The Use Of Humor And Laughter In Therapy

Progressive spiritualists and medical professionals alike are increasingly propagating the
value of laughter therapy in the healing of mind and body. The question whether there is a
firm scientific basis to this has initially haunted the medical fraternity. This is
understandable – the possibility of being denounced as non-serious and petty is one of the
foremost fears in the mind of every serious researcher or healer. However, there is
increasing evidence being found in favor of this rapidly emerging form of treatment.

The Association for Applied and Therapeutic Humor (AATH) succinctly defines
therapeutic humor as ‘any intervention that promotes health and wellness by stimulating a
playful discovery, expression, or appreciation of the absurdity or incongruity of life's
situations. This intervention may enhance work performance, support learning, improve
health, or be used as a complementary treatment of illness to facilitate healing or coping,
whether physical, emotional, cognitive, social, or spiritual’.

The Scientific Basis Of Laughter Therapy

As early as 1989, Lars Ljungdahl reported in an article for the Journal of the American
Medical Association (1) that the regular inducement of the laughter reflex can have
profound positive effects on a patient’s symptoms. He went on to state that a patient who
is given the benefit of laughter therapy will invariably experience an upward curve in the
general quality of life.

As already stated, there is now sufficient scientific basis to validate such findings. It has
been found that hearty laughter – induced or naturally-occurring – produces biological
effects comparable with the much-publicized and highly cherished ‘jogger’s high’. In
other words, it causes the release of endorphins, which are the body’s very own
painkilling and depression-combating chemicals. They have an effect comparable to that
of opiates, meaning that they cause a radical upward swing in mood that can often attain
euphoric heights. This effect is, of course, a strictly temporary one, but it can be
replicated with regular application of the stimulus that produced them.

Other studies have revealed that laughter involves the amygdale and the hippocampus,
sectors of the limbic system that are closely linked in emotional coping and survival. This
would seem to indicate that laughter is, in fact, an act of survival. It is also significant that
nitrous oxide, or ‘laughing gas’, is often used as a pain reliever. When subjected to
laughter therapy, drug and alcohol dependent patients undergoing the painful ‘withdrawal
period’ invariably report substantial relief from their physical and mental anguish.

There are still, of course, many an eyebrow raised at such an unconventional form of
treatment. The primary problem with establishing verifiable test results that would
convince the more procedure-oriented academia is not lack of success of humor in
treatment of physical and emotional disorders, but rather the fact that such success is
based on spontaneous therapeutic situations that can often not be replicated under test
conditions. However, in an article for the Journal of General Psychology (2) Louis R.
Franzini confirms that the popularity of humor as a therapeutic tool is on the increase
despite the fact that a lot of research still remains to be done.

There is no scientific evidence that laughter therapy can produce anything as dramatic as
remission of cancer or other serious ailments. Though it definitely does produce highly
beneficial metabolic changes, including on the cellular level, it would be premature to
state that it can actually reverse a degenerative biological process. It is without doubt an
enormously helpful adjunctive line of treatment in certain organic diseases. The
established fact that laughter promotes the production of endorphins in the body makes it
an invaluable tool in the pain management of arthritis, rheumatism and other painful
degenerative ailments. Moreover, there is sufficient documentation to substantiate its
validity in the field of mental health.

Laughter Therapy In Mental Health

In an article entitled ‘Using Humor in the Counseling Relationship’ (3) Steven M.

Sultanoff, Ph. D. is unequivocal in his assertion that humor has profound beneficial
effects on a patient’s feelings, behaviors, thinking and biochemistry. These areas
encompass the width and breadth of almost all known mental illnesses. However, he goes
on lay down strict parameters on how it should be employed. He stresses that the use of
humor should be part of the therapist’s dedicated arsenal, thereby implying that the
therapist himself should believe in its efficacy. He also points out that a regimen of
laughter/humor therapy should be planned in accordance with the patient’s own level of
understanding and ability to respond to it.

