Laughter and Healing the Effects of Laughter

Laughter and Healing

The Effects of Laughter on the Healing Process and the Use of Technology to Track Statistics

How Laughter Works

Benefits of Laughter

Using Technology in Humor Research

Humor Therapy

The Effects of Laughter on the Healing Process and the Use of Technology to Track Statistics

In the United States, billions of dollars are spent every year on medical treatments (Diggs, 2004). However, according to Diggs, people often "overlook the coping mechanisms we have been endowed with." The human body has innate mechanisms that provide self-care, which is often better than drugs. The Bible says: "A merry heart doeth good like a medicine, but a broken spirit drieth the bones."

There has been a great deal of research on the effects of laughter on a person's physical and mental health (Diggs, 2004). These studies show that when we laugh, there is an actual chemical change in our bodies that eases pain and releases stress. Laughter serves as coping mechanism for the normal stress of life and may even aid the healing process.

There are two types of stress -- distress, which is negative stress; and eustress, which is positive stress (Diggs, 2004). While distress increases stress hormones such as beta-endorphin, corticotrophin, cortisol, growth hormone, prolactin, and the catecholamines, eustress lowers hormones and increases the activity of Natural Killer (NK) cells that prevent disease and heal (Berk & Tan 1996). Distressful events and major life changes often have a negative impact on a person's health. Stress depletes the immune system's ability to fight disease.

Several studies have examined the stimulating effects of laughter on the circulatory, respiratory, as well as the psychoneuroimmune system and connections within the body. Researhers have found a pattern of stimulation from laughter followed by realization of various body systems. Still, while humor is one of the most prevalent forms of human social behavior, it is still among the least studied or understood.

The purpose of this paper is to address the question of whether laughter plays a role in the healing process. The literature review will include studies on laughter and humor in the medical industry, then discuss some of the mechanisms by which humor and laughter are believed to affect health.

How Laughter Works

Laughter is a type of eustress that releases the negative emotions that cause harmful chemical effects on the body (Berk and Tan, 1996) (Diggs, 2004). Similar to exercise, there are two stages to laughter: the arousal phase -- when the heart rate increases -- and the resolution phase -- when the heart rests. A person's heart can increase to120 beats per minute (bpm) when laughing. Laughing can lower a person's blood pressure, increase vascular flow, and improve the immune system. It works out the diaphragm, abdominal, intercostal, respiratory accessory, and facial muscles. Laughter also releases endorphins in the brain; which are the bodies' natural painkillers (Wooten, 1995).

Nearly 2000 years ago, the physician Galen said that cheerful women were less likely to get cancer than depressed women (Simonton, 1978) (Diggs, 2004). John Steinbeck wrote: "A sad soul can kill you quicker, far quicker, than a germ." Laughter's painkilling elements and its ability to fight disease have added a new area of research to cancer. Researchers O. Carl Simonton, M.D. And Stephanie Matthews-Simonton (1978) demonstrated that a person's emotional status affects their likelihood of getting or overcoming cancer. Perhaps, if people would start relieving their stress through laughter before they get cancer, there might be a reduction in the total number of cancer patients.

Review of Existing Literature

According to Christopher Kent (2001): "A frequent question asked by patients and practitioners is "To what extent do intent, attitude and touch affect health outcomes?" Although these issues may seem unrelated to the technical aspects of health care, a growing body of evidence suggests that such factors may significantly affect the healing process." recent study (Bunnell, 1999) examined whether "healing with intent" had a proven effect on pepsin enzyme activity (Kent, 2001). The rate of breakdown of egg albumin by a one percent pepsin solution was measured across 20 separate trials. This assessment method eliminated the possibility of a placebo effect. The reaction rate of samples "healed with intent" was measured against "unhealed" controls. The samples "healed by intent" revealed significantly greater reaction rates than the controls.

