The best drug for depression, anxiety and stress

“Laughter is wine for the soul — laughter soft, or loud and deep, tinged through with seriousness — the hilarious declaration made by man that life is worth living.” ― Sean O’ Casey

Laughter and Laughter Therapies

Laughter is the physiological response to humor. The act of laughing stimulates the release of the body’s natural feel-good chemicals — endorphins. With endorphins surging through your bloodstream, your are more apt to feel happy and relaxed, while endorphins can even temporarily relieve pain.

The philosopher John Morreall — author of the book “The Philosophy of Laughter and Humor” — believes that the first human laughter may have begun as a gesture of shared relief at the passing of a danger. And since the mutual relaxation that results from laughter inhibits the biological “fight-or-flight” response, that might indicate trust in one’s companion. In fact, people are up to 30 times more likely to laugh in a group than when alone.

Moreover, John Cleese — the English actor, comedian, screenwriter and producer — once said:

“Laughter connects you with people. It’s almost impossible to maintain any kind of distance or any sense of social hierarchy when you’re just howling with laughter.”

In fact, in a study published in the Proceedings of the National Academy of Sciences in 2016 — and involving a large group of researchers led by Gregory Bryant from UCLA — researchers suggested that laughter might indicate to listeners the friendship status of those laughing. In their study the researchers asked listeners to judge the friendship status of pairs of strangers (from 24 different societies) and friends based on short snippets of their simultaneous laughter. In the end, they found that listeners were able to reliably distinguish friends from strangers, based on specific acoustic characteristics of the laughter.

Very briefly, the study of laughter and its effects on the body — from a psychological and physiological perspective — is called Gelotology (from the Greek gelos “laughter”) and it was pioneered by William F. Fry of Stanford University. Gelotology was first studied by psychiatrists, but it was initially deprecated by most physicians. But things changed when early studies demonstrated the effectiveness of laughter in clinical settings for helping patients with atopic dermatitis to respond less to allergens, or helping patients alleviate stress and pain.

So far, different physiological effects of laughter have been reported such as:

• decreasing levels of the stress hormones (that is cortisol termed “the stress hormone”, epinephrine also known as adrenaline and dopac, a dopamine catabolite, a brain chemical which helps produce epinephrine). By doing this, laughter provides a safety valve that shuts off the flow of stress hormones and the “fight-or-flight” compounds that swing into action when you experience stress, anger or hostility (that suppress your immune system and raise your blood pressure). By turning of the “fight-or-flight” response that initiated your sympathetic nervous system you enter in the “rest and digest” or the “chill out” response that calms your body down after a danger situation has passed and eventually you relax. Another effect of laughter is the

• strengthening of the immune function. When you are laughing, natural killer cells that destroy tumors and viruses, gamma-interferon (a disease-fighting protein), T-cells — which are a major part of the immune response — and B-cells which make disease-destroying antibodies, they all increase. Laughter also increases the concentration of salivary immunoglobulin A, which defends against infectious organisms entering through the respiratory tract.

And is getting better.

Researchers have estimated that laughing 100 times is equal to 10 minutes on the rowing machine or 15 minutes on an exercise bike, namely your blood pressure is lowered, there is an increase in the vascular blood flow and in oxygenation of your blood. Just to give a perspective to “laughing 100 times”: it has been estimated that children laugh over 300 times a day compared to around 20 for adults! Moreover, laughter also gives your diaphragm, abdominal, respiratory, facial, leg and back muscles a workout.

Even though there is evidence that laughter has physical, emotional and social benefits, however, scientific research is still in an early stage when it comes to determine the therapeutic value of laughter.

Current scientific literature broadly distinguishes between:

• ‘simulated’ laughter — voluntarily and consciously triggered by oneself (self-induced, a ‘fake’ laugh, or non-humorous laughter) in a controlled environment for no specific reason and by definition not caused by humor or other stimuli  —  versus

• ‘spontaneous’ laughter  —  triggered by a joke causing contractions around the eye sockets, and often perceived as a ‘genuine’ laugh.

Both spontaneous and simulated laughter have been applied in Laughter therapies from children to the elderly and with a broad range of targeted outcomes such as mental health, cancer, diabetes, migraine and other chronic conditions. For example right now 116 “Laughter Clinical trials” are registered on ClinicalTrialGov, to treat patients with depression, cancer and stress.

