“Hearty laughter is a good way to jog internally without having to go outdoors.” – Norman Cousins
A case study in laugh therapy
In the years after WWII, American journalist, peace activist, and author Norman Cousins developed a sudden-onset case of connective tissue disease, along with what was later diagnosed as ankylosing spondylitis. Doctors gave him a slim chance of recovery. Cousins, undeterred, set about creating his own plan for recovery.
His primary medicine? Hearty laughter.
Facilitated by comic films and episodes of Candid Camera, Cousins discovered that as little as ten minutes of belly laughter eased his symptoms and gave him hours of pain-free sleep. Cousins documented his experiments, and their positive results, in his 1979 book titled Anatomy of an Illness as Perceived by the Patient.
Recommended for nurses: Humor as a Healthcare Professional Intervention
The science of laughter
Cousins’ approach to healthcare is not merely anecdotal. The physical, mental, and psychological benefits of laughter are well-documented and grounded in science. Indeed, many physicians recognize the therapeutic benefits of laughter, recommending funny movies, “laughter yoga,” or comedy shows to their patients over, or sometimes in conjunction with, medications.
But why does laughter work? Humor is composed of three experiences: intellectual (wit), emotional (fun, joy), and physiological (laughter, smiling). Likewise, comedy always contains some measure of truth or self-awareness, which can be healing, even in the darkest moments.
The benefits of humor go deep. Laughter effects mood, stress levels, cognitive health, and overall quality of life.
Studies have shown that laughter can elevate mood and relieve stress and anxiety. Laughter also increases the “happy” brain chemicals, dopamine and serotonin, while reducing stress hormones cortisol and epinephrine. A study involving “laughing yoga” classes found that participants reported increased energy and reduced tension. Laughter can also alleviate depression and improve sleep quality.
Quality of life
Laughter has benefits for patients and caregivers alike, reducing stress and improving their psychological health. Quality of life markers among nursing home residents have been shown to improve when introducing humor. Laughter therapy improves the quality of life for cancer patients, as well as boosting their immune systems.
In one study among older diabetic patients, watching humorous videos improved participants’ short-term memory, learning, and visual recognition. Additionally, humor and laughter play a role in creating a safe social environment. According to one study, people with cognitive impairment could still engage in humor during social interactions, despite difficulty recognizing social cues.
The cognitive benefits of humor go beyond healthcare. Teachers who incorporate humor into their lessons help to create a fun learning environment, in which their students are more likely to retain the main points of the lesson.
A 2019 study (Lapierre et al.) involving pain and muscle soreness supported Norman Cousins’ experimental findings. The study showed that watching a comedic movie for only 30 minutes significantly and immediately reduced symptoms, compared to a placebo group that viewed a documentary.
Similarly, Behrouz et al. (2017) observed a 43% decline in moderate pain intensity after a six-week humor therapy program in a sample of older people residing in an Iranian nursing home. The intervention consisted of six weekly, one-hour sessions, including funny video clips, games, comical stories, humorous music, and jokes.
The researchers conclude that humor therapy can potentially impact pain intensity and suggested implementing a humor program in nursing homes.
Laughter is also good for your heart. Researchers discovered that intense laughter provides a short burst of aerobic exercise. A good hard belly laugh can increase your heart rate, respiratory rate, and oxygen consumption. Stress can release adrenaline and noradrenaline, resulting in blood vessel constriction. Evidence exists that laughter helps reverse that by engaging the endothelium, the blood vessels’ inner lining, which allows for increased blood flow.
Biophysical studies show that laughter stimulates the diaphragmatic breathing necessary for increasing lymphatic flow, releasing more lymphocytes. Improved lymphocyte production results in better immunity toward all diseases, especially cancer.
Additional findings indicate that laughter can further strengthen the immune system by:
- Activating T-cells
- Increasing gamma interferon, which signals various components of the immune system to “turn on”
- Raising the production of IgB to fight infected cells
- Reducing the inflammation-triggering cytokines found in rheumatoid arthritis
Laughter helps build social cohesion and connection. Telling a joke can relieve anxiety, promote communication, and act as a buffer against disagreements. A shared laugh is one of the most effective ways to build and maintain relationships and heal resentments. Properly used, laughter helps connect people during adversity and brings levity to dark moments.
Recommended for behavioral health professionals: The Essentials of Play Therapy, 1st Edition
Using humor in the workplace
Though laughter is universal, not all forms of humor are appropriate in the healthcare space. Goodhearted irony, satire, and other affirming humorous styles can help both patients and their caregivers cope with stress, build rapport, and improve communication.
Dark humor, as well as sarcasm and cynicism, may not be appropriate, as those styles are easily hurtful or misconstrued. They may also exacerbate patient fears, and should be avoided unless the patient has already established a preference for that kind of humor. In all cases, tact is essential.
Emerging evidence indicates that certain styles of humor are associated with resilience. Adaptive styles use a cheerful, friendly tone to connect with others through funny comments, anecdotes, or self-effacing humor. In contrast, maladaptive styles use sarcasm to insult others, elevate themselves at the expense of someone else, or leverage cruel humor to gain attention.
Exposing children to humor and laughter is paramount in developing resilience. Nurturing a sense of humor helps children cope with school stressors, relationships, and home life, while comedy can enhance social bonding, promote stress relief, and help with pain management. Growing up with laughter propels children on a positive pathway where humor is predictive of better college performance.
The best medicine
The therapeutic benefits of laughter are profound and far-reaching, touching all aspects of life. Humor strengthens interpersonal relationships, improves cognitive function and mental health, strengthens our bodies, and helps reduce stress.
For healthcare professionals and patients alike, the adage holds up: sometimes, laughter truly is the best medicine.
- AANMC (2020) Therapeutic Benefits of Laughter and Humor. https://aanmc.org/featured-articles/therapeutic-benefits-laughter-and-humor/
- Ask the Scientists (2021). Laughing as Medicine: The Benefits of Sharing a Laugh. https://askthescientists.com/laughter-immunity/
- Behrouz, S.et al. (2017). Investigating the Effect of Humor Therapy on Chronic Pain in the Elderly Living in Nursing Homes in Mashhad, Iran. Evidence Based Care Journal, 7 (2), 27-36. doi: 10.22038/EBCJ.2017.24247.1529
- Fritz, H.L. (2020). Coping with Caregiving: Humor styles and health outcomes among parents of children with disabilities. Research in Developmental Disabilities, 104, 1-13. doi: 10.1016/j.ridd.2020.103700
- Gendry, S. (2020). Why Laughter is Good for the Immune System, Opens Inner Cellular Pharmacy. Laughter Online University. https://www.laughteronlineuniversity.com/laughter-immune-system/
- Greengross, G. (2018). How Humor Can Change Your Relationship. Psychology Today. https://www.psychologytoday.com/us/blog/humor-sapiens/201811/how-humor-can-change-your-relationship
- Laugh Off Life. The Remarkable Story of Norman Cousin. https://sites.google.com/site/laughofflife/page-1
- Lipstak, A., et al. (2014). Humor and laughter in persons with cognitive impairment and their caregivers. Journal Holistic Nursing, 32(1), 25–34. doi: 10.1177/0898010113500075
- Proyer, R.T. & Rodden, F.A. (2020). Virtuous Humor in Healthcare. AMA J Ethics, 22(7), 615-618. doi: 10.1001/amajethics.2020.615.