Combs, now an assistant professor of psychology at the University of Texas at Tyler, recounted one particularly memorable moment from the study group at an Oklahoma treatment facility last spring. Several schizophrenic inpatients approached the nurse on duty to share a lesson they had learned in SCIT group therapy. Having noticed she was in a bad mood, they calmly suggested that her emotions were most likely affecting her interactions with other people.
The nurse was reportedly stunned at their perception. Despite difficulty with social interaction and empathy, these patients had overcome their natural inclinations to remain socially isolated.
It was one of the many moments that made Combs realize SCIT had the potential to change lives.
"I was pleased with the fact that they learned the material and were able to recognize it in others and use it in their daily lives," he said. "Knowing it and then actually using it are different things."
During SCIT therapy sessions, therapists use video tapes, computers, role playing and other methods. The interaction is one reason why participants keep coming back.
"Normally when we do treatment we just stand there and lecture," Combs said. "This way the videos are engaging and fun, and teach important social skills."
Attendance was more than 90 percent during the 18-week long study program in Oklahoma.
Penn said their approach was to make teaching as fun as possible. "It's not just us sitting in front of the TV with people. That's not it at all. We use these things as models," Penn said.
The idea to use video came from David Roberts, a graduate student in psychology at the University of North Carolina-Chapel Hill who helped develop SCIT. He had spent six years working with schizophrenic inpatients before he began to wonder whether they were appreciating television the way he did.
People with schizophrenia tend to have blank expressions, something psychologists refer to as "flat affect." But watching TV can bring out subtle reactions: smirks, winces, and even the occasional chuckle. This kind of enjoyment is hard to see, however, in part because patient medications mute emotional expression.
Over the past several years, psychologists have come to expect more from people with schizophrenia, Roberts said.
"There is a large subset of people who pick up on more than they are typically given credit for," he said. "There is a lot of subtlety and nuance and thought that is happening behind the flat face of someone with schizophrenia."
Eventually Roberts approached Penn, his advisor, and told him about the patients' interest in television.
"If you went to an old-school behaviorist and said these things, it doesn't mesh with their understanding of the illness," Roberts said. "But my advisor, he was game. He was definitely willing to explore and talk about it."
Roberts started showing clips of HBO's "Curb Your Enthusiasm" during therapy sessions, and it turned out that the Larry David comedy was more than an entertaining string of embarrassing, socially awkward circumstances. It was also a case study for the negative consequences that can arise when people jump to conclusions, or misinterpret behavior.