A novel intervention called AVATAR therapy allows people with psychosis, who hear distressing voices, to interact with a digital representation of the voices they hear, which could improve the distress associated with these voices in the short term. The findings are published in ‘Nature Medicine’.
The team of researchers from King’s College London (United Kingdom) carried out a phase 2/3 clinical trial in people with a psychotic disorder to study the effectiveness of interaction with a digital avatar in alleviating the discomfort generated by hearing voices. . After analyzing it in 345 people, they conclude that it can reduce its frequency of appearance at 16 and 28 weeks. The discomfort caused is reduced at 16 weeks, but not at 28.
Hearing distressing voices is a symptom of psychosis that can seriously affect quality of life, and conventional treatments, such as medication and cognitive behavioral therapy, are not always effective.
AVATAR therapy is a digital treatment aimed at people who hear voices, also known as auditory hallucinations, and could transform the lives of people with psychosis. In this therapy, patients tThey work with a therapist to create a digital avatar of the voice they hear, customizing how it looks, what it says and how it sounds. During the sessions, the patient talks with the avatar, supported by the therapist, practicing confrontation and control of the conversation to reduce the discomfort associated with the voice.
Philippa Garety’s team looked at the effectiveness of two versions of AVATAR therapy alongside standard treatment for adults in the UK with psychosis who hear disturbing voices.
Participants received either a short version of AVATAR (AVATAR-Short), which encouraged them to confront the avatar to improve their assertiveness and self-esteem, or an extended version (AVATAR-Extended), which included dialogues personalized based on the life history of the participants. Special software allowed participants to customize the avatar’s appearance and voice.
The study shows that this therapy can reduce discomfort and frequency of voices. The National Institute for Health and Clinical Excellence (NICE) has endorsed the therapy under a Early Value Assessmentallowing its inclusion in the National Health System (NHS) while more evidence is generated.
The findings suggest that AVATAR therapy, along with standard treatment, could improve voice-related symptoms in people with psychosis.
Clinical relevance
José García-Valdecasas, psychiatrist and deputy secretary of the Board of the Spanish Association of Neuropsychiatry, is not so clear. In statements to Science Media Center, he comments that the study follows a fairly current line of research that seeks to implement digital solutions for the treatment of different psychiatric pathologies, in general, with poor results.
The data, he adds, “speak of a certain effectiveness in week 16, which is not maintained in week 28. It is true that current treatments with psychotropic drugs or psychotherapy are sometimes not helpful enough, but there are approaches, for example, in mutual support groups of voice hearers, which seem more promising, in my opinion.
Furthermore, he warns, “some of the authors have conflicts of interest to take into account, with companies dedicated to these digital tools, what I consider may affect their judgment.
“It does not seem to me that these findings are going to have clinical relevance.”
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