AVATAR therapy more effective than supportive counselling for hallucinations
AVATAR therapy is more effective than traditional supportive counselling in lessening the severity of persistent auditory verbal hallucinations, suggesting that brief and targeted approaches may also be effective against psychosis, a recent randomized controlled trial (RCT) has shown.
“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 researchers said.
The research team performed a single-blind RCT on 150 schizophrenia spectrum disorder patients with distressing auditory verbal hallucinations for at least 12 months. Participants were randomized to receive either supportive counselling (n=75; mean age 42.9±11.2 years; 60 percent male) or AVATAR therapy (n=75; mean age 42.5±10.1 years; 76 percent male).
During AVATAR therapy, participants first created a digital representation of their hallucinations. The therapist, speaking through the digital avatar, then conducted a dialogue with the patients where the avatar gradually conceded power and acknowledged the good qualities of the participants. The study primary outcome was the change in severity of hallucinations.
After 12 weeks, reductions in auditory hallucinations, as measured by the auditory hallucinations subscale of the Psychotic Symptom Rating Scales, were significantly greater in patients who received AVATAR therapy than in those who received traditional supportive counselling (adjusted mean difference [MD], -3.82; 95 percent CI -6.70 to -0.94; p=0.009). [Lancet Psychiatry 2017;doi:10.1016/S2215-0366(17)30427-3]
AVATAR therapy also resulted in significantly greater 12-week improvements in the frequency of hallucinations (adjusted MD, -1.22; -1.97 to -0.48; p=0.0013) and patient distress (adjusted MD, -2.34; -4.26 to -0.42; p=0.017).
At the 12-week follow-up, nine participants reported complete absence of hallucinations, of whom seven belonged to the AVATAR group and two to the supportive counselling group. The number who reported the same absence increased to 14 participants (eight in the AVATAR and six in the supportive counselling groups) after 24 weeks.
Aside from the confirmation of the primary outcomes, the study largely supported the “second and third hypotheses … in that AVATAR therapy had a positive and significant on omnipotence, and that these positive effects on voices were sustained at 24 weeks,” researchers said.
In contrast, AVATAR therapy had no impact on the malevolence of the voices.
Overall, “AVATAR therapy was feasible to deliver, acceptable to participants, and did not result in any adverse events that could be attributed to the therapy. The study corroborated the primary hypothesis concerning clinical efficacy by showing a rapid and sustained reduction in the severity of auditory verbal hallucinations by end of therapy,” the researchers said.