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Schizophrenia patients may be helped by talking to ‘avatar’

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An experimental therapy involving patients with schizophrenia interacting with a computer-generated character that embodies one of the voices they hear, can help rapidly reduce symptoms, according to a new UK study.

Findings from a randomised trial, published on Thursday in The Lancet Psychiatry, suggest that “avatar therapy” could be of benefit when used alongside standard treatment.

“It is important that we look at newer, effective and shorter forms of therapy”

Tom Craig

The ground-breaking therapy sees patients talk directly to a computer simulation – or avatar – of one of the voices they hear regularly, helping them confront and gradually take control of their hallucinations.

The study, which is the first large-scale trial of its kind, took place at the Maudsley Hospital’s SHARP (Social Inclusion, Hope and Recovery Project) clinic and the Institute of Psychiatry, Psychology and Neuroscience at King’s College London.

It involved 150 patients who had been diagnosed with schizophrenia for about 20 years and heard three to four voices on average.

Half of the group had avatar therapy, while the other half underwent a form of supportive counselling developed for the study.

All continued with their usual anti-psychotic medication throughout the trial, which was conducted by researchers from King’s, the Royal Free and University College Medical School, University College London, University of Manchester, and Manchester Academic Health Science Centre.

Institute of Psychiatry, Psychology & Neuroscience, King's College London

Schizophrenia patients may be helped by talking to ‘avatar’

One of the avatars created by participants in the study

Participants assigned to avatar therapy had six sessions – one 50-minute session per week. Before starting treatment, they worked with a therapist to design an avatar to represent the voice they most wanted to influence, including how it sounded, the things it said and how it might look.

Sessions involved a three-way conversation between the patient, therapist and avatar, with the therapist speaking as themselves but also voicing the computer character.

These included 10 to 15 minutes where the patient talked directly to the avatar, practising standing up to it, correcting misconceptions it had about them and taking control of the conversation. Sessions were recorded so the patient could re-listen at home when they heard voices.

Those in the counselling group had the same number of sessions, which encouraged patients to raise issues of concern and looked at practical ways to improve their quality of life. They also took home a positive recorded message to listen to in their own time.

After 12 weeks, researchers found symptoms were less severe among those who had received avatar therapy. People in the group also found their hallucinations less distressing and less powerful than those who had the counselling.

Seven people in the avatar group said their symptoms had completely disappeared after 12 weeks, compared with two people in the counselling group.

The rapid improvements seen in the avatar group were maintained at 24 weeks, but by this time hallucinations had also become less frequent and distressing for those receiving counselling, so there were no differences between the two groups after six months.

Institute of Psychiatry, Psychology & Neuroscience, King's College London

Schizophrenia patients may be helped by talking to ‘avatar’

Another one of the avatars

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

“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,” he said.

“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,” he said. “So far, these improvements appear to last for up to six months for these patients.”

However, he said more research was needed to find the best way of delivering the therapy and to show it could be effective in other types of NHS setting.

One of the study’s limitations was the fact that the counselling element was carried out by graduate trainee therapists, which may have had an impact on how effective it was. In contrast, the avatar therapy was delivered by very experienced therapists in a centre with expertise in treating psychosis.

The researchers said it was not yet clear how easy it would be for the wider mental health workforce – such as nurses – to provide avatar therapy.


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