What’s New in Psychology

Virtual Reality Therapy Can Help Clients Confront their Inner Demons

Jim Windell

            If only there was a way for clients to face their fears. If only they could talk to their traumas. And look their inner wounds in the eye and make them go away.

            It turns out that these are all possibilities.

            Thanks to scientists led by Dr. Alexandre Dumais, a medical professor in Université de Montreal's Department of Psychiatry and Addiction, there is now a therapy that uses virtual reality (VR) to recreate the voices patients hear in their heads.

            Given the name Avatar, the technique allows people to confront their demons and do it in a safe space. The technique has proven its efficacy with patients experiencing severe auditory hallucinations, now it is being tested for conditions such as substance-use disorder and major depression.

            Avatar gives physical form to the inner voices that torment patients so they can deal with them more effectively, says Dumais. “The avatar is a virtual figure controlled by the therapist. It embodies a voice heard by the patient, which is often critical and derisive, sometimes violent.”

            Together, client and therapist give this entity a shape. Its appearance, tone and words are all adjusted to reflect the patient’s subjective experience as closely as possible. For instance, "the demon tells me I’m a moron, I’m worthless,” one client reported.

            The virtual reality (VR) headset then projects an avatar that repeats these statements word for word, in a voice fine-tuned to match what the patient hears during the hallucinations.

            The therapy has three stages: preparation, VR immersion, and then more traditional talk therapy with the therapist. “We don’t just expose the person to the violence of the voice,” says Dumais. “The goal is to change the conversation, to transform this inner dialogue.”

            The therapy takes about nine weeks. Over the course of the sessions, the dialogue shifts. At first, the avatar is faithful to the original voice, but then it starts to modulate. The therapist encourages the client to talk back and become more assertive. Gradually, the demon is thrown off-balance. This is where the therapeutic effect kicks in: clients begin to question the negative view they have of themselves.

            “Sometimes the patients will transform the avatar,” said Dumais. “They no longer see it as just a demon but as a reflection of their illness. They take a step back and ask themselves, ‘What if I was the one who was running myself down?’”

            While Avatar therapy was initially designed for schizophrenia patients experiencing drug-resistant auditory hallucinations, its creators saw wider potential. Dumais and his team launched a pilot project to put the method to use with people who have cannabis-related disorders, "and the results are very encouraging,” he says.

            Here, the avatar represents an influential external figure, such as a friend, rather than a hallucination. The personification enables clients to express their resistance and understand what triggers for their drug use, psychologically. After eight sessions, participants in Dumais' experiment reduced their cannabis intake by around 50 per cent.

            More recently, Avatar has been used in a third pilot project for clients with refractory major depression – that is, those who do not respond to antidepressants or traditional psychotherapy. In these cases, the approach is used to deal with factors that are often neglected, such as unresolved conflict, unprocessed loss and traumatic associations.

            “These people have often already tried everything,” says Dumais. “We use an avatar to create a relational space where patients can say things they’ve never been able to express. The avatar takes the form of a deceased loved one, a critical parent, an ex-spouse or any other figure who has left a painful imprint.”

            Eventually, some avatars could be programmed with automated responses from a database of validated therapeutic content. The aim is not to replace the therapist but to tailor the avatar more closely to the client’s needs. These “augmented avatars” would remain under human supervision but could sustain more fluid interactions, the researchers believe.

            To read an article that was the basis for this blog, go to Archyde at: https://www.archyde.com/inner-demons-find-peace-through-virtual-dialogue/