Avatars ease voices for schizophrenia patients

Avatars created by patients

Use of an avatar can help treat patients with schizophrenia who hear voices, a UK study suggests.

The trial, published in the British Journal of Psychiatry, focused on patients who had not responded to medication.

Using customised computer software, the patients created avatars to match the voices they had been hearing.

After up to six therapy sessions most patients said their voice had improved. Three said it had stopped entirely.

The study was led by psychiatrist emeritus professor Julian Leff, who spoke to patients through their on-screen avatars in therapy sessions. Gradually he coached patients to stand up to their voices.

"I encourage the patient saying, 'you mustn't put up with this, you must tell the avatar that what he or she is saying is nonsense, you don't believe these things, he or she must go away, leave you alone, you don't need this kind of torment'," said Prof Leff.

"The avatar gradually changes to saying, 'all right I'll leave you alone, I can see I've made your life a misery, how can I help you?' And then begins to encourage them to do things that would actually improve their life."

By the end of their treatment, patients reported that they heard the voices less often and that they were less distressed by them. Levels of depression and suicidal thoughts also decreased, a particularly relevant outcome-measure in a patient group where one in 10 will attempt suicide.

Treatment as usual

The trial, conducted by Prof Leff and his team from University College London, compared 14 patients who underwent avatar therapy with 12 patients receiving standard antipsychotic medication and occasional visits to professionals.

Later the patients in the second group were also offered avatar therapy.

Only 16 of the 26 patients completed the therapy. Researchers attributed the high drop-out rate to fear instilled in patients by their voices, some of which "threatened" or "bullied" them into withdrawing from the study.

New treatment options have been welcomed for the one in four patients with schizophrenia who does not respond to medication. Cognitive behaviour therapy can help them to cope but does not usually ease the voices.

Paul Jenkins, of the charity Rethink Mental Illness, said: "We welcome any research which could improve the lives of people living with psychosis.

"As our Schizophrenia Commission reported last year, people with the illness are currently being let down by the limited treatments available.

"While antipsychotic medication is crucial for many people, it comes with some very severe side effects. Our members would be extremely interested in the development of any alternative treatments."

Next phase

A larger trial featuring 142 patients is planned to start next month in collaboration with the King's College London Institute of Psychiatry.

Prof Thomas Craig, who will lead the larger study, said: "The beauty of the therapy is its simplicity and brevity. Most other therapies for these conditions are costly and take many months to deliver.

"If we show that this treatment is effective, we expect it would be widely available in the UK within just a couple of years as the basic technology is well developed and many mental health professionals already have the basic therapy skills that are needed to deliver it."

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