The Healing Power of Humor

The Healing Power of Humor Dr. Stuart Robertshaw, EdD, JD President & CEO National Association for the Humor Impaired www.drhumor.com The 14 th Annual North Alabama Nurse Practitioner Association Symposium Sept. 25, 2009 What is Psychoneuroimmunolgy? The study of the impact on our health of our thoughts, moods, emotions and belief systems. We know that our body s healing responds positively to some events and negatively to others. We know that failure to be able to express negative emotions may cause us to stew in our own juices Laughter and the Immune System It has long been recognized that stress weakens the immune system, leaving us more vulnerable to illness. Further, the immune system is sensitive to our moods being stronger on up days and weaker on down days. Evidence is now accumulating to conclude that humor boosts the immune system. That evidence is from a series of studies where immune system measures are taken before and after a humorous event usually a comedy video. - Immunoglobulin A (IgA) the greatest amount of research has focused on IgA which is a chemical that serves to protect us against upper respiratory problems like colds and the flu. Our saliva contains IgA and is referred to as the body s first line of defense against upper respiratory viral and bacterial infections. Following a humorous event, IgA increases and is measurable up to 12 hours after a 45 minute laughter session. Laughter and the Immune System (cont.) - Immunoglobulins M and G also have been shown to be enhanced as a result or humor/laugher - Complement 3 increases which helps antibodies pierce through defective or infected cells in order to destroy them - B Cells Increased B cells are produced in the bone marrow and are responsible for making the immunoglobulins. If you count these cells in the blood before and after a comedy video, there is a significant increase circulating throughout the body. - Natural Killer (NK) Cells increase following a comedy video - NK cells have the role of seeking out and destroying tumor cells in the body, as well as battling the latest cold and flu generating viruses and other foreign organisms. - Gamma Interferon increases following a comedy video gamma interferon is a complex substance that plays an important role in the maturation of B cells and the activation of NK

cells. It also tells different components of the immune system when to become more active and regulates the level of cooperation between cells of the immune system. A Sense of Humor and Immunity Studies indicate that those with higher scores on a humor test: - had a higher baseline of IgA - showed the greatest gain in IgA watching a funny video Further, those with a well developed sense of humor, it appears that daily problems did not weaken their immune system. And those who rarely found humor in their own lives were associated with greater suppression level of IgA Laughter and Stress When you re under stress, your body undergoes a series of hormonal changes which make up the fight or flight response. Even though there may not be any physical threat, your body reacts as if there were. If you re under stress day after day, it poses a serious threat to your health. Anything which reduces the level of stress hormones in the blood on a regular basis helps reduce this health threat. A 2001 UC-Irvine study demonstrated that just knowing you will be involved in a positive humorous event days in advance reduces the levels of stress hormones in the blood and increases levels of chemicals known to aid relaxation.16 adult males were surveyed on their opinions of what they thought was funny including a specific video tape that all 16 agreed was very funny. 8 subjects were then told 3 days in advance that they would participate in an experimental laughter group and would be watching the funny video. Periodic blood samples were collected from both groups. For those who knew in advance that they would be watching the funny video: 1. Epinephrine (also known as adrenaline) decreased 70% 2. Cortisol (a stress hormone) decreased 39% 3. Endorphin levels of the feel-good hormone rose 27% 3. Growth Hormone rose 87%. The growth hormone is a beneficial chemical that stimulates the immune system Incidentally, there is a 2008 study that indicates joyful music may also increase blood flow by 26%, while anxiety inducing music (i.e.. for the middle aged subjects it was heavy metal) narrowed blood vessels by 6%. Humor and Pain Reduction A Japanese study involving patients with rheumatoid arthritis documented that listening to a one hour tape of comic stories daily significantly reduced the level of pain experienced by the patients. A Swedish study reported that six women suffering from painful muscle disorders got significant relief from pain through a 13 week course on humor therapy where they read funny books, watched comedy tapes and worked at giving higher priority to humor in their everyday lives. Researchers examined the responses to pain among 21 healthy children, ages 8 to14, as they put an arm in a tub of ice-cold water while watching a humorous video and when they watched the video before and after the experiment. Results: If they laughed beforehand, they reported the cold water did not feel so bad. If they laughed during the experiment, they were able to keep their arm submerged longer. Two young girls who were burn victims were able to reduce the level of pain during hydrotherapy by watching cartoons. A Dec., 2008 involved 649 adults who completed self-report questionnaires before and after laughter club exercises. The questionnaires measured pain and mood levels of the participants. The researchers reported a significant decrease in pain reduction and an increase in positive mood elevation following the simulated laughter exercises.. Laughter and the Impact on Respiration The process of breathing is designed to inhale fresh, oxygen rich air and exhale carbon dioxide. When we are not breathing deeply, residual air remains in our lungs which has less oxygen, more water vapor and carbon dioxide all conditions that are a favorable environment for bacterial growth and pulmonary infection.

