Laughter and health- Dr Srikant Sharma
Laughter and health Dr Srikant Sharma Laughter is the tonic, the relief, the surcease for pain. Charlie Chaplin In India, World Laughter Day was first observed was on January 10, 1998, in Mumbai. It was created in 1998 by Dr Madan Kataria, founder of the worldwide Laughter Yoga movement. It was marked for world peace and to build up a sense of brotherhood and friendship through laughter.
Laughter may be defined as the manifestation of the combination of bodily phenomena (such as the rapid deep inspiration, the forcible jerky expiration, the utterance of inarticulate sounds, the facial distortion, the shaking of the sides) that forms the instinctive expression of joyous; and that can be produced by certain physical sensations, such as tickling.
There are primarily two types of laughter- Duchenne laughter (relaxed, unforced laughter that is emotional stimulus-driven, involving involuntary contraction of the orbicularis oculi muscles) and non-Duchenne laughter (context-driven and emotionless, with no orbicularis oculi involvement).
Neuroimaging evidence suggests that these two types of laughter involve different neural pathways. The involuntary nature of Duchenne laughter is largely responsible for the well-known contagion effect whereby we are stimulated to laugh just by others laughing. Precisely because Duchenne laughter is intensely social and contagious. And it has the capacity to secrete endorphin effect.
Vigorous laughter exercises muscles, improves respiration, stimulates circulation. Also increases the production of pain-killing endorphins, decreases the production of stress-related hormones, and enhances immunity. Individuals with a good sense of humour may be more socially competent and attractive than other people, and better able to reduce tensions and conflicts in relationships, which might result in greater intimacy and more numerous and satisfying social relationships.
Again there are two types of stress: distress (the negative type), and eustress (the positive type also known as mirthful laughter). Distress was shown to increase stress hormones such as beta-endorphins, corticotrophins and catecholamines, but laughter (a form eustress) decreased these hormones, fortified activity of natural killer (NK) cells, activated T cells and B cells and increased Immunoglobulin levels. Thus, laughter is capable of fortifying the individual's immune system.
Physical benefits of humour
Stimulates your organs: When you laugh, you take in more oxygen-rich air. This stimulates your lungs, heart and muscles.
Improves cardiac health: Laughing increases your heart rate and the amount of oxygen in your blood. This can improve vascular function and decrease the risk of heart attacks.
Lowers blood pressure: Laughter releases endorphins that counteract the negative effects of stress hormones-lowering your blood pressure as a result.
Boosts immune system: When you're stressed, negative thoughts can turn into chemical reactions that decrease your immunity to sickness. When you laugh, you adopt a positive mindset that can release infection-fighting antibodies and neuropeptides that help fight stress.
Laughter decreases serum levels of cortisol, epinephrine, and 3,4- dihydrophenylacetic acid (a major dopamine catabolite), indicating a reversal of the stress response. In Depression neurotransmitters in the brain, such as norepinephrine, dopamine, and serotonin, are reduced, and therefore mood control circuit of the brain is disturbed. Laughter can alter dopamine and serotonin activity. Furthermore, endorphins secreted by laughter can help. Helps with weight loss: A common side effect of chronic stress is weight gain. Laughing not only reduces the stress hormones, but it also burns calories.
Laughter is a good exercise for toning face (15 facial muscles contract for getting a glee to face) giving an attractive facial look.
A good bout of laughter before sleeping reduces anxiety and leads to a good quality of sleep, which improves our overall immunity, physical and mental well being.
Blood glucose increases because of stress, fear and anxiety. Laughter stimulates neuroendocrine system and monitors body's glucose level, hence prevent diabetes.
Longevity individuals with a greater sense of humour report fewer symptoms of illness and medical problems.
Scientific evidences:
Various studies have been done to examine salivary immunoglobulin A (S-IgA), a component of the immune system that is found in saliva and is involved in the body's defense against upper respiratory infections. Individuals with higher scores on a sense-of-humor test were less likely than individuals with lower scores to show a stress-related decrease in immunoglobulins over 1 months.
