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Digital avatar therapy improves verbal hallucinations in schizophrenia

Avatar therapy decreased the severity of persistent auditory verbal hallucinations among individuals with schizophrenia or affective disorders and was more effective than supportive counseling alone.

“A large proportion of people with schizophrenia continue to experience distressing voices despite lengthy treatment, so it is important that we look at newer, effective and shorter forms of therapy,” Tom K.J. Craig, PhD, of King’s College London, said in a press release. “Our study provides early evidence that avatar therapy rapidly improves auditory hallucinations for people with schizophrenia, reducing their frequency and how distressing they are, compared to a type of counselling. So far, these improvements appear to last for up to 6 months for these patients. However, these results come from one treatment center and more research is needed to optimize the way the treatment is delivered and demonstrate that it is effective in other NHS settings.”

Avatar therapy involves a dialogue among individuals with auditory verbal hallucinations and a digital representation (avatar) of their presumed persecutor, which is voiced by a therapist “so that the avatar responds by becoming less hostile and concedes power over the course of therapy.”

To assess effects of avatar therapy on auditory verbal hallucinations, researchers conducted a single-blind, randomized controlled trial among individuals diagnosed with schizophrenia spectrum disorders or affective disorder with enduring auditory verbal hallucinations in the past year. Study participants were randomly assigned to receive avatar therapy (n = 75) or supportive counseling (n = 75).

Overall, 83% of the cohort met the primary outcome of reduction in auditory verbal hallucinations at 12 weeks, designated by total score on the Psychotic Symptoms Rating Scales Auditory Hallucinations (PSYRATS-AH).

At 12 weeks, reduction in PSYRATS-AH total score was significantly greater among participants who received avatar therapy, compared with those who received supportive counseling (mean difference = –3.82; 95% CI, –6.7 to –0.94).

Researchers did not find evidence of adverse events associated with either therapy.

In an accompany editorial, Ben Alderson-Day, PhD, of Durham University, United Kingdom, and Nev Jones, PhD, of the University of South Florida, Tampa, discussed the potential impact of the study findings.

“Technology can both obscure and enhance our view of reality, but in the case of AVATAR it seems to provide a powerful method of personifying and externalizing an otherwise internal and often intrusive phenomenon. ... Thinking of voices as entities or agents that can be engaged with — a notion largely ignored or discouraged for many years within mainstream psychiatric thinking — raises a key question: who, or what, is changing in AVATAR therapy?” Alderson-Day and Jones wrote. “An emphasis on equipping the voice-hearer with responses, challenges, and answers of their own implies that the voice hearer is changing, but their voices might not be. ... On the other hand, the voices might change in terms of their content, valence, or power over the voice-hearer.” – by Amanda Oldt

Disclosures: Craig reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.