IntroductionSchizophrenia is one of the mental disorders that generate the greatest human disability in the world. The treatment of negative symptoms in schizophrenia is still far from being resolved satisfactorily. The unique ability of cinema to activate attention, imagination and memory, as well as to activate complex mental processes in viewers leads one to think that it can be an effective therapeutic tool for the treatment of certain mental disorders. ObjectiveTo evaluate the efficacy of a new psychotherapeutic technique (designed ad hoc) based on the analysis of film sequences and double viewed using fiction films in patients diagnosed with spectrum disorders of schizophrenia and other psychotic disorders. MethodsA multicentre, randomised and parallel group clinical trial was conducted on 48 patients with a diagnosis of psychotic disorders of the schizophrenia spectrum. The effects of the application of a psychotherapeutic group therapy technique, based on the use of fiction films, were compared to a control group that also worked with fiction films, but using a non-specific technique. Three film analysis techniques with potential therapeutic properties were selected for the development of the new group psychotherapy technique: 1) the segmentation of the cinematic material into sequences, 2) the analysis by sequences of the contents of the film, 3) the double viewing of the cinematographic material. The intervention consisted of 26 sessions, which involved the double viewing of the 13 episodes of the first season of the television series Los Soprano. The primary outcome measures were the changes obtained in the Positive and Negative Syndrome Scale (PANSS) subscales, according to Wallwork's five-factor model, between the baseline and final situation after treatment. Cognitive outcome measurements included changes in the cognition scales included in the Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS) Consensus Cognitive Battery (MCCB) and in social cognition scales, like MSCEIT, FEIT, and FBS (Mayer-Salovey-Caruso Emotional Intelligence Test, Facial Emotion Identification Test, and Frankfurt self-assessment scale for persons with schizophrenia, respectively), before and after treatment. ResultsThe results showed a statistically significant improvement in the experimental group versus the control group in the positive [P=.01; d=0.82 (95% CI; 0.2-1.43)], negative [P=.005; d=0.89 (95% CI; 0.26-1.51)] and disorganised symptoms [P=.013; d=0.49 (95% CI; 0.11-1.09)]. In the “post-hoc” analysis of the negative factor, statistically significant improvements were found in the following variables: blunted effect (P=.041, d=0.64 (95% CI; 0.03-1.24)], emotional withdrawal (P=.012, d=0.80 (95% CI; 0.18-1.41)], poor contact (P=.000, d=1.18 (95% CI; 0.52-1.82)], and motor retardation (P=.003, d=0.96 (95% CI; 0.33-1.58).] In the “post-hoc” analysis of the positive factor there was a significant improvement in the delusions subdomain [P=.01; d=0.82 (95% CI; 0.2-1.4).] No significant differences were found between groups in affective symptoms or in any of the cognitive domains. ConclusionsThe proposed new psychotherapy technique is applicable and well accepted by patients with schizophrenia and other psychotic disorders. The use of this new psychotherapy technique inspired in film analysis is effective in leading to improvements in the positive, negative, and disorganised symptoms in patients with schizophrenia.
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