Giving the voice a face: Efficacy and feasibility of avatar therapy in a Hungarian cohort.
Abstract
Background
Avatar therapy is a virtual reality-based intervention designed to reduce the distress and severity of persistent auditory verbal hallucinations (AVHs) in schizophrenia spectrum disorders. Despite promising initial evidence, methodological limitations and implementation barriers have prevented widespread adoption. This study evaluated the feasibility and preliminary effectiveness of an enhanced VR-Avatar therapy in a Hungarian cohort as part of an international multi-site trial.
Methods
In a non-randomized, waitlist-controlled pre-post design study, 30 outpatients with schizophrenia spectrum disorders and persistent AVHs received seven sessions of individual VR-Avatar therapy following a 12-week waiting period. Assessments were conducted at baseline, pre-intervention, and post-intervention by blinded raters, using measures of symptom severity, comorbid symptoms, and well-being. Piecewise linear mixed-effects models examined changes in slopes between waitlist and therapy phases.
Results
Regarding primary outcomes, VR-Avatar therapy was associated with significant reductions in AVH severity (PSYRATS Hallucinations: Δslope = -0.36, p = 0.02, partial η2 = 0.09, PANSS hallucination: Δslope = -0.04, p = 0.02, partial η2 = 0.17) The PANSS positive symptoms subscale, the third primary outcome, showed a marginal improvement (Δslope = -0.09, p = 0.05, partial η2 = 0.056). The secondary outcome (BAVQ-R) showed trends toward reduction in voice malevolence (Δslope = -0.12, p = 0.16) and omnipotence (Δslope = -0.11, p = 0.09). Among exploratory outcomes, trait anxiety improved significantly (STAI-Trait: Δslope = -0.47, p = 0.02, partial η2 = 0.17). Dropout was low (2.85%). Therapy produced heterogeneous responses, where 43.3% (N = 13) achieved ≥6-point PSYRATS-AH reduction. Older age significantly predicted stronger outcomes (p = 0.028).
Conclusion
VR-Avatar therapy demonstrated good feasibility and high acceptability in a Hungarian clinical setting, with preliminary evidence suggesting potential benefits in reducing the severity of AVH and related distress.