Laugh Out Loud

August 17, 2011 Written by JP    [Font too small?]

It’s a little known fact that Korea is at the forefront of research pertaining to laughter therapy and health promotion. In the first half of 2011 alone, three Korean studies were published which evaluated the impact of structured laughter programs on parameters of mental and physical wellness. All of the trials lasted between 2 to 4 weeks and employed twice-weekly, 60 minute laughter therapy sessions. The participants of the various studies included breast cancer survivors, postpartum mothers and seniors living in retirement homes. The results indicate positive outcomes in each of the disparate populations. The cancer survivors reported an improvement in quality of life and resilience. The postpartum mothers demonstrated a decline in fatigue and stress hormone levels. Finally, the “community-dwelling elderly” volunteers exhibited “positive effects on depression, insomnia, and sleep quality”.

These studies add to a growing body of evidence suggesting that laughter, whether in a controlled or informal setting, can make an important difference in objective and subjective measures of health. And perhaps best of all, laughter can be contagious.

Note: Please check out the “Comments & Updates” section of this blog – at the bottom of the page. You can find the latest research about this topic there!

To learn more about the studies referenced in today’s column, please click on the following links:

Study 1 – Effects of Laughter Therapy on Depression, Quality of Life, Resilience … (link)

Study 2 – Effects of Laughter Therapy on Postpartum Fatigue & Stress Responses … (link)

Study 3 – Effects of Laughter Therapy on Depression, Cognition and Sleep … (link)

Laughter Therapy Improves Various Measures of Mental Health

Source: J Korean Acad Nurs. 2011 Jun;41(3):285-293. (link)

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Posted in Alternative Therapies, Mental Health, Women's Health

18 Comments & Updates to “Laugh Out Loud”

  1. Zeph Says:

    Wow! I love to laugh! I believe also that if old or sick people or even the average people everyday are able to laugh out loud, they’d feel so much better. This is good that they’re having therapy sessions with laughter because some illness can hardly be cure, at least the patients are happy and better with their emotional aspect which is so crucial in their state.

  2. liverock Says:

    I agree, we owe a debt of gratitude to all the people who have made us laugh over the years.

    Heres a sample from the great Henny Youngman:

    My wife and I we go to a nice restaurant two times a week have a little beverage, good food and companionship. She goes on Tuesdays, I go on Fridays.

    We also sleep in separate beds. Hers is in California and mine is in Texas.

    I take my wife everywhere…..but she keeps finding her way back.

    I asked my wife where she wanted to go for our anniversary. “Somewhere I haven’t been in a long time!”
    She said. So I suggested the kitchen.

    We go to the mall we always hold hands. If I let go, she shops.

    My wife has an electric blender, electric toaster and electric bread maker. She said “there are too many gadgets and no place to sit down!” .. So I bought her an electric chair.

    My wife told me the car wasn’t running well because there was some water in the gas. I asked where the car was; she told me “in the lake.”

    My wife got a mud pack and looked great for two days. Then the mud fell off.

    My wife ran after the garbage truck, yelling “am I too late for the garbage? The driver said “no, jump in!”

    Remember: marriage is the number one cause of divorce.

    I married miss right. I just didn’t know her first name was always.

    I haven’t spoken to my wife in 18 months. I don’t like to interrupt her.

    The last fight was my fault! My wife asked? “What’s on the TV?” I said “dust!”

    Just ignore me. My wife does.

  3. JP Says:

    I agree 100%, Zeph.

    Good ol’ Henny. Thanks, Liverock! Made me chuckle! 🙂

    Be well!


  4. sheilah Says:

    This proves Proverbs 17:22 A cheerful heart is good medicine…

    Love it! Thanks for sharing.

  5. Cynthia D'Auria Says:

    Hello JP,
    Laughing is my salvation. I am postive I laugh for at least one half hour everyday, sometimes more.
    I choose people and TV programs to view, that make me laugh aloud, to the extent it is difficult for me to stop.
    My sister is serious, with major health issues. I make sure I make her laugh at least 3 times a week. Now,she enjoys a good hearty laugh.
    This is a subject people find very difficult to believe. It is 100% true.
    Thank you for the article it is excellent! I hope more people believe it.
    Warm regards,

  6. JP Says:

    Thank you, Cynthia! I appreciate you sharing your experience and spreading the laughter. It’s one form of contagion that this world could use more of! 😉

    And now, a funny quote I recently read:

    “I always wanted to be somebody, but now I realize I should have been more specific.”- Lily Tomlin

    Be well!


  7. JP Says:

    Update 04/28/15:

    The Journal of Alternative and Complementary Medicine. April 2015, 21(4): 217-222.

