Covert Sensitization

Covert sensitization is a form of behavior therapy in which clients are taught to associate an imagined aversive or negative stimulus with a behavior that they wish to eliminate or reduce. Together with overt sensitization, covert sensitization is considered a form of aversion therapy. Covert sensitization is also called verbal aversion therapy or aversion imagery.

Covert sensitization is a form of aversion therapy that was developed in the 1960s, most notably by Joseph Cautela (1927–2009), a psychologist in the Boston area, as an ethical replacement for the form of aversion therapy that was then widely practiced, overt sensitization. Overt sensitization was used primarily to treat substance abuse disorders, paraphilias, juvenile delinquency, compulsive gambling, and similar maladaptive behaviors. In overt sensitization, clients were given a stimulus related to their problem behavior at the same time as unpleasant external consequence, most often an electric shock or nauseating drug. For example, a pedophile might be shown a picture of an attractive child and given a simultaneous electric shock so that he would learn to associate sexual desire for children with physical pain. The most familiar form of overt sensitization, still used as of 2015, was disulfiram (Antabuse), a medication given to alcoholics that cause many of the painful effects of a hangover if the client drinks an alcoholic beverage while taking disulfiram.

In contrast to overt sensitization, covert sensitization makes use of the client's thought processes and mental imagery rather than an external consequence to change the client's undesirable behavior. The word covert in the term covert sensitization refers to the location of the stimulus and the consequence in the client's mind rather than in the external world. For example, a therapist using covert sensitization with a pedophile would instruct the pedophile to imagine himself approaching an attractive child and then imagine a painful or frightening scenario—such as a neighbor seeing the client approach the child and calling the police, and the police then arresting the client. As therapy proceeds, the therapist will instruct the client to make his aversive scenario even more detailed and frightening—perhaps losing his job, being divorced by his wife, or being sent to prison after a humiliating public trial. The scenario must be sufficiently vivid in the client's mind to elicit a clear physiological response and the accompanying emotional anxiety in order to be effective. The client is then asked to imagine himself leaving the painful situation and experiencing the corresponding sensations of relief.


Aversion therapy—
A type of behavior therapy in which an unpleasant or disgusting stimulus is associated with an undesirable behavior in order to eliminate or reduce the behavior. The English word aversion is derived from a Latin verb that means “to turn away from.”
Referring to principles of right and wrong; also, being in line with the standards of right conduct that govern the practice of a profession.
Insight-oriented therapy—
A form of therapy based on the premise that clients need to gain understanding of or insight into their motivations in order to improve control over thoughts, feelings, and behavior. Psychoanalysis and psychodynamic psychotherapy are two forms of insight-oriented therapy.
Overt sensitization—
The older and harsher form of aversion therapy, in which the patient is exposed to a stimulus at the same time as an unpleasant external consequence, most often an electric shock or a drug that induces nausea.
A general term for intense sexual urges toward atypical or inappropriate objects, situations, or persons. Although the number of behaviors considered paraphilias varies somewhat among psychotherapists, most would include sexual behavior that involves the infliction or acceptance of physical suffering or that involves children, nonconsenting adults, corpses, animals, or inanimate objects.
In psychology, the process of building up a client's avoidance of an aversive stimulus.
In psychology, any external or internal event, situation, or agent that elicits a response from a human or animal.

Covert sensitization has several advantages in practice. It does not require the long-term relationship between therapist and client necessary for insight-oriented therapy. It is considered more ethical than overt sensitization because it does not involve external painful consequences. It can also easily be tailored to the specific client. As the therapist comes to know the client over the course of the first few sessions, the therapist can help the client devise an aversive scenario with details drawn from the client's actual living situation, occupation, outside interests, and the like. Third, covert sensitization is reported to be an effective short-term form of therapy. Although the duration of therapy varies according to the nature or the severity of the behavior to be changed, treatment usually requires between 5 and 20 sessions spaced over a period of a few weeks to several months. The client can also return to the therapist for periodic refresher sessions.

Covert sensitization is practiced more as one technique among others within the general field of behavior therapy than as a clearly defined form of therapy in its own right. One of its drawbacks in terms of research is that it is a difficult form of treatment to evaluate in controlled experiments. Much of the literature about covert sensitization consists of case studies of individuals, and the therapists reported varying degrees of success. Joseph Cautela and his colleague Albert Kearney, the founding practitioners of covert sensitization, were most active in the 1960s through the 1990s. It is telling that the most recent journal article in the National Library of Medicine's database that refers explicitly to covert sensitization was published in 2002 and describes it as a cognitive-behavioral technique.

See also Alcoholism; Aversion therapy; Behavior modification ; Behavior therapy ; Paraphilia .



Barlow, David H. Clinical Handbook of Psychological Disorders: A Step-by-step Treatment Manual, 5th ed. New York: Guilford Press, 2014.

Cautela, Joseph R., and Albert J. Kearney. Covert Conditioning Casebook. Pacific Grove, CA: Brooks/Cole, 1993.

Wedding, Danny, and Raymond J. Corsini, eds. Case Studies in Psychotherapy, 6th ed. Belmont, CABrooks/Cole, Cengage Learning, 2011.


Kearney, Albert J. “A Primer of Covert Sensitization.” Cognitive and Behavioral Practice 13 (May 2006): 167–75.

Krueger, R. B., and R. S. Kaplan. “Behavioral and Psychopharmacological Treatment of the Paraphilic and Hypersexual Disorders.” Journal of Psychiatric Practice 8 (January 2002): 21–32.

Moergen, S. A., W. T. Merkel, and S. Brown. “The Use of Covert Sensitization and Social Skills Training in the Treatment of an Obscene Telephone Caller.” Journal of Behavior Therapy and Experimental Psychiatry 21 (December 1990): 269–275.


Brannon, Guy E. “Paraphilic Disorders.” Medscape Reference. (accessed August 16, 2015).

“Covert Sensitization in Alcohol Rehab.” (accessed August 16, 2015).

Mikulas, William. “Chapter Six: Aversive Counterconditioning.” (accessed August 16, 2015). (accessed August 16, 2015).


Association for Behavioral and Cognitive Therapies, 305 7th Ave., 16th Fl., New York, NY, 10001, (212) 647-1890, Fax: (212) 647-1865, .

Association for the Treatment of Sexual Abusers (ATSA), 4900 SW Griffith Dr., Ste. 274, Beaverton, OR, 97005, (503) 643-1023, Fax: (503) 643-5084,, .