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Therapeutic Benefits of Laughter

Dr. Lee Berk and fellow researcher Dr. Stanley Tan of Loma Linda University in California have been studying the effects of laughter on the immune system. To date their published studies have shown that laughing lowers blood pressure, reduces stress hormones, increases muscle flexion, and boosts immune function by raising levels of infection-fighting T-cells, disease-fighting proteins called Gamma-interferon and B-cells, which produce disease-destroying antibodies. Laughter also triggers the release of endorphins, the body’s natural painkillers, and produces a general sense of well-being.

Following is a summary of his research, taken from an interview published in the September/October 1996 issue of the Humor and Health Journal.

 Laughter Activates the Immune System

In Berk’s study, the physiological response produced by belly laughter was opposite of what is seen in classical stress, supporting the conclusion that mirthful laughter is a eustress state — a state that produces healthy or positive emotions.

Research results indicate that, after exposure to humor, there is a general increase in activity within the immune system, including:

bullet An increase in the number and activity level of natural killer cells that attack viral infected cells and some types of cancer and tumor cells.
bullet An increase in activated T cells (T lymphocytes). There are many T cells that await activation. Laughter appears to tell the immune system to “turn it up a notch.”
bullet An increase in the antibody IgA (immunoglobulin A), which fights upper respiratory tract insults and infections.
bullet An increase in gamma interferon, which tells various components of the immune system to “turn on.”
bullet An increase in IgB, the immunoglobulin produced in the greatest quantity in body, as well as an increase in Complement 3, which helps antibodies to pierce dysfunctional or infected cells. The increase in both substances was not only present while subjects watched a humor video; there also was a lingering effect that continued to show increased levels the next day.

 Laughter Decreases “Stress” Hormones

The results of the study also supported research indicating a general decrease in stress hormones that constrict blood vessels and suppress immune activity. These were shown to decrease in the study group exposed to humor.

For example, levels of epinephrine were lower in the group both in anticipation of humor and after exposure to humor. Epinephrine levels remained down throughout the experiment.

In addition, dopamine levels (as measured by dopac) were also decreased. Dopamine is involved in the “fight or flight response” and is associated with elevated blood pressure.

Laughing is aerobic, providing a workout for the diaphragm and increasing the body’s ability to use oxygen.

Laughter brings in positive emotions that can enhance – not replace — conventional treatments. Hence it is another tool available to help fight the disease.

Experts believe that, when used as an adjunct to conventional care, laughter can reduce pain and aid the healing process. For one thing, laughter offers a powerful distraction from pain.

In a study published in the Journal of Holistic Nursing, patients were told one-liners after surgery and before painful medication was administered. Those exposed to humor perceived less pain when compared to patients who didn’t get a dose of humor as part of their therapy.

Perhaps, the biggest benefit of laughter is that it is free and has no known negative side effects.

So, here is a summary of how humor contributes to physical health.  More details can be found in the article, Humor and Health contributed by Paul McGhee

Muscle Relaxation – Belly laugh results in muscle relaxation. While you laugh, the muscles that do not participate in the belly laugh, relaxes. After you finish laughing those muscles involved in the laughter start to relax. So, the action takes place in two stages.

Reduction of Stress Hormones – Laughter reduces at least four of neuroendocrine hormones associated with stress response. These are epinephrine, cortisol, dopac, and growth hormone.

Immune System Enhancement – Clinical studies have shown that humor strengthens the immune system.

Pain Reduction – Humor allows a person to “forget” about pains such as aches, arthritis, etc.

Cardiac Exercise – A belly laugh is equivalent to “an internal jogging.” Laughter can provide good cardiac conditioning especially for those who are unable to perform physical exercises.

Blood Pressure – Women seem to benefit more than men in preventing hypertension.

Respiration – Frequent belly laughter empties your lungs of more air than it takes in resulting in a cleansing effect – similar to deep breathing. Especially beneficial for patient’s who are suffering from emphysema and other respiratory ailments.

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Humor Therapy

Other common name(s): Laugh Therapy

Scientific name(s): None

Description

Humor therapy is the use of humor for the relief of physical or emotional pain and stress. It is used as a complementary method to promote health and cope with illness.

Overview

Although available scientific evidence does not support claims that laughter can cure cancer or any other disease, it can reduce stress and enhance a person’s quality of life. Humor has physical effects because it can stimulate the circulatory system, immune system, and other systems in the body.

How is it promoted for use?

Humor therapy is generally used to improve quality of life, provide some pain relief, encourage relaxation, and reduce stress. Researchers have described different types of humor. Passive humor results from seeing prepared material, such as a funny movie, standup comedy, or an amusing book. Spontaneous or unplanned humor involves finding humor in everyday situations. Being able to find humor in life can be helpful when dealing with cancer.

What does it involve?

The physical effects of laughter on the body include increased breathing, more oxygen use, and higher heart rate. Many hospitals and treatment centers have set up special rooms where humorous materials, and sometimes people, are placed to help make people laugh. Materials commonly used include movies, audio and videotapes, books, games, and puzzles. Many hospitals use volunteers who visit patients for the purpose of providing opportunities for laughter. A 1999 survey found that about 1 in 5 National Cancer Institute-designated treatment centers offered humor therapy.

What is the history behind it?

Humor has been used in medicine throughout recorded history. One of the earliest mentions of the health benefits of humor is in the book of Proverbs in the Bible. As early as the 13th century, some surgeons used humor to distract patients from the pain of surgery. Humor was also widely used and studied by the medical community in the early 20th century. In more modern times, the most famous story of humor therapy involved Norman Cousins, then editor of the Saturday Review. According to the story, Mr. Cousins cured himself of an unknown illness with a self-invented regimen of laughter and vitamins.

What is the evidence?

Available scientific evidence does not support humor as an effective treatment for cancer or any other disease; however, laughter has many benefits, including positive physical changes and an overall sense of well being. One study found the use of humor led to an increase in pain tolerance. It is thought laughter causes the release of special neurotransmitter substances in the brain (endorphins) that help control pain. Another study found that neuroendocrine and stress-related hormones decreased during episodes of laughter. These findings provide support for the claim that humor can relieve stress. More studies are needed to clarify the impact of laughter on health.

