A therapy which uses digital avatars to represent the voices heard by people with psychosis could be a “game changer”, researchers have said.


The Avatar2 trial is using the unique therapy to help patients increase power and control over auditory hallucinations and reduce the distress they cause.

It builds on a previous clinical trial, Avatar1, which was led by King’s College London and hosted by South London and Maudsley NHS Trust. The trial found that the therapy resulted in a rapid and substantial fall in frequency and associated distress of voices, when compared with supportive counselling alone after 12 weeks.

The Avatar2 trial developed by King’s College London, University College London (UCL) and UCL Business has just marked its first full quarter of running in Scotland, where it is led by the University of Glasgow.

Professor Andrew Gumley, who leads the University of Glasgow’s Psychosis Research Group, said his team “has been at the forefront of developing new therapies for people with distressing voices.”

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He added: “This includes digital therapies to promote recovery, wellbeing and empowerment in people who have a diagnosis of schizophrenia.

“Avatar therapy is a new digital therapy that can help people change their relationship with distressing auditory hallucinations. People with distressing voices have had poor access to talking therapies in Scotland.

“If this trial is successful it could be a game changer in terms of enabling access to psychological therapies for people with distressing voices.”

The trial is being extended to sites across the country, including at the University of Manchester, as well as King’s College London and UCL.

Avatar therapy involves innovative use of digital technology to allow “face-to-face” dialogue between the person who hears voices and a computerised representation of their voice (the avatar), with a therapeutic focus on increasing power and control over the voice.

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The Avatar2 trial aims to test two forms of therapy to find out which might be most helpful, and to learn more about how the therapy may work, how it can be tailored to the individual and how best to deliver it in clinical services.

Participants will be randomly allocated one of three pathways – their usual care, six sessions of avatar therapy or 12 sessions of avatar therapy, delivered along with their usual care.

One participant identified only as Jane received avatar therapy during the Avatar1 trial. “Since I’ve been unwell, I have had many psychological therapies. I can honestly say that avatar therapy has helped me the most," she said.

“Being face-to-face with the avatar was very hard for me at first, especially the first session, but after a while I became more confident. It was easier for me to talk back to the avatar.


“At times it was very challenging but I was very well supported during all of my sessions. I think it’s hard for people like me to try new therapies, but it has helped me so much in my recovery.”

Reader Q&A: What are the most successful therapies for depression?

Asked by: Serena Collins, Reading

There’s no simple answer because success depends on age, sex, the type of depression and whether it’s combined with anxiety or other mental-health problems. Generally, however, therapies based on exploring and changing the patient’s own thoughts and behaviour are far more effective than old-fashioned talking therapies such as psychoanalysis.

Alternative therapies, although popular, also fare badly. One meta-analysis combined many studies and found that cognitive behavioural therapy (CBT) did best, especially with long sessions. But a newer therapy called behavioural activation also did well.

These are both based on the idea that depression is made worse by adopting the wrong coping strategies. So patients are helped to understand what triggers their depression and how their reactions to life’s events affect their moods and emotions. Learning to replace bad coping strategies, such as drugs, drink and endless rumination, with positive coping strategies can help, either used alone or in combination with medication.

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Sara RigbyOnline staff writer, BBC Science Focus

Sara is the online staff writer at BBC Science Focus. She has an MPhys in mathematical physics and loves all things space, dinosaurs and dogs.