Virtual Reality Avatar Therapy for People Hearing Voices

Hearing voices is probably the worst form of acoustic hallucinations; which can be experienced as severely disturbing and is influenced by diverse factors including the ability of the individual to influence and control the hallucinatory experience itself. In recent years virtual reality has become a treatment option. In the so-called AVATAR Therapy, patients with schizophrenia and acoustic hallucinations design a visual and auditory recreation (avatar) of the entity to which they attribute their hallucinations. Working with a therapist over the course of several sessions, participants change the avatar from controlling to benevolent. Avatar Therapy involves similar processes to learning and cognitive restructuring, comparable to other psychotherapeutic interventions. The investigators plan to conduct an interventional study using a cross-over design, to compare the feasibility and efficacy of virtual reality avatar therapy for patients with acoustic hallucinations (independent of psychiatric diagnosis) with a cognitive behavioural group therapy aimed to improve social competence.

Study Overview

• Status: Recruiting
• Conditions: Schizophrenia; Psychosis; Schizo Affective Disorder; Hearing Voices When No One is Talking (Symptom)
• Intervention / Treatment: Behavioral: Virtual Reality Avatar Therapy (VRAT); Behavioral: Assertiveness Training Program (ATP)

• Study Type: Interventional
• Enrollment (Estimated): 100
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Stephan T. Egger, MD; Phone Number: +41523049340; Email: stephan.egger@puk.zh.ch

Study Locations

• Switzerland
  • Zürich, Switzerland, 8032
    • Recruiting
    • Psychiatrische Universitätsklinik Zürich
    • Contact: Stephan T Egger, MD; Phone Number: +4152304940; Email: stephan.egger@puk.zh.ch
    • Contact: Godehard Weniger, MD; Phone Number: +41523049341; Email: godehard.weniger@puk.zh.ch

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 16 years to 63 years (Adult, Older Adult)
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Consistent acoustic hallucinations, with the presence of voices for at least two months.
• Participants are competent to give informed consent, as determined by the referring physician or psychiatrist.
• German language proficiency as a native speaker or level B1 Common European Framework of Reference for Languages (CEFRL)

Exclusion Criteria:

• Current neurological disorder.
• Current substance use or withdrawal.
• Concomitant group psychotherapeutic intervention.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Crossover Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Virtual Reality Avatar Therapy (VRAT); In the VRAT, patients with schizophrenia and acoustic hallucinations design a visual and auditory recreation (avatar) of the entity to which they attribute their hallucinations. Working with a therapist over the course of several sessions, participants change the avatar from controlling to benevolent.	Behavioral: Virtual Reality Avatar Therapy (VRAT); The Virtual Reality Avatar Therapy (VRAT) is a Cognitive Behavioral Intervention, delivered through Virtual Reality.; Behavioral: Assertiveness Training Program (ATP); The Assertiveness Training Program (ATP) is a Cognitive Behavioral Intervention, delivered as group therapy.
Active Comparator: Assertiveness Training Program (ATP); The ATP is a transdiagnostic cognitive behavioural treatment programme, which aims to increase self-confidence and social competence in patients with a psychiatric disorder.	Behavioral: Virtual Reality Avatar Therapy (VRAT); The Virtual Reality Avatar Therapy (VRAT) is a Cognitive Behavioral Intervention, delivered through Virtual Reality.; Behavioral: Assertiveness Training Program (ATP); The Assertiveness Training Program (ATP) is a Cognitive Behavioral Intervention, delivered as group therapy.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Psychopathological Assessment	Symptom Questionnaire	Change: Baseline, 3, 6 weeks, 6 and 12 months]

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Psychotic Symptoms	Symptom Questionnaire	Change: Baseline, 3, 6 weeks, 6 and 12 months]
Insecurity- Self-confidence	Symptom Questionnaire	Change: Baseline, 3, 6 weeks, 6 and 12 months]

Collaborators and Investigators

• Sponsor: Psychiatric University Hospital, Zurich

Publications and helpful links

General Publications

• Craig TK, Rus-Calafell M, Ward T, Leff JP, Huckvale M, Howarth E, Emsley R, Garety PA. AVATAR therapy for auditory verbal hallucinations in people with psychosis: a single-blind, randomised controlled trial. Lancet Psychiatry. 2018 Jan;5(1):31-40. doi: 10.1016/S2215-0366(17)30427-3. Epub 2017 Nov 23. Erratum In: Lancet Psychiatry. 2017 Nov 29;:
• Brander M, Egger ST, Hurlimann N, Seifritz E, Sumner RW, Vetter S, Magnenat S. Virtual Reality Human-Human Interface to Deliver Psychotherapy to People Experiencing Auditory Verbal Hallucinations: Development and Usability Study. JMIR Serious Games. 2021 Jun 1;9(2):e26820. doi: 10.2196/26820.

Study record dates

Study Major Dates

• Study Start (Actual): July 1, 2021
• Primary Completion (Estimated): May 30, 2025
• Study Completion (Estimated): December 31, 2025

Study Registration Dates

• First Submitted: September 18, 2019
• First Submitted That Met QC Criteria: September 19, 2019
• First Posted (Actual): September 23, 2019

Study Record Updates

• Last Update Posted (Actual): September 28, 2023
• Last Update Submitted That Met QC Criteria: September 26, 2023
• Last Verified: September 1, 2023

More Information

Terms related to this study

• Keywords: Hearing Voices, Virtual Reality Avatar Therapy, Cognitive Behavioural Therapy
• Additional Relevant MeSH Terms: Mental Disorders; Schizophrenia Spectrum and Other Psychotic Disorders; Schizophrenia; Psychotic Disorders; Mood Disorders
• Other Study ID Numbers: VRAT- ATP

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No