So Funny, It Doesn't Hurt

Can improv be a form of therapy? Some psychologists think so.

When I took my first improv class in August 2013, I harbored no delusions of someday headlining comedy shows. My interest was more practical: A colleague at the Los Angeles-based startup where I worked had recently started taking the class, hoping that it would help him become quicker on his feet in meetings. He told the rest of our department how fun the classes were, and encouraged us to try it. I was a hard sell—I hate public speaking—but I also knew that improvising was a skill that I could stand to develop. Begrudgingly, I signed up to audit a beginner’s class at Improv for the People (IFTP), a theater in Culver City, California.

And somehow, despite my ingrained self-consciousness, I quickly discovered that I loved it. The give and take of improv performance felt exhilarating; I would arrive at each evening class feeling tired and leave three hours later full of energy.

According to Matthew Moore, my improv teacher and the founder and artistic director of IFTP, that’s not unusual among his students, even the shyer ones. Moore, who has led many corporate workshops through Improv for the People, said a handful of companies have sent employees to his class to work on their public-speaking skills. The majority of Moore’s students, however, sign up of their own accord, many for reasons similar to mine: They’re hoping to build confidence, or they want to improve their communication skills.

For some, the benefits can be even more significant: Researchers and clinical psychologists alike have begun to pay attention to improv, conducting studies or incorporate it into work with their patients. The improv stage, in theory, is a space free of judgment or fear of failure, making it an ideal environment for people who struggle with low self-esteem, social anxiety, or other types of anxiety disorders.

While not a substitute for therapy, some psychologists believe improv can be an effective complement, in part because of the way it mirrors the patient/therapist dynamic. In 2013, Gordon Bermant, a psychology professor at the University of Pennsylvania, published a paper in the journal Frontiers in Psychology that outlined the similarities between improv and applied psychology, or the use of psychological research to solve real-world problems. “Both improv and applied psychology practices aim to increase personal awareness, interpersonal attentiveness, and trust,” he  wrote.

The lack of planning and structure in improv means that performers must function without a safety net, but, as Bermant noted in his paper, “if all play authentically to each other, fear of failure loses its sting—a net of support is constructed from the openness, trust, and acceptance.” The relationship among members of an improv ensemble hinges on trust, as does the relationship between therapist and patient.

“The idea of a therapist holding a client in ‘unconditional positive regard’ describes a way of relating to others which is close to the ‘yes, and’ affirmations of improv,” Bermant told me. A key tenet of therapy is the guarantee that the therapist will not judge the client for what he or she says. Similarly, improv’s “yes, and” concept—one performer accepts another’s premise and adds to it—is built on the implicit promise that no idea will be shot down.

“The beauty of improv,” he said , “is that it is quintessentially a collective, cooperative form that rests completely on trust for the spark of creativity that can transport the players, briefly, into confidence-building interpersonal connections.”

According to Simon Rego, the director of psychology training at Montefiore Medical Center in New York, performing improv could function as informal exposure therapy for people who struggle with social anxiety or fear speaking in front of crowds. In exposure therapy, psychologists help patients to gradually confront their fears, working up from the slightly nerve-racking (like performing in front of only one other person) to the full-blown worst-case scenario (like “bombing” in front of a large crowd).

“For people who feel anxious socially, getting up in front of a crowd repeatedly would create an excellent opportunity to reduce their fear—no matter what the outcome,” Rego said. “It will either turn out better than they thought so they'll feel less anxious next time, or if it does not go well, they will learn that they can cope with it.” Rego practices cognitive-behavioral therapy, which helps people change their thoughts and behaviors in order to change how they feel. It’s a common treatment for anxiety and the idea is to teach patients to question negative thought patterns by identifying “cognitive distortions,” or gathering evidence for and against their thoughts. At the same time, they learn effective ways to alter problematic behavioral patterns, like facing feared situations instead of avoiding them.

David Carbonell, a Chicago-based psychologist and anxiety specialist, runs a workshop for people with a fear of public speaking that incorporates elements of improv. In Carbonell’s workshop, one participant gives a speech while another participant voices the negative, self-critical thoughts that are likely running through the speaker’s mind: “How come you’re pausing for so long? It looks like you’re nervous up there! What kind of breathing is that you’re doing?”

