Evidence
Clinical evidence
Heka VR's platform is used in peer-reviewed clinical research investigating avatar therapy across schizophrenia, eating disorders, OCD and further psychiatric indications. We work with research groups at psychiatric hospitals and universities across three continents.
Evidence at a glance
Publications in The Lancet Psychiatry, PLOS One, Journal of Clinical Psychology, Digital Health and JMIR Formative Research, among others.
Active research programmes spanning Europe, North America and Australia.
Schizophrenia, eating disorders, and OCD, with further psychiatric conditions under investigation.
Completed trials with sites in Denmark, Spain, Turkey, Poland and Hungary.
By indication
Schizophrenia spectrum disorders
Avatar therapy for persistent auditory verbal hallucinations in schizophrenia has been investigated in multiple randomised controlled trials. Heka VR's immersive VR adaptation was investigated in the CHALLENGE trial, a single-blind randomised clinical trial conducted across Danish mental health services.
Key publications
The CHALLENGE Trial — randomised clinical trial of VR-assisted avatar therapy
Smith LC, Vernal DL, Mariegaard LS, et al. The Lancet Psychiatry, 2025.
Read the publication →Patient perspectives on modified VR-assisted avatar therapy — qualitative substudy of CHALLENGE
Rasmussen K, Vernal DL, Mariegaard LS, et al. Digital Health, 2026.
Read the publication →The CHALLENGE trial — study protocol
Smith LC, Mariegaard L, Vernal DL, et al. Trials, 2022.
Read the publication →Early findings on VR-Avatar therapy effectiveness in a Hungarian cohort: Clear trends amid contradictory experiences
Gerlinger L, Egervári L, Simon L, et al. Computers in Human Behavior Reports, 2026.
Read the publication →Active research
- Multi-centre trial in Canada led by The Royal (Ottawa),
with University of British Columbia and McGill University. - Study at Manhattan Psychiatric Center in collaboration with
Weill Cornell Medicine (USA). - The Amethyst Trial, led by Swinburne University,
offering telehealth avatar therapy for schizophrenia (Australia). - Completed multi-centre trial across Spain (Parc Sanitari Sant Joan de Déu and University of Barcelona),
Hungary (Semmelweis University) and Poland (Medical University of Łódź).
Eating disorders
An estimated 94% of patients with an eating disorder report a dominant internal "eating disorder voice." Avatar therapy has been adapted to target this relational dynamic, drawing on the method developed for psychosis.
The Dialogue Study
The Dialogue Study is a randomised parallel-group superiority clinical trial led by Mental Health Center Copenhagen, evaluating immersive VR-based avatar therapy plus treatment as usual versus treatment as usual alone in 96 patients with eating disorders. Results are expected end of 2026. Registered on ClinicalTrials.gov as NCT06345040.
Obsessive-compulsive disorder
Patients with OCD often adopt a submissive position toward their obsessions, particularly those with poor or ambivalent insight — a group for whom standard exposure and response prevention therapy is associated with lower response rates. Avatar therapy has been investigated as a novel approach in this group, externalising the OCD into a visible avatar to support the patient in differentiating their functional self from the disorder.
Enhancing insight in patients with OCD — case study of VR-assisted avatar therapy
Wille L, Lohse L, Jelinek L, et al. Journal of Clinical Psychology, 2025.
Read the publication →Further indications
Avatar therapy may offer therapeutic benefit in any psychiatric condition where externalising a dominant inner voice or critical part of the self is clinically meaningful. We welcome research partnerships investigating avatar therapy in depression, borderline personality disorder, and other indications where the relational mechanism may apply.
All publications
Full bibliography
Peer-reviewed articles, protocols, and conference proceedings where Heka VR's platform has been used in research.
2026
Gerlinger L, Egervári L, Simon L, Kilencz T, Csizmadia L, Csukly G, Hermán L, Tombor L, Birkedal Glenthøj L, Shiraz F, Haluska-Vass E (2026).