    The Effects of Laughter Therapy on Mood State and Self-Esteem in Cancer Patients Undergoing Radiation Therapy: A Randomized Controlled Trial

    Background: To investigate whether laughter therapy lowers total mood disturbance scores and improves self-esteem scores in patients with cancer.

    Design/Setting: Randomized controlled trial in a radio-oncology outpatient setting.

    Patients: Sixty-two patients were enrolled and randomly assigned to the experimental group (n=33) or the wait list control group (n=29).

    Interventions: Three laughter therapy sessions lasting 60 minutes each.

    Outcome measures: Mood state and self-esteem.

    Results: The intention-to-treat analysis revealed a significant main effect of group: Experimental group participants reported a 14.12-point reduction in total mood disturbance, while the wait list control group showed a 1.21-point reduction (p=0.001). The per-protocol analysis showed a significant main effect of group: The experimental group reported a 18.86-point decrease in total mood disturbance, while controls showed a 0.19-point reduction (p<0.001). The self-esteem of experimental group was significantly greater than that of the wait list control group (p=0.044).

    Conclusions: These results indicate that laughter therapy can improve mood state and self-esteem and can be a beneficial, noninvasive intervention for patients with cancer in clinical settings.

    Be well!


  8. JP Says:

    Update 05/18/15:

    J Korean Acad Nurs. 2015 Apr;45(2):221-30.

    Effect and Path Analysis of Laughter Therapy on Serotonin, Depression and Quality of Life in Middle-aged Women.

    PURPOSE: This study was done to examine how laughter therapy impacts serotonin levels, QOL and depression in middle-aged women and to perform a path analysis for verification of the effects.

    METHODS: A quasi-experimental study employing a nonequivalent control group and pre-post design was conducted. Participants were 64 middle-aged women (control=14 and experimental=50 in 3 groups according to level of depression). The intervention was conducted five times a week for a period of 2 weeks and the data analysis was conducted using repeated measures ANOVA, ANCOVA and LISREL.

    RESULTS: Results showed that pre serotonin and QOL in women with severe depression were the lowest. Serotonin in the experimental groups increased after the 10th intervention (p=.006) and the rise was the highest in the group with severe depression (p=.001). Depression in all groups decreased after the 5th intervention (p=.022) and the biggest decline was observed in group with severe depression (p=.007). QOL of the moderate and severe groups increased after the 10th intervention (p=.049), and the increase rate was highest in group with severe depression (p<.006). Path analysis revealed that laughter therapy did not directly affect depression, but its effect was indirectly meditated through serotonin variation (p<.001). CONCLUSION: Results indicate that serotonin activation through laughter therapy can help middle-aged women by lessening depression and providing important grounds for depression control. Be well! JP

  9. JP Says:

    Update 05/31/15:

    Altern Ther Health Med. 2015 May;21(3):16-25.

    Humors Effect on Short-term Memory in Healthy and Diabetic Older Adults.

    Context • With aging, the detrimental effects of stress can impair a person’s ability to learn and sustain memory. Humor and its associated mirthful laughter can reduce stress by decreasing the hormone cortisol. Chronic release of cortisol can damage hippocampal neurons, leading to impairment of learning and memory.

    Objectives • The study intended to examine the effect of watching a humor video on short-term memory in older adults.

    Design • The research team designed a randomized, controlled trial.

    Setting • The study took place at Loma Linda University in Loma Linda, CA, USA. Participants • The study included 30 participants: 20 normal, healthy, older adults-11 males and 9 females-and 10 older adults with type 2 diabetes mellitus (T2DM)-6 males and 4 females.

    Intervention • The study included 2 intervention groups of older adults who viewed humorous videos, a healthy group (humor group), aged 69.9 ± 3.7 y, and the diabetic group, aged 67.1 ± 3.8 y. Each participant selected 1 of 2 humorous videos that were 20 min in length, either a Red Skeleton comedy or a montage of America’s Funniest Home Videos. The control group, aged 68.7 ± 5.5 y, did not watch a humor video and sat in quiescence.

    Outcome Measures • A standardized, neuropsychological, memory-assessment tool, the Rey Auditory Verbal Learning Test (RAVLT), was used to assess the following abilities: (1) learning, (2) recall, and (3) visual recognition. The testing occurred twice, once before (RAVLT1) and once after (RAVLT2) the humorous video for the humor and diabetic groups, and once before (RAVLT1) and once after (RAVLT2) the period of quiescence for the control group. At 5 time points, measurements of salivary cortisol were also obtained. The Kruskal-Wallis test was used to measure significance of the data based on the 3 groups.

