THE AVATAR PROJECT

The Avatar Project is a single-blind, randomized controlled clinical trial comparing Avatar Therapy to Cognitive Behavioral Therapy.

The goal is to enable patients with treatment-resistant schizophrenia to develop better control over the intrusive and disruptive manifestations of the voices they hear. We aim to compare the efficacy of Avatar Therapy, which uses virtual reality, with that of Cognitive Behavioral Therapy (CBT) adapted for psychosis. Once scientifically validated, Avatar Therapy appears to be a promising complement to existing pharmacological treatments and could become an integral part of our clinical practices.

Objectives

Avatar Therapy differs from CBT in its dialogic approach: it allows patients to engage directly with their persecutory voices and to put new coping strategies into practice.

The goal of the Avatar Project is to develop a clinical treatment to reduce hallucinations and residual symptoms of schizophrenia and to improve quality of life for patients with treatment-resistant schizophrenia.

Study Protocol

The trial includes 136 participants: 68 patients will undergo Avatar Therapy, and the other 68 will receive specialized CBT.

First, participants will complete a 4-hour pre-treatment clinical assessment, which is conducted in two stages. They will then be randomly assigned to one of the two treatment groups. An external online service will handle this randomization. Avatar Therapy, like CBT, consists of 9 weekly one-hour sessions. Afterward, participants will complete a 4-hour post-treatment clinical assessment, which, like the pre-treatment assessment, takes place in two stages. At 3, 6, and 12 months after the end of their treatment, participants will complete a 2-hour follow-up assessment.

Thus, patients will be invited to 7 assessment appointments (2 pre-treatment appointments, 2 post-treatment appointments, and 3 follow-up appointments). They will receive compensation of $20 per appointment.

Since this is a single-blind trial, the research nurses conducting the clinical evaluations will not know which therapy each patient received. It is therefore important that participants do not disclose this information to them.

Whether assigned to Avatar Therapy or CBT, each participant will receive supportive therapy.

Measures

Various clinical questionnaires, completed during pre-treatment, post-treatment, and follow-up evaluations, will allow the research team to compare the effectiveness of the therapies. Administered as interviews with our research nurses, these questionnaires assess the effects of the therapy on hallucinations, schizophrenia symptoms, quality of life, and emotional regulation.

AVATAR THERAPY FOR schizophrenia

An Innovative Treatment for Treatment-Resistant Schizophrenia

Hallucinations in the form of persecutory voices—which patients with treatment-resistant schizophrenia often hear—have significant and debilitating effects.

Avatar Therapy uses virtual reality to recreate the faces and voices of the patients’ persecutors in the form of avatars. This unprecedented therapy thus allows patients to engage in dialogue with an external representation of their hallucinations within the virtual environment. In doing so, it encourages the learning of new strategies to control the persecutory voices.

How does the therapy work?

Avatar Therapy consists of 9 sessions of 60 minutes each, with different objectives for each session. It targets one persecutory voice at a time.

First, 3D virtual reality technologies create a visual representation of the verbal persecutor based on the patient’s mental image of that voice. These precise and advanced technologies enable the creation of a realistic virtual avatar bearing the physical characteristics of the hallucinated voice. Additional technologies modify the treating psychiatrist’s voice to resemble that of the verbal hallucination, while ensuring proper prosody and lip-syncing.

The treating psychiatrist then conducts a series of therapeutic sessions through which various therapeutic goals are addressed. Each session begins with a discussion between the patient and the psychiatrist. This discussion provides an opportunity to review recent events, assess the patient’s progress, and set the session’s objectives. Once in the virtual environment, the patient engages in dialogue with the persecutor avatar, played by the treating psychiatrist. The psychiatrist guides the exchanges to stimulate emotional regulation, rebuild self-esteem, and practice assertiveness. Finally, the psychiatrist and the patient review the virtual world immersion experience and set the next objectives.

In conclusion, by simulating treatment-resistant auditory hallucinations through the creation of a 3D avatar, patients develop the ability to self-manage their verbal auditory hallucinations, thereby improving their symptoms.

What Are the Therapeutic Targets?

Avatar Therapy has five main therapeutic targets. The first is the emotional response to the voices, which centers on the emotional spectrum induced by the voices. The second is cognition regarding the voices, which addresses the patient’s ability to reflect on the origin, controllability, power, and meaning of the voices. The third is self-perception, which relates to the patient’s observations and beliefs about themselves. The fourth is coping strategy, which refers to the set of techniques the patient develops during therapy to manage their interactions with the avatar and, by extension, with the voices. The final therapeutic target is aspirations, which highlights the patient’s stance toward their avatar regarding their hopes and desires for the future.

CALL FOR PARTICIPANTS (ELIGIBILITY CRITERIA):

We are currently recruiting new participants. Here are the eligibility criteria:

Please feel free to refer a friend or family member—or sign up yourself—to take part in this study!