Psychological Benefits of Therapeutic Improvisational Theatre
for People With Parkinson’s Disease (2025)
Margot Escott LCSW, RfG-CT
About Parkinson’s disease
Parkinson’s disease (PD) affects more than 1.1 million patients in the U.S., with 90,000 newly diagnosed each year. Although medications and surgical procedures like Deep Brain Stimulation assist in treating the symptoms, there is currently no cure for this disease. It is more prevalent with males than females.
PD primarily affects the nervous system, causing progressive problems with movement, like tremors, stiffness and slow walking. This is due partly to the loss of dopamine-producing brain cells. It also impacts non-motor functions like mood, memory and focus.
There are five stages of PD beginning in the early stage, where people can continue with most of their Activities of Daily Living (ADL’s). This early stage is characterized by mild tremors and facial expressions. Patients also suffer from Hypophonia, speaking too quietly; they feel that they are speaking loudly but others cannot hear them. Their facial expressions are disinhibited and this rigidity is called “facial masking”.
As the disease progresses, motor symptoms increase and patients are at risk for falls. In the more advanced stages, patients may be unable to walk and need assistance with most ADL’s.
My Work with PD
In 1998 my father was diagnosed with Parkinsons’ disease (PD). He died in 2007 and had Dementia with Lewy bodies, a more severe condition characterized by hallucinations and loss of physical and cognitive abilities. Because of my experience as my dad’s care partner and as a clinician II became very interested in this incurable neurological disorder and began working with clients with PD and with their care partners.
A few years later, I began studying Improvisational Theatre and immediately recognized the therapeutic benefits of using those techniques and skills with diverse populations. I discovered the work of Daniel Wiener, founder of “Rehearsals for Growth” (RfG), an application of improv games to psychotherapy. I began studying with him, becoming a RfG Certified Trainer. I began using improv techniques more frequently in my clinical practice and therapy groups and the results were astounding, significant changes in mood and self-confidence. I discovered an intervention that was very useful to my clients.
This inspired me to create improv classes for people with PD. I have been teaching these classes for ten years, I and have transitioned from in-person to online since 2020. When I was teaching in-person, classes were attended both by PD clients and their care partners. Since working online our classes have been attended only by people with PD.
Currently, I have two ongoing weekly classes with people in the early or middle stages of PD. The students are both male and female, ranging in age from 45 to 82. For the last ten years I’ve heard from both students and their care partners about continuing improvement in their psychosocial functioning.
In these classes, the focus is not on PD but the focus is on having fun and laughing. Research shows that laughter releases dopamine in the brain which helps boost this neurotransmitter.
I start each class with a musical exercise I call “Two-line Freeze”. I put on lively music (usually from the 60’s and 70’s) and encourage students to use different facial expressions and to move hands and arms so that everyone can see that motion on the Zoom screen. I then pause the music and call “Freeze,” pick two students, and invite them to improvise a two-line scene based on their facial and body expressions. This helps with facial masking as well as the enjoyment of music they know.
There is significant research on the value of music with PD clients, including improved voice quality, respiratory function and swallow function. Music also has a strong effect on emotions and can uplift the mood. This is a helpful exercise as many PD clients suffer anxiety and depression.
Next, we play “Guess what I’m Thinking?”. This game starts with one person showing an emotion on their face I show a “Feeling Chart” to help students identify various feelings. The others “guess” what the target person may be thinking; then that player shares their actual feeling state. This game is very helpful to “unmask” PD clients’ rigid facial expressions.
Gibberish games, like “Translator” and “Foreign Film”, are favorites. As some students have difficulty with speaking, using a “silly” language or even just making sounds, helps them stay engaged and laugh!
Benefits of PD Improv Groups
High Engagement: There is a high retention rate and students consistently look forward to classes, indicating strong motivation and enjoyment. They are highly enthusiastic about attending improv classes. This strong anticipation reflects high engagement and motivation, which is essential for sustained participation in therapeutic activities. Some comments include, “This is the only time in my week where I forget about my PD and have so much fun.”
Cognitive and Communication Improvement: Listening, communication, and facial expressiveness improve through practice, supporting functional and social skills. Students and their families observe notable improvement in listening, highlighting improv’s role in enhancing attention, responsiveness, and cognitive engagement. Stacey, a long-term student, said, “My husband notices a big change in our communication, especially in my ability to hear what he’s saying. Learning how to focus has really helped us.”
Mood Enhancement: Many students report experiencing anxiety and depression throughout the week. Improv helps mitigate these feelings through humor, spontaneity, and social interaction. Improv’s emphasis on playfulness, laughter, and social interaction helps elevate mood and reduce anxious and depressive feelings. Ted, who has studied with me since 2024, shared that because he really enjoys the interactions with other students and looks forward to class, he is already in a better mood when he enters the Zoom room.
Social Impact: For many students, classes are their primary outlet for socialization, outside of specific groups focused on PD symptoms and treatments. Family observations suggest increased engagement and confidence, reinforcing improv’s social benefits. Family and care partners notice some positive changes, particularly in listening and communicating with confidence. By engaging in exercises that help with “facial masking,” students are better able to express their feelings.
Summary
Improv classes are highly engaging and enjoyable, with PD patients and their care partners both reporting improved communication, listening, and facial expressiveness, effects that persist outside of classes. There is also significant mood enhancement, laughter, and emotional relief, suggesting that improv serves not only as a cognitive and social exercise but also as a therapeutic tool for enhancing emotional well-being.
Speaking from personal experience as a care partner for my father with PD, I see these classes as a way to continue to honor the memory of my father.
