What is it like to meet the voices in your head?

Hello, I am Mads, a psychologist and PhD student currently visiting Swinburne University and collaborating with the AMETHYST team.  

I am from Denmark where I am involved in a clinical trial called CHALLENGE. This trial is testing out virtual reality assisted therapy, for people who hear voices, which is very similar to the AMETHYST trial here in Australia. The CHALLENGE trial is inspired by avatar therapy from the UK. More information about the UK avatar trial can be found at the end of this blog post.

The CHALLENGE trial is testing how therapy using virtual reality technology might facilitate a dialogue between a voice-hearer and digital representation of one of the voices being heard (a so-called avatar). Whereas, on the AMETHYST trial the same therapy is tested, but it is delivered via videoconferencing (Zoom) without virtual reality, so that the trial can reach people across Australia. However, despite this difference in delivery method, the core therapy remains consistent, underpinned by the same software and therapeutic principles. 

I'm excited to share a summary of the clinical insights we've gathered from the CHALLENGE trial. While we are still waiting to analyse all the data and find out the statistical outcomes from the trial we have published a paper, which provides valuable glimpses into potential results and experiences of our participants. By delving into these experiences, we demonstrate how virtual reality assisted therapy can be used for different individuals with various life circumstances and backgrounds.  

Here, I’ll summarise the stories and experiences of some previous CHALLENGE trial participants. These snippets are based on the Vernal et al (2023) publication, and the details of this publication can be found at the end of the blog. 

Dennis, a man in his 50s, had struggled with persistent voices since childhood and tried various treatments. Dennis decided to participate in the CHALLENGE trial, and received a course of therapy. Dennis started to experience some breaks from the voices each day. He also found that the relationship with the most distressing voice he heard started to change; he used the avatar therapy to open a dialogue with this voice and found it began to listen to him and respond differently to him. Dennis became an advocate for this novel therapy and gained a newfound confidence in public speaking. 

Cille, a young woman, also participated in the trial and received a course of avatar therapy. For Cille a helpful part was to be able to share her experiences of voice hearing with her family. Cille was able to make a recording from the therapy session and share a clip of a dialogue with her most distressing voice. The ‘voice’ was played by the therapist but sounded and looked like her voice. In the sessions the therapist ‘played the voice’ and repeated the horrible things that the voice often said to her, providing Cille with an opportunity to test out different ways of responding to the voice. After sharing this clip with her family Cille’s experience of voice-hearing was no longer private but shared, which was very helpful and important to her. Cille has also found that after the novel therapy the former voice is less critical and more friendly now. 

Julia, a young woman, had hear heard voices for many years and experienced a loss of control. Julia had been a patient in a psychiatric hospital for over one year when she began participating in the trial. At this time, Julia felt that the voices were in total control, often leading to unpleasant experiences and encounters with the mental health care system. At the start of the therapy, Julia was unable to stand up to the voices at all. However, through practise and with the support of her therapist she slowly gained confidence and became more engaged in the dialogue with the avatar. Julia began to feel more able to stand up to the avatar and her voices. After completing therapy, she was discharged from the psychiatric hospital to a different setting where she had more freedom. 

We hope you found these insights helpful in understanding more about virtual reality assisted therapy and how it might work for different people.  

For those interested, the publication detailing our clinical experiences can be accessed or downloaded for free here:  

https://vbn.aau.dk/en/publications/status-and-clinical-experiences-from-the-challenge-trial-a-random

Reference: 

Vernal, D. L., Nordentoft, M., Christensen, M. J., Smith, L. C., Mariegaard, L., Mainz, J., & Glenthøj, L. B. (2023). Status and Clinical Experiences from the Challenge Trial–A Randomized Controlled Trial Investigating Virtual Reality-based Therapy for Auditory Hallucinations. World Social Psychiatry, 5(1), 71-76.

In addition, for those interested, more information about avatar therapy from the UK can be accessed or downloaded for free here: 

AVATAR therapy for auditory verbal hallucinations in people with psychosis: a single-blind, randomised controlled trial - The Lancet Psychiatry 

Reference:

Craig, T. K., Rus-Calafell, M., Ward, T., Leff, J. P., Huckvale, M., Howarth, E., ... & Garety, P. A. (2018). AVATAR therapy for auditory verbal hallucinations in people with psychosis: a single-blind, randomised controlled trial. The Lancet Psychiatry, 5(1), 31-40.