Improvisational Theater Tools for Anxiety

“We start from a place of acceptance, with the ground rule that everything you say is right.” In my work of facilitating Medical Improv workshops, I’ve learned that It’s not about becoming a performer, or being funny. It’s about taking risks and focusing on others.

Improv for Anxiety: A Stand-Up Therapeutic Tool?

Kathleen Louden

CHICAGO — Even after attending a residential program to treat anxiety and obsessive-compulsive disorder, Annie Clark was unable to make eye contact or speak to strangers.

But after attending Improv for Anxiety, a unique therapeutic program developed in concert with The Second City, Chicago’s famous improv-based sketch comedy troupe, she has a newfound ability to interact socially and speak in public.

“It was a gift to find my voice,” Clark said.

Known as Improv for Anxiety, the joint program between The Second City and Panic/Anxiety Recovery Center on the city’s North Side combines improvisation and cognitive-behavioral therapy (CBT) to combat social phobia.

Clark spoke, along with several other program graduates, to mental health providers here at the Anxiety and Depression Association of America (ADAA) Conference 2014 during a preconference session to introduce improvisation as a therapeutic tool.

Anxiety “Boot Camp”

Improv for Anxiety is thought to be the only currently operating program of its kind in the world, according to its founder, Mark Pfeffer, LMFT, a CBT therapist and director of Panic/Anxiety Recovery Center.

Billed as a social anxiety “boot camp,” the program began in August 2011 to help adults with moderate social anxiety disorder, also known as social phobia. A separate program is now available for teenagers with social anxiety.

Pfeffer founded the 8-week program to help patients overcome their fear and avoidance of social situations due to what he called “exquisite sensitivity to scrutiny from others.”

“This workshop stemmed from my frustration as a therapist for clients with social anxiety, who wouldn’t do their [psychotherapy] homework,” Pfeffer told Medscape Medical News.

“I wondered what would be accessible and affordable and would work for treating social anxiety,” he said.

After taking improvisation classes at The Second City Training Center in Chicago himself, Pfeffer discovered it was a safe and fun environment that had the potential to build confidence, improve public speaking skills, and boost comfort in social settings. He began to recommend these courses to his clients with anxiety, but found they would not attend.

As a result, he designed a program to meet the specific needs of this patient population and teamed up with Second City instructors, who led groups of 8 to 12 participants at weekly sessions.

Since its introduction, approximately 200 people have attended the program, Pfeffer said.

Why Does It Work?

Although there is little scientific research demonstrating the efficacy of improvisation as therapy, Pfeffer said anecdotal evidence suggests “people are making life decisions that previously were unavailable to them, such as going on a job interview. Basically, they now have quality of life.”

Improvisation is an effective therapeutic tool for managing social anxiety for several reasons, he said, including the fact that it is “ensemble based.” Continue Reading

“This population needs acceptance from the tribe, and we become their tribe,” Pfeffer said. “And, it’s hard to be terrified when you’re laughing.”

The Second City Training Center instructor Piero Procaccini.

Many improvisation skills can help ease social anxiety, said Piero Procaccini, an instructor for The Second City Training Center in Chicago. He facilitated improvisational techniques for a group of ADAA preconference delegates.

“Improv involves taking risks,” Procaccini said. “We start from a place of acceptance, with the ground rule that everything you say is right.”

The most important principle of improvisation, according to Procaccini, is what he describes as the “Yes and…” tenet. In improv, this phrase moves the action forward and shows acceptance and collaboration, he explained.

Having learned this principle in Second City and iO Chicago improv classes, Becca Barish, MSW, said she now uses it to treat her clients at Panic/Anxiety Recovery Center.

“We can say to a client, who mentions an unhealthy behavior, ‘Yes, and… when you do that, what happens? Does it take you to a place you want to be?’ ” Barish told the audience.

Yes, And…

Other principles of improvisation, according to Procaccini, are the following:

  • Reserve judgment of yourself and others.
  • Be in the moment.
  • Be others focused.
  • Be willing to take action.

Improv exercises slowly build confidence by encouraging patients to engage in activities that make most people uncomfortable. During the workshop, participants played a series of short games in a large group.

One game involved passing an imaginary red ball to each other while shouting out “red ball.” In another game, a person voluntarily formed a live “statue” in the center of the group and could not leave until a second person joined in.

After each game, participants discussed how they felt during the exercise.

Later, ADAA workshop participants improvised giving eulogies at an imaginary funeral. They were asked to spontaneously incorporate a phrase from a film or song, which others had previously written on a slip of paper.

In Their Shoes

Procaccini said Second City instructors find that the group benefits the most when the goal of the exercise is not explained ahead of time.

Melanie Santos, PsyD, a Chicago-based clinical psychologist who attended the ADAA workshop, said that the improvisational exercises gave her “a better idea of what it feels to be in the shoes of someone with social anxiety.”

She also added that she would apply some of the principles she learned to future therapy sessions.

“I hope to focus on encouraging acceptance and willingness to put yourself out there,” she said.

