Barely able to breathe, a young man battling a panic attack hesitantly enters the group room and makes his way to an empty chair. He and a dozen others “check in” and are then guided through a simple, calming breathing exercise. The lights are dimmed and the group members are asked to focus their attention on the flickering images and pulsating sounds coming from a screen in front of them. Transfixed by these moving images and sounds, the young man’s anxiety begins fading away. He is no longer in the throes of a panic attack.

Seated next to him is a middle-aged woman who has been struggling with racing thoughts and rumination. She, too, is becoming engrossed in this experience, her thoughts slowing down as she shifts her attention to what is unfolding on the screen before her. She settles into a restful state.

The group sits together, sharing this experience, for 45 minutes. Afterward, they together process what they have just experienced. All report being in better moods, much calmer and more reflective than when they first entered the room. All the group members readily agree to explore their experiences in their journals during the upcoming week and then return to share their reflections with the group.

What these group members share a week later is both unexpected and remarkable. They bring journals filled with prose, poetry and sketches. One group member struggling with an addiction shares that focusing on this homework prevented him from relapsing. A few others note that they were inspired to make major life changes during the past week, letting go of unhealthy relationships and circumstances, and even embarking on new careers. Some report having been freed of creative blocks and now being able to paint, write or compose music for the first time in months — or years. All attribute their enhanced awareness and healthy changes to the experience of sitting together in a room and collectively focusing on the same moving images and sounds.

The group didn’t experience some new, groundbreaking therapeutic technology during those 45 minutes in a darkened room. Members viewed “all things,” an episode of The X-Files television series.

 

The therapeutic power of cinema

From full-length feature films to episodes of TV shows, cinema engages individuals like few other mediums. Leading researchers studying the neuroscience of cinema, via the emerging field of neurocinematics, have found that when groups of people view evocative, “well-directed” cinema together, they become collectively engaged through a phenomenon known as neural synchrony. Neuroimaging studies show that the activation of specific areas of their brains and their brain wave patterns actually become synchronized.

According to neuroscientists, the human brain is wired to connect with and be activated by cinema. The iconic Swedish filmmaker Ingmar Bergman suggested that this connection might be even deeper: “No art passes our conscience the way film does, and goes directly to our feelings, deep down into the dark rooms of our souls.”

Cinema can be a powerful, transformative catalyst. As a licensed professional counselor, I have found that the therapeutic use of this catalyst, otherwise known as cinematherapy, can be profoundly effective with even the most troubled or resistant clients. While integrating cinematherapy within an experiential, mindfulness-oriented approach, I have used everything from The Wizard of Oz to The X-Files with more than 1,000 clients in individual and group therapy — with remarkable results.

Simply defined, cinematherapy is an expressive, sensory-based therapy that uses movies, TV show episodes, videos and animation as therapeutic tools for growth and healing. The clinical use of cinema has been found to enhance the therapeutic process on many levels, including strengthening the therapeutic alliance and increasing overall engagement in clients who are “difficult to-reach.” As noted by Joshua Cohen, co-editor of Video and Filmmaking as Psychotherapy: Research and Practice, cinema has been used as a healing tool since its inception “because creating and watching a film often can speak directly to the human soul.” What makes this medium therapeutic, he writes, is its use “with therapeutic intent within the safe environment of therapy with credentialed and trained therapists.” Cinematherapy moves beyond talk therapy “by appealing to clients’ visual, auditory and other senses” and offers “opportunities for self-discovery that are not found through words alone,” according to Cohen.

Neuroscientist Uri Hasson, a pioneer in neurocinematics, similarly notes that the multisensory, multilayered complexity of cinema provides viewers with an experience “that evolves over time, grabbing their attention and triggering a sequence of perceptual, cognitive and emotional processes.”

Evidenced-based therapy

Research spanning more than four decades has shown that cinematherapy is effective with many populations in multiple settings, ranging from outpatient to residential treatment, psychiatric hospitals to nursing homes. Cohen and his co-authors reference numerous studies in their book, including a pilot study dating back to the 1980s which found that the use of videos with 17- to 19-year-olds who had dropped out of high school resulted in enhancing their self-worth and self-esteem. More recently, Michael Powell, Rebecca Newgent and Sang Lee found the use of The Lord of the Rings film trilogy effective in the treatment of depression in adolescents.

Several notable international studies published in 2014 explored the use of cinematherapy within different cultures, settings and age groups. A Korean study by H.G. Kim noted the positive effects of a cinematherapy-based “group reminiscence program” on managing depression in nursing home residents. An Iranian study of “vulnerable women” receiving treatment from nongovernmental social service clinics in Tehran found cinematherapy effective in increasing self-esteem. Research from the University of Bucharest in Romania by Sorina Dumtrache concluded that group cinematherapy is effective in decreasing anxiety in young adults.

