Talking therapies aimed at voices: a small but real effect, largest with avatar therapy

The edition in brief

A JAMA Psychiatry meta-analysis of 23 randomised trials (2,016 adults with schizophrenia-spectrum disorders) found psychological interventions aimed specifically at auditory hallucinations reduced their severity versus control (SMD -0.18, 95% CI -0.31 to -0.05; NNT 16; low-certainty evidence). Avatar therapy showed the largest effect (SMD -0.37), and dropout was low. In the US, benzodiazepine dispensing prevalence fell 26.7% between 2013 and 2024, from 7.5% to 5.5% of the population, with the largest fall among young adults and a doubling of prescriptions from advanced practice providers. A Swedish primary care trial of 172 adults with stress-related ill health found nurse-led collaborative care was not non-inferior to psychologist-guided internet CBT, although both groups improved substantially and the difference was small. The FDA lists a Class III recall of one distributor's buprenorphine 2 mg sublingual tablets for a label mix-up. The pearl: taper long-term benzodiazepines gradually and never stop them abruptly.