Temporal contiguity in electric aversion therapy for cigarette smoking

Seventy dependent heavy smokers (32 cigarettes per day) were randomly assigned to one of five treatment and control procedures: (1) electric aversion therapy, involving ten 20-trial sessions of shocks contiguous with the smoking act. (2) simulated electric aversion. with non-contiguous shocks, (3) non-shock smoking sessions, to control for stimulus satiation and negative practice effects. (4) simple support and attention from therapist, (5) no-treatment. Before treatment, simple ‘self-monitoring’ and ‘self-control’ reduced cigarette consumption by an average of 12% (p < 0.001) and 26% (p < 0.001) respectively. Thirty-four of the 56 treated subjects (61%) were able to stop smoking compared with two out of fourteen (14%) of the no-treatment controls (p < 0.005). Treatment was highly effective at reducing and stopping smoking during the 4-week course and for 2 weeks afterwards (p < 0.005). Its effect was rapid, but not immediate. Outcome was virtually decided after 1 week (five sessions); subjects who had not stopped or almost stopped at this stage were most unlikely to respond later on (p < 0.001). All four treatments were equally effective, regular attendance for 15 min of simple support being as effective as the treatments involving additional 45-min sessions with a second therapist. The effects of contiguous vs non-contiguous shocks did not differ. A motor response was conditioned in 19 of the 28 subjects who received shocks but this was therapeutically irrelevant. The clinical outcome depended on the kind of subject rather than the kind of treatment. Those who were depressed, with poor psychiatric adjustment and a high Eysenck-Scale P score tended to do badly, while those who initially expressed high confidence in the outcome were more likely to succeed (p < 0.001). It is concluded that traditional conditioning processes do not contribute significantly to the clinical response of human subjects to electric aversion therapy for cigarette smoking.