Covert sensitization is an imagery-based procedure. The technique consists of having the client imagine himself or herself engaging in an undesirable behavior (e.g., overeating or excessive alcohol consumption). When this image is vivid, the client imagines an aversive consequence associated with the behavior (e.g., feeling nauseous). The purpose of treatment is to build up an aversion toward stimuli which previously served as a source of attraction. The technique is referred to as covert because the procedure is conducted in imagination. The client does not have to engage in the behavior but only imagine behaviors associated with particular consequences. The effects of treatment, however, carry over to actual behavior.
Hayes, Brownell, and Barlow (1978) used covert sensitization to alter sexual deviation of an adult male who was in a psychiatric facility because of his multiple sexual deviations. The client's history included attempted rape, multiple fantasies involving sadistic sexual acts (e.g., forced sexual acts with bound women, use of pins and whips during intercourse), and exhibitionism. He had been arrested both for attempted rape and for exhibitionism.
Treatment consisted of having the client imagine aversive consequences associated with situations in which exhibitionistic and sadistic acts were performed. For example, a typical exhibitionistic scene with aversive consequences was:
"I call her over to the car. She doesn't see what I'm doing. I say 'Can you please help me with this?' She looks down and sees my ..... It's hard and she's really shocked. Her face looks all kinds of distorted. I quick drive away. As I drive away I see her look back. I think 'Oh, shit, she's seen my license plate!' I begin to worry that she might call the police....I get home and I'm still worried. My wife keeps saying 'What's wrong?'...As we all sit down to dinner I hear a knock on the door. I go open it, and there are four pigs. They come charging in and throw me up against the wall and say 'You're under arrest for indecent exposure!' My wife starts to cry and says 'This is it! This is the last straw!'"
After several days of treatment, similar scenes were developed to associate imagined aversive consequences with sadistic acts. Over the course of treatment, sexual arousal was directly measured by the degree of the client's erection (penile blood volume) as the client viewed slides of exhibitionistic, sadistic, and heterosexual scenes. For example, heterosexual slides displayed pictures of nude females and sadistic slides displayed nude females tied or chained down in a number of provocative positions. Also, the client reported his degree of arousal to cards describing various sexual situations.
Both physiological arousal and self-reported attraction
to exhibitionistic and sadistic sexual stimuli decreased as a function
of treatment. On the other hand, arousal to heterosexual stimuli was never
focused upon and did not change. Moreover, these effects were maintained
up to eight weeks after treatment.