Treating Pain and Anxiety with Mindfulness and Improv


Margot Escott, LICSW, RfG-CP

Carla had been a happy-go-lucky 63-year- old nurse, married to a wonderful man for 30 years. Life could not have been better.

Then, she suffered a fall in 2018 that led to spinal fusion, chronic pain, hopelessness, and depression.

Carla now takes pain medications daily, including morphine, which she feels contributes to her depression. Nothing has alleviated her constant pain.

She found my website and my combination of humor and therapy appealed to her. She became a patient of mine in February 2022.

My training as a psychotherapist has included pain management with hypnosis, Mindfulness, Cognitive Behavioral Therapy (CBT), and addiction studies. But what I’ve found is that the work of improvisational pioneers Viola Spolin and Neva Boyd are equally impactful.

Boyd was a sociologist who worked at Hull House in Chicago; Viola Spolin, her student, went on to become an acting coach. Together they developed improv games to teach language skills, self-confidence, and social skills.

These improv games have become crucial to my practice. I’ve seen first-hand the effects they’ve had on myself and my patients by effecting changes by generating laughter through stimulating parts of the brain.

When patients are very focused on playing these games, they often become unaware of their pain. The production of Endorphins like Dopamine increases feelings of well-being and decreases feelings of pain. Through our sessions, Carla started finding the relief that she was so desperately looking for.

Like during most of my initial sessions, I began by introducing Carla to the practices of mindfulness and meditation. We explored the concept of “being in the present, “using the mantra “Be here Now”, whenever she started to experience anxiety.

Next, I coached her to practice a two-minute silent meditation, focusing on her breathing, offering the suggestion that her anxious and fearful thoughts would dissipate through focused breathing as we increased the meditation time.

Because of her sense of humor, self-confidence, and intelligence, I decided to add improv games quickly into her treatment.

In Session Two, I introduced the “Yes, and” concept of Improv, the concept that each player will agree with whatever their partner says.

For example, if Player A says, “I admire your ability to climb Mt Everest” Player B might reply, “Yes, and I’m traveling across the Indian sea in a rowboat now!” When the responder agrees with whatever his/her partner says, that’s the “Yes,” and when they add new details, that’s the “And.”

We also played Story Spine 1(See attached). Like most newcomers to improv Carla was concerned about “doing it wrong,” but was able to overcome that by accepting the premise that “nothing is wrong when we improvise”.  After that, improv games frequently drew forth laughter and smiles from Carla. Laughter increases Dopamine levels which decreases feelings of sadness.

In our fourth session, we played the game “Tiger, Martian, Cow”. In this exercise, the player is required to change their facial expression, use specific body movements and make a sound like either a tiger, a Martian, or a cow.  This brought forth riotous laughter from Carla.

We then increased the time of her meditation to seven minutes with the further suggestion that she practice this daily. I made it clear that if she didn’t practice, she wouldn’t be graded or judged.

In the following session, we played “Fortunately/Unfortunately,” a game that requires focus and active listening. Next, I introduced two people scene game with the traditional format of: “who” (the fictional character in the scene); their character’s relationship to that of a scene partner; “what,” which can be any object; and “where,” a specific place like a restaurant, library or gas station. Carla threw herself into playing this scene; she described how much better she felt at the end of this session.

Over the next few sessions, we played The Mirror Game at the beginning of the session. Carla found this game particularly calming for her.

In our 5th month of treatment, I asked Carla if she was feeling any benefit from the improv. She responded, “It makes me laugh! I feel less anxious and forget the pain”.

We are now introducing her husband to the art of improv and encouraging them both to play improv games daily!

THE STORY SPINE (attributed to Ken Addams) 

This is a form of telling a story using flash cards. Each flash card has the beginning line for the first player, then a different one for each subsequent player. Players recite the written line and improvise the completion of that sentence. The point of this tool is to provide a model for a well-constructed story with a beginning that establishes a routine, an event that breaks the routine, a middle that shows the consequence of having broken the routine, and a climax that sets the resolution to the story in motion and the resolution. It goes like this:

  • Once upon a time…
  • Every day…
  • But, one day…
  • Because of that…
  • Because of that…
  • Because of that…
  • Until, finally…
  • And, ever since then…


He Says I’m Great But Doesn’t Want a Relationship – What Should I Do? – Deep Soulful Love

by Kat Peoples – Ph.D., LMHC, LPC, Amy Sherman – M.A., LMHC, Margot Escott – MSW, LCSW, Dana Hall – LCPC, MA, TF-CBT

# Quit taking it personally

Margot Escott

Many men have reasons why they don’t want a relationship and it often has nothing to do with you. 

I love the acronym Q-Tip. Quit Taking It Personally!

