Find peace by confronting your inner demons—virtually
- UdeMNouvelles
06/05/2025
- Virginie Soffer
Avatar gives physical form to the inner voices that torment patients so they can deal with them more effectively, said Dumais.
Credit: Courtoisie
Avatar therapy helps patients deal with hallucinations, addictions and depression by interacting with figures in virtual reality.
What if we could sit down and talk to our fears? Give our trauma a face? Look our inner wounds in the eye, speak to them, and make them go away? Well, it turns out we can.
Scientists led by Dr. Alexandre Dumais, a medical professor in Université's Department of Psychiatry and Addiction, have come up with a therapy that uses virtual reality (VR) to recreate the voices patients hear in their heads.
Given the name Avatar, the technique allows people to confront their demons —most importantly, in a safe space.
Having proven its efficacy with patients experiencing severe auditory hallucinations, the therapy is now being tested for conditions such as substance-use disorder and major depression.
'Often critical and derisive'
Avatar gives physical form to the inner voices that torment patients so they can deal with them more effectively, said Dumais.
“The avatar is a virtual figure controlled by the therapist. It embodies a voice heard by the patient, which is often critical and derisive, sometimes violent.”
For people suffering from auditory hallucinations, this involves literally recreating the demon they hear, a voice that constantly insults, belittles and harasses them.
Together, patient and therapist give this entity a shape. Its appearance, tone and words are all adjusted to reflect the patient’s subjective experience as closely as possible. For instance, "the demon tells me I’m a moron, I’m worthless,” one patient reported.
The VR headset then projects an avatar that repeats these statements word for word, in a voice fine-tuned to match what the patient hears during the hallucinations.
The therapy has three stages: preparation, VR immersion, and then more traditional talk therapy with the psychiatrist. “We don’t just expose the person to the violence of the voice,” said Dumais. “The goal is to change the conversation, to transform this inner dialogue.”
The therapy takes about nine weeks. Over the course of the sessions, the dialogue shifts.
At first, the avatar is faithful to the original voice, but then it starts to modulate. The therapist encourages the patient to talk back and become more assertive. Gradually, the demon is thrown off-balance. This is where the therapeutic effect kicks in: patients begin to question the negative view they have of themselves.
“Sometimes the patients will transform the avatar,” said Dumais. “They no longer see it as just a demon but as a reflection of their illness. They take a step back and ask themselves, ‘What if I was the one who was running myself down?’”
Adapting to cannabis disorders
While Avatar therapy was initially designed for schizophrenia patients experiencing drug-resistant auditory hallucinations, its creators saw wider potential.
Dumais and his team launched a pilot project to put the method to use with people who have cannabis-related disorders, "and the results are very encouraging,” he said.
Here, the avatar represents an influential external figure, such as a friend, rather than a hallucination. The personification enables patients to express their resistance and understand what triggers for their drug use, psychologically.
After eight sessions, participants in Dumais' experiment reduced their cannabis intake by around 50 per cent.
New hope for treatment-resistant depression
More recently, Avatar has been used in a third pilot project for patients with refractory major depression – that is, those who do not respond to antidepressants or traditional psychotherapy. In these cases, the approach is used to deal with factors that are often neglected, such as unresolved conflict, unprocessed loss and traumatic associations.
“These people have often already tried everything,” said Dumais. “We use an avatar to create a relational space where patients can say things they’ve never been able to express. The avatar takes the form of a deceased loved one, a critical parent, an ex-spouse or any other figure who has left a painful imprint.”
This simulated confrontation provides a safe space to explore ambivalent feelings and conclude unfinished conversations. It is based on interpersonal therapy, with an added immersive experiential dimension.
Dumais gave the example of a fictional scene from a real case involving a patient whose spouse had died suddenly. The man had loved his spouse passionately and they had many plans for the future. With Avatar therapy, he was able to recreate the image of his partner and say, “I miss you so much. I think about you. How can I organize my life now that you’re gone? I feel I’m betraying you if I move on.”
After talking to the avatar of his deceased spouse, the patient continued the conversation with his therapist and was liberated by it. “This approach makes it possible to redefine the link with the deceased and let them go,” Dumais explained.
It’s easier to talk to an avatar
The therapists were surprised by how much more readily patients confided in an avatar than they do during traditional therapy. Sabrina Giguère, an UdeM doctoral student who is working on this subject, "is always taken aback by the depth of the revelations,” Dumais related. “The patient's defences come down.”
The presence of a third person—even a fictional one—seems to create a freer emotional space shielded from the therapist’s judgement. “You learn things in virtual reality that never come out in face-to-face sessions,” said Dumais. “And then that informs the subsequent sessions.”
Researchers are looking for theoretical explanations for this phenomenon. Alexandre Hudon, a psychiatrist and assistant clinical professor in Dumais' department, is currently modelling these interactions using artificial intelligence.
“We’re analysing the topics discussed,” he said. “We want to understand what types of conversations lead to the best clinical outcomes.”
Eventually, some avatars could be programmed with automated responses from a database of validated therapeutic content. The aim is not to replace the therapist but to tailor the avatar more closely to the patient’s needs. These “augmented avatars” would remain under human supervision but could sustain more fluid interactions, the researchers believe.
Attend a symposium on advances in the Avatar approach
Alexandre Dumais will moderate a discussion on advances in the Avatar approach at a conference on mental-health research in Quebec marking the 30th anniversary of the UdeM-affiliated CR-IUSMM, to be held on Thursday, June 12.
Sabrina Giguère will deliver a paper on using Avatar therapy to treat treatment-resistant depressive disorders and Alexandre Hudon will give a talk on whether experiential data could be used to automate care.
