title: Computer-assisted therapy for medication-resistant auditory hallucinations: proof-of-concept study.
abstract: BACKGROUND
  One in four patients with schizophrenia responds poorly to antipsychotic medication, continuing to hear persecutory auditory hallucinations. Patients who are able to sustain a dialogue with their persecutor feel much more in control.
  
  
  OBJECTIVE
  To develop a computerised system that enables the patient to create an avatar of their persecutor. To encourage them to engage in a dialogue with the avatar, which the therapist is able to control so that the avatar progressively yields control to the patient.
  
  
  METHODS
  Avatar therapy was evaluated by a randomised, single blind, partial crossover trial comparing the novel therapy with treatment as usual (TAU). We used three main outcome measures: (a) the Psychotic Symptom Rating Scale (PSYRATS), hallucinations section; (b) the Omnipotence and Malevolence subscales of the Revised Beliefs About Voices Questionnaire (BAVQ-R); and (c) the Calgary Depression Scale (CDS).
  
  
  RESULTS
  The control group showed no change over time in their scores on the three assessments, whereas the novel therapy group showed mean reductions in the total PSYRATS score (auditory hallucinations) of 8.75 (P = 0.003) and in the BAVQ-R combined score of omnipotence and malevolence of the voices of 5.88 (P = 0.004). There was no significant reduction in the CDS total score for depression. For the crossover control group, comparison of the period of TAU with the period of avatar therapy confirmed the findings of the previous analysis. The effect size of the therapy was 0.8.
  
  
  CONCLUSIONS
  Avatar therapy represents a promising treatment for medication-resistant auditory hallucinations. Replication with a larger sample is required before roll-out to clinical settings.
authors: Department of Mental Health Sciences, Royal Free and University College Medical School, London, UK. j.leff@ucl.ac.uk
authors: Julian
authors: J
authors: Leff
authors: Geoffrey
authors: G
authors: Williams
authors: Mark A
authors: MA
authors: Huckvale
authors: Maurice
authors: M
authors: Arbuthnot
authors: Alex P
authors: AP
authors: Leff
mesh_terms: D018592:Cross-Over Studies; D005260:Female; D006212:Hallucinations / Q000628:therapy*; D006801:Humans; D008297:Male; D016037:Single-Blind Method; D011795:Surveys and Questionnaires; D013813:Therapy, Computer-Assisted / Q000379:methods*; D016896:Treatment Outcome