Optimising AVATAR therapy for distressing voices

Conditions

People with schizophrenia spectrum disorder or affective disorder with psychotic symptoms who have been experiencing distressing voices for longer than 6 months Mental and Behavioural Disorders Schizophrenia spectrum disorder or affective disorder with psychotic symptoms

Emily Rutter-Eley, Thomas J. Craig, Philippa A. Garety, Mar Rus-Calafell, Hannah Ball et al. (19 authors)

JMIR Mental Health2026-01-28

10.2196/77566

Exploration of Factors That Affect Engagement With the Experience Sampling Method and Service Users' Experience of This Within the AVATAR2 Trial: Mixed Methods Study.

Dennard S, Garety P, Edwards C, Gumley A, Owrid O, Miller L, Allan S, Duerden A, Yanga F, Burns C, Fletcher H, Grant A.

2025-12-12

10.2196/78204

“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 (Preprint)

Emily Rutter-Eley, Thomas Craig, Philippa A. Garety, Mar Rus-Calafell, Hannah Ball et al. (19 authors)

2025-05-15

10.2196/preprints.77566

Digital AVATAR therapy for distressing voices in psychosis: the phase 2/3 AVATAR2 trial.

Garety PA, Edwards CJ, Jafari H, Emsley R, Huckvale M, Rus-Calafell M, Fornells-Ambrojo M, Gumley A, Haddock G, Bucci S, McLeod HJ, McDonnell J, Clancy M, Fitzsimmons M, Ball H, Montague A, Xanidis N, Hardy A, Craig TKJ, Ward T.

2024-10-2827 citations

10.1038/s41591-024-03252-8

Participants’ experiences of AVATAR therapy for distressing voices: a thematic qualitative evaluation

Mar Rus‐Calafell, Nils Ehrbar, Thomas Ward, Clementine Edwards, Mark Huckvale et al. (8 authors)

BMC Psychiatry2022-05-2416 citations

10.1186/s12888-022-04010-1

Optimising AVATAR therapy for people who hear distressing voices: study protocol for the AVATAR2 multi-centre randomised controlled trial.

Garety P, Edwards CJ, Ward T, Emsley R, Huckvale M, McCrone P, Rus-Calafell M, Fornells-Ambrojo M, Gumley A, Haddock G, Bucci S, McLeod H, Hardy A, Peters E, Myin-Germeys I, Craig T.

2021-05-2528 citations

10.1186/s13063-021-05301-w

Interventions

Current intervention as of 30/09/2020: People will be randomised to receive brief or extended AVATAR therapy added to Treatment As Usual (TAU) compared to TAU alone. Independent randomisation (King’s

Eligibility

Sex/Gender

All

Age

18 Years to 99 Years

Inclusion criteria

Inclusion criteria: 1. Aged 18+ years 2. Currently under the care of a specialist mental health team (inpatient and outpatient settings) 3. Have current frequent and distressing voices, (as measured by a score of at least 2 on the sum of the intensity of distress and frequency items of the PSYRATS (Voices) scale), persisting for at least 6 months and in a language spoken by the therapist 4. Speak and read English to a sufficient level to provide consent and complete the assessment procedures 5. A clinical diagnosis of Schizophrenia spectrum disorder (ICD10 F20-29) or affective disorder with psychotic symptoms (ICD-10 F30–39, subcategories with psychotic symptoms)- as determined by clinical records

Exclusion criteria

Exclusion criteria: 1. Primary diagnosis of substance disorder, personality disorder or learning disability 2. Lacking capacity to consent 3. Profound visual/hearing impairment or insufficient comprehension of English to be able to engage in assessment or therapy 4. Currently undertaking individual psychological therapy for voices 5. Currently experiencing an acute mental health crisis

Design outcomes

Primary

Measure	Time frame
Distress associated with voices as measured by the Psychotic Symptoms Rating Scale- Auditory Hallucinations at 16 and 28 weeks	—

