AVATAR Therapy Reduces Auditory Verbal Hallucinations in Schizophrenia

upset woman sitting at her computer
upset woman sitting at her computer
AVATAR therapy significantly reduced the severity of hallucinations compared with supportive counseling.

A new treatment approach for patients with auditory verbal hallucinations called AVATAR therapy significantly reduced the severity of hallucinations over the course of 12 weeks compared with supportive counseling, according to the results of a study published in Lancet Psychiatry.

In this single-blind single-center trial, researchers enrolled 150 adults with schizophrenia spectrum or affective disorder who had experienced persistent auditory verbal hallucinations for at least 1 year. They randomly assigned participants to receive supportive counseling or AVATAR therapy, which consisted of a digital representation (avatar) of the participant’s hallucinations voiced by his or her therapist and to whom the participant could talk.

Over the course of therapy, the avatar became less hostile and conceded power to the participant. The Psychotic Symptom Rating Scales Auditory Hallucinations score measured auditory verbal hallucinations at baseline, at 12 weeks, and at 24 weeks.

Reduction in auditory verbal hallucination was reported in 124 participants overall (83%).

At 12 weeks, the reduction in auditory verbal hallucination score was significantly higher in the AVATAR group compared with the supportive counseling group (mean difference -3.82; 95% CI, -6.70 to -0.94; P <.009). At 24 weeks, improvements in auditory verbal hallucinations were maintained for the AVATAR group and increased for the supportive counseling group, resulting in no significant difference at this time point. No adverse events were reported for either therapy.

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“AVATAR therapy is a brief therapy for persistent, distressing voices that makes creative and novel use of digital representations of psychotic experiences to provide a controlled but realistic therapeutic encounter, enabling dialogue and change,” the study authors noted. “In a rapid development, from an initial pilot to the first powered randomised controlled trial, AVATAR therapy has shown large, clinically worthwhile benefits for voice hearers.”


Craig TKJ, Rus-Calafell M, Ward TW, et al. AVATAR therapy for auditory verbal hallucinations in people with psychosis: a single-blind, randomised controlled trial [published online November 23, 2017]. Lancet Psychiatry. doi:10.1016/ S2215-0366(17)30427-3