Use of an avatar in cognitive-behavioural therapy of a person who is chronically experiencing negative auditory hallucinations – case study

Abstract

Purpose: Description of cognitive behavioural therapy (CBT) of a patient diagnosed with paranoid schizophrenia, who experienced chronic negative auditory hallucinations (voices). Case description: Elements of CBT complemented by the use of virtual reality were described. Stages of the therapy of a 40-yearold patient hearing voices constantly for 7 years were presented. During the therapy, the patient was still treated pharmacologically (olanzapine 20 mg/day and risperidone 2 mg/day). Conceptualisation of the problem, therapy plan and the course of selected therapeutic interventions using an avatar were discussed. The empty chair technique supported by the use of the avatar was presented. The effects of 20 therapeutic sessions were evaluated, confirming a significant reduction in the frequency and intrusiveness of voices and sustainability of these effects in the 6-month follow-up. Comment: The described case is an example of a short-term effective therapeutic intervention during which, at the cognitive level, changes were observed in the experienced auditory hallucinations. Thanks to the use of the avatar, it was possible to create a representation of auditory hallucinations and to give them physical features, and, consequently, to work on changing beliefs about the source of these hallucinations. Furthermore, during the therapy, the avatar served as an exponent of critical content which the patient experienced in relations with his father. Key words: auditory hallucinations, schizophrenia, cognitive behavioural therapy, computer techniques, avatar. StreszczenieCel: Opis terapii poznawczo-behawioralnej (CBT) pacjenta z rozpoznaniem schizofrenii paranoidalnej, który doświadczał przewlekłych, negatywnych omamów słuchowych (głosów). Opis przypadku: Przedstawiono fragmenty CBT dopełnionej wykorzystaniem rzeczywistości wirtualnej. Wskazano fazy terapii 40-letniego pacjenta doświadczającego głosów nieustannie od 7 lat. Pacjent w trakcie terapii był nadal leczony farmakologicznie Izabela Stefaniak, Kamil Sorokosz, Ar tur Janicki, Jacek Wciórka 276 PURPOSEWe present the most important elements of the therapy of a patient with schizophrenia, who has been experiencing chronic negative auditory hallucinations for 7 years. He was referred by a psychiatrist as there were no more pharmacological treatment options available. The patient often reported significant severity of the experienced hallucinations, which initially resulted in frequent changes of medications, usually increasing the dose and adding other antipsychotics. It created a sense of helplessness on the part of both the patient and the doctor.The therapy was given in the Mental Health Outpatient Clinic of the Institute of Psychiatry and Neurology in Warszawa. Sessions were held regularly every week. Each session lasted 50 minutes.The patient continued his pharmacological treatment (olanzapine 20 mg, risperidone 2 mg) which remained unchanged during the therapy. The patient lived alone and worked off and on.He was experiencing negative auditory hallucinati...

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

“…This innovative therapy has had several variants including its merge with CBT (Dellazizzo, Potvin, Phraxayavong, & Dumais, 2020 ; Stefaniak, Sorokosz, Janicki, & Wciórka, 2017 ) and the use of a paper mask (Cichocki, Palka, Leff, & Cechnicki, 2016 ).…”

“…Lastly, the final variant was an intervention combining both CBT and AT approaches as one sole therapy, which was investigated with a case study (Stefaniak et al, 2017 ) followed by a pilot trial (Stefaniak, Sorokosz, Janicki, & Wciórka, 2019 ). One of the differences with AT was that during sessions, the therapist is seated next to the patient in the same room.…”

“…The case study, with evidence graded as being of very low quality, showed a significant reduction in voice frequency and intrusiveness at the end of 20 therapy sessions, which was maintained at 6 months follow-up. Moreover, the patient felt more capable of facing voices when present (Stefaniak et al, 2017 ). This same team conducted a pilot study including 23 treatment-resistant patients having followed a shorter version of the therapy (8 sessions), with evidence being evaluated as low quality.…”

Przyszłość nowych technologii w diagnozie psychologicznej i psychoterapii. Analiza jakościowa na podstawie metody delfickiej

“…Nową metodą jest również terapia ze wsparciem awatara (avatar therapy), której skuteczność otrzymała wsparcie empiryczne. Wykazano korzystne wyniki terapii poznawczobehawioralnej omamów słuchowych w schizofrenii przy wsparciu komputerowego awatara imitującego głosy słyszane przez pacjenta, w warunkach polskich wspartej dodatkowo animowanym modelem głowy [16].…”