A Laugh a Day Keeps the Doctor Away

laughter
Image by Nicolás Borie Williams from Pixabay

The proverbial phrase “A laugh a day will keep the doctor away” is common in mainstream culture. At first glance, the saying may imply that laughter is a more effective cure than other treatments or medicine.

However, it is generally not interpreted so literally. Rather, it is referring to the positive impact laughter can have on our health and wellbeing.

The phrase can be referenced flippantly; however, recent research and attention bring more credibility to the impact of laughter. There is even a scientific field of laughter medicine research. Scientists have explored whether and how laughter impacts health and disease. Recent studies have been more vigorous and are producing promising results for the positive effect of laughter on our health.

In this article, we explore the research and proven health benefits of laughter and smiling. As it turns out, the study of laughter is serious business.

Will a Laugh A Day Keep the Doctor Away?

The term suggests that laughter has a beneficial effect on various aspects of our health. It also indicates that having a positive life outlook helps build resilience and assists in overcoming adversity. It is widely acknowledged that laughter is not a miracle panacea or cure.

It is not suggested that laughter take the place of medical interventions and scientifically proven treatments for illness. However, laughter produces health benefits that we can use to our advantage. It even has a field of study named for it: gelotology.

It is noted in research that while laughter can relieve suffering, it is not considered a cure for disease. The emphasis on studying the impact of laughter on health is related to the suffering experienced. Suffering is defined as the negative personal experience that results from a disease process.

Suffering has complicated factors that interface including: physical, psychological, social, emotional and neurological. While laughter may not cure a disease or heal a person fully, it seems to be impactful in improving symptoms and individual’s coping abilities, therefore, reducing their experience of suffering.

There is no shortage of benefits noted in the research exploring the positive benefits of laughter. Here are a few highlights:

Much research and support are evidenced in this article about the health benefits of laughter. Here is a snapshot of such examples highlighting how laughter can be beneficial.

Physical health benefits:

  • Boosts immunity
  • Improves cardiac functioning
  • Enhances vascular blood flow
  • Promotes healing
  • Lowers stress hormones
  • Decreases pain
  • Relaxes your muscles
  • Prevents heart disease
  • Burns calories
  • Simulates aerobic exercise
  • Improves memory and cognitive functioning
  • Builds abdominal muscles
  • Relieves physical tension

 

Mental health benefits:

  • Produces wellbeing
  • Adds joy and zest to life
  • Releases endorphins
  • Reduces symptoms of depression
  • Eases anxiety and tension
  • Relieves stress
  • Improves mood
  • Strengthens resilience

 

Social benefits:

  • Strengthens relationships
  • Builds connections
  • Enhances rapport
  • Attracts others to us
  • Enhances teamwork
  • Helps diffuse conflict
  • Promotes team bonding
  • Lightens the mood

 

Laughter as the best medicine suggests the power it can have in aiding healing and recovery. We would all agree laughter feels good and is a positive experience. Laughing can bring a new perspective on life and fosters a positive attitude. It helps build relationships and resolve conflicts. It pushes out negative emotions and uplifts mood. It fosters fun and fuels energy. And the list goes on…

A critical question about this idea is whether it is medically and scientifically proven that laughter benefits our physical and mental health. Can it improve our health to the point that it can be used as an intervention?

On the whole, research does support that laughter can help our heart, enhance our immune system and improve our health. Researchers have also validated the pain-relieving benefits of laughter, which is explored later in this article. Studies indicate that laughter strengthens the immune system by triggering the nervous system’s relaxation response. Laughter also produces positive changes in mental health.

 

An Expansion of the Idea

The role humor and laughter play in the world of medicine has a long history. Even in the 13th century, it is understood that surgeons used humor as a method to distract their patients from their pain and discomfort.

Scientists continued to explore the effects of humor on wellness and healing into the 20th century. Norman Cousins is well known in this space and wrote: “Anatomy of an Illness” in 1979. He claims to have cured himself with a customized treatment of laughter and vitamins. He describes how after years of pain from a chronic illness, he found relief through watching comedies. Cousins also became the early champion of gelotology.

William Fry, a Professor Emeritus at Stanford University, is an early pioneer in gelotology and has been involved in research on the physiological benefits of laughter. According to Fry:

“Mirthful laughter has a scientifically demonstrable exercise impact on several body systems. Muscles are activated, heart rate is increased, respiration is simplified with increase in oxygen exchange -all similar to the desirable effects of athletic exercise.”

