Improvisation – The Anxiety Antidote for Middle and High School Students

Margot Escott, LCSW April 2019

Using Improvisational Theatre to Alleviate Stress and Anxiety in Adolescents; a 6-week class for middle and high school students

While the prevalence of anxiety among adolescents increases, the stigma associated with mental health remains a barrier to relief, resulting in 80% of adolescents with a diagnosable anxiety disorder not receiving treatment. Through improvisational theatre games taught by a mental health professional, best practices for treating anxiety and stress become accessible to at-risk adolescents.









Interchangeable Effects of Stress and Anxiety

You’re on a highway stuck in traffic, in your rearview mirror you spot a semi-truck speeding toward you. Your heart races, your breath quickens, and your muscles flood with adrenaline to prepare you to react quickly. This response was designed to protect your body in an emergency. Now imagine a week after this incident you find yourself on the highway stuck in traffic again. You feel yourself begin to sweat as you remember the fear you experienced the week before. Your heart races, your breath quickens and adrenaline floods your muscles. Your body does not differentiate between anticipatory stress and a physical threat.  That is what anxiety feels like, for the adolescent, the stress/anxiety response keeps firing, day after day, putting their health and quality of life at serious risk.

Anticipatory stress stimulates the same stress response as an actual response. Stress kills neurons in the part of the brain called the hippocampus and weakens the cables between neurons, so they can’t talk to each other. This impairs the formation and retrieval of long-term memory. The opposite thing happens in the amygdala, which is where we see the fear in a brain scanner. In the hippocampus, stress causes stuff to shrivel up. But stress feeds the amygdala. It actually gets bigger. Chronic stress creates a hyper-reactive, hysterical amygdala, showing us how stress and anxiety disorders connect. (Sapolsky 2001)

Anxiety and Adolescence

Nearly one-third of American adolescents are affected by anxiety, according to the NCS-A. (Kessler 2005) It’s the most common mental health disorder in the country. A complex set of risk factors, including genetics, brain chemistry, personality, and life events, predispose some adolescents to anxiety disorders. Over the last decade, anxiety has surpassed depression as the most common reason college students seek counseling services. (Penn State 2018) According to the Anxiety and Depression Association of America (ADAA), 80 percent of kids with a diagnosable anxiety disorder are not getting treatment. While antidepressants and anti-anxiety medications can offer relief from symptoms, they are not cures.

Adolescence is a time of many psychosocial and physiological changes. One such change is how an individual responds to stressors. Specifically, adolescence is marked by significant shifts in hypothalamic-pituitary-adrenal (HPA) axis reactivity, resulting in heightened stress-induced hormonal responses. The stress-sensitive limbic and cortical brain areas that continue to mature during adolescence may be particularly vulnerable to these shifts in responsiveness and may contribute to the increase in stress-related psychological dysfunctions during this stage of development. (Romeo 2013)

Adolescence is also a significant period of continued neural maturation, specifically within stress-sensitive limbic and cortical regions. Prolonged or repeated exposure to stress may result in a heightened sensitivity to these stressors, ultimately leading to maladaptive neurobehavioral development. (Grissom & Bhatnagar, 2009).  An adult animal repeatedly exposed to the same stressor (homotypic stress) displays a habituated hormonal response compared with an adult exposed to that stressor for the first time. (Sapolsky 2001)

Barriers to Treatment

Adolescents who have Social Anxiety Disorder do not receive the support they need. Adolescents identify barriers to accessing mental health treatment including embarrassment, not wanting to talk about mental health problems, and not trusting clinicians (Chandra & Minkovitz, 2006; Lavik, Veseth, Froysa, Binder, & Moltu, 2018).

Improv to Alleviate Stress and Anxiety in Adolescents

Let’s put you back in that car. This time you have a friend along for the ride and you are both singing along to a favorite song on the radio. You are in the same car and it is in the same location, but your heart rate and breath are calm and measured and there is no surge in adrenaline.  What changed? Instead of thinking about what might happen, you are fully immersed in the present moment. Being present is a keystone of improvisation.

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. Both improv and applied psychology aim to increase personal awareness, interpersonal attentiveness, and trust. (Bermant 2013) The improv stage, in theory, is a space free of judgment or fear of failure, making it an ideal environment for adolescents who struggle with low self-esteem, social anxiety, or other types of anxiety disorders.

The group process is a focus of improvisation. Understanding that each group member is supporting one another builds trust and helps group members feel safer taking risks. (Spolin, 1983).  While improvisational theater games have been used for promoting psychological health broadly, its potential to reduce levels of social anxiety is likely because it offers exposure to social performance experiences in the face of intentional uncertainty in a safe space.

