How Improvisation & OCD affect the brain
How our brain's "error detection mechanism" inhibits creative expression
In the OCD patient’s brain, the error detecting mechanism is hyperactive
Perceived Error -> “Just not right“ feeling is triggered
Loop of thoughts & routines are performed
Improv trains in categorical substitution -> “THERE ARE NO MISTAKES, only opportunities.”
“Yes, and…“ training translates to:
“Yes” = Emotional Acceptance +
“and …“ = categorical substitution, adding explorative meaning
Neural correlates of Improvisation & OCD are related by their inverse neural activation patterns
A man is walking down the street, clapping his hands together every ten seconds. Asked by another man, why he is performing this peculiar behavior, he responds: “I’m clapping to scare away the elephants”. Visibly puzzled, the second man notes that there are no elephants there, where upon the clapping man replies: “See, it works!”
Did I lock the door? Did I turn off the stove? Maybe I shall check again, just once… Sometimes we catch ourselves being insecure if we already performed a certain action. Usually, when we check a second time we feel safe and can continue with other actions.
People who have an obsessive-compulsive disorder (OCD) may check to make sure the toaster is not only turned off but just to be really safe, unplugged. In fact, it is part of their illness to check, over and over again.
OCD patients feel forced by their never-ending doubts to perform rigid controlled rituals in order to calm their worries. E.g. Tip with the middle finger on each control panel of the stove and repeat this six times.
Unless they can finish their rituals, they will not be able to feel secure about the oven being turned off. Such patients can see the absurdity of their rituals, yet their mind does not stop torturing them with obsessive thoughts & anxiety till the rituals are performed.
This cycle of thoughts and actions in OCD might reflect a fault in an essential network in the brain. The network involved in obsessive-compulsive behavior is a loop involving three brain regions.
The strong firing of the orbital-frontal cortex (OFC) acts like an error detection mechanism and gives a feeling of something is wrong. For example, when the OFC registers that the door was not locked, it sends a 'worry' signal to the cingulate gyros. The cingulate gyros makes you feel anxious and worried until you correct the mistake.
Once the mistake is corrected, a third area (caudate nucleus) activates and acts like an automated gear shift (sending “All Clear”) allowing you to shift gears, forgetting about it, and get on with other activities.
Brain scans of OCD patients show that all three of these brain areas are hyperactive. That means that the “Something is wrong” feeling and the anxiety that comes with it are abnormally strong.
What happens in OCD patients is that the caudate nucleus becomes very “sticky”. [A] That means even after correcting a mistake or checking something the feeling doesn’t go away. Most OCD patients are aware of the irrationality of their rituals, yet since their orbital cortex & cingulate gyros are stuck in an “On” position, the feeling doesn’t go away. Neuroscientist Jeffrey Schwartz calls this state the “Brain Lock” 
In the so-called state of “Brain Lock” the hyperactivity of our brain’s error detection mechanism (OFC) correlates directly with the severity of anxiety symptoms .
“Kill the judge in your head and just take action.”
In contrast, several studies [2, 3, 4] describe extensive deactivation in the orbitofrontal cortex (OFC) during musical improvisation. As Roger Beaty’s paper “The Neuroscience of Musical Improvisation“ stated:
“[The] deactivation was interpreted as reflecting a suspension of inhibitory or conscious monitoring processes.”
Deactivation of executive control mediated by conscious self-monitoring is thought to reflect neural correlates of “flow” (Limb and Braun, 2008; Landau and Limb, 2017). Flow is described to be an effortless conscious state characterized by internally motivated actions with minimal top-down control (Limb and Braun, 2008; Landau and Limb, 2017).
Skilled Improvisers Detect Easy-to-Substitute Chords Faster than Non-improvisers
In a recent study [5, 6], it was shown that skilled improvisers are better than musicians with limited improvisational experience at distinguishing between chords that can be used interchangeably in a piece of music and chords that cannot. This categorical knowledge partly enables the ability to improvise by allowing performers to make substitutions.
