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The Science and Practice of

the Healing Power of Humor, Laughter, and Play

Mariusz Wirga, M.D.Medical Director - Psychosocial Oncology

Todd Cancer Institute, Long Beach Memorial Medical Center

www.memorialcare.org/tci

Beat the Odds®

High Impact Therapy

• What helps us to reduce stress, helps also to

prevent or reduce the risk of (or survive from):

• heart desease

• stroke

• cancer

• dementia

• diabetes

• obesity

• etc.

An Old Joke

Pharaohs laughed too

• Carol Andrews, British investigator of humor, states that ancient Egyptian humor was not unlike the contemporary. Like us, the ancient Egyptians liked obscene jokes; they had political satire, parodies, something akin to animated cartoons, and even black humor.

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O. Carl Simonton, M.D.

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William F. Fry

Humor, as an adjunct therapy in cardiac rehabilitation,

attenuates catecholamines and myocardial infarction

recurrence.

Tan SA, Tan LG, Lukman ST, Berk LS.

Adv Mind Body Med. 2007 Winter;22(3-4):8-12.

The effect of mirthful laughter on stress and natural killer cell

activity. Bennett MP, Zeller JM, Rosenberg L, McCann J.

Altern Ther Health Med. 2003 Mar-Apr;9(2):38-45.

Modulation of neuroimmune parameters during the eustress

of humor-associated mirthful laughter.

Berk LS, Felten DL, Tan SA, Bittman BB, Westengard J.

Altern Ther Health Med. 2001 Mar;7(2):62-72, 74-6.

Neuroendocrine and stress hormone changes during mirthful

laughter. Berk LS, Tan SA, Fry WF, Napier BJ, Lee JW, Hubbard

RW, Lewis JE, Eby WC.

Am J Med Sci. 1989 Dec;298(6):390-6.

Lee S. Berk

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No laughing matter:

Laughter is good psychiatric medicine

Laughter can be helpful for treating mood disorders

and other conditions. Current Psychiatry 2013 August;12(8):20-25.

Laughter as an evidenced-based psychiatric treatmentEVIDENCE-BASED REVIEWS

• Humans begin to laugh at approximately 4 months of age. Children

laugh, on average, 400 times a day; adults do so an average of only 5

times a day. In addition:

• Tickling a baby induces her (him) to laugh, which, in turn, makes the

parent laugh; a social bond develops during this playful exercise. This

response is probably mediated by 5-HT1A receptors, which, when

stimulated, induces the release of oxytocin, which facilitates social

bonding.

• Lower species are also known to enjoy laughter. Mice emit a chirping

sound when tickled, and laughter is contagious among monkeys.

• Berk et al reported that, when 52 healthy men watched a funny video

for 30 minutes, they had significantly higher activity of natural killer (NK)

cells and higher levels of IgG, IgA, and IgM compared with men who watched an emotionally neutral documentary.

• Bennett et al showed that, in 33 healthy women, the harder the

laughter, the higher the NK activity.

• Sugawara et al15 showed improved cardiovascular function in 17

healthy persons (age 23 to 42) who watched a 30-minute comedy

video, compared with their cardiovascular function when they

watched a documentary video of equal length.

• Svebak et al examined the effect of humor as measured by the Sense

of Humor Survey on the survival rate of more then 53,000 adults in one

county in Norway. They concluded that the higher the sense of humor score, the higher the odds ratio of surviving 7 years, compared with

subjects who had a lower sense of humor.

• Fonzi et al summarized data on the neurophysiology of laughter and the effect of laughter on the hypothalamus-pituitary-adrenal axis. They

noted that depression reduces the frequency of laughter and, inversely,

laughter reduces the severity of depression. Laughter, they reported,

also increases the connectivity of patients with people in their life, which

further alleviates symptoms of depression.

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BOTTOM LINE

Humor and laughter are underutilized and underreported in therapy, in part because it is a nascent field of research. Laughter

has social and physiologic benefits that can be used in the context

of a therapeutic relationship to help patients with a variety of ailments, including depression, anxiety, and pain.

”Studying humor is like dissecting a frog--you may know a lot but you end up with

a dead frog.”

Mark Twain

Unconditioned Laughter is going to

revive the subject.

Plot represents the relationship between change in NK cell functioning and subject humor response.

Bennett, MP, Lengacher, C., Evid Based Complement Alternat Med. 2009 June; 6(2): 159–164.

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He firmly believes laughter is the best medicine.

But I can’t tickle myself

Central cancellation of self-produced tickle sensation.

