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Treating Pain & Anxiety with Mindfulness & Improv (2022)

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, however, has alleviated her constant pain. She found my website where my combination of humor and therapy appealed to her.

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 useful.

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 through 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 that relief she was so desperately looking for.

As in 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 though 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”, described below, a game that has players improvise around a scripted narrative structure. Like most newcomers to improv, Carla was initially 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 decrease feelings of sadness.

In our fourth session we played “Tiger, Martian, Cow.” In this game, each 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 which 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.

At the beginning of the next few sessions, we played “Mirrors,” a game Carla found 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 at home 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, 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…