Cinematherapy and video treatments are artistic therapeutic techniques in which patients are exposed to complex audiovisual material displaying their psychological or physical difficulties. In the case of cinematherapy, commercial films are used, while in the video treatments, ad hoc created videos or brief documentaries are administered to the subjects. Focusing on the patients’ difficulties, the film or video presentation aims to comprehensively understand them through a “third-person” perspective (Berg-Cross et al., 1990). The characters on the screen face the same problems as the patients and offer new ways to cope with them. Such an approach encourages patients to consider their difficulties from a different perspective (Sharp et al., 2002). Typically, the therapist chooses commercial films for an individual to view alone or with specified others. The patient and the therapist look at “reality” with the same magnifying glass by watching a film. This approach also helps strengthen the therapeutic alliance: the therapists’ objective is to allow patients to recognize themselves in one of the characters; thus, they will better understand their emotions and, at the same time, realize their therapists have comprehended their difficulties. Therefore, therapists can better talk about patients’ situations because they have created a “common vocabulary” (Berg-Cross et al., 1990).

Cinematherapy and video treatments originate from bibliotherapy, in which book plots are used with therapeutic aims. These techniques have become increasingly popular with the advent of VHS players, more and more replacing reading books with watching films for therapeutic purposes. Indeed, the use of films or videos is thought to be more “incisive and immediate” (Berg-Cross et al., 1990). One of the first scientific studies on clinical populations dates back to 1974. The authors used videos to treat specific phobias (Morris et al., 1974). Berg-Cross et al. (1990) described the cinematherapy technique providing some guidelines for its clinical application. Later, Heston and Kottman (1997) reported two descriptive cases of patients with depressive disorder treated with cinematherapy. Although using qualitative approaches, these early studies offered promising results, paving the way for other authors to approach the topic more objectively.

Over the years, several authors have also proposed different models of functioning with distinct phases for these techniques. For instance, Dermer and Hutchings (2000) have identified three stages in cinematherapy: (i) Assessment, in which the therapist or the counselor identifies the patient’s problems and objectives and chooses films that, in their opinion, fulfill the therapeutic purpose but are also enjoyable to the patient; (ii) Implementation, which means that the therapist assigns a film to the patient to let them understand why the therapist has explicitly chosen that film; and then (iii) Debriefing, the session after viewing the film for understanding the patient’s reactions. At this stage, the therapist and the patient link the film and the patient’s history (making the cinematherapy effective). Brainstorming is also encouraged to make the patient reflect on what can be therapeutic in the film.

Other authors postulated four main stages for cinematherapy: (i) Identification, in which the patient identifies with the character because of the character’s behavior and goals, becoming aware of the character’s feelings and emotions; (ii) Catharsis, the patient tries to learn through the character’s experiences; (iii) Insight, in which the patient internalizes the character’s experience and creates a connection between the character’s and their experience to become aware of their situation. A further stage was also identified (Jeon, 1992) that is universalization, in which the patient does not feel alone because they are watching the character’s story and thus understand how similar they are to the character. This multistage process helps patients act positively toward difficulties in improving problem-solving strategies (Stamps, 2003). In other words, cinematherapy attempts to promote self-exploration and change by using film metaphorically (Berg-Cross et al., 1990).

Using cinema in clinical practice can allow patients to externalize their problems in a less formal context and discuss their problems in a more detached way to overcome their resistance to the therapy (Dermer and Hutchings, 2000). In such a process, emotions and emotional interaction play a pivotal role. One of the main features of the emotional interaction between the seen and the felt is the metaphor (Heston and Kottman, 1997). The film not only has to deal with the patients’ problems clearly to let them create a link with their lives, but it also has to deal with them obscurely so as not to cause resistance that can interfere with the therapy. Consequently, the film must not describe the situation literally; instead, it must do so metaphorically. It generates a triadic relationship between the patient, the therapist, and the film. At this point, a link between the patient’s situation and the situation represented in the film must be created to let the plot enter the patient’s life. Such a metaphor may work on three distinct levels: (i) the literal plot of the film; (ii) the general metaphor beyond the literal plot; and (iii) the patient’s metaphor, in which the film acquires a special meaning based on the patient’s experiences (Heston and Kottman, 1997). Heston and Kottman (1997) helped a woman who had a troubled relationship with her mother by using the film “Lost in Yonkers.” In this specific case, the first level is represented by the literal plot of the film (the story of the two boys who spend the holidays with their grandmother), the second level is represented by the general metaphor (the relationship of a mother with adult children). The third level is the one that represents the patient’s metaphor, the meanings and personal connections that she can find with her own story. When talking about her feelings about the movie, the patient described her experience as follows: “I was too much like watching my own family […].”