Similarly, studies on healing by laughter have yielded remarkable results (Kent, 2001). Laughter and humor may have beneficial health effects, according to recent research. Berk et al. (2000) studied how humor-associated laughter modulated certain neuroimmune parameters. Fifty-two healthy men took part in a study. Blood samples were taken 10 minutes before watching an hour-long humor video. According to Kent (2001): Additional blood samples were taken 30 minutes into the video, 30 minutes after the viewing was completed and 12 hours after the viewing. Increases were found in natural killer cell activity: Immunoglobins G. And M, with several immunoglobin effects lasting 12 hours after viewing the humor video. Other effects lasting at least 12 hours were increases in leukocyte subsets and cytokine interferon gamma."

The study concluded, "Modulation of neuroimmune parameters during and following the humor-associated eustress [pleasant or curative stress] of laughter may provide beneficial health effects for wellness... (Kent, 2001)"

Berk's findings were met with skepticism. Robert R. Provine, a psychology professor at the University of Maryland Baltimore County and author of Laughter: A Scientific Investigation (Lee, 2001), criticized Berk's research methods. "It's impossible to know whether the reported effects are produced by laughter, humor or something not considered, like watching the video," Provine suggests."My not unreasonable concern is that a study about laughter should observe laughter."

Berk and Tan have completed a great deal of research in psychoneuroimmunology (PNI). PNI holds that the immune system is directly connected to the brain; therefore, it would be influenced by emotions (Diggs, 2004). One of Berk and Tan's experiments revealed that immunosuppressive hormones (hormones that harm the immune system) such as epinephrine and cortisol were lower in those participants that laughed than in those who did not (Wooten, 1995). Another experiment performed by Berk and Tan (1996) proved that laughing (while watching a funny video) increases the amount of NK cells.

Indirectly, stress is one of the greatest killers of human beings (Diggs, 2004). It is physically and mentally harmful, breaking the immune system down, and making people more susceptible to sickness and disease. While many doctors concentrate on treating the disease, it is important to treat the cause.

In many cases, stress is impossible to treat, as the stressors cannot be removed from a person's life (Diggs, 2004). Laughter can help lessen the stress. As Mark Twain once said, "The human race has only one really effective weapon, and that's laughter. The moment it arises, all our hardnesses yield, all our irritations and resentments slip away, and a sunny spirit takes their place."

In a separate study by Kimata (2001), allergy patients who watched a Charlie Chaplin comedy had skin welts shrink, an effect that did not occur in control subjects who watched weather reports instead (Kent, 2001).

Dr. Lee Berk and fellow researcher Dr. Stanley Tan of Loma Linda University in California study the effects of laughter on the immune system (Holistic Online, 2004). Their research suggests 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."

Berk's 1996 research on the effects of laughter on the immune system revealed that the physiological response produced by belly laughter was opposite of what is typically seen in classical stress, suggesting that laughter is a eustress state -- a state that produces healthy emotions (Holistic Online, 2004).

Studies show that, after exposure to humor, activity within the immune system tends to increase, including (Holistic Online, 2004):

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.

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."

An increase in the antibody IgA (immunoglobulin A), which fights upper respiratory tract insults and infections.

An increase in gamma interferon, which tells various components of the immune system to "turn on."

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."

Berks' study also found a general decrease in stress hormones that constrict blood vessels and suppress immune activity (Holistic Online, 2004). These decreased in the study group exposed to humor. For instance, levels of epinephrine were lower in the group both in anticipation of humor and following exposure to humor. Epinephrine levels remained low during the experiment.

Dopamine levels (as measured by dopac) decreased, as well (Holistic Online, 2004). Dopamine plays a major part in the "fight or flight response" and is associated with elevated blood pressure. Laughing is aerobic, exercising the diaphragm and increasing the body's ability to use oxygen.

These studies suggest that laughter enhances positive emotions that can aid conventional treatments (Holistic Online, 2004). However, it is not believed that it can replace conventional treatment. Therefore, it is viewed mainly as a tool that can help fight disease. Many experts agree that, when used as an aid to conventional treatment, laughter can not only help the healing process but also lessen pain.

