Making referrals to the AVATAR2 trial: An interview with Dr Helen Harding

The AVATAR2 trial is a multi-centre study of therapy aiming to help people who hear distressing voices by enabling them to build an avatar to represent the owner of the voice. Referrers play a pivotal role by recommending participants take part in the trial. In this interview clinical psychologist, Dr Helen Harding, talks about the referral process and how she sees the research benefitting patients in the short and long term. Dr Harding is a Clinical Psychologist in Lambeth Community Services.

Q. How did you hear about AVATAR2? What were your initial thoughts about the trial?

A. I first heard about avatar therapy a few years ago around the time of the AVATAR1 study. More recently, I came across the AVATAR2 trial when the research team joined one of our team meetings to give a presentation about the study. My initial thoughts were that this could be great for some of our clients – the therapy had promising results from the AVATAR1 study, to the extent that they decided that every participant in AVATAR2 should be offered the therapy (either as part of the trial or after their involvement has ended). With many research trials there is only a 50% chance of our clients receiving therapy, so this was particularly appealing and seemed like a great opportunity to help our clients and help us manage our caseload.

Q. What motivated you to refer clients to the trial? How much time did referring to AVATAR2 take?

A. When the team came to present, I felt comfortable that our clients would be in safe hands. The therapists on the trial are established and very experienced clinicians within South London and Maudsley NHS Foundation Trust. I was reassured to hear that no adverse events had been linked to the therapy and was really interested to hear examples of some of the positive changes reported by clients. For example, in some cases, clients had stopped hearing voices altogether after just a few sessions of therapy.

On a practical level, the referral process has always been very quick with no tricky hurdles. To make a referral all I have to do is to inform my client that there is a study of a therapy for people who hear distressing voices, then ask if they’d be interested in hearing from the research team. If they are willing, I send a brief email to pass on their contact details to the research team and that is it. Didn’t take more than a couple of minutes.

Q. In your mind what are the benefits for those participating in research trials like AVATAR2?

A. The main benefit from my perspective, is that it gives our clients access to a psychological therapy for distressing voices. Often our clients report that hearing voices is one of their most distressing experiences, so having the study as an additional way of accessing therapy makes a big difference.

We have also found that many clients enjoy giving back and doing something for others through taking part in research. Through taking part in AVATAR2 some clients describe feeling pleased to be able to contribute to research aimed at ultimately improving our psychological understanding and support available for people with distressing voices.

Q. And how about clinicians like yourself – how do you think trials like AVATAR2 help your work both in the short-term and long-term?

A. In the short-term, trials like AVATAR are a helpful way of increasing access to psychological therapies for our clients with distressing experiences such as voices. It is reassuring to know that everyone we refer will receive avatar therapy and the waiting times are usually short (two thirds of participants receive therapy within two weeks of taking part, whilst the remaining third are offered therapy after 7 months). That means our clients have a 100% chance of receiving an innovative therapy with really encouraging results so far often with very little waiting time.

In the longer-term I hope that the results of the AVATAR2 trial will ultimately help to improve the care available for people who are troubled by distressing voices, including better understanding people’s experiences of distressing voices and who the therapy might be best for. This could allow more people across the country to access help for their distressing voices within the NHS, where options are currently limited.

Q. What feedback have you received from your clients who have accessed the trial?

A. Clients have sometimes been a little apprehensive initially, particularly about the idea of being referred to a research study. I find it helpful to explain a bit more about the research, in terms of the additional meetings with one of the research team to complete the measures (which they will be compensated for) and how the team can be quite flexible in terms of when and where they meet (e.g. they can pay for transport costs or arrange for home visits, where possible, or offer remote meetings depending on client preference). Often this helps to put people at ease and feel more open to discussing the study further with the team.

Once clients have spoken with the research team, the feedback has been very positive – clients have felt comfortable, staff have been in touch quickly and communicate the next steps clearly. I have noticed a sense of hope from clients that they are going to receive this new therapy, specifically around managing their voices, which often feel extremely distressing and debilitating, preventing people from connecting with the things that are most important to them. I am very much looking forward to hearing more about how the therapy has gone for the clients I have referred who have consented to take part in the study.

Q. What involvement did you have with the trial after referring someone?
A. There wasn’t too much involvement after we referred as the research team handle all the research assessments and therapy sessions. They let us know once our client had decided to take part and which treatment arm they were in (6x therapy sessions, 12x therapy sessions or treatment as usual). Following that we generally can keep up with a client’s involvement in the trial through their electronic care notes, as the AVATAR2 team upload notes before and after each research assessment and therapy session. The only times they would get in touch were occasionally if having trouble reaching a client, or to let us know about a risk picture developing. When I have had any questions, a member of the team has always got back to me really quickly with a helpful response.

Q. Would you recommend the trial to other clinicians who see people who hear voices?
A. Yes – my experience with AVATAR2 has been overwhelmingly positive. I know that the study is recruiting for another 6 months and I would encourage any clinicians to make use of this option whilst it’s still available!

The AVATAR2 trial follows on from the success of the AVATAR1 trial which was supported by the NIHR Maudsley Biomedical Research Centre. AVATAR2 is led by Professor Philippa Garety (King’s College London) in partnership with University College London, University of Manchester and University of Glasgow.

This interview forms part of our contribution to the 2022 National Institute for Health and Care Research (NIHR) TrialBlazers campaign, celebrating people who take part in research. See the NIHR's campaign page and follow our Twitter account to find out more.