Digital characters – avatars – can help people with psychosis hear voices less often and reduce the distress they cause, research suggests.
The therapy involves a series of guided sessions during which patients can have a conversation with an animated digital representation of their disturbing voice.
Often in psychosis, as in other conditions, the voices people hear can be abusive or bullying and affect people’s daily lives.
The voices can be experienced as powerful and almost omniscient, seeming to know what the person is thinking and feeling, and preventing them from taking the actions they want every day.
According to research from the Institute of Psychiatry, Psychology & Neuroscience (IoPPN) at King’s College London, the avatar therapy using computer-generated animations is an effective way to help people with psychosis who hear voices.
Philippa Garety, emerita professor of clinical psychology at King’s IoPPN and the study’s lead author, said: “To our knowledge, this is the first therapeutic intervention to have a direct and sustained impact on the frequency with which people hear voices.
“This is an extremely important finding, as it is a clear priority for voice hearers, and hearing fewer voices, less often, or voices that go away altogether, can have a huge positive impact on their daily lives.
“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.”
Nick, who took part in the Avatar trial, said: “When I had the therapy in 2015 I was hearing up to 30 or 40 abusive voices a day and that brought it down to about four or five.
“I felt like I was taking back control of my life.”
Before the therapy, patients work with a therapist to create a computerized visual representation of the voice they hear (the avatar).
The session involves a three-way conversation between the voice listener, the therapist and the on-screen avatar, with the therapist speaking as themselves and voicing the avatar using voice conversion software.
The avatar’s likeness and sound are made to match the description provided by the patient.
Over several sessions, participants learn to stand up to the voice and take control.
The researchers recruited 345 people from four centers linked to the Universities of Glasgow, Manchester, UCL and King’s.
Miranda Wolpert, the director of mental health at Wellcome, which helped fund the study, said: “It’s 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 pioneering research.”
The research, published in Nature Medicine, was recommended by a National Institute for Health and Care Excellence (Nice) early value assessment, with the researchers aiming to provide this in routine NHS settings to gather further real-world evidence of effectiveness over the next three years.
