Health As Humor: Humor As Health (Laughing Through Uncertainty)

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NK cells are able to lyze tumor cell line in vitro , while leaving normal cells intact This demonstrates the ability of NK cells to discriminate between normal and cancerous cells. Additional in vitro data has demonstrated that NK cells are capable of killing a wide variety of cancerous cells including leukemia, carcinomas, sarcomas and melanomas 15 , Lower levels of NK cell activity have been correlated with the spread of cancer, demonstrated by increased tumor cell metastasis in both humans and animals In addition, the NK cell is a spontaneous killer, in that it does not have to be activated by tumor antigens, nor is it limited by major histocompatibility complex requirements There is also some evidence that natural killer cell activity is important in the prevention of some types of viral illnesses, most notably those induced by herpes simplex type 1, Epstein Barr and influenza viruses 19 , Cardiovascular patients in Japan demonstrated a relationship between various psychological measures and immune function.

A positive correlation was noted between NK cell activity and scores on both the extraversion scale and a sense of humor scale. They also reported a negative correlation between NK activity and scores on the neuroticism scale.


The authors stated that the results indicate an association between general positive feelings and higher levels of NK cell activity. However, it should be noted that this work was correlational and did not examine cause and effect With 22 breast cancer patients as the sample in a randomized crossover design 22 , all subjects viewed both a humorous video and a distressing video. NK cell cytotoxicity and numbers of NK cells were used as outcome measures.

Half of the subjects viewed the humorous video first, while the other half viewed the distressing video first. Blood samples were taken from an indwelling catheter before and after each video, at 30 min following the video, and 23 h following the first video just prior to viewing the second video. Scores on the CHS were positively correlated with numbers of NK cells, which would indicate that subjects with higher coping humor scores also had more NK cells. However, contrary to what was expected, no significant changes were noted in NK numbers or cytotoxicity at the end of either video or during recovery.

This unpublished dissertation also included an unexpected finding that NK cytotoxicity was significantly decreased 23 h after viewing the humorous video and was significantly increased 23 h after viewing the distressing film. Wise suggested that this could be a rebound effect, from a change in NK cytotoxicity in the expected direction sometime in the preceding 22 h. However, it should be noted that the 23 h post-stimulus test point was immediately prior to viewing the second video.

Perhaps this result was related to anticipation of the upcoming video. This is a confounding factor that needs to be avoided in future humor research. In addition, as NK level is known to be reduced in patients with cancer, using cancer patients as the subjects in this investigational work may have lead to an additional confounding factor. Another investigation concerning the effect of humor on NK cell activity used 10 healthy male subjects 5. The experimental group viewed a 60 min humorous video, while the control group watched a non-humorous video.

Blood samples were drawn from an indwelling catheter at baseline, during the movie, and 30 min after the movie recovery. However, this study involved a very small sample and was published in abstract form only. In what is probably the most comprehensive report thus far, Berk 23 reports the results of a series of five separate studies.

The results are from a total of 52 healthy males, who viewed a humor video for 1 h. Blood samples were taken 10 min before, 30 min into, 30 min after and 12 h after the intervention. The authors conclude that modulation of neuroimmune parameters by laughter may have indications for use in health and wellness intervention programs as adjunct to other integrative medicine therapies Most studies that document a positive effect of laughter on NK activity have used all male samples.

The use of all male subjects in studies using immune or endocrine-based outcomes simplifies the methodology, as it negates any possible effects that may occur due to female hormonal changes. However, it then becomes difficult to determine how a particular intervention may work in women. Because of this, a later study by our group used a sample of 33 healthy adult women to examine the effect of laughter on stress and NK cell activity This controlled study was designed to test the effect of humor on NK function, and to determine if sense of humor measured by two different instruments or laughter measured by the Humor Response Scale—HRS is related to change in stress NK activity when subjects are exposed to humor.

Subjects were randomly assigned to view either a humor video or a neutral control video, with pre and post measures of stress and natural killer cell activity measured in all subjects. Humor response also played a role in change in NK cell activity following the video. This finding indicated that only the subjects who laughed out loud during the humor video had significantly increased immune function following the intervention.

Persons who just smiled or did not have observable responses to the humor video did not have positive changes in immune function. This finding is demonstrated in Fig. Plot represents the relationship between change in NK cell functioning and subject humor response Similar to findings from other studies, there was no connection between sense of humor as measured Situational Humor Response Scale and the Multidimensional Humor Scale and change in any of the study outcomes.

Sense of humor was not related to change in stress, change in NK activity or even observed laughter in response to the humor stimulus. This finding supports earlier work 8—10 that suggest that sense of humor as measured by currently available instruments does not appear to play a significant role in the physiological response to a humor stimulus. Findings from this study support that the act of laughing is correlated to changes in stress and immune function following exposure to a humor stimulus. Laughing can apparently reduce stress and improve NK cell activity, at least temporarily.

As low NK cell activity is linked to decreased disease resistance and increased morbidity in persons with cancer and HIV disease, the authors conclude that laughter may be a useful cognitive-behavioral intervention for use in these patients. As an interesting side note, the differentiation in the effects of smiling versus laughing out loud was noted in another study of laughter, which examined the effect of smiling, laughing and howling on mood changes. It was found that howling did not substantially improve mood but both smiling and laughing did.