In a study published in the Journal of Holistic Nursing, medical staff members told jokes to their patients after surgery and before painful medication was given (Holistic Online, 2004). Those exposed to humor perceived less pain than patients who did not receive humor with their treatment.

Medical professionals are not the only ones who have launched research projects on the effects of laughter (Jacobson, 2000). Television executive Sherry Hilber saw that studio audiences writhed with laughter on the studio sets of sitcomes. "I'd see them leave at the end of the show and think, 'Maybe for the rest of the night something is happening inside their bodies.' " Intrigued, Hilber read the limited literature about humor's effects on physical health. She found an incomplete mix of studies.

Determined to use her comedy knowledge for a greater cause, Hilber started Rx Laughter, a nonprofit project that aimed to dually help the ill via humor and support scientific research on the subject (Jacobson, 2000). As a result of Hilber's fund-raising efforts, researchers at the University of California, Los Angeles are now involved in a research project on whether funny videos can promote healing.

The UCLA/Rx Laughter researchers are screening the videos Hilber assembled for 100 elementary school children to determine what they find funny (Jacobson, 2000). Initially, they'll monitor how often each child laughs and also ask the subjects whether they thought the video was funny, looking for correlation.

According to Jacobson (2000): "Next, investigators will examine the nervous and immune system effects of laughter: heart rate, blood pressure and the presence of the stress hormone cortisol in saliva, before and after the funny videos. Eventually, the researchers expect to explore whether comedy changes how kids perceive and respond to pain. Ultimately, they want to see if humor can change the kids' actual health, not just their stress hormones. For example, they may measure how fast wounds heal after surgery and how fast white blood cells rebound to their normal levels after being lowered by chemotherapy."

You have to pass the 'so what?' test," according to the study's co-director, Margaret Stuber, M.D., a UCLA professor of psychiatry and biobehavioral sciences (Jacobson, 2000). "It may be very interesting to us that we can change salivary cortisol, but does that actually change anything that matters?"

The idea that humor could improve health is supported by prior medical research (Jacobson, 2000). Studies reveal that anger, depression, and pessimism have a negative effect on the immune response, increase surgical recovery and wound-healing times, and may even result in higher death rates.

Many researchers feel that humor and laughter may counter a negative outlook (Jacobson, 2000). "Humor and distressing emotion cannot occupy the same psychological space," says Steven Sultanoff, Ph.D., a clinical psychologist and president of the American Association for Therapeutic Humor.

Despite questioning, studies continue to support laughter's physiological benefits. A recent letter in the Journal of the American Medical Association by Hajime Kimata, a Japanese doctor, related his findings that allergy patients who watched Modern Times, a Charlie Chaplin film, showed reduced swelling of skin welts (Lee, 2001).

The extent of laughter's healing potential is still a gray area, but researchers have not found any harmful side effects. Therefore, laughter remains a useful tool for therapeutic programs.

Benefits of Laughter

The following list summarizes how humor contributes to physical health (Holistic Online, 2004):

Muscle Relaxation: Belly laughing cause muscle relaxation.

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

Immune System Enhancement: research shows that humor strengthens the immune system.

Pain Reduction: Humor distracts patients from pains.

Cardiac Exercise: A belly laugh serves as "an internal jogging." Laughter can provide good cardiac conditioning for those who cannot physically exercise.

Respiration: Frequent laughter empties the lungs of more air than it takes in resulting in a cleansing effect, like that involved with deep breathing. This is good for patients who are suffering from emphysema and other respiratory ailments.

Researchers believe that laughter has a positive effect on the cardiovascular system (Mahony, 2004). To track this, they often use technology to monitor the heart rate. According to findings, laughter, like exercise, reduces the heart rate. William Fry in 1971 proved that laughter increases the heart rate, blood pressure, oxygen consumption, and works the muscles in the face and stomach. Following a good laugh, these levels drop, providing a relaxation response.

