VR-AT

Fighting auditory hallucinations using virtual reality.

The challenge

Schizophrenia ranks among the most severe and debilitating mental disorders, with far-reaching consequences for patients, their families, healthcare professionals, and society. It is the most common form of psychosis affecting over 24 million individuals globally[1] with an estimated 5 million people affected in the European Union (EU).[2] The disorder manifests through various symptoms, the most incapacitating of which are auditory hallucinations – often characterised by distressing, threatening, and commanding voices.[3]

The healthcare costs associated with schizophrenia are considerable. In the EU, the average cost per patient per year ranges from €20,000 to €55,000, with additional costs for caregiving.[4] For instance, in Denmark, families spend an average of €22,000 per year on caregiving.[5] The total financial burden of schizophrenia in Europe is estimated at €93.9 billion annually. These costs are compounded by the societal impact, as individuals with schizophrenia often experience social isolation, unemployment, and reduced quality of life .[6]

The challenges in managing schizophrenia are significant for both patients and healthcare professionals. Typical treatments include pharmacotherapy and cognitive behavioural therapy for psychosis (CBTp). While pharmacotherapy is the primary treatment for schizophrenia providing some relief, it is only effective for approximately 70% of patients.[7] In addition, these medications come with significant side effects, including weight gain, metabolic syndrome, and neurological impairment, leading to high rates of non-adherence and relapse.[8] The remaining 30% of patients that do not respond to traditional medications are classified as pharmaco-resistant, further increasing the healthcare, economic, and social burdens.[9] On the other side, CBTp offers psychological support but does not specifically address the challenges posed by auditory hallucinations, which are among the most distressing symptoms of schizophrenia.

The wide-reaching impact of schizophrenia calls for more targeted, effective treatments, and improved support systems for those affected.

The solution

HekaVR is pioneering the integration of Virtual Reality and Artificial Intelligence, providing mental health practitioners with cutting-edge software for addressing auditory hallucinations in patients with schizophrenia. It offers a comprehensive treatment package, combining VR technology, machine learning for realistic voice simulation, a clinical manual for therapy, and ongoing clinical training and support for both practitioners and patients.

HekaVR immerses patients in a controlled, therapist-guided experience where they interact with a digital avatar representing their hallucinations. This approach empowers patients to confront and manage their symptoms, leading to a reduction in the frequency and severity of auditory hallucinations. Early clinical trials, including the world’s largest Randomized Controlled Trial (RCT) conducted in Denmark in 2024, show significant improvements in symptom management and reduced frequency of hallucinations, as measured by the Psychotic Symptoms Rating Scales for Auditory Hallucinations (PSYRATS-AH).[11]

The treatment is cost-effective, requiring only up to 9 sessions compared to 26 sessions for traditional Cognitive Behavioral Therapy for psychosis (CBTp), making it more accessible to a broader patient population.

HekaVR is expanding into Spain, Poland, and Hungary to validate the therapy in different healthcare systems, conduct health economic assessments, and establish reimbursement frameworks, with plans for a strategic market launch in 2026.

The VR-based therapy protocol was developed by the VIRTU Research Group at the Copenhagen Centre for Mental Health (CORE) and has been validated through the largest global RCT involving 266 patients with treatment-resistant schizophrenia across three hospital regions in Denmark.

Expected impact

Health Impact: VR- based Avatar Therapy (VR-AT) is expected to reduce the severity and frequency of auditory hallucinations by 3.8 points or more on the PSYRATS-AH scale (or a validated equivalent), significantly improving patients’ daily functioning and overall mental health.

Social Impact: An anticipated 30% improvement in patients’ quality of life, as measured by the Quality-of-Life Scale (QLS). Additionally, qualitative interviews will explore the broader social impact of VR-AT, highlighting its effects on patients’ relationships, work, and social engagement.

Economic Impact: By offering a more efficient treatment (requiring fewer sessions than traditional therapies), VR-AT is projected to reduce healthcare costs by 20% over three months or longer, if the results are applicable across different regions.

The project will generate critical data on the effectiveness of VR-AT in diverse healthcare systems, providing evidence for wider acceptance and implementation. The focus on cultural adaptation will ensure that the solution is tailored to local contexts, facilitating its adoption in other countries and settings, and supporting global scalability.

External Partners

• Heka VR (lead partner)
• VIRTU Research Group (clinical training)
• Ditte Lammers Vernal from OPUS

This consortium merges clinical expertise, academic insight, and innovative technology to advance the project’s goals, positioning HekaVR at the forefront of this initiative.

References

[1] Schizophrenia (2022) World Health Organization. Available at: https://www.who.int/news-room/fact-sheets/detail/schizophrenia (Accessed: 14 August 2023).

[2]  Wittchen, H.-U. et al. (2011) ‘The size and burden of mental disorders and other disorders of the brain in Europe 2010’, European neuropsychopharmacology, 21(9), pp. 655–679.

[3] Leff, J. et al. (2014) ‘Avatar therapy for persecutory auditory hallucinations: What is it and how does it work?’, Psychosis, 6(2), pp. 166–176

[4] Kovács, G. et al. (2018) ‘Direct healthcare cost of schizophrenia–European overview’, European Psychiatry, 48(1), pp. 79–92.

[5] Hastrup, L.H. et al. (2020) ‘Societal costs of schizophrenia in Denmark: a nationwide matched controlled study of patients and spouses before and after initial diagnosis’, Schizophrenia Bulletin, 46(1), pp. 68–77

[6] Gustavsson, A. et al. (2011) ‘Cost of disorders of the brain in Europe 2010’, European neuropsychopharmacology, 21(10), pp. 718–779.

[7] Mayor, S. (2017) ‘Avatar therapy reduces auditory hallucinations in schizophrenia, trial finds’.

[8] Patel, K.R. et al. (2014) ‘Schizophrenia: overview and treatment options’, Pharmacy and Therapeutics, 39(9), p. 638

[9] Leboyer, M. et al. (2021) ‘Immune signatures of treatment resistant schizophrenia: a FACE-SZ study Running title: Immune profile of treatment-resistant schizophrenia’, Schizophrenia Bulletin Open, 2(1), p. sgab012

[10] Turner, D.T. et al. (2014) ‘Psychological interventions for psychosis: a meta-analysis of comparative outcome studies’, American Journal of Psychiatry, 171(5), pp. 523–538

[11] Vernal, D.L. et al. (2023) ‘Status and Clinical Experiences from the Challenge Trial–A Randomized Controlled Trial Investigating Virtual Reality-based Therapy for Auditory Hallucinations’, World Social Psychiatry, 5(1), p. 71