Dr. Santos acknowledged that it is often difficult to encourage people with social anxiety to engage in exposure therapy, despite accompanying them into real-world settings.

She said she would consider doing group exposure therapy, which one Improv for Anxiety program graduate suggested would make anxious clients more comfortable.

Pfeffer said the people who attend the program are initially fearful to register for it but that “they often have tried everything else, and they want to get better.”

In addition to social anxiety, there are other improvisational therapy courses to help individuals with autism spectrum disorder and, elsewhere, even Alzheimer’s disease.

Joy of Being Silly

As part of their recovery, some participants choose to go on to more advanced improvisation courses through The Second City Training Center. After completing these higher-level classes, they have the opportunity to perform an improvisational show at The Second City.

Program graduates are invited to speak at new Improv for Anxiety classes as part of their recovery, and several did so at this workshop. Dr. Santos said she was impressed with their self-reported improvement.

One graduate, Maren Lovgren, not only shared the story of recovery from her fears, she did a standup comedy routine — without any apparent nervousnes — that had the audience laughing.

For Lovgren, anxiety was standing in the way of her desire to be a performer. “Before [the improv class], I thought fear was my enemy,” she said. “Now I call it my numb hands and run toward it.”

Currently a performer and comedy writer, Lovgren said she felt the support of her classmates, noting, “We were not competitive. We were not fighting to be on Saturday Night Live.”

Clark told the audience that her experience in the program differed from past therapy sessions that were “drudgery, and everyone cried all the time.”

“In improv,” she said, “I found the joy of being silly.”

Resilience and Self-Care

Resilience isn’t just for dealing with the tough times.  We can learn and build new ways of facing personal and professional challenges.  Consider these strategies…

How to Build a Stronger Work Life: Reconsider Resilience

Dr. Marla Gottschalk

I’ve often wondered why building resilience isn’t a key business imperative. Because being human, is often at odds with work life. Our work can routinely bring stress, negativity, setbacks and outright failures — and we are challenged to employ strategies to combat the effects.

We often frame our conversations about resilience with stories of extreme hardship or extenuating circumstances. However, resilience could serve as an ever-present, daily mentor — helping us to rebound from the collected pressures of work life. Most of us forge on, taking little note of the collected toll.

This can be a serious mistake.

Through all of the trials and tribulations, we rarely notice that our psychological resources are waning.We muddle on. We develop idiosyncratic mechanisms to bolster our mood and maintain motivation. However, the damage can accumulate and we become less able to bounce back. Months later, we may realize that we still lament the project that has been cut, laid off co-workers or failing to land an important client contract and our energy levels are affected. When the next event unfolds, we find ourselves essentially bankrupt. Devoid of the necessary resources to meet the challenge.

There have been a number of discussions on the topic, including protecting ourselves from overload, banking positive currency and practicing self-compassion. However, what if we could take resilience one step further? Could we effectively build our skills (and our team’s skills) in this area — just as we challenge our muscles in the gym?

Can we learn to think and act more “resiliently”?

Well — yes. There is evidence that resilience can be learned. The work of Dr. FredLuthens (who explores the construct of Psychological Capital) has completed research examining this area which could be fostered by organizations and shared with their employees. Supporting research completed completed by Ann Masten also provides foundational elements. This includes addressing 1) asset factors (elements that enhance our resilience, such as a stable home life or a healthy way to examine failure), 2) lowering risk factors (for example, a lack of a mentor) and 3) altering our perceptions concerning the potential to influence work life circumstances.

Here are a just few ways to apply this knowledge to our daily lives:

  • Facilitate network building. Building long-term asset factors, provides a stable foundation to help us deal with stressful work situations when they do arise. Consider losing a job for example; stronger networks can help employees move on more effectively by providing access to critical information concerning roles and growth needs.
  • Clarify strategy and goals. Reducing risk factors — elements which weaken our psychological safety net, is also vital. For example, knowing “why” we are completing a task and how our role contributes to outcomes is critical. If we fail to believe that our actions have meaning, we are less likely to forge on.
  • Utilize the “staunch reality” viewpoint. One scenario that quickly depletes psychological resources, is sticking to a game plan that is simply not working. Understanding that we have the ability to influence outcomes by embracing realistic assessments of workplace situations — can help us to prepare. This honest view is necessary to review history, properly identify setbacks, evaluate potential impact and brainstorm possible responses before they occur.
  • Aggressively focus on strengths as a “vaccine”. We can mitigate the negative after effects of stressful events, with a focus on positive elements. This includes the identification and utilization of an individual’s stronger vs. weaker skill sets. A focus on the latter, can quickly deplete our psychological reserves.
  • Explore the sources of “drain”. The elements that drain our psychological reserves can be varied (and often surprising). Consider the sources that affect you and meet with your team to determine where the leaks are occurring. Brainstorm actions to stem the tide.

How do you build (and protect) resilience for yourself or your team? Share your strategies.

