A novel treatment using computer-generated avatars, developed by UCL researchers, is an effective way of helping people with psychosis who hear distressing voices, according to a new study.
AVATAR therapy is a series of guided therapy sessions during which voice hearers are able to have a conversation with an animated digital representation of their distressing voice. The research, published in Nature Medicine and led by King’s College London researchers, found that AVATAR therapy is an effective means of helping participants to feel less distressed by the voice and more empowered in daily life.
Before the therapy, participants work with a therapist to create a computerised visual representation of the voice that they hear (the avatar). Therapy involves a three-way conversation between the voice hearer, therapist and avatar, with the therapist speaking as themselves as well as voicing the avatar using voice conversion software. Over several sessions, participants learn to stand up to the voice and take control.
The therapy was first created by the late Professor Julian Leff at UCL, and the voice conversion system was built by Emeritus Professor Mark Huckvale (UCL Psychology & Language Sciences). Professor Huckvale said:
“The results of this trial confirm the value of AVATAR therapy for the reduction in the frequency and the distress of persecutory voices in psychosis, and open the door to providing the therapy within clinical practice.”
The researchers recruited 345 participants from eight clinical settings in four centres linked to the Universities of Glasgow, Manchester, UCL and King’s. They were randomly assigned to receive either AVATAR Brief (six sessions of therapy), AVATAR Extended (12 sessions of more personalised therapy), or continue with their usual support. The researchers conducted follow up interviews at the end of therapy (16 weeks) and three months after therapy concluded (28 weeks) to assess the effectiveness of the intervention across several measures, investigating the long-term impact on the related distress, severity and frequency of voices, as well as participant mood and wellbeing.
Researchers found that, at the 16-week follow-up, participants in both the Brief and Extended versions of the therapy showed statistically significant improvements in voice-related distress, voice severity, empowerment, mood and wellbeing compared to those who did not receive the therapy. Participants who received AVATAR Extended also saw a reduction in the frequency of distressing voices.
While AVATAR’s effects on distress did not differ significantly at the 28-week mark, compared to those receiving their usual support, researchers did find that AVATAR Extended was an effective means of reducing the frequency of distressing voices and increasing participants’ empowerment and wellbeing over the longer-term.
Nick, a former trial participant, said:
“I was hearing 40 to 50 abusive voices a day. With the help of AVATAR therapy, that went down to four or five. I felt like I was taking back control of my life.”
Nature Medicine: Digital AVATAR therapy for distressing voices in psychosis: the phase 2/3 AVATAR2 trial
UCL News: Digital avatar may improve wellbeing for those hearing voices
Wellcome: AVATAR: a digital mental health treatment for psychosis
The Guardian: Using avatars in psychosis therapy can help those who hear voices, study finds | Psychology
Image: King's College London