Using laughter as the best medicine was also popularized in the Robin Williams movie, Patch Adams. The movie enhanced this message by demonstrating the health benefits of engaging patients in laughter and humor.

Hunter Campbell, M.D. was the physician whose life inspired the movie to be created. Campbell and colleagues operated a free hospital in the 1970s.

At their health care facility, patients received humor-infused care throughout 12 years. The hospital was later named the Gesundheit Institute, which currently offers volunteer programs such as clown visits to health care facilities and educational training programs for medical students.

Campbell’s intention was to inspire other medical treatment facilities to consider treatments beyond traditional interventions.

When considering the relevance of the idea of “laughter is the best medicine,” it is important to note the wide-ranging health benefits that are thought to result from laughter. The research supporting laughter as a medicine is highlighted later in the article.

In the meantime, here is a summary of thoughts supporting the notion of laughter as the best medicine and how it is being explored further.

It has also been explored how pertinent the differentiation between humor and laughter is. Humor is a stimulus in the environment that sparks emotional, behavioral, and social responses. Laughter is a psycho-physiological response, a behavior and expression of a humorous situation. Laughing results in a positive psychological change and it is understood that the physical action of laughter has demonstrated greater physiological benefits in scientific studies.

It is important to note that in the literature, laughter is promoted as a complementary and adjunct component rather than a replacement for accepted treatments, interventions, and therapies. There is little downside to using laughter as a medicine, as it is easy to prescribe, low risk, and no side effects or allergies.

Nonetheless, parts of the medical community have resisted the concept, with concerns that using laughter as a treatment intervention could be misapplied or misunderstood. Although there has been attention in mainstream media on the idea, there was not sufficient data to validate its claims, until recently.

Some scientists argue that the research has not been substantial to support the medical benefits of laughter. They may recognize support for the impact of humor and laughter in areas such as patient-physician communication, psychological aspects of patient care, medical education, and reducing stress among medical professionals.

However, there may be concerns that laughter could be mistakenly interpreted to be a replacement for well documented, proven treatment interventions. Where critics and supporters may find alignment is that using laughter and humor as an extra coping mechanism is supported. The evidence of its exact effect on health benefits is still being explored.

 

What Does the Research Say?

Research evaluating the impact of laughter on health is fairly extensive. Overall, there is evidence that laughter has physical, emotional, and social benefits (Bennett et al., 2014; Mora-Ripoll, 2011; Yim, 2016).

Research is still at a relatively early stage in terms of scientifically differentiating exactly what the therapeutic dynamic is. Physical and mental health benefits have been reported including: decrease of pain, and increase of immune functioning (Bennett and Lengacher, 2006; Martin, 2001; Mora-Ripoll, 2011). It is suggested to decrease hormone stress levels and therefore elevates mood (Bennett and Lengacher, 2009).

Current research generally distinguishes between ‘simulated’ versus ‘spontaneous’ laughter (Mora-Ripoll, 2011; Yim, 2016). Spontaneous laughter is naturally triggered by an external stimulus (a joke, comedic experience), and simulated laughter is voluntarily and consciously triggered in a controlled environment (forced laughter).

Mora-Ripoll (2011) completed a literature review of both ‘simulated’ and ‘spontaneous’ laughter therapies, and concluded that there is some evidence that ‘simulated’ laughter (non-humorous laughter) has positive effects on health compared to control groups (waiting list or receiving no intervention), other experimental groups (exercise therapy), or not compared to another group (interventional study).

Numerous reviews have summarized research in the field. McCreaddie and Wiggins (2008) assessed direct and indirect links between humor and health, particularly in nursing applications. Their results suggest the research designs were not especially precise in methodologically, causing some uncertainty in the conclusions.

Bennett et al. (2014) also completed a review of laughter therapy for dialysis patients. It was concluded that humor therapies have positive effects on immunity, pain, sleep quality, respiratory function, depression, and anxiety; all of which are relevant for patients undergoing dialysis.

Researchers specified that it is unclear how or if these health benefits are sustained long-term. These meta-analytic reviews indicate that there is evidence to support the health benefits of laughter and humor, but clear guidelines for laughter therapies are necessary.

There are numerous individual medical studies that have found benefits from treatments based on laughter and humor. Results from a study in the journal Parkinsonism Related Disorders indicated that taking an improv class could cause a “significant improvement” in the symptoms of patients who have Parkinson’s disease (Beta et. al., 2017).

