There’s a lot about the digital world that people find disturbing but some things are exciting and hold the possibility of life change for many people – especially in the world of mental health care.

Shortly after speaking with eMHPrac Director Heidi Sturk in a recent webinar about what we can expect of digital mental health (dMH) in the future  Public Dashboard | Black Dog Institute (webinar 76), I was fascinated to read in an article in the October 28^th edition of Nature Medicine about research that has been conducted at the Institute of Psychiatry, Psychology and Neuroscience at Kings College London. The research involves AVATAR therapy for people experiencing verbal auditory hallucinations.

Severe mental illness such as psychosis is not generally seen as something that digital technologies can address, but that position reflects a mindset where digital resources are regarded as self-help options. Increasingly clinicians are using digital mental health resources as adjuncts to face-to-face care and blending them into care in innovative ways. The use of avatars for people experiencing “voices” is one example of that kind of approach. Whilst still in the research phase it shows considerable promise.

The research was built around the use of bespoke software which enabled the participants to create an avatar to embody the distressing voice(s) they were hearing. Avatars were customised by the user both in terms of appearance and the sound of their voice. The treatment involved a series of face-to-face dialogues between the avatar and its creator, with therapist support, aimed at reducing the voice-related distress they were experiencing and building empowerment.

There was an initial proof of concept study (6 sessions) which established the safety of the avatar therapy approach.

The AVATAR 1 trial was a single site RCT which “demonstrated a substantial reduction in the severity of voices in the Avatar therapy group after 12 weeks.”

The AVATAR 2 trial was a multisite trial involving 345 participants which aimed to compare treatment as usual to brief (6 session) avatar therapy and extended (12 session) avatar therapy. (You can read about it in more detail in Nature Medicine by following the link above)

“Voice distress mean scores and overall mean voice severity significantly improved” in both the brief and extended avatar therapy groups compared with the treatment as usual group. These improvements were maintained for 16 weeks though by 28 weeks the improvement was no longer statistically significant.

I hear these objections and they are true but I think it reflects the fact that we all need to modify our expectations as well as our work practices when it comes to the use of digital mental health resources.

Firstly, although the use of digital treatment programs provides excellent results for some people, many programs and resources are only able to provide symptom relief in some areas of the illness. This is especially true for those with complex issues.

Secondly, digital resources are more effective if their use is blended into face-to-face care.

The research is swelling to support blended care. We are going to be challenged in the very near future by a host of new developments and we probably all need to get onboard and work out ways to use digital resources in our clinical work if we are going to be able to be of greatest service to the people whose mental health we support.