    Results • In the humor, diabetic, and control groups, (1) learning ability improved by 38.5%, 33.4%, and 24.0%, respectively (P = .025); (2) delayed recall improved by 43.6%, 48.1%, and 20.3%, respectively (P = .064); and (3) visual recognition increased by 12.6%, 16.7%, and 8.3%, respectively (P = .321). For levels of salivary cortisol, the research team found significant and borderline decreases for the humor group between baseline and (1) post-RAVLT1 (P = .047), (2) postvideo (P = .046), and (3) post-RAVLT2 (P = .062). The diabetic group showed significant decreases between baseline and (1) post-RAVLT1 (P = .047), (2) postvideo (P = .025), and (3) post-RAVLT2 (P = .034). The study found no significant changes for the control group.

    Conclusion • The research findings supported potential clinical and rehabilitative benefits for humor that can be applied to whole-person wellness programs for older adults. The cognitive components-learning ability and delayed recall-become more challenging as individuals age and are essential to older adults for providing a high quality of life: mind, body, and spirit. Because older adults can experience age-related memory deficits, complementary, enjoyable, and beneficial humor therapies should be implemented for them.

    Be well!


  10. JP Says:

    Updated 09/07/15:

    BMC Complement Altern Med. 2015 Jun 9;15:176.

    Intradialytic Laughter Yoga therapy for haemodialysis patients: a pre-post intervention feasibility study.

    BACKGROUND: Laughter Yoga consists of physical exercise, relaxation techniques and simulated vigorous laughter. It has been associated with physical and psychological benefits for people in diverse clinical and non-clinical settings, but has not yet been tested in a haemodialysis setting. The study had three aims: 1) to examine the feasibility of conducting Laughter Yoga for patients with end stage kidney disease in a dialysis setting; 2) to explore the psychological and physiological impact of Laughter Yoga for these patients; and 3) to estimate the sample size required for future research.

    METHODS: Pre/post intervention feasibility study. Eighteen participants were recruited into the study and Laughter Yoga therapists provided a four week intradialytic program (30-min intervention three times per week). Primary outcomes were psychological items measured at the first and last Laughter Yoga session, including: quality of life; subjective wellbeing; mood; optimism; control; self-esteem; depression, anxiety and stress. Secondary outcomes were: blood pressure, intradialytic hypotensive episodes and lung function (forced expiratory volume). Dialysis nurses exposed to the intervention completed a Laughter Yoga attitudes and perceptions survey (n = 11). Data were analysed using IBM SPSS Statistics v22, including descriptive and inferential statistics, and sample size estimates were calculated using G*Power.

    RESULTS: One participant withdrew from the study for medical reasons that were unrelated to the study during the first week (94 % retention rate). There were non-significant increases in happiness, mood, and optimism and a decrease in stress. Episodes of intradialytic hypotension decreased from 19 pre and 19 during Laughter Yoga to 4 post Laughter Yoga. There was no change in lung function or blood pressure. All nurses agreed or strongly agreed that Laughter Yoga had a positive impact on patients’ mood, it was a feasible intervention and they would recommend Laughter Yoga to their patients. Sample size calculations for future research indicated that a minimum of 207 participants would be required to provide sufficient power to detect change in key psychological variables.

    CONCLUSIONS: This study provides evidence that Laughter Yoga is a safe, low-intensity form of intradialytic physical activity that can be successfully implemented for patients in dialysis settings. Larger studies are required, however, to determine the effect of Laughter Yoga on key psychological variables.

    Be well!


  11. JP Says:

    Updated 09/07/15:

    Crit Care. 2015 May 11;19:222.

    Virtuous laughter: we should teach medical learners the art of humor.

    There is increasing recognition of the stress and burnout suffered by critical care workers. Physicians have a responsibility to teach learners the skills required not only to treat patients, but to cope with the demands of a stressful profession. Humor has been neglected as a strategy to help learners develop into virtuous and resilient physicians. Humor can be used to reduce stress, address fears, and to create effective health care teams. However, there are forms of humor which can be hurtful or discriminatory. In order to maximize the benefits of humor and to reduce its harms, we need to teach and model the effective and virtuous use of humor in the intensive care unit.

    Be well!


  12. JP Says:

    Updated 07/26/16:

    Tohoku J Exp Med. 2016;239(3):243-9.

    Therapeutic Benefits of Laughter in Mental Health: A Theoretical Review.