Are there any possible problems or complications?

Humor therapy is considered safe when used as along with conventional medical therapy. It can be harmful if used to avoid difficult or delicate issues that are important to you or your family. Laughter can also cause temporary pain after some types of surgery. This improves as the body heals, and causes no lasting harm.

Relying on this type of treatment alone, and avoiding or delaying conventional medical care for cancer, may have serious health consequences.

Additional Resources

More Information from Your American Cancer Society

The following information on complementary and alternative therapies may also be helpful to you. These materials may be ordered from our toll-free number (1-800-ACS-2345).

References

Berk LS, Tan SA, Fry WF, et al. Neuroendocrine and stress hormone changes during mirthful laughter. Am J Med Sci. 1989;298:390-396.

Joshua AM, Cotroneo A, Clarke S. Humor and Oncology. Journal of Clinical Oncology. 2005;23:645-648.

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Simple put, laughter raises one’s frequency to help with the healing process. People who are ‘up’ positive personalities and laugh a lot generally have less physical problems than those who are depressed – wounded souls – who dwell in their issues and find it hard to laugh at life.

Effects of Laughter:

  • Laughter therapy boosts the interferon levels of the immune system which helps the system’s ability to fight illness and escalates healing. Laughter decreases stress hormones that constrict blood vessels and suppress immune activity.
  • Muscle Relaxation – Belly laugh results in muscle relaxation. While you laugh, the muscles that do not participate in the belly laugh, relaxes. After you finish laughing those muscles involved in the laughter start to relax. So, the action takes place in two stages.
  • Reduction of Stress Hormones – Laughter reduces at least four of neuroendocrine hormones associated with stress response. These are epinephrine, cortisol, dopac, and growth hormone.
  • Immune System Enhancement – Clinical studies have shown that humor strengthens the immune system.
  • Pain Reduction – Humor allows a person to “forget” about pains such as aches, arthritis, etc.
  • Cardiac Exercise – A belly laugh is equivalent to “an internal jogging.” Laughter can provide good cardiac conditioning especially for those who are unable to perform physical exercises.
  • Blood Pressure – Women seem to benefit more than men in preventing hypertension.
  • Respiration – Frequent belly laughter empties your lungs of more air than it takes in resulting in a cleansing effect – similar to deep breathing. Especially beneficial for patient’s who are suffering from emphysema and other respiratory ailments.

In modern times, the tendency is toward acceptance of incongruity as the probable cause of laughter, and incongruity-based theories are slowly gaining ground, although other schools of thought still hold some favour. A common explanation of humour (in the broader sense of ‘laughter-provoking’) is based on language. Premises: as we interpret a text, we automatically consider what language says, supposes, doesn’t say, and implies (this is the perspective of hermeneutics); the sentences we listen to and we tell, follow the universal conversational rules, that can be reduced to only one: be relevant.

Laughter and the Brain
Principal fissures and lobes of the cerebrum viewed laterally. Modern neurophysiology states that laughter is linked with the activation of the ventromedial prefrontal cortex, which produces endorphins after a rewarding activity: after you have a good meal, after you have sexual intercourse and after you understand a joke. Research has shown that parts of the limbic system are involved in laughter[citation needed]. The limbic system is a primitive part of the brain that is involved in emotions and helps us with basic functions necessary for survival. Two structures in the limbic system are involved in producing laughter: the amygdala and the hippocampus[citation needed]. The December 7, 1984 Journal of the American Medical Association describes the neurological causes of laughter as follows:

    “Although there is no known ‘laugh centre’ in the brain, its neural mechanism has been the subject of much, albeit inconclusive, speculation. It is evident that its expression depends on neural paths arising in close association with the telencephalic and diencephalic centres concerned with respiration. Wilson considered the mechanism to be in the region of the mesial thalamus, hypothalamus, and subthalamus. Kelly and co-workers, in turn, postulated that the tegmentum near the periaqueductal grey contains the integrating mechanism for emotional expression. Thus, supranuclear pathways, including those from the limbic system that Papez hypothesised to mediate emotional expressions such as laughter, probably come into synaptic relation in the reticular core of the brain stem. So while purely emotional responses such as laughter are mediated by subcortical structures, especially the hypothalamus, and are stereotyped, the cerebral cortex can modulate or suppress them.”

Laughter and the body

The Heart
It has been shown that laughing helps protect the heart. Although studies are not sure why laughing protects the heart, the studies do explain that mental stress impairs the endothelium, which is the protective barrier lining a person¹s blood vessels. Once the endothelium is impaired, it can cause a series of inflammatory reactions that lead to cholesterol build up in a person¹s coronary arteries, which can ultimately cause a heart attack.

From Psychologist Steve Sultanoff, Ph.D., the president of the American Association for Therapeutic Humor — With deep, heartfelt laughter, it appears that serum cortisol, which is a hormone that is secreted when we¹re under stress, is decreased. So when you¹re having a stress reaction, if you laugh, apparently the cortisol that has been released during the stress reaction is reduced. Laughter has been show to increase tolerance of pain and boost the body¹s production of infection-fighting antibodies, which can help prevent hardening of the arteries and subsequent conditions caused thereby such as angina, heart attacks, or strokes. Research shows that distressing emotions lead to heart disease. It is shown that people who are chronically angry and hostile have a greater likelihood for heart attack, people who ³live in anxious, stressed out lifestyles have greater blockages of their coronary arteries, and people who are chronically depressed have a two times greater change of heart disease.