Early findings on VR-Avatar therapy effectiveness in a Hungarian cohort: Clear trends amid contradictory experiences
Computers in Human Behavior Reports, 22, 101042.
doi.org/10.1016/j.chbr.2026.101042 →Glenthøj LB, Mariegaard LS, Smith LC, Christensen MJ, Jensen SN, Rus-Calafell M, Thomas N, Nordentoft M, Vernal DL (2026).
Impact of avatar features and presence on treatment outcomes in virtual reality-assisted therapy for auditory hallucinations
Schizophrenia Research, 287, 1–2.
doi.org/10.1016/j.schres.2025.11.004 →Habla AF, Soleim SB, Due AS, Tinglef TH, Eskelund K, Díaz-i-Calvete J, Larsen KM, Kristensen TD, Ebdrup BH, Nordentoft M, Lyngholm D, Miskowiak KW, Ambrosen KS, Birkedal Glenthøj L (2026).
Study protocol for a randomized clinical pilot trial investigating feasibility and efficacy of augmenting a virtual reality-assisted intervention targeting auditory verbal hallucinations with biofeedback: The Neuro-VR study
PLOS One, 21(2), e0333716.
doi.org/10.1371/journal.pone.0333716 →Hansen NK, Ries ES, Rasmussen K, Cardi V, Bryde A, Hjorthøj C, Micali N, Ward T, Glenthøj LB (2026).
Virtual Reality–Based Avatar Intervention for Eating Disorders: Mixed Methods Feasibility Study
JMIR Formative Research, 10, e88445.
doi.org/10.2196/88445 →Opper F, Henges S, Weinstein P, Arnheim D, Fässler L, Percie Du Sert O, Stefaniak I, Sabé M, Glenthøj LB, Thomas N, Liang C-S, Stubbs B, Böge K (2026).
Audio Visual Assisted Therapy Aid for Refractory Auditory Hallucinations (AVATAR) therapy for voice hearers: Systematic review and meta-analysis
BJPsych Open, 12(3), e104.
doi.org/10.1192/bjo.2026.11014 →Rasmussen K, Vernal DL, Mariegaard LS, Jørgensen G, Zeka F, Smith LC, Nordentoft M, Midtgaard J, Glenthøj LB (2026).
Patient perspectives on modified virtual reality-assisted therapy for persistent auditory verbal hallucinations: A qualitative substudy of the CHALLENGE randomized clinical trial
Digital Health, 12, 20552076251411033.
doi.org/10.1177/20552076251411033 →Wille L, Lohse L, Moritz S, Schultz J, Borsutzky S, Yassari AH, Mariegaard L, Vernal DL, Bekker SH, Glenthøj LB, Miegel F, Jelinek L (2026).
Meeting OCD face-to-face: Preliminary findings from an avatar-based dialogue intervention
Digital Health, 12, 20552076261434822.
doi.org/10.1177/20552076261434822 →
2025
Bargum AR, Sønderskov Hansen E, Erkut C, Serafin S (2025).
Exploring the Impact of AI-Generated Speech on Avatar Perception and Realism in Virtual Reality Environments
2025 IEEE Conference on Virtual Reality and 3D User Interfaces Abstracts and Workshops (VRW), 647–652.
doi.org/10.1109/VRW66409.2025.00134 →Birkedal Glenthøj L, Nordentoft M (2025).
Findings from RCT's on virtual reality-based interventions for auditory hallucinations and paranoia
European Psychiatry, 68(S1), S17–S18.
doi.org/10.1192/j.eurpsy.2025.55 →Christensen MJ, Rydborg MP, Jørgensen R, Nielsen CD, Mainz J, Bell IH, Thomas N, Smith LC, Mariegaard LS, Ward T, Nordentoft M, Glenthøj LB, Vernal DL (2025).
Immersive Virtual Reality–Assisted Therapy for Distressing Voices in Psychosis: Qualitative Study of Participants' and Therapists' Experiences in the Challenge Trial
JMIR Serious Games, 13, e77920.
doi.org/10.2196/77920 →Hansen NK, Ries ES, Ward T, Cardi V, Christensen AB, Hjorthøj C, Nordentoft M, Micali N, Glenthøj LB (2025).
