Prof. Mar Rus Calafell

Mar Rus-Calafell is a Professor of Clinical Psychology and Digital Psychotherapy at the Faculty of Psychology of the Ruhr University Bochum, and a licensed clinical psychologist. She is also a visiting Senior Research Fellow at the Institute of Psychiatry, Psychology and Neuroscience (London). She has worked as a clinician and researcher at the University of Barcelona (Spain), King’s College London and the University of Oxford (United Kingdom). In 2020, she was awarded the prestigious Sofja Kovalevskaja Award (Alexander von Humboldt Foundation and Ministry of Education and Research, Germany) and she became the independent research group leader of the Young VOices Research and Interventions (YVORI) research group, which is based at the Mental Health Research and Treatment Centre (MHRTC, Ruhr-Universität Bochum). Her research focus through her clinical and research career is the understanding and treatment of mental health disorders, and psychosis specifically, and the application of digital technologies to improve prevention, assessment, and treatment of these disorders. Prof. Rus-Calafell has extended expertise in the application of Virtual Reality to enhance psychotherapy outcomes. Since 2013, she is part of the core research and clinical team who developed the first AVATAR therapy for distressing auditory verbal hallucinations in people with psychosis.

Digital technology offers new and innovative ways to enhance cognitive and behavioural techniques for managing symptoms of psychosis. By creating engaging, personalized, and interactive therapeutic experiences, digital interventions can extend beyond traditional face-to-face therapy, providing new opportunities for real-time feedback and personalised treatment settings. One such approach is AVATAR therapy, a novel intervention designed for individuals with psychosis who experience distressing auditory hallucinations. AVATAR therapy utilizes virtual reality (VR) technology to create a digital representation of the distressing voice—referred to as an "avatar"—which enables individuals to engage in structured, therapist-guided dialogues with their persecutory voice. This approach aims to help individuals develop a greater sense of control and reduce the distress associated with their hallucinations. Originally developed by Julian Leff in the United Kingdom in 2013, AVATAR therapy provides a unique therapeutic setting in which individuals can confront anxiety-provoking auditory experiences in a controlled and supportive environment. Through repeated exposure and direct interaction with the avatar, individuals work towards reframing their relationship with the voice, ultimately reducing its perceived power and influence. Research on AVATAR therapy indicates that participants continue to perceive the presence of the voice throughout therapy and engage in real-time interactions that reflect their usual experiences. Notably, anxiety reductions are often observed early in treatment, particularly after the first three sessions. This suggests that repeated and structured exposure, combined with changes in cognitive and emotional responses to the voice, helps to weaken maladaptive beliefs and decrease the distress and perceived threat associated with auditory hallucinations. This talk will provide a comprehensive overview of the current evidence supporting AVATAR therapy, summarizing its effectiveness based on key clinical trials. The presentation will break down the therapy’s core components, its therapeutic targets, and the underlying mechanisms believed to drive symptom improvement. Findings from two major randomized controlled trials (AVATAR1 and AVATAR2) will be discussed, including their outcomes and clinical implications. Additionally, the talk will explore exciting new research directions, including the integration of immersive social environments and artificial intelligence (AI) to enhance the therapy’s personalization and interactivity. These advancements aim to further optimize AVATAR therapy, making it more accessible, engaging, and effective in reducing distressing voices for individuals with psychosis.

• Rus-Calafell M et al. (2025). Using Virtual Reality Social Environments to Promote Outcomes' Generalization of AVATAR Therapy for Distressing Voices: A Case Study. Journal of Clinical Psychology. https://doi.org/10.1002/jclp.23785
• Garety P, Edwards C, Jafari H, Emsley R, Huckvale M, Rus-Calafell M. et al. (2024). Digital AVATAR therapy for distressing voices in psychosis: the phase 2/3 AVATAR2 trial. Nature Medicine, https://doi.org/10.1038/s41591-024-03252-8
• Rus-Calafell, M. et al. (2020). The Role of Sense of Voice Presence and Anxiety Reduction in AVATAR Therapy. Journal of clinical medicine, 9(9), 2748. https://doi.org/10.3390/jcm9092748
• Craig TK, Rus-Calafell M, et al. (2018). AVATAR therapy for auditory verbal hallucinations in people with psychosis: a single-blind, randomised controlled trial. The Lancet Psychiatry, 5(1), 31–40. https://doi.org/10.1016/S2215-0366(17)30427-3