In another study, a group of care home residents participated in “humor therapy,” comparing results to a control group who did not have the therapy. As reported in the Journal of Aging Research, participants experienced significant reductions in pain and loneliness, as well as increases in happiness and life satisfaction (Tse, et., al., 2010).

Additional studies indicate that humor and laughter enhance student performance by attracting and sustaining attention, reducing anxiety, enhancing participation, and increasing motivation (Savage et. al, 2017).

Research results also support that laughter can enhance your immune system. In a study published in the journal Alternative Therapies in Health and Medicine, laughing played a role in reducing stress and improving natural killer cell activity—a white blood cell that aids in protecting your body against disease (Bennett et. al., 2003).

The effect of laughter has been studied with varying populations. Several studies report that laughter significantly improved the social health of children and teenagers. More specifically, it has been reported that laughter improves social support and life satisfaction and enhances self-esteem and coping skills of children and teenagers (Choi and Cho, 2011).

An important set of studies has assessed laughter therapy used with cancer patients. Laughter is proven to boost mental health and reduce anxiety. In a 2015 review published in the Journal of Cancer Science and Therapy evaluating six studies, laughing played a significant role in decreasing anxiety (Demir, 2015). There have been promising results in other studies as well: laughter therapy decreased perceived stress and improved mood (Choi et al., 2010; Kim et al., 2009).

Laughing can decrease symptoms of depression. According to a recent 2015 study in the Journal of Alternative and Complementary Medicine, three 60 minute laughter therapy sessions improved mood and self-esteem (Kwon et. al., 2015).

The effect of laughter therapy was discussed in a recent review (Yim, 2016). The report suggests that the endorphins released during laughter reduce symptoms of depression. It is recommended as a noninvasive and non-pharmacological alternative treatment for stress and depression. The author concludes that laughter therapy is effective and scientifically supported as a single or adjuvant therapy.

The following are a few studies highlighting the impact of laughter on mental. Studies report that laughter-inducing therapy significantly decreased depression in the elderly, with studies using both spontaneous as well as simulated laughter (Ko and Youn, 2011; Shahidi et al., 2011).

Studies conducted in Spain demonstrated that laughter releases physical and emotional tension, elevates mood, enhances cognitive functioning, and increases friendliness. (Mora-Ripoll, 2015).

In another study, researchers exposed participants to depression-inducing stimuli, then played humorous or non-humorous audiotapes. Listening to the humorous tapes reduced levels of depression more quickly.

Findings from a 2011 study indicated that individuals who laughed most frequently at funny images of themselves showed fewer signs of negative emotions (Beermann & Ruch, 2011).

Using laughter as a way to ease difficult discussions between patients and doctors has also been assessed. Kelly Cawcutt, MD, assistant professor of internal medicine at the University of Nebraska Medical Center states, “Laughter may help us engage in talking about more difficult concepts, provide a relatable conversation, and positively enhance communication if done with the perception of shared laughter — as opposed to laughing at someone, which has clearly deleterious effects.

A recent study published in the Journal of Clinical Oncology reported that terminal cancer patients reported benefits of using humor in having tough conversations with their doctors, and to address challenges throughout their disease. In this study, 97% of oncologists indicated using humor during patient consultations and 83% of oncologists found it beneficial.

In the Oncology community, professionals have studied and discussed this topic, noting that it can be a careful balance integrating humor during such painful, dark times. General consensus is that integrating humor can be positive, as long as doctors and other health care professionals tread with caution in utilizing humor in their interactions with patients (Kamath, 2019).

The social and relational benefits of laughter are also highlighted. Contagious laughter strengthens interpersonal bonds. The endorphin effect helps us understand how laughter in a group promotes a sense of togetherness and closeness.

Laughter establishes and reinforces connectivity in the brain. In a study by Wildgruber et. al. (2013), it was reported that different types of laughter modulated connectivity between distinct parts of what is referred to as the laughter perception network.

Complex social laughter types and tickling laughter were found to modulate connectivity in two parts of the laughter perception network in the brain. These results provide the foundation for further exploration of how laughter creates brain connectivity.

Critics suggest that earlier studies produced inconclusive results and were not as academically rigorous as would have been desired.

However, recent studies are confirming the benefits of laughter and smiling. It is anticipated that there is more to come on understanding the interventional and treatment opportunities leveraging laughter. Critics of the research supporting laughter as a treatment for health concerns also suggest that the specific positive effects are not yet fully understood. They point out gaps in understanding exactly what the biological and physiological impact is.

