More than 1.25 million people in the United Kingdom are estimated to be affected by eating disorders, conditions widely recognized as challenging to treat effectively. Traditional therapies, such as family therapy and cognitive behavioral therapy, combined with hospital stays for severe cases, have yielded only moderate success, with long-term recovery rates for anorexia and bulimia estimated at around 50 percent. Anorexia is noted as having the highest mortality rate among psychiatric disorders.
A novel approach called avatar therapy, originally developed in the UK for psychosis, is now being explored as a treatment for eating disorders. The therapy was pioneered nearly two decades ago by retired psychiatrist Julian Lef, who initially created it to help patients confronting auditory hallucinations by personifying distressing voices using computer-generated avatars. In the early iterations, patients co-designed two-dimensional avatars with therapists, who operated the figures remotely, using voice-modulating technology to simulate the voices the patients heard.
Recent research indicates that avatar therapy significantly reduces the distress caused by intrusive voices in individuals with psychosis, with many participants reporting improvement after only a few sessions. Building on this success, Louisa Birkedal Glenthoj, a clinical psychologist and psychosis specialist, has adapted the method for use with eating disorders. Since up to 94 percent of people with eating disorders experience a persistent critical inner voice, her team hypothesized that externalizing this voice through avatar technology could help patients separate their identity from the disorder and gain greater control over it.
The treatment for eating disorders involves seven sessions, in which patients are encouraged first to confront and challenge the avatar representing their inner critic, then to reconnect with other aspects of their lives overshadowed by the disorder. The therapy is designed as a brief intervention to motivate patients toward change rather than as a standalone cure.
One participant, Mikala, described initially designing her avatar as an idealized version of herself paired with a frightening voice. Through repeated dialogue with the avatar in virtual reality—set in a simulated living room environment where the avatar’s proximity could be controlled—she practiced countering the negative comments with logical and affirming responses. Over sessions, Mikala reported that the critical voice diminished and eventually disappeared, leading to a cessation of bulimic behaviors.
A recent trial involving 96 participants found that those receiving avatar therapy reported that their eating disorder voices became less malevolent and controlling than those in a control group receiving standard treatment. They also demonstrated increased motivation for change, greater self-compassion, and improved quality of life. Although overall symptom reduction was not statistically significant, researchers highlighted the ambitious nature of attempting broad symptom improvement within a seven-session timeframe.
Ginnie Brochner, another participant battling anorexia, described her avatar as embodying the voice of her abusive former partner, whose criticisms had fueled her disorder. Initially overwhelmed, she gradually found the strength to assert herself against the avatar and continued this practice outside therapy sessions. While she experienced some relapse months after completing treatment, Ginnie noted that the therapy equipped her with tools to confront her eating disorder voice more effectively.
While avatar therapy has shown promise, its wider implementation faces challenges, including the need for trained therapists to operate the avatars and supervise treatment. Discussions are ongoing about integrating artificial intelligence to assist therapists by suggesting possible dialogue options, though some remain cautious about fully automated avatars for vulnerable patients.
The technology is being trialed internationally for other conditions like obsessive-compulsive disorder, bipolar disorder, and treatment-resistant depression, and researchers suggest it may have potential for broader mental health applications, including support for young people struggling with critical self-talk.
Although inspired by the British development of avatar therapy, it is not yet available within standard healthcare services such as the NHS. Experts emphasize that eating disorders require long-term management and that avatar therapy is one potential tool among many in addressing these complex conditions. Participants like Mikala and Ginnie acknowledge ongoing challenges but express hope that the experience has offered them valuable strategies to cope and improve their well-being.