[When virtual reality gives voice to silence: A case report of a patient with schizoaffective disorder and progressive bilateral deafness treated with Avatar therapy].

Auditory verbal hallucinations (AVH) are a common and often debilitating symptom of psychotic disorders. Despite pharmacological treatments, approximately 30% of patients continue to experience resistant AVH. Avatar therapy (AT), a virtual reality therapy, is an innovative approach aimed at changing the relationship between the patient and their voices. This case report describes the clinical course of a 72-year-old man with schizoaffective disorder and bilateral hearing loss with almost total deafness in the right ear, who reported AVH in both ears, but more intense on the right side. This atypical clinical presentation raises specific issues regarding the understanding of perceptual mechanisms and the adaptation of therapeutic interventions. The patient participated in a AT protocol consisting of nine weekly sessions at the Montreal University Institute of Mental Health. Pre- and post-therapy clinical assessments showed a significant decrease in the frequency and distress associated with AVH, improved emotional regulation and quality of life, and an overall reduction in psychiatric symptoms. Clinical interviews confirmed a greater sense of control and a less threatening relationship with the voices. This case highlights the potential of AT in patients with sensory impairments and emphasises the importance of personalised therapeutic approaches that incorporate immersive technologies in mental health.