Also, it still remains somewhat unclear how the impact of humor is differentiated from the effects of laughter. There can even be variations of types of laughter that could be explored further to gain clarity.

While there are somewhat mixed results about the exact nature of the biological benefit of laughter, enough data supports that it is effective as an intervention. There is enough evidence to demonstrate that it has a positive impact on mental and physical health.

In addition, it is a low-risk intervention, as there is no cost and a low barrier of entry. There is essentially no downside to employing the strategy of laughter. It is an intervention with no negative side effects.

 

Interesting Studies

A study titled “Effects of laughter therapy on depression, cognition, and sleep among the community-dwelling elderly” was published in the journal Geriatrics and Gerontology (Ko & Young, 2011). Half of the participants were enrolled in laughter therapy. Mental health, depression, self-reported physical health, and sleep quality were measured before and after the laughter therapy intervention.

Authors concluded: “Laughter therapy is considered to be [a] useful, cost-effective, and easily-accessible intervention that has positive effects on depression, insomnia, and sleep quality in the elderly.”

A study at Georgia State University incorporated laughter into a physical activity program for older adults (Greene et. al, 2017). Participants engaged in a group exercise program called LaughActive that incorporates playful simulated laughter into a strength, balance and flexibility workout.

They were exposed to simulated and genuine laughter exercises with the physical workouts. Participants reported that 96.2% found laughter to be an enjoyable addition to a traditional exercise program, 88.9% said laughter helped make exercise more accessible and 88.9% reported the program enhanced their motivation to participate in other exercise classes.

Finland and UK researchers reported that social laughter triggers the release of endorphins – “feel good hormones” – in brain regions responsible for arousal and emotion (Manninen et. al, 2017). Endorphins generally interact with opioid receptors in the brain, which relieves pain and triggers feelings of pleasure and wellbeing.

In this study published in The Journal of Neuroscience, participants underwent PET scans two times. The first was after they spent 30 minutes alone in a room and the second after spending 30 minutes watching laughter-inducing video clips of their close friends.

Results indicated that the social laughter condition led to a significant increase in endorphin release in the brain regions that play a role in arousal and emotional awareness. They report that the release of endorphins triggered by laughter plays a role in social bonding.

In another interesting study evaluating the neuroscience of laughter, MRI scans were used to investigate which regions of the brain were at work (Wattendorf et. al., 2013). In this research, participants were in three groups: the first group was tickled on the sole of the foot and given permission to laugh, the second group was tickled but told to suppress their laughter, and the final group was asked to laugh voluntarily without being tickled.

In the group where participants were laughing genuinely, certain regions were activated more consistently when compared with the other groups. The activation of the periaqueductal gray matter during voluntary and involuntary laughter was also measured.

This gray matter is understood to play a role in analgesia and has been considered a target for brain-stimulating implants to treat chronic pain patients. While the neuroscientific details noted here are complex, this research indicates that during laughter, regions of the ventromedial prefrontal cortex are activated. During this activation, endorphins are released, which are understood to decrease pain and increase euphoria.

Advances in specialty areas such as psycho-neuroimmunology are demonstrating the connections with psychology, neurological activity, and our hormonal state. It is becoming more and more clear that a positive state of mind makes us healthier.

Laughter as a treatment modality has been studied in cancer victims and patients with HIV disease. The positive effects of laughter have been proven to reduce stress and improve natural killer cell activity in these populations. Low natural killer cell activity is connected to decreased disease resistance and increased morbidity in these patients. Research supports that laughter can be an effective cognitive behavioral intervention.

According to psychologist Jennifer Aaker, Ph.D., humor can help people relax, feel safer emotionally and subsequently, lead to increased creativity. It also may be of interest to many how laughter can burn calories. According to medical studies at Vanderbilt University Medical Center, laughing for 10 to 15 minutes can burn between 10 to 40 calories per day, and potentially more with deep belly laughs.

There are numerous interesting anecdotal studies as well exploring unique effects of laughter. For example, laughter research pioneer William Fry reported that it took 10 minutes on a rowing machine for his heart rate to reach the same level as one minute of intense laughter.

Also, a study of 19 people with diabetes assessed the effects of laughter on blood sugar levels. After eating, the group attended a tedious lecture and the following day, ate the same meal and watched a comedy. After the comedy, the group had lower blood sugar levels than after the tedious lecture.

 

How and Why is Laughter the Best Medicine?