There’s a line we often hear in comedies that have become a cliché. “It’s more about me than it is about you.” We can laugh at that thought unless it’s happening to ourselves.

If you have been “seeing” a man – going to movies, having coffees, and sharing meals – you have a friend! 

Perhaps you received “signals” that he wanted a more intimate relationship with you or you were imagining a different relationship and confronted him. You got the response that he “doesn’t want a relationship”.

Well, if you are already friends, you Do have a relationship. 

The “R” word gets bandied about and many of us consider it to mean a committed, intimate partnership. But relationships can have many forms.

We have relationships with our family, siblings, and friends. 

In these relationships, the only expectations are to be a friend, which means honoring commitments, honesty, trust, and other values. But when we set expectations with someone, like an intimate relationship, we may be misreading the signs.

I’ve had many “boyfriends” in my life and a few really good male friends. These are men that I can hang out with, share ideas with, and just be myself with any of the anxiety that often accompanies “Intimate” relationships.

Having male friends, and that is a relationship, is wonderful in so many ways. 

It can help us to better understand men, especially when they enjoy and appreciate me.  And besides, the best way to have a friend is to be a friend.

Margot Escott, MSW, LCSW –

Click here to read the full article


Margot WTCI’d just been in NY for the most popular game show and it was pretty exciting. But the memory that stands out in my mind the February night in 2001 was the indelible sight memory of the Twin Towers that cloudless night. I’d lived in the city when the towers were being built. There were wonderful memories of being at the top where one could see for miles and miles and miles. Enjoying meals with my parents, also long gone, at Windows of the World.

As we approach 20 years since the towers went down I am forever grateful that ABC paid for a trip to the city so that I could see them one last time!

Improv in the Third Act

“You can’t help growing older, but you don’t have to grow old.” George Burns

Improv Anonymous – WIth Improv Master and my first teacher Craig Price at the start of my Third Act

Almost a decade ago, my family sat in the hospital waiting room, waiting to hear the outcome of the surgery I was undergoing to repair the damage caused by a sudden cerebral aneurysm. My surgeons appeared with the good and the bad news for my family. I had survived the surgery, but my surgeon warned, it was too early to know if I would recovery my memory or ever speak again. To which my brother responded, “Too bad about the memory.”

As you can tell, I grew up in a family that laughed a lot. The 1950s were the stage for the “First Act” of my life. It was filled with hours of us gathered around a black and white television laughing along with “Leave it to Beaver,” “I Love Lucy,” Imogene Coco, Sid Caeser, Jack Parr, Red Skelton, Danny Kaye, Ernie Kovacs, George & Gracie, Carl Reiner. Regardless of what was happening in the world, these shows made you laugh and feel better.

Inspired by these comedy greats and by the work and teachings of Norman Cousins and others like him on “The Healing Power of Laughter & Play,” I used my “Second Act” to become a social worker and tour the country holding workshops to teach other therapists to use humor and play to help their clients.

I did recover my memory and to my brother’s dismay, my ability to speak following the surgery. But recovery took time and a friend suggested I try an acting class in a local community theater to help me through this period. My first classes were in a rundown former bar that had been abandoned during the great recession. Some of my classmates were actual rats and cockroaches. The teacher of the class was a charismatic fellow who taught improvisational theater. Although following directions was challenging, I had so much fun at the first class that I decided to sign up for a six-week class and have continued taking Improvisational Theatre classes and workshops ever since.

Improvising as the mother of the bride in Who Killed the Rabbi

So, there I was in my “Third Act,” recovering from brain surgery and a double knee and double hip replacements.  I was the eldest member of my improv group and I was not as agile as the predominantly young white men who made up the group. If I played a game that required sitting on the floor, I wasn’t sure if I could get up again! I suppose it’s not surprising that I was often cast as someone’s mother or grandmother. But I kept going because my teacher encouraged and validated me and soon, I began teaching as well. Being part of that improv team and working on supporting and loving each other was an incredible mind-blowing experience for me.

I wanted to learn everything I could about this improv and went to different parts of the country to study improv at festivals. Each time I attended a workshop, I came home with renewed energy and commitment to play. For 9 years I was fortunate to attend the Annual Improv Festival at Will Luera’s FST. I learned from so many terrific teachers and discovered that I could make choices! Through the festival, I met many folks that I’ve studied with on Skype and continue to do so on Zoom.

With my dear friend Dr. Daniel Wiener at his Rehearsals-for-Growth Improv for Therapists Workshop.

I left that team about five years ago and ever since then I’ve been teaching improv which I have learned in my “Third Act,” which is my love and my mission. As a psychotherapist I’ve applied improvisational theater techniques to my work with people with Parkinson’s and other neurodegenerative diseases along with their care partners, people with anxiety and depression, and people on the Autism spectrum.