The Dialogue study: Protocol for a randomized clinical trial evaluating the efficacy of virtual reality-based psychotherapy plus treatment as usual versus treatment as usual for eating disorders
PLOS One, 20(7), e0319875.
doi.org/10.1371/journal.pone.0319875 →Smith LC, Vernal DL, Mariegaard LS, Christensen AG, Jansen JE, Schytte G, Stokbro LA, Albert N, Christensen MJ, Thomas N, Hjorthøj C, Nordentoft M, Glenthøj LB (2025).
Immersive virtual reality-assisted therapy targeting persistent auditory verbal hallucinations in patients diagnosed with schizophrenia spectrum disorders in Denmark: The Challenge assessor-masked, randomised clinical trial
The Lancet Psychiatry, 12(8), 557–567.
doi.org/10.1016/S2215-0366(25)00161-0 →Wille L, Lohse L, Jelinek L, Moritz S, Schultz J, Borsutzky S, Yassari AH, Mariegaard L, Vernal DL, Bekker SH, Glenthøj LB, Miegel F (2025).
Enhancing Insight in Patients With Obsessive Compulsive Disorder: A Case Study on Avatar Therapy Using Virtual Reality
Journal of Clinical Psychology, 81(5), 355–365.
doi.org/10.1002/jclp.23772 →
2024
Vass E, Gerlinger L, Egervári L, Kilencz T, Csukly G, Hermán L, Réthelyi J, Farkas K, Mariegaard L, Glenthøj LB, Simon L (2024).
Exploring the acceptability, and feasibility of a modified virtual reality-based AVATAR therapy in schizophrenia spectrum disorders: A case series report
Acta Psychologica, 250, 104520.
doi.org/10.1016/j.actpsy.2024.104520 →
2022
Glenthøj L, Smith L, Mariegaard L, Due AS, Christensen A, Christensen M, Vernal D, Jeppesen U, Nordentoft M (2022).
CHALLENGE and Face Your Fears: Virtual Reality Treatment for Auditory Hallucinations and Paranoid Ideations
European Psychiatry, 65(S1), S22.
doi.org/10.1192/j.eurpsy.2022.82 →Smith LC, Mariegaard L, Vernal DL, Christensen AG, Albert N, Thomas N, Hjorthøj C, Glenthøj LB, Nordentoft M (2022).
The CHALLENGE trial: The effects of a virtual reality-assisted exposure therapy for persistent auditory hallucinations versus supportive counselling in people with psychosis: study protocol for a randomised clinical trial
Trials, 23(1), 773.
doi.org/10.1186/s13063-022-06683-1 →
In conversation
The Lancet Psychiatry podcast
The Lancet Psychiatry hosted Louise Birkedal Glenthøj, Ditte Lammers Vernal and patient ambassador Vibeke Andersen in conversation about VR-based avatar therapy for auditory hallucinations.
Active collaborations
Where Heka VR is in use
Our platform is in active research use with psychiatric institutions across nine countries on three continents.
Europe
- Denmark — Mental Health Center Copenhagen, Aalborg University Hospital, Glostrup Psychiatric Center, Mental Health Center Ballerup
- Spain — Parc Sanitari Sant Joan de Déu, University of Barcelona
- Italy — University of Padova
- Hungary — Semmelweis University
- Poland — Medical University of Łódź
- Turkey — Dokuz Eylül University
- Sweden, UK, Czech Republic — Ongoing feasibility studies
North America
- Canada — The Royal (Ottawa), University of British Columbia, McGill University
- United States — Manhattan Psychiatric Center, Weill Cornell Medicine
Australia
- Swinburne University — The Amethyst Trial
Interested in a research collaboration?
Heka VR actively partners with academic researchers and clinical research groups investigating avatar therapy in new indications and clinical settings. We can provide platform access, technical and clinical support, training, and collaborative input on study design.