AVATAR therapy for auditory verbal hallucinations in people with psychosis: a single-blind, randomised controlled trial.
Level 2 - randomized trial
Individual randomized controlled trial with masked outcome assessors.
PubMed 29175276 · doi:10.1016/S2215-0366(17)30427-3
What was done
A single-blind randomized controlled trial was conducted at a single UK site (South London and Maudsley NHS Trust) enrolling 150 adults aged 18–65 with schizophrenia spectrum or psychotic affective disorders experiencing persistent auditory verbal hallucinations despite treatment. Participants were randomly assigned (1:1) to AVATAR therapy (dialogue with a therapist-manipulated digital representation of the persecutor) or active supportive counselling. Assessors were masked to group allocation. The primary outcome was the change in total score on the Psychotic Symptoms Rating Scales Auditory Hallucinations (PSYRATS-AH) at 12 weeks, analyzed by intention-to-treat using linear mixed models.
What was found
Among 150 randomized patients (75 per group), 124 (83%) completed the 12-week assessment. AVATAR therapy produced a significantly greater reduction in PSYRATS-AH total score at 12 weeks compared to supportive counselling (mean difference -3.82, SE 1.47, 95% CI -6.70 to -0.94, p = 0.0093). No adverse events attributable to either therapy were observed.
Why it matters
This trial demonstrates that interactive digital simulation therapy can significantly decrease the severity of medication-resistant auditory hallucinations compared to standard supportive counselling.
Limits
The study was conducted at a single clinical centre. Masking applied only to assessors, as participants could not be blinded to the psychological intervention type. The primary outcome reflects short-term (12-week) follow-up, and 17% of participants were lost to follow-up at the primary endpoint.
Cited by
- supports Avatar therapy uses computer animation to create an image of a persecutory voice for dialogic therapy to reduce hallucination-related distress in schizophrenia.