Blakemore SJ, Wolpert DM, Frith CD.

Nat Neurosci. 1998 Nov;1(7):635-40.

Why can't you tickle yourself?Blakemore SJ, Wolpert D, Frith C.

Neuroreport. 2000 Aug 3;11(11):R11-6.

Attenuation of somatosensory responses to self-produced tactile stimulation.

Hesse MD, Nishitani N, Fink GR, Jousmäki V, Hari R.

Cereb Cortex. 2010 Feb;20(2):425-32. Epub 2009 Jun 8.

Many Theories and Definitions

Empirical studies on humor and laughter demonstrate that

physiological benefits occur regardless

of the theory or definition that is used to

explain their function.

Humor theories and the physiological benefits of laughter.

Wilkins J, Eisenbraun AJ.

Holist Nurs Pract. 2009 Nov-Dec;23(6):349-54.

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Definitions – Laughter (Merriam-Webster)

• Laughter : a sound of or as if of laughing

• Laugh :

a : to show emotion (as mirth, or joy) with

a chuckle or explosive vocal sound

b : to find amusement or pleasure in

something

Definitions – Play (O. Carl Simonton, M.D.)

Play : an experience of having fun

Let’s laugh and play together

Laughter : a sound of or as if of laughing

Play : an experience of having fun

So we ask you to:

play along with making laughing

sounds and having fun with it

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Laughter Yoga

• Laughter Yoga combines Unconditioned Laughter with Yogic Breathing

(Pranayama). Anyone can Laugh for No

Reason. The concept of Laughter Yoga is

based on a scientific fact that the body

cannot differentiate between fake and

real laughter. One gets the same

physiological and psychological benefits.

"Laughter yoga is a concept where anybody

can laugh for no reason at all. You don't need

any jokes, any humor, or any comedy. You

don't even need to be happy. What we do is

laugh in a group and initiate laughter as a

form of bodily exercise, but when we have

eye contact with others, this laughter

becomes real and contagious."

Dr. Madan Kataria with wife Madhurico-founders of the Laughter Yoga Clubs movement

"To bring about physiological and biochemical changes, laughter

has to be hearty, from the belly. Second, laughter must be

extended. Laughter in real life lasts for a couple of seconds and

then is done, but this isn't enough. That's why laughter in laughter

yoga is hearty laughter extended for a period of time until our

physiology changes. Also, it is unconditional. You're not

dependent upon any conditions except the ones that we create."

• Functional imaging agrees with clinical evidence that the neuroanatomical networks supporting voluntary and humor-evoked smiling are different. Motor-related areas (e.g. primary motor cortex, premotor cortex, operculum) are consistently activated during voluntary facial movement (left), but not during humor-evoked smiling (right). Differences in the areas activated probably relate to the different contrasts utilized in these three studies.

• J Neuropsychiatry Clin Neurosci 19:358-362, November 2007© 2007 American Neuropsychiatric Association

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The Laughter Network

Regions involved in the generation of normal and pathological laughter. Note that in the mesencephalic and pontine regions the fibers from the PAG, which probably transmit the signal to laugh, are located dorsally/tegmentally, whereas the fibers from the frontal motor areas run ventrally, probably inhibiting facial emotional expressions. BASAL TEMP =basal temporal lobe including amygdala; CB = cerebellum; CMN = cervical motor neurons; BG = basal ganglia; HYPOTHAL = hypothalamus; MOTOR = motor area; N.X = vagal nerve nucleus; PAG = periaqueductal grey; PREFRONTAL = medial and dorsolateral prefrontal cortex; PREMOTOR = premotor area; SMA = supplementary motor area; THAL = thalamus.

Wild (2003). Neural correlates of laughter and humour Brain, 126 (10), 2121-2138

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Corpus Callosum LIMBIC-HYPOTHALAMIC

SYSTEM

AUTONOMIC

NERVOUS

SYSTEM

Neuropeptides

PupilLacrimal Glands

Salivary Glands

Heart

PancreasStomach

Bowels

Adrenal Glands

Kidneys

Urinary Tract

Sex Organs

Respiratory TractLungs

Memory

Kidneys

Uterus

Thyroid

Adrenal Cortex

TesticlesOvaries

Breasts

Metabolism

Growth

Pituitary

HORMONAL SYSTEM

Thymus Lymph Nodes Spleen Bone Marrow

Immune CellMaturation

(Immune CellsProduction)

Lymphocyte A Lymphocyte B

Modulation

(StimulationInhibition)

Plasmatic Cell

Antibodies Production

Tymozines

Cytokines

Receptor Sites for:

• Hormones• Neuropeptides

• Neurotransmitters

Re-establishment of telomere with the help of telomerase

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Effects of Mirthful Laughter

on the Vascular Endothelium

Med Hypotheses. 2009

Nov;73(5):636-9. Epub 2009 May 27.

