Award Date


Degree Type


Degree Name

Doctor of Philosophy (PhD)


Interdisciplinary Programs

First Committee Member

James Navalta

Second Committee Member

Tony Terrell

Third Committee Member

Laura Kruskall

Fourth Committee Member

Anne Weisman


Parkinson’s disease (PD) is the fastest growing neurological disorder in the world, with leading researchers calling it a pandemic. While there is no cure, pharmaceuticals and surgical interventions increase people with Parkinson’s (PWP) ability to lead longer and more productive lives. However, there is a lack of care available for PWP supporting their social and emotional domains. PWP report high levels of stress, anxiety, and isolation due to the chronic and unpredictably progressive nature of the disease. This leads to a vicious cycle of loss of confidence, decreased activity and socialization, and increased falls.A common phrase in the PD community is, “if you’ve met one person with Parkinson’s, you’ve met one person with Parkinson’s.” This important distinction points to the need for highly individualized treatment programs focused on empowering the individual to feel autonomy and self-efficacy to manage both daily and long-term goals. The first study (D1), was an online, group-based narrative program called Day One: PD Superheroes. Participants were taught about Joseph Campbell’s Hero’s Journey as a narrative structure and given practical tools to engage in it and apply their lives to it. Participants were encouraged to question, explore, and rewrite what their personal story about having PD is and how they would like to shape and present their story going forward. This represented storytelling as a novel intervention to improve quality of life for PWP. The second study (D2), involved another novel intervention in which we tested online improvisation by comparing three group-based interventions in a mixed-method randomized controlled clinical trial. The first group, Improv Plus, received improvisation plus additional support elements. The second, Improv, received just traditional improvisation and the third, a control group, watched improvisation. Participants showed high levels of engagement, enjoyment and a desire to connect further with each other. We found both interventions (D1 and D2) to be effective from the standpoints of attendance, engagement, and enjoyment. The main outcomes included increases in communication, confidence, and creativity. Though the sample sizes were small, the early evidence points to the need for further research and expansion of these programs. While the interest levels from participants was notable in both studies, these are novel approaches for a complex disease. Results from the feasibility trial engaging people in their personal narrative appears to have benefits including increases in positive social engagement and a decreased focus on having PD. At the same time, what participants will do with these newly learned skills and personal understanding as they age, and PD progresses, is unknown. Similarly, defining what improvisation is in a clinical setting, including dosage and frequency, and giving it a specific, repeatable form so it can be applied generally is an ongoing challenge. There does appear to be enough interest, benefit and enjoyment from participants to continue testing these programs. The third area of research was a systematic review (D3), comparing and contrasting the qualitative and quantitative results of 16 different improvisation studies across special populations. The main takeaways from these studies was that the groups, overall, appeared to enjoy the improvisation intervention and experienced a variety of improvements across mental and social health spectrums.


communication; improvisation; isolation; parkinson's; resilience; storytelling


Medicine and Health Sciences

File Format


File Size

1458 KB

Degree Grantor

University of Nevada, Las Vegas




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