Diabetes
A study in Japan shows that laughter lowers blood sugar after a meal. Keiko Hayashi, Ph.D., R.N, of the University of Tsukuba in Ibaraki, Japan, and his team performed a study of 19 people with type 2 diabetes. They collected the patients¹ blood before and two hours after a meal. The patients attending a boring 40 minute lecture after dinner on the first night of the study. On the second night, the patients attend a 40 minute comedy show. The patients¹ blood sugar went up after the comedy show, but much less that it did after the lecture. The study found that even when patients without diabetes did the same testing, a similar result was found. Scientists conclude that laughter is good for people with diabetes. They suggest that Œchemical messengers made during laughter may help the body compensate for the disease.² WebMD 2003

Children
According to an article of WebMD, studies have shown that children who have a clown present prior to surgery along with their parents and medical staff had less anxiety than children who just had their parents and medical staff present. High levels of anxiety prior to surgery leads to a higher risk of complications following surgeries in children. According to researchers, about 60% of children suffer from anxiety before surgery. The study involved 40 children ages 5 to 12 who were about to have minor surgery. Half had a clown present in addition to their parents and medical staff, the other half only had their parents and medical staff present. The results of the study showed that the children who had a clown present had significantly less pre-surgery anxiety. – WebMD 2005

Asthma
Nearly 2/3 of people with asthma reported having asthma attacks that were triggered by laughter, according to a study presented at the American Thoracic Society annual meeting in 2005. It did not seem to matter how deep of a laugh the laughter entailed, whether it be a giggle, chuckle, or belly laugh, says Stuart Garay, M.D., clinical professor of medicine at New York University Medical Center in New York. Patients were part of an 18 month long program who were evaluated for a list of asthma triggers. The patients did not have any major differences in age, duration of asthma, or family history of asthma. However, exercise-induced asthma was more frequently found in patients who also had laughter-induced asthma, according to the study. 61% of laughter induced asthma also reported exercise as a trigger, as opposed to only 35% without laughter-induced asthma. Andrew Ries, M.D. indicates that ³it probably involves both movements in the airways as well as an emotional reaction. – WebMD 2005

Laughter is Genetic
Robert R. Provine, Ph.D. has spent decades studying laughter. In his interview for WedMD, he indicated that laughter is a mechanism everyone has; laughter is part of universal human vocabulary. There are thousands of languages, hundreds of thousands of dialects, but everyone speaks laughter in pretty much the same way. Everyone can laugh. Babies have the ability to laugh before they ever speak. Children who are born blind and deaf still retain the ability to laugh. Even apes have a form of Œpant-pant-pant¹ laughter. Laughter is primitive, an unconscious vocalization. And if it seems you laugh more than other, Provine argues that it probably is genetic. In a study of the ‘Giggle Twins,’ two exceptionally happy twins were separated at birth and not reunited until 40 years later. Provine reports that until they met each other, neither of these exceptionally happy ladies had known anyone who laughed as much as she did. They reported this even though they both had been reared by adoptive parents they indicated were undemonstrative and dour. Provine indicates that the twins inherited some aspects of their laugh sound and pattern, readiness to laugh, and perhaps even taste in humor.

Therapeutic Effects of Laughter

While it is normally only considered cliché that “laughter is the best medicine,” specific medical theories attribute improved health and well-being to laughter. A study demonstrated neuroendocrine and stress-related hormones decreased during episodes of laughter, which provides support for the claim that humor can relieve stress. Writer Norman Cousins wrote about his experience with laughter in helping him recover from a serious illness in 1979’s Anatomy of an Illness As Perceived by the Patient.

In 1989, the Journal of the American Medical Association published an article, wherein the author wrote that “a humor therapy program can increase the quality of life for patients with chronic problems and that laughter has an immediate symptom-relieving effect for these patients, an effect that is potentiated when laughter is induced regularly over a period”.

Some therapy movements like Re-evaluation Counseling believe that laughter is a type of “bodily discharge”, along with crying, yawning and others, which requires encourgement and support as a means of healing.

Types of Therapy
There is well documented and ongoing research in this field of study. This has led to new and beneficial therapies practiced by doctors, psychiatrists, and other mental health professionals using humor and laughter to help patients cope or treat a variety of physical, mental, and spiritual issues. The various therapies are not specific to health care professionals or clinicians. Some of the therapies can be practiced individually or in a group setting to aid in a person’s well-being. There seems to be something to the old saying “laughter is the best medicine”.

Humor Therapy:
It is also known as therapeutic humor. Using humorous materials such as books, shows, movies, or stories to encourage spontaneous discussion of the patients own humorous experiences. This can be provided individually or in a group setting. The process is facilitated by clinician. There can be a disadvantage to humor therapy in a group format, as it can be difficult to provide materials that all participants find humorous. It is extremely important the clinician is sensitive to laugh “with” clients rather than “at” the clients.

Clown Therapy:
Individuals that are trained in clown therapy, proper hygeine and hospital procedures. In some hospitals “clown rounds” are made. The clowns perform for others with the use of magic, music, fun, joy, and compassion. For hospitalized children, clown therapy can increase patient cooperation and decrease parental & patient anxiety. In some children the need for sedation is reduced. Other benefits include pain reduction and the increased stimulation of immune function in children. This use of clown therapy is not limited hospitals. They can transform other places where things can be tough such as nursing homes, orphanages, refugee camps, war zones, and even prisons. The presence of clowns tends to have a positive effect.

Laughter Therapy:
A client’s laughter triggers are identified such as people in their lives that make them laugh, things from childhood, situations, movies, jokes, comedians, basically anything that makes them laugh. Based on the information provided by the client, the clinician creates a personal humor profile to aid in the laughter therapy. In this one on one setting, the client is taught basic exercises that can be practiced. The intent of the exercises is to remind the importance of relationships and social support. It is important the clinician is sensitive to what the client perceives as humorous.

Laughter Meditation:
In laughter meditation there are some similarities to traditional meditation. However, it is the laughter that focuses the person to concentrate on the moment. Through a three stage process of stretching, laughing and or crying, and a period of meditative silence. In the first stage, the person places all energy into the stretching every muscle without laughter. In the second stage, the person starts with a gradual smile, and then slowly begins to purposely belly laugh or cry, whichever occurs. In the final stage, the person abruptly stops laughing or crying, then with their eyes now closed they breathe without a sound and focus their concentration on the moment. The process is approximately a 15 minute exercise. This may be awkward for some people as the laughter is not necessarily spontaneous. This is generally practiced on an individual basis.