According to Sultanoff, a mental therapist who has accurately gauged the patient’s
response patterns can employ spontaneous humor to great strategic advantage. A lot
depends on the therapist’s insight into the patient’s case, as well as the means he has at
his disposal to evoke a humorous response at short notice. While some patients respond
well to light hearted banter or other interactive means, others might react more favorably
to stimuli such as cartoons and the narration of anecdotes.

In yet another article entitled Using Humor For Treatment and Diagnosis:
A Shrinking Perspective (4) Sultanoff maintains that manipulating one area of a patient’s
mental environment can have direct and favorable bearing on a corresponding area. In
terms of treating a mental ailment, this has enormous significance. It means that by the
application of laughter therapy to upgrade a patient’s emotions, that patient’s behavior
can be effectively modified.

On this subject, president of The Laughter Remedy Paul E. McGhee, PhD (5) refers to
Candace Pert’s assertion (6) that emotions – the state of which dictates a person’s mental
wellbeing – are the key to a healthy connection between mind and body. The
neurochemicals called neuropeptites produced by the body decide whether the person is
well or not. From a mental as well as holistic health point of view, this means that the
brain and the body are in constant communication with each other by means of these
chemicals. According to her, laughter therapy ensures that the messages sent via these
neuropeptites are positive and beneficial.

Paul McGee goes on to confirm his belief that overall physical and mental wellbeing is
directly related to a person’s attitudes, thoughts, moods and emotions. Our immunity to
disease of any kind is directly related to the positive emotions such as optimism, caring -
and humor, and the presence of physical or mental sickness is traceable to negative
emotions such as hate, suspicion and humorlessness. This phenomenon, known as
psychoneuroimmunology, seems to encompass the premise that laughter promotes
physical, mental and spiritual health.

His findings substantiate those of other researchers the world over, as well as a fact
known to astute observers from the beginnings of recorded medical history - laughter
promotes muscle relaxation, stress reduction and immunity to mental and physical
disease. Mental health treatment that includes humor therapy is obtaining amazing results
in institutions all over the world now, and the medical community is taking note. Bernard
Saper (7) notes that ‘a well-developed sense of humor provides a beneficial ingredient to
the patient's coping or adjustive ability’.

Practical Implementation Of Laughter Therapy

Like any other form of structured treatment, laughter therapy can and must be integrated
into the overall therapeutic module. While spontaneous humor definitely has its merits in
a patient-therapist relationship, it is far from predictable and cannot be counted on to reap
definite and progressive results. Unless the therapist is a gifted humorist in his or own
right, bringing laughter into the treatment process is a matter of planning and strategy.

The process begins with an analysis of the patient’s or patient groups overall receptivity.
Introducing humor into a therapeutic community consisting of chronic melancholics is
obviously not an easy task. In such circumstances, a lot depends on a ‘never-say-die’
attitude on the part of the therapist. Patients generally take some time to warm up to
lightheartedness, especially in the face of serious illnesses such as cancer or massive
depression. In the case of the latter, a pharmaceutical approach to making a patient less
self-involved and more open to the humor stimulus may be opted for.

In certain cases, the concept may well have to be explained to a therapeutic community.
Vancouver-based mental health counselor and stand up comedian David Granirer notes
that he found a less than favorable response with his mentally ill patients to begin with. In
his Stand Up For Mental Health courses, he involves them in regular workshops that
propagate an appreciation for laughter – and perhaps instill the ability to laugh in the first
place. Since most people do have at least a nominal sense of humor, such extreme
measures are not usually called for.

However, the level of trust between therapist and patient will decide how effective
laughter therapy will be in that particular case. If it exists sufficiently, much can be
achieved. As Sylvia Mauger correctly observes in her article for Stress News (8) –
‘(Humor) is based on caring and empathy. An invitation to laugh is an invitation to share
and, as such, it is supportive and so builds confidence between two people. This can be as
true in a group situation as that of one-to-one counseling.’