Medical Improv Melds With Applied Improvisation

The healthcare industry is in the business of selling services.  Why not make it more “human centered” for both the employees and patient-clients served?  Medical Improv can do that!

Defining Applied Improvisation

  • By Andrew Tarvin

When clients hear that my training includes applied improvisation, they often have no idea what I’m talking about or immediately fear the worst.

They worry that it means their employees will have to tell jokes, will be forced to do silly exercises, or will have to do some form of trust fall.

Applied improv is none of the above.


At its basic level, applied improv is simply taking concepts, ideas, and techniques from the world of improvisation and applying them to business, relationships, and life.

It’s not joke-telling, silly activities, or the theater equivalent of Minute to Win It challenges. It is effective, experiential learning that inspires, educates, and entertains.

With this is mind, it’s important to understand that applied improv is a not a what, but a how.

It’s how we train incredibly valuable business skills such as communication, collaboration, innovation, problem-solving, and leadership. It’s how we instill a culture of growth mindset, build psychological safety, and embrace authentic leadership. It’s how we learn to be more effective at what we do.

As my good friend Kat Koppett says, improv is the gym. It’s a way to get reps building valuable skills in a low-risk, effective way.


Why is applied improv so important? Why do I, as an engineer obsessed with efficiency and effectiveness, incorporate applied improv into my programs? Because it works.

There are five primary benefits to using applied improv in training and development:

#1. Participants experience the learning.

Remember as a kid when your parents told you not to touch the stove because it was hot, but you touched it anyway and burned yourself? And after that, you never touched the hot stove again? You know that the things you learn from experience have a more lasting impression than the things you learn because someone told you.

So much of today’s training is the equivalent of a parent telling you not to touch the stove. Lectures are great for introducing an idea like growth mindset, but it’s not how we learn to actually live it.

Applied improv serves as the hot stove where you experience the lesson (but without the burn). Rather than be told what’s important, participants go through an activity that helps them come to the learning point on their own. It’s one thing to hear an idea, it’s another thing to experience it.

#2. Participants practice the skills.

Imagine you’ve decided you wanted to become a violinist. To do this, you wouldn’t just read a bunch of books on what it means to play the violin and then immediately step on stage in front of thousands of people. Instead, you might do some of that reading, but mostly you would practice. A lot. Before you ever stepped foot on stage, you would have spent hours practicing scales, exercises, and songs.

And yet, when we train business skills, we have people go sit in a lecture and then expect them to be able to implement those ideas immediately, without any practice or experience. Listening to a talk on communication is like listening to a talk on how to be a violinist–it won’t be effective unless you can practice what you’ve learned.

Applied improv gives participants an opportunity to practice new skills so they can be more effective immediately. A trainer doesn’t just talk about the importance of listening to understand, the participants actually have an opportunity to build their skill in doing so.

#3. Participants feel safe to try new things.

Think back to the first time you learned how to ride a bike. How did it go? Did you pedal to glory on your first attempt? Probably not. If you’re like me, you fell on your first few tries but eventually you got better and before you knew it, you were riding down the entire length of the street (only to realize you didn’t know how to stop).

Failure is a key part of any learning experience; it’s how you learn to make adjustments and determine what works and what doesn’t. But failing in our jobs can have consequences. A first time leader can be at risk of demotivating their employees while trying to learn what it means to lead.

Applied improv provides a safe environment for the participants to try new things and to fail in a low stakes environment. Participants learn what works and doesn’t work in a classroom instead of in the middle of an important project for their company.

#4. Participants build relationships with each other.

Of all the people you work with, who do you have the best relationships with? Chances are it’s the people who you have something in common with: maybe you work in the same department, sat next to them at a training, or have bonded over your mutual love of the show Game of Thrones.

That’s how all relationships are formed, through shared interests and shared experiences. Relationships, both internal and external, are a vital part of any company; it’s why Google determined that the most important trait of an effective team is psychological safety.

Applied improv creates a positive shared experience that helps build the relationships of the people in the room. You could learn about psychological safety by listening to someone talk about it, or you could do it through interacting with your fellow participants, learning about each other, becoming closer together, and actually building that safety in the room.

#5. Participants have fun.

Which would you rather do: sit in a room and be bored or laugh with your peers and have fun? Which would you learn more from? Which would leave you with a more lasting impression? Which would you think more positively about and share with others? I’ll take “laugh with my peers and have fun” every time.

Sadly, many of today’s corporate trainings are death-by-PowerPoint boring. Learning about a topic as interesting as innovation can still be heart-wrenchingly dreadful. The simple truth is that you quickly forget about boring experiences and become more invested in the things you find enjoyable (duh).

Applied improv is fun. And not in a “corporate is telling us this is fun so it’s actually going to be awful” way, but in an actual “I haven’t laughed like this at work in years” way. The exercises are geared to be entertaining and the fun doesn’t come from cracking jokes, but by having authentic moments with the other participants. As a result, you learn the keys to something like being more innovative while staying actively involved in the learning experience.

NOTE: This post was originally published on Andrew Tarvin’s blog at What is Applied Improv.