Digital AVATAR therapy for distressing voices in psychosis: the phase 2/3 AVATAR2 trial.

Name: Αlpha¹ Rigor Record — Digital AVATAR therapy for distressing voices in psychosis: the phase 2/3 AVATAR2 trial.
Item: Digital AVATAR therapy for distressing voices in psychosis: the phase 2/3 AVATAR2 trial.
Rating: 100
Author: Αlpha¹

Garety PA, Edwards CJ, Jafari H, Emsley R, Huckvale M, Rus-Calafell M, Fornells-Ambrojo M, Gumley A, Haddock G, Bucci S, McLeod HJ, McDonnell J, Clancy M, Fitzsimmons M, Ball H, Montague A, Xanidis N, Hardy A, Craig TKJ, Ward T

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Αlpha¹ Editorial

This rigor review was examined and confirmed by Αlpha¹ Editorial · August 16, 2026

Αlpha¹ Rigor Review

Rigor Reviewed

2.25 / 5

Weak — serious problems found

Interventional Study

Critical

High-priority

How this rating was calculated▸

Started at 5★ — deductions

IntegrityIntegrity concern ×3−1.5★
ClaimsEfficacy rests on an unvalidated surrogate endpoint−0.5★
ClaimsTreatment effect not shown to be clinically meaningful−0.5★
CitationsUnresolved reference−0.25★

Model-reported confidence: highReviewer agreement: highEngine: 7.39.0Source: full text

Problems surfaced4 types

Numerical inconsistencies1

Values that contradict each other or are impossible for the stated sample: recomputed p-values and test statistics, GRIM/GRIMMER checks on summary numbers, percentages against their own counts, totals against their parts, and estimates against their own confidence intervals.

Internal contradictions in the reported numbersAssessed

Overstated conclusions2

Conclusions that reach past what the paper's own results support — including a significance claim that no longer holds when the statistic is recomputed, and efficacy resting on an unvalidated surrogate endpoint.

Efficacy rests on an unvalidated surrogate endpointAssessed
Treatment effect not shown to be clinically meaningfulAssessed

Broken references and links1

References checked against Crossref, OpenAlex and Retraction Watch for retractions and resolvability, plus declared data and code links probed for whether they resolve to content matching the paper.

References not resolvable to a published paperRecomputed

This Αlpha¹ Rigor Review uses AI Rigor Reviewers trained on a curated corpus of high-fidelity and retracted papers, with expert supervision and curation. It can still make mistakes; verify each finding against the source before relying on it.

This is a well-conducted and transparently reported phase 2/3 randomized controlled trial. The methodology is rigorous, with clear randomization, blinding, and prespecified analysis, and the paper adheres to high reporting standards including trial registration, ethics approval, and data availability. Minor gaps include the absence of a formal power analysis in the main text and lack of version identifiers for the intervention software.

Both reviewers independently scored all eight dimensions and agreed on all statuses, so no divergence needed reconciliation. The study type is interventional (RCT). Non-applicable sub-criteria (e.g., animal housing, cell line authentication) were excluded from scoring. The statistics verification covered only a subset of reported tests (4 recomputed consistently); the remaining statistics are unverified but not flagged as problematic.

6 major claims checked against the paper's own evidence: all adequately supported.

Premise concern: surrogate not validated for clinical benefit; effect size not shown to be clinically meaningful.

Recomputed 4 tests: 4 consistent, 0 inconsistent; 4 via agent-written checks.

3 integrity concerns flagged (0 high).

Reporting

Eight Dimensions8 pass

The introduction cites prior research on AVATAR therapy, including a proof-of-concept study and the AVATAR1 trial, and acknowledges limitations such as delivery by a small cohort of therapists in research settings. The rationale for testing two forms of AVATAR therapy is clearly linked to the need for personalization and wider workforce delivery. The paper does not explicitly describe how limitations of prior research are addressed beyond the trial design, but the premise is well-supported.

Sub-criteria

prior work citedADEQUATE

premise rationaleADEQUATE

limitations addressedINADEQUATE

Per reviewer (2) — the votes behind the verdict

PASSReviewer 1· 90% conf

The paper establishes a clear scientific premise, citing prior work and providing a logical rationale for the trial.

Evidence

direct quote[Main, paragraph 2]

“A proof-of-concept study found that a six-session course of AVATAR therapy was safe, with positive effects on voice severity . A previous fully powered single-site randomized controlled trial (AVATAR1) compared AVATAR therapy with supportive counseling and demonstrated a substantial reduction in the severity of voices in the AVATAR therapy group at 12 weeks.”