The results have been terrific, and I believe I get as much out of teaching than my students do.


Ed Asner joined me for my Improv Interviews podcast

Several years ago, I started a podcast called improv interviews. Because there were a limited class-opportunities in my area, I wanted to talk to other improvisers, play with them and learn more about improvisation. Through my podcast — Improv Interviews — I met terrific therapists and other professionals who use improv clinically to help others. I have been blessed to interview some of my favorite improv teachers including David Razowksi, Jay Sukow, Aretha Sills, Jimmy Carrane, Susan Messing, Racheal Mason, Joe Bill, and a host of other wonderful improvisers.

Improv became the theme of my “Third Act” when I was 61 years old. I’m 71 now and am thrilled to meet other improvisers like Miki Manting and the folks at “Vintage Improv” who are making their “Third Act,” the best one ever by embracing improv.

The Pandemic has hit the theatre and improv world very hard. Improvisers rose to the challenge and immediately began offering online classes and workshops to support people through this difficult time. Being guided by Acceptance and Yes, and… we are resilient folks and giving hope and inspiration around the world.

Margot’s next workshop, “Improv for Wellness” starts soon. Contact her via email for more info:






Tele-therapy during COVID-19 Social Distancing


As an LCSW who has been practicing in Naples for 35 years, I know that mental health is being impacted by COVID-19 and that affects our physical bodies as well.

My greatest concern for people who are experiencing fear is that they trigger the “Stress Response” or Fight or Flight Syndrome, stress hormones are released and these “stress hormones” cause several changes in the body, including an increase in heart rate and blood pressure. While we need to stay socially distant to protect ourselves and others, we shouldn’t socially isolate ourselves with our fear and concerns.

Fortunately, technology makes it possible for health care professionals to see their patients online. Physicians have been using Telehealth for the past 40 years and Tele-therapy since the 1990s. To ensure client safety, the CMS has lifted any HIPPA restrictions on this type of treatment and are recommending it as a safe way to continue counseling sessions or see new patients. You don’t need to be computer savvy to use Tele-therapy, and it allows us to see our patients and them see us. Telephone therapy is also available to people who aren’t computer friendly.

To find a therapist in Collier who is providing this service you may go to and search by your zip code. I am here to answer any questions you may have

Support for those with Parkinson’s


Finding Support & Information
While the diagnosis of Parkinson’s Disease (PD) may be frightening, it is important to remember support and interventions are available right here in Naples, Florida both for those diagnosed with this disease and those family members who now find themselves in the role of Care Partner. Many people are familiar with Parkinson’s disease, which affects one million Americans, with 60,000 new diagnoses each year. But there are several other neurodegenerative disorders that have Parkinson’s like symptoms called A-typical Parkinson’s or Parkinsonism that are important to be aware of.

Continue reading “Support for those with Parkinson’s”

Tips to Help Seniors Thrive During Their Transition to Assisted Living – Guest Post Sharon Wagner


Sharon Wagner
(Guest Post)
Moving to an assisted-living campus does not have to feel like walking into a foreign land. Change is not always easy. At no other time in life is this as blazingly true as in our senior years when we have to make a decision about where to live. Mobility issues, financial struggles, and living too far away from loved ones can compound to the point where it is no longer safe for us to stay in our own home. When this happens, you have a choice: go into assisted living feeling like it means defeat or have a positive attitude and make the most of your situation.

Here are a few things you can do to make your new community feel like home.

Continue reading “Tips to Help Seniors Thrive During Their Transition to Assisted Living – Guest Post Sharon Wagner”

Improv as Therapy

Gulfshore Life Magazine
Melanie Pefinis
February 2019 (Pages 63-64)

The Naples Players put on a great show, as we theatergoers know. But maybe not all of us know that the 65-year-old institution seeks to educate our community as well as entertain it. There are the KidzAct youth program, internship opportunities, diverse creative workshop offerings for adults–and inclusive classes for people with additional needs, including improv for individuals with autism and those with social anxiety.

Margot Escott was familiar with the mission, so when she approached the players about bringing her own improv classes to the company, she knew the techniques she used with Parkinson’s patients would fit right in.

Continue reading “Improv as Therapy”


Hurricane IrmaAlthough it has been 2 months since Hurricane Irma devastated Collier County, many people are still feeling the effects of this traumatic event. Today I was with some friends who continue to suffer daily due to Irma. Some are homeless for an indefinite amount of time, some are seeking welfare and Food Stamps (something they never thought would happen in their lives), and spending their days on the phone with government agencies, insurance companies, etc. A traumatic event is a life-threatening occurrence and post-trauma stress is a normal response to an abnormal event, such as Irma. Living through a trauma affects the body, mind, and spirit. Continue reading “TIPS ON RECOVERING FROM TRAUMA”