Craig TKJ, Rus-Calafell M, Ward T, et al. (2017). AVATAR therapy for auditory verbal hallucinations in people with psychosis: A single-blind, randomised controlled trial. Lancet Psychiatry. doi: 10.1016/S2215-0366(17)30427-3
Researchers recruited 150 people with schizophrenia spectrum disorders who experience auditory verbal hallucinations (i.e. “hear voices”) and randomized them to receive AVATAR therapy or supportive counseling as control. In AVATAR therapy, a therapist assists patients with creating digital visual representations of the main voice of concern and facilitating a dialogue between the patient and the voice, by switching between speaking as themselves and the voice. Over 6 50-minute sessions, the patient gains power and control over the AVATAR voice as the voice becomes less powerful. Supportive counseling involved fostering an empathic therapeutic relationship and collaborative exploration of fundamental personal issues (e.g., quality of life, identity, trauma) for the patient. Participants completed similar numbers of AVATAR (5.6) and supportive counseling (5.1) sessions. At baseline, 12 weeks, and 24 weeks, researchers assessed participants’ auditory hallucinations, voice frequency and distress, perceived “speaker” qualities, voice acceptance, patient/voice power differential, psychotic symptoms, affective symptoms, self-esteem, quality of life, and addiction. Between baseline and 12 weeks, AVATAR participants experienced greater reductions in auditory hallucinations, frequency of voices, and distress than control participants. AVATAR group reductions were maintained to 24 weeks, but there were no significant differences between groups at this point. Future trials should evaluate effectiveness of AVATAR compared to treatment as usual and explore whether additional sessions of AVATAR improve long-term outcomes.