A new multi-site study from the Institute of Psychiatry, Psychology & Neuroscience (IoPPN) at King’s College London has found that a new therapy using computer-generated avatars is an effective way to help people with psychosis reduce suffering and reduce the frequency with which they suffer. hearing voices.
AVATAR therapy is a series of guided therapy sessions in which voice hearers can have a conversation with an animated digital representation of their disturbing voice. The research, published in Naturopathyhas been recommended by a NICE Early Value Assessment, with researchers now seeking to implement this in routine NHS settings to gather further real-world evidence of effectiveness over the next three years.
Before therapy, participants work with a therapist to create a computerized visual representation of the voice they hear (the avatar). Therapy involves a three-way conversation between the voice hearer, the therapist, and the avatar, with the therapist both speaking themselves and voicing the avatar using voice conversion software. Over several sessions, participants learn to stand up to the voice and take control.
This study represents the result of more than ten years of research. The therapy was first developed by Dr. Julian Leff and the voice conversion system was built by Professor Mark Huckvale at University College London, and published the first results in 2013.
The researchers recruited 345 participants from eight clinical settings in four centers affiliated with the universities of Glasgow, Manchester, UCL and King’s. They were randomly assigned to receive either AVATAR Brief (six sessions of therapy), AVATAR Extended (12 sessions of more personalized therapy), or to continue with their usual support.
The researchers conducted follow-up interviews at the end of therapy (16 weeks) and three months after therapy was completed (28 weeks) to assess the effectiveness of the intervention across measures, examining the long-term impact on associated suffering, severity and its severity was examined. frequency of voting, as well as the mood and well-being of the participants.
Researchers found that participants in both the short and extended versions of the therapy showed statistically significant improvements in voice-related complaints, voice severity, empowerment, mood and well-being during the 16-week follow-up, compared to those who received no treatment. the therapy. Participants who received AVATAR Extended also saw a reduction in the frequency of distressing voices.
Although the effects of AVATAR on distress at 28 weeks were not significantly different, compared to those receiving their usual support, researchers did find that AVATAR Extended was an effective means of reducing the frequency of distressing voices and increasing the empowerment and well-being of the increase participants. in the longer term compared to treatment.
“People who hear voices rarely hear just one. In an interesting development, the extended version of the therapy was effective in reducing voice frequency overall, despite participants creating only one avatar for one voice,” explains Philippa Garety, Emerita professor of clinical psychology, from. at King’s IoPPN and lead author of the study.
“To our knowledge, this is the first therapeutic intervention that has a direct and sustained impact on the frequency with which people hear voices. This is an extremely important finding because it is a clear priority for voice hearers, and hearing fewer voices, less often, or voices going away altogether, can have a hugely positive impact on their daily lives,” Professor Garety added.
“I was hearing 40 to 50 abusive voices a day. With the help of AVATAR therapy that dropped to 4 or 5. I felt like I was taking back control of my life,” says Nick, a former participant in the AVATAR study .
Thomas Craig, Emeritus Professor of Social Psychiatry at King’s IoPPN and one of the co-senior authors of the study, commented: “It is extremely gratifying that the AVATAR2 study has confirmed and extended the findings of our previous research, which showed that AVATAR therapy is an innovative and innovative way of working.” An effective treatment for one of the most persistent and disturbing experiences of schizophrenia has laid the foundation for widespread availability of the therapy in mainstream care.”
The research team is now investigating how to roll out AVATAR therapy across England, and is conducting further research with mental health teams around the world. In March 2024, the National Institute for Health and Care Excellence (NICE) carried out an Early Value Assessment (EVA) for medical technology and has since recommended the therapy be used in the NHS while researchers continue the evaluation.
Dr. Thomas Ward, Research Clinical Psychologist at King’s IoPPN, Clinical Lead for AVATAR therapy and one of the co-senior authors of the study, said: “Our latest findings have demonstrated the effectiveness of AVATAR therapy across multiple sites. With these results and the NICE Recommendation for an Early Value Assessment, we hope that AVATAR therapy will be available in several NHS Trusts by 2025.”
Dr. Clementine Edwards, a Wellcome Early Career Award Fellow and Research Clinical Psychologist at King’s IoPPN and AVATAR2 Trial Coordinator, said: “The AVATAR technology allows both the patient and therapist to hear the voice together; this shared experience is such a powerful and unique aspect of AVATAR therapy.”
Miranda Wolpert, director of mental health at Wellcome, commented: “It is very exciting to see the emergence of a powerful new digital therapy that could be life-changing for people who hear voices. This study builds on more than a decade of groundbreaking research AVATAR therapy has been shown to reduce the distress people experience from auditory hallucinations and the frequency with which they hear them. This is a striking example of how mental health science can advance breakthrough treatments and provide new approaches to intervene early and help bring about improvements and resolve symptoms.”
The research was conducted by methodologists and statisticians from the Mental Health & Neuroscience Clinical Trial Statistics Group, part of King’s Clinical Trials Unit.
More information:
Philippa A. Garety et al, Digital AVATAR therapy for distressing voices in psychosis: the phase 2/3 AVATAR2 trial, Naturopathy (2024). DOI: 10.1038/s41591-024-03252-8
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