Patients who suffer from schizophrenia often have auditory hallucinations. They hear voices that are not there. Many times these hallucinations say things like “You are a terrible person, you are lazy, you are a waste of time” and other derogatory or critical remarks. The patient is naturally very distressed over these voices. It’s difficult enough dealing with a mental illness like schizophrenia without having a voice in your head criticizing your actions.
A new experimental therapy has patients who hear voices conducting a face to face conversation with an avatar on a computer. The avatar is designed based on the description from the patient, and the words and phrases they say are put on a soundtrack. The patient is then counseled on how to respond to the voices. A study by researchers at King’s College in London looked at how this therapy might help patients who can’t seem to get free of the hallucinations
The study was a randomized trial of avatar therapy controlled trial compared the avatar therapy to a form of supportive talk therapy that was developed specifically for the patients in the study. After twelve weeks, those who had participated in the avatar program of treatment had fewer auditory hallucinations than the group in supportive talk therapy. The study was just the beginning, to see if the program was safe and effective, and it will have to be tested in other therapeutic settings, but it was a good start.
There were 150 study participants in this trial, and all were patients who had been diagnosed with schizophrenia and who had struggled with auditory hallucinations for more than a year with no relief. None of the participants were taken off their regular medication or asked to discontinue whatever therapy they had been in; the avatar therapy was in addition to their usual care. The group was split into 75 patients in the avatar therapy and 75 in the supportive counseling.
Estimates show that anywhere from 60-70% of people with schizophrenia also have auditory hallucinations. The voices never seem to be benign either; they are commonly abusive, insulting and sometimes threatening. Some medications work to reduce them, but about 25% of patients will still experience the hallucinations. The standard of care for schizophrenia is cognitive behavioral therapy; however, CBT is a long-term undertaking that doesn’t show quick results and often doesn’t reduce auditory hallucinations.
Lead author Professor Tom Craig from King’s College London explained, “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. 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 counseling. So far, these improvements appear to last for up to six months for these patients. However, these results come from one treatment center, and more research is needed to optimize the way the treatment is delivered and demonstrate that it is effective in other NHS settings.”
The avatar therapy included six sessions in which the therapist would voice the avatar, and the patient would interact with it, in a conversation for about 15 minutes. The patients were instructed how to stand up to the belittling and were given a recording of each session to take home and review. Supportive talk therapy was given for the same amount of sessions and was a conversation between the therapist and patient, strategizing on ways to overcome the voices and their impact. At the end of 12 weeks, the avatar patients were evaluated, and their symptoms were rated less severe. Also, the patients found the voices less stressful, and they felt more able to stand up to the criticism.
Take a look at the included video to see how some of the sessions were conducted