King's College London

The AVATAR Project was a clinical research trial of an innovative new therapeutic treatment designed to help people suffering from distressing voices. The therapy was created by Professor Julian Leff and tested in a small pilot study. Professor Tom Craig and his team conducted this larger randomised controlled trial. For the latest work on optimising AVATAR therapy and details of the AVATAR 2 study incorporating a new multi-centre randomised controlled trial please see https://www.kcl.ac.uk/research/avatar2

A previous pilot study showed that AVATAR therapy may be helpful and so we conducted research to test these findings via a study that compares this therapy with the established treatment of supportive counselling. The study demonstrated the basic principles of AVATAR therapy but only involved a small number of patients. The outcomes of the study were promising, in that there was a significant reduction in the severity of symptoms expressed by those taking part, with three out of sixteen patients treated claiming that they were no longer affected by hearing voices.

The effectiveness of Avatar Therapy was tested against Supportive Counselling, which is a therapy that has been found to be a helpful treatment for people experiencing ongoing stress. Participants were assessed by researchers to collect information about their voice hearing experience at the beginning of the study then after 12 and 24 weeks. Following this initial assessment participants were randomly allocated to Supportive Counselling or AVATAR Therapy.

Trial design

Supportive Counselling

Supportive Counselling Participants allocated to supportive counselling spoke to their therapist about voices, everyday life and feelings more generally, in order to explore ways of dealing with any problems. Treatment comprised of 7 appointments, sessions were recorded and participants were given these recordings on a small MP3 player to take away and use at any time. The audio recordings of therapy were listened to by the senior clinical researchers in charge of the study to see that treatment was delivered correctly. Throughout involvement in the study all other care and treatment remained the same, unless changed by the participant's consultant or GP.

AVATAR therapy

AVATAR Therapy Participants allocated to the AVATAR therapy group were helped to use a computer program to develop an 'avatar' (image and voice) similar to the person or entity whose voice bothers you. The therapist then used this program in the therapy sessions to talk to participants with the avatar, and suggest coping skills which will lead to the voice gradually coming under control. If at any point participants found the avatar too distressing, they were able to turn it off. Treatment comprised of 7 appointments, sessions were recorded and given to participants on a small MP3 player to take away and use at any time. The audio recordings of therapy were listened to by the senior clinical researchers in charge of the study to ensure that treatment was delivered correctly. Throughout involvement in the study all other care and treatment remained the same, unless changed by the participant's consultant or GP.

Summary of findings

We have now completed the AVATAR research study and are delighted to share the exciting findings.

Between Nov 1, 2013, and Jan 28, 2016, 394 people were referred to the study, 150 people were eligible and randomly assigned to receive either AVATAR Therapy (n=75) or Supportive Counselling (n=75). Across both therapy groups, 1030 therapy sessions were offered to the participants.

In general, people who took part in the study did very well. However, the improvement in voices after therapy which was our main outcome (assessed as frequency and severity) was greater for those who had AVATAR Therapy than for Supportive Counselling. This was at 12 weeks and was statistically significant, with a large effect. Importantly, these improvements were maintained when researchers met participants again at 24 weeks. People who received Supportive Counselling also showed some improvements by 24 weeks. There was no evidence of any adverse events attributable to either therapy.