Early findings on VR-Avatar therapy effectiveness in a Hungarian cohort: Clear trends amid contradictory experiences

Background Auditory verbal hallucinations (AVH) significantly impact patients’ lives with schizophrenia spectrum disorders. Modified VR-Avatar therapy, integrating cognitive behavioral therapy and acceptance and commitment therapy, offers a promising approach to address AVH by enhancing patient engagement through personalized virtual interactions. Methods This non-randomized, waitlist-controlled, single-group, pre-post pilot trial, enrolled 16 patients with schizophrenia spectrum disorders experiencing persistent AVH. Recruited participants undergo a 3-month waitlist period with standard care before receiving modified VR-Avatar therapy. Comprehensive assessments at baseline, pre-treatment, and post-treatment evaluate symptom severity, comorbid depression and anxiety, quality of life, well-being, and therapy perceptions. Assessments are conducted by blinded raters. Results VR-Avatar therapy was associated with significantly improved PANSS total (g = 0.77), positive symptoms (g = 0.81), hallucination score (g = 1.07), cognitive symptoms (g = 0.49), PSYRATS hallucinations (g = 0.96), and BAVQ-R omnipotence (g = 0.51) post-treatment (w12 vs. w24, p < 0.05). Preliminary analyses comparing responders (68.75%) and non-responders (31.25%) indicate potential tendencies where responders exhibited higher baseline AVH severity (PSYRATS, p = 0.057), greater distress (p = 0.08), and stronger behavioral resistance (p = 0.057), hinting that these domains might contribute to therapeutic responsiveness; however, these observations are exploratory and warrant confirmation in larger samples. No significant changes in functionality or comorbid symptoms occurred. Screen failure rate was 65%, dropout 18%, and 37% reported mild side effects (e.g., dizziness). Satisfaction was high (56.25% rated excellent), with 50% showing >20% improvement. Conclusions Early findings suggest modified VR-Avatar therapy is feasible and may benefit Hungarian patients with AVH, particularly those with more severe baseline symptoms and distress.