Conversing with a computer-generated face playing the part of the "voices" experienced by patients with schizophrenia can suppress the problem within hours in some individuals, new research has revealed.
A small trial of 16 patients at University College London by a team led by Julian Leff, who invented the techique, achieved in three participants complete cessation of the distracting auditory hallucinations - usually one or more voices making disparaging and distracting comments - that had been plaguing the patients for years. And even in those participants for whom the technique did not completely suppress their auditory hallucinations, almost all showed improvements in their symptoms and wellbeing more generally.
The approach involves first asking the patient to use a computer to design an "avatar" that best represents, for them, the face of the source of the most intrusive voice that they hear in their head. They also use computer software to generate a voice that most closely resembles the voice they experience. The therapist then sits in another room and can make the avatar "speak" to the patient in a convincing way, using lip-syncing software.
Initially the avatar behaves in a critical and confrontational way, but the patients are urged to be confrontational in return. Slowly, over 6 one-hour sessions, the therapist alters the way the avatar engages with the patient, switching from being highly negative to being positive, collaborative and encouraging.
The result is that the patient gains confidence and feels that the threat posed by the voice is reduced so they can legitimately "tell it where to go". In three of the 16 patients initially enrolled, the voices were arrested completely. Followed up at 3 months, the benefits largely remained.
The researchers speculate that the approach works because, although schizophrenic patients generally lack insight into the authenticity of the voices they can hear, because they have created the avatar themselves, they are not at risk from it so they need not be fearful of trying out control strategies to make it cease.
Most schizophrenics are too fearful of the voices they hear to risk disobeying them. But the avatar gives them the mental fortitude to do this and, perhaps, fools their own brain into suppressing the real voice alongside the one they can see on the screen. The team have now secured substantial grant funding to evaluate and refine the technique on a further 142 patients over the next 18 months.