Laughter Yoga & Laughter Clubs:
Somewhat similar to traditional yoga, laughter yoga is a exercise which incorporates breathing, yoga, stretching techniques along with laughter. The structured format includes several laughter exercises for a period of 30 to 45 minutes facilitated by a trained individual. Practiced it can be used as supplemental or preventative therapy. Laughter yoga can be performed in a group or a club. Therapeutic laughter clubs are extension of Laughter Yoga, but in a formalized club format. The need for humorous materials is not necessarily required. Laughter yoga is similar to yogic asana and the practice of Buddhist forced laughter. Some participants may find it awkward as laughter is not necessarily spontaneous in the structured format. A growth of laughter-related movements such as Laughter Yoga, Laughing Clubs and World Laughter Day have emerged in recent years as a testament to the growing popularity of laughter as therapy. In China, for example, the popularity of Laughing Clubs has even led to a detailed lexicon of laughing styles, such as “The Lion Bellow” or “The Quarreling Laugh”.
The Laughing Yogi – Crystalinks

Abnormal Laughter
Researchers frequently learn how the brain functions by studying what happens when something goes wrong. People with certain types of brain damage produce abnormal laughter. This is found most often in people with pseudobulbar palsy, gelastic epilepsy and, to a lesser degree, with multiple sclerosis, amyotrophic lateral sclerosis (ALS) , and some brain tumours. Inappropriate laughter is considered symptomatic of psychological disorders including dementia and hysteria. Some negative medical effects of laughter have been reported as well, including laughter syncope, where laughter causes a person to lose consciousness.

Why We Laugh

A number of competing theories have been written. For Aristotle, we laugh at inferior or ugly individuals, because we feel a joy at being superior to them. Socrates was reported by Plato as saying that the ridiculous was characterised by a display of self-ignorance. Schopenhauer wrote that it results from an incongruity between a concept and the real object it represents. Hegel shared almost exactly the same view, but saw the concept as an “appearance” and believed that laughter then totally negates that appearance. For Freud, laughter is an “economical phenomenon” whose function is to release “psychic energy” that had been wrongly mobilised by incorrect or false expectations.

Philosopher John Morreall theorises that human laughter may have its biological origins as a kind of shared expression of relief at the passing of danger. The General Theory of Verbal Humour (GTVH) proposed by Victor Raskin and S. Attardo identifies a semantic model capable of expressing incongruities between semantic scripts in verbal humour; this has been seen as an important recent development in the theory of laughter. Recently Peter Marteinson theorised that laughter is our response to the perception that social being is not real in the same sense that factual states of affairs are true, and that we subconsciously blur the distinctions between cultural and natural truth types, so that we do not normally notice their differing criteria for truth and falsehood. This is an ontic-epistemic theory of the comic (OETC). Robert A. Heinlein’s view of why people laugh is explained in one of his most praised novels, Stranger in a Strange Land, “because it hurts”, is empathic but also a release of tension.

How Laughter Happens (cognitive model)

In modern times, the tendency is toward acceptance of incongruity as the probable cause of laughter, and incongruity-based theories are slowly gaining ground, although other schools of thought still hold some favor. A common explanation of humor (in the broader sense of ‘laughter-provoking’) is based on language. Premise: as we interpret a text, we automatically consider what language says, supposes, doesn’t say, and implies (this is the perspective of hermeneutics); the sentences we listen to and we tell, follow the universal conversational rules, that can be reduced to only one: be relevant.

This is the basis of the cognitive model of humor: the joke creates an inconsistency, the sentence appears to be not relevant, and we automatically try to understand what the sentence says, supposes, doesn’t say, and implies; if we are successful in solving this ‘cognitive riddle’, and we find out what is hidden within the sentence, and what is the underlying thought, and we bring foreground what was in the background, and we realize that the surprise wasn’t dangerous, we eventually laugh with relief. Otherwise, if the inconsistency is not resolved, there is no laugh, as Mack Sennett pointed out: “when the audience is confused, it doesn’t laugh” (this is the one of the basic laws of a comedian, called “exactness”). This explanation is also confirmed by modern neurophysiology.


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Researchers unveil seven great ‘medical myths’

Despite frequent mentions in the popular press of the need to drink eight glasses of water, researchers found no scientific basis for the claim. (File photo)

Despite frequent mentions in the popular press of the need to drink eight glasses of water, researchers found no scientific basis for the claim. (File photo) (ABC News: Cate Grant)

Reading in dim light will not hurt your eyes, you do not need eight glasses of water a day to stay healthy and shaving your legs will not make the hair grow back faster.

These well-worn theories are among seven “medical myths” exposed in a paper published in the British Medical Journal, which traditionally carries light-hearted features in its Christmas edition.

Two US researchers took seven common beliefs and searched the archives for evidence to support them.

Despite frequent mentions in the popular press of the need to drink eight glasses of water, they found no scientific basis for the claim.

They say the complete lack of evidence has been recorded in a study published the American Journal of Psychology.

The other six “myths” are:

Reading in dim light ruins your eyesight

The majority of eye experts believed it was unlikely to do any permanent damage, but it might make you squint, blink more and have trouble focusing, the researchers say.

Shaving makes hair grow back faster or coarser

Studies say shaving has no effect on the thickness or rate of hair regrowth. But stubble lacks the finer taper of unshaven hair, giving the impression of coarseness.

Eating turkey makes you drowsy

It does contain an amino acid called tryptophan that is involved in sleep and mood control. But turkey has no more of the acid than chicken or minced beef. Eating lots of food and drink at Christmas are probably the real cause of sleepiness.

We use only 10 per cent of our brains

This myth arose as early as 1907 but imaging shows no area of the brain is silent or completely inactive.

Hair and fingernails continue to grow after death

This idea may stem from ghoulish novels. The researchers said the skin dries out and retracts after death, giving the appearance of longer hair or nails.

Mobile phones are dangerous in hospitals

Despite widespread concerns, studies have found minimal interference with medical equipment.