If, on the one hand, in cinematherapy, commercial films are used as treatment, on the other hand, some researchers create experimental designs using ad hoc created videos or documentaries in which some actors show skills of interest to the patient’s case. This technique, called “video modeling,” originated from Bandura’s work (Bandura, 1986). Children naturally imitate social and cultural models to learn skills of interest independent of reinforcement. They can also practice the behavior they have learned in different situations because they have created general schemas to follow. In this process, attention plays an important role: if the subject does not pay sufficient attention to the model, or if the model is not attractive enough, the learning process could be unsuccessful. Moreover, the most salient parts of the process should significantly impact the subject (Taylor and Fiske, 1978; McArthur, 1981). This discovery has led to the creation of videos that show important skills for patients. This technique is typically used with individuals affected by Autism Spectrum Disorder (ASD) and related social difficulties (Walsh et al., 2018), but it can also be used to treat different kinds of pathologies, such as phobias (Morris et al., 1974). The types of video modeling will be explained later in this article.

Cinematherapy and video modeling have been applied in several pathologies, such as Anorexia (Gramaglia et al., 2011), anxiety (Lee et al., 1983), and ASD (Golan et al., 2010; Isong et al., 2014). Many approaches have been used, ranging from traditional cinematherapy (Heston and Kottman, 1997) to ad hoc–created video stimuli and documentaries (Brown et al., 2016). Notably, most therapists/researchers do not apply standard criteria to use video stimuli in their studies. They instead adopt an ad hoc paradigm or even ad hoc video stimuli, cartoons, or documentaries as needed (Golan et al., 2010; Isong et al., 2014), thus preventing any generalizability of the results. Furthermore, not all studies have confirmed their effectiveness. With such a puzzling background, the need for a review of cinema and video therapy is crucial.

The review was conducted following the PRISMA guidelines for Scoping Review (Tricco et al., 2018). The review included the following four key phases: (i) formulation of the research questions, (ii) research of the effective keywords accordingly to our scope, (iii) selection of the relevant studies in the literature, (iv) relevant information extraction.

Through databases, 484 articles were identified, and after duplicates were removed, 453 articles were analyzed. After analyzing the content of 186 articles, 148 were excluded because they did not meet the inclusion criteria, such as studies in which cinema or videos were not used for therapeutic aims. Thirty-eight studies published from 1974 to 2018 comprised the final sample included in the review (Figure 1). Among studies included in this review, seven used classical cinematherapy (Turley and Derdeyn, 1990; Heston and Kottman, 1997; Bierman et al., 2003; Marsick, 2010; Gramaglia et al., 2011; Ballard, 2012; Eğeci and Gençöz, 2017), 9 used video modeling approach (Charlop and Milstein, 1989; Reeve et al., 2007; Scattone, 2008; Coughlin et al., 2009; Jones et al., 2014; Copple et al., 2015; Macpherson et al., 2015; von Maffei et al., 2015; Walsh et al., 2018), 5 applied video peer modeling (Morris et al., 1974; Muzekari, 1976; Corbett et al., 2011; Perlick et al., 2011; Brown et al., 2016), 1 used video self-modeling, (Wilkes et al., 2011), one combined video peer modeling and video self-modeling (Decker and Buggey, 2014). Eleven out of 38 studies used a generic video treatment (Lee et al., 1983; Gelkopf et al., 1993, 2006; Kimata, 2007, 2008; Golan et al., 2010; Lim, 2010; Marx et al., 2010; Olatunji et al., 2012; Savorani et al., 2013; Yan et al., 2018), 1 with video feedback (Thiemann and Goldstein, 2001), 1 with video prompting (Rayner, 2011), 1 with video peer modeling and a generic video treatment (Isong et al., 2014), and 1 with video joint modeling (Dueñas et al., 2019). Notably, 36 of the 38 studies reported a positive effect of the technique. All the articles applying classical cinematherapy can be classified as qualitative studies. In the case of video treatments, a quantitative approach has been mainly used. For a more detailed characterization of each study (see Table 1).

In the following paragraphs, we define cinematherapy and video techniques arising from the scoping review of the literature. We also summarized their features, such as the type of film stimuli used, the type of treatments applied, and the populations to which these treatments are administered.

Cinematherapy and video treatments can help people manage life challenges. Movies or videos can help develop new skills, increase awareness, and offer new ways of thinking about specific problems in various patient populations. Cinematherapy and video treatments are flexible: they can be applied in several modalities and are adaptable to diverse situations. Nevertheless, there are some critical concerns. In classical cinematherapy, the choice of viewing material is not standardized; it varies according to the therapist’s beliefs and experience. Even if some therapists have proposed lists of films that can be utilized to treat different emotional difficulties (Berg-Cross et al., 1990), these simply remain as advice.

This scoping review found that 38 articles using classical cinematherapy and others employing video modeling (or its subcategories) or other forms of video treatment have been applied to clinical/subclinical populations. In most cases (14 studies), the video technique was applied to treat behavioral difficulties related to ASD. Interestingly, we also found five studies that examined the effect of cinematherapy and video treatments in patients affected by Schizophrenia.

