Mental health care for young people using fictional narratives; a study on the development of a new intervention method

概要

筑

波 大

学

博士（医学）学位論文

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Mental health care for young people using
fictional narratives; a study on the
development of a new intervention method
（物語作品を用いる若年層向けのメンタルヘルスケア；
新介入方法の開発に関する研究）

２０２２
筑波大学大学院博士課程人間総合科学研究科

PANTŌ

FRANCESCO

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Abbreviations list
ACT (Acceptance and Commitment Therapy)
CES-D (The Center for Epidemiological Studies Depression Scale, Japanese version)
CCBT (Computerized cognitive behavior therapy)
CD-ROMs (Compact disc read-only memory)
CLT (Central limit theorem)
EBM (Evidence-based medicine)
ELM (The elaboration likelihood model)
GHQ-28 (The General Health Questionnaire – 28)
GPS (Global Positioning System)
HSM (Heuristic-systematic model)
iCBT (Internet-delivered cognitive behavioral therapy)
ILO (Organization Bangkok)
MES (Multidimensional Empathy Scale)
NBM (Narrative-based medicine)
NTS- J (Narrative Transportation Scale)
POMS (Japanese Edition of Profile of Mood States)
PROMPT (Project for Objective Measures Using Computational Psychiatry Technology)
QMEE (Questionnaire Measure of Emotional empathy)
S-MARE (Short-form self-report measure to assess relaxation effect)
STAI (The State-Trait Anxiety Inventory)
TMD (Total Mood Disturbance)

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INDEX
1. GENERAL LITERATURE REVIEW…………………………………………………………...7
1.1 fiction and nonfiction persuasion effects………………………………………………………..7
1.2 Cinema therapy…………………………………………………………………………….…..14

1.3 Gamification and its clinical implications……………………………………………..17
1.4 Hikikomori, Futōkō, Otaku and possible interventions ……………………………..19
2. RESEARCH 1: DEVELOPING AN INTERVENTION TO SUPPORT HIKIKOMORI WITH
FICTIONAL NARRATIVES: AN INTERVIEW SURVEY WITH HIKIKOMORI AND FUTOKO
SUFFERERS
……………………………………………………………………………………..…………

29

2.1 Research Purpose and Objectives……………………………………………..…….….29
2.11Summary………………………………………………………………………………..….…29
2.12 Introduction………………………………………………………………………………….29

2.2 Methods…………………………………………………………………………………….30
2.21 Subjects…………………………………………………………………………………..….30
2.22 Survey Method……………………………………………………………………………….31
2.23 Survey Items…………………………………………………………………………………31
2.24 Analysis method……………………………………………………………………..………32
2.25 Ethical considerations……………………………………………………………………….33

2.3 Results………………………………………………………………………………………33
2.4 Discussion……………………………………………………………………………….…38
2.5 Conclusion…………………………………………………………………………………41
3. RESEARCH 2: DEVELOPING AN INTERVENTION TO SUPPORT HIKIKOMORI WITH
FICTIONAL NARRATIVES: A QUESTIONNAIRE SURVEY WITH HIKIKOMORI AND
FUTOKO SUFFERERS
……………………………………….…………………………………………………………….43

3.1 Research Purpose and Objectives……………………………………………………..43
3.11 Hikikomori and fictional narratives and study rationale………………………………….43

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3.2 Methods…………………………………………………………………………………..43
3.21 Participants……………………………………………………………….………………43
3.22 Procedures……………………………………………………………….……………….44
3.23 Outcomes measures…………………………………………………………………….…44
3.24 Predictor measures……………………………………………………………………….46
3.25 Descriptive measures…………………………………………………………………..…47
3.26 Data analysis……………………………………………………………………………..47

3.3 Results………………………………………………………………………………..…48
3.4 Discussion………………………………………………………………………………56
3.41 Study limitations…………………………………………………………………………59

3.5 Conclusions………………………………………………………………….…………60
4. RESEARCH 3: DEVELOPING AN INTERVENTION TO SUPPORT HIKIKOMORI WITH
FICTIONAL NARRATIVES: AN INTERNET-DELIVERED RCT
TRIAL…………………………………………………………...………………………………...61

4.1 Research Purpose and Objectives……………………………………………..…...…61
4.11 Summary ……………………………………………………………………………….….61
4.12 Play therapy, gamification as a tool of mental health…………………………….……… 63
4.13 The study……………………………………………………………………..……………..67

4.2 Methods……………………………………………………………………………….… 68
4.21 Participants………………………………………………………………………..….…….68
4.22 Intervention study materials ………………………………………………..………………69
4.23 Control group program materials ……………………………………….………..……… 79
4.24 Outcome Mesures…………………………………………………………..…….…..…….80
4.25 Predictor measures……………………………………………………………….…..… .82
4.26 Research process………………………………………………………………….….… .82
4.27 Data analysis……………………………………………………………….….…………..83

