Schizophrenia: Angry Avatars Help People Stop Hearing Voices by Shouting at Them

Avatar therapy involved the patient creating a digital avatar that represented the main voice plaguing them. The patient was then encouraged to defy the threats and insults hurled at them by the avatar. King’s College London and Maudsley Hospital

The most common hallucination experienced by people with schizophrenia is hearing voices. The voices often threaten and insult the sufferer, damaging the self-esteem of people already dealing with a difficult condition.

But a new study has shown that rude virtual avatars that hurl abuse at people with schizophrenia may actually help patients overcome their own voices by confronting the symptom head-on.

A study published Friday in The Lancet Psychiatry found that of 75 people who underwent "avatar therapy"—during which a therapist would use a virtual avatar to insult the patient, who then spoke back to and defied the avatar—seven people reported that they "completely stopped hearing their voices" after a three-month trial.

In another control group who received counseling rather than avatar therapy, only two people said that their hallucinations stopped.

The participants had all experienced distressing hallucinations for between one and 20 years and had taken antipsychotic medication for the condition. Experts said that while the study's results showed promise, further analysis would be needed to see whether avatar therapy could provide a useful means of treatment for people suffering from schizophrenia.

More than 21 million people around the world live with schizophrenia. The condition is characterized by distorted thinking and behavior and often living with "voices" from imaginary people. Common symptoms include hallucinations or delusions—holding false beliefs or suspicions, even if there is evidence to the contrary.

People with schizophrenia are often portrayed as having a split personality, but that is often not the case, according to mental health charity Mind. The condition is usually treated by a combination of mental health support, including counseling, and antipsychotic drugs.

Read more: The concept of schizophrenia is coming to an end—here's why

The trial involved a patient working with a therapist to create an avatar—a digital character or personality—that represented the main voice plaguing the patient. The patient would determine the voice, character and even image of the avatar.

The patient and therapist would then work through six 50-minute sessions in which the patient and avatar would confront one another. The therapist would coach the patient from another room over the computer speakers while also voicing the avatar.

People with schizophrenia sometimes experience auditory hallucinations—hearing voices—that can be disturbing. The avatar was created to sound like the voices the patients heard and to look how the patients imagined them. King’s College London and Maudsley Hospital

"You're rubbish. You're rubbish. You're a waste of space," were some of the phrases used by the avatar to undermine the patient. But the patient would be encouraged to respond defiantly, telling the avatar to "go away" or stop talking to them.

The therapist would encourage the patient to be more assertive, and gradually the avatar would begin to concede to the patient and praise their good qualities.

"The whole experience changes from something that's very frightening to something that's much more in the person's control," lead author Tom Craig, a professor at King's College London, told AFP.

After 24 weeks, however, the trial found that patients in both groups—those receiving avatar therapy and those receiving counseling—had achieved the same levels of improvement, suggesting that the therapy may need booster sessions to be effective in the long term.

Other experts welcomed the results but cautioned that more work was needed. "Further study is required to replicate these results, establish the role of such treatment versus others such as CBT [cognitive behavioral therapy] and clarify who might benefit most," said Stephen Lawrie, head of psychiatry at the University of Edinburgh, the BBC reported.

Brian Dow of Rethink Mental Illness, a U.K. charity, said that the results of the trial were "promising."