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Virtual Reality: An Intervention to Treat Auditory Hallucinations

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Katrine Konyher | Marketing Specialist and Business Developer | Khora

14 May 2021 | 5 min read

Schizophrenia and virtual reality (VR). An unusual combination to a stranger, but a lifeline that could save millions to a medical professional. But how? How can VR lessen the symptoms of schizophrenia?

The most expensive mental health disorder

Schizophrenia is a chronic and severe mental disorder affecting 20 million people worldwide (WHO 2019). This mental health disorder is associated with considerable disability. People with schizophrenia are 2-3 times more likely to die early than the general population (WHO 2019).

In Denmark alone, the Danish Health Authority has estimated that schizophrenia is among the most expensive disorders in terms of lost workforce and costs of treatment.

Auditory verbal hallucinations are one of the most common symptoms for people suffering from schizophrenia. Around 60-80% of people diagnosed with schizophrenia report hearing derogatory and threatening voices. Auditory hallucinations are among the most painful and disabling symptoms for those who suffer from disorders in the schizophrenia spectrum.

Treatment resistant patients

Schizophrenia is considered a treatable mental health disorder. But around 28% of patients try all current treatment methods without any success. This leads to a big population group with persistent auditory hallucinations. Many of the 72% of respondents, who respond well to the current treatment, however still suffer from significant side effects.

There is an unmet need for a new and effective treatment.

The Challenge Project virtual reality treatment - calm beach image

Source: Khora

Novel treatment with virtual reality exposure

Virtual reality technology offers the possibility of creating artificial experiences in real-time. These experiences make the user feel immersed and able to interact as if the situation was happening in real life.

The use of virtual reality allows exposure to challenging situations in an immersive environment. The environment is controlled, flexible and protected. Auditory hallucinations are hard to control and overcome in real life. But VR has a huge potential for simulation training of strategies to combat hostile and unpleasant auditory hallucinations.

The Challenge Project

The Challenge Project is a research project with a focus on developing a new treatment for people suffering from auditory hallucinations. The goal of the project is to test the effectiveness of the VR form of the treatment.

The Danish Innovation Fund has granted 13 million Danish kroner to the Challenge Project.

The Challenge virtual reality treatment

The Challenge VR treatment is a type of Avatar therapy. According to Ward et al. (2020:1038), ‘Avatar therapy [is] a novel therapeutic context [which] allows “face-to-face” dialogue between the person and a digital representation matching the auditory characteristics and associated imagery of their main persecutory voice’. Neil Thomas, an associate professor at the University of Swinburne, Australia, is assisting with the development of the treatment.

The treatment is a therapist-to-patient conversation where the therapist uses the Challenge VR software as a tool. The software includes a virtual reality simulation program and a voice modulation in real-time. These features enable the patient to face their malevolent voices and can reduce their control over the patient’s life. See how it works below.


The VR part of the Challenge treatment is developed by Khora, a Danish company of virtual reality experts and developers. Khora’s team is responsible for the development of voice distortion and avatar creation in virtual reality. Everything is done in close collaboration with the Capital Region Mental Health department.

With Challenge, patients will be able to develop new skills and strategies to cope with their persecutory voices. The VR intervention is expected to greatly improve the cost-effectiveness and efficacy of the current treatment of auditory hallucinations.

What makes Challenge virtual reality treatment unique?

Face creation

With Challenge you can create a visual representation of the patient’s malevolent voice. The gender, age, and facial characteristics of the avatar are all customizable.

Voice modulation

A recording of the therapist’ voice can be modulated – by changing age, gender, pitch, and other traits – to resemble the patient’s persecutory voice.

Real-time VR

The patient can engage in a dialogue with the visual representation of the malevolent voice in VR. The therapist meanwhile is acting as the voice via the real-time voice modulation feature.

“Often patients are in a position where they are very submissive to the voice they hear. They listen to what the voice says and do what it commands. It can be from cutting and hurting themselves, or in the worst case, harming others. We must change the power balance between the voice and the patient. The power, to a greater extent, needs to be returned to the patient so that they can answer back and say ‘No’ to the voice.”

-Louise Birkedal Glenthøj, Postdoc at CORE and part of the research unit at the Psychiatric Center in Copenhagen who is currently working on this research project.

the challenge project virtual reality treatment - visualisation of the voice

Source: Khora

The Challenge Project: where we are now?

Trials are currently taking place in three regions in Denmark.

A total of 266 patients with severe hearing hallucinations are included in a research trial. Half will go through nine sessions where they will be exposed to malevolent voices in the virtual reality format. While the other half will have a similar number of supportive conversations.

Future of the Challenge Project

The work on the Challenge Project never stops. Khora is currently working on optimizing the software to support this novel treatment.

The mission of the Challenge Project is to revolutionise the healthcare industry. You may ask how? The answer is simple – by using VR’s ability to improve people’s lives and by democratising the software capable of doing so.

The Challenge Project lets patients with schizophrenia confront their malevolent voices and allows the development of new skills and strategies to cope with the voices. This makes their lives significantly easier to live!

The Challenge Project is a 5-year project set to be concluded in 2024.


Credits For the Challenge Project: Luís Vieira, Stefania Serafin, Merete Nordentoft, Simon Max Bloch Lajboschitz, Peter Fisher, Nicole Dumanski, Lise Sandvig Mariegaard, and the rest of the Challenge team.


Featured Photo: Sebastian Stigsby for Digital Hub Denmark

About the author:

Katrine Konyher is Marketing Specialist and Business Developer at the VR and AR production studio Khora based in Copenhagen. Khora is creating cutting edge content within multiple application areas and over the last five years they have produced more than 300 VR/AR applications. Part of Khoras business has been working with application and software that is documenting the effectiveness of using virtual reality in various areas such as pain distraction and exposure therapy. The potential for using virtual reality and augmented reality to improve people’s mental health is immense and Khora is pushing the boundaries of what immersive technologies can do.