A Guide to Laughter Therapy

We’ve all heard the axiom, “Laughter is the best medicine.”  In many mental health situations, laughter is a key to healing emotional and psychological problems. It can also ease physical ailments and pains, improve outcomes and symptoms of some diseases, and aid people, especially the elderly, to stay mentally sharp.  Laughter therapy uses humor to help improve a person’s sense of health and well-being. Laughter helps patients to release anxiety, anger, and boredom and get along better with other people. When used by a trained therapist, laughter can enable patients to resolve issues quickly.

History of Laughter Therapy

Laughter therapy has existed for centuries. In the 14th century, a French surgeon, Henri De Mondeville, believed that patients benefited from having relatives and friends visit them to tell jokes. In the 16th century, two clergymen — Robert Burton and Martin Luther — used humor when working with depressed people. Herbert Spencer, a sociologist, used humor to aid in relaxation in the 17th century. In the 18th century, the English doctor William Battie used laughter to treat illness.

In the United States, laughter therapy began to gain popularity during the 20th century. During the polio epidemic in the 1930s, hospitals hired clowns to cheer up sick children.   Dr. Hunter “Patch” Adams established the Gesundheit Institute in 1972, a hospital dedicated to spreading humor and joy to patients. In 1979, Norman Cousins, a political writer, published a book, Anatomy of an Illness, in which he described how humor helped him fight a potentially fatal disease.

Dr. William F. Fry, a Stanford University psychiatrist, studied the physiological effects of laughter in the 1960s and is considered the father of gelotology. Gelotology comes from the Greek word “gelos,” meaning laughter, and refers to the science of laughter. In his studies, he discovered that laughter can decrease the risks of respiratory infections and can cause the body to produce natural painkillers known as endorphins.

Finally, in the 1980s, Dr. Lee S. Berk and a team of researchers at Loma Linda University Medical Center in California found that humor reduced arrhythmias, blood pressure, and stress hormones. In that study, heart attack patients were divided into two groups. One group watched funny videos for a half-hour each day for a year. The control group received standard medical care. The test also found that those in the control group suffered more heart attacks than those in the laughter group. In fact, 50 percent of those in the control group had recurrent heart attacks, while only 20 percent of those in the humor group did.

Humor and Laughter As a Therapy Tool

Humor and laughter are often used interchangeably, yet they have slightly different definitions. Humor refers to the stimulus, such as a joke, that evokes laughter. Laughter is a physical reaction characterized by facial expressions, a sound, and the contraction of muscle groups. Laughter is of five types: genuine or spontaneous, self-induced or simulated, stimulated, induced, and pathological. Pathological laughter is related to a disorder and is not a therapeutic tool.

Research is inconclusive on whether spontaneous and simulated laughter provides the same benefits. The Motion Creates Emotion Theory (MCET) hypothesizes that the body doesn’t know the difference between simulated and spontaneous laughter and that simulated laughter and spontaneous laughter equate to the same benefits. Still, other studies say that simulated laughter actually may be more beneficial to overall health than spontaneous laughter. Other theories say that the benefits come more from a positive mood rather than specifically from laughter itself.

Evidence suggests that primary care physicians could improve patients’ wellness by having a short conversation to determine what makes them laugh and then write a laughter prescription tailored to the patient. For example, they might prescribe for the patient to watch their favorite sitcom once a week with the aim of the patient belly laughing. A prescription for group laughter sessions, which could include anything from attending a show at a Comedy Club to a laugh yoga session, might also help promote overall patient physical and mental health.

Benefits of Laughing

Laughter therapy uses both spontaneous and simulated laughter. Laughter therapy has several benefits that improve physical and mental health and quality of life.

Physical Benefits

Laughter causes the release of several hormones and chemicals in the body that improve health. These include

• The release of endorphins, which are peptides that activate the body’s opiate receptors, causing a natural painkilling effect.
• Stimulation of good neuropeptides, which relay sensory information to the central nervous system, can help reduce pain and inflammation and repair the body after injury. Research also shows that continuous laughter can increase a patient’s pain threshold by as much as 10 percent.
• The altering of chemical communicators that help communicate our emotional state.
• Increasing the number of T-lymphocytes through activation of natural killer cells. This activation strengthens the immune system.
• Increasing muscle flexion

Laughter also decreases cortisol. A decrease in cortisol increases oxygen intake, lowers blood pressure, reduces the risk of heart attack and stroke, and enhances the immune system.