When the therapist has a good idea of what level of receptivity and trust is available with
an individual patient or patient group, certain techniques are definitely called for. The
Indian discipline of Haasya Yoga (9) for instance, is a reportedly highly efficacious
method of yogic stretching and breathing based on stimulated laughter. The point that the
laughter is, to begin with, induced and not natural is not considered significant – the
physical and mental benefits accrued are the same. Moreover, Haasya Yoga states that
induced laughter helps and individual to develop the ability to laugh naturally.

Induced (non-spontaneous) laughter as a valid form of therapy is also borne out by the
findings of Norman Cousins (10) in alleviating the symptoms of his ankylosing
spondylitis (a painful disease causing the disintegration of the spinal connective tissue).
These were investigated by medical professionals, who confirmed that vigorous, self-
induced laughter performed regularly seemed to have biologically reversed some of
Cousins’ symptoms and even certain physical manifestations of the disease. Inflammation
levels were dramatically decreased and had helped him to sleep soundly.

Certified laughter leader Florence Rita Rickards, a protégé of ‘Laughter Guru’ Dr. Madan
Kataria, conducts workshops to instruct in the therapeutic use of laughter. She states that
her techniques "reduce stress, increase respiration, increase heart rate (three to five
minutes of hearty laughter is equivalent to three minutes of strenuous activity on a rowing
machine), decrease high blood pressure, boost the immune system, reduce hardening of
the attitudes" and make them feel and look younger. Dr. Madan Kataria’s module
launched the initial spate of Laughter Clubs in his native India – the movement has now
taken on global proportions.

Dr. Kataria’s method of therapeutic laughter is not based on spontaneous or ‘genuine’

laughter. It is unlikely that any contemporary human being will find it possible to laugh
with real mirth for the 10 to 15 minutes that are required to produce beneficial results.
Jokes and humor of any kind are not employed in his method. Rather, he states that it ‘is
purely a physical process where you laugh for no reason. It soon becomes infectious and
real. This is much deeper and powerful than laughter coming out of jokes and comedies.’

Humor In Cognitive Therapy

The process of desensitizing a patient from a certain fear, phobia or neurosis is an

essential part of cognitive therapy. There are various approaches, but the classic module
described by McKay, Davis and Fanning (11) outlines the process of ‘learn(ing) to relax
while imagining scenes that are progressively more anxiety provoking’. A phobias is the
fear of a relatively commonplace object or situation the threat of which is multiplied
infinitely in the phobic’s mind. It could be the fear of spiders (arachnophobia), the fear of
enclosed spaces (claustrophobia) or any number of other things.
As illogical as they may seem, phobias can have an extremely debilitating effect on the
phobic. For example, Dr. Edmund J. Bourne (12) describes some common phobias faced
by executives in the corporate world –such as the fear of giving presentations. In all
cases, however, the process of desensitization involves making the patient imagine
progressively more threatening situations associated with the object of the phobia within
a safe, therapeutic setting. In this manner, the patient is confronted with the baselessness
and self-defeating nature of his or her phobia and is effectively relieved to a great or even
complete extent of the burden of that phobia.

When laughter therapy is used in desensitization, the patient is also guided through a
process of imaginary threatening situations under controlled therapeutic conditions.
However, here the element of humor is introduced and used to progressively lessen the
provoked anxiety response. In other words, the fear or phobia is gently ridiculed. W.
Larry Ventis, Garrett Higbee and Susan A. Murdock (13) quote the finding of Koestler,
who proposed that ‘laughter serves to relieve physiological arousal associated with the
emotions of aggression or apprehension’.

They add that such findings have not been clinically proven; however, they are in favor
of a desensitization process that does not expose the patient to needless suffering. In the
normally understood format, desensitization requires the patient to undergo a great
amount of emotional and mental discomfort as he or she is confronted with mental
imagery with escalating levels of danger and distress. In laughter therapy, such negative
emotions are kept to the minimum – instead, the patient may, by definition, even enjoy
the process of confronting a long-standing fear. This can have significant bearing on
patient attrition rates in therapy groups where traditional desensitization techniques are
employed. A patient who is offered an opportunity to laugh while being weaned off a
long-standing fear is certainly less likely to drop out of therapy than one who is subjected
to increasingly more discomforting mental imagery.

