Plain English Summary
Background and study aims
The experience of distressing voices that persist despite medical treatment is a serious problem for many patients suffering from severe mental health problems. Avatar therapy is a new computer-assisted therapy that has shown some benefit in a small pilot study. The aim of the present study is to test whether avatar therapy is more effective than supportive counselling.
Who can participate?
Anyone aged over 18 who has experienced voices speaking in English that have persisted for at least 12 months despite medical treatment.
What does the study involve?
After consenting to take part, a researcher will ask you questions about the voices you hear, your mental and physical health and how the voices affect the quality of your life. You will then be randomly allocated to either avatar therapy or supportive counselling. Random allocation means by chance, a bit like flipping a coin. It is a way of testing two treatments by ensuring that researchers are not being biased in the choice of the two treatments. If you are allocated to the avatar therapy, we will help you to use a computer program to develop an 'avatar' (image and voice) similar to the person or entity whose voice bothers you. The therapist will use this avatar in the therapy sessions to talk with you and help you to practice ways of coping with the voices. If you are allocated to supportive counselling, you will not create or use the avatar but will talk with the therapist about the voice, your everyday life and how you are feeling more generally. Both types of treatment are given over six sessions of a half-hour each. All treatment sessions are recorded and you will be given these recordings on a small MP3 player to take away to use on your own at any time. After the six therapy sessions a researcher will ask you the same questions we asked before you started therapy. We will then contact you again at 12 and 24 weeks from when you joined the study to see whether any improvement has continued. We will also be interested in your views about the therapy and how it may be improved in future.
What are the possible benefits and risks of participating?
The possible benefits are reductions in the frequency, severity and distress caused by the voices. The risks are that the treatment may be distressing and may not be effective.
Where is the study run from?
Clinics in the South London and Maudsley NHS Foundation Trust (UK).
When is the study starting and how long is it expected to run for?
The study will be starting in the early summer of 2013 and is expected to run for 3 years.
Who is funding the study?
The study is being funded by the Wellcome Trust (UK).
Who is the main contact?
Professor Thomas J Craig
Prof Thomas Jamieson Craig
PO 33 HSPRD
Institute of Psychiatry
De Crespigny Park
Reducing the frequency and severity of auditory hallucinations: a randomised clinical trial of a novel Audio-Visual Assisted Therapy Aid for Refractory auditory hallucinations (AVATAR) compared to supportive counselling
AVATAR therapy will result in a greater decrease in the frequency and subjective severity of auditory hallucinations than is achieved by supportive counselling.
NRES Committee London - Hampstead, 26/04/2013, REC ref: 13/LO/0482
Single-centre pragmatic two-arm observer-blind randomised controlled trial
Primary study design
Secondary study design
Randomised controlled trial
Patient information sheet
Not available in web format, please use the contact details below to request a patient information sheet
Severe mental illness
1. AVATAR therapy: an average of 6 x ½ hour weekly sessions
2. CONTROL therapy: supportive counselling also for 6 x ½ hour weekly sessions
Six sessions of a half an hour each, once per week
Primary outcome measures
Total score on the auditory hallucinations component of the Psychotic Symptoms Rating Scale PSYRATS-AH (Haddock et al., 1999), measured at baseline, 8 weeks, 12 weeks and 6 months
Secondary outcome measures
1. Beliefs about Voices Revised BAVQ-R (Chadwicket al., 2000)
2. Voices Acceptance and Actions Scale (Shawyer et al., 2007)
3. Voice power differential scale (Birchwood et al., 2000)
1. Scales for the Assessment of Positive and Negative Symptoms (SAPS/SANS - Andreasen,1984)
2. Psychotic Symptoms Rating Scale- Delusions (Haddock et al., 1999)
3. Beliefs about problems (Watson et al., 2006)
4. Calgary Depression Scale (Addington et al., 1993)
Quality of life:
1. Manchester Short Assessment of Quality of Life - MANSA (Priebe et al., 1999)
2. EQ5-D (EuroQol, 1999)
Client service receipt inventory (Beecham and Knapp, 2001)
Measured at baseline, 8 weeks, 12 weeks and 6 months
Overall trial start date
Overall trial end date
Participant inclusion criteria
Male or female, aged 18+ who have experienced persistent auditory hallucinations despite medical treatment
Target number of participants
Participant exclusion criteria
1. Age under 18
2. Primary diagnosis of organic brain disease or substance dependency
3. Auditory hallucinations in a language not spoken by therapists
Recruitment start date
Recruitment end date
Countries of recruitment
Trial participating centre
PO 33 HSPRD
King's College London (UK)
c/o Keith Brennan
Director of Research Management
Room 1.8 Hodgkin Building
Guys Campus King's
Wellcome Trust (UK), FWBC-AVATAR 098272/z/12/z
Funding Body Type
private sector organisation
Funding Body Subtype
Results and Publications
Publication and dissemination plan
Not provided at time of registration
Intention to publish date
Participant level data
Not provided at time of registration
Results - basic reporting
2015 protocol in: http://www.ncbi.nlm.nih.gov/pubmed/26269098