AVATAR therapy for auditory verbal hallucinations in people with psychosis: a single-blind, randomised controlled trial.
AVATAR therapy for auditory verbal hallucinations in people with psychosis: a single-blind, randomised controlled trial.
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DOI：
10.1016/s2215-0366(17)30427-3
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发表时间：
2018-01
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影响因子：
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通讯作者：
Garety PA
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作者：
Craig TK;Rus-Calafell M;Ward T;Leff JP;Huckvale M;Howarth E;Emsley R;Garety PA
四分之一的精神病患者尽管接受了治疗，但仍会出现持续的幻听。AVATAR疗法（由Julian Leff于2008年发明）是一种新的方法，在这种方法中，听到声音的人与他们假定的迫害者的数字表示（化身）进行对话，由治疗师发声，以便化身通过变得不那么敌对并在治疗过程中承认权力来回应。我们的目的是调查AVATAR治疗对听觉言语幻觉的影响，并与支持性咨询对照条件进行比较。我们在一个临床地点（南伦敦和Maudsley NHS信托）进行了这项单盲、随机对照试验。参与者年龄在18至65岁之间，临床诊断为精神分裂症谱系（ICD 10 F20-29）或情感障碍（F30-39伴精神病症状），尽管继续治疗，但在过去12个月内仍有持续的听觉言语幻觉。参与者被随机分配（1：1）接受AVATAR治疗或随机排列区组的支持性咨询（区组大小在2到6之间随机变化）。在基线、12周和24周时由对治疗分配设盲的研究评估员进行评估。主要结果是12周时听觉言语幻觉的减少，通过精神病症状评定量表听觉幻觉（PSYRATS-AH）的总分进行测量。采用线性混合模型进行意向治疗分析。该试验在ISRCTN登记处进行了前瞻性登记，编号为65314790。在2013年11月1日至2016年1月28日期间，有394人被推荐参加这项研究，其中369人接受了资格评估。在这些人中，150人符合条件，并被随机分配接受AVATAR治疗（n=75）或支持性咨询（n=75）。124例（83%）达到主要结局。第12周时，AVATAR治疗组的PSYRATS-AH总分降幅显著大于支持性咨询组（平均差异为-3.82 [SE 1.47]，95%CI为-6.70至-0.94; p<0.0093）。没有证据表明任何不良事件可归因于任何一种治疗。据我们所知，这是第一个关于AVATAR治疗的有把握度的随机对照试验。在治疗12周后，这种简短的靶向治疗比支持性咨询更有效地降低了持续性听觉言语幻觉的严重程度，具有较大的效应量。未来的多中心研究需要建立AVATAR治疗的有效性，如果证明有效，我们认为它应该成为听觉语言幻觉心理治疗的一种选择。Wellcome Trust.
A quarter of people with psychotic conditions experience persistent auditory verbal hallucinations, despite treatment. AVATAR therapy (invented by Julian Leff in 2008) is a new approach in which people who hear voices have a dialogue with a digital representation (avatar) of their presumed persecutor, voiced by the therapist so that the avatar responds by becoming less hostile and concedes power over the course of therapy. We aimed to investigate the effect of AVATAR therapy on auditory verbal hallucinations, compared with a supportive counselling control condition. We did this single-blind, randomised controlled trial at a single clinical location (South London and Maudsley NHS Trust). Participants were aged 18 to 65 years, had a clinical diagnosis of a schizophrenia spectrum (ICD10 F20–29) or affective disorder (F30–39 with psychotic symptoms), and had enduring auditory verbal hallucinations during the previous 12 months, despite continued treatment. Participants were randomly assigned (1:1) to receive AVATAR therapy or supportive counselling with randomised permuted blocks (block size randomly varying between two and six). Assessments were done at baseline, 12 weeks, and 24 weeks, by research assessors who were masked to therapy allocation. The primary outcome was reduction in auditory verbal hallucinations at 12 weeks, measured by total score on the Psychotic Symptoms Rating Scales Auditory Hallucinations (PSYRATS–AH). Analysis was by intention-to-treat with linear mixed models. The trial was prospectively registered with the ISRCTN registry, number 65314790. Between Nov 1, 2013, and Jan 28, 2016, 394 people were referred to the study, of whom 369 were assessed for eligibility. Of these people, 150 were eligible and were randomly assigned to receive either AVATAR therapy (n=75) or supportive counselling (n=75). 124 (83%) met the primary outcome. The reduction in PSYRATS–AH total score at 12 weeks was significantly greater for AVATAR therapy than for supportive counselling (mean difference −3·82 [SE 1·47], 95% CI −6·70 to −0·94; p<0·0093). There was no evidence of any adverse events attributable to either therapy. To our knowledge, this is the first powered, randomised controlled trial of AVATAR therapy. This brief, targeted therapy was more effective after 12 weeks of treatment than was supportive counselling in reducing the severity of persistent auditory verbal hallucinations, with a large effect size. Future multi-centre studies are needed to establish the effectiveness of AVATAR therapy and, if proven effective, we think it should become an option in the psychological treatment of auditory verbal hallucinations. Wellcome Trust.