Rus-Calafell Mar, Luker Melina, Marzinzik Maren, Nguyen Phuong-Mi, Schneider Silvia, Teismann Tobias, Ehrbar Nils, Tas Ekincan, Zhang Xiao Chi, Edwards Clementine, Huckvale Mark, Craig Tom K J, Garety Philippa, Ward Thomas
Mental Health Research and Treatment Centre, Faculty of Psychology, Ruhr-Universität Bochum, Bochum, Germany
German Center for Mental Health, Partner Site Bochum/Marburg, Bochum, Germany.
BMJ Open. 2025 Apr 17;15(4):e098004. doi: 10.1136/bmjopen-2024-098004.
Around 70% of people with psychosis experience auditory verbal hallucinations (AVHs), which can cause distress and impair the social functioning of the individual. AVATAR therapy works by facilitating a 'face-to-face' dialogue between the person and a digital representation (avatar) of their persecutory voice. Although there is cumulative evidence of this way of working with voices, enhancing the therapeutic focus on improved confidence and sense of control of the voices in social situations represents a promising way to boost generalisation of therapy gains into social contexts. We aim to enhance AVATAR therapy by incorporating immersive Virtual Reality (VR) social environments aiming to help the person to deal better with their voices in daily situations.
A randomised controlled feasibility trial will be conducted. 40 patients aged 18 or above who are at early stages of psychosis (first episode of psychosis in the last five years) and report distressing and interfering voices will be recruited. Participants will be randomised to receive either a novel, enhanced version of AVATAR therapy (AVATAR_VRSocial) in addition to usual care or usual care alone. Assessor-blinded assessments will be conducted at baseline, 3 months (post-intervention) and 6 months (follow--up). Key therapeutic targets of AVATAR_VRSocial will be those established by the previous evidence of this approach (ie, power and control, self-esteem and future focus), while introducing exposure and management of distressing voices during social interactions. Analyses will focus on feasibility outcomes (recruitment, retention and completion rates) and preliminary estimates of intervention effects. Qualitative interviews will be carried out with participants allocated to AVATAR_VRSocial to gain a comprehensive understanding of participants' views on the acceptability of the intervention and research procedures. Thematic analysis of the qualitative interviews will assess the acceptability of the intervention, trial procedures and the new VR technology and software involved.
The study has received ethical approval from the Ethics Commission at the Faculty of Psychology (Ruhr-Universität Bochum), and there is an independent Trial Steering Committee and Lived Experience Advisory Panel also supporting it. Findings will be disseminated through peer--reviewed publications, conference presentations and science dissemination events.
ISRCTN35980117.
约70%的精神病患者会经历幻听，这会给患者带来痛苦并损害其社会功能。“阿凡达”疗法通过促进患者与迫害性声音的数字化身进行“面对面”对话来发挥作用。尽管有越来越多的证据支持这种处理幻听的方式，但加强治疗对提高患者在社交场合中对幻听的信心和控制感的关注，是将治疗效果推广到社交情境中的一种很有前景的方法。我们旨在通过纳入沉浸式虚拟现实（VR）社交环境来增强“阿凡达”疗法，以帮助患者在日常情境中更好地应对幻听。
将进行一项随机对照可行性试验。招募40名年龄在18岁及以上、处于精神病早期（过去五年内首次发作精神病）且报告有令人痛苦和干扰性幻听的患者。参与者将被随机分配，一组除接受常规治疗外，还接受新型强化版“阿凡达”疗法（“阿凡达_VR社交”疗法），另一组仅接受常规治疗。评估人员将在基线、3个月（干预后）和6个月（随访）时进行盲法评估。“阿凡达_VR社交”疗法的关键治疗目标将是基于该方法先前证据所确立者（即力量与控制、自尊和未来关注点），同时在社交互动中引入对令人痛苦的幻听的暴露和管理。分析将聚焦于可行性结果（招募率、留存率和完成率）以及干预效果的初步评估。将对分配到“阿凡达_VR社交”疗法组的参与者进行定性访谈，以全面了解参与者对干预措施和研究程序可接受性的看法。对定性访谈的主题分析将评估干预措施、试验程序以及所涉及的新VR技术和软件的可接受性。
该研究已获得波鸿鲁尔大学心理学系伦理委员会的伦理批准，并有一个独立的试验指导委员会和生活经验咨询小组提供支持。研究结果将通过同行评审出版物、会议报告和科学传播活动进行传播。
ISRCTN35980117。