The effect of mirthful laughter on the

human cardiovascular system.

Miller M, Fry WF.

Plots of levels of inflammatory markers

Vlachopoulos C et al. Psychosom Med 2009;71:446-453

Laughter up-regulates the genes related to NK cell

Genes showing continuous increase in expression

1.5 and 4 hours after watching a comic video

Laughter up-regulates the genes related to NK cell activity in diabetes. Hayashi T, Tsujii S, Iburi T, Tamanaha T, Yamagami K, Ishibashi R, Hori M, Sakamoto S, Ishii H, Murakami K.Biomed Res. 2007 Dec;28(6):281-5.

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Plot represents the relationship between change in NK cell functioning and subject humor

response. Bennett, MP, Lengacher, C., Evid Based Complement Alternat Med. 2009 June; 6(2): 159–164.

Laughter

• Decreases anxiety and improves mood

• Hope – “If we can laugh, it is not all so bad.”

• Engaged and alive

• Healthy distance to ourselves and to the situation we are in

• Engaged but with non-attachment

• Sense of connection to those who are laughing with us

• Transcendence

Universal Medicine

“Laughter is the most inexpensive and most effective wonder drug. Laughter is a

universal medicine.”

Bertrand Russell

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Universal Medicine

• Unconditioned laughter, without humor or jokes, is the universal medicine.

• Humor depends on our tastes and timing

and sometimes may be inappropriate.

• Unconditioned lauhter doesn’t have limitations of humor and can be applied

for anything anytime (e.g. in grieving).

• Laughter is universal and free of any

language barriers.

Spirituality

• Laughter is a deeply spiritual emotion. Maybe that's why the list of Jewish

comedians is so long! Understand the

dynamics of laughter and use it wisely.

Rabbi Noah Weinberg

Spirituality

• Laughter and play touch the deepest parts of our soul – where we are still

innocent and are not afraid to express

our true nature. Like children who express

it effortlessly.

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Spirituality

• Laughter brings us back in touch with our

bodies and to the present moment. When

playing with full abandon, all our problems

effortlessly melt away like snowflakes falling in

warm water. Laughter arises and brings us back

to the essence of our existence and the

timeless present.

Spirituality

• "What is this precious love and laughter budding in our hearts? It is the glorious sound of a soul waking up!"-- Hafiz

• "When you laugh, aside from the endorphin rush, there's also a spiritual opening. You're not so tight inside yourself. That opening I've found to be a real gift, in people being able to absorb spirituality."--Rabbi Sydney Mintz

• "It's one thing to say, 'I don't fear death', but to laugh out loud somehow drives the idea home. It embodies our theology."--Rev. Laura Gentry

Relationships

• "Laughter is the shortest distance between two people."--Victor Borge

• "When we laugh together, there is instantaneous recognition of "sameness" even in the midst of vast differences."--Rebecca Foster

• “Laughter as a primal behavioral tool used by individuals - be they human or ape - to prompt other individuals of a peer group and to create a mirthful context for social interaction and communication.”

How the brain laughs. Comparative evidence from behavioral, electrophysiological and neuroimaging studies in human and monkey. Meyer M, Baumann S, Wildgruber D, Alter K.

Behav Brain Res. 2007 Sep 4;182(2):245-60.

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Aerobic Exercise

• Genuine voiced laughter causes a 10-20% increase in EE and HR above resting

values, which means that 10-15 min of

laughter per day could increase total EE

by 40-170 kJ (10-40 kcal).

Energy expenditure of genuine laughter.

Buchowski MS; Majchrzak KM; Blomquist K; Chen KY; Byrne DW;

Bachorowski

JA Int J Obes (Lond). 2007; 31(1):131-7 (ISSN: 0307-0565)

Normalizes Blood PressureReduces stress

• The effects of hearty extended unconditional

(HEU) laughter using laughter yoga techniques

on physiological, psychological, and

immunological parameters in the workplace: a

randomized control trial.

Chaya MS, Kataria M, Nagendra R, et al. American Society of Hypertension 2008

Annual Meeting; May 14, 2008; New Orleans, LA.

• Humor: an antidote for stress.Wooten P.

Holist Nurs Pract. 1996 Jan;10(2):49-56.

