Photo By Marco Castellani via Wikimedia Commons
Schizophrenia is a chronic brain disorder that is present in about one percent of the world's population.When the disorder is active, symptoms can manifest like delusions, hallucinations, trouble with thinking, and a lack of motivation.While there is no cure for schizophrenia, treatment helps most people with the disorder who significantly improve over time.
Various researches on the disorder over the years has led to the discovery of newer, safer treatments.Researchers are also trying to unravel mysteries surrounding the disease by studying genetics, conducting behavioral research, and using advanced imaging to look at the brain's structure and function.
At least 60 percent of people with schizophrenia have auditory verbal hallucinations that are normally of a derogatory and threatening nature.Pharmacological therapy is considered an effective way of treating hallucinations but approximately 25 percent of patients with psychotic conditions continue experiencing the hallucinations even after the therapy.Cognitive behavioral therapy for psychosis has also been used although the effect sizes remain in the small to moderate range.Also, the training and sources required mean that the therapy reaches only a fraction of those of who might benefit.
As a result, there has been a need for the development of novel therapies that borrow the principles of cognitive behavioral therapy for psychosis.However, the therapies need to be much shorter, specifically targeting auditory verbal hallucinations, and need to be delivered by a much wider workforce.Researchers at the Kings College in London developed an experimental therapy involving a face-to-face discussion between a schizophrenia patient and an avatar representing their auditory hallucinations.The therapy was used alongside usual treatment methods in an attempt to help reduce symptoms.
Lead author, Professor Tom Craig from King's College London, in highlighting the importance of their experimental therapy, said, "A large proportion of people with schizophrenia continue to experience distressing voices despite lengthy treatment, so it is important that we look at newer, effective and shorter forms of therapy.Our study provides early evidence that avatar therapy rapidly improves auditory hallucinations for people with schizophrenia, reducing their frequency and how distressing they are, compared to a type of counseling."
Craig also claims that so far, these improvements appear to last for up to six months. "However, these results came from one treatment center, and more research is needed to optimize the way the treatment is delivered and demonstrate that it is effective in other NHS settings," he added.
The study took place at Maudsley hospital SHARP clinic and the Institute of Psychiatry, Psychology, and Neuroscience at King's College London, and involved 150 patients who had been suffering from schizophrenia for about 20 years and heard an average of three to four voices.The number of patients were divided in half with one half undergoing the avatar therapy and the other half undergoing a form of supportive counseling designed for this study.The patients also continued with their normal antipsychotic medication throughout the trial.
The avatar therapy was undertaken in over six sessions, with each session lasting 50 minutes and it was taken once a week.Before the therapy started, patients worked with therapists to create a computerized simulation (avatar) of the voice they were most comfortable with, including what the voice said, how it sounded, and how it could look.Therapy sessions involved a three-way conversation between the avatar, the patient and the therapist, with the therapist taking turns speaking as themselves and also voicing the avatar.
In each session, the patients started with discussing the targets for that day's work.Afterwards, the patients spent 10 to 15 minutes speaking face-to-face with the avatar.During that time they practiced standing up to it, correcting any misconceptions it had about them, and taking control of the conversation in an attempt to shift power from the avatar to the patient.The sessions were recorded and the audio recordings given to the patients.They were to listen to the recordings at home whenever they heard the voices.
The group undergoing supportive counseling also had a similar format, with the same number and length of sessions.Patients were encouraged to discuss any issues of concern to them and aimed to lessen distress and discuss practical ways of improving their quality of life.Patients were given a recorded positive message after the end of every session to listen to.
The patients' auditory hallucination assessments were completed by researchers who were oblivious to the type of treatment each patient had.After 12 weeks, the group that underwent avatar therapy sessions had symptoms which were less severe than those who underwent counseling.Patients on the avatar therapy also recorded less distressful and less powerful hallucinations.Additionally, seven people who underwent the avatar therapy and two people from the counseling group reported that their hallucinations disappeared after 12 weeks.
The study also found that the improvements seen in the avatar group stalled after 24 weeks.However, over that period, hallucinations continued being less frequent and less distressing for the counseling group, suggesting that counseling could also be a useful therapy.In the end, there were no differences in outcomes between the two groups at 24 weeks.
The researchers are aiming to conduct a cost-effectiveness analysis and further investigate the mechanisms of how the treatment reduces symptoms.