Each time we laugh, we get rid of the excess carbon dioxide and water vapor that builds up and replace it with oxygen-rich air. Emphysema patients often have a build-up of phlegm or mucous in their respiratory tracts. However, when they laugh, they inevitably start coughing, producing the exact effect medical personnel want for the patient as it helps expel the built up fluids. Audience demonstration: 15 seconds of laughter Laughter and Diabetes A 2003 study in Japan found that laughter lowers blood sugar in people with type 2 diabetes. Procedure: blood-sugar measurements were collected from 19 adults with Type 2 diabetes. After dinner on day 1, patients attended a boring lecture. After dinner on day 2, they were entertained by stand-up comedy. After meal blood-sugar went up after the comedy show but significantly less than it did after the lecture. Even in healthy subjects without type 2 diabetes, a similar response to laughter was observed. The researchers suggest that chemical messengers made during laughter may help the body compensate for the disease. Laughter and Diabetes (cont.) A 2009 study assigned 20 adults with type 2 diabetes to a control or laughter group. All adults were taking high blood pressure medicines and cholesterol-lowering drugs. The laughter group was instructed to view self-selected humor for at least 30 minutes every day. That usually meant watching sitcoms or funny movies. After 12 months, the researchers evaluated both groups by measuring cholesterol levels and levels of C-reactive protein, a marker of inflammation thought to be associated with heart disease. Results: The laughter group had an increase in good HDL cholesterol of 26 percent, compared to just a 3 percent increase in the good cholesterol of the control group. In addition, harmful C-reactive proteins declined by 66 percent in the laughter group but just 26 percent for the control group. The researchers concluded that you are decreasing the bad chemicals in the body with laughter and increasing the good chemicals, which help you stay well, may prevent disease and may well have additional value relative to the therapies you are taking. Additional Benefits of Laughter Laughter is an excellent source of cardiac exercise. (even 15 seconds of belly laughing can produce an elevated heart rate). As Dr. Paul McGhee says, Laughter is FUNdamental to good cardiac conditioning. Cardiac Patients - A 1997 study involved 2 groups of patients who had had myocardial infarctions and were followed in a cardiac rehab program. Both groups were matched, but the experimental group was allowed to view selfselected humor for 30 minutes per day as an adjunct to standard cardiac therapy. The control group watched travel videos. The patients in the humor group had: 1. fewer episodes of arrhythmias, lower blood pressure, a lower requirement for beta-blockers and nitroglycerine, and 2. markedly lower incidence of recurrent myocardial infarctions.

Additional Benefits of Laughter (cont.) Allergies A Japanese Study involved 26 patients with atopic dermatitis (an allergic inflammation of the skin). The patients refrained from taking their allergy medication for 72 hours and then watched Charlie Chaplin s movie Modern Times. After the movie, the patients were injected with dust mites allergen to see if the movie had any effect on their allergies. There was a significant decrease in the size of the hives, an effect that lasted for 2 hours. Weight Reduction 10 to 15 minutes of daily laughter can burn up to 50 calories daily which would result in a weight loss of 4.4 pounds annually. A Sense of Humor and Longevity Out of 54,000 adults studied those who evidence a great sense of humor outlived those who don t find life funny. Further, a subgroup of 2,015 who had a cancer diagnosis, after seven years, those with a great sense of humor decreased their chances of dying by 70% when compared to those with a poor sense of humor. Question: Do People with a Good Sense of Humor, Who Laugh Often, Get Sick Less Often? Studies of Mothers of Newborns: In a study of mothers of newborn infants, those mothers who actively use humor to cope with stress: had fewer respiratory infections and their infants also had fewer infections, and had a higher concentration of IgA in their breast milk. Another study showed that mothers with low levels of IgA at the time of birth had babies who showed more illnesses in the first 6 weeks postpartum. What is Therapeutic Humor? (Association for Applied and Therapeutic Humor, 2000) 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 health or be used as a complementary treatment to illness to facilitate healing or coping, whether physical, emotional, cognitive social or spiritual. Note: AATH was founded in 1987 to advance the understanding and application of humor and laughter for their positive benefits. In summary, what do we know to be true about humor, mirth and laughter? According to the Association for Applied Therapeutic Humor... We know that humor (the cognitive perception of playful incongruity)... 1. Reduces stress, anxiety, and tension 2. Promotes psychological well-being 3. Raises self-esteem 4. Improves interpersonal interactions and relationships 5. Builds group identity, solidarity and cohesiveness 6. Enhances memory (for humorous information) We know that mirth (the positive emotion that accompanies humor)... 7. Increases pain tolerance 8. Elevates mood 9. Increases hope, energy, and vigor 10. Counteracts depression and anxiety 11. Enhances creative thinking and problemsolving 12. Increases friendliness and helpfulness We know that laughter (the respiratory-vocal behavior that communicates emotion to other)... 13. Intensifies mirth 14. Is contagious (and induces mirth in others) 15. Increases interpersonal attraction and closeness 16. Exercises respiratory muscles References Bellert, J.L. Humor: A therapeutic approach to oncology nursing. Cancer Nursing, 1989, 12, 65-70.

