Aversion therapy has reemerged as a treatment for self-injurious behavior (SIB) but remains unpopular, as it is perceived to be unethical. The purpose of this mixed-methods sequential explanatory study was to investigate the effectiveness of positive therapy and aversion therapy in the treatment of twins with SIB as well as to understand the lived experiences of their caretakers regarding treatment ethics. The frameworks used included classical and operant conditioning as well as utilitarian ethics theory. Quantitative research questions focused on changes in SIB, aggressive and prosocial behaviors with treatment, while the qualitative research question focused on the perceptions of caretakers regarding treatment. The quantitative component used a case study design and archived data from 2 U.S.-based treatment centers. The qualitative component included essay-type questionnaires for family members and caretakers regarding perceptions of the different therapies. The quantitative data that was obtained measured different behaviors that were not comparable. The twin in aversion therapy demonstrated aggressive behaviors that decreased with treatment, while the twin in positive therapy demonstrated positive behaviors that showed little to no change. Caretaker and family reports were consistent with the quantitative data, and family members considered aversion therapy ethical because they perceived it to be effective in treating SIBs. They also perceived it as ethically preferable to the use of large amounts of medication. Findings suggest that aversion therapy may be effective and ethical. Implications for positive social include potential continued research on aversion therapy to enhance treatment outcomes for individuals with SIB, and possible changes in public perceptions of aversion therapies.

Le trouble de stress post-traumatique (TSPT) est un trouble de type anxieux se déclenchant généralement suite à une expérience traumatisante. Des structures cérébrales telles que le cortex préfrontal, l’hippocampe ou encore l’amygdale, appartenant au réseau impliqué dans l’apprentissage et les mémoires émotionnelles, sont particulièrement altérées. Ce réseau étant extrêmement bien conservé au cours de l’évolution, la mise en place et le maintien des mémoires aversives peut être étudiés chez le rongeur par un paradigme pavlovien de peur conditionnée. Notre équipe a identifié une forte expression du transporteur vésiculaire du glutamate, VGLUT3 dans l’amygdale basolatérale (BLA). VGLUT3, comme les autres transporteurs vésiculaires du glutamate (VGLUTs), permet l’internalisation du glutamate dans les vésicules synaptiques. Il se distingue des autres VGLUTs par sa distribution et ses fonctions atypiques. Mes travaux de recherche nous ont permis d’identifier les populations neuronales exprimant VGLUT3 dans la BLA, et de définir son rôle dans les processus de mémoires aversives. La caractérisation anatomique a révélé que : 1/ VGLUT3 est uniquement présent dans une sous-population d’interneurones GABAergiques de la BLA, et 2/ VGLUT3 est exprimé dans les terminaisons cholinergiques et sérotoninergiques de la BLA, permettant d’identifier deux populations de neurones de projections possédant VGLUT3. L’étude du rôle fonctionnel de VGLUT3 a été réalisé par l’utilisation d’une approche génétique couplée à une approche virale pour invalider VGLUT3 dans les terminaisons GABAergiques, sérotoninergiques ou bien cholinergiques. Les souris présentant une inactivation constitutive de VGLUT3 montrent une généralisation au contexte et une extinction rapide. L’inactivation spécifique de VGLUT3 dans la BLA ou dans le cerveau antérieur basal – site d’origine des neurones de projections cholinergiques vers la BLA perturbent également les mémoires aversives, soulignant le rôle spécifique de VGLUT3 dans les réponses modulant la peur à travers sa présence dans l’amygdale basolatérale. Ces nouvelles données permettront de mieux comprendre le fonctionnement et le rôle de VGLUT3 dans les mémoires émotionnelles, et d’explorer son éventuelle implication dans des troubles de l’anxiété tel le TSPT. / Post-Traumatic Stress Disorder (PTSD) is an anxiety-like disorder usually triggered by a traumatic experience. Brain structures such as the prefrontal cortex, the hippocampus or the amygdala belonging to the learning and emotional memories network, are particularly affected. As this network is extremely well conserved during evolution, acquisition and consolidation of aversive memories can be studied by a Pavlovian fear conditioning paradigm in rodents. Our team has identified a strong expression of the vesicular glutamate transporter, VGLUT3 in the basolateral amygdala (BLA). VGLUT3 allows, like all vesicular transporters, neurotransmitter internalization, here the glutamate in synaptic vesicles. VGLUT3 is atypical because of its distribution and its functions. The aim of my work is to identify the neuronal population expressing VGLUT3 in the amygdala as well as its role in processing aversive memories. The anatomical characterisation revealed: 1/ VGLUT3 mRNA in BLA GABAergic interneurons, 2/ VGLUT3 protein in cholinergic and serotoninergic terminals in the BLA, identifying two populations of projecting neurons expressing VGLUT3. To decipher the functional role of VGLUT3, we used viral and genetic approaches to ablate VGLUT3 either in GABAergic, serotoninergic or cholinergic terminals. Mice lacking VGLUT3 constitutively show contextual generalization and rapid extinction. Specific inactivation of VGLUT3 in BLA impairs aversive memories, shedding light on a specific role of VGLUT3 in modulating fear responses through its presence in BLA interneurons. These new data will be discussed in the context of PTSD and would open a new direction for the development of therapeutic treatment.

The dynamic adaptation of cognitive control in the face of competition from conflicting response tendencies is one of the hallmarks of flexible human action control. Here, we suggest an alternative framework that places conflicttriggered control adaptation into the broader context of affect regulation. Specifically, we review evidence showing that (a) conflicts are inherently aversive, that (b) aversive stimuli in the absence of conflict also trigger behavioral adjustments, and, finally, that (c) conflict stimuli do trigger processes of affective counter-regulation. Together with recent findings showing that conflict-triggered control adaptation depends on the subjective experience of the conflict, we suggest that it is the subjective aversive conflict experience that originally motivates control adaptations. Such a view offers new perspectives for investigating and understanding intra- and interindividual differences in the regulation of cognitive control by differentiating between the individual sensitivity to experience and the individual ability to utilize the aversive signal.