The acceptability of electric shock programs.

The authors asked professionals how acceptable electric shock is as a treatment. They used a short survey that described different problem behaviors. The survey also said whether the behavior happened often and if gentler treatments had already failed.

Respondents were not parents or students; they were working clinicians. The goal was to see which factors make shock look more or less okay in their eyes.

Shock moved up the acceptability scale only when three things lined up: the behavior was severe, it happened a lot, and other interventions had failed. Without that mix, professionals still rated it as one of the least acceptable choices.

Kazdin (1980) built the first acceptability scale and found shock dead last for lay raters. Tallant et al. (1989) later showed the same bottom ranking among professionals, but added the nuance that severity, frequency, and prior failure can shift the number upward.

Roberts et al. (1987) asked parents the same type of questions and again found reinforcement-based tactics on top and punishment near the bottom. The pattern holds across parents, students, and clinicians; the 1989 paper simply clarifies when clinicians might say yes.

Mansell et al. (2002) tested whether age or severity changes acceptability for trichotillomania treatments and saw no effect. Tallant et al. (1989) did find an effect, but only for the extreme case of severe, high-rate, treatment-resistant behavior—showing that severity matters only at the far end of the continuum.

If you ever consider aversive procedures, you now know the three talking points that make colleagues more likely to agree: document the behavior as severe, show it occurs at high frequency, and provide data that gentler methods failed. Bring those three pieces to the treatment team or ethics board and the discussion moves from "never" to "maybe, with safeguards."