A new therapy that uses computer-generated avatars has been hailed as potentially “life-changing” for people with psychosis.
The treatment, named AVATAR, helps people with psychosis reduce the distress and frequency with which they hear voices – a key symptom of the condition.
People with schizophrenia commonly experience auditory hallucinations where they hear voices that are not real. These are often distracting or abusive and may include threats or orders to engage in self-harm.
Until now, patients have been treated using antipsychotic medication that decreases the severity of auditory hallucinations, but these cause serious side-effects.
The AVATAR therapy involves a series of guided sessions during which voice hearers are able to have a conversation with an animated digital representation of their distressing voice.
Before the therapy, participants work with a therapist to create a computerised visual representation of the voice they hear.
The session involves a three-way conversation between the voice hearer, therapist and avatar, with the therapist speaking as themselves as well as voicing the avatar using voice conversion software.
Over several sessions, participants learn to stand up to the voice and take control.
The avatar’s likeness and sound is made to match the description provided by the patient.
Philippa Garety, professor emerita of clinical psychology at King’s College London and the study’s lead author, said: “To our knowledge, this is the first therapeutic intervention that has a direct and sustained impact upon the frequency with which people hear voices.
“This is an extremely important finding, as it is a clear priority for voice-hearers, and hearing fewer voices, less often, or voices going away altogether can have a hugely positive impact on their day-to-day lives.
“People who hear voices rarely only hear one. In an interesting development, the extended version of the therapy proved effective at reducing voice frequency in total, despite participants only creating one avatar for one voice.”
Researchers recruited 345 people from four centres linked to the Universities of Glasgow, Manchester, UCL and King’s.
They were randomly assigned to receive either AVATAR Brief (six sessions of therapy), AVATAR Extended (12 sessions of more personalised therapy), or continue with their usual support.
Follow-up interviews were then conducted at the end of therapy (16 weeks), and three months after therapy concluded (28 weeks) to assess the effectiveness of the intervention across several measures, investigating the long-term impact on the related distress, severity and frequency of voices, as well as participant mood and wellbeing.
Researchers found that, at the 16-week follow-up, participants in both the Brief and Extended versions of the therapy showed significant improvements in voice-related distress, voice severity, empowerment, mood and wellbeing compared to those who did not receive the therapy.
Miranda Wolpert, director of mental health at Wellcome, which helped fund the study, said: “It is very exciting to see the emergence of a powerful new digital therapy that could be life-changing for people who hear voices.
“This study builds on more than a decade of pioneering research.
“Avatar therapy has been shown to reduce the distress people experience from auditory hallucinations and the frequency with which they hear them.
“This is a striking example of how mental health science can drive forward cutting-edge treatments, providing new ways to intervene early to help improve and resolve symptoms.”