While it is not proposed that laughter be a replacement for medical or mental health treatments, it can be a supplement to improving health in general. The positives are that there is a low barrier of entry, low risk to participate, and positive upside to engaging in laughter.

It almost sounds unrealistic that laughter can promote a sense of wellbeing, reduce symptoms of pain, trigger endorphin release, and increase immunity in the body. As noted in this article, these health benefits have been studied and proven to be effective in the right circumstances.

Laughter can be considered the best medicine since there it is culturally and demographically accessible to everyone. As a powerful antidote for pain, stress, and handling conflict, and it is a valuable resource. Having the power to renew and heal, the ability to laugh is an underleveraged gift.

Laughter brings our body into balance and can lighten negative emotional burdens. It even builds connections with people and enhances relationships. These benefits can all be experienced for free, at absolutely no cost. Laughter is free, fun, easy to access, and no risk. There are essentially no negative side effects or symptoms experienced from laughter. It almost sounds too good to be true!

 

14+ Proven Health Benefits

The health benefits of laughter are featured throughout this article. Here are a few more specific examples supported by the research.

Martin & Ford (2018) discuss the benefits of laughter in The Psychology of Humor: An Integrated Approach. They discuss the link between humor and physical health. They highlight how modern medical discoveries like endorphins, cytokines, natural killer cells, and immunoglobulins have been recent discoveries of substances considered to be beneficially affected by laughter.

The benefits of laughter and humor are also explored in health psychology, an area of study addressing how behavior, cognition, and emotions influence health, illness, and wellness. Authors discuss a biopsychosocial model, recognizing the importance of psychological, social, contextual, and cultural variables on health.

The positive effect of laughter on individuals with chronic obstructive pulmonary disease (COPD) has been studied. Research published in Heart & Lung studied this patient population. In the study, 46 participants completed questionnaires evaluating sense of humor, symptoms of depression and anxiety, recent illness, and quality of life (Lebowitz, et. al., 2011).

Approximately half of the participants completed a “laughter induction study” where lung function, mood, and dyspnea (difficulty breathing) were evaluated before and after a funny or neutral clip. The results were complicated, due to the nature of the disease in which patients have difficulty with breathing.

Conclusions indicated that “Sense of humor among patients with COPD is associated with positive psychological functioning and enhanced quality of life.” Laughter can clear your mind and enhance cognitive functioning. This was explored further in the FASEB Journal, with findings indicating laughing puts your brain in a mental state in which you can think more clearly (Gains et. al., 2014).

Overall, the health benefits experienced from laughter are expansive. Here are a few additional examples of how laughter improves health:

  • lowers blood pressure,
  • triggers the release of endorphins,
  • increases the number of T cells critical to immune functioning,
  • improves the function of blood vessels and increases blood flow,
  • reduces stress hormone levels, and
  • improves cardiac health.

 

A recent study evaluating humor and mental health also supports that the benefits arise from the cognitive, emotional, and interpersonal aspects (Martin, 2016). From a cognitive perspective, it is suggested that humor finds incongruous alternative perspectives, less commonly accessed, contributing to healthy coping with life stress.

Martin explores further how humor involves positive emotions which counteract distress and enhance functioning. Interpersonal benefits are also explored as, humor can help to reduce conflicts, enhance relationships, and increase social support.

In the Psychology of Humor, authors highlight clinical research and the relationship between humor and psychological well-being (Martin & Thomas, 2018). They also explore the applications of humor to the clinical practice of psychotherapy.

Research has provided support for the idea that humor regulates emotions that directly relate to psychological well-being. Studies reinforce that humor produces an increase in positive feelings of exhilaration and wellbeing and perceptions of mastery and control.

It is also discussed how laughter produces a reduction in negative feelings such as anxiety, depression, and anger. Authors address how humor mitigates the negative impact of stressful events by creating a positive lens or perspective for interpreting stressful events.

Laughter also contributes to positive mental health. It helps us feel good and the positive feeling from laughing stays with us for a period of time even after the laughter ends. Having a good sense of humor contributes to resilience and optimism to help people get through difficult times.

Laughter prevents distressing emotions. It allows us to recharge, relax, and increase our energy levels. Laughing brings us to a more centered place emotionally and allows us to shift to a healthier perspective. It can help reduce feelings of overwhelm, anxiety, and distress.

 

10+ Examples on the Topic

yoga laughter
Photo by bruce mars from Pexels

There are studies that evaluate examples of laughter-inducing therapeutic interventions.

Laughter Humor therapies often involve exercises with humor such as funny videos or clowns (Brodaty et al., 2014).

