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AVATAR Therapy Shows Promise in Schizophrenia Treatment



Man with schizophrenia smoking a cigarette

A new study published in The Lancet Psychiatry has found that the use of avatars representing auditory hallucinations of persons with schizophrenia, can help reduce symptoms of this disorder in affected patients. The study involved a comparison between avatar therapy and supportive counselling, finding that the former was significantly more effective at reducing hallucinations. The study is the first to look into the effectiveness of avatar therapy on patients who continue to have hallucinations despite medication and other treatments.

A New and Promising Approach to Schizophrenia

The study is promising for a vast majority of persons with schizophrenia, since around 70% of them have auditory hallucinations that can be uncomfortable and distressing. Around 25% of people who are treated for hallucinations continue to suffer them, even while receiving treatment.

Schizophrenia Underdiagnosed and Undertreated on a Worldwide Level

According to the World Health Organization, around 50% of people with schizophrenia do not receive appropriate care. Although approximately 90% of untreated persons come from low- and middle-income countries, even in countries where the majority of people are protected in terms of financial costs of mental illness, patients can be reticent to receive treatment because they find that standard medication can fail to have the required effect. Cognitive behavioral therapy (CBT), meanwhile, can be costly and lengthy, and while it is the gold standard treatment for many mental conditions, its effect on auditory hallucinations (‘voices’) can be limited.

Face to Face Discussions with Once Internal Voices

The study involved the participation of 150 patients who had been battling schizophrenia for 20 years, and who heard between three and four voices on average. Half this group had AVATAR Therapy and the other had counselling which was specifically created for the study. Participants also took their usual medication during the treatment.
Prior to treatments, therapists worked with patients to simulate particular voices (the messages given, the way they sounded, and how the avatar should look). During therapy, the patient had face-to-face ‘conversations’ with the avatar, in the presence of the therapist.

Sessions lasted between 10 and 15 minutes, and the aim was for the patient to ‘take control’ of the conversation so that the avatar ‘acknowledged’ the patient’s power of decision. Patients were then given an audio recording to listen to when they began hearing voices again at home.

In addition to finding that the number of hallucinations dropped, patients in the AVATAR group also found the voices less distressing and powerful. They were therefore able to take this newfound sense of control to their daily lives. Further research is currently being conducted to understand the mechanisms that make avatar therapy successful. As noted by Dr. Ben Alderson-Day, who conducted the study, “Technology can both obscure and enhance our view of reality, but in the case of AVATAR it seems to provide a powerful method of personifying and externalising an otherwise internal and often intrusive phenomenon.”

The study showed that AVATAR Therapy is quick to control auditory hallucinations; moreover, improvements can last for up to six months. Researchers noted that further investigation was necessary to improve the delivery of treatment and to analyse possible effectiveness in other settings, though they are pleased with the results and hope AVATAR Therapy can play an important role in reducing both the frequency and intensity of stubborn hallucinations.

Craig TKJ, Rus-Calafell M, Ward T, Leff JP, Huckvale M, Howarth E, Emsley R, Garety PA (2017) AVATAR therapy for auditory verbal hallucinations in people with psychosis: a single-blind, randomised controlled trial The Lancet Psychiatry DOI:



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