Research has shown that laughter can improve outcomes and symptoms of several diseases. On average, about 10 percent of white blood cells are natural killer cells. Natural killer cells regularly protect our bodies from infected cells. Research has shown that the more frequently cancer patients laugh, the stronger the natural killer cell activity became, which means that the body’s capacity to kill cancer cells increases with laughter therapy.

Researchers also believe that laughter therapy may relieve symptoms of neurological diseases, including Parkinson’s disease, amyotrophic lateral sclerosis (ALS), and muscular sclerosis. Laughter does this by helping to strengthen the muscles used to breathe, lift moods and relieve pain and stress.

Research in Japan has also shown that mothers’ laughter may help treat infants with eczema. Another Japanese study from the Foundation for Advancement of International Science showed that laughter decreased levels of a protein involved in the progression of diabetic nephropathy. Diabetic nephropathy occurs as a result of diabetes and is the leading cause of kidney failure.

Mental and Intellectual Health

Laughter-inducing therapies are being applied more regularly within the last 10 to 15 years to treat many mental illnesses and disorders. These therapies can be cost-effective as the main therapy or when used in conjunction with other therapies. Some of the significant benefits laughter provides to mental and intellectual health include:

• Fighting depression. Laughter raises the levels of serotonin in the body. A 2015 study on depression in middle-aged women showed that laughter increased serotonin levels in the women in all three groups — those without depression, those with mild depression, and those with severe depression. Serotonin increased the most in those with severe depression. Serotonin is a neurotransmitter known as the “happy chemical.”
• Relieving stress. Laughter decreases the amount of stress-making hormones found in the blood. It also results in the production of anti-stress hormones. A 2019 study found that cultivating a sense of humor significantly reduced the stress experienced by nurses.
• Reducing unpleasant feelings such as tension, anxiety, hatred, and anger. Laughter does this by triggering the production of neurochemicals, such as dopamine, which are calming.
• Enhancing resilience
• Improving cognitive function by increasing EEG gamma wave frequency in the brain. In a 2014 Loma Linda University study, 20 healthy senior citizens watched a funny video distraction-free for 20 minutes, while a control group sat calmly with no video. Afterward, they performed memory tests. Those who had watched the funny video scored better on the memory tests than those who had sat calmly.
• Improving sleep, especially in elderly patients. In a 2017 study, 42 residents of a long-term care facility were divided into two groups, one of which engaged in laughter therapy for 40 minutes twice a week for four weeks.  Those who engaged in laughter therapy had significantly fewer sleep problems than those who did not.
• Helping with addiction recovery. In early recovery, patients have a lot of serious work to do. Laughter therapy helps them avoid taking themselves too seriously. Taking themselves too seriously can zap the energy that is needed for recovery work. Humor also can reduce confrontations in group therapy undertaken for addictions.
• Improving schizophrenia symptoms by reducing hostility and lowering levels of psychopathology.
• Aiding in relaxation.

Social Benefits

Laughter therapy also provides significant social benefits. These include

• Promoting innovative behavior among employees. A 2020 study showed that employees became better engaged and were able to think creatively when their boss used humor in the workplace.
• Promoting teamwork. Laughter has been found to help resolve conflict and improve communication and collaboration.
• Increasing one-on-one connections and bonding. Research suggests that laughter occurs in everyday social situations and increases friendship. It also increases an individual’s willingness to disclose.

How Much Laughter Therapy Is Needed?

Researchers have documented benefits when patients participated in as little as 15 minutes a day of laughter therapy over several months, although longer sessions two or three times a week yield equal benefits.

The duration of the laugh is not as important as the reason behind it. Joyous, merry laughter, as opposed to nervous laughter, is the healthiest. Laughing is non-invasive, non-pharmaceutical, and has no adverse side effects, so laughing as often as possible is a good idea.

Hearty laughter is a gift, wrote Cousins whose laughter helped heal him.  Claiming that gift of hearty laughter, whether guided by a therapist trained in healing for a specific mental health issue or done on your own, can improve life quality and duration.