A study done in Morinomiya University of Medical Sciences, Suminoe‐ku, Japan, (1) where 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. 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.
A research done by University of South Florida on outcomes of laughter on health (2) revealed that serum cortisol (P 1⁄4 0.011), growth hormone (P 1⁄4 0.0005) and plasma dopac—a metabolite of dopamine (P 1⁄4 0.025), all decreased with laughter. There was no significant change in serum prolactin, beta-endorphins, plasma epinephrine or plasma norepinephrine in either the experimental or the control group.
There are a number of studies which have examined potential analgesic effects of laughter by testing participants' pain threshold or tolerance before and after exposing them to comedy videotapes.
A study done by University of Oxford (3) which showed that pain thresholds are significantly higher after laughter than in the control condition. This pain-tolerance effect is due to laughter itself and not simply due to a change in positive affect.
Similar study done by school of Nursing, The Hong Kong Polytechnic University, Kowloon, Hong Kong, (4) showed that Upon completion of the humor therapy program, there were significant decreases in pain and perception of loneliness, and significant increases in happiness and life satisfaction for the experimental group, but not for the control group.
A research done in Nursing and Midwifery Care Research Center , Iran (5) showed that laughter Yoga had a positive effect on students' general health and improved the signs of physical and sleep disorders, lowered anxiety and depression, and promoted their social function.
Laughter is actually associated with short-term increases in blood pressure and heart rate, but no longer-term effects. Two stages of laughter have been defined, the first is the arousal phase in which there is elevation of heart rate and the second is the resolution phase which has resting of the heart.
Another study involving over 20,000 people investigated the correlation between how often the participants laughed and their risk of developing heart disease and stroke. Those who claimed to rarely or never laugh had significantly higher occurrences of both conditions than those who said that they laughed daily. In patients awaiting organ transplants, laughing yoga classes significantly improved cardiac function, and their moods improved immediately. (6)
A Cross-Sectional Study of Cardiovascular Disease Among Older Japanese Adults (7) was sought to evaluate the associations between frequency of daily laughter with heart disease and stroke
One very early report by Paskind et al. examined the impact of laughter upon muscle tone. Unlike the effects of some exercise, it was demonstrated that periods of intense laughter lead to decreased skeletal muscle tone or relaxation of muscle groups. During laughter, various muscle groups are activated for periods of seconds, while the period immediately after the laugh leads to general muscle relaxation. This post-laughter relaxation can last up to 45 min.
A study was done to see the Effects of laughter therapy on postpartum fatigue and stress responses of postpartum women which showed that laughter therapy has a positive effect on decreasing postpartum fatigue. (8)
In another study investigating obese women, laughing therapy reduced the inflammatory markers, tumor necrosis factor alpha (TNF-α) and interleukin-6 (IL-6). The participants' blood glucose levels were also decreased. (9)
Freud's psychodynamic viewpoint described humor as one of the strongest of the defense mechanisms that allow an individual to face problems and avoid negative emotions.
Laughter prescription
Laughter prescriptions remain largely speculative, but existing research indicates that efficacious laughter "treatments" typically occur once a week or less, for 30 to 60 minutes. Nevertheless, shorter frequencies and times, such as individual sessions as short as 20 minutes, can still have a positive impact. Intensity remains an open-ended question. It remains unclear how much, or with what amount of enthusiasm, one's laugh leads to emotional and physical benefits. Laughter prescriptions should contain detailed information as to the frequency, intensity, time, and type of laughter (useful mnemonic "FITT"), much like pharmacological prescriptions.
Adverse effects of laughter:
Perhaps, laughter as a form of exercise and as an emotional response triggers bronchial asthma. Specifically, the physical aspect (exercise) of laughter was considered to cause exercise induced bronchial asthma which is a later age asthma.