Laughter therapy without humor interventions has also shown to be effective (Yim, 2016). These exercises can include engaging in funny exercises, clapping, dancing, and singing.

Laughter yoga has become popular in recent years. In sum, it involves breathing exercises and forcing yourself to laugh. This forced laughter soon turns genuine as participants discover how ridiculous the situation is.

In a 2012 pilot study, the effects of 10 laughter yoga sessions on participants across a 4-week period were explored. Researchers measured heart rate variability (HRV), considered a risk factor for health conditions, and mood prior to and post each session.

Participants longer term anxiety and depression were also assessed. The authors concluded: “Participants showed improved immediate mood (vigor-activity and friendliness) and increased HRV after the laughter intervention. Both the laughter and control interventions appeared to improve longer-term anxiety.” Various studies have supported the benefits of laughter yoga in groups (Cokolic et al., 2013; Farifeth et al., 2014).

Psychologist Steve Wilson has capitalized on the psychological benefits of laughter and it inspired him to start the World Laughter Tour in 1988. Wilson and his colleagues created programs to train Certified Laughter Leaders. The leaders present workshops to provide education on the science and philosophy of laughter, and to teach therapeutic techniques to be used in laughter therapy.

Their mission is for the CLLs to establish Laughter Clubs where they can practice the techniques and share the benefits of laughter with their communities.

A recent overview of research on the association between humor and well-being was explored in the Reference Module of Neuroscience and Biobehavioral Psychology (Proyer & Wolf, 2017). While findings are slightly mixed, studies point to an association of laughter with greater pain tolerance. It is also noted that research within the field of positive psychology provides hope for future programming on humor-based positive psychology interventions.

Psychologists have even discovered ways to incorporate laughter into therapeutic treatments. A group of therapists established the Association for Applied and Therapeutic Humor (AATH). These professionals endorse and promote the use of humor in psychiatric settings in treating mental illness.

Another unique organization, Stand Up for Mental Health, uses stand-up comedy acts to promote healing. David Granirer is a counselor and comic who provides training for people who have experienced mental health problems into comedy routines.

There are many ways to create opportunities for laughter to maximize the impact on your physical and mental health. The following are practical examples of how to incorporate laughter as “medicine.”

  • Gratitude exercise: Make a list of your blessings and things you are thankful for and what makes you happy. This can spark smiling, which is the beginning of laughter.
  • Find laughter: When you hear it, move toward it. Laughter is contagious, so finding people who are laughing at something funny can initiate your own laughing.
  • Spend time with playful people who have fun. Make plans with friends who laugh easily and do not take themselves too seriously.
  • Inquire about humor: ask people to tell funny stories.
  • Create opportunities to laugh such as: watching a comedy show, going to a comedy club, reading the funny pages, watching comedians, read funny books, learn jokes, participate in game nights, spend more time with kids.
  • Develop your sense of humor by not taking yourself too seriously. Practice laughing at yourself and your mistakes. Find something funny about your quirks and habits. Share embarrassing memories with people.
  • Remember funny stories and tell them.
  • Schedule laughter. Be intentional about finding something to laugh at every day.

 

Laughter and the Heart

Considering the wide impact of heart disease, evaluating any promising mitigating factors is worth the investment. Scientific research has established that negative emotional states such as anxiety and depression can increase cardiovascular risk.

The effect of negative emotions has been studied thoroughly in the practice of preventive medicine. The effect of negative emotions has been attributed to increased adrenal activity. If negative feelings increase vascular problems, it makes sense to explore how positive emotions may improve vascular health.

In a study in The American Journal of Cardiology, subjects were shown a comedy or a documentary, and their heart rates and blood pressure were subsequently evaluated. Results indicated that heart rate and blood pressure increased significantly while participants watched the comedy, but not the documentary (Sugawara, et. al, 2010).

While the study included a small sample size, researchers concluded that: “These results suggest that mirthful laughter elicited by comic movies induces beneficial impact on vascular function.”

A larger scale study was conducted in Japan to assess if there was an association between how often someone laughs on a daily basis and their risk of heart disease and stroke.

Researchers evaluated data from 20,934 men and women aged 65 or above. They were interested in the impact of laughing on heart disease, after controlling for a number of medical factors such as hyperlipidemia (high levels of fat in the blood), high blood pressure, depression, and body mass index (BMI).