Improvisers & non-improvisers know in different ways (improv & non-improv). If a music improviser reads a chord like “Cm7” they can play it in various ways.
In contrast, non-improvisers read music that already fully specifies in which realization they should play it. Even tho, in theory, it could be substituted with similar sounds. These musicians will rarely actually make these substitutions because it contradicts the aesthetics of classical music.
The equivalent is true for game design, it was shown that open-world games which provide the player with clear tasks are less likely to be creatively explored than in scenarios where the goal of the game is rather vague and doesn’t specify the “How”.
Improvisers have the ability to switch between different variations of the same structural category. They could play the same peace in different ways and successfully interact with a new ensemble member who is using different variations.
The same is true for an improviser in theatre, who can react to a wide range of possible story variations and still create new innovative meaning when a fellow player is making a formal mistake.
This also applies to other domains of creative behavior. A chef following a recipe that calls for lemons who doesn’t have any lemons can use categorical knowledge to make a substitution. They may know that the reason the recipe calls for lemons is the “citrus” quality and can therefore improvise a solution and use limes instead. Knowing that citrus fruit will work better in the recipe than a banana. In the same way as an improvising musician knows that a chord with a similar harmonic function will work better than one with a different function.
Improvisation is hardly confined to music—it underlies much of daily life. Faced with a delayed train, you might decide to walk or take the bus; a missing ingredient, the closest alternative.
Everything can be substituted & played with. Learning by “Yes, and…“ creates a mindset that makes use of aesthetics that are not dogmatic or static but a dynamic network on aesthetic associations.
In this sense, OCD patients & improvisers can be placed on the opposite ends on a spectrum of perceiving errors & cognitive flexibility of reaction. In certain situations, the slightest variation (e.g.: traces of dust) can trigger in the OCD patient the “Just not right“ feeling which causes him or her to gets stuck in a loop of thoughts & actions.
In contrast, the experienced improviser accepts with a mental “Yes“ a wide range of categories “And” can add his or her new meaning to the current situation. Creative substitution allows a flexible mindset in which exploration can be perceived as a collaborative play with aesthetics.
A similar mindset of unconditional acceptance is used in therapy. “Utilization” is an approach in hypnotherapy which is utilizing whatever response your client offers you in a positive way. An attitude to meet every peculiarity of the client and his life situation with appreciation and to use what is unique about it. When the hypnotherapy session is interrupted by bird sounds, the therapist might say:
“And as you hear the calling of the birds outside, it might remind you of a warm summer's day, with birds in the trees and soft grass beneath.“
And if the client says, “I don’t know if I was in trance.” The therapist could answer with:
“That’s right, you don’t know if you were in trance because you’re trying to evaluate it with your conscious mind and trance is not a conscious process.”
This ability to improvise & utilize is not set in stone. The results of recent studies [7, 8] indicate that already a brief intervention based on improv exercises may provide a strong and efficient treatment for patients with anxiety and depression. The emotional impact of improv was only very recently assessed to find it can help reduce anxiety and depression in young and older (27–72 years old) adults (Krueger et al., 2017).
Other studies used improv exercises to enhance divergent thinking , as free walking (Kuo and Yeh, 2016), in jazz music (Benedek et al., 2014), spontaneous sentences, and conversation (Lewis and Lovatt, 2013).
With the optimistic “Yes, and…“ which offers unconditional acceptance to all players, improv offers a collaborative playful therapeutic possibility for people with anxiety & OCD. Improvising together trains our tolerance for uncertainty in an emotionally safe space & kicks us out of our overthinking loops.
Reaction Patterns of OCD & Improv:
“Is“<-> “Should“ -> “Just not right“ Feeling -> Obsessive Routines
Each obsessive situation requires one “right way” of acting. Routines that solve the “Just not right“ feeling
“Is“ -> “Could“ -> “Emotional Acceptance“ + Explorative Action
Each improvised situation offers a diverse range of possible explorative actions