Avatar Therapy for Distressing Voices in Psychosis: A King's College London Pilot

Overview

The podcast explores Avatar therapy, a pioneering approach designed to help people who experience distressing voices linked to psychosis by giving the inner voice a visible avatar that patients and therapists can interact with. The episode features a King’s College London demonstration, clinical perspectives, and lived-experience insights, while also examining how avatars are created and how therapy is conducted in practice.

• Avatar therapy aims to change the power dynamics between patient and voice rather than suppressing the voice
• Faces, voices, and dialog are customized to reflect the patient’s internal experience
• Early results suggest the approach can reduce distress and related symptoms compared with standard CBT
• AI-assisted dialogue is being explored to scale training while preserving therapist involvement

Overview

The podcast from the British Psychological Society’s Research Digest investigates Avatar therapy, a digital mental health treatment designed for distressing voices associated with psychosis. Host Tabby Taylor Buck visits King’s College London, where researchers are developing a therapy that makes the patient’s internal voice visible as a computer-generated avatar. The approach is described as a way to bring the voice out into the open, enabling direct interaction with both the avatar and the therapist. Avatar therapy is still experimental, with early-stage work conducted within the Avatar 2 trial, coordinated by Dr. Clem Edwards, a clinical psychologist.

How the Avatar Is Created

The process begins with a demo of an avatar gallery. Practitioners select humanity, gender, age range, and ethnicity to create a face that patients can relate to. The avatar’s facial features are highly adjustable, including skin texture, expressions, and eye movement, so the face can reflect the patient’s internal voice while remaining visually plausible. Therapists aim for an 80%+ match between the avatar’s appearance and the patient’s experience. The dialogue is not static; it can be tweaked in real time by the therapist and through the avatar’s expressions and timing.

From Humors to High-Tech Therapy

The narrative shifts from historical treatments to contemporary digital interventions. The episode juxtaposes the grim past of mental health care with the compassionate, person-centered approach of Avatar therapy. Museum pieces from Wakefield’s Mental Health Museum illustrate how far treatments have come, while interviewees reflect on the importance of staff empathy and understanding in patient care.

The Therapy Session Process

During sessions, the therapist uses two channels: therapist voice and avatar voice. The therapist guides the patient through dialogues that begin with what the distressing voices say, such as insults or commands, and gradually steer conversations toward more compassionate, boundary-setting dialogue. Patients’ voices can include threats and derogatory language, and the aim is to renegotiate the relationship with the voice rather than simply eliminating it. The process emphasizes safety and collaboration, with patients often describing staff as allies in managing the voices’ impact on identity and safety.

Clinical Perspectives and Outcomes

Chris Taylor from the University of Sheffield explains core terms such as psychosis, voice hearing, and schizophrenia, and how Avatar therapy fits within these frameworks. Lived experience researcher Dr. Andrew Grundy discusses the potential advantages and concerns around technology, including technophobia and fears of surveillance. Importantly, trial results from Avatar 2 indicate twice the effectiveness of current gold-standard CBT for distress related to voices, along with reductions in how often voices are heard, anxiety, depression, and concerns about harm. The program emphasizes the complexity of voice relations: some voices are benevolent or protective, while others are abusive or frightening, necessitating a nuanced, relational approach to therapy.

Future Directions: Avatar 3 and AI

The podcast previews Avatar 3, an AI-enabled project led by Tom Ward to explore AI-generated early dialogues. The idea is to have AI assist with avatar dialogue while the therapist remains present with the patient, enabling broader access and training without replacing human guidance. The developers stress that Avatar therapy is not intended to be a standalone digital intervention; therapists remain essential given the emotional load and safety considerations involved. The interview concludes with reflections on the voices as social agents and the importance of validating patients’ experiences through compassionate engagement.

Key Takeaways

• Avatar therapy reframes distressing voices as social agents that can be understood and engaged with in therapy
• Avatar creation is a collaborative process tailored to each patient’s inner experiences
• Early results signal meaningful reductions in distress beyond what CBT alone achieves
• AI-assisted dialogue may help scale therapy, but therapists will stay central to the process