Results indicated that individuals who “never or almost never laughed” had a 21% higher risk of heart disease than those who laughed daily (Hayashi, et. al., 2016). Additionally, there was a 60% higher rate of stroke in those who rarely laugh over regular laughers.

Studies support that laughter can have a positive anti-inflammatory effect on the body. This effect protects blood vessels and heart muscles from the damage that occurs as a result of cardiovascular disease.

The physiological dynamic of this change is not fully understood yet. However, researchers suggest that it is related to decreasing the body’s natural stress response, which therefore leads to the decrease of inflammation. Preventive heart clinics are exploring further how laughter can be incorporated into their treatment protocols.

 

Laughter and Pain

Laughing seems to have a positive impact on one’s ability to tolerate pain. A recent literature review highlighted the positive impact laughter has on how people experience pain (Perez-Aranda, et. al., 2019).

In a study conducted by Tse et. al. (2010), the effectiveness of a humor therapy program in relieving chronic pain, enhancing happiness and life satisfaction, and reducing loneliness among older persons with chronic pain was evaluated.

Older persons in a nursing home joined an 8-week humor therapy program (experimental group), while those in another nursing home were not offered the program. Results indicate 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. Results from this study provide possibilities for the use of humor therapy to be used as an effective non-pharmacological intervention for chronic pain.

Earlier studies suggest that laughter was more likely when in a group than when alone. To explore this element, researchers tested the pain tolerance of individuals who were shown comedy clips (Dunbar et., al, 2012).

After viewing the videos, subjects were given pain tolerance tests to evaluate how long they could sustain cold, a tight blood pressure cuff, or engage in strenuous exercise. They hypothesized that laughter elevates the pain threshold in both laboratory and natural conditions. In both settings, pain thresholds were increased.

Results indicated that pain thresholds are significantly higher after laughter than for individuals in the control condition. They suggest that the pain-tolerance effect is due to laughter itself and not simply due to a change in positive affect.

Thomas Benz and his Swiss colleagues study how humor interventions should be utilized as a part of pain therapy. They propose that laughter and humor increase pain tolerance and improves quality of life. In their research, individuals who laughed at comedy videos kept their hands in ice cold water longer than participants who were not laughing. Subsequent assessment indicated that increased pain tolerance remained present 20 minutes after laughing.

Researcher Williband Ruch at Zurich University proposes that “Humor can be used specifically as a cognitive technique, for example in terms of a distraction to control the pain and increase pain tolerance.”

 

A Look at the Importance of Smiling

Scientific research and anecdotal examples also support the importance of smiling. The obvious benefits mentioned are enhancing mood, reducing blood pressure, increasing endurance, reducing pain and stress, and strengthening immune systems. People who smile more are also found to be more likeable, courteous and competent.

There is biological support for how smiling affects your brain. The act of smiling releases the neuropeptides used to fight off stress. Neurotransmitters dopamine, endorphins, and serotonin, are released when you smile, contributing to positive emotion. Smiling not only relaxes your body, but it can also lower heart rate and blood pressure.

It may sound like good news to many that people are considered better looking when they smile. When you smile, people respond differently.

You are likely to be considered more attractive, relaxed, and genuine. The Journal of Neuropsychologia published a study suggesting that seeing a smiling face produces changes in your brain functioning. It activates the orbitofrontal cortex, which is the part of the brain that reinforces sensory rewards (Odoherty, et.al, 2003).

It is indicated that mimicking facial expressions such as smiling is in the cingulate cortex, part of an unconscious automatic response area of the brain. This finding can have implications on how you interact with people and how you influence in general. If you smile at someone, they will likely respond in kind with a smile back. If not, they are being intentional in not doing so.

Smiling can also have a significant impact on people around you. Smiling, like other emotions, is contagious. Psychological research on the study of emotional contagion explores the positive impact of smiling.

Even when asked to frown when looking at pictures of people smiling, individuals still imitate the smile. According to the theory of emotional contagion, there is great opportunity to spread positive emotion through smiling alone.

The benefits of smiling are wide-ranging, including:

  • Smiling makes you look younger and more attractive.
  • It makes you seem successful.
  • People who smile appear more confident.
  • Smiling helps you remain positive.
  • Smiling sends out positive energy to others.
  • It builds connections with people.
  • It can be contagious, contributing to the wellbeing of others.
  • Smiling makes us feel good.

 

What are the Proven Benefits of a Smile?

Similar to the positive effects of laughter, smiling contributes to health benefits as well.

When we experience happiness, our intuitive response is to smile. Researchers have explored if the opposite is true… does smiling produce happiness?

