Laughter Is the Best Medicine

August 17, 2018
Kavita Khajuria, MD

Volume 35, Issue 8

Given the brain's neuroplasticity, it’s to our benefit to make our lifetime experiences as positive and hilarious as possible

Modern life has become increasingly complicated and it’s believed that stress is the primary obstacle to laughter. Laughter is a physical expression of humor and joy that has numerous protective qualities. It’s one of the best ways to manage perceptions of stress and to develop resilience and improve psychological sturdiness as it strongly correlates with happiness.2 Happiness and humor can improve brain function-there is evidence of increased connectivity in various parts of the brain in response to laughter.3 Humor releases brain derived neurotrophic factor, which supports existing neurons and encourages the growth of new neurons and synapses.4 Given the brain's neuroplasticity, it’s to our benefit to make our lifetime experiences as positive and hilarious as possible.

The field of medicine has long recognized the importance of humor. In the 1300s, Henri de Mondeville, a professor of surgery, propagated post-operative therapy with humor.5 Norman Cousins, a journalist and a professor, also initiated this trend when he developed his own “treatment,” based on mood elevation through laughter.6 According to Cousins, ten minutes of laughter resulted in two hours of pain free sleep.

Many studies have demonstrated the beneficial effects of laughter. Laughing during a humorous film elevates the pain threshold and can help break the cycle between pain, sleep loss, depression, and immunosuppression.4 Laughter lowers blood pressure, epinephrine, and glucose levels, and increases glucose tolerance. Laughter also assists in the recovery and prevention of cancer by increasing natural killer cell activity, the response of gamma interferon and T cells, and improves the defense against respiratory infections. Humor and laughter produce a discharge of endorphins with both euphoric and calming effects.7

Laughter yoga is a contemporary technique developed in India that encourages participants to mimic the act of laughing with the goal of achieving positive psychological outcomes. The results have shown significant improvements in positive emotions and reductions in the severity of symptoms of stress and anxiety as well as reduced anxiety and improved quality of sleep in patients suffering from Parkinson disease.8,9

Humorous interventions may be especially helpful with aging. Findings indicate that happier people are less likely to develop tau tangles and amyloid plaques.4 Moreover, increased use of humor in the period following the death of a spouse was found to promote greater emotional resilience.2 In particular, those using more humor were better able to keep positive emotions distinct and separate from their negative emotions, resulting in fewer depressive symptoms. Humor related benefits have also been reported by elderly residents in assisted living facilities.

As suggested by Freud, humor may be the highest of the defense processes of the psyche, which we can invoke to guard against anxiety.10,11 Throughout history, humor has been linked to tragedy in literature and theater, but it can also be a form of escape.3,7 Black humor or “Gallows” humor can qualify as support mechanisms in the presence of impossible situations or traumatic circumstances in order to relieve tension and cope with the stress.2,7 The search for a funny aspect in a difficult moment can help us endure it, and when used to help others to copy, can be altruistic.11

Freud postulated that humor works by condensation and displacement and believed that cultivating a sense of humor could lift repression.12 When used appropriately, humor can have a place in therapy for generalized anxiety disorder, depression, and social anxiety. It can be a part of interpersonal therapy and CBT.4 Humor in CBT can help patients reframe their maladaptive thoughts, elevate mood, and overcome perceived obstacles.

It’s recommended that humor be utilized only after establishment of the therapeutic alliance and knowledge of the cultural customs of the patient.7 In group settings, laughter strengthens interpersonal relationships, promotes group bonding, facilitates teamwork and cooperation, and defuses conflict.4 If used appropriately, humor can convey a sense of humanity, overcome barriers, build trust and encourage empathy.12

Laughing at oneself also encourages healing. As Poland writes “there is a need to learn to laugh at oneself as an individual and also as a professional.”13 Anne Dean goes so far as to cite humor as a characteristic necessary for a successful career in psychiatry.14 Patch Adams, a physician and a clown, believed that humor and love were at the core of a good bedside manner.15 Humor also facilitates acceptance of traits in others that are unlikely to change. Laughter helps tame the inner critic that can demand unattainable standards, and can be used to boost self-esteem and buffer the self.2,4

It has been suggested that humor differs from other cognitive based emotional regulation strategies in that it doesn’t deny the negative experience, but helps to construe it as less threatening.2 Being able to laugh at traumatic events in our lives doesn’t cause us to ignore them, but prepares us to endure them through playfulness and a changed prism of perception of life’s challenges.

Humor can enhance the willingness to change and improve emotional expectations and can revise habitual narratives that perpetuate shame, hurt, isolation, inferiority, sadness, worry, and perfectionism.4 Of all the commonly endorsed character strengths, humor contributes most strongly to life satisfaction.

A notable body of literature on the role of humor and well-being has developed over recent years and much of it addresses how humor can facilitate coping with stress or enhance personal and social relationships. Research has also provided evidence that humor can serve as an important facet of resilience and can contribute to the enhancement of positive life experiences.

Disclosures:

Dr Khajuria is Staff Psychiatrist, Men’s Forensic Outpatient Unit, Twin Towers Correctional Facility, Los Angeles, CA.

References:

1. Brainy Quote. https://www.brainyquote.com/quotes/reba_mcentire_457608. Accessed July 6, 2018.

2. Kuiper NA. Humor and resiliency: towards a process model of coping and growth. Eur J Psychol. 20;8:475-491.

3. Wildgruber D, Szameitat Dp, Ethofer T, et al. Different types of laughter modulate connectivity within distinct parts of the laughter perception network. PLoS One. 2013;8:e63441.

4. King B. Health-Related Benefits of Humor and Laughter. Seminar DVDs. Los Banos, California: Institute for Brain Potential.

5. Brehony KA. After the Darkest Hour: How Suffering Begins the Journey to Wisdom. New York: Henry Holt; 2000: 228.

6. Cousins N. Anatomy of an illness. NEJM. 1976:293:1458-1463.

7. Craciun B. Humor as a defense mechanism and working instrument of the cognitive-behavioral therapy. Roman J CBTherapy Hypnosis. 2014;1:1-9.

8. Weinberg MK, Hammond TG, Cummins RA. The impact of laughter yoga on subjective well-being: a pilot study. Eur J Hum Res. 2013;1 25-34.

9. Memarian A, Sanatkaran A, Bahari SM. The effect of laughter yoga exercizes on anxiety and sleep quality in patients suffering from Parkinson’s disease. Biomed Res Ther. 2017;4:1463-1479.

10. Vaillant GE. Resilience and posttraumatic growth. Positive Psychiatry. Arlington, VA: American Psychiatric Publishing; 2015: 45-71.

11. Lickerman A. Why we laugh: how laughter can help build resilience. Psychology Today. 2011. https://www.psychologytoday.com/us/blog/happiness-in-world/2001/why-we-laugh. Accessed July 12, 2018.

12. Swaminath G. Joke’s A Part: in defense of humor. Indian J Psychiatry. 2006;48:177-180.

13. Poland WS. The gift of laughter on the development of a sense of humour in clinical analysis. Psychoanal Quart. 1990;197:225.

14. Dean A. Career focus-psychiatry. BMJ. 1996:313;7071.

15. Patch Adams. Wikipedia. https://en.wikipedia.org/wiki/Patch_Adams. Accessed July 12, 2018.

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