Justification for using improvisational theater to promote psychological health (Phillips Sheesley et al., 2016; Wiener, 1994), shows promise that participating in an improvisational theater program may offer a low stigma, low cost, more accessible context for reducing symptoms for adolescents with social anxiety problems. One recent study showed that Theraprov, a program of four, two-hour sessions of improv plus homework targeting psychological outcomes, facilitated by a licensed clinical psychologist, reduced anxiety and depression and boosted self-esteem in a sample of 32 adult psychiatric patients (Krueger, Murphy, & Bink, 2017).

The best-documented evidence-based practice for treating social phobia is cognitive-behavioral therapy (CBT). CBT includes cognitive restructuring and exposure to social situations. (Kaczkurkin, Antonia N., Foa, Edna B., 2015)  Improv offers an opportunity for a therapist to offer both without the barriers of the stigma that deter adolescents from seeking treatment.

Class Goals

To create a safe, stigma-free outlet for adolescents with stress-induced anxiety to learn with others who share their issues that they have control over their anxiety through improvisational theatre games. Students will learn mindfulness techniques to help them stay grounded at the moment and connect to their bodies, to accept their anxious feelings instead of holding onto them, to let go of self-judgment and feel safe to make mistakes, to trust others and experience the joy of laughing and playing.

Additional Class Benefits

  • Life Skills.
  • Goal setting.
  • Imagination.
  • Focus and Self-Control.
  • Perspective.
  • Making Connections.
  • Critical Thinking.
  • Taking on Challenges.
  • Self-directed, engaged learning.
  • Coping with setbacks and deaing with problems or trouble in an effective way.
  • Self-awareness.
  • Empathy.
  • Creative thinking.
  • Decision making.
  • Problem Solving.
  • Effective communication.
  • Interpersonal relationships.

Upcoming Improvisational Theatre Classes


About Margot Escott and Improv 4 Wellness Classes

Margot Escott incorporates over 34 years of experience as a counselor, speaker, and teacher in her Improv 4 Wellness classes that are designed to use humor, play and improv to achieve well being. Improv for Wellness is about playing games and having fun, it’s not about being funny or memorizing scripts. The improv games and laughter we share in all of my Improv 4 Wellness, have tremendous therapeutic benefits. Come play in a space that is free of judgment or fear of failure, making it an ideal environment for people who struggle with anxiety or physical impairment. A great way for all ages and abilities to let go, laugh and meet fun friends.

For a list of upcoming classes click here.


Anxiety and Depression Association of America (ADAA)

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Besser, M., Roberts, I., Walsh, M., & Wengert, J. (2013). The upright citizens’ brigade comedy improvisation manual.

Chandra, A., & Minkovitz, C. S. (2006). Stigma starts early: Gender differences in teen willingness to use mental health services. Journal of Adolescent Health, 38, 754.e1–754.e8.

Craske, M. G., Kircanski, K., Zelikowsky, M., Mystkowski, J., Chowdhury, N., & Baker, A. (2008). Optimizing inhibitory learning during exposure therapy. Behaviour Research and Therapy, 46(1), 5–27.

Grissom, N., & Bhatnagar, S. (2009). Habituation to repeated stress: Get used to it. Neurobiology of Learning and Memory, 92, 215–224.

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Kaczkurkin, Antonia N., Foa, Edna B., (2015)  Cognitive-behavioral therapy for anxiety disorders: an update on the empirical evidence. Dialogues Clinical Neuroscience, 17(3): 337–346.

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Krueger, K. R., Murphy, J. W., & Bink, A. B. (2017). Thera-prov: a pilot study of improv used to treat anxiety and depression. Journal of Mental Health, 1–6.

Penn State Center for Collegiate Mental Health (CCMH) (2018) Annual Report.

Phillips Sheesley, A., Pfeffer, M., & Barish, B. (2016). Comedic improv therapy for the

treatment of social anxiety disorder. Journal of Creativity in Mental Health, 11(2), 157–169.

Romeo, Russell D., (2013) The Teenage Brain: The Stress Response and the Adolescent Brain. Department of Psychology and Neuroscience and Behavior Program, Barnard College of Columbia University, New York, NY 10027, 140-144

Sapolsky, Robert M. (2001) Depression, antidepressants, and the shrinking hippocampus. Department of Biological Sciences, Stanford University, and Department of Neurology, Stanford University School of Medicine, Gilbert Laboratory, MC 5020, Stanford, CA 94305-5020

Spolin, V. (1983). Improvisation for the Theater: A handbook of teaching and directing techniques (2nd ed.). Evanston, IL: Northwestern University Press.

Felsmana, Peter a,b, Seiferta, Colleen M. a,c, Himle, Joseph A. b,d, (2019) The use of improvisational theater training to reduce social anxiety in adolescents. Department of Psychology, University of Michigan, United States, bSchool of Social Work, University of Michigan, United States, cInstitute for Social Research, University of Michigan, United States, dDepartment of Psychiatry, University of Michigan, United States. The Arts in Psychotherapy, Volume 63, Pages 111-117, April 2019.