Furthermore, when Bennett et al. (2014) conducted a narrative review of laughter and humor therapy specifically for patients undergoing dialysis, he concluded that Laughter Yoga had positive effects on immunity, pain, sleep quality, respiratory function, depression and anxiety for patients undergoing dialysis.

In particular, Laughter-inducing therapies typically include exercises with

• humor, such as humorous videos or clowns,

• without using humor, such as clapping, dancing, and vocalizing laughter-like sounds like “hoho-hahaha”, and

• elements not involving laughter, such as breathing and relaxation exercises.

For example, Laughter Yoga is a specific example of non-humorous laughter-inducing therapy, done in groups and involving laughter exercises like clapping and yoga exercises like breathing and relaxation exercises.

But let’s see now the findings regarding the therapeutic value of laughter — on a broad range of mental and physical health outcomes, focusing on laughter-inducing therapies — summarized in this article “Laughter-inducing therapies: Systematic review and meta-analysis” (2019).

The first systematic review and meta-analysis on laughter-inducing therapies

“I love people who make me laugh. I honestly think it’s the thing I like most, to laugh. It cures a multitude of ills. It’s probably the most important thing in a person.” ― Audrey Hepburn

For this study PubMed, EMBASE, Web of Science (WoS), EBSCO, Google Scholar were all screened until December 2017 and in the end were selected:

• 86 studies for the systematic review (a type of literature review that uses systematic methods to collect secondary data, critically appraise research studies, and synthesize findings qualitatively or quantitatively, with the purpose to deliver a meticulous summary of all the available primary research in response to a research question). And

• 29 studies for the meta-analysis (a quantitative, formal, epidemiological study design used to systematically assess the results of previous research to derive conclusions about that body of research, and typically, but not necessarily, the study is based on randomized, controlled clinical trials).

The outcome measures in the articles selected varied broadly from:

• mental health (in the meta-analysis, only mental health outcomes were used due to the diversity of physiological outcomes),

• well-being (e.g. agitation, anxiety, cognitive function, coping responses, depression, life satisfaction, mood, pain, quality of life, resilience, self-efficacy, self-esteem, stress), and

• physical health (e.g. blood glucose level, blood pressure, body weight, fatigue, heart rate, immune function, insomnia, pulmonary function, sleep quality).

Very briefly, in this first systematic review and meta-analysis on laughter-inducing therapies they concluded that:

• The systematic review found there was a reasonably convincing trend indicating ‘simulated’ laughter has a more positive effect on depression and anxiety compared to ‘spontaneous’ laughter. This was based on effect sizes twice as large for non-humorous therapies than humorous therapies.

• In the systematic review as well as the meta-analysis, a similar pattern was found for the laughter-inducing studies and their effect on depression. Both found a positive effect on depression. The systematic review also found a convincing replication of depression outcomes.

• Furthermore, laughter-inducing therapies seem to improve perceived stress. The systematic review showed that cortisol levels (salivary, serum and breast milk cortisol) and pain could potentially be reduced by laughter-inducing therapy, but results remain inconclusive (because the methodological shortcomings of these studies make it hard to critically interpret the summary positive results).

Moreover, a positive affect with a laughter therapy — for depression, anxiety and stress — it is understood as a state of experiencing pleasure, happiness, enthusiasm, satisfaction and excitement. For example, a positive affect is positively associated with:

• meaning in life: Positive affect and the experience of meaning in life

• future life satisfaction:Intensity of smiling in Facebook photos predicts future life satisfaction

• positive health behaviours:Moving beyond a one-size-fits-all view of positive affect in health research

• restful sleep:The whole is not the sum of its parts: Specific types of positive affect influence sleep differentiallyand

• longevity: Smile intensity in photographs predicts longevity.

So, in the end we can conclude that:

Against a backdrop of increasing healthcare expenditure, of losing the meaning of life, of insomnia, of fear of death and of negative behaviours, apparently, there is a potential for simple, cheap, broadly applicable, and easily implementable therapy such as laughter therapy, as a cost-effective solution for depression, anxiety and stress.

In the end it takes nothing to watch a funny video on YouTube or to do your Laughter Yoga inside your own four walls. But remember if you want to protect youself from an ever increasing tsunami of depressed or stressed people, it would be recommended before starting to laugh to set your mindset on “Laughter is the Best Medicine”.

Thank you for reading 💙

And if you liked this post why not share it?