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People Are Yelling at Avatars to Get Rid of the Voices Inside Their Head

Dr. Julian Leff is a therapist who specializes in avatar therapy, a process that animates the voices people suffering from schizophrenia hear in their heads, and helps them fight back. We talked to him about it.

Schizophrenia is a brain disorder that affects a person’s ability to tell the difference between what is reality and fantasy. It affects an estimated one in 100 people.

Basically, schizophrenia makes living a normal life extremely difficult. Those afflicted with it often hallucinate, think others are controlling their minds, or are plotting to harm them. Even after drugs and therapy, most sufferers have to deal with these symptoms their whole lives.


Sadly, it’s an illness that not only ruins lives, but takes them too. We all know the story of Vince Li, who decapitated his seatmate on a Greyhound bus because the voices in his head told him to. On top of this, an estimated 40 percent of schizophrenics will attempt suicide at least once. Prescribed drugs help keep symptoms at bay, but a quarter of schizophrenics see no change after medication.

Oddly enough, the solution to all this may lie in yelling at your computer.

Five years ago, retired psychiatrist and professor Dr. Julian P. Leff had a radical idea. 12 years into his retirement, he decided that the best way to get rid of hallucinated voices was to meet them, and tell them off. Using patented 3D facial imaging software from Toronto, he constructs avatars with the face and voice of the patient’s tormentor. He sits in with the patient during sessions and encourages them to verbally confront their avatar on a computer screen.

Dr. Leff is now using avatar therapy to treat patients in a 1.2 million pound study over the next three years. If he can replicate the positive results from an initial pilot study, it will mark a huge advance in psychotherapy. I reached out to him over the phone to talk about schizophrenia, avatars, and yelling at computer screens.

VICE: Hi Dr. Leff. Tell me about this project, in your own words.
Dr. Leff: We allow schizophrenic patients to interact with the voices in their heads as a form of therapy. Using patented 3D facial imaging software from Toronto, the being in the patient’s head comes to life on a computer screen. I encourage my patients to confront the avatar during sessions with the hope that they can gain control of the voices, or even eliminate them completely. The project started in 2009 with a small group of patients and has since grown to a much larger study with the 1.2 million pound grant we were given.


How did you think of this? What inspired the avatar aspect?
I was seven years out of retirement, reading books, and relaxing when the idea came to me. It was a complete shot in the dark, but I thought, Why not try this? Oneout of 100 people are affected by schizophrenia and one out of four people affected by schizophrenia experience no improvements with medication. So I wanted to do something, I wanted to offer treatment to these people who have their lives controlled by this devastating illness. What other forms of therapy don’t offer is the ability to put a face and a being to their voices, and I’ve found that interacting with the tormentor can have a profound impact on getting patients’ lives back on track.

What have the results been like so far?
The first study was a randomized control trial from 2009 to 2011 that involved 16 patients who had had no improvement with drugs. Out of the 16, three lost their voices altogether, and the others showed promising improvements. The effect size (a measurement of the strength of treatment) for other therapies treating auditory schizophrenia is between 0.2 and 0.4. For my avatar therapy, the effect size was 0.8. This means that my treatment is at least twice as effective as any other non-pharmaceutical therapy. I was not expecting such extremely effective results. I had hoped for a minor improvement, so this came as a very big surprise.

What does a typical session look like?
Once we’ve designed their avatar, the patient is seated front of the screen, face to face with it. I am in a separate room from the patient, and the two rooms are connected with a cable. At the first meeting with the patient, I ask what the voice habitually says. I warn the patient that in the first session the avatar will say those things, but reassure them that as the therapist I will support them against the avatar. During a session, I switch back and forth from my two voices to mediate the conversation. As the therapy goes on, I progressively allow the avatar to yield to the patient's control and eventually to cease abusing the patient and instead to offer to help and support the patient.

How do your patients react when they first see their avatar?
Typically they are very timid at first. A few of my patients were sexually abused so naturally the treatment was very difficult for them. We have a panic button that the patient can press at any point if they feel overwhelmed, at which point the screen changes to a beach scene and Vivaldi’s "Four Seasons" is played to relax them. It’s tough at first to look at the thing that has been controlling their life, but it very rarely gets to the point where they have to use the panic button.

Tell me about the patients who were cured altogether.
The one’s whose voices disappear have their lives changed. I had one patient who was tormented by a devil inside his head who controlled him and got him to make bad decisions with his money. He took the devil’s advice and lost all of his money. In the first session he came in furious and just shouted at the devil. “Go to hell and leave me alone!” he said. In the second session he came back more relaxed, and when I phoned him for a third session he said, “I don’t need it!” He thanked me for giving him his life back, and for feeling clear in his mind for the first time. He now works as a successful financial analyst in Europe.

What does the future hold for avatar therapy?
Right now we’re conducting a much larger study using 140 patients over the course of three years. Up to date the statistics are outstandingly strong for the treatment, and if the results of this next study compare to the first trial, this kind of thing will become applicable all over the world. We’re not yet sure how the treatment will work in other languages, so there is still a lot of work to do. But if the first study can be replicated, this is a huge advance in psychotherapy that will change lives. @keefe_stephen