Optimising AVATAR therapy for distressing voices: a multi-centre randomised controlled trial

People who hear distressing voices will test a digital therapy that lets them build and speak to a 3D avatar of the voice they hear, in a large-scale trial across multiple NHS sites. This matters because around one in four people with psychosis experience persistent voices that standard treatments—medication and talking therapies—often fail to quieten. AVATAR therapy, developed in earlier smaller studies, allows a therapist to help a patient create a computer-generated face and voice that represents their tormentor, then guides them through a conversation where the avatar gradually becomes less powerful and more supportive. The current trial will compare a shorter, simpler version of the therapy (phase 1) against the full two-phase version, to see which works best for which patients. If successful, the research could give the NHS a proven, cost-effective treatment for distressing voices that is easier to roll out than current specialised psychological therapies. The simpler phase 1 approach requires less advanced therapeutic training, meaning it could be delivered more widely and at lower cost. The team also aims to produce enough evidence for NICE to recommend AVATAR therapy as a standard NHS treatment, which would pave the way for adoption in other countries' healthcare systems.