What is Avatar Therapy? A look at the promising new technique to combat schizophrenia

What is Avatar Therapy? A look at the promising new technique to combat schizophrenia

Schizophrenia is a complicated mental health condition with which one in one hundred of us will be diagnosed in our lives. Schizophrenia can present itself in different ways, and each person may experience unique symptoms. However, some common symptoms that someone might experience include:

  • A lack of interest in things
  • Feeling disconnected from emotions
  • Difficulty concentrating
  • Wanting to avoid people
  • Hallucinations, such as hearing voices or seeing things that other people don’t see
  • Delusions (strong beliefs that others don’t have), including paranoid delusions
  • Disorganised thinking and speech
  • Not wanting to look after yourself

Approximately 60-70% of individuals who have schizophrenia struggle with frightening auditory hallucinations. There are various treatments available, and for some, drug treatments will reduce symptoms such as auditory hallucinations. However, about a quarter will continue to experience voices. Another available therapy includes cognitive behavioural therapy for psychosis (CBTp), which can be effective but requires a longer commitment and can have limited effects on symptoms such as voices.

Avatar Therapy

An alternative therapy used to treat schizophrenia is Avatar Therapy, which Professor Julian Leff invented to alleviate the symptoms of voice hallucinations that often plague schizophrenia patients. After reading the report of a survey about how patients felt helpless about their auditory hallucinations, he thought, ‘That’s not surprising because the voices are invisible. So I wondered, what if we could give them a face?’

This computer-based, therapy-assisted approach focuses on helping people with schizophrenia and other similar conditions manage their hallucinations by enabling them to speak back to a digital representation of the voices that they hear. Avatar Therapy gives these hallucinations a face.

Three avatars created by people hearing schizophrenic voices taking part in the research. Credit: King's College London

How does Avatar Therapy work?

Avatar Therapy uses software to create a visual representation of the patient’s persistent auditory hallucinations and creates an external version of the voices they hear. The therapist controls this digital avatar from a separate room. Over six sessions, each lasting between 30 and 50 minutes, the patient is encouraged to have a dialogue with the avatar and stand up to them.

A red ‘stress button’ is available for patients to press if they become too anxious during the session, which replaces the avatar on the screen with a relaxing scene and music to alleviate any distress that the patient may be experiencing. At the end of the session, patients receive a recording of their session. Avatar Therapy has also been adapted for use within the virtual reality world, presenting even more opportunities.

How effective is Avatar Therapy?

Despite being relatively new and experimental, the psychiatry community has seen promising early results since Avatar Therapy came to attention in 2017. In the first clinical trial of Avatar Therapy in 2017, run by the Institute of Psychiatry at King’s College London, 150 patients suffering from persecutory voices were treated with two different therapy approaches. Individuals treated with Avatar Therapy found that their symptoms were less severe than people who only received traditional forms of counselling. Patients who received Avatar Therapy also experienced less distressing and less powerful hallucinations than those in conventional counselling. Additionally, these results were found to be lasting. Some who received Avatar Therapy reported their hallucinations had completely disappeared after 12 weeks. The study found these improvements continued at 24 weeks.

Another study in 2020 found that ‘Avatar Therapy offers a powerful therapeutic context, involving exposure to an embodied representation of the disembodied voice and direct real-time work on “hot” cognitive, emotions, and relational processes.’ Avatar Therapy aims to ‘enable the person to (re)build a sense of power, control and self-respect; enacting new modes of social relating that they carry into their life.’

Professor Philippa Garety, Chief Investigator and Principal Investigator of the 2021 AVATAR2 Trial, a new Avatar Therapy trial at King’s College London, states:

‘What we have seen so far is that this can become much more of a balanced conversation and that voices which were once considered overwhelming and scary can now become manageable. Now more than ever with increased isolation due to COVID-19, we are looking for robust, effective treatments that make the difference for our patients.’

It is undoubtedly an exciting and promising time for the world of schizophrenia and mental health, and Avatar Therapy will likely see more development in the years to come.

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