4.3 Results……………………………………………………………….…….………………83
4.4 Discussion………………………………………………………….………..…..………94

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4.41 Limitations and Future Prospects of this Study…………………….………………….…102
4.5 Conclusions…………………..……………………………………………………………….106

5. Acknowledgements………………………………………………….…….….…..……..107
6. References ……………………………………………………………..…………………109

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General Literature Review
1.1 fiction and nonfiction persuasion effects
In our daily lives, we consume entertainment in various forms (movies, drama, anime, manga,
concerts). These activities can provide a narrative consumption experience, (Andrade & Cohen,
2007; Deighton ,1992; Escalas & Stern, 2003). Data shows how a significant part of the income of
an average person is consumed in entertainment-related activities. (Americans spent 8.5% on
average). Entertainment can include emotional melodramas. This refers to a subtype of dramatic
entertainment with a focus on emotional depiction, human struggles, and poignant stories.
(http://www.britannica.com). The protagonist usually is depicted along with their sufferings and
challenges. The protagonist tries to overcome their problems through sacrifice and bravery. This
depiction could foster deep emotional reactions in the spectator. This form of entertainment is
ubiquitous and very profitable. (e.g., Titanic, $1.8 billion worldwide gross, A Beautiful Mind, $316
million worldwide gross).
From a scientific point of view is still unclear why consumers enjoy so much this kind of
entertainment. Emotional transportation and empathy toward the characters and the story of
emotional melodramas could be the key to understanding the psychological effects. (Deighton,
Romer, & McQueen, 1989). Some researchers advanced the hypothesis that a difference in
individuals’ empathy (high and low empathizers) interacts with the stimulus characteristic
(melodrama) level of fictionality in determining the extent of transportation developed toward the
characters of a story. This could influence the overall effects of the melodrama in terms of
enjoyment. (Argo et al., 2008). An important factor in melodrama effects could be the degree to
which a consumer is absorbed (Green & Brock, 2000; Wang & Calder, 2006) into the narrative
world.
A lot of research traditionally focused on the effects of social marketing and advertising (Aaker &
Williams, 1998; Bagozzi & Moore, 1994). But evaluating the effects of emotional melodramas
could be useful to identify moderating factors, like the level of fictionality. (Argo et al., 2008).
A Broader term for emotional melodrama is !Fictional Narratives”. This term describes the activity
of enjoying a production that does not include real factual information, like watching movies or
anime, reading novels, or playing video games. These products are not based on real facts or stories
(or at least not entirely). (Busselle & Bilandzic, 2008). This activity is something everybody has
experienced at least once in their lifetime and it has been suggested to benefit the personal insight of

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individuals, giving opportunities for self-discovery and self-insight (Green & Brock, 2002; Oatley,
1999; Oatley, 2002; Pelowski & Akiba, 2011).
Mechanisms based on theories like Green & Brock’s Transportation-imagery model or Emotional
transportation theory (Green & Brock, 2002) are considered responsible for these psychological
effects.
Emotional transportation happens when the viewer gets emotionally involved with the fictional
characters of a fictional story. If certain personal and environmental preconditions are present, the
viewer will fall into a state of emotional detachment and will be transported to the world of the
story (Van Laer et al., 2014). This process, according to Van Lear, is regulated by the empathy the
spectator grows toward the story characters and the vivid imagination of the plot occurring in the
mind of the spectator (Coplan, 2004).
What kind of psychological effects can we expect from playing games or watching anime with a
fictional story? It has been suggested that people who enjoy a large quantity of fictional narrative
productions become more empathetic towards other people (Mar et al., 2006). One possible
interpretation for this effect is that fictional stories function as a simulation of human and social
interactions, therefore narrative may function as an indirect learning experience (Argo et al., 2008).
Other than emotional effects, the narrative transportation model suggested that fictional narratives
consumption can induce a strong cognitive persuasion in the spectator, (Coplan, 2004). Narratives
could also reduce counter-arguing, leading to change in the belief system of the spectator. Fictional
narratives may trigger a cognitive transformation experience (Green & Brock, 2000; Phillips &
Mcquarrie, 2010).
The author thinks that this transformation experience could be mediated by emotional persuasion
(narrative persuasion).
Researchers distinguish between analytical and narrative persuasion (Petty & Cacioppo, 1986).
Compared to analytical persuasion of factual stories (facts), narrative persuasion is not inherently
critical and does not involve scrutiny, characteristics that allow persuasion to be more effective and
long-lasting and the viewer to be more open to being persuaded (Appel & Richter, 2007; Locke,
1987; Slater, 2002).
To reach a Narrative transportation state, Narrative engagement must occur. This process consists
of four dimensions (Busselle & Bilandzic, 2009): narrative understanding, attentional focus,
emotional engagement, and narrative presence. In Narrative understanding, the viewer makes sense

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of the contents of a story. Secondly, the viewer reaches attentional focus, when they focus their
attention mainly on the events of the narrative, without being distracted by ambient noises, etc. ...

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