Secondary

Measure	Time frame
Current secondary outcome measures as of 19/11/2020: 1. Frequency of voices and overall severity as measured by the Psychotic Symptoms Rating Scale - Auditory Hallucinations frequency dimension and total score at baseline, 16 and 28 weeks 2. Remission of voices (standalone item) at baseline,16 and 28 weeks 3. Beliefs about Voices Revised (BAVQ-R) at baseline, 16 and 28 weeks 4. Voices acceptance and action scale (VAAS) at baseline, 16 and 28 weeks 5. First item from the Voice Power Differential Scale at baseline, 16 and 28 weeks 6. In daily life, occurrence of voices, associated distress and anxiety, using Experience Sampling Method at quasi-random occasions during the waking day over a 7-day period at baseline, 16 and 28-week assessment points 7. Wellbeing and patient-led outcome measures i.e. Warwick-Edinburgh Mental Well-being Scale, Choice of Outcome in CBT for Psychoses (CHOICE) at baseline, 16 and 28 weeks 8. Clinical characteristics and hypothesised sources of moderation of effects i.e. mood (Beck Depression Inventory), anxiety (DASS-21), delusions (PSYRATS), trauma (e.g. International Trauma Questionnaire and negative symptoms (Clinical Assessment Interview for Negative Symptoms) at baseline, 16 and 28 weeks Previous secondary outcome measures: 1. Frequency of voices as measured by the Psychotic Symptoms Rating Scale - Auditory Hallucinations at baseline, 16 and 28 weeks 2. Remission of voices (standalone item) at baseline,16 and 28 weeks 3. Beliefs about Voices Revised (BAVQ-R) at baseline, 16 and 28 weeks 4. Voices acceptance and action scale (VAAS) at baseline, 16 and 28 weeks 5. First item from the Voice Power Differential Scale at baseline, 16 and 28 weeks 6. In daily life, occurrence of voices, associated distress and anxiety, using Experience Sampling Method at quasi-random occasions during the waking day over a 7-day period at baseline, 16 and 28-week assessment points 7. Wellbeing and patient-led outcome measures i.e. Warwick-Edinburgh Mental Wel	—

Measure

Time frame

Current secondary outcome measures as of 19/11/2020: 1. Frequency of voices and overall severity as measured by the Psychotic Symptoms Rating Scale - Auditory Hallucinations frequency dimension and total score at baseline, 16 and 28 weeks 2. Remission of voices (standalone item) at baseline,16 and 28 weeks 3. Beliefs about Voices Revised (BAVQ-R) at baseline, 16 and 28 weeks 4. Voices acceptance and action scale (VAAS) at baseline, 16 and 28 weeks 5. First item from the Voice Power Differential Scale at baseline, 16 and 28 weeks 6. In daily life, occurrence of voices, associated distress and anxiety, using Experience Sampling Method at quasi-random occasions during the waking day over a 7-day period at baseline, 16 and 28-week assessment points 7. Wellbeing and patient-led outcome measures i.e. Warwick-Edinburgh Mental Well-being Scale, Choice of Outcome in CBT for Psychoses (CHOICE) at baseline, 16 and 28 weeks 8. Clinical characteristics and hypothesised sources of moderation of effects i.e. mood (Beck Depression Inventory), anxiety (DASS-21), delusions (PSYRATS), trauma (e.g. International Trauma Questionnaire and negative symptoms (Clinical Assessment Interview for Negative Symptoms) at baseline, 16 and 28 weeks Previous secondary outcome measures: 1. Frequency of voices as measured by the Psychotic Symptoms Rating Scale - Auditory Hallucinations at baseline, 16 and 28 weeks 2. Remission of voices (standalone item) at baseline,16 and 28 weeks 3. Beliefs about Voices Revised (BAVQ-R) at baseline, 16 and 28 weeks 4. Voices acceptance and action scale (VAAS) at baseline, 16 and 28 weeks 5. First item from the Voice Power Differential Scale at baseline, 16 and 28 weeks 6. In daily life, occurrence of voices, associated distress and anxiety, using Experience Sampling Method at quasi-random occasions during the waking day over a 7-day period at baseline, 16 and 28-week assessment points 7. Wellbeing and patient-led outcome measures i.e. Warwick-Edinburgh Mental Wel

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Countries

England, Scotland, United Kingdom

Contacts

Public ContactClementine Edwards

clementine.edwards@kcl.ac.uk+44 (0)7557866053

Outcome results

None listed