Trial reportThe British journal of clinical psychology2021
Relating behaviours and therapeutic actions during AVATAR therapy dialogue: An observational study.
Trial report in The British journal of clinical psychology, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers.
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
9 citing papers in PubMed.
- "It Felt Good to Be Able to Say That Out Loud"-Therapeutic Alliance and Processes in AVATAR Therapy for People Who Hear Distressing Voices: Peer-Led Qualitative Study.JMIR mental health · 2026Trial
- Participants' experiences of AVATAR therapy for distressing voices: a thematic qualitative evaluation.BMC psychiatry · 2022Trial
- Process Evaluation of Digital Mental Health Interventions for Psychosis: Scoping Review With Framework Synthesis.JMIR human factors · 2026Article
- Relational Therapies for People Who Hear Voices: Operationalisation and Current Status of an Emergent Group of Psychological Therapies.Schizophrenia bulletin · 2026Review
- Immersive Virtual Reality-Assisted Therapy for Distressing Voices in Psychosis: Qualitative Study of Participants' and Therapists' Experiences in the Challenge Trial.JMIR serious games · 2025Article
- Using Virtual Reality Social Environments to Promote Outcomes' Generalization of AVATAR Therapy for Distressing Voices: A Case Study.Journal of clinical psychology · 2025Article
- The role of trauma, attachment, and voice-hearer's appraisals: a latent profile analysis in the AVATAR2 trial.Psychological medicine · 2025Article
- An Exploratory Study of the Potential of Online Counseling for University Students by a Human-Operated Avatar Counselor.Healthcare (Basel, Switzerland) · 2024Article
- Unsupervised Machine Learning Driven Analysis of Verbatims of Treatment-Resistant Schizophrenia Patients Having Followed Avatar Therapy.Journal of personalized medicine · 2023Article
Corrections and comments
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Authors and funding
7 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesAVATAR therapy is a novel relational approach to working with distressing voices by engaging individuals in direct dialogue with a digital representation of their persecutory voice (the avatar). Critical to this approach is the avatar transition from abusive to conciliatory during the course of therapy. To date, no observational study has examined the moment-to-moment dialogical exchanges of this innovative therapy. We aim to (1) map relating behaviours between participants and their created avatars and (2) examine therapeutic actions delivered within AVATAR dialogue.
methodTwenty-five of the fifty-three AVATAR therapy completers were randomly selected from a randomized controlled trial (Craig et al. The Lancet Psychiatry, 5, 2018 and 31). Seventy-five audio recordings of active dialogue from sessions 1 and 4 and the last session were transcribed and analysed using a newly developed coding frame. Inter-rater reliability was good to excellent.
resultsFine-grained analysis of 4,642 observations revealed nuanced communication around relational power and therapeutic activity. Early assertiveness work, reinforced by the therapist, focussed on increasing power and distancing. Participants' submissive behaviours reduced during therapy, but the shift was gradual. Once the transition to a more conciliatory tone took place, the dialogue primarily involved direct communication between participant and avatar, focussing on sense of self and developmental and relational understanding of voices.
conclusionsAVATAR therapy supports voice-hearers in becoming more assertive towards a digital representation of their abusive voice. Direct dialogue with carefully characterized avatars aims to build the voice-hearers' positive sense of self, supporting the person to make sense of their experiences. PRACTITIONER POINTS: AVATAR therapy enables voice-hearers to engage in face-to-face dialogue with a digital representation ('avatar') of their persecutory voice. Fine-grained analyses showed how relating behaviours and therapeutic actions evolve during active AVATAR therapy dialogue. Carefully characterized avatars and direct therapist input help voice-hearers become more assertive over the avatar, enhance positive sense of self, and support individuals to make sense of their experiences.
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