement and
punishment can be used every time the actual behavior occurs or even
starts to occur, as well as during time set aside for imaginary
experience. That's a 100% schedule of reinforcement (or punishment).
If you are using an unpleasant thought, the more disgusting or
upsetting or intensely it is experienced, the more effective the method
seems to be. Therefore, experience the awful details of vomiting as
fully as possible, e.g. imagine the food and bile starting to come up,
notice the sour taste and lumps of decaying food in your mouth, the
sickening, awful smelling puke fills your nose, you vomit all over
yourself and others, see it drip off, you are crying from total
embarrassment, etc., etc. Gross! If you use an accident, make it
gruesome.
It may be helpful to have a hierarchy of unwanted behaviors, so
that you vomit on them (or something equally disgusting) in order
from mildly tempting (addictive) to highly enticing. Likewise, since the
conditioning is very situation-specific, you may have to vomit on each
kind of high-calorie food you crave or on several kinds of hostile,
sarcastic remarks you make.
Therapists have found that our imagery is clearer when we are
relaxed, so try some relaxing first.
Time involved
The planning time is minimal. The two sessions per day will take
15 -30 minutes or so for a few weeks.
Common problems with the method
Dropping out is a problem with any aversive approach. The images
are gross in cognitive sensitization. Also, many people don't believe
there is a strong relationship between fantasy and behavior. Just
because a sexual fetish with bras has been associated hundreds of
times with imagined vomit, it doesn't guarantee that the attraction to
real bras will be extinguished. Remember from chapter 4 that for
conditioning to work, the association between the CS (bra) and UCS
(vomit) must make sense.
Perhaps these methods work because the people who persevere
are "believers." The role of suggestion is unknown in most self-help
methods.
Effectiveness, advantages and dangers
