AVATAR therapy could help those who hear voices

Embargoed until: Publicly released: 2024-10-29 03:00

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Natalie, a Patient and Public Involvement (PPI) Consultant who received AVATAR therapy, spoke face-to-face with the avatar in each session, practicing standing up to it. The therapist spoke with Natalie remotely, talking as themselves as well as voicing the avatar using voice conversion software. This image is intended for illustrative purposes only and does not depict an actual therapy session. Credit: Chris Ratcliffe. Commissioned by Wellcome.

People with psychosis who hear distressing voices could benefit from AVATAR therapy – a therapy which allows people to engage with a digital embodiment of the voice – according to international researchers. The team recruited 345 participants to test the efficacy of two forms of AVATAR therapy alongside usual treatment for people with psychosis who hear distressing voices. The brief version of the therapy, which allowed patients to confront the avatar, was associated with slight improvements in distress and voice severity levels, but not quite enough to be considered clinically significant. The extended version, which involved a more personalised series of dialogues based on the person’s life history, was associated with clinically significant improvements in voice-related distress and voice severity after 16 weeks, but not 28 weeks. They were also found to have reductions in voice frequency at both 16 and 28 weeks, compared to those only receiving usual treatment.

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From: Springer Nature

Mental health: Digital avatar may improve well-being for those hearing voices

A novel intervention known as AVATAR therapy that enables people with psychosis who hear distressing voices to engage with a digital embodiment of the voice they hear may lead to short-term improvements in voice-related distress. The findings, which are based on a randomised controlled trial of 345 participants, are published in Nature Medicine.

Although hearing distressing voices is a symptom of psychosis that can impair a person’s quality of life, conventional treatments such as medication and cognitive behavioural therapy are not always effective.

Philippa Garety and colleagues tested the efficacy of two forms of AVATAR therapy delivered alongside treatment as usual for adults in the UK with psychosis who hear distressing voices. Participants receiving AVATAR therapy were assigned to either a brief version (AVATAR-Brief) during which they confronted the avatar to boost assertiveness and self-esteem, or an extended version (AVATAR-Extended), which involved a more personalised series of dialogues based on the participants’ life history. Bespoke software enabled participants to customize how the avatar looked and sounded.

The authors found that patients who received the AVATAR-Extended therapy reported clinically significant improvements in voice-related distress and voice severity levels after 16 weeks, but not 28 weeks, and reductions in voice frequency at both 16 weeks and 28 weeks, compared with those receiving only treatment as usual. AVATAR-Brief was also associated with improvements in distress and voice severity levels, but these were just below the pre-specified level of clinical significance. Those receiving AVATAR-Brief therapy had a higher completion rate (82%) than that of those receiving AVATAR-Extended (58%). Both forms of AVATAR therapy were associated with improvements in mood and anxiety at 16 weeks and sustained improvements in wellbeing and recovery. Overall, AVATAR-Extended showed a wider range of positive effects and these tended to be stronger and longer lasting.

The findings suggest that AVATAR therapy in combination with standard treatment may lead to improvements in voice-related symptoms among those with psychosis who hear distressing voices.

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Journal/
conference: Nature Medicine

Research:Paper

Organisation/s: King’s College London, UK

Funder: This research was funded by a Wellcome grant no. 215471/Z/19/Z. The study was supported by the National Institute for Health and Care Research (NIHR), the Wellcome Trust King’s Clinical Research Facility, the NIHR Maudsley Biomedical Research Centre and Maudsley NHS Foundation Trust, King’s College London (P.A.G. and R.E., no. NIHR203318) and the Manchester Biomedical Research Centre (S.B. and G.H., no. NIHR203308). S.B. discloses support for publication of this work from the NIHR research professorship (no. NIHR300794). R.E. discloses support for publication of this work from the NIHR research professorship (no. NIHR300051). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. This study was supported by NHS Research Scotland through the Chief Scientist Office and the NHS Scotland Mental Health Network (A.G. and H.J.M., no. NRSMHN/2021/01). M.R.-C. discloses support for the publication of this work from the Sofja Kovalevskaja Award from the Alexander von Humbold Foundation and the Ministry of Education and Research in Germany (SKP2020RusCalafell). The funding bodies did not have any role in study design, data collection and analysis, data interpretation or writing of the manuscript.

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