Psychological and Psychosocial Interventions Help Reduce Auditory Hallucinations in Schizophrenia: JAMA
Germany: A systematic review and meta-analysis published in JAMA Psychiatry has revealed that psychological and psychosocial interventions produce small-to-moderate improvements in reducing auditory hallucinations (AHs) among individuals with schizophrenia spectrum disorders (SSDs).
While various therapeutic approaches were effective in decreasing the severity and other characteristics of hallucinations, their benefits differed considerably across interventions. Notably, avatar therapy emerged as one of the most promising strategies for targeting auditory hallucination symptoms. These findings support the use of targeted psychological treatments and may guide future research and clinical practice toward developing more effective, personalized interventions for managing auditory hallucinations in schizophrenia.
The study was conducted by Laura Fässler from the Department of Psychiatry and Psychotherapy at Charité – University Medicine Berlin and colleagues.
Auditory hallucinations are a hallmark symptom of schizophrenia spectrum disorders and often cause significant distress and functional impairment. Since many patients continue to experience hallucinations despite antipsychotic treatment, researchers evaluated the effectiveness of psychological and psychosocial interventions specifically targeting these symptoms.
The researchers conducted a systematic review of randomized clinical trials identified through major databases, including Embase, MEDLINE, PsycInfo, PsycArticles, PSYNDEX, and the Cochrane Library, through August 2025.
The analysis included 23 studies involving 2,016 participants, with 1,081 receiving one of five targeted interventions and 935 assigned to control groups. Treatment effects were assessed using validated clinical measures and pooled through a random-effects meta-analysis.
The following were the key findings:
- Psychological and psychosocial interventions significantly reduced the severity of auditory hallucinations compared with control treatments.
- These interventions were associated with improvements in hallucination frequency and the distress caused by auditory hallucinations.
- Participants also showed reductions in overall psychiatric symptoms, positive psychotic symptoms, delusions, depression, and anxiety.
- Avatar therapy demonstrated the greatest effectiveness in reducing the severity of auditory hallucinations among the interventions evaluated.
- Avatar therapy produced the largest reduction in auditory hallucination symptoms compared with other therapeutic approaches included in the analysis.
- The interventions were generally well tolerated, with low dropout rates across studies.
- Reports of adverse events indicated good acceptability and safety of the treatments.
- Sensitivity analyses confirmed the consistency and robustness of the study findings.
The authors noted that the included studies differed in methodology, assessment measures, and therapeutic approaches, and many had some risk of bias. The absence of direct head-to-head comparisons between interventions also limited conclusions regarding the superiority of specific treatments.
The researchers concluded that psychological and psychosocial interventions can effectively reduce auditory hallucinations and related symptoms in people with schizophrenia spectrum disorders. Although the benefits were generally small to moderate, avatar therapy showed the most consistent and favorable outcomes. The findings support combining targeted psychological therapies with standard pharmacological treatment and may inform future clinical guidelines and research.
Reference:
Fässler L, Koop S, Opper F, et al. Psychological Interventions Targeting Auditory Hallucinations in Persons With Psychotic Disorders: A Systematic Review and Meta-Analysis. JAMA Psychiatry. Published online June 17, 2026. doi:10.1001/jamapsychiatry.2026.1443
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