Reduces Pain

• "I made the joyous discovery that ten minutes of genuine belly laughter had an anesthetic effect and would give me at least two hours of pain-free sleep." "When the pain-killing effect of the laughter wore off, we would switch on the motion picture projector again and not infrequently, it would lead to another pain-free interval."

Norman Cousins (long term survivor of heart disease and connective tissue disease)

• Laughter, humor and pain perception in children: a pilot study.Stuber M, Hilber SD, Mintzer LL, Castaneda M, Glover D, Zeltzer L.

Evid Based Complement Alternat Med. 2009 Jun;6(2):271-6.

• Humor as a cognitive technique for increasing pain tolerance.Weisenberg M, Tepper I, Schwarzwald J.

Pain. 1995 Nov;63(2):207-12

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Helps in Dementia

• Laughter is a compensatory behavior utilized to overcome communication barriers

Laughter and humor as complementary and alternative medicines for dementia

patients.

Takeda M, Hashimoto R, Kudo T, Okochi M, Tagami S, Morihara T, Sadick G,

Tanaka T. BMC Complement Altern Med. 2010 Jun 18;10:28.

• Laughter, communication problems and dementia.Lindholm C

Commun Med. 2008; 5(1):3-14 (ISSN: 1612-1783)

• The use of conversational laughter by an individual with dementia.

Wilson BT; Müller N; Damico JS

Clin Linguist Phon. 2007; 21(11-12):1001-6 (ISSN: 0269-9206)

Type 2 Diabetes

• laughter suppressed 2-h postprandial blood glucose

level increase in patients with type 2 diabetes

• laughter decreased the levels of prorenin in blood;

prorenin is involved in the onset of diabetic complications

• laughter delays onset of diabetic peripheral neuropathy

• laughter inhibits the onset/deterioration of diabetic

complications at the gene-expression level

• increased Natural Killer cell activity and improved

glucose tolerance

The effects of laughter on post-prandial glucose levels and gene expression in type 2 diabetic

patients. Hayashi T; Murakami K Life Sci. 2009; 85(5-6):185-7 (ISSN: 1879-0631)

Immunity

Watching a funny video is not enough. Laughing at it improves immunity.

• The effect of mirthful laughter on stress and natural killer cell activity.

Bennett MP, Zeller JM, Rosenberg L, McCann J.

Altern Ther Health Med. 2003 Mar-Apr;9(2):38-45.

• Modulation of neuroimmune parameters during the eustress of humor-associated mirthful laughter.

Berk LS, Felten DL, Tan SA, Bittman BB, Westengard J.

Altern Ther Health Med. 2001 Mar;7(2):62-72, 74-6.

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Cancer

• Positive correlation between humor and comfort levels in patients

with cancer

• Humor frequently was used for relaxation and as a coping

mechanism that aided in

• Promoting general wellness.

• Humorous material lessened anxiety and discomfort, which allowed

for patients' concerns and fears to be discussed openly.

• Positive effect on the immune system. Improvements in pain

thresholds and elevations in natural killer cell activity consistently appeared in quantitative experimental studies.

• In addition, measurements of specific neuroendocrine and stress

hormone levels revealed biochemical changes that suggested improved physical stress responses and increased feelings of well-

being after humorous interventions.

• Humor can be an effective intervention that impacts the health and well-being of patients with cancer.

The impact of humor on patients with cancer.

Christie W, Moore C.

Clin J Oncol Nurs. 2005 Apr;9(2):211-8.

Aging and Longevity

• The role of psychotherapy and humor for death anxiety, death wishes, and aging.

Richman J.

Omega (Westport). 2006-2007;54(1):41-51.

• Laughing as we go. Humor and aging.Glasgow-McDowell MA.

N C Med J. 1996 Nov-Dec;57(6):401-5.

• Laugh it off. The effect of humor on the well-being of the older adult.

Tennant KF.

J Gerontol Nurs. 1990 Dec;16(12):11-7.

• Smile Intensity in Photographs Predicts LongevityErnest L. Abel and Michael L. Kruger

Psychological Science February 2010

Smile Intensity in Photographs

Predicts Longevity

Ernest L. Abel and Michael L. Kruger

Psychological Science February 2010

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Unconditional laughter

Play with making laughing sounds and have fun with it!

Listen to your body – no new pain or symptoms

Make and maintain eye contact

No talking

Remember: pretending is OK – just use your

imagery

Participate without inhibitions or judgments

Laughter - Resources

LaughYourCancerOff.com