The therapeutic processes of avatar therapy: A content analysis of the dialogue between treatment‐resistant patients with schizophrenia and their avatar

Abstract

Objective: Because the therapeutic processes of Avatar Therapy remain equivocal, the current study aims to further extend our previous findings by analysing the evolution of the avatars' and patients' speech and changes in patient responses as sessions progressed.Design: Eighteen patients with treatment-resistant schizophrenia were selected from two clinical trials on Avatar Therapy. Three coders analysed both the avatars' and patients' discourse during immersive therapy sessions using content analysis methods.Results: Our analyses enabled the categorization of the avatar discourse into confrontational techniques (e.g., provocation) and positive techniques (e.g., reinforcement). Patients responded to these utterances using coping mechanism or by expressing emotions, beliefs, self-perceptions or aspirations. Through identification of mutual changes in the interaction between the patient and their avatar, a shift was observed over the sessions from confrontation to a constructive dialogue.Assertiveness, emotional responses and prevention strategies seemed to be central to the therapeutic process, and these usually occur in response to positive techniques. Conclusion:Investigating AT's therapeutic process may help to identify components to achieve positive outcomes and can enable the development of more effective treatments. Further studies should explore the association between these themes and therapeutic response to help predict which patients will better respond to Avatar Therapy.

Implementation of a machine learning algorithm for automated thematic annotations in avatar: A linear support vector classifier approach

“…A dataset was elaborated using 162 manually typed therapy transcripts of 18 randomly selected patients who undertook AT between 2017 and 2020 at our institution, which accounts for up to 10 therapy sessions per patient. 23 The language of the transcripts was Canadian French. Transcripts were manually annotated using the 28 themes described in Beaudoin et al 2021.…”

“…23 The language of the transcripts was Canadian French. Transcripts were manually annotated using the 28 themes described in Beaudoin et al 2021. Please refer to Figure 1 in Beaudoin's study for classification of the themes.…”

A systematic review of relational-based therapies for the treatment of auditory hallucinations in patients with psychotic disorders

“…As an experiential therapy, it primarily focuses on how patients relate to and respond to their voice by addressing emotional regulation, improving self-esteem, and fostering acceptance rather than to directly challenge beliefs about voices. Importantly, this new intervention allows patients to converse with their voice with the aim of improving coping and decreasing distress by addressing power and control within these relationships as well as altering negative relationships and self-perceptions (Beaudoin et al, 2021 ; Craig, Ward, & Rus-Calafell, 2016 ; Dellazizzo, Potvin, Phraxayavong, Lalonde, & Dumais, 2018 ; Leff, Williams, Huckvale, Arbuthnot, & Leff, 2014 ; Ward et al, 2020 ).…”

“…AT/VRT is the latest innovative relational-based therapy combining many elements from previous dialogical therapies to improve treatment efficacy. In doing so, AT/VRT may touch a range of therapeutic targets as shown in several studies (Beaudoin et al, 2021;Dellazizzo, Percie du Sert, Phraxayavong, Potvin, et al, 2018a;Ward et al, 2020) that are relevant to the voice-hearing experience and allow patients to live their experience in a secure therapeutic environment, thus enabling learnings to be more readily transferred to the real world, which may likewise explain the significant improvement observed on subjective quality of life.…”

Could Avatar Therapy Enhance Mental Health in Chronic Patients? A Systematic Review

“…This allowed them to incorporate new information and change their relationship with the voices, thus achieving a reduction in anxiety during the sessions. In this regard, recent research [60] has revealed that empathic listening-attempting to reconcile with the avatar representing their auditory hallucinations and taking control of the experience-seems to improve the relationship between the patients and their hallucinated voices. As such, the interaction between the strong sense of presence of the hallucinations and the decrease in anxiety was key in reducing the frequency of the hallucinations, although the level of patient satisfaction was unknown, as the authors did not provide this information.…”