Have you ever experienced hearing something, like your name being called, that others do not? It’s quite common to hear voices or sounds that are not present, with roughly 10% of people reporting auditory hallucinations at some life stage. These experiences vary considerably among individuals and can shift over time. The voices may belong to a known or unknown individual, range from one to many, and vary in volume from loud to a whisper. Some find these experiences positive, perhaps viewing them as spiritual or comforting. However, others find them distressing, with voices being intrusive, negative, critical, or threatening, leading to feelings of anxiety, fear, embarrassment, or frustration.
These experiences may interfere with concentration, social interaction, and daily activities. While hearing voices does not always indicate a mental health issue, it is more prevalent in those who do. It is often associated with schizophrenia, affecting about 24 million people globally. Yet similar experiences are frequent in other mental health conditions, especially mood and trauma-related disorders like bipolar disorder or depression, and post-traumatic stress disorder, where up to 50% of those affected might hear voices. The reasons why some people hear voices are not entirely understood, but long-term stress, trauma, or depression can increase the likelihood.
Some studies suggest that people who hear voices might have differently “wired” brains, particularly between the areas responsible for speech and hearing, causing parts of inner speech to be perceived as external voices. So a thought like “you are useless” after a mishap might feel like someone else is voicing it. Other research indicates it may involve how our brain uses past experiences to interpret and predict our environment, sometimes skewing our perception, including hearing what the brain anticipates rather than reality.
When individuals tell us they hear voices, they genuinely perceive them as though someone is speaking in the room – this misperception is somewhat like being prone to optical illusions. When hearing voices becomes life-disruptive, treatment guidelines propose the use of medications, but about a third experience persistent distress. Hence, psychological therapies like cognitive behavioral therapy are also recommended. New psychological therapies are emerging, employing digital technologies, and virtual reality presents a promising approach. Avatar therapy allows individuals to craft a virtual representation of the voice or voices, mirroring their experience in appearance and sound.
This technique empowers them to reclaim agency over the “relationship,” aided by a therapist’s guidance. For instance, a 53-year-old individual, Jason (a pseudonym), coped with relentless voices since his early 20s. While antipsychotic medication had provided some relief, he continued to endure distressing voices. As part of a research initiative, Jason engaged in avatar therapy. Initially, he struggled to confront the voices, but gradually he built confidence and experimented with responding differently to the avatar and voices, with therapeutic support.
Over time, he gained the ability to establish boundaries, such as ignoring the voices at specific times, and felt more empowered to challenge their content and make independent decisions. Over a few months, Jason began experiencing daily breaks from the voices, altering his relationship with them. They transformed from tormentors to critical allies, offering constructive criticism.
Encouraged by positive results from international studies and recommendations from the United Kingdom’s National Institute for Health and Care Excellence, we have started adapting avatar therapy for an Australian setting. We are conducting trials to deliver this therapy from our specialist voices clinic through telehealth, while also evaluating whether avatar therapy is more effective than the current cognitive behavioral therapy standard for treating hearing voices. Given that only a minority of individuals with psychosis receive specialized psychological therapy for hearing voices, we aim for our trial to help expand the availability of these innovative treatments more broadly across the nation.