# Reattribution of Auditory Hallucinations Throughout Avatar Therapy: A Case Series

## TL;DR

This study explores how Avatar Therapy helps people with schizophrenia reassign their hallucinations from external to internal sources, leading to improved self-perception and reduced distress.

## Contribution

The study provides new insights into how reattribution of hallucinations occurs during Avatar Therapy and its impact on self-perception and emotional regulation.

## Key findings

- Two participants reported reduced severity of auditory hallucinations after reattribution.
- All three participants experienced improved self-perception and emotional regulation.
- Participants began to view their hallucinations as self-generated thoughts rather than external voices.

## Abstract

Background and Clinical Significance: Avatar Therapy (AT) for individuals with treatment-resistant auditory verbal hallucinations (AVHs) in schizophrenia aims to address emotional responses, beliefs about voices, self-perception, and coping strategies. This study focuses on three participants who, during AT, shifted their belief about the origin of their most distressing voice from an external source to a self-generated one. Case Presentation: The objective of this study was to explore the evolution of the reattribution of the participants’ most distressing voice to oneself during AT and the patients’ perception of this reattribution. Immersive sessions and semi-structured interviews were transcribed and qualitatively described to provide a session-by-session account of the evolution of each participant’s AVH reattribution to themselves during the course of AT, along with their perceptions of this reattribution. This process led to the recognition that initially perceived as external voices were internally generated thoughts, reflecting how participants viewed themselves. Two participants reported a reduction in AVH severity. All three described positive changes in how they related to their voices and self-perception. Additional improvements were observed in emotional regulation, social functioning, and engagement in personal projects. Conclusions: This reassignment of the voice from an external source to an internal one suggests that AT can modify how individuals relate to their voices and may empower them to regain control over their hallucinations. However, given the exploratory nature of this study, the results should be interpreted as examples.