AVATAR therapy in the Real World (AVATAR-RW): A process evaluation, effectiveness and cost-effectiveness study in routine care of AVATAR therapy, a digitally supported therapy for distressing voices.
Associated organisationsKing's College London · University College London · University of Glasgow · University of ManchesterEurope PMC affiliations are not treated as award recipients or mapped locations.
Funding£2.9M
PeriodOct 2025 — Oct 2028
In plain English
AI plain-English summary
People who hear persecutory voices are being offered a digital therapy where they talk back to a computer-generated avatar of the voice they hear, and a new study will test whether this approach works when rolled out across routine NHS mental health services. Around one in three people with psychosis continue to hear distressing voices despite medication. AVATAR therapy—where a therapist helps the patient create a digital representation of their persecutory voice and then guides them in a three-way dialogue with it—has shown strong results in two controlled trials, but those were run under ideal research conditions. This project will follow 140 patients for 12 months across diverse NHS settings to see if the therapy remains effective and cost-effective when delivered by regular clinical staff rather than specialist researchers. If the therapy works in routine care, the team aims to generate the real-world evidence needed for a full NICE recommendation. That could make AVATAR therapy widely available within five years, giving thousands of people with psychosis a practical, non-drug option for reducing the power and frequency of the voices that disrupt their daily lives.
View original technical description
Background:AVATAR therapy is a highly effective digital therapy for distressing voices in psychosis. Following two successful randomised controlled trials and in line with a NICE-EVA recommendation for generation of Real-World Evidence (RWE) the next steps are to test AVATAR therapy in routine care. Aims:This project will test, for the first time, AVATAR therapy when delivered within routine psychological therapy pathways, across diverse NHS settings. We will generate RWE on effectiveness and cost-effectiveness as well as uptake and acceptability across different stakeholders. Specific aims: 1) To optimise AVATAR therapy for real-world deployment. 2) To establish effectiveness and cost-effectiveness in routine care. 3) To conduct a process evaluation of AVATAR therapy implementation. 4) To establish a reliable and sustainable method for real-world outcome monitoring. 5) To deliver a strategy to support AVATAR therapy spread and sustainment. Methods:We will conduct a prospective controlled cohort study with 12-month follow-up (N=140), delivering RWE on clinical and cost-effectiveness across diverse routine care settings. We will identify barriers and facilitators to sustainable implementation. Anticipated Impact:The outputs will support evaluation for a full NICE recommendation and strongly position AVATAR therapy for wide-spread NHS adoption within the next 5 years.
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