Video self-confrontation as a therapeutic tool in schizophrenia: A randomized parallel-arm single-blind trial

Background: Lack of insight is a barrier to treating psychosis. Preliminary studies have suggested that showing people videos of their psychotic behaviour may improve personal insight. This clinical trial aimed to assess the effect of video self-confrontation. Methods: Inpatients between 18 and 65 years old with schizophrenia or schizoaffective disorder were filmed upon admission to two psychiatric hospitals while experiencing acute psychosis. After stabilization, individuals were randomized 1:1 to the self-video group where they watched their own video or to the no video control group. The primary outcome was the Scale to assess Unawareness of Mental Disorder (SUMD) at 48 h by a blinded assessor. Secondary objectives included psychotic and depressive symptoms, medication adherence and functioning using the Functional Remission of General Schizophrenia. Patients were followed up for four months. Results: 60 participants were randomized and the level of insight did not differ between groups at 48 h (p = 0.98). There was no impact on SUMD subscores or the other insight questionnaires at any timepoint, nor on psychopathology or medication adherence. At one month, the level of functioning of those in the self-video group (n = 23) was higher (61.8 vs 53.5, p = 0.02), especially concerning Treatment and Daily life. No adverse effects were reported. After video self-confrontation, people expressed more positive than negative emotions and were less lost to follow-up. Conclusion: Video self-confrontation did not change levels of insight, but may have a therapeutic impact nonetheless, by improving levels of self-care and adherence to care, indicating that this innovative therapeutic tool requires further study. Trial Registration Number: NCT02664129

Automated summary

This clinical trial aimed to assess the effect of video self-confrontation on insight in patients with psychosis. The results showed that video self-confrontation did not change levels of insight, but it may have a therapeutic impact on self-care and adherence to treatment. Further research is needed on this innovative therapeutic tool.