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Psychosis. 2014 Jun;6(2):166-176. Epub 2013 Mar 4.

Avatar therapy for persecutory auditory hallucinations: What is it and how does it work?

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University College London, Mental Health Sciences, 1 South Hill Park Gardens, London, NW3 2TD, United Kingdom.
University College London, Hearing, Speech and Phonetic Sciences, Chandler House, 2 Wakefield Street, London, WC1N 1PF, United Kingdom.
University College London, Speech, Hearing and Phonetic Sciences, Chandler House, 2 Wakefield Street, London, WC1N 1PF, United Kingdom.
University College London, Mental Health Sciences, Flat D, Bentley House, Kings Scholar Passage, London, SW1P 1NN, United Kingdom.
Institute of Cognitive Neuroscience, Brain Repair and Rehabilitation, Institute of Neurology, Queen Square, London, WC1N 3BG, United Kingdom.


We have developed a novel therapy based on a computer program, which enables the patient to create an avatar of the entity, human or non-human, which they believe is persecuting them. The therapist encourages the patient to enter into a dialogue with their avatar, and is able to use the program to change the avatar so that it comes under the patient's control over the course of six 30-min sessions and alters from being abusive to becoming friendly and supportive. The therapy was evaluated in a randomised controlled trial with a partial crossover design. One group went straight into the therapy arm: "immediate therapy". The other continued with standard clinical care for 7 weeks then crossed over into Avatar therapy: "delayed therapy". There was a significant reduction in the frequency and intensity of the voices and in their omnipotence and malevolence. Several individuals had a dramatic response, their voices ceasing completely after a few sessions of the therapy. The average effect size of the therapy was 0.8. We discuss the possible psychological mechanisms for the success of Avatar therapy and the implications for the origins of persecutory voices.


avatar therapy; child abuse; client-centred therapy; defence mechanisms; hearing voices; treatment outcome research

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