{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T11:36:55Z","timestamp":1791459415223,"version":"4.3.4"},"reference-count":40,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2020,8,25]],"date-time":"2020-08-25T00:00:00Z","timestamp":1598313600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100010269","name":"Wellcome Trust","doi-asserted-by":"publisher","award":["FWBC-AVATAR 098272\/z\/12\/z"],"award-info":[{"award-number":["FWBC-AVATAR 098272\/z\/12\/z"]}],"id":[{"id":"10.13039\/100010269","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>AVATAR therapy offers a unique therapeutic context that uses virtual reality technology to create a virtual embodiment of the voice-hearing experience, enabling the person to visualize their persecutory voice and engage in real-time \u201cface-to-face\u201d dialogue. The present study explores, for the first time, the contribution of sense of voice presence, together with session-by-session reduction of anxiety and paranoid attributions about the avatar, to changes in primary outcomes following AVATAR therapy. Data from 39 participants, who completed AVATAR therapy and attended a 12-week follow-up assessment, were analysed. Mid- to high-levels of sense of voice presence were reported across the therapy sessions, along with significant reductions of anxiety levels and paranoid attributions about the avatar. The interaction of sense of voice presence and reduction of anxiety was associated with two of the significant therapy outcomes: PSYRATS total and frequency of voices. The findings suggest that improvements in voice severity and frequency at post AVATAR therapy may be influenced by the combination of feeling less anxious in the context of a realistic simulation of the voice, while voice-related distress may involve additional cognitive and relational processes.<\/jats:p>","DOI":"10.3390\/jcm9092748","type":"journal-article","created":{"date-parts":[[2020,8,25]],"date-time":"2020-08-25T09:30:07Z","timestamp":1598347807000},"page":"2748","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":41,"title":["The Role of Sense of Voice Presence and Anxiety Reduction in AVATAR Therapy"],"prefix":"10.3390","volume":"9","author":[{"given":"Mar","family":"Rus-Calafell","sequence":"first","affiliation":[{"name":"Mental Health Research and Treatment Center, Faculty of Psychology, Ruhr-Universit\u00e4t Bochum, 44787 Bochum, Germany"},{"name":"Department of Health Service and Population Research, Institute of Psychiatry, Psychology &amp; Neuroscience, King\u2019s College London, London SE5 8AB, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Ward","sequence":"additional","affiliation":[{"name":"Department of Psychology, Institute of Psychiatry, Psychology &amp; Neuroscience, King\u2019s College London, London SE5 8AB, UK"},{"name":"South London &amp; Maudsley NHS Foundation Trust, London SE5 8AZ, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiao Chi","family":"Zhang","sequence":"additional","affiliation":[{"name":"Mental Health Research and Treatment Center, Faculty of Psychology, Ruhr-Universit\u00e4t Bochum, 44787 Bochum, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9949-2401","authenticated-orcid":false,"given":"Clementine J.","family":"Edwards","sequence":"additional","affiliation":[{"name":"Department of Psychology, Institute of Psychiatry, Psychology &amp; Neuroscience, King\u2019s College London, London SE5 8AB, UK"},{"name":"South London &amp; Maudsley NHS Foundation Trust, London SE5 8AZ, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philippa","family":"Garety","sequence":"additional","affiliation":[{"name":"Department of Psychology, Institute of Psychiatry, Psychology &amp; Neuroscience, King\u2019s College London, London SE5 8AB, UK"},{"name":"South London &amp; Maudsley NHS Foundation Trust, London SE5 8AZ, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tom","family":"Craig","sequence":"additional","affiliation":[{"name":"Department of Health Service and Population Research, Institute of Psychiatry, Psychology &amp; Neuroscience, King\u2019s College London, London SE5 8AB, UK"},{"name":"South London &amp; Maudsley NHS Foundation Trust, London SE5 8AZ, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2020,8,25]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"S246","DOI":"10.1093\/schbul\/sbu003","article-title":"Interdisciplinary Approaches to the Phenomenology of Auditory Verbal Hallucinations","volume":"40","author":"Woods","year":"2014","journal-title":"Schizophr. 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