The Improv Cure

Many years ago , well after I became a practicing clinician, I decided to take up a new part time interest : improvisational comedy . As many of you know who have been to improv comedy presentations, the performers are challenged to create songs, skits, and various other formats based on the ideas that audience members throw out. The outcome of these immersive performances can often be hilarious comedy that leave the performers, both exhausted and emotionally replenished

At that time, I also observed many fellow performers were reporting new feelings of confidence and self-worth after their classes and their performances, I, too, experienced many of those same uplifting emotional feelings.

I also observed that many corporate firms were hiring improvisational professionals to put on performances for their employees, also aimed at bolstering workers' self-confidence and leadership abilities. Therefore, over the years, it made sense to see if improvisational comedy classes could be helpful in my work with very socially anxious and socially rigid patients..

Improvisational classes usually include many of the following elements:

1. Allowing oneself to act silly and out of character in front of their fellow classmates.

2. Using their imagination to take on character roles that are often the opposite of the way they see themselves in their everyday lives.

3. Learning to listen attentively to their fellow performers, since successful improvisation requires that each person not disagree (and only agree) with what the last person said, to build on and to create a comedic story. This is called the “and ..then” technique. For example if one character is pretending to be an elephant on stage, then the next character does not question that choice but rather asks them “why are your tusks so shiny”.

4. Using physicality in a way their bodies are not used to (jumping wildly, rolling around on stage, laughing loudly, curling up in a ball, and more).

In a fundamental way, improvisational classes help individuals take risks that may lead them to feel embarrassed, judged, disapproved of, all in a safe space, where their fellow classmates are experimenting with the same boundary-pushing, and in the end, serve the improvisational goal of creating comedy.

To prepare my socially anxious patients for joining an improvisational class, I will often assign them similar exercises in session. For example, some patients may be asked to answer my questions using nonsense syllables and words that make no sense. Another might be asked to introduce novel topics into our conversation based on words that I throw out and which they must include immediately in our interaction.

I have also asked patients to create, in the moment, a silly rhyming limerick based on various topics that we have discussed. The goal throughout is to help my patients free themselves of the self imposed rules and restrictions on what they can say and how they can act—always risking disapproval and learning that they can manage their feelings in a safe environment.

Of the many patients that I have suggested signing up for improv classes, approximately 35% have gone through with it and, of that number, about 40% to 50% have stuck it out through a six-session course.

Many others have chosen to go one or two sessions and felt satisfied with the results. There have been no negative outcomes. Although many patients have chosen not to take on the assignment, none have complained that it felt inappropriate; most have suggested that they don’t feel ready for the demands of the assignment.

There are improvisational comedy classes opening in many major cities throughout the country, and some have even gone online! One patient who is very satisfied with taking an improv course said to me that they finally feel happy that a therapist has put the behavioral (B) back in the CBT approach!