Patients suffering from schizophrenia who were unresponsive to medication learned to control their auditory hallucinations with the help of a computer program that uses an avatar of their imaginary persecutor, according to research by British scientists.
The Wellcome Trust, the world's second-largest biomedical funder, announced today that it will give University College London and King's College London $2 million to test "avatar therapy" in more patients.
Schizophrenia is a condition that affects the thinking, feeling and behaviour of around one in 100 people. A quarter of these are not helped by medication. Avatar therapy reduced the frequency and intensity of auditory hallucinations in patients in the British study. It also reduced the disruption to patients’ lives and the delusions they developed around the voices. Three patients stopped “hearing voices” altogether.
“Many of the patients learned to deal with their voices and tell them to go away,” Julian Leff, an emeritus professor at University College London who led the research published in the February issue of the British Journal of Psychiatry , told Bloomberg in a telephone interview .
The computer software uses gaming technology. One of Leff's colleagues combined 3D facial imaging software FaceGen with animation software to allow patients to create a face and voice that represented their abuser. Leff then spoke to the patient through the modified voice until the patient regained control.
The researchers recorded the sessions on MP3 players so that patients could listen to them again as a reminder of their ability to cope with and overcome the voices that terrify and disorient them.
The trial involved 26 patients aged 14 to 74 who had not been helped by antipsychotic drugs such as Seroquel and Abilify. They received either usual care or up to seven “avatar therapy” sessions lasting up to 30 minutes.
“It’s short and it’s very easy to administer,” says Tom Craig, a professor of psychiatry at the Institute of Psychiatry at King’s College London, whom Leff trained to deliver the treatment. Those in the control group were offered the treatment at the end. After treatment, the patients were assessed by a psychiatrist on widely used scales to assess psychiatric symptoms, their beliefs about the voices and their depression.
The overall effect of avatar therapy was at least twice as good as that of another non-drug treatment for schizophrenia, cognitive behavioral therapy, Leff says. The approach was likely effective for the mental illness because the avatar and its voice were the patient's creation, and the image of the oppressor's voice gave credibility to the patient's experience, Leff says.
"One patient after two sessions said 'the voice was gone,'" Leff said. "He had been hearing this voice all the time for three and a half years. It would wake him up at 5 a.m. and continue throughout the day. He said 'it was like it left the room.'".
Another patient was a successful businessman until he started hearing the devil's voice 16 years ago, followed his advice, and lost all his money, Leff says. The voice died down as the patient was leaving the hospital after his second session of therapy. "He came back to see me in the third session and said, 'He's gone, he's stopped talking to me,'" Leff says. "He said, 'Thank you for giving me my life back.'".
The treatment initially had no effect on the patients' depressive symptoms, although at follow-up assessments three months later, they reported significant improvement, the study found. Suicidal thoughts also decreased, which is important for patients who face a 10 percent risk of suicide, Leff said. "Quite often they're told by a voice to jump off a bridge or under a train," he says.
Leff and his colleagues had difficulty recruiting enough people for the pilot study because, he says, other doctors were hesitant to refer their patients to an unproven treatment. Only 16 of the 26 patients completed the trial, he says. Some were terrorized by voices threatening to harm them if they participated. “The voices, which can be particularly brutal, end up telling patients, ‘If you try this treatment, I will kill you,’” Leff explains.
The treatment is not recommended for every patient with schizophrenia, Leff notes. Those who hear more than one voice have had difficulty concentrating when interrupted by other voices. Some patients enjoy their auditory hallucinations, like one young man Leff did not include in the trial because the voice he heard was that of a producer broadcasting his favorite football game.
The Wellcome Trust is interested in the research because mental illnesses such as schizophrenia and depression take a significant toll on health, says John Williams, the trust's head of neuroscience and mental health. "One of our biggest challenges is understanding the brain," he adds.
The pilot study was funded by the UK's National Institute for Health Research and the Camden and Islington NHS Foundation Trust. The Wellcome Trust-funded trial will involve 140 patients aged 18 and over at centres in the UK, Vienna and Bologna, Italy. It will primarily measure the reduction in anxiety caused by voices, Craig says.
