Patients treated at the University of Iowa Department of Psychiatry for obsessive compulsive disorder (OCD) are getting up on stage together as part of a pilot improv therapy program run by Kristin Bowers, MA, LMHC.

Bowers runs a support group for patients with OCD in the division of Interventional Psychiatry. Her patients experience a wide range of OCD subtypes, ranging from fear of contamination to intrusive thoughts that they might involuntarily harm someone else.

The most common theme that all of her OCD patients’ experience, however, is intolerance of uncertainty.
“What improv does is it directly targets that fear of uncertainty,” Bowers said. “Learning to be able to tolerate ‘I don’t know what’s coming next’ directly addresses that specific aspect of OCD. This promotes new learning which is a principle of Exposure and Response Prevention.”

Bowers specializes in Exposure and Response Prevention (ERP), an evidence-based treatment modality tailored specifically to patients with OCD. Considered by many in the field to be the gold standard of care, ERP treats OCD by gradually exposing patients to their fears or the situations that make them anxious in an agreed upon environment under the guidance of a trained therapist. Over repeated exposures, the patient learns that anxiety is tolerable, and feared outcomes are often less likely or less harmful than expected. This approach arms patients with strategies to manage or even refrain from their compulsions moving forward.

Bowers got the idea that improv might be a helpful ERP activity from a pilot study completed at Stanford University in April, 2025. Led by Dr. Carolyn Rodriguez, the Stanford study suggests that improvisational comedy exercises are effective at reducing OCD symptoms and improving intolerance of uncertainty.

Intrigued, Bowers partnered with Chu Hsiao, MD and Dan Junis, a professional improv instructor who works at the UI. Then she asked her patients what they thought of doing improv exercises as a form of group therapy on a voluntary basis. The group is typically run online, so participants would have to be willing to show up in person. Not everyone was onboard with the idea, but enough signed on that they decided to give it a shot.

They’ve been running the improv group together since June. Every other Thursday, Bowers and a group of about 6 to 11 patients pile into an auditorium near her office in the General Hospital of the main medical campus in Iowa City. There, under her and

Junis’ guidance, the patients engage in a variety of improvisational activities , acting out scenarios together, laughing at their shared antics, and learning how to keep a cool head when something unexpected happens.
So far, the reactions have been positive.

“When participants are doing the improv exercises, they’re experiencing uncertainty and anxiety, but they can’t rely on the compulsions, avoidance, or safety behaviors that typically fuel the OCD cycle. Instead, they’re fully engaged in the moment,” Bowers said.

Marie is one of the patients who signed on to participate in the improv sessions. Referred to here by a pseudonym to protect her identity, Marie has received therapy for her OCD from Bowers for the last year and a half. She has prior experience with acting and improv and was excited about the idea when Bowers first brought it up.

“Since I was familiar with the way of thinking that improv encourages, it made sense to me that it could help disrupt OCD connections in the brain, given that it exercises spontaneity and breaks regular thought patterns,” she said.

For Marie, getting to watch her fellow patients push past their fears and discomforts when interacting together on stage has been a real inspiration. For her part, it’s also helped her practice important skills for living with OCD.

“[Improv] requires you to let go of your control over a situation and accept that someone else is going to do something, and it might not be what you intended,” Marie said. “Practicing this in a low-stakes environment like improv, where the relinquishing of control is baked into the activity, has helped me to pinpoint areas where I can work on accepting uncertainty and how that can translate to my everyday experience.”

The experience has also highlighted for her how science and art can work together to create unique new forms of therapy.

“Normally, improv and psychiatry are not things that go together, since one is ‘for fun’ and the other is ‘for advancement,’” Marie said. “Groups and studies like this one show how interconnected everything is and how art can really help people in their journeys…You can find meaning and importance in anything if you approach it with an open mind.”

Bowers and her patients will have their final improv session at the end of this month. She’s given some thought to someday partnering with Stanford on a follow-up study, or maybe continuing the program if grant funding can be found.

“I’m not sure. We’ll just have to see what happens,” she said with a wink.