Department of Mental Health Sciences, Royal Free and University College Medical School, London, UK.
Br J Psychiatry. 2013 Jun;202:428-33. doi: 10.1192/bjp.bp.112.124883. Epub 2013 Feb 21.
One in four patients with schizophrenia responds poorly to antipsychotic medication, continuing to hear persecutory auditory hallucinations. Patients who are able to sustain a dialogue with their persecutor feel much more in control.
To develop a computerised system that enables the patient to create an avatar of their persecutor. To encourage them to engage in a dialogue with the avatar, which the therapist is able to control so that the avatar progressively yields control to the patient.
Avatar therapy was evaluated by a randomised, single blind, partial crossover trial comparing the novel therapy with treatment as usual (TAU). We used three main outcome measures: (a) the Psychotic Symptom Rating Scale (PSYRATS), hallucinations section; (b) the Omnipotence and Malevolence subscales of the Revised Beliefs About Voices Questionnaire (BAVQ-R); and (c) the Calgary Depression Scale (CDS).
The control group showed no change over time in their scores on the three assessments, whereas the novel therapy group showed mean reductions in the total PSYRATS score (auditory hallucinations) of 8.75 (P = 0.003) and in the BAVQ-R combined score of omnipotence and malevolence of the voices of 5.88 (P = 0.004). There was no significant reduction in the CDS total score for depression. For the crossover control group, comparison of the period of TAU with the period of avatar therapy confirmed the findings of the previous analysis. The effect size of the therapy was 0.8.
Avatar therapy represents a promising treatment for medication-resistant auditory hallucinations. Replication with a larger sample is required before roll-out to clinical settings.
四分之一的精神分裂症患者对抗精神病药物反应不佳，继续听到迫害性幻听。能够与迫害者进行对话的患者会感到更有掌控感。
开发一种计算机系统，使患者能够创建迫害者的化身。鼓励他们与化身进行对话，治疗师能够控制对话，以便化身逐渐将控制权交给患者。
通过随机、单盲、部分交叉试验，将新型治疗与常规治疗（TAU）进行比较，评估化身疗法。我们使用了三个主要的结果测量指标：（a）精神病症状评定量表（PSYRATS），幻觉部分；（b）修订后的幻听信念问卷（BAVQ-R）的全能和恶意子量表；（c）卡尔加里抑郁量表（CDS）。
对照组在三项评估中的得分在时间上没有变化，而新型治疗组在 PSYRATS 总分（听觉幻觉）上的平均降低了 8.75（P=0.003），在 BAVQ-R 总分中的全能和恶意声音降低了 5.88（P=0.004）。CDS 抑郁总分没有显著降低。对于交叉对照组，将 TAU 期间与化身治疗期间进行比较，证实了之前分析的结果。治疗的效果大小为 0.8。
化身疗法代表了一种有前途的治疗药物抵抗性听觉幻觉的方法。在推广到临床环境之前，需要进行更大规模的样本复制。
