Optimising AVATAR therapy for people who hear distressing voices: study protocol for the AVATAR2 multi-centre randomised controlled trial (original) (raw)
Related papers
AVATAR Therapy for Distressing Voices: A Comprehensive Account of Therapeutic Targets
Schizophrenia Bulletin, 2020
AVATAR therapy represents an effective new way of working with distressing voices based on face-to-face dialogue between the person and a digital representation (avatar) of their persecutory voice. To date, there has been no complete account of AVATAR therapy delivery. This article presents, for the first time, the full range of therapeutic targets along with information on acceptability and potential side effects. Interest in the approach is growing rapidly and this report acts as a necessary touchstone for future development.
BMC Psychiatry
Background AVATAR therapy is an innovative therapy designed to support people with distressing voices. Voice hearers co-create a digital representation of their voice and engage in dialogue with it. Although it has been successfully tested in a powered randomised controlled trial (ISRCTN65314790), the participants’ experience of this therapy has not been yet evaluated. We aimed to explore enablers and barriers to engagement with the therapy and potential for real-world impact on distressing voices. Methods Thirty per cent of those who completed AVATAR therapy (15 people in total) and 5 who dropped out from therapy within the main AVATAR RCT were invited to participate in a semi-structured interview, which was audio-recorded and subsequently transcribed. Results Fourteen therapy completers (28% of the full sample) and one person who dropped out of therapy after 1 active session, were interviewed. Thematic analysis was used to explore the interviews. A total of 1276 references were co...
The Role of Sense of Voice Presence and Anxiety Reduction in AVATAR Therapy
Journal of Clinical Medicine
AVATAR therapy offers a unique therapeutic context that uses virtual reality technology to create a virtual embodiment of the voice-hearing experience, enabling the person to visualize their persecutory voice and engage in real-time “face-to-face” dialogue. The present study explores, for the first time, the contribution of sense of voice presence, together with session-by-session reduction of anxiety and paranoid attributions about the avatar, to changes in primary outcomes following AVATAR therapy. Data from 39 participants, who completed AVATAR therapy and attended a 12-week follow-up assessment, were analysed. Mid- to high-levels of sense of voice presence were reported across the therapy sessions, along with significant reductions of anxiety levels and paranoid attributions about the avatar. The interaction of sense of voice presence and reduction of anxiety was associated with two of the significant therapy outcomes: PSYRATS total and frequency of voices. The findings suggest ...
AVATAR Therapy for Refractory Auditory Hallucinations
2016
While attempts to understand voice hearing need to acknowledge the complexity and diversity of the experience (Woods et al. 2014), the majority of hearers describe voices that take the form of a characterized “other” with whom a personally meaningful relationship develops (Beavan 2011; McCarthy-Jones et al. 2014). AVATAR therapy is part of a new and exciting wave of therapies which adopt an explicitly relational and dialogic approach to working with the distressing voices. In this article we provide a brief overview of the therapy with illustrative case material and comment on the implications for its future implementation in routine care.
2013
This paper presents a radical new therapy for persecutory auditory hallucinations (“voices”) which are most commonly found in serious mental illnesses such as schizophrenia. In around 30% of patients these symptoms are not alleviated by anti-psychotic medication. This work is designed to tackle the problem created by the inaccessibility of the patients' experience of voices to the clinician. Patients are invited to create an external representation of their dominant voice hallucination using computer speech a technology. Customised graphics software is used to create an avatar that gives a face to the voice, while voice morphing software realises it in audio, in real time. The therapist then conducts a dialogue between the avatar and the patient, w view to gradually bringing the avatar, and ultimately the hallucinatory voice, under the patient’s control. Results of a pilot study reported elsewhere indicate that the approach has potential for dramatic improvements in patient voic...
The lancet. Psychiatry, 2018
A quarter of people with psychotic conditions experience persistent auditory verbal hallucinations, despite treatment. AVATAR therapy (invented by Julian Leff in 2008) is a new approach in which people who hear voices have a dialogue with a digital representation (avatar) of their presumed persecutor, voiced by the therapist so that the avatar responds by becoming less hostile and concedes power over the course of therapy. We aimed to investigate the effect of AVATAR therapy on auditory verbal hallucinations, compared with a supportive counselling control condition. We did this single-blind, randomised controlled trial at a single clinical location (South London and Maudsley NHS Trust). Participants were aged 18 to 65 years, had a clinical diagnosis of a schizophrenia spectrum (ICD10 F20-29) or affective disorder (F30-39 with psychotic symptoms), and had enduring auditory verbal hallucinations during the previous 12 months, despite continued treatment. Participants were randomly ass...