The Improv Anxiety Treatment?

Source: Photo by Gift Habeshaw on Unsplash

Getting up on stage in front of an audience and performing without a script may sound like the opposite of anxiety treatment, but new research is beginning to show that theatrical improvisation may actually help people cope with their anxiety disorders.

About 40 million Americans are dealing with some type of anxiety disorder and anxiety rates seem to show no sign of abating. Researchers are now looking at how improvisation can help people manage and curb their anxiety.

There are a handful of anxiety disorders, but the two that current improv research focuses on are generalized anxiety disorder (GAD) and social anxiety disorder (SAD). Generalized anxiety disorder is when individuals struggle with anxious feelings most days. One anxious thought leads to another with little to no downtime from this anxious state.

Social anxiety disorder affects people in a wide variety of social situations and is more than just self-consciousness. It’s when anxious feelings in social situations seem overwhelming and negatively impact one’s life.

So, how in the world might improv help people manage these pervasive, overwhelming thoughts?

Improv for Anxiety

Mark Pfeffer, a psychotherapist and the director of the Panic Anxiety Recovery Center (PARC) helped found Second City’s Improv for Anxiety classes in 2011. Pfeffer co-wrote an article with Alison Phillips Sheesley and Becca Barish which calls Improv for Anxiety’s hybrid improv and group therapy classes Comedic Improv Therapy (CIT). They explain that CIT helps patients explore four modalities: group cohesion, play, exposure, and humor to help people get more comfortable with uncertain social situations and begin allaying their social anxieties.

Improv for Anxiety classes last eight weeks and include improv classes that explore the four modalities and additional group therapy sessions that combine cognitive-behavioral therapy and exposure therapy by trained professionals.

Kristin Krueger, Ph.D., led a 2017 study that examined the efficacy of hybrid approaches (improv and therapy) similar to Improv for Anxiety. In Krueger’s study, people with diagnosed anxiety or depression participated in a four-week improvisation intervention. The intervention was two hours each week with one of those hours being an improv lesson and the other a group therapy session.

Krueger’s improv intervention is a preliminary study with no control group, but the findings are encouraging. Participants completed multiple self-reported questionnaires, and researchers found that symptoms of anxiety, depression, and perfectionism declined and self-esteem increased marginally after participants completed the month-long improv and group therapy intervention.

Krueger continues to facilitate therapeutic improv workshops through Nobody’s Business in Chicago. The classes are open to all community members, so if someone is interested and self-reports feelings of anxiety or depression, they are allowed to participate. Krueger reports great success with this approach and plans more studies to quantify the efficacy of improv for anxiety and depression in the near future. Peter Felsman, Watson Swift, Cliff Saper, Eleni Liosis-Dimitriou, Katie Hammen, and Angela Suico were all vital organizers in past and current workshops.

Murray Dabby, LCSW, also facilitates improv for anxiety workshops in Atlanta through Curtain Up! Anxiety Down!, which he co-founded with Lesly Fredman. Their workshops are 12 weeks and have included people with social anxiety, social phobia, shyness, and depression. Dabby reports that the workshops have been most impactful for people with social anxiety or fears of speaking in public.

In another study, researchers looked at how improv impacted 268 middle and high school students’ social anxiety symptoms. Students filled out questionnaires before and after improv workshops, and the data shows that improv helped students feel less social anxiety symptoms.

Peter Felsman, Ph.D., is one of the author’s of the aforementioned social anxiety study and is now studying the use of theater to help scientists communicate more effectively at the Alan Alda Center for Communicating Science and the use of theater to help youth with psychosocial development at the Social Competence and Treatment Lab. His current research helps identify “features of improvisation that explain its benefits” and “the role of uncertainty tolerance in explaining the relationship between improv training and social anxiety.” So, more concrete answers on why improvisation helps treat anxiety symptoms are forthcoming.

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Why Does Improv Help Treat Anxiety?

I asked Krueger, Felsman, and Dabby why they thought improv was effective as an anxiety treatment, and two themes emerged from their responses.

Felsman points to exposure as integral to improv’s power as an anxiety treatment. He explains that avoidance is a central component of anxiety disorders. People with social anxiety avoid social situations that make them feel self-conscious or uncomfortable. This avoidance helps them replace unpredictable situations (a big party) with more predictable ones (staying at home alone).

Felsman states that in the short-term, people are rewarded with avoidance. They don’t have to endure the uncertainty and discomfort of putting themselves out there. However, avoidance also means they miss out on potentially positive outcomes.

Improv allows people with anxiety a safe space to practice exposure. They are encouraged to experiment with situations they would normally avoid, and, because improv is generally fun, they start experiencing positive rewards of exposure instead of avoidance. Felsman explains, “I think the necessary and repeated encounter with the unknown is what makes improv so powerful.”

Dabby expands on this concept of exposure by explaining that participants become more comfortable with embarrassment and humiliation through playful risk-taking. He states, “Improv requires risk-taking in stating your creative thoughts, ideas, or contributions. The experience of that activity helps rewire one's expectations of what is possible to do with others.”

Krueger agrees that exposure is an important factor in improv’s success as an anxiety treatment and also points to Bermant’s insights on “unconditional positive regard” as a second reason improv helps people with anxiety.

She links “unconditional positive regard” with improv’s Yes, And principle. The idea behind Yes, And is that improvisers must agree with each other’s realities and then add onto the scene in order for improvised scenes to develop. For example, if my scene partner says, “Pizza again, mom?” the Yes, And principle requires me to go along with the ideas that I am my partner’s mom and that we are having pizza. The Yes, And principle also means I have to add new detail to that mom/pizza reality. Negating the scene might mean I refute the idea that I am Mom or that we’re having pizza.

Bermant links Yes, And with the concept of unconditional positive regard because both encourage participants to positively regard each other, actively engage together, and “accept other’s comments without condition.” This helps people with symptoms of anxiety feel safe enough to take the risks required to experiment with anxiety exposure.

Krueger clarifies by saying that most of us experience some form of not being good enough, and improv provides a unique environment where, not only are you good enough, but you’re 100 percent accepted. This acceptance and positive experience allows people to step out of their comfort zones, experiment, and experience situations they might normally avoid due to their anxiety disorders.

Dabby also points to fun being an important element of improv’s appeal as an anxiety treatment. He explains, “More and more today, play is recognized as essential for overall health and well being. And this experience is so important for people suffering from anxiety.”

Final Thoughts

Anxiety is the most prevalent mental illness in the United States, but, unfortunately, only about one-third of people with anxiety are receiving treatment. That means millions of people are going it alone with their anxiety disorders.

Improvisation offers a hopeful, inviting, playful option for people with anxiety. There are classes such as Second City’s Improv for Anxiety in Chicago, Detroit Creativity Project, Curtain Up! Anxiety Down! in Atlanta, and Nobody’s Business in Chicago that thoughtfully and strategically use improvisation, sometimes in combination with group therapy, to help ease people’s anxiety.

One obstacle for improvisation as an anxiety treatment is that people’s anxiety-related avoidance can make them steer clear of improv workshops altogether. My hope is that laying out some of the latest research and upcoming studies will help embolden people to take the plunge. When done correctly, with trained professionals and in conjunction with therapies such as cognitive behavioral therapy, improv can help people experience positive, playful uncertainty in a safe and accepting environment.

More research needs to be done, but in the meantime, improv seems an encouraging option for people to start interacting, playing, and embodying the joy of embracing uncertainty, getting out of their heads, and becoming more mindful and present in the here and now.