The role of characterisation in everyday voice engagement and AVATAR therapy dialogue

Thomas Ward; Rachel Lister; Miriam Fornells-Ambrojo; Mar Rus-Calafell; Clementine J. Edwards; Conan O’Brien; Tom K.J. Craig; Philippa Garety

doi:10.1017/S0033291721000659

The role of characterisation in everyday voice engagement and AVATAR therapy dialogue

Thomas Ward^*, Rachel Lister, Miriam Fornells-Ambrojo, Mar Rus-Calafell, Clementine J. Edwards, Conan O’Brien, Tom K.J. Craig, Philippa Garety

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

2 Citations (Scopus)

Abstract

Background. Voices are commonly experienced as communication with a personified ‘other’ with ascribed attitudes, intentionality and personality (their own ‘character’). Phenomenological work exploring voice characterisation informs a new wave of relational therapies. To date, no study has investigated the role of characterisation in behavioural engagement with voices or within psychological therapy for distressing voices. Methods. Baseline characterisation (the degree to which the voice is an identifiable and characterful entity) of the dominant voice was rated (high, medium or low) using a newly developed coding framework, for n = 60 people prior to starting AVATAR therapy. Associations between degree of characterisation and (i) everyday behavioural engagement with voices (The Beliefs about Voices Questionnaire-Revised; n = 60); and (ii) interaction within avatar dialogue [Session 4 Time in Conversation (participant–avatar); n = 45 therapy completers] were explored. Results. Thirty-three per cent reported high voice characterisation, 42% medium and 25% low. There was a significant association between characterisation and behavioural engagement [H(2) = 7.65, p = 0.022, ε2 = 0.130] and duration of participant–avatar conversation [F(2,42) = 6.483, p = 0.004, η2 = 0.236]. High characterisation was associated with increased behavioural engagement compared with medium (p = 0.004, r = 0.34; moderate effect) and low (p = 0.027, r = 0.25; small−moderate effect) with a similar pattern observed for the avatar dialogue [high v. medium: p = 0.008, Hedges’ g = 1.02 (large effect); high v. low: p = 0.023, Hedges’ g = 1.03 (large effect)]. No differences were observed between medium and low characterisation. Discussion. Complex voice characterisation is associated with how individuals interact with their voice(s) in and out of therapy. Clinical implications and future directions for AVATAR therapy and other relational therapies are discussed.

Original language	English
Pages (from-to)	3846-3853
Number of pages	8
Journal	Psychological Medicine
Volume	52
Issue number	16
DOIs	https://doi.org/10.1017/S0033291721000659
Publication status	Published - 8 Dec 2022

Keywords

Auditory hallucinations
digital health
personification
relational therapy
voices

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1017/S0033291721000659

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@article{0208c265bf50467c8a279c91944bc3a2,

title = "The role of characterisation in everyday voice engagement and AVATAR therapy dialogue",

abstract = "Background. Voices are commonly experienced as communication with a personified {\textquoteleft}other{\textquoteright} with ascribed attitudes, intentionality and personality (their own {\textquoteleft}character{\textquoteright}). Phenomenological work exploring voice characterisation informs a new wave of relational therapies. To date, no study has investigated the role of characterisation in behavioural engagement with voices or within psychological therapy for distressing voices. Methods. Baseline characterisation (the degree to which the voice is an identifiable and characterful entity) of the dominant voice was rated (high, medium or low) using a newly developed coding framework, for n = 60 people prior to starting AVATAR therapy. Associations between degree of characterisation and (i) everyday behavioural engagement with voices (The Beliefs about Voices Questionnaire-Revised; n = 60); and (ii) interaction within avatar dialogue [Session 4 Time in Conversation (participant–avatar); n = 45 therapy completers] were explored. Results. Thirty-three per cent reported high voice characterisation, 42% medium and 25% low. There was a significant association between characterisation and behavioural engagement [H(2) = 7.65, p = 0.022, ε2 = 0.130] and duration of participant–avatar conversation [F(2,42) = 6.483, p = 0.004, η2 = 0.236]. High characterisation was associated with increased behavioural engagement compared with medium (p = 0.004, r = 0.34; moderate effect) and low (p = 0.027, r = 0.25; small−moderate effect) with a similar pattern observed for the avatar dialogue [high v. medium: p = 0.008, Hedges{\textquoteright} g = 1.02 (large effect); high v. low: p = 0.023, Hedges{\textquoteright} g = 1.03 (large effect)]. No differences were observed between medium and low characterisation. Discussion. Complex voice characterisation is associated with how individuals interact with their voice(s) in and out of therapy. Clinical implications and future directions for AVATAR therapy and other relational therapies are discussed.",

