The therapist talks to the patient through a computer-generated avatar of the "face" of their hallucinations

Computer avatars help treat schizophrenics

Psychiatrists are using computer avatars to help people with schizophrenia control the voices in their heads.

In a pilot study of 16 patients who underwent the experimental treatment, known as "avatar therapy", doctors found almost all of them reported a reduction in how often they heard voices and how severe the distress caused by them was.

The first stage in the therapy is for the patient to create a computer-based avatar by choosing a face and a voice for the entity they believe is talking to them.

The system then synchronises the avatar's lips with its speech, enabling a therapist to speak to the patient through the avatar in real time. The therapist encourages the patient to oppose the voice and gradually teaches them to take control of their hallucinations.

"Even though patients interact with the avatar as though it was a real person, because they have created it they know that it cannot harm them, as opposed to the voices, which often threaten to kill or harm them and their family," says Professor Julian Leff, who developed the therapy.

"The therapy helps patients gain the confidence and courage to confront the avatar, and their persecutor."

Schizophrenia is a psychiatric disorder that affects around one in 100 people worldwide. Its most common symptoms are delusions and auditory hallucinations, or hearing voices.

Leff, a professor of mental health sciences at University College London, says patients often told him the voices were the worst feature of their condition.

"They can't think properly, they can't concentrate, they can't work and they can't sustain social relationships," says Leff.

In the pilot study, three of the patients, who until the trial had been tormented by voices for between 3.5 and 16 years, stopped hearing them completely after working with the avatar system.

Each therapy session was also recorded and given to the patient on an MP3 player "so that the patient essentially has a therapist in their pocket which they can listen to at any time when harassed by the voices", Leff says.

As a result of the early success, the medical charity The Wellcome Trust has given Leff's team £1.3m to test the therapy in a larger group of patients.

Thomas Craig, a psychiatrist who will lead the larger trial at King's College London's Institute of Psychiatry, says: “Auditory hallucinations are a very distressing experience that can be extremely difficult to treat successfully, blighting patients’ lives for many years.

“I am delighted to be leading the group that will carry out a rigorous randomised study of this intriguing new therapy with 142 people who have experienced distressing voices for many years.

“The beauty of the therapy is its simplicity and brevity. Most other psychological therapies for these conditions are costly and take many months to deliver.

“If we show that this treatment is effective, we expect it could be widely available in the UK within just a couple of years as the basic technology is well developed and many mental health professionals already have the basic therapy skills that are needed to deliver it.”

Current guidelines from the National Institute for Health and Care Excellence (NICE) recommend that schizophrenia is treated using a combination of medication and talking therapies, such as cognitive behavioural therapy, but fewer than one in ten patients with schizophrenia in the UK have access to this kind of psychological therapy.

Ted Bianco, director of Technology Transfer and acting director of the Wellcome Trust, says: “At a time when many companies have become wary about investing in drug discovery for mental health, we are delighted to be able to facilitate the evaluation of an alternative approach to treatment based on the fusion of a talking therapy with computer-assisted 'training'.

“In addition to the attraction that the intervention is not reliant on development of a new medication, the approach has the benefit of being directly testable in patients. Should the results of the trial prove encouraging, we expect there may be further applications of the basic strategy worth exploring in other areas of mental health.”

The Wellcome Trust has funded this project through its translational funding programme, which helps turn early-stage innovations into new health products by supporting researchers to advance the innovation to the point where it becomes attractive for further development by the medical industry or healthcare agencies.

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