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A merry heart doeth good like a medicine.

Bible, Proverbs 17:22

In the 1970s, word spread that Norman Cousins, a journalist, had markedly improved his symptoms of ankylosing spondylitis through the use of humor.[1] He watched Marx Brothers movies regularly and found that they did much to improve his pain. Ultimately, his book, Anatomy of an Illness, did a lot to spark interest in the healing benefits of humor and laughter.

This tool focuses on humor and laughter and their effects on health. Keep them in mind as you help Veterans create their Personal Health Plans. Bringing humor into patient care, when appropriate, can help your patients in many ways. It can also make your work more enjoyable and fulfilling.[2]

Physiological Changes

Laughter has physiological effects; it changes body chemistry and brain function. For example:[3][4]

• Laughter increases heart and respiratory rates as well as oxygen consumption over a short period. After these initial changes, a person moves into a state of relaxation. While these effects may not be the equivalent to aerobic exercise, as some claim, that is not to say it is entirely without benefit as a physical activity. 10-15 minutes of laughter per day may burn 10-40 extra calories.
• Laughter affects heart function. It increases stroke volume and cardiac output, and it dilates blood vessels.
• After intense laughter, muscle tone
• Watching humorous videos revs up the sympathetic nervous system (SNS). However, this does not increase blood pressure.
• Laughter lowers levels of the stress hormone, cortisol.
• Laughter activates the mesolimbic dopaminergic reward system in the brain.
• Laughter increases serum immunoglobulins A and E. In most studies, it seems to increase natural killer cell activity as well.
• It raises levels of beta-endorphins (the feel-good chemicals of the body) and increases human growth hormone

Effects on Health Conditions

Laughter and humor also have the following effects on specific illnesses:[3][4]

• There is an inverse association between coronary heart disease and propensity to laugh; laughing more means lower heart attack risk. [5]
• A 2018 study found that laughter therapy effectively delays cardiovascular complications of type 2 diabetes.
• Watching a comedy show decreased overall rise in glucose levels after eating. [6]
• Higher propensity to laugh correlates with fewer episodes of arrhythmias and recurrent MIs during cardiac rehabilitation. [7]
• Laughter increases pain tolerance. [8][9]
• Laughter therapy improves self-esteem and mood in cancer patients, according to a small 2015 trial. [10]
• Watching a funny movie decreased bronchial responsiveness in people with [11]
• Laughter and clowning reduced hyperinflation of the lungs in people with severe chronic obstructive pulmonary disease (COPD). [12]
• Hospital clowns reduce stress and anxiety levels in hospitalized children and their parents. [13]
• ElderClowns reduced agitation and increased happiness in nursing home patients. [14]
• Humor therapy (watching a 20-minute humorous movie) led to improvements in cognitive function, including learning ability, delayed recall, and visual recognition in study that included 30 older adults. [15]
• Comedy improv training led to subjective improvements in symptoms for people with Parkinsons disease. [16]
• A study of 30 people with schizophrenia found that 10 hours of humor skill training can improve rehabilitative outcomes and sense of humor (including change in negative symptoms). [17]
• Laughter decreased inflammation (as measured by pro-inflammatory cytokine levels) in people with rheumatoid arthritis. [18]
• Laughter and humor reduce wheal (skin swelling) reactions to [19]

Laughter also has the potential to significantly affect the quality of our work lives. Humor helps relieve tension, reassures people, and draws them together. It likely strengthens the bonds between patients and members of their care team.[20] It even seems to increase peoples willingness to disclose, so it may help with obtaining good information during patient interviews.[21] A study of laughter therapys effects on volunteer community care workers found that it reduced stress, anxiety, and depression.[22]

There are many ways to draw laughter and humor into a Personal Health Plan. Here are some suggestions:[20]

Simply mentioning that laughter, humor and fun are important in life can be helpful. If you say it as a clinician, patients are likely to pay attention.

Remember it is NOT just about recommending it, but intentionally bringing it into your daily practice and your life in general. As appropriate, share your humor with your patients and your colleagues. It will enhance their Whole Health, and it will enhance yours too. Learn a new joke every so often. (We take no responsibility for whether or not the jokes featured in this clinical tool are successful!)

Some hospitals have created clown care units (CCUs). Clowns go on rounds to help bring humor and laughter to inpatients. In the New York City area, Big Apple Circus offers CCU programs in seven hospitals.

Check out The Gesundheit Institute and their activities. Created by Patch Adams, MD, this organization is focused on bringing humor and laughter into health care. For more information, visit http://patchadams.org/.

Some health care facilities offer Laugh Mobiles; carts with items to facilitate humorous encounters are wheeled onto different services by humor volunteers. The Duke Humor Project has done this, for example, for cancer patients at Duke University Medical Center.

Encourage your patients to try laughter yoga. You can easily take just a minute or two to offer it during a patient visit. A quick Google search using Laughter Yoga will provide a number of groups offering courses. Research on laughter yoga is in its early stages, but it has been found to be at least as effective as group exercise for improving depression and life satisfaction in elderly women,[23] and it enhanced health in a group of nursing students.[24] It increased heart rate variability (which correlates with better overall health) in a small group of people waiting for organ transplants.[25] Parkinsons patients also had improvements in symptoms after laughter yoga.[26] A 2018 review of 6 Laughter Yoga studies concluded it has potential benefit for mental health issues, but more research is needed.[27]

To learn more about Laughter Yoga, refer to the following:

• Laughter Yoga International
  • This site has a lot of useful introductory information on laughter yoga.
• Wikihow
  • Note that the instructions featured on the site mention some Buddhist ideas, but laughter yoga is not itself linked to a specific spiritual or religious practice.
• YouTube videos
  • Laughter Yoga on Discovery Channel
  • People Laughing at Other People’s Laughs
• For other ideas on incorporating humor into health care, check out the Association for Applied and Therapeutic Humor.

“The Healing Benefits of Humor and Laughter” was written by J. Adam Rindfleisch, MPhil, MD, (2014, updated 2018).

References