A study done in Sydney on 285 children who presented to the Emergency Department of Sydney Children's Hospital, with an acute episode of asthma. Laughter was more commonly reported as a trigger than excitement; cough was the most prominent symptom; and symptoms mostly occurred within 2 min of the mirthful stimulus. Mirth while watching a film led to PEF of 73% of baseline, compared with 81% for mirth with exertional play, and 95% for mirth with nonexertional play (P = 0.01). Mirth‐triggered asthma is common, and is an indicator of suboptimal asthma control. (10)
The overuse of humor by either patient or doctor as a mechanism to avoid sensitive issues, and its inappropriate use by a doctor could undermine the patient's confidence in therapy or medical care.
But nonetheless, Laughter is the most inexpensive and most effective wonder drug, and hence being universal medicine.
There are 3 major obstruction to joy i.e., fear, egotism and addiction; which can be overcome by laughter therapy. Your mind cannot heal without laughing hence You grow older if stop laughing. Hence it is a powerful healer for mind, body and soul. A right person will laugh without knowing why.
Reference
1. Yoshikawa Y, Ohmaki E, Kawahata H, Maekawa Y, Ogihara T, Morishita R, Aoki M. Beneficial effect of laughter therapy on physiological and psychological function in elders. Nurs Open. 2018 Jul 18;6(1):93-99. doi: 10.1002/nop2.190. PMID: 30534398; PMCID: PMC6279721.
2. Bennett MP, Lengacher C. Humor and Laughter May Influence Health: III. Laughter and Health Outcomes. Evid Based Complement Alternat Med. 2008;5(1):37-40. doi:10.1093/ecam/nem041
3. Dunbar RI, Baron R, Frangou A, et al. Social laughter is correlated with an elevated pain threshold. Proc Biol Sci. 2012;279(1731):1161-1167. doi:10.1098/rspb.2011.1373
4. Tse MM, Lo AP, Cheng TL, Chan EK, Chan AH, Chung HS. Humor therapy: relieving chronic pain and enhancing happiness for older adults. J Aging Res. 2010;2010:343574. Published 2010 Jun 28. doi:10.4061/2010/343574
5. Yazdani M, Esmaeilzadeh M, Pahlavanzadeh S, Khaledi F. The effect of laughter Yoga on general health among nursing students. Iran J Nurs Midwifery Res. 2014;19(1):36-40.
6. Dolgoff-Kaspar R, Baldwin A, Johnson MS, Edling N, Sethi GK. Effect of laughter yoga on mood and heart rate variability in patients awaiting organ transplantation: a pilot study. Altern Ther Health Med. 2012 Sep-Oct;18(5):61-6. Erratum in: Altern Ther Health Med. 2012 Nov-Dec;18(6):79. PMID: 22894892.
7. Kei Hayashi, Ichiro Kawachi, Tetsuya Ohira, Katsunori Kondo, Kokoro Shirai, Naoki Kondo, Laughter is the Best Medicine? A Cross-Sectional Study of Cardiovascular Disease Among Older Japanese Adults, Journal of Epidemiology, 2016, Volume 26, Issue 10, Pages 546-552,
8. Shin HS, Ryu KH, Song YA. [Effects of laughter therapy on postpartum fatigue and stress responses of postpartum women]. J Korean Acad Nurs. 2011 Jun;41(3):294-301. Korean. doi: 10.4040/jkan.2011.41.3.294. PMID: 21804338.
9. Lee DY, Hyun MS. [The Effects of Laughter Therapy Program on Perceived Stress, and Psycho-Neuro- Endocrino-Immuno Responses in Obese Women]. J Korean Acad Nurs. 2018 Jun;48(3):298-310. Korean. doi: 10.4040/jkan.2018.48.3.298. PMID: 29968686.
10. Liangas, G., Morton, J.R. and Henry, R.L. (2003), Mirth‐triggered asthma: Is laughter really the best medicine?. Pediatr. Pulmonol., 36: 107-112. https://doi.org/10.1002/ppul.10313
Dr Aayushi Gupta Shri Moolchand Kharaiti Ram Hospital And Ayurvedic Research Institute.
Dr Srikant Sharma Senior Consultant Internal Medicine, Shri Moolchand Kharaiti Ram Hospital And Ayurvedic Research Institute.
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