Title: Optimising AVATAR therapy for distressing voices: a multi-centre randomised controlled trial
Funder: Wellcome Trust

Abstract: A VA TAR therapy is a brief intervention aimed at reducing the frequency of auditory verbal hallucinations (A VH, henceforth 'voices'). It involves the use of a digital simulation (avatar) of the entity the person believes is the source of the voice in a three-way discussion between participant, avatar and therapist, focussing initially on managing anxiety and helping the participant to stand up to the avatar (phase 1) followed by a realistic enactment of the ascribed character of the voice, targeting processes that are specific to an individualised formulation (phase 2). The first fully powered RCT found AVATAR therapy resulted in a rapid and substantial fall in frequency and associated distress of voices that was superior to a supportive counselling control condition at 12 weeks. In the current study we have four main goals. First, a multicentre RCT to examine the effects of high and low intensity A VA TAR therapy (where high intensity involves both phases and low intensity only phase 1) by comparing each to a treatment as usual comparator, and to identify who would be likely to benefit from the high intensity therapy versus those for whom low intensity alone would be sufficient. Second, to examine the relative cost-effectiveness of the two levels of A VA TAR therapy and routine treatment. Third, to broaden the availability of AVATAR therapy by expanding the number of staff trained in geographically dispersed NHS settings. Finally, to provide the evidence on effects and cost-effectiveness necessary to take AVAVAR therapy to recommendation by guideline bodies such as NICE.

Lay abstract: AVATAR therapy is a brief intervention aimed at reducing the frequency of auditory verbal hallucinations (AVH, henceforth ‘voices’). It involves the use of a digital simulation (avatar) of the entity the person believes is the source of the voice in a three-way discussion between participant, avatar and therapist, focussing initially on managing anxiety and helping the participant to stand up to the avatar (phase 1) followed by a realistic enactment of the ascribed character of the voice, targeting processes that are specific to an individualised formulation (phase 2). The first fully powered RCT found AVATAR therapy resulted in a rapid and substantial fall in frequency and associated distress of voices that was superior to a supportive counselling control condition at 12 weeks. In the current study we have four main goals. First, a multicentre RCT to examine the effects of high and low intensity AVATAR therapy (where high intensity involves both phases and low intensity only phase 1) by comparing each to a treatment as usual comparator, and to identify who would be likely to benefit from the high intensity therapy versus those for whom low intensity alone would be sufficient. Second, to examine the relative cost-effectiveness of the two levels of AVATAR therapy and routine treatment. Third, to broaden the availability of AVATAR therapy by expanding the number of staff trained in geographically dispersed NHS settings. Finally, to provide the evidence on effects and cost-effectiveness necessary to take AVAVAR therapy to recommendation by guideline bodies such as NICE.

Research activity codes: 6.6 PSYCHOLOGICAL AND BEHAVIOURAL
Health categories: MENTAL HEALTH