Abusive avatars help schizophrenics fight the distressing voices in their head

Researchers have devised an innovative new therapy which could help people suffering with schizophrenia to deal with the threatening voices in their head, according to a new study.

The experimental technique, created by a team at King's College London, involves the schizophrenia sufferer having a face-to-face discussion with a computer avatar representing their auditory hallucinations - which are typically insulting or threatening in nature - in order to overcome their symptoms.

The findings, published in the journal The Lancet Psychiatry, showed that this method was more effective at reducing hallucinations than a form of supportive counselling after 12 weeks.

The people who took part in the study had experienced persistent and distressing auditory hallucinations for more than a year, despite taking anti-psychotic medication – which they continued throughout the trial.

Around 60-70% of people who have schizophrenia experience auditory hallucinations, which can cause serious distress. Drugs can reduce symptoms in most cases, however, for one-in- four people, the voices continue. Alternative treatment options may include cognitive behavioural therapy for psychosis (CBTp) which can be helpful, although it is a lengthy process and, at times, has a limited effect on the voices.

"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," said Tom Craig from King's College London, and the South London and Maudsley NHS Foundation Trust, UK.

"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. So far, these improvements appear to last for up to six months for these patients.

The study involved 150 people who had suffered from schizophrenia for approximately 20 years and heard 3-4 different voices on average. The participants were split evenly between two groups: one which received the avatar therapy and another which received a form of supportive counselling.

The avatar therapy involved six, 50-minute sessions, over six weeks. Working with a therapist the patients created a computerized simulation of the voice which they wanted to influence the most – shaping what it said, how it sounded and what it may look like.

The sessions were essentially a three-way conversation between the patient, the therapist and the avatar – which was voiced by the therapist. Patients set targets before each session and practised standing up to the avatar and correcting any misconceptions it had about them. Participants also practiced taking control of the conversation in order to shift power away from the avatar. Over time, the avatar came to recognise the patient's good qualities.

The sessions were recorded and given to the patient to take home and listen to whenever they began to hear the voices for real. Those who had received the avatar therapy found that their hallucinations became less distressing and less powerful than people in the counselling group, while seven people reported that their voices had completely disappeared.

It should be noted however, that after 24 weeks, there were no differences in outcomes between the avatar therapy group and the counselling group.

"Schizophrenia affects 1-in -100 people, often with a devastating effect, making it impossible for people to work and sustain relationships," said Ann Mills-Duggan, from Wellcome's Innovations team who funded the trial.

"Avatar therapy is a promising new approach and these early results are very encouraging. If the researchers can show that this therapy can be delivered effectively by different therapists in different locations, this approach could radically change how millions of psychosis sufferers are treated across the world."