keywords = "Auditory hallucinations, digital health, personification, relational therapy, voices",

author = "Thomas Ward and Rachel Lister and Miriam Fornells-Ambrojo and Mar Rus-Calafell and Edwards, {Clementine J.} and Conan O{\textquoteright}Brien and Craig, {Tom K.J.} and Philippa Garety",

note = "Publisher Copyright: {\textcopyright} The Author(s), 2021. Published by.",

year = "2022",

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doi = "10.1017/S0033291721000659",

language = "English",

volume = "52",

pages = "3846--3853",

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AU - Ward, Thomas

AU - Lister, Rachel

AU - Fornells-Ambrojo, Miriam

AU - Rus-Calafell, Mar

AU - Edwards, Clementine J.

AU - O’Brien, Conan

AU - Craig, Tom K.J.

AU - Garety, Philippa

N1 - Publisher Copyright: © The Author(s), 2021. Published by.

PY - 2022/12/8

Y1 - 2022/12/8

N2 - Background. Voices are commonly experienced as communication with a personified ‘other’ with ascribed attitudes, intentionality and personality (their own ‘character’). Phenomenological work exploring voice characterisation informs a new wave of relational therapies. To date, no study has investigated the role of characterisation in behavioural engagement with voices or within psychological therapy for distressing voices. Methods. Baseline characterisation (the degree to which the voice is an identifiable and characterful entity) of the dominant voice was rated (high, medium or low) using a newly developed coding framework, for n = 60 people prior to starting AVATAR therapy. Associations between degree of characterisation and (i) everyday behavioural engagement with voices (The Beliefs about Voices Questionnaire-Revised; n = 60); and (ii) interaction within avatar dialogue [Session 4 Time in Conversation (participant–avatar); n = 45 therapy completers] were explored. Results. Thirty-three per cent reported high voice characterisation, 42% medium and 25% low. There was a significant association between characterisation and behavioural engagement [H(2) = 7.65, p = 0.022, ε2 = 0.130] and duration of participant–avatar conversation [F(2,42) = 6.483, p = 0.004, η2 = 0.236]. High characterisation was associated with increased behavioural engagement compared with medium (p = 0.004, r = 0.34; moderate effect) and low (p = 0.027, r = 0.25; small−moderate effect) with a similar pattern observed for the avatar dialogue [high v. medium: p = 0.008, Hedges’ g = 1.02 (large effect); high v. low: p = 0.023, Hedges’ g = 1.03 (large effect)]. No differences were observed between medium and low characterisation. Discussion. Complex voice characterisation is associated with how individuals interact with their voice(s) in and out of therapy. Clinical implications and future directions for AVATAR therapy and other relational therapies are discussed.

AB - Background. Voices are commonly experienced as communication with a personified ‘other’ with ascribed attitudes, intentionality and personality (their own ‘character’). Phenomenological work exploring voice characterisation informs a new wave of relational therapies. To date, no study has investigated the role of characterisation in behavioural engagement with voices or within psychological therapy for distressing voices. Methods. Baseline characterisation (the degree to which the voice is an identifiable and characterful entity) of the dominant voice was rated (high, medium or low) using a newly developed coding framework, for n = 60 people prior to starting AVATAR therapy. Associations between degree of characterisation and (i) everyday behavioural engagement with voices (The Beliefs about Voices Questionnaire-Revised; n = 60); and (ii) interaction within avatar dialogue [Session 4 Time in Conversation (participant–avatar); n = 45 therapy completers] were explored. Results. Thirty-three per cent reported high voice characterisation, 42% medium and 25% low. There was a significant association between characterisation and behavioural engagement [H(2) = 7.65, p = 0.022, ε2 = 0.130] and duration of participant–avatar conversation [F(2,42) = 6.483, p = 0.004, η2 = 0.236]. High characterisation was associated with increased behavioural engagement compared with medium (p = 0.004, r = 0.34; moderate effect) and low (p = 0.027, r = 0.25; small−moderate effect) with a similar pattern observed for the avatar dialogue [high v. medium: p = 0.008, Hedges’ g = 1.02 (large effect); high v. low: p = 0.023, Hedges’ g = 1.03 (large effect)]. No differences were observed between medium and low characterisation. Discussion. Complex voice characterisation is associated with how individuals interact with their voice(s) in and out of therapy. Clinical implications and future directions for AVATAR therapy and other relational therapies are discussed.

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KW - digital health

KW - personification

KW - relational therapy

KW - voices

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ER -

The role of characterisation in everyday voice engagement and AVATAR therapy dialogue

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UN SDGs

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