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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:
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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. |
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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.” |
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An increase in the antibody IgA (immunoglobulin A), which fights upper respiratory tract insults and infections. |
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An increase in gamma interferon, which tells various components of the immune system to “turn on.” |
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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 |
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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.
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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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