Moreover, laughter seemed to boost positive affect more than just smiling Additional support for the effect of laughter on various physiological outcomes is briefly summarized in Table 1. Empirical evidence concerning the effect of sense of humor on NK cell function is conflicting; with one study finding that sense of humor was related to higher baseline levels of NK activity 23 , while a second using an intervention design did not find any relationship between sense of humor and NK activity One researcher did report that sense of humor, as measured by psychological self report instruments, is related to increased numbers of NK cells in the periphery 18 , but this work needs replication in a larger sample.

For patients in tough situations, sometimes the best thing is humor | Hub

The overall impression obtained from the studies conducted thus far indicates that sense of humor has a minor role, if any, in changes in physiological outcomes when subjects are exposed to a humorous stimulus. However, it should be acknowledged that this finding may be due to inadequate methods currently available to measure sense of humor. As for the effect of exposure to a humorous stimulus and subsequent laughter on measures of immune function, a few small studies demonstrate an increase in SIgA levels following exposure to a humorous video, but the clinical benefits of increasing SIgA levels are somewhat uncertain.

However, it is not known if the increases demonstrated in these studies are of a significant value to have a clinical benefit, as long term studies looking at health outcomes have yet to be conducted. Therefore, additional research in this area is certainly indicated. As can been seen from the research reviewed in this article, humor researchers have used different conceptualizations of humor and different methodologies to examine the effect of humor, making it difficult to summarize this body of research. In some analyses, sense of humor is measured with a number of self-report instruments and then correlated with various health outcomes.

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The problem with this is that the various measures of sense of humor are subject to social desirability. Most people like to believe that they have a good or above average sense of humor, and thus this variable is difficult to capture using self-report instruments. Experimental design is also used to determine the effect of a humorous stimulus on health outcomes.

However, what one person feels is a humorous movie or situation, another person may not view as being humorous. Therefore, while these studies may determine the outcome of viewing a supposedly humorous video in a given set of participants, there is no guarantee that the results obtained are, in fact, due to humor or laughter. In order to determine the effectiveness of humor or laughter, some objective measure of humor response is needed.

Unfortunately, most publications thus far have not included measurement of humor response. As previous research indicates, some subjects who are exposed to a humorous stimulus do not laugh. In addition, what one person views as a humorous stimulus, another person may not find funny. This has been addressed in earlier work by allowing subjects a choice of different videos, etc. Humor response is known to be affected by environmental conditions, and it can be difficult for subjects to relax and laugh at a humor video when experimental conditions require blood draws for laboratory testing.

To help control for this, it is critical that future humor research includes some measure of subject response to the humorous stimulus. Videotaping subject responses and then measuring these responses with observer rating scales such the Humor Response Scale can help document the effect of individual humor responses to the stimulus.

Another concern is that of control groups. While experiments using a humorous stimulus should include some type of neutral stimulus to control for factors such as the passage of time, experimental conditions and the relaxation that might be associated with watching an interesting video of some type, many of the earlier studies did not include this type of control. And to more completely control for other possible mechanisms which might affect health outcomes, Martin 33 has suggested the need for at least two additional control groups. Of course, all of these additional control groups add to the complexity of the design and analysis, and would require some measure of the emotions supposedly evoked by videos, to be sure that a subject who viewed the negative video actually experienced negative emotional arousal, etc.

As can be seen, research design in this area can be quite challenging. Clearly, more groundwork is required to determine the best methods of testing and documenting psychological and physiological outcomes of humor in various populations. The next step is to incorporate the prior methodological work into future humor research design and investigate the phenomena in larger samples of healthy subjects. In addition, small clinical pilot studies may be used to investigate the possibly different effects of humor in different clinical populations.

Research results concerning humor and healing are thus far rather tentative, and more work is needed before broad claims can be made concerning an effect of humor upon health outcomes. While in a frequently cited case study, Cousins 34 attributed his cure from ankylosing spondylitis to complementary therapies including laughter, empirical research supporting this type of response is currently not available. In fact, as can be seen from the above review, documentation of the effects of humor on various health related outcomes in healthy populations is still in the infancy stages, and research documenting benefits in a clinical population such as persons with cancer is yet to be established.

National Center for Biotechnology Information , U. Evid Based Complement Alternat Med. Published online Dec 5. Mary Payne Bennett 1 and Cecile Lengacher 2. For reprints and all correspondence: Received Jul 25; Accepted Jul This article has been cited by other articles in PMC. Abstract This is the final article in a four part series reviewing the influence of humor and laughter on physiological and psychological well-being.

Humor, Laughter, Immune Function, Psychoneuroimmunology. Introduction This article is the conclusion of a multipart series reviewing the evidence currently available concerning the influence of humor on various health outcomes. Exposure to Humor, Subsequent Laughter and Salivary IgA In order to determine if simply exposing people to a humorous situation can result in immunoenhancement, a few small studies have been conducted using humor videos.

