Ask an Expert: Dr. Jonathan Squires Discusses the Brain Health Benefits of Improvisation for People with Parkinson’s

Dr. Jonathan Squires is a movement disorder neurologist and co-medical director of the University of British Columbia (UBC) Movement Disorder Clinic in Vancouver. He completed his neurology residency training at UBC and did his fellowship in movement disorders at Mount Sinai Beth Israel in New York City. He is interested in improving care delivery for people with Parkinson’s disease and other movement disorders.

Can you tell our readers a little bit about how you became interested in studying the effects of improv on brain health and Parkinson's disease (PD)?

Full disclosure, my husband, Daniel Dumsha, is a professional improviser, so I’ve been to a great many improv shows over the years. Several years back, I stumbled on a paper from the Movement Disorder Group at Northwestern University in Chicago, in partnership with Second City Improv. They had done a pilot project to explore the feasibility of holding improv classes for people with Parkinson’s disease. It was only a small study (and I haven’t seen any follow-up work), but the participants enjoyed the classes and there were some improvements in quality-of-life measures on the rating scale we use to track Parkinson’s symptoms. Around that time, one of my patients approached the improv school at what was then called Vancouver Theatre Sports on Granville Island asking to develop a program for people living with PD. Dan was teaching at that school at the time, and it seemed like a natural match. The rest is history!

How can improv help people with Parkinson's? Are there any observable changes or improvements in brain function in individuals with PD who participate in improv sessions?

I’m not aware of any studies looking at the effect of improvised comedy on brain function. However, there are studies of musical improvisation that suggest that the brain areas involved in word retrieval (which is commonly affected in Parkinson’s disease) are also involved in improvisation. We know that cognitive activity helps to maintain brain health, and this activity seems to exercise an area of the brain that is affected by PD, so it’s at least plausible that there could be changes in brain function that are meaningful to people living with PD. Anecdotally, the wife of one of my patients did notice significant improvements in her husband’s ability to communicate for a day or two after he took an improv class, which may support this idea!

How does the social aspect of improv contribute to its benefits?

Certainly, we know that social activity (along with cognitive and physical activity) is important for maintaining brain health and quality of life. People with PD who have participated in improv programs have told me that they really value the sense of community they develop by participating in these programs. One person described his improv troupe as “a support group without the complaining.”

Are there any specific improv techniques or exercises that you find particularly beneficial for individuals with Parkinson’s disease, and if so, why?

The foundational principle of improv comedy is “yes, and.” This means that you accept whatever your scene partners throw at you (the “yes”) and then build on it (the “and”). I think that this principle is very applicable to living with Parkinson’s disease. One theme I hear commonly from my patients and their caregivers is the challenge of dealing with the unpredictability of life with PD. Some days are just bad days, and it makes it hard to plan your life. I think (and hope) that applying the principle of “yes, and” to life with PD will teach people skills that they can use to roll with the punches, so to speak, and live the best life possible with PD. Another principle in improv is celebrating mistakes; sometimes when a performer “fails” at a task, that’s where the joy in the scene is found.

In terms of specific exercises, I asked Dan what participants have told him they’ve liked about the improv classes. His top three were the following:

1. Emotional rollercoaster – during a scene, one participant is assigned to “coast”. As the scene unfolds, the host will give them emotions they have to express, so they may have to go from euphoria to rage to indifference over the span of a couple of minutes. They also do a warmup practicing different facial expressions to match the emotions, which hopefully helps deal with facial masking.
2. Word association – focuses on active listening and can help with projecting the voice and dealing with anxiety.
3. New choice – a game where the audience will yell/type “new choice” at any time, and the improviser has to change the last thing they said to something different. This can help work on working memory and cognitive flexibility.

In a 2023 webinar, you previously mentioned that you would like to do a study on the effects of improv on PD. Do you have any updates on the study? Additionally, what benefits of improv therapy for Parkinson’s disease do you hope to demonstrate?

The study remains an aspirational goal at this point, pending some bandwidth among our research team to design and carry out the study. My great hope is that improv helps people living with PD and their caregivers cope better with the disease and improve their relationships and quality of life. In addition, we know that cognitive and social activity help to maintain brain health and slow the progression of neurodegenerative diseases like Parkinson’s disease, so I’m optimistic that there may be some benefit on the disease itself. This is, of course, very difficult to prove.

Do you think the fact that improv comedy usually makes people laugh is important for its benefits? If so, why?

Absolutely! Patch Adams taught us that laughter is the best medicine! I remember several years ago working with a physiotherapist who has an interest in PD and talking to her about studying improv. Her comment was “do we really need to do a study to show that something that brings people joy has health benefits?” That has stuck with me. There is a body of research that supports the idea that humour has health benefits as well.

Can improv also help caregivers/carepartners of people with PD? If so, how?

There is at least one study that I’m aware of that demonstrates that training in improvisation helps to reduce caregiver depression and burnout. Improv training is also something that people living with PD and their caregivers can do together to bring some joy and laughter into their relationship.

I think that skills you learn in improv are applicable to lots of situations we commonly face. I’ve heard one person say after an improv class, that she thought the techniques would help with her parenting. Daniel has recently started a company called Improv for Work and Wellness that uses improv techniques to help people think on their feet and improve their presentation skills at work.

Anything else you would like to add?

First of all, I’d like to thank Parkinson Society BC and the BC Brain Wellness Program for seeing the value in this program and supporting it over the years. I would also encourage people to look into classes. For the converted, there is actually an improv troupe of people living with PD who come together to put on shows online. They actually performed live to a sold-out crowd at last year’s World Parkinson’s Congress in Barcelona. As a seasoned viewer of improv, I can honestly say it was one of the best improv shows I’ve seen in the past few years!

This content was published in the Summer 2024 edition of our quarterly magazine, Viewpoints. The content was accurate as of this publication date.