Humor Therapy- Therapeutic Benefits of Laughter

Introduction

Patients, doctors and health-care professionals are all finding that laughter may indeed be the best medicine. Finding humor in a situation and laughing freely with others can be a powerful antidote to stress. It is also a very good coping mechanism when you are suffering from deadly diseases such as cancer. Many people find that maintaining a sense of humor at such occasions are useful for good quality of life. Our sense of humor gives us the ability to find delight, experience joy, and to release tension. This can be an effective self-care tool. Scientific evidence on the effectiveness of humor as a therapy is now overwhelming.
For many years medical professionals have recognized that those patients who maintained a positive mental attitude and shared laughter responded better to treatment. Physiological responses to laughter include increased respiration, circulation, hormonal and digestive enzyme secretion, and a leveling of the blood pressure. Many report a general sense of euphoria after vigorous laughter. But until the New England Journal of Medicine in 1979 published the Norman Cousins case study, few considered the therapeutic uses of humor.

The first documented case of humor positively affecting disease was in 1964 when Norman Cousins, published "Anatomy of an Illness". Medical professionals were for the first shown that humor biologically reversed Cousins' ankylosing spondylitis, a painful disease causing the disintegration of the spinal connective tissue. Given a one in five hundred chance of recovery, Cousins decided to infuse himself with humor treatments. With Cousins' self-designed humor treatments, he found that 15 minutes of hardy laughter could produce two hours of pain free sleep. Blood samples also showed that his inflammation level was lowered after the humor treatments. Eventually Cousins was able to completely reverse the illness. Cousins later documented his story in a book he called "Anatomy Of an Illness."

Today, interest in humor's effects has grown so much that the field has a name -- psychoneuroimmunology, the study of how psychological factors, the brain and the immune system interact to influence health.

"If you took what we now know about the capability of laughter to manipulate the immune system, and bottled it, it would need FDA approval," Dr. Lee Berk, a preventive care clinician, medical research scientist, psychoneuroimmunologist, and professor at LLU's Schools of Medicine and Public Health

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:
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.
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.

Humor and Cancer
Many of us feel awkward in joking in front of terminally ill patients. Many may even consider it inappropriate or insensitive. However, it has been known scientifically that the best thing you can do to your friends is to provide a humorous environment and let them "forget" about their condition. Sitting and feeling sorry for their condition will not help them much.
Dr. Michael B. Van Scoy-Morsher, an oncologist in California says that "one characteristic of the cancer patient who does well is the ability to often put cancer in the background for periods of time."
TV journalist Linda Ellerbee wrote about some of her cancer experiences and of being bald in the January 1993 edition of McCall's :
That summer I bought some breast prostheses to use while swimming. Instead of fastening them to my skin with Velcro as the directions instructed, I simply inserted the prostheses into my bathing suit. When I came out of the water, one had migrated around to my back! Now, how can you not laugh at such a thing? Either you laugh or you cry your eyes out. . . . It's something I've tried to teach my kids as well. When my 23-year-old daughter saw me with my bald head and no breast, she said, "You look just like a Buddha without the wisdom," and we both howled. I think we are never braver than when we stand tall and look into the sun and laugh. Laughter may be a form of courage.
In his book "Intoxicated by My Illness," Anatole Broyard wrote about the final months of his life after he was diagnosed with prostate cancer. He stated that "Illness is primarily a drama, and it should be possible to enjoy it as well as to suffer it. . . . . Illness," after all, "is not all tragedy. Much of it is funny."

Humor: How Does It Work?
In her book, "Pulmonary Rehabilitation: Guidelines to Success," Patty Wooten noted:
The ability to laugh at a situation or problem gives us a feeling of superiority and power. Humor and laughter can foster a positive and hopeful attitude. We are less likely to succumb to feelings of depression and helplessness if we are able to laugh at what is troubling us. Humor gives us a sense of perspective on our problems. Laughter provides an opportunity for the release of those uncomfortable emotions which, if held inside, may create biochemical changes that are harmful to the body.

Herbert Lefcourt, a noted psychologist from the University of Waterloo in Canada has explored the possibility that a sense of humor and its use can change our emotional response to stress. In this study, subjects were asked to review the frequency and severity of stressful life changes occurring to them over the previous six months, and their recent negative mood disturbances were evaluated. Lefcourt then administered tests to evaluate use of humor, perception of humor, appreciation of laughter, and efforts to include opportunities for humor and laughter into each subjects lifestyle. Results of this study have shown that the ability to sense and appreciate humor can buffer the mood disturbances which occur in response to negative life events.
Humor perception involves the whole brain and serves to integrate and balance activity in both hemispheres. Derks, at the College of William and Mary in Williamsburg, has shown that there is a unique pattern of brain wave activity during the perception of humor. EEG's were recorded on subjects while they were presented with humorous material.

During the setup to the joke, the cortex's left hemisphere began its analytical function of processing words. Shortly afterward, most of the brain activity moved to the frontal lobe which is the center of emotionality. Moments later the right hemisphere's synthesis capabilities joined with the left's processing to find the pattern -- to 'get the joke'. A few milliseconds later, before the subject had enough time to laugh, the increased brain wave activity spread to the sensory processing areas of the brain, the occipital lobe. The increased fluctuations in delta waves reached a crescendo of activity and crested as the brain 'got' the joke and the external expression of laughter began. Derks' findings shows that humor pulls the various parts of the brain together rather than activating a component in only one area.

The emotions and moods we experience directly effect our immune system. A sense of humor allows us to perceive and appreciate the incongruities of life and provides moments of joy and delight. These positive emotions can create neurochemical changes that will buffer the immunosuppressive effects of diseases and stress.