Cinema selection: Therapeutic resonance and relevance

Cinema must resonate deeply, on multiple levels, with clients for it to be effective therapeutically. The individual’s age, developmental level and relationship with the cinema selection are all crucial factors. As Cohen has noted, “Movies can help clients achieve insights if the movies are strategically selected for relevance to the client’s interests and needs in treatment.”

To meet the unique needs of my clients, I have to give careful consideration to cinema selection. My clients, ranging in age from 3 to their late 70s, have come from diverse backgrounds and have struggled with varying challenges, including anxiety, addiction, depression, domestic violence, grief, panic disorder, social phobia, body dysmorphia, eating disorders and trauma. The selections I use are based on the specific needs, strengths, challenges and aspirations of each individual.

For instance, I have found the films 28 Days, When a Man Loves a Woman and Flight to be particularly useful in helping adults with substance use disorders break through the denial of their addiction and gain a better awareness of the impact it has had on their lives and the lives of their loved ones. While doing a skills-based group on prevention of sexual exploitation for young women with intellectual disability, I discovered that all of the participants were avid fans of Buffy the Vampire Slayer, so I used an episode of the TV show to help them explore the risks of alcohol and drug use. I have also used the favorite cartoons of children in residential treatment in therapeutic exercises to enhance self-regulation and healthy attachment.

When carefully integrated within the therapeutic process, cinema has powerful healing potential. The iconic film The Wizard of Oz and the fantasy drama What Dreams May Come have long served as powerful catalysts of personal healing for my clients. With the help of these movies, they have explored core concepts of mindfulness such as resilience, compassion, acceptance and being present within oneself. Barnet Bain, the producer of What Dreams May Come, has noted that both cinema and psychotherapy use “the power of stories to heal.” An advocate of integrative body psychotherapy, he believes that we all “take refuge” and find healing in transformational stories. “In my view,” Bain explained during a brief interview with me at the Illuminate Film Festival in 2015, “any story that can lead one home to integration in the embodied present, that is a therapeutic story.”

It is through the integration of mindfulness-oriented practices and cinematherapy that I have seen the most profound changes in my clients. In group therapy, for example, I integrate mindfulness-oriented exercises before and/or after viewing cinematic selections, followed by in-depth processing of the cinematic experience. I also assign homework that includes practicing and applying mindfulness skills, watching “prescribed” cinema, journaling and engaging in other expressive exercises. Follow-up sessions explore cinematic experiences via group discussion and experiential exercises, including role-play and writing or rewriting one’s own script. Countless clients have reported that this integrative approach has helped them make life-changing progress.

Mindfulness, resonance and synchronicity

In my work, the therapeutic power of integrative, mindfulness-oriented cinematherapy was perhaps best exemplified by the impact that “all things” had on my clients. Unlike more typical episodes of the sometimes scary sci-fi show The X-Files, “all things” features no monsters, aliens or government conspiracies. Instead, it examines paths to personal transformation and investigates concepts of the mind-body connection, spirituality and synchronicity.

More than a decade ago, I was challenged with introducing mindfulness and mind-body healing concepts to clients who were court ordered for treatment because of substance use, domestic violence or related convictions. At the time, mindfulness was not yet mainstream, and very few of the people referred to me had any prior exposure to its concepts or practices. They were coming to group therapy to avoid incarceration, loss of their driver’s license or removal of their children from the home. These were individuals most in need of having simple, powerful, mindfulness-based skills and concepts to better manage their lives. I needed a means through which I could introduce these concepts in a nonthreatening, entertaining and effective manner.

Initially, I showed only those segments and sequences of the “all things” episode that best illustrated core concepts of mindfulness and mind-body healing, including slowing down, paying attention, acceptance, self-compassion and the impact of toxic emotions on health and well-being. Clients were so moved by these evocative clips that they routinely requested to view the episode in its entirety.

Coincidentally, the 45-minute episode fit very well within groups that ran 90 minutes to two hours, allowing us time to engage in mindfulness-oriented exercises before or after the viewing and time to process the experience as a group and discuss homework assignments. I have now used “all things” in its entirety with more than 1,000 clients in both individual and group therapy.

Over the years, I have used the episode in dozens of different groups focusing on everything from stress management to trauma recovery. These groups have varied from eight- to 16-week structured, skills-based groups to less structured, ongoing groups for individuals with chronic mental health needs. In nearly every instance, at least one group member has reported experiencing some sort of breakthrough or making some sort of positive life-altering change after viewing “all things.” In some groups, every member reported experiencing a significant impact. Many group members have noted that the episode’s images and themes resonated with them on a deeply personal level. In fact, numerous clients have contacted me months or even years after completing treatment and shared that the experience of viewing this episode, in a therapeutic context, played a significant role in their recovery and personal growth.