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http://www.humourfoundation.com.au/index.php?page=318

LaughterBoss – The Court Jester in Aged Care
Dr Peter Spitzer MB BS, FACRRM, Churchill Fellow
Chairman, Medical Director Humour Foundation
PO Box 1893
Bowral NSW Australia 2576

The Humour Foundation is a charity dedicated to promoting the health benefits of humour. Founded in 1997 by Dr Peter Spitzer, a GP, and Jean-Paul Bell, a professional performer, the Foundation’s core project is the Clown Doctor programme. Clown Doctors visit paediatric and general hospitals, hospices and nursing homes. They have helped people find their smiles again in East Timor and Afghanistan.

The demand for Clown Doctors to visit aged care facilities was too great and could not be met by the Humour Foundation so, Dr Spitzer developed the LaughterBoss concept and first presented the model at The First National Conference on Depression in Aged Care: “Challenging Depression In Aged Care” at The University of NSW, Sydney, Australia, June 2003.

The LaughterBoss, a member of staff, can be considered as the court jester in the facility working directly with quality of life and psychosocial ‘coal face’ issues as they arise and as they need to be met. They must work in partnership with other therapeutic modalities. This position is supported by the management of the facility.
The LaughterBoss knows the people (residents, staff and families), the environment, the ethos and culture of their facility. The LaughterBoss can; create bonds, be nourishing, help with improved coping, be supportive, give cognitive control, provide positive diversion and increase the ‘smileage factor’.

The selected person attends an intensive one day training course together with follow–up workshops. Usually this person is either the Director of Nursing, registered nurse, nursing aide, diversional therapist, occupational therapist, physiotherapist etc. An overview of the training day will be presented. Feedback and results of surveys from training workshops held throughout Australia will also be presented.
The LaughterBoss is not restricted to aged care. All organizations would benefit from such a person.

“It is the job of the LaughterBoss, via open-heart surgery, to touch the soul and give it room to smile and laugh.”

Dr Peter Spitzer.

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Miles for Smiles Walk

http://www.humourfoundation.com.au/index.php?page=321

Miles for Smiles Walk – Burnie to Claremont, Tasmania
The walk is from 21 March to 31 March and is being organised by staff at Cadbury Schweppes and the Commonwealth Bank. Commonwealth Games gold-medal winner Kerryn McCann (Clown Doctors Ambassador) will be in Burnie to start the walk. This is our second year doing the walk and local RSL members have volunteered to assist with collections along the way. A huge thanks to all involved – you are a great team!
Contact claire@clowndoctors.com.au to get involved.