    In modern society, fierce competition and socioeconomic interaction stress the quality of life, causing a negative influence on a person’s mental health. Laughter is a positive sensation, and seems to be a useful and healthy way to overcome stress. Laughter therapy is a kind of cognitive-behavioral therapies that could make physical, psychological, and social relationships healthy, ultimately improving the quality of life. Laughter therapy, as a non-pharmacological, alternative treatment, has a positive effect on the mental health and the immune system. In addition, laughter therapy does not require specialized preparations, such as suitable facilities and equipment, and it is easily accessible and acceptable. For these reasons, the medical community has taken notice and attempted to include laughter therapy to more traditional therapies. Decreasing stress-making hormones found in the blood, laughter can mitigate the effects of stress. Laughter decreases serum levels of cortisol, epinephrine, growth hormone, and 3,4-dihydrophenylacetic acid (a major dopamine catabolite), indicating a reversal of the stress response. Depression is a disease, where neurotransmitters in the brain, such as norepinephrine, dopamine, and serotonin, are reduced, and there is something wrong in the mood control circuit of the brain. Laughter can alter dopamine and serotonin activity. Furthermore, endorphins secreted by laughter can help when people are uncomfortable or in a depressed mood. Laughter therapy is a noninvasive and non-pharmacological alternative treatment for stress and depression, representative cases that have a negative influence on mental health. In conclusion, laughter therapy is effective and scientifically supported as a single or adjuvant therapy.

    Be well!


  13. JP Says:

    Updated 12/17/16:

    J Clin Nurs. 2016 Dec 16.

    The Effect of Laughter Therapy on the Quality of Life of Nursing Home Residents.

    AIMS AND OBJECTIVES: To carry out laughter therapy and evaluate its effect on the quality of life of nursing home residents.

    BACKGROUND: By improving the quality of life of residents living in nursing homes and allowing them to have a healthier existence, their lives can be extended. Therefore, interventions impacting the quality of life of older adults are of critical importance.

    DESIGN: Quasi-experimental design.

    METHOD: The study was conducted between March 2 and May 25, 2015. The experimental group was composed of 32 nursing home residents from one nursing home while the control group consisted of 33 nursing home residents from another nursing home in the capital city of Turkey. Laughter therapy was applied with nursing home residents of the experimental group two days per week (21 sessions in total). A socio-demographic form and the Short-Form Health Survey (SF-36) were used for data collection.

    RESULTS: After the laughter therapy intervention, total and subscale (physical functioning, role-physical, bodily pain, general health, vitality, social functioning, role-emotional, and spiritual health) quality of life scores of residents in the experimental group significantly increased in comparison to the pretest.

    CONCLUSION: Laughter therapy improved the quality of life of nursing home residents. Therefore, nursing home management should integrate laughter therapy into health care and laughter therapy should be provided as a routine nursing intervention.

    RELEVANCE TO CLINICAL PRACTICE: The results indicated that the laughter therapy programme had a positive effect on the quality of life of nursing home residents. Nurses can use laughter therapy as an intervention to improve quality of life of nursing home residents.

    Be well!


  14. JP Says:

    Updated 07/13/17:

    Australas J Ageing. 2017 Jul 12.

    Laughter yoga activities for older people living in residential aged care homes: A feasibility study.

    OBJECTIVE: To evaluate the effects of a laughter yoga activities (LY) program for older people living in residential aged care homes (RACHs).

    METHODS: A 6-week LY program was implemented at three RACHs with twenty-eight residents. A pre-post design was used to measure positive and negative affect, happiness, blood pressure and pulse.

    RESULTS: Post-session mean scores for positive mood, and happiness were significantly higher than pre-session scores in weeks 1, 3 and 6, and the post-session mean negative mood scores were significantly lower than pre-session scores in weeks 3 and 6. Post-session readings for mean systolic blood pressure were significantly lower than pre-session readings in weeks 1 and 6.

    CONCLUSION: This study demonstrates the potential for using LY to improve mood and lower blood pressure of older people living in RACHs.

    Be well!


  15. JP Says:

    Updated 12/12/18:

    Nurs Open. 2018 Jul 18;6(1):93-99.

    Beneficial effect of laughter therapy on physiological and psychological function in elders.

    Aim: In the present study we investigated the effect of laughter therapy on physiological and psychological function in older people.

    Design: An open-label trial.

    Methods: Seventeen older people who regularly attended an elderly day care centre were recruited. Stand-up comedy as laughter therapy was performed once a week for 4 weeks. Parameters of physiological and psychological function were evaluated before and after laughter therapy.

    Results: Laughter therapy intervention resulted in a significant reduction in systolic blood pressure and heart rate, accompanied by a significant increase in plasma concentration of serotonin and a significant decrease in salivary concentration of chromogranin A. Questionnaire surveys of SF-8, GDS-15, and Vitality Index demonstrated alleviation of depression and improvement of sociability and activity in older people. Laughter therapy could be expected to become a practical treatment to improve quality of life of older people in an elderly day care centre.