Open in a separate window. Brief overview of outcomes using a humorous stimulus. Health Outcome Results Muscle relaxation Periods of intense laughter are followed by relaxed muscle tone 26 , Urinary epinephrine and norepinephrine levels Hormonal measures of sympathetic nervous system activation increased during a humorous video Galvanic skin response and blood pressure A humorous stimulus lead to increased galvanic skin response, but stable blood pressure indicating that while humor appears to involve activation of the sympathetic nervous system SNS , it also acts to buffer some of the actions of the SNS on blood pressure Sometimes, especially at the hospital , they are so busy.

They just go through the motions. That place is scary, they have no time. Either way, Lara is clearly alluding to a need for something other than a formal clinical interaction. Thus, participants might have significant physical disabilities with regard to mobilizing or speaking.

For patients in tough situations, sometimes the best thing is humor

The group meets once a fortnight and volunteers facilitate the group. A male volunteer, Bob, is leading the discussion about upcoming festive activities:. He then asks who could be Santa. This raises a big laugh, more banter and Peggy laughs and smiles across at me. Each member of the group speaks at some point, almost invited individually to contribute by Bob. Bob is going on a boat trip with three other guys. Leigh another volunteer asks how many [alcohol] bottles there would be.

What is particularly interesting is how people allow each other to speak and assist occasionally, particularly the patients more so than the volunteers. In the above extract, Peggy has severe speech problems. She walks with difficulty with a tripod but has no use of her right arm. She is sitting to the right of Bob the volunteer and so when she pats him on his belly she quickly adjusts her posture and does so deliberately. It is almost triumphant and the humour endures for the rest of the session as both Peggy and the first author continue to exchange smiles.

There are particular limitations with this study. Second, the focus groups were all peer groups whose members were largely known to each other.

10 Health Benefits of Laughter

Focus groups comprising individuals not known to each other might have produced different findings. Third, the study was carried out in a particular geographical area of the UK. There are, as noted by Davies, 40 distinct cultural differences in the expression of humour.

Consequently, the study is specific to the geographical area studied. However, it is our contention that the absence of such a framework would have made the findings less explicit and tangible. In particular, it confirmed that patients and CNSs have asymmetrical and divergent humour uses. Humour has been recognized as being an integral part of support groups, 41 and there are a number of studies exploring humour among peers in a variety of settings. The question is — why is that so? The main study suggested that CNSs may not identify some humour initiation by patients, particularly the more subtle nuances of humour use — humour that is not obviously humour e.

Therefore, unlike patients, CNSs lack humour awareness. Hence, they are unable to either acknowledge or reciprocate humour. Similarly, while patients apparently embrace humour use, CNSs fail to do so and rarely initiate humour. Thus, professionalism and humour expression need not be mutually exclusive entities. Initiating humour is a potentially risky endeavour. Who wants to tell a joke only to be met with a wall of silence?

For example, Sumners 56 reviewed nurses and concluded that older, more experienced nurses had more positive attitudes towards humour use. Consequently, older nurses may be more able or willing to take risks vis a vis humour use. Humour might be a risk, but, according to patients, it is a risk worth taking. Indeed, there may even be therapeutic potential in nurses initiating humour.

National Center for Biotechnology Information , U.

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  6. Journal List Health Expect v. Published online Jan 2. This article has been cited by other articles in PMC. Introduction Humour is a complex, dynamic phenomenon that primarily occurs in social situations between two or more people. The aim of this paper is, therefore, threefold: Methods There were two particular challenges in this study: Open in a separate window.

    Table 1 The baseline data corpus. The CNS was asked to respond to a sheet of open ended questions regarding the patient and the interaction, including, environment, length of relationship, condition etc. Following the interaction CNSs were asked to open a sealed envelope. The CNSs may therefore, have been alerted to the focus of the study when undertaking the second interaction.

    Table 2 Focus group participants patients perspectives. Table 3 Interpretative and illustrative frameworks. Table 4 Interpretation and illustration of humour use applied to all data. Table 5 The differences between patients and CNSs in relation to humour use in healthcare interactions. Prior to the following extract, the participants were asked whether they had any particular examples of humour being used in a positive or negative way: Graeme — prostate cancer, group 4 When you are speaking about humour, the day I went for my biopsy, there were eight men and they were all going in within a half hour period.

    Humour, narrative identity and caring Strauss p. First names, football and herbal tea Dewey and Bentley 39 maintained that the extent of knowing is dependent upon the naming of an individual. Billy — Lung cancer focus group 1 They had a smile on their face, they called you by your first name. Jean — Lung cancer focus group My district nurses and doctors, they come in just to see you. Lara — Breast cancer support group 3 Sometimes, especially at the hospital , they are so busy. A male volunteer, Bob, is leading the discussion about upcoming festive activities: Limitations There are particular limitations with this study.

    Conclusion Humour might be a risk, but, according to patients, it is a risk worth taking. Conflict of interests The authors report no conflicts of interest. Acknowledgements The authors thank the patients and CNSs who took part in the study.

    Humour in health‐care interactions: a risk worth taking

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