A therapy that involves face-to-face discussion a between a person with schizophrenia and a virtual avatar representing their hallucinations may help reduce symptoms, a study has found. The trial compared the avatar therapy to a form of supportive counselling. It found that avatar therapy was more effective at reducing hallucinations at 12-week follow-up, and had a large effect size.
The study, published in The Lancet Psychiatry journal, is the first large-scale trial of this type of therapy, and was used in people with schizophrenia who had persistent and distressing auditory hallucinations for more than a year, despite treatment. Around 60-70 per cent of people who have schizophrenia experience auditory hallucinations that are typically insulting and threatening.
“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,” said Tom Craig from King’s College London in the UK. “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,” Craig said.
The study involved 150 patients who had had schizophrenia for about 20 years and heard 3-4 voices on average. Of these, 75 people had the avatar therapy and the other 75 people had a form of supportive counselling designed for this study. They also continued with their usual antipsychotic medication throughout the trial.
The avatar therapy took place over six sessions, with one 50-minute session each week. Before starting treatment, patients worked with the therapist to create a computerised simulation or avatar of the voice they most wanted to influence – including what the voice said, how it sounded, and how it could look. Therapy involved a three-way conversation between the patient, therapist, and avatar, with the therapist speaking as themselves and also voicing the avatar.
In each session, after discussing the targets for that day’s work, patients spent 10-15 minutes speaking face-to-face with the avatar, practising standing up to it, correcting any misconceptions it had about them, and taking control of the
conversation, so that power shifted from the avatar to the patient.
The avatar came to recognise the patient’s strengths and good qualities, and the patient’s greater control and power in the relationship. The sessions were recorded, and an audio recording was given to the patient to take home to listen to when they heard the voices. The supportive counselling ran for the same number and length of sessions.
It encouraged patients to discuss any issues of concern to them and aimed to lessen distress and discuss practical ways of improving their quality of life. At the end of the session, each patient recorded a positive message to listen to during the following week. After 12 weeks, the avatar group’s symptoms were rated as less severe than those who received counselling.
People who had received avatar therapy also found their hallucinations less distressing and less powerful than people in the counselling group. Seven people who had the avatar therapy and two in the counselling group also reported that their hallucinations had completely disappeared after 12 weeks.
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