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The Use Of Humour In Stress Management
By Sylvia Mauger
Stress News July 2001 Vol.13 No.3
There is no doubt that any form of counselling, be it psychotherapy, stress management or anything else, is a very serious business. We read so many serious texts and go to so many serious meetings and classes that it is easy to get into a mode of solemn gravity. And, of course, this is largely because we are committed to treating our clients with respect. But in this paper I would like to suggest that respect can include humour and that laughter during a counselling session can be very therapeutic.
Humour: what is it and what place does it have in stress management counselling?
The Oxford Concise Dictionary defines humour as ‘the quality of being amusing or comic; the ability to perceive or express humour or take a joke’, but this is not particularly helpful in therapeutic terms. What is amusing or comic to one person may not be to another and, of course, we are not in the business of entertaining our clients as comics. So if humour is not necessarily about telling a joke, then what is it and how can it have beneficial effects in stress management counselling?
Windy Dryden, writing in Brief Rational Emotive Therapy, quotes Albert Ellis saying ‘that one way of conceptualising psychological disturbance is that it is the tendency of humans to take themselves, other people and life conditions TOO seriously.’ He goes on to describe how, in order to change, negative events need to be taken seriously, but that if they are taken too seriously, emotional disturbance may follow and action for change can be impaired. Indeed, as the whole model of stress management as conceived in Rational Emotive Behaviour Therapy and Cognitive Behavioural Therapy is based on the idea that people suffer emotional dysfunction when their thinking is irrational, humour can be seen as one of the many ways of ‘untwisting’ a client’s cognitive distortions.
Of course, this does not imply that every stress management counsellor can laugh and joke their way through every session with every client, but it does mean that if a counsellor is sensitive to the mood of the client, a little humour can go a long way. If the therapeutic bond is comfortable, it will be clear to the client that the therapist is not laughing at the client but at the irrationality of her/his ideas. Laughing with people is compassionate, laughing at them is immoral and unethical. Indeed, it can often be the case that laughing together can act, not only as a tool of communication, but can strengthen the bond between the two people concerned. As Victor Borge, the American entertainer, once wrote, ‘Laughter is the shortest distance between two people’. (quoted by Robert Holden, ISMA)
The physiology of humour
It is well known that stress causes physiological changes that are dangerous when prolonged Cortisol levels and blood pressure are elevated and the heart rate is increased amongst a host of other stress triggered responses. There is now considerable research that suggests that laughter lowers cortisol levels and stimulates the immune system, off-setting the immunosuppresive effects of stress. (Patty Wooton, Humour: An Antidote for Stress).
This research was preceded in 1979 by Norman Cousins who had, through his personal experience, attracted the attention of the medical profession to the possible therapeutic effects of humour. He contracted ankylosing spondylitis in 1964 and decided that the hospital regime of strong medication, dull food and the institutional regime was so depressing that any benefits he was gaining could be maximised outside the conventional regime. So, based on his own research, he developed a programme of therapy consisting of megadoses of a mix of vitamin C combined with regular doses of laughter stimulated by re-runs of the Marx Brothers films and Candid Camera. These treatments of belly laughs appeared to relieve his pain considerably and, indeed, when his levels of inflammation were tested, they were found to have decreased. Cousins also asserted that the increased release of endorphins caused by laughter eased the pain.
The beneficial effects of humour
A patient of mine suffering from a combination of physical and psychological stresses, not the least of which was a severely deteriorating irreversible eye condition, stated emphatically at one point that she would like a magic wand to cure all her ills. As it happened I had been given a gift of a joke wand and I promised her we would try out its properties at the next session. I duly brought it in and waved a shower of tinkling sparkles at her. She laughed delightedly although she could not have seen much apart from the basic shape and the sparkling effect. When I added my regrets that although I had a wand, I did not know the spells to go with it, she laughed even more and agreed that CBT would have to do instead. As I joined in her laughter, I felt that this shared experience had brought us closer, and indeed, she referred to it on several occasions afterwards. In her case it seemed that the laughter – particularly at something so absurd – had mitigated her stress by providing a coping mechanism. And when we had finished laughing, we seemed able to return to the serious matters at hand with renewed application. This is supported by Robert Holden, Stress Consultant, in his description of an
‘after-glow period in which we relax muscle tension, reduce stress in the nerves, massage the lungs, restore a full and flowing breathing pattern and gently expand our circulation once more’.
This sort of experience supports the concept of the counsellor as ‘authentic chameleon’ (Lazarus 1993). The key to this theory is that, in order for the client to achieve maximum benefit, the counsellor needs to be as flexible as possible to meet the client’s needs. Some clients will prefer a formal mode of interaction and the counsellor may choose to match this with more formal clothes and body language than are used with other clients and to use an empathic but business like dialogue. This sort of client may well be bewildered by the use of laughter. At the other end of the scale, there are clients who are most comfortable with a very casual style of communication. Clearly the therapist is unlikely to change clothes for every client but, provided they are sensitive to their clients’ individual backgrounds and personalities, they will try to adapt their body language and style of address. This adaptability also includes making a judgement as to the appropriateness of the use of humour.
When I used my magic wand, I sensed that my client felt supported by the counsellor joining her at The same level. Assuming that the humour is appropriate and genuine, not merely a gesture to please the other person, then the ideal of unconditional positive regard can be reinforced. To some extent it can be assumed that many clients feel they are talking to ‘an expert’ implying that they themselves are ‘lesser beings’. The employment of humour can be useful in reducing this distance and bringing about parity between client and therapist. And it does not always have to be the case that it is the counsellor who introduces the element of humour. In a recent session with a client who was experiencing difficulties in his relationship and who confessed to being a poor listener, I was discussing ways in which people show they are listening. The two-way discussion soon turned into my monologue as he stopped talking and just sat looking at me thoughtfully with the odd ‘hmm’ thrown in. There followed a pause and I asked him what was going through his mind. He beamed at me silently, then explained that he was listening in an appropriate manner, and we both roared with laughter. I was delighted that he was comfortable enough to be able to laugh at our situation.
My magic wand was used in a fairly light situation, but humour seems to have beneficial effects on a pretty extensive continuum of situations. Charles Rubin, in his book for parents of drug addicts, says:
‘Having a sense of humour in a situation that isn’t necessarily funny can lighten the tension of what’s going on. By trying not to take every little thing seriously, you will greatly reduce stress. There is a lot of drama associated with drug and alcohol addiction. If you can begin to see how ridiculous most of it is, you can start to put things into perspective. If you can just laugh and hang up when the addict calls … you’ve graduated to a new level.’
Humour can often be used to reinterpret or re-frame distressing events. As laughter distances the individual from the stressor, a feeling of perspective and safety is created. This certainly appeared to be the case for an elderly agoraphobic client whose homework had progressed to travelling two floors in a lift. In the event, being a person of extremes, she decided to visit a friend who lived on the twelfth floor. She went up in the lift for four floors – a triumph in itself – but when she left her friend, was too embarrassed to let him see her walk down the stairs, so took the lift all the way down the twelve floors. This client smiled broadly as she walked into the session, told me I’d never believe what she had to tell me, then laughed uproariously as she described the situation, realising that embarrassment was more important to her than her fear of lifts. The laughter encompassed relief that she had survived such a feat and also understanding of the absurdity of the incongruity of the situation. I felt it helped her to see her fears in a slightly different light and provided some reinforcement in her belief that she had some control over the situation.
Appropriate humour never belittles or criticises. It is based on caring and empathy. An invitation to laugh is an invitation to share and, as such, it is supportive and so builds confidence between two people. This can be as true in a group situation as that of one-to-one counselling. A group of part- time women trainees, for example, who had known each other for only two weeks, began a very brief course of stress management with me. They were a little reticent to begin with as can be expected in a situation where trust has not yet been established. Within the first 20 minutes it emerged that one of them felt she had a problem with her adult daughter who still lived with her and for whom she did all the washing, cleaning, cooking and ironing. She laughed in an embarrassed fashion as she told us about this, but soon the entire group was laughing uproariously with her as they predicted what she would be doing for her daughter before and after she was married. The raucous details can be imagined. The laughter proved to be a bonding experience as it showed her that everyone there identified with and shared her feelings. Thus a basis of trust was established within which it became possible for the group to take seriously the issues of why she behaved in this way and what she could do to change.
Laughter with a client about himself or herself can serve to reinforce their understanding of globalising and perfectionism. If, for example, a client has appreciated the irrationality of dismissing anything positive about themselves or the world but has not yet developed a firm counteracting belief, a little mockery of this negative perspective can help them to accept the irrationality of the core belief. The feeling that ‘things can’t be that bad if I can still laugh’ can be a considerable relief as well as having a distancing effect on the problem.
As stated at the beginning of this paper, there is no suggestion here that a counsellor can laugh all the way to a successful therapeutic conclusion for every client. And, indeed, it would be extremely foolish to laugh at all unless the client has indicated that they feel safe, supported and able to see a funny side to the issues that they bring to the sessions. Counsellors must however always be alert to the dangers of using humour for drawing attention to their own cleverness. There must also be a constant sensitivity to the client’s cultural background: an inappropriate laugh can do untold damage to the therapeutic relationship.
Nevertheless, the notion that humour can have beneficial effects is demonstrated by the current plethora of related web sites. In this country, one of the best known is Robert Holden’s Oxford- based Happiness Project. This was set up after he launched the UK’s first laughter clinics in 1991 with NHS funding. Holden runs workshops and also runs eight-week Happiness Programmes targeted, amongst others, at health professionals and also top level managers of some of the country’s largest companies.
Another ‘laughter practitioner’ is Dr. Brian Kaplan, a medically qualified doctor who claims that as soon as you start to laugh at a problem, ‘the problem is completely disempowered’. Further afield, the American, Cathy Ripplinger Fenwick, fronts an ‘Online Laughter Therapy Centre’ which advises on ways to ‘put more laughter into your life’. There are also panic/anxiety disorders web sites which advise readers to ‘laugh yourself calm, and papers on humour in emergency work (Moran and Massam).
Some of these web sites may be questionable in that they imply that self-help through humour is easy, but there is no doubt that the current trend is to take the funny side of things seriously and to appreciate the psychological benefits that humour can bring.
Summary
In this paper I have tried to cover the main benefits of the uses of humour in stress management counselling. There appears to be both anecdotal and scientific evidence that humour and laughter can act as antidotes to stress. Humour can:
• act as a communication tool as well as provide an emotional bonding and a demonstration of supportiveness and acceptance
• enhance the therapeutic alliance by confirming parity between client and counsellor
• help to reinterpret a distressing event and to distance the individual from the stressor thus providing a more realistic perspective on the problem
• serve to reinforce belief in new adaptive ways of thinking
• improve the physiological state
There remains one more area to be addressed and that is the use of humour to the counsellor. If we take ourselves too seriously we may become too concerned with our own thought processes and so risk losing sight of the clients’ issues. To be able to laugh at ourselves, acknowledging that we are fallible human beings, is an effective tool that enables us to see things in perspective. It is quite often the case that a good laugh in the middle of a serious discussion can provide the relief from tension that is needed to carry on with the seriousness of the deliberations.
‘Life does not cease to be funny when something bad happens any more that it ceases to be serious when we are laughing.’ Cathy Fenwick. Online Laughter Therapy Centre