Authors who used video treatments or video modeling are more inclined to implement experimental designs; on the contrary, those who used classical cinematherapy produced descriptive studies. Indeed, 8 of the 38 studies were designed as randomized controlled trials and all involved video treatment as a technique. This finding could be intrinsic to the differential nature of cinematherapy and video treatments. On the one hand, cinematherapy uses video material that is strongly characterized by an artistic component and thus challenging to standardize; on the other hand, video treatment involves straightforward video material without artistic intent. When cinematherapists use a film, they manage a complex artistic medium to treat patients. Transforming this approach into a standardized paradigm is far from banal. In some cases, standardizing a specific protocol appears to be more of a limitation than a treatment improvement. Due to these methodological limitations, estimating the objective efficacy for cinematherapy is complex, and the results, therefore, remain mainly descriptive.

Another issue involves a possible bias on the outcome effect: 36 out of 38 studies reported that the treatment had a positive effect. Consequently, a positive-results bias should also be taken into account. In one study that showed the technique to be ineffective, the authors ran a randomized controlled trial exploring the possibility of helping people quit smoking through videos (Brown et al., 2016). Brown et al. (2016) administered an online documentary film to motivate quit attempts among smokers in the general population. In this study, participants were randomly exposed to one of the three conditions: no-intervention control (n = 1,016), an informational film (n = 1,004), or an ad hoc documentary (4 Weeks2Freedom) (n = 999). Results showed that there was no detectable effect of the intervention compared with the no-intervention control or informational control film. Among the possible causes of the negative result, the authors suggested that the film may not have been sufficiently engaging to keep participants viewing for long enough to have an effect. Furthermore, they stated that the intervention was unsuccessful as the identification process according to which viewers identify with the people in the ad hoc documentary might not have been effective. We also advise caution when using video modeling, as its efficacy may also depend on the choice of material. For instance, in some studies, videos with adult models were shown to children to improve their skills (Charlop and Milstein, 1989). However, Jones et al. (2014) found that when social skills were taught to children with ASD using adults as models, the children only applied the new competencies when interacting with other adults, not with peers. Finally, it is interesting to note that Isong et al. (2014) suggested that this treatment is effective only when combined with additional instruments (e.g., video peer modeling plus video goggles).

Another critical aspect of this technique is the pathology type for which it is applied. Whereas researchers use classical cinematherapy or video treatment for a large plethora of difficulties (from children with divorced parents to blood phobia), they more often successfully use video modeling to treat people with ASD (14 studies). As a result, we cannot have a global view of the actual efficacy of this technique for other kinds of pathologies. It would be interesting to apply it to different patient populations and other psychological/physical difficulties to analyze who can best benefit from the treatment.

The main criticism of using cinematherapy and video treatment is that they lack a standardized set of stimuli and protocols. Future studies should aim to create standardized protocols, above all in cinematherapy practice, for patient populations. It would be helpful to select a film or some particular scenes of a film and standardize them through an adequate number of healthy subjects who judge the emotional valence of the selected stimuli. Most importantly, the main outcome should be measured objectively. A rigorous methodological approach will allow for the scientific validation of these audiovisual techniques, which are easy to administer and flexible.

We have all been to the cinema and have relived the emotions we were experiencing through the characters in the film. This experience is a widespread testimony to the value of the technique. Nevertheless, its justification cannot remain purely anecdotal; further scientific validation is necessary.

To conclude, the mapping of the published literature shows that a rigorous and robust methodology is not characteristic of diverse approaches, making the generalization of the results, if anything, more complicated. Cinematherapy and video treatments are flexible, easy-to-use approaches that can be applied to different patient populations. Although the application of stricter rules is complicated due to the complexity of the adopted stimuli, we believe that such an effort is desirable: implementing standard protocols with more precise efficacy indexes will make these treatments objectively valid rehabilitation tools.

The art therapy landscape is vast and complex. In recent years, the application of cinematherapy and video modeling to treat psychological difficulties has increased enormously. Nevertheless, the methodological approach is mixed, and the outcome measures are mainly subjective. To our knowledge, this scoping review represents the first attempt to map the available studies on cinematherapy and video treatment, with a twofold implication. First, it organizes what we know so far about cinematherapy and video treatment applied to clinical populations. On the other hand, it represents a starting point from which future research can improve protocols, increasing the efficacy of the use of these techniques at the intersection of art and psychology.

The original contributions presented in the study are included in the article/supplementary material, further inquiries can be directed to the corresponding author/s.

ES: investigation, data curation, and writing—original draft. GS: conceptualization, writing—original draft, and writing—review and editing. FS and FV: writing—review and editing. GB: conceptualization, writing—review and editing, and supervision. All authors contributed to the article and approved the submitted version.

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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