Therapy using a digital avatar could help patients suffering from psychosis, study says

Therapy involving computer-generated avatars may show promise in easing symptoms for people with psychosis, a new study suggests. 

The research involved 345 participants who experienced auditory hallucinations, a common symptom of psychosis.

Tested across multiple UK centres, the therapy uses virtual representations akin to an avatar, to help patients engage directly with the voices they hear.

During sessions, participants design an avatar with their therapist to represent the voice they hear.

The therapist speaks both as themselves and as the avatar, using software to mimic the voice's tone.

Participants were assigned to either six sessions of therapy or to an extended 12 sessions.

Both versions were combined with standard care and compared against people who only received their usual care.

“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,” Mark Huckvale, an emeritus professor of speech, hearing, and phonetic sciences at University College London (UCL) who built the voice conversion system, said in a statement. 

From hearing 50 voices to fewer than five

At 16 weeks, both therapy groups reported lower levels of distress compared to those in the standard support group, according to the findings published in Nature. 

By 28 weeks, the group in extended therapy showed a “sustained reduction in the frequency of the occurrence of voices”.

“To our knowledge, this is the first therapeutic intervention that has a direct and sustained impact upon the frequency with which people hear voices,” said Philippa Garety, a professor at King’s College London and the study’s lead author. 

“This is an extremely important finding, as it is a clear priority for voice hearers, and hearing fewer voices, less often, or voices going away altogether can have a hugely positive impact on their day-to-day lives," Garety added.

Nick, a trial participant who experienced significant relief, described hearing up to 50 abusive voices a day before the therapy, which sessions helped reduce to fewer than five. 

“I felt like I was taking back control of my life,” he said.

Building on these results, researchers are investigating how AVATAR therapy could be introduced in clinical practices nationwide.

“We hope to see AVATAR therapy available in several NHS Trusts in 2025,” said Dr Thomas Ward, the therapy’s lead and one of the study’s authors.

However, Alberto Ortiz Lobo, a psychiatrist at the Carlos III Day Hospital, who didn't take part in the study noted in a statement that the research wasn't comparing the intervention to other types of intervention or technique except standard care.

"The results are unpromising because they find a significant difference in improvement at 16 weeks that is lost when the results are measured at the end of the study, at 28 weeks," he said.