Bibliography
Adams, M. Humour in the Psychotherapeutic Relationship, Counselling, Volume 11 No. 3
Dryden, W. Brief Rational Emotional Behaviour Therapy. Wiley, 1995 3
Ellis, A. A New Guide to Rational Living Robert Harper 1975
Fenwick, C. An Online Laughter Therapy Centre, (undated)
Lazarus, A. The Practice of Multimodal Therapy: John Hopkins 1989
Massam, Margaret & Moran, Carmen: An Evaluation of Humour in Emergency Work. The Australasian Journal of Disaster and Trauma Studies: volume 1997-3
Rubin, C. Don’t Let Your Kids Kill You. Element Books 1996
Trower, Casey and Dryden. Cognitive-Behavioural Counselling in Action. Sage Publications, 1988
Wooton, P. Humour: an Antidote for Stress. Anti-stress.htm undated

Sylvia Mauger works as a Stress Management Counsellor in the NHS and in private practice in South London. She also delivers Personal Effectiveness training in a Further Education setting. Sylvia is a member of ISMA (International Stress Management Association).

Reproduced by kind permission of the author © Sylvia Mauger.

Humor And Healing
The following is an excerpt taken from Chapter 3: Humor and Healing, or Why We’re Building a Silly Hospital of Gesundheit!: Bringing Good Health To You, The Medical System, And Society Through Physician Service, Complementary Therapies, Humor And Joy.
Thank you to Patch Adams for kindly giving me permission to reproduce the said excerpt.

