The Laughter Prescription

5066327879_ceb9338556On a recent trip to Indonesia I came across a temple, in a small village outside of Ubhud, where a group of local Balinese were rolling around on yoga mats in fits of hysterical laughter. The sound emanating from the temple walls was quite amazing and, intrigued, we went closer to see what they were doing. What we had stumbled across was a laughing yoga class run by a group called ‘Bali Happy’ who move around Bali promoting laughter as an exercise, with the aim of ridding the local people of their ailments. The lovely group leader invited us in, and explained the principles of the class; apparently there are different ‘sounding’ laughs to treat problems in different areas of the body, such as your gut, lungs, throat, head etc. He explained that the Balinese people were suffering from illness resulting from an unusual spate of weather which had left Bali wetter and colder than usual; and that they were helping people by focusing on the healing properties of laughter. He then invited us to join the class. This amazing experience left me questioning; aside from the psychological, emotional and communicative benefits, what are the biological principles underlying the healing properties of laughter, and could it really be of therapeutic value?

Norman Cousins
Norman Cousins

The Western ideology for laughter as a medicine began in 1976, when Norman Cousin published his paper ‘Anatomy of an Illness’ which sparked a cascade of enthusiasm for health benefits of this innate, involuntary reaction. But is laughter really the best medicine? Well one thing’s for sure, it can’t hurt. Indeed, unlike many forms of prescribed medication, laughter certainly has no undesirable side-effects. Also a number of studies have highlighted its health benefits.

The act of laughing causes a series of physiological changes. These act rapidly and are often accompanied by many beneficial consequences; particularly to the muscular, respiratory and cardiovascular systems of the body. One of the most frequently reported benefits of laughter is that it exercises and subsequently relaxes many important muscles. In 1979, Cousins described laughing as “a form of jogging for the innards”; this is because when we laugh our whole body becomes involved, leading to the coordinated action of our facial, chest, abdominal, skeletal and even gastrointestinal muscles. Furthermore, after laughing we experience a period of muscle relaxation with assists in reducing tension in the neck, shoulders and abdominals.

Our cardiovascular and respiratory systems stand to benefit too. Laughter causes a prompt increase in heart rate and blood pressure, which can improve circulation. This, coupled with an elevated respiratory rate, respiratory depth and oxygen consumption, improves the rate of residual air exchange and ventilation. These physiological changes are followed by a drop in heart rate, respiratory rate and blood pressure. Indeed, research has identified an inverse association between the propensity to laugh and coronary heart disease. Laughter has also been suggested as an adjuvant therapy to reduce the risk of heart attack in high-risk diabetic patients. For a review of the health benefits of laughter, see here.

5515038358_09f4285956Studies have also identified that the muscle exertions involved in producing laughter may have a stimulatory effect on the production of endorphins. Endorphins are opioid compounds that stimulate feelings of euphoria and lower pain thresholds. It is widely accepted that a patient’s emotional state will often affect the course of a disease. Therefore any therapy which encourages positive emotions in patients may ultimately improve their prognosis.

Interestingly, laughter therapy it is one of the most frequently used complementary therapies in cancer patients worldwide. It’s success most likely stems from the observation that laughter can reduce stress levels. Any therapy which successfully reduces stress certainly can’t be a bad thing; especially since studies have correlated both laughter and reduced stress with improvements in immune function and increases in pain tolerance. Some studies even suggest that laughter may increase disease resistance. The precise mechanism of this is yet to be defined, but may be linked to attenuation of serum levels of the ‘stress hormone’ glucocorticoid. Glucocorticoids are known to suppress the immune system, making stressed individuals more susceptible to disease. So, in it’s action on the neuroimmune system, it seems that laughter can directly improve disease resistance, by manipulating our innate immune responses and reducing glucocorticoid levels.

Given the known psychological benefits of a positive emotional state, it’s not surprising that laughter therapy has also been suggested to have clinical applications for neurological diseases like dementia and schizophrenia. As with most serious illnesses, dementia can place both sufferers and their families under high levels of stress. Since stress is believed to negatively affect an individuals cognitive ability, this may exacerbate symptoms. Laughter therapy has been suggested as a way of reducing stress in both patients and their families. Indeed, when a positive attitude is shared by patients, families and staff, it can have a positive effect on the emotional-affective and cognitive functioning of the patients.

Laughter has helped patients to withdraw from feelings of irritability, stress, tension, and counteract symptoms of depression; it elevates self-esteem, hope and energy, promotes memory, creative thinking and problem solving; increases aspects of self-efficacy and optimism and improves relationships and general quality of life. In other neurological diseases like schizophrenia, laughter has been shown to reduce hostility, depression and anxiety scores and encourage social competence.

Although complementary therapies such as this are not meant to replace mainstream treatment and are not promoted to cure disease. They may often be effective in controlling symptoms, improving well-being and quality of life. While laughter research is still in it’s infancy, there is much to be said for its numerous psychological and physiological benefits and the potential for it to become a very successful complementary and alternative therapy. With laughter as an exercise emerging into the main-stream, through clubs like laughing yoga, it appears that laughter-based interventions are gaining more acceptance, and hopefully further scientific study will follow as a result. As laughter medicine continues to generate more medical and public interest, it may be important to consider that along with eating your vegetables, exercising regularly and getting enough sleep, laughter is a wonderful way to enhance your health. Most importantly, as demonstrated here, there are more than a few reasons to conclude laughter is, and could in the future be, a widespread and effective complimentary intervention for many diseases.

Post by: Isabelle Abbey-Vital

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