Historically, laughter's benefits were primarily considered psychological. However, the publication of Norman Cousins' Anatomy of an Illness in 1979 sparked interest in its potential analgesic effects(1).
The field of psychoneuroimmunology now investigates the impact of laughter on our physiology and psychology. Current research indicates that laughter has quantifiable positive physiologic benefits(1). It’s important for practitioners to enhance their understanding of laughter in medicine and how it can be incorporated into lifestyle medicine.
While current benefits appear small and not yet widely corroborated, their potential in preventative medicine makes further research timely and useful and potentially fiscally sound due to its low cost and lack of side effects.
There is a distinction between "humor" (the stimulus) and "laughter" (the physical reaction). Laughter is defined as a physical reaction characterized by a distinct repetitive vocal sound, certain facial expressions, and contraction of various muscle groups(1).
Five types of laughter are identified in the literature:
This article focuses on non-pathological laughter(2).
Pathological laughter and crying are generally characterized as a disorder of emotional expression resulting from damage to pathways in the cortex and brainstem. This condition is distinctly different from the laughter and humor explored in this article.
Laughter can occur individually, such as when recalling a memory, watching television, or reading a book, as well as socially in groups, such as in a laughter yoga session or while exchanging stories with friends.
There are essentially three dominant psychological theories of laughter are discussed:
Currently, there is no definitive consensus on the most valid theory.
Spontaneous laughter ("genuine" or unforced) has been more extensively studied than other types of laughter. Below are the physiological benefits from laughter.
The proposed benefits of simulated laughter are primarily based on the Motion Creates Emotion Theory (MCET), which posits that the body may not distinguish between intentional and instinctive laughter, leading to similar physiological responses(2). Research is more recent and preliminary compared to spontaneous laughter.
A study on laughter yoga with IT professionals found significant reductions in blood pressure and cortisol levels, despite no significant changes in other physiological markers(7).
Another study on laughter yoga with depressed geriatric patients showed significant decreases in depression scores and increased life satisfaction, comparable to exercise therapy(8).
Positive mood is often linked with spontaneous laughter and has independent cognitive effects. Research attempting to isolate the effects of positive mood versus laughter has yielded mixed results, highlighting the complexity of the interaction. One study found that a video eliciting only positive effect (without laughter) was not enough to cause endorphin release, unlike a comedy video.
While health is serious, appropriate humor and laughter can foster trust and improve communication between provider and patient. Cynical and derogatory humor directed at the patient is deemed inappropriate and potentially harmful. Medical providers are advised to be cautious and follow the patient's lead regarding humor.
Given the link between depressed mood and decreased physical activity, laughter's therapeutic potential for depression could indirectly aid in promoting healthier lifestyles. Humor is increasingly used in geriatric care for patients with dementia, creating a positive environment conducive to lifestyle changes(9).
There is a speculative template for a "laughter prescription," suggesting providers could inquire about patients' recent experiences with laughter and make tailored recommendations. The Motion Creates Emotion Theory (MCET) suggests that even self-induced laughter can be beneficial, making it accessible to a wider range of patients.
Laughter prescriptions might contain detailed information as to the frequency, intensity, time, and type of laughter (forming the useful mnemonic “FITT”), much like pharmacological prescriptions and exercise prescriptions. This format aims to give patients clear and easy-to-remember guidelines. It is also a way to present laughter in a serious manner. When prescribing laughter, it would be of utmost importance to individualize the recommendations, taking into consideration the patient’s own sense of humor and willingness to engage in new activities, such as laughter yoga.
An example of a laughter prescription:
(F) Frequency: once a week, (I) Intensity: belly laughing, (T) Time: 30 minutes, and (T) Type: your favorite sit-com
Group laughter sessions are also highlighted as a potential avenue, with some research suggesting benefits for self-rated health, bone mineral density, and HbA1c levels in older adults(10).
Unfortunately, there are barriers to implementing laughter therapy into one’s practice. Time constraints for discussing laughter during consultations are acknowledged. Engaging patients with depression or dementia in laughter therapy may present challenges, especially during times of significant life stressors. Long-term success may depend on the support of the patient's environment and close social network.
The understanding of laughter's physiological effects has significantly grown, driven in part by the practice of laughter yoga. Laughter is now recognized as a distinct physical action with potential benefits, even without the presence of humor.
Research indicates that laughter can lead to positive chemical changes in the body, potentially reducing stress and increasing pain tolerance.
Given the rising costs of healthcare, laughter's potential as a low-cost, no-side-effect preventative and therapeutic tool warrants serious consideration, despite the need for more rigorous research.
In addition to frequent laughter, keeping your brain healthy with nutrition is the best thing you can do to make sure you remain sharp no matter your age. One of the most effective supplements you can take for that is creatine. It has been shown to have wide-ranging benefits on your muscles, brain, and more, including depression. You can learn more about creatine's effects on brain health and cognitive function here.
So now the question is: if laughter really is the best medicine, does that make stand-up comedians healthcare providers?
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References:
1. Louie D, Brook K, Frates E: The Laughter Prescription: A Tool for Lifestyle Medicine. Am J Lifestyle Med 10:262-267, 2016
2. Mora-Ripoll R: The therapeutic value of laughter in medicine. Altern Ther Health Med 16:56-64, 2010
3. Szabo A, Ainsworth SE, Danks PK: Experimental comparison of the psychological benefits of aerobic exercise, humor, and music. 2005
4. Bennett MP, Zeller JM, Rosenberg L, et al: The effect of mirthful laughter on stress and natural killer cell activity. Altern Ther Health Med 9:38-45, 2003
5. Dunbar RI, Baron R, Frangou A, et al: Social laughter is correlated with an elevated pain threshold. Proc Biol Sci 279:1161-7, 2012
6. Jacka FN, O’Neil A, Opie R, et al: A randomised controlled trial of dietary improvement for adults with major depression (the ‘SMILES’ trial). BMC Medicine 15:23, 2017
7. Nagendra H, Chaya M, Nagarathna R, et al: The efficacy of Laughter Yoga on IT professionals to overcome professional stress. Laughter Yoga International: Mumbai, India, 2007
8. Shahidi M, Mojtahed A, Modabbernia A, et al: Laughter yoga versus group exercise program in elderly depressed women: a randomized controlled trial. Int J Geriatr Psychiatry 26:322-7, 2011
9. Hafford-Letchfield T: Funny things happen at the Grange: introducing comedy activities in day services to older people with dementia--innovative practice. Dementia (London) 12:840-52, 2013
10. Hirosaki M, Ohira T, Kajiura M, et al: Effects of a laughter and exercise program on physiological and psychological health among community-dwelling elderly in Japan: randomized controlled trial. Geriatr Gerontol Int 13:152-60, 2013
