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AVATAR versus cognitive-behavioral therapy for medication-resistant auditory hallucination: a systematic review and
Tien-Wei Hsu1,2,3,4, Chih-Sung Liang5,6, Te-Chang Changchien2,4
1Department of Psychiatry, https://ror.org/04d7e4m76E-DA Dachang Hospital, I-Shou University, Kaohsiung, Taiwan.
Psychological Medicine
|April 13, 2026
Summary
Audio Visual Assisted Therapy Aid for Refractory auditory hallucinations (AVATAR) therapy shows lasting efficacy for medication-resistant auditory hallucinations, comparable or superior to Cognitive Behavioral Therapy (CBT). This novel digital avatar approach offers a promising alternative for persistent symptoms.
Area of Science:
- Psychiatry and Mental Health
- Digital Therapeutics
- Clinical Psychology
Background:
- Auditory hallucinations (AH) persist in schizophrenia spectrum disorder despite antipsychotic treatment.
- Cognitive Behavioral Therapy (CBT) is an established intervention for AH.
- AVATAR (Audio Visual Assisted Therapy Aid for Refractory auditory hallucinations) therapy is a novel digital avatar approach for AH.
Conclusions:
- AVATAR therapy exhibits lasting efficacy, comparable or slightly superior to CBT for medication-resistant AH.
- AVATAR therapy presents a viable alternative for patients with persistent AH.
- Cautions regarding interpretation due to small-study effects and risk of bias in included trials.
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