Putting a face to the voice in your head: New therapy for people with auditory hallucinations

What if patients put a face to the voice in their head? A new therapy where people with psychosis engage with an avatar of the voice in their head has shown benefits. The current treatment for people who hear distressing voices is medication and cognitive behavioural therapy, but it’s not always effective.The new therapy, called AVATAR, aims to reduce the distress caused by the voices. Participants work with therapists to create an avatar that looks and sounds like the voice. They learn how to confront the avatar, which aims to boost confidence and self-esteem.Researchers from the U.K. carried out a trial testing a brief and extended version of AVATAR therapy. The extended version was 12 sessions instead of six sessions in the brief version. It was also more personalized with a series of dialogues based on the participants’ history.A total of 345 participants were equally randomized to engage in one of three treatments: brief version of AVATAR, extended version of AVATAR, or usual treatment. The participants were from four different centres in the U.K.After 16 weeks, the groups receiving extended AVATAR therapy had significantly lower levels of distress, as measured by the psychotic symptom rating scale for auditory hallucinations, and voice severity compared to those getting usual treatment. Three months after the end of the treatment the improvement was maintained but it was no longer significantly different from the usual treatment group. Participants in the brief version of AVATAR also had benefits, but they were slightly below the level of clinical significance compared to usual therapy. Both AVATAR groups showed improvements in mood and anxiety measures.Read: How to counsel about weight gain and metabolic adverse effects with atypical antipsychoticsThose in the extended version of the AVATAR group reported additional benefits, such as improvements in wellbeing (as measured by WEMWBS), voice acceptance, empowerment, personal recovery and voice frequency.More participants (82%) in the brief version of AVATAR group completed treatment compared to those in the extended version (58%). The researchers note this difference may be due to "the increased direct trauma-focused work within sessions and suggests the need for improved treatment engagement, adherence and, consequently, efficacy, based on learning from the current trial."A recent National Institute for Health and Care Excellence (NICE) assessment of digital therapies for psychosis recommended that the National Health Service adopt AVATAR therapy. The researchers plan to publish cost-effectiveness and reports of patient and therapist experiences with the therapy.“The beauty of the therapy is its simplicity and brevity. Most other psychological therapies for these conditions are costly and take many months to deliver,” said co-senior author Dr. Thomas Craig in a King’s College London press release prior to the start of the trial. “If we show that this treatment is effective, we expect it could be widely available in the U.K. within just a couple of years as the basic technology is well developed and many mental health professionals already have the basic therapy skills that are needed to deliver it.” Dr. Craig is an emeritus professor of social psychiatry at King’s College London.The trial results were published in Nature Medicine. The NICE report was published in March 2024. Read: Could MRI findings help diagnose and tailor treatment for people with schizophrenia?This video further explains the findings from the trial:Video credit: King’s College London. Produced by Carse & Waterman. Supported by Vanessa Pinfold (The McPin Foundation) with input from AVATAR2 Patient and Public Involvement (PPI) consultants. Copyright holder: ioppn-pr@kcl.ac.uk

Putting a face to the voice in your head: New therapy for people with auditory hallucinations

Register for free access or login.

Related Topics