    Be well!


  16. JP Says:

    Updated 12/22/18:

    Nurs Health Sci. 2018 Sep;20(3):304-312.

    Psychological and physiological effects of laughter yoga sessions in Japan: A pilot study.

    The purpose of this pilot study was to examine and evaluate the psychological and physiological effects of multiple sessions of laughter yoga on community members. Participants took part in a 45 min laughter yoga session once per month for 6 months. Before and after all sessions, participants completed the Profile of Mood States-Brief Japanese Version (J-POMS-B) questionnaire to assess their mood, and had blood drawn for the measurement of stress indicators and immune function. Serial changes in J-POMS-B scores were tested by three way analysis of variance, and changes in laboratory results per session were evaluated with a paired t-test. The results showed that repeated sessions of laughter yoga had psychologically beneficial effects, especially on the aspects of tension-anxiety, and vigor. Adrenocorticotropic hormone and cortisol values related to the participants’ stress levels were significantly decreased after the fourth laughter yoga session. These results indicated that multiple laughter yoga sessions appeared to be effective in improving the psychological and physiological status of healthy adults.

    Be well!


  17. JP Says:

    Updated 01/03/19:

    Biopsychosoc Med. 2018 Dec 21;12:22.

    Hearing laughter improves the recovery process of the autonomic nervous system after a stress-loading task: a randomized controlled trial.

    Background: It has become necessary to develop mental health management methods that do not require specialized skills or tools to implement. With this in mind, we performed a subjective and objective investigation of the stress-reducing effect of hearing laughter.

    Methods: Ninety healthy students were randomly assigned to a laughter (n = 45) or rest (n = 45) group. Both groups were then administered the Uchida-Kraepelin test for 15 min, which served as a stress-loading method. The laughter group listened to a specially prepared CD for five minutes, while the rest group rested for five minutes. The participants’ subjective stress level was assessed using a visual analogue scale and their physiological status was assessed by measuring blood pressure and monitoring heart rate variability.

    Results: The visual analogue scale score for subjective stress was found to decrease significantly in both the laughter and rest groups after the intervention. However, a two-way repeated-measures analysis of variance revealed significant interaction and main effects for the change in heart rate and the natural logarithm of the high-frequency component of heart rate variability (lnHF). A post-hoc analysis using Dunnett’s test showed that hearing laughter caused the lnHF to significantly increase compared to that recorded during the Uchida-Kraepelin test and the rest period.

    Conclusions: These results suggest that hearing laughter might produce a relaxing effect by increasing parasympathetic nervous activity. This would make it an easily accessible method for improving the recovery process of the autonomic nervous system after a stress-loading task that does not require specialized skills or tools.

    Be well!


  18. JP Says:

    Updated 06/29/19:

    PLoS One. 2019 Jun 27;14(6):e0219065.

    Effects of laughter therapy on quality of life in patients with cancer: An open-label, randomized controlled trial.

    BACKGROUND: Few randomized controlled trials have assessed the effects of laughter therapy on health-related quality of life (QOL) in cancer patients. This study aimed to evaluate these effects as an exploratory endpoint in cancer patients as part of a randomized controlled trial conducted at a single institution in Japan.

    METHODS: The Initiative On Smile And CAncer (iOSACA) study was an open-label randomized controlled trial conducted in 2017 in which participants aged 40-64 years with cancer were randomly assigned to either an intervention group (laughter therapy) or control group (no laughter therapy). Each participant in the intervention group underwent a laughter therapy session once every two weeks for seven weeks (total of four sessions). Each session involved a laughter yoga routine followed by Rakugo or Manzai traditional Japanese verbal comedy performances. We assessed QOL as a secondary endpoint in this intention-to-treat population using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30). The questionnaire was completed at baseline (Week 0) and at Weeks 3 and 7. Mixed-effects models for repeated measures were developed to compare time-dependent changes in each QOL domain from baseline between the intervention and control groups.

    RESULTS: Four participants retracted consent and one participant was retrospectively excluded from analysis due to unmet inclusion criteria. The analysis was conducted using 56 participants, with 26 in the intervention group and 30 in the control group. Questionnaire completion rates were high (>90%), with similar QOL scores reported at baseline in both groups. The mixed-effects models showed that the intervention group had significantly better cognitive function and less pain than the control group for a short period.

    CONCLUSION: Laughter therapy may represent a beneficial, noninvasive complementary intervention in the clinical setting.

    Be well!


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