Evidence map›Paper›PMID 41391105›Full record

Trial reportSchizophrenia bulletin2026

The Impact of AVATAR Therapy on Voice Hearing in Everyday Life: ESM Outcomes of the AVATAR2 Trial.

Clementine J Edwards, Robin Smith, Ginette Lafit, Thomas Ward, Richard Emsley, Mar Rus-Calafell, Inez Myin-Germeys, Emmanuelle Peters, Sandra Bucci, Thomas K Craig and 11 more

Abstract readRandomized Controlled TrialMulticenter Study
In one paragraph

Trial report in Schizophrenia bulletin, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

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.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed.

  1. Trial
  2. Trial
  3. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

21 authors.

Clementine J EdwardsDepartment of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom.ORCID 0000-0001-9949-2401
Robin SmithDepartment of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom.
Ginette LafitResearch Group of Quantitative Psychology and Individual Differences, Faculty of Psychology and Educational Sciences, Methodology of Educational Sciences Research Group, KU Leuven, Leuven, Belgium.
Thomas WardDepartment of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom.
Richard EmsleyDepartment of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.ORCID 0000-0002-1218-675X
Mar Rus-CalafellDepartment of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom.
Inez Myin-GermeysDepartment of Neurosciences, Center for Contextual Psychiatry, KU Leuven, Leuven, Belgium.ORCID 0000-0002-3731-4930
Emmanuelle PetersDepartment of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom.
Sandra BucciDivision of Psychology and Mental Health, School of Health Sciences, University of Manchester and the Manchester Academic Health Sciences Centre, Manchester, United Kingdom.
Thomas K CraigSouth London and Maudsley NHS Foundation Trust, London, United Kingdom.
Gillian HaddockDivision of Psychology and Mental Health, School of Health Sciences, University of Manchester and the Manchester Academic Health Sciences Centre, Manchester, United Kingdom.
Hannah BallDivision of Psychology and Mental Health, School of Health Sciences, University of Manchester and the Manchester Academic Health Sciences Centre, Manchester, United Kingdom.
Miriam Fornells-AmbrojoResearch Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom.
Amy HardyDepartment of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom.ORCID 0000-0002-6044-6093
Hamish McLeodInstitute of Health and Wellbeing, School of Mental Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom.ORCID 0000-0002-4225-1815
Andrew I GumleyInstitute of Health and Wellbeing, School of Mental Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom.
Jeffrey McDonnellResearch Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom.
Alice MontagueSouth London and Maudsley NHS Foundation Trust, London, United Kingdom.
Moya ClancyInstitute of Health and Wellbeing, School of Mental Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom.
Mark HuckvaleDepartment of Speech, Hearing and Phonetic Sciences, University College London, London, United Kingdom.
Philippa Anne GaretyDepartment of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom.

Funding

Wellcome TrustWellcome Trust 215471/Z/19/Z
6 · The paper itself

Abstract

AVATAR therapy involves facilitated dialogs between a voice hearer and a digital embodiment of their distressing voice ("the avatar"). We conducted a multi-site single-blind randomized controlled trial to evaluate the efficacy of brief (AV-BRF) and extended (AV-EXT) forms of AVATAR therapy, compared with treatment as usual (TAU) alone (AVATAR2). This study reports the data from experience sampling method (ESM) assessments conducted at baseline, end of therapy (16 weeks), and follow-up (28 weeks). The research questions focused on whether those in the AV-BRF or AV-EXT arms experienced less voice-related distress, anxiety, and beliefs as measured by ESM, compared to TAU. Separate mixed-effects models were fitted for each research question. The final sample (n = 200) completed approximately 40% of questionnaires across all timepoints. Participants who received AV-EXT therapy, but not AV-BRF, reported reduced momentary voice-related distress at 16 (P = .022) and 28 weeks (p = .029). Appraisals of voice control were also reduced in the AV-EXT arm at 16 weeks when the voice was present (P = .002) or not (P = .008). Voice power appraisals were reduced (P < .035) in both arms when the voice was "not present but on my mind" at all timepoints. There were no changes in the frequency of voice hearing, appraisals of voice intent, or assertive responding. These findings from everyday life, reported for the first time, provide evidence of the impact on the primary AVATAR therapy treatment targets, including appraisals of voice power and control. The weight of evidence favors the AV-EXT protocol in the further development and implementation of AVATAR therapy.

Indexed as

Ecological Momentary AssessmentHallucinationsOutcome Assessment, Health CarePsychotherapyAdultAvatarFemaleFollow-Up StudiesHumansMaleMiddle AgedSingle-Blind MethodYoung AdultAVATAR therapydigital therapyexperience sampling methodologyhearing voicespsychosisrandomized controlled trial

Identifiers

PMID41391105
PMCPMC12809824

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.