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

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-year-old 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.