These researchers conducted a study with 40 undergraduate psychology students who

professed a fear of spiders to varying degrees. 39 of these participated in the study from
beginning to end. The object was to desensitize this control group using an American
tarantula using humor as well as traditional desensitization techniques, and to compare
the resultant findings in order to establish whether the former was more effective than the
latter. Though the study could not establish such a hypothesis, it did confirm that both
humor desensitization and traditional desensitization result in a significant reduction in
fear responses, while leaving the patient untreated with any kind of desensitization at all
shows no significant improvement in the fear response.

While the primary research hypothesis that ‘humor desensitization’ was far more
effective in reducing the fear response in phobics than the more conventional methods of
desensitization could not be confirmed there were nevertheless some interesting findings.
One subject in the case study responded favorably to humor desensitization where
traditional techniques had failed completely, while yet another subject displayed
significant improvement in the phobic response in a single humor desensitization session.
The study involved having the subjects associate humorous contexts to the object of their
phobia (i.e. the tarantula). They were also provided with humorous props such as a
squeaking rubber tarantula to further help them in modifying their fear response.

Louis R. Franzini (14) advocates the inclusion of humor in the formal training curriculum
for therapists and offers some convincing arguments in favor of this. Furthermore, he
reiterates what many therapists who employ humor therapy in their regular treatment
modules have found to be true – that the benefits of using humor therapy are mutually
shared by both therapist and patient. In essence, it has been found that it reduces the
normally high stress levels among professional therapists and greatly reduces the early
onset of ‘professional burnout’ (sic).

Aaron T. Beck (15) describes the confrontative nature that traditional cognitive therapy
can sometimes assume, and points out that the patient can often experience the feeling
that he or she is being trapped for contradictions by the therapist. In contrast, a therapist
who has been trained in the skillful use of humor during the treatment process is
equipped to defuse this fear with a patient. Beck points out the importance of eliminating
feelings of being ridiculed or belittled by the therapist – therefore, it makes a lot of sense
that the therapist be trained in the best possible use of humor under treatment conditions,
since unskilled use of this tool can have adverse rather than beneficial effects and erode
the necessary bond of trust between patient and therapist.

Summary

Laughter has been recognized as a curative treatment tool since ancient times. Healers
from the East have employed it to counter the detrimental effects of a number of
ailments, both physiological and psychological. Many other ancient therapeutic
disciplines had remained in use only by obscure practitioners whose teachings were not
scientifically established. However, there has been a general awakening to alternative
treatment methods in the last century, and laughter therapy has now become a matter of
serious research.

The findings of Dr. Lee Berk (16) and Dr. Stanley Tan of Loma Linda University,
California have published papers on the subject of neuroimmunology that are very
definite on the beneficial effects of laughter on the immune system. Briefly, they have
found that laughter produces physiological responses that are directly opposed to those
produced by stress. The state produced by mirthful laughter, also known as the ‘eustress
state’, is typified by healthy and positive emotions. They go on to enumerate all the
positive metabolic changes produced by laughter – a reduction in blood pressure and
stress hormones, increased muscle flexion, enhanced production of disease-countering T
and B-cells and increased production of endorphins, among others.

Humor therapy is also findings increasing application in pain management. A study was
conducted by Henderson (17) to suggest the possibility that humor therapy programs
could be developed to relieve pain. The findings, though limited by the small numbers
and the lack of a control group, were nevertheless significant - pain decreased in 13 of 15
different pain types. This is extremely noteworthy, since it suggests an alternative avenue
of treatment in a field presently dominated by analgesics. If laughter therapy offers itself
as even a marginal substitute for pharmacological solutions in pain management (and it
certainly seems to) then the quality of life and survival rate among patients suffering from
painfully degenerative diseases can be boosted by its use. In other words, though it can
assuredly not be claimed that laughter therapy can reverse the ravages of cancer or
rheumatism, they can certainly benefit from such a non-medicinal solution to pain
management.