Berk, L.S., et al. Neuroendocrine and stress hormones change after mirthful laughter. American Journal of the Medical Sciences, 1989, 298, 390-396 Berk, L.S., et al. Eustress of humor associated with laughter modulates specific immune system components. Annals of Behavioral Medicine, 1993, 15, S111. Berk, L.S., et al. Immune system changes during humor associated with laughter. Clinical Research, 1991, 39, 124A. Berk, L.S. & Tan, S.A. A positive emotion, the eustress of mirthful laughter, modulates the immune system lymphocyte interferon-gamma. Research Perspectives in Psychoneuroimmunology. Berk, R. (2008) What Everyone Should Know About Humor and Laughter. Association for Applied and Therapeutic Humor. Cousins, N. (1979). Anatomy of an illness. New York: W.W. Norton Psychoneuroimmunology Research Society Program Abstracts, June, 1996. Dillon, K.M. et al. Positive emotional states and enhancement of the immune system. International Journal of Psychiatry in Medicine, 1985, 5, 13-18. Fry, W. (1977). The respiratory components of mirthful laughter. Journal of Biological Psychology, 19(2), 39 50. Fry, W. (1979). Mirth and the human cardiovascular system. In H. Mindess & J. Turek (Eds.), The study of humor (pp. 56 61). Antioch University Press. References (cont.) Gruber, B.L. et al. Immune system and psychologic changes in metastatic cancer patients while using ritualized relaxation and guided imagery: A pilot study. Scandinavian Journal of Behavior Therapy, 1988, 17, 25-46. Hayashi, K., Diabetes Care, May 2003 Iberg, M.L.m Oswalt, G. and Boltz, E. (2008) The effect of simulated laughter on self-reported pain and mood. Unpublished manuscript. Itami, J., et. al. Laughter and immunity. Japanese Journal of Psychosomatic Medicine, 1994, 34, 565-571. Kamei, T., et al. Changes of immunoregulatory cells associated with psychological stress and humor. Perceptual and Motor Skills, 1997, 84, 1296-1298. Kelly, M.L., et al. Decreasing burned children s pain behavior: Impacting the trauma of hydrotherapy. Journal of Applied Behavior Analysis, 1984, 17, 147-158. Kiecolt-Glaser, J. et al. Modulation of cellular immunity in medical students. Journal of Behavioral Medicine, 1986, 9, 5-21. Lefcourt, H. et al. Humor and immune system functioning, International Journal of Humor Research, 1990, 3, 305-321 Lefcourt, H. (1986). Humor and life stress. New York: Springer-Verlag References (cont.) Levy, S.M., et al. Prognostic risk assessments in primary breast cancer by behavior and immunological parameters. Health Psychology, 1985, 4, 99-113. Ljungdahl, L. Laugh if this is a joke. Journal of the American Medical Association, 1989, 262, 558. McClelland, D. & Cheriff, A.D. The immunoenhancing effects of humor on secretory IgA and resistance to respiratory infections. Psychology and Health, 1997, 12, 329-344 McGhee, P. (1999) Health, Healing and the Amuse System: Humor As Survival Training. Dubuque, IA: Kendall/Hunt McGhee, P. (1989). Humor and children s development: A guide to practical applications. New York: Haworth Press. Miller, M., Beach, V., Mangano, C.M., and Vogel, R.A. Positive Emotions and the Endothelium: Does Joyful Music Improve vascular Health? Oral Presentation, American Heart Association Scientific Session, 11/11/08 Pelletier, K., & Herzing, D. (1989). Psychoneuroimmunology: Toward a mind-body model. Advances, 5(1), 27 56. Robertshaw, S. (2009) Audio CD: Laughter: The gift that keeps on giving. National Association for the Humor Impaired. References (cont.) Robertshaw, S.(2005) Dear Dr. Humor. National Association for the Humor Impaired Press. La Crosse: Wisconsin. Robertshaw, S. (2004). The Healing Power of Humor. The Virginia Journal of Education Jan., 2004, 22-23. Siegel, B.S. Peace. Love and Healing. New York: Harper & Row, 1989. Stone, A.A., et. al. Evidence that secretory IgA is associated with daily mood. Journal of Personality and Social Psychology, 1987, 52, 988-993. Sultanoff, S. Survival of the Witty-est: Creating Resilience through Humor. Therapeutic Humor,1997, 11,1-2. Valdimarsdottir, H.B. & Bovbjerg, D.H. Positive and negative mood: Association with natural killer cell activity. Psychology and Health, 1997, 12, 319-327. Weisenberg, M. et al. Humor as a cognitive technique for increasing pain tolerance. Pain, 1995, 63, 207-212. Yoshino, S., et al. Effects of mirthful laughter on neuroendocrine and immune systems in patients with rheumatoid arthritis. Journal of Rheumatology, 1996, 23, 793-794.