Quieting the 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.