Studies also show a positive effect on stress levels. Prolonged stress has many negative effects (Mahony, 2004). Stress causes the adrenal glands to give off cortico steroids and high levels have an immunosuppressive effect. Laughter serves as an antidote. Berk and other researchers reported this in Neuroendrocrine and stress hormone changes during mirthful laughter. These researchers use technology to monitor these levels.

Laughter has also been touted as a positive way to stimulate the immune system. L. Berk, of Loma Linda University School of Medicine revealed that laughter (Mahony, 2004):

lowers serum cortisol levels increases the number of T-cells that have helper/suppressor receptors increases the number & activity of natural killer cells."

Other research supported these findings.

To prove this theory, researchers analyzed the blood of subjects before, during and after watching a humorous video (Mahony, 2004). The results showed a 'significant' boost to immune function, including higher levels of anti-bodies and natural killer cells. These elements defend the body against aberrant cells such as cancer.

The positive effects of laughter on the immune system lasted through the next day. Levels of Plasma Immunoglobulin, Plasma Cytokine Gamma Interferon and killer cells stayed high for more than 12 hours (Mahony, 2004).

To examine the effects of laughter on the repertory system, David Garlick of University of NSW School of Physiology and Pharmacology measured abdominal movements during funny videos and documentaries (Mahony, 2004). Laughter was followed by a long sigh and a large intake of breath, resulting in better respiratory movement.

While recent studies show promise, there is still a need to further analyze the positive effects of humor. According to Mahony (2004): "Is laughter any medicine at all? Yes; there is sufficient empirical evidence to support many -- although certainly not all -- of the claims that mirthful laughter benefits both physical and mental health. Is laughter the best medicine? No, not necessarily. Those empirical studies that have controlled well for alternative explanations serve to support Cousins's point: mirthful laughter is merely one selection from a large menu of positive emotions and behaviors that have therapeutic value. However, most of the items on this menu are so tied to personal beliefs, values, and style that the choice of mind-body connection is best left to the individual."

Using Technology in Humor Research

Cogan, Cogan, Waltz, and McCue (1987) conducted two experiments that measured discomfort thresholds with a blood pressure cuff (Mahony, 2004). In the first experiment, 40 participants listened to one of three 20-minute audiotapes: Lily Tomlin comedy, relaxation, or informative narrative. The study's control group did not listen to a tape. Discomfort thresholds for both the humor and relaxation groups were higher than those of the narrative and control groups. The second experiment compared the effects of various types of distraction. Forty participants, who had similar discomfort thresholds, either listened to humor, an interesting narrative or a dull narrative, multiplied three-digit numbers, or were controls. Only the laughter group showed higher thresholds.

Hudak, Dale, Hudak, and DeGood (1991) studied the effects of both humor trait and humor state on reported discomfort induced by transcutaneous end nerve stimulation (Mahony, 2004). Thirty-one participants who had either very high or very low scores on Martin and Lefcourt's SHRQ were placed in groups that watched either Bill Cosby or a gardening show. The humor group had higher discomfort thresholds, but the effect of the video group was largely affected by the responses of the low-sense-of-humor members of each group. The study concluded that individuals with a high sense of humor have a higher threshold with or without the aid of a humor stimulus and that individuals with low sense of humor are more likely to experience discomfort and are less able to cope with pain.

Nevo, Keinan, and Teshimovsky-Arditi (1993) exposed 72 undergraduates to a cold-water pressor while they watched either comedy, a documentary, or no film (Mahony, 2004). They did not get the results they were aiming for. The only significant group difference was that the people who watched comedy estimated the effectiveness of the film as higher even though it did not have a significant effect. However, all participants had previously filled out Ziv's Sense of Humor Questionnaire and Martin and Lefcourt's SHRQ, and a significant correlation was found, across groups, between scores on Ziv's humor creation subtest and pain tolerance.

