Status and Clinical Experiences from the Challenge Trial – A Randomized Controlled Trial Investigating Virtual Reality-based Therapy for Auditory Hallucinations

Background: Auditory verbal hallucinations are a prevalent symptom in schizophrenia and other psychotic disorders, affecting around 70% of patients. A sizable proportion does not achieve adequate treatment response with current interventions, including antipsychotic medication. Virtual reality-based therapy (VRT) shows promise as a new intervention. Methods: The Challenge Trial is a randomized controlled study examining the efficacy of VRT compared to standard treatment for auditory hallucinations in patients with psychotic disorders. In the intervention arm, virtual reality software and voice modulation are used to design a visual representation of the patient's voice (an avatar) and to transform the therapist's voice to sound like the voice the patient hears. The aim is to foster a dialogue for the patient to strengthen their power, practice self-efficacy, and alter their relation to the voice. During therapy, the avatar becomes more compassionate and/or less powerful. Results: Quantitative data are currently unavailable as recruitment is ongoing. Instead, the design and intervention are presented along with recruitment data, retention rates, and case vignettes. Early clinical experiences are promising, with high acceptability and tolerance among patients. The trial has successfully enrolled a diverse patient population, including those with long-standing histories of hospitalization, medication use, and chronic hallucinations. The effectiveness of VRT varies, for example, some patients have reported significant reductions in the frequency of voices and associated distress, whereas others have primarily noted improvements in emotional responses to the voices. Conclusions: Based on the first 2 years of the Challenge Trial, VRT shows considerable promise as a potential treatment for auditory verbal hallucinations.