Having watched so many clients view “all things,” I have noted what moves and soothes them within this episode. Letting go of shame and guilt, seeking meaning in life experiences and “seeing the reasons why all things happen” are themes within the episode that resonate universally with clients. Grief, loss, shame, abandonment and exploitation are among the more personal themes that have emerged and brought tears to the eyes of many clients after watching “all things.” The episode became the means through which those clients could safely identify and begin to process their painful experiences.

The use of “all things” in group therapy has had yet another surprising effect. I found that clients become much calmer and more reflective immediately after viewing the episode. In dozens of cases, I have observed clients shift out of highly anxious or agitated states while watching the episode. As a result, they were better able to reflect on and process their reactions after viewing it.

The way “all things” was directed and filmed seems to have contributed to this effect. Pulsating chimes, dripping water, ticking clocks and tapping pencils set the rhythm, while slow-motion sequences and extreme close-ups focus viewers’ attention. Shots of a window shade toggle undulating back and forth, circulating fans, spinning wheels, flowing curtains, swinging signs and even the main character swaying back and forth while having a mystical experience in a Buddhist temple serve to grasp and direct the gaze of viewers.

I suspect that these cinematic devices are partly what produce an immediate calming effect on my clients, quite possibly inducing a state of mindfulness. They may even contribute to client “breakthroughs.” As if they were some form of cinematic eye movement desensitization and reprocessing, could the audio and visual techniques used in “all things” produce bilateral stimulation of the brain and subsequently enhance adaptive information processing and alleviation of affective distress?

Synchronicity, neural synchrony and interconnection

Neurocinematic research may well explain some of the therapeutic power of “all things.” The episode’s cinematic and thematic complexity, along with its well-directed and evocative sequences, are what neuroscientists have found to contribute most to interspectator neural synchrony, or the synchronization of brain activation and brain wave patterns across viewers. Intersubject correlation (ISC) measures the collective engagement of a group of viewers via neural synchrony. As researchers Kaisu Lankinen, Jukka Saari and Ritta Hari noted in 2014, emotional film clips enhance ISC. Likewise, “a well-directed movie,” in contrast to one that is loosely structured, strengthens ISC.

According to Hasson, a research scientist and lead author of an article titled “Neurocinematics: The Neuroscience of Film,” the concept of ISC is relatively straightforward and simple. “In cinema,” Hasson and his co-authors write, “some films (or films’ segments) lead most viewers through a similar sequence of perceptual, emotional and cognitive states. Such a tight grip on viewers’ minds will be reflected in the similarity of the brain activity (high ISC) across most viewers. By contrast, other films exert (either intentionally or unintentionally) less control over viewers’ responses during movie watching (e.g., less control of viewers’ emotions or thoughts). Throughout the years filmmakers have developed an arsenal of cinematic devices (e.g., montage, continuity editing, close-up) to direct viewers’ minds during movie watching. These techniques, which constitute the formal structure and aesthetics of any given cinematic text, determine how viewers respond to the film.”

When I inquired whether inducing bilateral brain stimulation and synchronized brain activity in viewers was intentional or intuitive, Gillian Anderson, the writer, director and star of the “all things” episode, indicated that it was the latter. She explained, via personal note, that she “had no idea” that those cinematic techniques could produce such “amazing” effects. As she has noted in previous interviews, the writing and directing of the episode was a “deeply personal” endeavor and an exploration of her own deeply held belief that “we are all connected.”

No stranger to counseling and psychotherapy, Anderson has both professional and personal connections to the field. She is currently penning a self-help book and has recently published the second in a trilogy of novels featuring a child psychiatrist as the main character. Personally, she began therapy at age 14 and credits it with keeping her “sane and alive.” She has been a strong supporter of counseling and psychotherapy ever since.

Anderson believes that cinema, like therapy, has powerful healing potential. “Any film that has a message that teaches people about themselves, that teaches people how to get out of a place where they are stuck and get on with their lives and get on with being a productive human being, is important,” she said. “Films are instruments to teach people, and they can affect people in profound and in life-changing ways.”

 

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Note: My use of all films, television episodes, film segments and videos in group and individual therapy was done via “fair use” with no copyright infringement intended.

 

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Bronwyn Robertson, a licensed professional counselor, has lectured and published internationally on the integration of mindfulness in counseling and psychotherapy. She specializes in the treatment of anxiety, depression and trauma-related disorders. Contact her at Bronwyn@BronwynRobertsonLPC.com.

Letters to the editor: ct@counseling.org