What is AVATAR therapy?

What is AVATAR therapy, what does it involve, and how can it help you? We explain more about the new therapy that looks to improve the quality of life for people who hear voices

A new approach to working with distressing voices could be on the horizon. It’s estimated as many as one in 10 experience auditory hallucinations (or ‘hearing voices’) on a more regular basis. For some people, these voices may be scary saying things that are abusive or persecutory, while for others, they may hear more comforting things. 

A new kind of therapy, AVATAR therapy, combines the use of digital technology and therapy to create a ‘face-to-face’ dialogue between individuals who hear voices, and a computerised representation of that voice. 

What is AVATAR therapy?

AVATAR therapy looks to improve the quality of life for people who hear voices. First created by Julian Leff and Mark Huckvale at the University College London (LCL) and developed through collaboration with King’s College London (KCL) and support of the Wellcome Trust (a charitable foundation focused on health research), trial results published in 2024 suggest that combining AVATAR therapy with standard treatments may lead to improvements in voice-related symptoms among those with psychosis who hear distressing voices. 

Research so far into AVATAR therapy has shown a reduction in the frequency of hallucinations and reductions in distress. Positive results were shown in both a small pilot study and a randomised controlled trial with 345 participants, comparing AVATAR therapy to supportive counselling amongst people who experienced unremitting voices (continued voices) for at least a year despite receiving medical treatment. Results showed a statistically and clinically significant benefit that was substantially greater than just using the existing gold-standard cognitive behaviour therapy for psychosis. 

What does AVATAR therapy do? What to expect from AVATAR therapy

AVATAR therapy offers a therapeutic focus on increasing the individual’s power and control over the voice that may be causing them distress or upset by bringing their experience into therapy in a new, powerful way.  It does this by using computer software to create a visual and auditory representation of the person’s hallucinated voice, empowering them to stand up to the voice and take control. 

Once, with the help of their therapist, they have created an avatar that looks and sounds like the main voice they hear, they sit with a computer with the avatar on-screen while a therapist sits apart from them and speaks as either themself or uses software to transform their speech to speak as the avatar. AVATAR therapy involves creating a three-way conversation between the person hearing voices, their therapist, and the avatar.

Lasting for multiple sessions (six or 12), therapists shape the dialogue in response to the individual’s efforts. Each session records the dialogue between the therapist, client and avatar to allow the individual to listen to the conversation again outside of the sessions.

Brief AVATAR therapy currently takes place over six sessions, while Extended AVATAR therapy takes place over 12. Both kinds of sessions involve the voice hearer spending 10-15 minutes speaking face-to-face with the avatar. During this time, they practice standing up to it, correcting misconceptions it has about them, and being more in control of the conversation. For the rest of each session, the therapist and individual discuss broader aspects of the voice hearer’s life in an aim to reduce anxiety and increase their sense of power.

Extented AVATAR therapy sessions also allow more time to share and explore earlier life experiences and relationships.

What can AVATAR therapy help with?

AVATAR therapy is designed to help people who hear voices. 

Hearing voices can be caused by any number of different mental health conditions, including schizophrenia, psychosis, severe depression, bipolar disorder, borderline personality disorder, eating disorders, PTSD, dissociative identity disorder, OCD, and schizoaffective disorder. Research has also shown that some people may hear voices or have other hallucinations without having mental illness. 

Currently, there are a number of different treatment options for people who experience auditory hallucinations. These range from talking therapies to medication or a combination, depending on the individual’s needs and what works best for them. While these treatments often help individuals, many people report continuing to hear voices for years. According to experts, as many as a third of people experiencing auditory hallucinations find it impacts their ability to work, maintain relationships, and manage everyday tasks. 

AVATAR therapy looks at the individual’s relationship with the voice that they hear in connection with current and previous significant relationships. Possible roles of early trauma, and unresolved social and emotional issues are considered throughout AVATAR therapy. Over the course of the sessions, AVATAR therapy looks to negotiate a transfer of power and control from the voice (avatar) to the individual. Gradually, the avatar’s character becomes more conciliatory or helpful, leading to a second phase where sessions can focus more on self-esteem and identity. 

Is AVATAR therapy available in the UK?

AVATAR therapy is still in the early stages. While there have been trials including a study of 345 people, funded by the Wellcome Trust, there are currently only around 30 trained therapists in AVATAR therapy.

As of March 2024, the National Institute for Health and Care Excellence (NICE) published an early value assessment of AVATAR therapy, which suggested that it would be suitable for use within the NHS. As of 2024, it is not yet available, but is in the process of transitioning from research into clinical use. 

Finding help, support, and treatment for auditory hallucinations

There are currently a number of different talking therapies recommended to help support those who hear voices. 

• Psychotherapy can be particularly helpful for those who hear voices related to previous trauma. A psychotherapist can help you better understand how to come with voices and understand why they are saying what they are saying. 
• CBT (cognitive behavioural therapy) can help to reduce anxiety you are feeling around hearing voices and can help you gain control and stand up to them, but doesn’t look at the underlying reasons why you may be experiencing voices. 
• CFT (compassion-focused therapy) is an approach that can work well for people experiencing critical voices. 
• MBCT (mindfulness-based cognitive therapy) combined mindfulness and CBT to help you learn to regain your focus and manage how you feel about hearing voices. 

Antipsychotic medication may also be prescribed if you find it difficult to manage your voices, as this can help stop the voices, make them less frightening, or help you feel more indifferent to them.

Talking with others with similar experiences can also be a huge help. Local and online support groups can provide a space for you to discuss your experiences, feel connected and feel less alone, while offering support and sharing what’s helped others. The Hearing Voices Network has a helpful list of support groups for hearing voices available in England and online