The efficacy of laughter therapy in the treatment of mental illness is an established and
highly documented fact. While much depends on the training and skill of the therapist,
and while there are certainly limitations on the scope of its applicability in this field,
mental treatment centers and professionals the world over are now including laughter
therapy in their treatment modules for chronically depressed patients.

There is some controversy as to whether induced (non-natural) laughter such as is

employed in the ancient Indian discipline of Haasya Yoga is as therapeutically beneficial
as spontaneous laughter. Indeed, therapists who have the ability to produce spontaneous
laughter in their patients report excellent results. However, the very fact that spontaneous
laughter can, by its very nature rarely be planned for makes its efficacy difficult to
document under controlled scientific study conditions. Emerging alternative therapists
like Dr. Madan Kataria do not depend on spontaneous laughter in their methods of
treatment; yet the benefits derived by members of ‘Laughing Clubs’ seem to be real and
inarguable. This offers a useful guidepost to therapists who are confused as to whether
they can actually elicit genuine laughter in their patients on a regular and therefore
therapeutically useful basis. The beneficial effects of therapeutically ‘planned’ laughter
have been extensively mapped and verified by various serious researchers.

One area where laughter has proved an immensely useful tool is that of systematic
desensitization. Patients suffering from a certain neuroses and phobias that prove to be
detrimental to the quality of their life have been successfully treated by application of
humor desensitization techniques. So far, it has not been established that this form of
treatment is more efficacious than conventional desensitization modules. However, the
use of humor in cognitive therapy has certainly produced some dramatic and even
unprecedented results.
Bibliography:

1. "Laugh If This Is a Joke", JAMA, Jan 1989, 261: 558.

2. Humor in Therapy: The Case for Training Therapists in Its Uses and Risks (April
2001)
3. Laugh It Up, Publication of the American Association for Therapeutic Humor,
May/June, 1992, p. 1.
4. Therapeutic Humor, Publication of the American Association for Therapeutic
Humor (January/February 2000, Vol. XIV, p. 5.
5. Humor and Health - Paul E. McGhee, PhD
6. The Molecules of Emotion by Candace Pert
7. The therapeutic use of humor for psychiatric disturbances of adolescents and
adults, Bernard Saper (Department of Psychology at Florida International
University)
8. The Use Of Humor In Stress Management, Stress News July 2001 Vol.13 No.3
9. Ayurvedic Dictionary on Laughter Therapy
10. Anatomy of an Illness As Perceived by the Patient, Norman Cousins (1979)
11. Thoughts & Feelings: The Art of Cognitive Stress Intervention, by McKay, Davis,
& Fanning, chapter 6.
12. The Anxiety & Phobia Workbook, by Dr. Edmund J. Bourne
13. Using Humor in Systematic Desensitization to Reduce Fear, W. Larry Ventis,
Garrett Higbee and Susan A. Murdock, Journal of General Psychology, April,
2001.
14. Humor in Therapy: The Case for Training Therapists in Its Uses and Risks,
Journal of General Psychology (April, 2001) by Louis R. Franzini
15. Cognitive Therapy of Depression, by Aaron T. Beck, page 71
16. a) "New Discoveries in Psychoneuroimmunology" an interview with Dr. Lee
Berk, Humor & Health Letter, Humor & Health Letter, vol 3, no. 6, 1994
b) "The Laughter-Immune Connection: New Discoveries," Lee S. Berk, DPH,
Humor and Health Journal, vol. 5, no. 5, 1996.
17. Management of Chronic Central Neuropathic Pain Following Traumatic Spinal
Cord Injury, Henderson (1993)

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