Within the comedy group, a link was found between the funniness rating given to the film and ability to tolerate the cold water (Mahony, 2004). The study concluded that "humor exerts its effects only when it is perceived as humorous." This research supported the belief that humor is beneficial.

Zillmann, Rockwell, Schweitzer, and Sundar (1993) compared pre- and posttests of discomfort thresholds using a blood pressure cuff (Mahony, 2004). One hundred beginner psychology students watched either stand-up comedy, situation comedy, drama, an instructional film, or tragedy. It was discovered that watching tragedy was just as effective in significantly increasing discomfort thresholds as comedy. This is the first study with a distraction treatment that induced arousal.

Weisenberg, Tepper, and Schwarzwald (1995) used a cold-water pressor on 80 volunteers who watched short film segments of either slapstick comedy, a repulsive scene from a horror movie, or a neutral popular-science film, or no film (Mahony, 2004). There was significant pain endurance advantage for both the humor and the repulsive treatments with the repulsive treatment being the most effective.

According to Mahony (2004): "In sum, these studies demonstrate that sense of humor trait is more beneficial than induced humor state, and that laughter has no unique contribution to pain tolerance beyond relaxation or beyond the level of distraction, providing the distraction involves arousal. Future research might investigate the effects of positive or enhanced mood without humor and the effects of humor without positive mood. There are enough humorous stimuli that are either disgusting enough or depressing enough to permit such an investigation. Additionally, with a small amount of deception it should be possible to manipulate participants' expectation of benefit."

Humor Therapy

Humor is an excellent way to distract patients from excessive anxiety or pain. Laughter between a healthcare provider and patient fosters a comfortable environment as patients try to heal and carry on with their lives.

Many hospitals are incorporating the result of research regarding humor and laughter (Troyer, 2004). For example, when they get their medications, patients at Duke University Medical Center in Durham, N.C., are encouraged to laugh. A rolling cart known as the Laugh Mobile features whoopee cushions, magic wands, games, rubber chickens, yo-yos, funny faces, bubbles to blow, and funny books and movies.

At Fox Chase Cancer Center in Philadelphia, patients experience a humor cart that includes a Mr. Potato Head, kaleidoscopes, and squirt guns (Troyer, 2004). "Laughter is a positive contagion that's spreading in the medical world," says Joel Goodman, who founded the HUMOR Project Inc., in Saratoga Springs, N.Y., in 1977. Since then, the project has provided grants to 300 hospitals, schools, and social service agencies to implement humor therapy.

The humor-in-hospitals movement is gaining momentum nationwide, according to Ann Weeks, president of the Association for Applied and Therapeutic Humor in Phoenix (Troyer, 2004). "More hospitals are offering humor carts and baskets to patients. We've also seen tremendous growth in programs in which volunteers prepare to be clowns in hospitals, nursing homes, and pediatric care centers."

Humor therapy describes the many ways in which health organizations use the art of laughter to treat disease (Healtheon, 2000). Modern hospitals and ambulatory clinics now encourage doctors to be funny. Other methods of humor therapy include in-hospital clowns and formal humor programs. As Voltaire noted in the 18th century, "The art of medicine consists of keeping the patient amused while nature heals the disease."

While every hospital has a different environment, in those that have created humor therapy programs, "Comedy Carts" (featuring props that poke fun at standard medical devices) or "Caring Clowns" who work with patients to promote laughter, are present (Healtheon, 2000). For a hospitalized child, humor therapy might begin with a huge clown shoe appearing around the door of the hospital room. Or a doctor may blow bubbles out of his stethoscope. For adult patients, humor therapy could be as simple as a nurse or friendly attendant sharing a wry look or a compliment about your "lovely designer (hospital) gown." Some hospitals even have special rooms where humorous materials such as movies, audio and videotapes, books, games, and puzzles are used to help make people laugh.

Laughter therapy is now also being considered as an alternative to aid stress management (Traynor, 1997). As work environments become more and more stressful and people have more on their agendas, people are experiencing higher levels of stress, whch can lead to health problems.