Schizophrenia symptoms may be reduced by a new experimental therapy that uses face-to-face discussion between a person with schizophrenia and an avatar representing their auditory hallucination.

More research into the treatment’s effectiveness in other healthcare settings will be needed, so the treatment is not yet widely available.

One of the most common symptoms for people with schizophrenia is auditory hallucinations, usually insulting and threatening. For most, drug treatments reduce these symptoms, but approximately one in four people continue to experience voices.

Avatar Therapy More Effective

The randomised controlled trial compared the avatar therapy, alongside usual treatment, to a form of supportive counselling adapted specifically for the study. It found that avatar therapy was more effective at reducing hallucinations at 12-week follow-up, and had a large effect size.

Cognitive behavioural therapy for psychosis (CBTp) can also be helpful but is a lengthy therapy with at times limited effects on voices.

This is the first large-scale randomized controlled trial of this type of therapy. The therapy was used in people with schizophrenia who had had persistent and distressing auditory hallucinations for more than a year, despite treatment. All participants continued to receive their usual treatment throughout the trial.

Schizophrenia Voices

Lead author Professor Tom Craig from King’s College London, and the South London and Maudsley NHS Foundation Trust, said:

“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.

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 six months for these patients. However, these results come from one treatment centre and more research is needed to optimise the way the treatment is delivered and demonstrate that it is effective in other NHS settings."

The AVATAR project study involved 150 patients who had had schizophrenia for approximately 20 years and heard 3-4 voices on average.

After 12 weeks, the avatar group’s symptoms were rated as less severe than those who received counselling.

“The whole experience changes from something that’s very frightening to something that’s much more in the person’s control,”

Craig said, speaking to AFP.

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.

[caption id=“attachment_93360” align=“aligncenter” width=“680”]Avatar therapy Avatar used in therapy.
Credit: King’s College London, Maudsley Hospital[/caption]

The rapid improvements seen in the avatar treatment group were sustained at 24 weeks. However, during this time, hallucinations continued to become less frequent and less distressing for the counselling group also, likely because counselling could be a potentially useful therapy.

As a result, there were no differences in outcomes between the two groups at 24 weeks. The researchers are now planning a cost-effectiveness analysis, and a further investigation of how the treatment reduces symptoms.

The study was funded by the Wellcome Trust

Tom KJ Craig, Mar Rus-Calafell, Thomas Ward, Julian P Leff, Mark Huckvale, Elizabeth Howarth, Richard Emsley, Philippa A Garety AVATAR therapy for auditory verbal hallucinations in people with psychosis: a single-blind, randomised controlled trial The Lancet Psychiatry, 2017; DOI: 10.1016/S2215-0366(17)30427-3

Top Image: Meg Wills/Flickr

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