“It’s amazing what happens when [the speaker] hears all of these terribly self-critical thoughts actually voiced by another person,” Carbonell told me. “It’s easier to handle than when it’s in the back of his or her own mind. [This exercise] really takes away some of the power of these self-critical thoughts.”

Carbonell also uses improv techniques in a group he leads for people with a fear of flying. The group meets several times before going on a flight together. At one meeting, with the group gathered around a conference table, Carbonell asks one of the participants to start chanting what he or she finds most terrifying about flying. Soon all are chanting: a cacophony of interwoven fears.

Carbonell stops the chanting, and singles out a participant to chant the fear of someone across the table, and so on.

“By the end they’re laughing hysterically, because it’s hard for them to even remember what their fear was,” Carbonell said. “Social anxiety is all about inhibition and self-censorship, and that’s exactly what improv helps flip around.”

Carbonell doesn’t just incorporate improv into his practice as a psychologist—he’s also part of Chicago’s all-psychologist improv troupe, the Therapy Players, which had its debut performance in 2013. Since then, the group has performed at setting ranging from a sketch comedy competition to a benefit for the Anorexia Nervosa Association. Much of the humor is, appropriately enough, psychology-themed: In a video Carbonell sent me, one scene involved a diagnostic evaluation for panic attacks. In another, a performer assumed the character of Dr. Generic, who attempted to cure a patient using types of therapy suggested by the audience (these ran the gamut from exposure therapy to aromatherapy).

Carbonell also refers some of his patients with less severe cases of social anxiety to Improv for Anxiety, a joint venture of Chicago’s Panic/Anxiety Recovery Center (PARC) and the comedy club Second City. The eight-week program consists of weekly improv training taught by a Second City instructor, paired with weekly CBT group sessions led by PARC.

Mark Pfeffer, the director of PARC and one of the founders of Improv for Anxiety, believes that the best way to help people combat anxiety is to put them in situations that provoke it. Improv, he said, helps enhance an individual’s ability and desire to take risks.

“Certainly we’re not going to cure someone in eight weeks from a lifetime of mild to moderate social anxiety; however, what we look for is changes in their behavior and their thinking,” Pfeffer told me.

A handful of programs similar to Pfeffer’s have cropped up around the world to  help people with anxiety. The School of Laughter in London, for example, runs an Improv for Anxiety workshop that encourages participants to “laugh in the face of fear.”

Another program, the Improv Social Skills Group at Vanderbilt University, accepts eight students per semester for six 90-minute sessions. “If you think of yourself as sitting back and watching all the fun happen without you, or feel unable to break into a conversation without feeling your face is on fire, or if you just wonder if your conversational skills are holding you back from better engagement on social or academic levels, you might consider attending,” reads the description on Vanderbilt’s Psychological and Counseling Center, which runs the group.

At least two research efforts are currently underway to assess just how effective improv is in helping with anxiety. One is a study of the Improv for Anxiety program, led by Greg Poljacik, a researcher at the University of Chicago and a stage-combat teacher at Second City. Before and after completing the program, study participants fill out the Liebowitz Social Anxiety Scale, which measures fear of certain everyday activities (like using a telephone in public, or speaking up at a meeting). Poljacik and his colleagues, who have been collecting data for the past year, plan to include a total of 50 participants in the study, along with a control group.

Kristin Krueger, a neuropsychologist at the John H. Stroger Jr. Hospital in Chicago and a member of the Therapy Players, is conducting another study evaluating the effects of improv on people with anxiety. Krueger started taking improv classes in 2006, she says, and became curious about the potential cognitive benefits. She’s drawn to improv, she said, because it isn’t about “getting it right”—a liberating departure from the pressures of a life in academia.

Krueger now runs what she calls “thera-prov” for patients who come to Stroger seeking treatment for anxiety or depression. In small weekly group sessions, Krueger uses pre- and post-meeting evaluations to measure five outcomes that she thinks improv may influence: symptoms of anxiety and depression, perfectionism, satisfaction with social roles, and self esteem.

By mid-October, 35 patients will have completed Krueger’s program, and she plans to soon begin writing up her results to submit for publication. Krueger, who was trained in CBT, views improv as complementary to CBT’s goals.

“When we try to change people’s thoughts, it’s a long process because not everybody is that verbally talented, or that cerebral,” said Krueger. “What’s great about improv is that you can change your mood without knowing exactly why you’ve changed it.”