Digital avatar therapy could help patients manage hallucinations

Schizophrenia and other psychosis-related conditions often involve auditory hallucinations, with individuals hearing voices that bully or urge self-harm. Traditional treatments like antipsychotic medications and psychotherapy don't always silence these voices.

Over the last decade, researchers in the UK have developed a novel digital intervention to address this challenge: avatar therapy. This innovative approach allows patients to confront their hallucinations in a controlled and therapeutic setting, offering a promising avenue for improving mental health care.

How does it work?

Avatar therapy enables patients to create a digital representation — or "avatar" — of the voice they hear, tailoring its appearance and tone to match their hallucination. Working with a therapist, the patient engages in guided three-way conversations between themselves, the avatar, and the therapist. The patient learns to challenge the voice's criticisms and take control of the dialogue.

For instance, when a voice tells a patient, "You're rubbish. You're a waste of space," the patient practices deflecting this negativity. Over time, these interactions, which last about 10-15 minutes in an hour-long session, help reduce distress and empower the individual. Eventually, the avatar's critical tone diminishes, shifting the overall experience from fear to control.

A trial conducted at multiple UK sites demonstrated the effectiveness of this therapy. Participants showed reduced distress, improved mood, and increased feelings of empowerment after as few as six sessions.

Why does it matter?

For individuals struggling with persistent and distressing hallucinations, avatar therapy represents a transformative option. By allowing patients to directly engage with their auditory hallucinations, the therapy fosters a sense of agency and control that traditional treatments often lack.

The UK's National Institute for Health and Care Excellence (NICE) has already recognized avatar therapy as a valuable digital health intervention for psychosis, recommending its integration into the National Health Service while further evidence is gathered.

As John Torous, M.D., director of digital psychiatry at Beth Israel Deaconess Medical Center, remarked, "Despite its limitations, it's exciting to give people new options for psychological therapy."

The context

The largest study on avatar therapy, published in Nature Medicine, included 345 participants across England and Scotland. Patients experienced significant improvements in distress, mood, and overall well-being after 16 weeks of therapy. While the extended 12-session program yielded more lasting effects than the brief six-session program, both outperformed standard psychotherapy.

However, challenges remain. High dropout rates — 20% in the brief program and 40% in the extended program — highlight the need for refining the therapy process. Additionally, experts caution against overly optimistic expectations, noting the potential for a "digital placebo effect."

As Nev Jones, Ph.D., a University of Pittsburgh professor, pointed out, "Just because it's a digital tool doesn't mean it will enable quasi-miraculous outcomes."

Efforts are underway to integrate avatar therapy into routine care and adapt it for diverse cultural settings like Ethiopia and India. Researchers are also exploring AI-driven avatars to enhance therapeutic conversations, opening up exciting possibilities for future mental health care innovations.

By offering a novel, tech-driven approach to tackling auditory hallucinations, avatar therapy underscores the growing potential of digital health technologies to revolutionize mental health treatment.