Objective: Because the therapeutic processes of Avatar Therapy remain equivocal, the current study aims to further extend our previous findings by analysing the evolution of the avatars' and patients' speech and changes in patient responses as sessions progressed.Design: Eighteen patients with treatment-resistant schizophrenia were selected from two clinical trials on Avatar Therapy. Three coders analysed both the avatars' and patients' discourse during immersive therapy sessions using content analysis methods.Results: Our analyses enabled the categorization of the avatar discourse into confrontational techniques (e.g., provocation) and positive techniques (e.g., reinforcement). Patients responded to these utterances using coping mechanism or by expressing emotions, beliefs, self-perceptions or aspirations. Through identification of mutual changes in the interaction between the patient and their avatar, a shift was observed over the sessions from confrontation to a constructive dialogue.Assertiveness, emotional responses and prevention strategies seemed to be central to the therapeutic process, and these usually occur in response to positive techniques. Conclusion:Investigating AT's therapeutic process may help to identify components to achieve positive outcomes and can enable the development of more effective treatments. Further studies should explore the association between these themes and therapeutic response to help predict which patients will better respond to Avatar Therapy.

Background: Cognitive misers are no happy fools. Earlier findings (1) came to this conclusion by assessing people’s sensitivity to attribute substitution, which they defined as the situation that occurs when we are confronted with a problem that demands greater cognitive effort, for which we rely on automatic and intuitive processes that substitute the complex situation for an easier one. Methods: Through the exploration of the “bat-and-ball” problem, (2) De Neys, Rossi, and Houdé  (1) found that participants were indeed sensitive to the substitution bias. Specifically, participants who incorrectly answered the question that gave rise to the substitution bias were significantly less confident in their answer relative to their answer on a control problem that did not give rise to the substitution. Using the same methods, we conducted a direct replication study on a sample of 264 undergraduate psychology students. Results and Conclusion: Our results suggest that we successfully replicated the original conclusions; participants who answered by substituting the difficult question for an easier one significantly (p<.0001) decreased their confidence ratings on the version of the problem that gave rise to the substitution bias, relative to the problem that did not. Limitations: Though there may have been limitations, it seems that we are sensitive to attribute substitution.