Applied improvisation for anxiety

Domain VIII · Creative & expressive arts therapies · Mark Pfeffer, Phillips Sheesley, Barish · 2011 · Chicago

What it is

Applied improvisation for anxiety is not one manualised therapy. It is a family of group programmes that use unscripted comedy-theatre games and scenework as a playful, graduated social exposure, usually alongside cognitive-behavioural processing. Three published delivery formats exist: (a) a…

Format

• No source opened gives a session-by-session manual. The phase structure below combines the published formats. Session counts are as published; criteria for moving on are my own synthesis.
• Phase 0: Referral, screening and preparation (1–2 individual contacts). Goals: confirm social or performance anxiety is the main target; screen out people for whom group exposure is unsafe now; agree personal goals; explain that the group is graduated and opt-out is allowed. The CIT summary advises…

Who practises it, and how they are trained or regulated

• Version followed: the combined "improv plus CBT group" model, as published for Second City's Improv for Anxiety (Chicago, from 2011, co-founded by psychotherapist Mark Pfeffer of the Panic Anxiety Recovery Center with Second City Training Centers) and its written-up form, Comedic Improv Therapy (CIT; Phillips Sheesley, Pfeffer & Barish, 2016). Session-level safety structure (check-in, warm-up, de-roling, closure,…
• Professional frame. No regulated profession or credential exists for "applied improvisation". In the published clinical versions the therapy component is run by licensed mental health professionals, and the improv component by trained improv teachers. The CIT authors' advice, as summarised, is that the therapist need not be a comedian but should take improv classes before leading a group and must be skilled at…

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Is there physical contact? Was it explained beforehand, and do you feel free to say no or stop at any point?
• Does it involve any substance, plant preparation, remedy or supplement? Has your doctor or prescriber been told, especially about any medication you take?
• Does it involve intense or unusual breathing? Have you been told about the medical conditions for which that is not advised?
• Does it involve fasting, a special diet or 'detox'? Have you discussed this with your doctor?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• pressure to perform from peers or from family in the audience.
• a quiet member leaving quickly. Follow up before the next session.
• grounding used as a safety behaviour mid-game. Keep it to transitions.
• freezing. A built-in rescue ("and then", or pointing on) keeps blanks safe.
• eye-contact distress. Allow mirroring hands or shoulders instead of the face.

Problems the guide addresses

• Dropout before or early in the programme
• "Passing" that becomes avoidance
• Overwhelm and panic mid-game
• Retraumatisation: humiliation, bullying and trauma triggers
• Ruptures: hurtful humour, dominant members, peer laughter that stings
• Stuck clients: plateau, no transfer to real life
• Non-adherence to between-session exposure
• Risk disclosure in session
• Children and adolescents
• Touch, body and cultural sensitivity

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.