SynthesisPsychological medicine2026
AVATAR versus cognitive-behavioral therapy for medication-resistant auditory hallucination: a systematic review and network meta-analysis.
Synthesis in Psychological medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
What it found
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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.
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.
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Who cites it
1 citing paper in PubMed.
Corrections and comments
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Authors and funding
12 authors.
Funding
Abstract
Auditory hallucinations (AH) frequently persist in schizophrenia spectrum disorder despite antipsychotic treatment. Cognitive behavioral therapy (CBT) remains an established psychological intervention, whereas AVATAR (Audio Visual Assisted Therapy Aid for Refractory auditory hallucinations) therapy has recently been introduced as a novel approach integrating interactive digital avatars. This meta-analysis compared the efficacy of AVATAR therapy with CBT for medication-resistant AH. A systematic search of five major databases up to June 1, 2025 identified randomized controlled trials (RCTs) that evaluated either therapy. The primary outcome was AH severity, and secondary outcomes included psychotic symptoms, mood measures, and all-cause discontinuation. Twenty-six RCTs (n = 2273; 65.0% male; mean age 39.3 [SD 4.1] years) met inclusion criteria. Compared with CBT, AVATAR therapy showed no significantly greater reduction in AH severity (standardized mean difference [SMD] = -0.23, 95% confidence interval [CI] = -0.55 to 0.10). However, it demonstrated superior sustained improvement three months post-treatment (SMD = -0.37, 95% CI = -0.69 to -0.05) and greater reduction in overall psychotic symptoms (SMD = -0.41, 95% CI = -0.75 to -0.06). No significant differences were observed in positive, negative, depressive, anxiety, or quality-of-life outcomes, and discontinuation rates were comparable. Interpretation should be cautious given evidence of small-study effects (Egger's tests
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