The arrival of a good clown exercises more beneficial influence upon the health of a town than of twenty asses laden with drugs.Dr. Thomas Sydenham,
seventeenth-century physician
Humor is an antidote to all ills. I believe that fun is as important as love. The bottom line, when you ask people what they like about life, is the fun they have, whether it’s racing cars, dancing, gardening, golf, or writing books. Philosophically speaking, I’m surprised that anyone is ever serious. Life is such a miracle and it’s so good to be alive that I wonder why anybody ever wastes a minute!
Anyone who has picked up a copy of Reader’s Digest in the last forty years knows that laughter is the best medicine. In spite of the empirical nature of this truth, the mainstream medical literature hasn’t refuted it, as far as I know. The late Norman Cousins wrote eloquently about having laughed himself back to health after suffering from a serious chronic disease. The experience had such an impact that he changed careers late in life to help bring this information to the health care profession. Jokes seemed so important to Sigmund Freud that he wrote a book on the subject. But we don’t need professionals to tell us about the magnetism of laughter. With great insight, we call a funny person “the life of the party.”
Humor has been strongly promoted as health-giving throughout medical history, from Hippocrates to Sir William Osler. As science became dominant in medicine, subjective therapies like love, faith, and humor took a backseat because of the difficult task of objectively investigating their value. I am astounded that anybody feels the need to prove something so obvious. When individuals and groups are asked what is most important for good health, humor invariably heads the list even over love and faith, which many people feel have failed them. Few people deny that a good sense of humor is essential for a successful marriage. All public speakers recognize that humor is essential in drawing attention to what they are saying.
People crave laughter as if it were an essential amino acid. When the woes of existence beset us, we urgently seek comic relief. The more emotions we invest in a subject, the greater its potential for guffaws. Sex, marriage, prejudice, and politics provide a bottomless well of ideas; yet, humor is often denied in the adult world. Almost universally in the business, religious, medical, and academic worlds, humor is denigrated and even condemned, except in speeches and anecdotes. The stress is on seriousness, with the implication that humor is inappropriate. Health education does little to develop the skills of levity. On the contrary, hospitals are notorious for their somber atmosphere. Although hospital staff members may enjoy camaraderie among themselves, with patients their goal seems to be to fight suffering with suffering. What little humor there is occurs during visiting hours.
The focus on humor in medicine at Gesundheit Institute has often been declared a major deterrent to our getting funds. Still, I insist that humor and fun (which is humor in action) are equal partners with love as key ingredients for a healthy life.
Although humor itself is difficult to evaluate, the response to humor-laughter-can be studied quite readily. Research has shown that laughter increases the secretion of the natural chemicals, catecholamines and endorphins, that make people feel so peppy and good. It also decreases cortisol secretion and lowers the sedimentation rate, which implies a stimulated immune response. Oxygenation of the blood increases, and residual air in the lungs decreases. Heart rate initially speeds up and blood pressure rises; then the arteries relax, causing heart rate and blood pressure to lower. Skin temperature rises as a result of increased peripheral circulation. Thus, laughter appears to have a positive effect on many cardiovascular and respiratory problems. In addition, laughter has superb muscle relaxant qualities. Muscle physiologists have shown that anxiety and muscle relaxation cannot occur at the same time and that the relaxation response after a hearty laugh can last up to forty-five minutes.
Psychologically, humor forms the foundation of good mental health. Certainly the lack of a good sense of humor indicates underlying problems like depression or alienation. Humor is an excellent antidote to stress and an effective social lubricant. Since loving human relationships are so mentally healthy, it behooves one to develop a humorous side.
I have reached the conclusion that humor is vital in healing the problems of individuals, communities, and societies. I have been a street clown for thirty years and have tried to make my own life silly, not as that word is currently used, but in terms of its original meaning. “Silly” originally meant good, happy, blessed, fortunate, kind, and cheerful in many different languages. No other attribute has been more important. Wearing a rubber nose wherever I go has changed my life. Dullness and boredom melt away. Humor has made my life joyous and fun. It can do the same for you. Wearing underwear on the outside of your clothes can turn a tedious trip to the store for a forgotten carton of milk into an amusement park romp. People so unabashedly thank you for entertaining them.
Being funny is a powerful magnet for friendship, life’s most important treasure. Nothing attracts or maintains friendship like being a jolly soul. I know that humor has been at the core of preventing burnout in my life. Finally, as a nonviolent person, I feel that humor has often protected me by deflecting potentially violent situations.
In the twelve years we saw patients during the pilot phase of Gesundheit Institute, we had many opportunities to explore the relationship between humor and medicine. Although we greatly appreciated casual humor, it seemed imperative that we deliberately incorporate it into our day-to-day lives to prevent an atmosphere of agony and despair. Some of this humor came from a stream of jokes that patients and staff brought with them. However, jokes die quickly, and we found that for an atmosphere of humor to thrive, we had to live funny.
We learned to first develop an air of trust and love, because spontaneous humor can be offensive, and we wanted it to be taken in the spirit of trying. (Cautious people are rarely funny.) It soon became clear that silliness was a potent force in keeping the staff together as friends. And I, as a physician, began to see the potent medicinal effect of humor on diseases of all kinds.
Humor is important, too, for the health of a community, whether a neighborhood, church, club, or circle of friends. It has helped me live communally for more than twenty years. The first twelve years we used our home as a free hospital, surrounded by patients who had great mental and physical suffering. The staff stayed many years without pay or privacy because it was so much fun. As physicians, we also discovered that humor was a major medicine. Humor, maybe even more than love, made our pioneering project work; it would have been impossible without this great social glue.
We live in a troubled world. Many aspects of society are unhealthy or even deadly, and large segments of the population live on the edge. If we are to doctor society we must rely heavily on humor. Often in public a parent and child are at odds, and the frustrated parent is ready to strike out at the child. If I put on my rubber nose and act goofy, most of the time the situation is defused and neither parent nor child has a win/lose feeling.
How can one inject more humor into a medical setting? First, it must be a joint decision by administration and staff. The most important elements of bedside manner are not medical knowledge or skill but the qualities inherent in fun and love. Once the medical establishment has agreed to accept more humor, people at all levels of employment will be willing to take steps in this direction. It is easiest to be funny when people are familiar with one another. Spend time together learning your limits and practicing being funny. Invite patients and visitors to participate. Be open to experimentation and escalate slowly. Expect many experiments to fail and even to cause some pain. Avoid racist and sexist humor. Strive for goofiness and fun, not an infinite string of jokes.
Some hospitals have begun the process already. At Duke University Hospital, humor carts deliver videos, cartoon and humor books, juggling equipment, toys, and games. DeKalb Hospital, near Atlanta, has created a Lively Room for romping. The clowns of the Big Apple Circus in New York City have created Clown Care Units, which visit children’s hospitals on a regular basis to bring joy and assist with patient care. The Association of Therapeutic Humor is creating a clearinghouse with information about humor and about people who practice it as therapy. Finally, we at Gesundheit Institute are building the first silly hospital, where the entire context will be geared to fun and play.
There are many avenues to explore. I think hospitals need to give patients a choice between a goofy ward or a “straight,” solemn ward. In lectures all over the United States, I ask medical groups which ward they would choose, and more than 90 percent always choose the goofy ward. In any hospital, “fun” rooms could be designated as playful environments for all to enjoy. This could attract many of the community’s creative people, forge closer bonds between hospital and community, and diminish the hierarchical nature of current medical practice.
For all levels of staff, I suggest classes, intimate gatherings, picnics, and even slumber parties to cultivate the closeness needed to ensure more humor and joy in the workplace. I suggest creating humor support groups and maybe a place where people come just to laugh. Many hospitals have realized the importance of faith and have included ministers and priests on the staff. The same could be done with humor: hire clowns and playful people. Many large communities have performers and artists who could be invited to bring their specialties to the hospital. Some hospitals might even consider creating space for them, including a well-stocked costume and prop room.
The practice of medicine is hurting at many levels. Patient discontent is so great that many are resorting to lawsuits. Many health care professionals are so dissatisfied that they are quitting or even killing themselves. Few if any happy hospitals exist. Most people hate going to a hospital and have traumatic experiences when they do. Yet, it doesn’t have to be this way if we make great efforts to change it. Service to people in times of pain and suffering should – and can – bring rich fulfillment. Let us call on humor to lend a hand and make medicine fun.

Adams P with Mylander M (1998) Gesundheit!: Bringing Good Health To You, The Medical System, And Society Through Physician Service, Complementary Therapies, Humor And Joy Rochester: Healing Arts Press

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