Putting a face to the voice (Image: UCL/Wellcome Trust)

Putting a digital face to the abusive voices in their head could help people with schizophrenia.

Results of a preliminary trial, announced today at the Wellcome Trust in London, demonstrated how people with schizophrenia could overcome their auditory hallucinations by conversing with an avatar representation of the voice in their head.

At the start of the trial, 16 people with schizophrenia created an on-screen avatar that best matched what they imagined the voice in their head to look like – much like a police photo-fit. They then chose a male or female voice closely resembling the one they hear.


By conversing with a therapist via the avatar, the volunteers reported reduced levels of distress and higher self-esteem. Three people stopped hearing the hallucinatory voice altogether – including one who had lived with it for 16 years.

Heckler inside

Hearing voices is a common symptom of schizophrenia, which affects about 1 per cent of the population worldwide. The hallucinations can stop people from thinking clearly and prevent them from working and sustaining social relationships. The voices are also typically abusive, telling the person to harm themselves or others.

“It’s hard to imagine what it’s like to hear a disembodied voice,” says Julian Leff at University College London, who led the trial. People often say that the helplessness is the worst thing, he says. They cannot control the voices and they feel dominated.

By giving the voices a face, Leff has developed a technique that lets people with schizophrenia “stand up for themselves”.

Power struggle

Participants took part in up to six sessions, each lasting 30 minutes. During each session, Leff sat in another room and played the role of both therapist and avatar. When Leff spoke as the avatar, software altered his voice to sound like the one selected by the participant.

When speaking as the avatar, Leff would begin by role-playing an abusive character similar to the one that the participants say they hear. Gradually, he changed the avatar’s responses to be more supportive. At the same time, he also used his normal voice to encourage the person to be more forceful and stand up for themselves.

Over the course of the sessions, Leff coordinated a shift of power ending with the avatar eventually yielding, and asking how it could help the participant.

Each volunteer was given a recording of the sessions to listen to whenever they liked. Three months later, 15 of the participants showed significant improvement in their hallucinatory symptoms. The person who found that the treatment did not work was unwilling to pretend that he was talking to the voice in his head rather than a therapist and insisted on using Leff’s name.

Making strides

“Auditory hallucinations are hard to shift,” says Thomas Craig at King’s College London, whose team has received £1.3 million from the Wellcome Trust to perform a larger trial in July with 142 people with schizophrenia.

It can take about a year of cognitive behavioural therapy to see an effect, he says. “Now just six sessions can give better results.”

“I found it good to visualise what was going on in my head,” says one of the 16 participants who now listens to recordings of his sessions on his iPod instead of music. Having dropped out of university when his auditory hallucinations became severe, he has since been able to return. “I’m doing a course now and I’ve moved out of home. I seem to be making strides,” he says. “I learned how to handle the voices.”