Studies have explored the effect of facial expressions on mental health problems. Specifically, Eric Finzi and Norman Rosenthal (2014) studied 74 individuals diagnosed with depression.

Participants were given a Botox injection that prevented frowning or a placebo injection that did not impact the facial muscles targeted between the eyebrows. Findings indicated that 6 weeks post-injection, 52% of the non-frowning Botox group reported a reduction in their depressive symptoms. Only a 15% rate of improvement was noted for the placebo group.

Researchers at UMKC recently explored the benefits of smiling, with results highlighted as follows: Smiling can make you look younger.

Researchers studied college students’ perception of the age of older people. They recognized older people who were smiling as seeming younger and older people with frowning facial expressions were identified as being older.

Another recent study at UMKC evaluated how smiling can make you look thinner. Subjects judged people with frowns on their faces as being heavier.

In Ron Gutman’s book, Smile: The Astonishing Powers of a Simple Act, he highlights “British researchers found that one smile can generate the same level of brain stimulation as up to 2,000 bars of chocolate.”

There are multiple studies supporting how laughter and smiling contribute to wellbeing, due to the release of neurotransmitters, helping you feel more relaxed and subsequently, enhancing your immune system.

Similar to laughter, smiling releases the feel-good neurotransmitters: endorphins, serotonin, and dopamine (Lane & Nadel, 2000). Smiling also activates neuropeptides, which contribute to dealing with stress (Seaward, 2009).

 

Can Fake Laughter and Smiling Be Beneficial?

Simulated laughter and smiling can even bring similar benefits as the real thing. So, even if you are faking the laughter, it can still produce positive effects.

When we smile or laugh, even when it is fake, our body responds as if it is authentic. It seems that the act of engaging in a smile, even if it is forced, can trick you into being happy. Smiling can elevate our mood because the physical activity of smiling activates neuro-messaging in the brain and again, causing the release of mood-enhancing neurotransmitters.

Scientists Tara Kraft and Sarah Pressman (2012) studied how crafting a smile impacts happiness. They conducted a study to evaluate the connection. Subjects were requested to put chopsticks in their mouths and to subsequently engage in one of three facial expressions: a neutral expression, a standard smile (a “half” smile that stays located by the mouth), or a Duchenne smile (a big one, ear to ear).

Individuals in a group instructed to smile had lower heart rate levels as well as less stress after the assignment. This was particularly true for those with the biggest smiles. Even subjects who had a forced smile emerged as feeling more content and less stressed than those with neutral facial expressions.

In making sense of the study, researcher Sarah Pressman proposed:

The next time you are stuck in traffic or are experiencing some other type of stress, you might try to hold your face in a smile for a moment. Not only will it help you ‘grin and bear it’ psychologically, but it might actually help your heart health as well!

Doukas et al. (2012) also highlighted the positive impact of forced smiling on physiology and affect. According to their research, faking it ‘til you make it is supported. Results from another study by Foley et. al (2002) also discusses the positive impact of forced laughter on mood.

Abel & Kruger (2010) explored how even smile intensity noted in a photograph can predict longevity.

 

20 Quotes on the Topic

Laughter is the most inexpensive and most effective wonder drug. Laughter is a universal medicine.

Bertrand Russell

Laughter is the tonic, the relief, the surcease for pain.

Charlie Chaplin

Laughter and tears are both responses to frustration and exhaustion. I myself prefer to laugh, since there is less cleaning do to do afterward.

Kurt Vonnegut

The human race has only one really effective weapon and that is laughter.

Mark Twain

Laughter is poison to fear.

George R.R. Martin

Laughter is the shortest distance between two people.

Victor Borge

I know why we laugh. We laugh because it hurts, and it’s the only thing to make it stop hurting.

Robert A. Heinlein

A good laugh heals a lot of hurts.

Madeleine L’Engle

A smile is a curve that sets everything straight.

Phyllis Diller

Earth laughs in flowers.

Ralph Waldo Emerson

Even the gods love jokes.

Plato

He who laughs, lasts!

Mary Pettibone Poole

I have not seen anyone dying of laughter, but I know millions who are dying because they are not laughing.

Dr. Madan Kataria

If laughter cannot solve your problems, it will definitely DISSOLVE your problems; so that you can think clearly what to do about them.

Dr. Madan Kataria

Laughter is a form of internal jogging. It moves your internal organs around. It enhances respiration. It is an igniter of great expectations.

Norman Cousins

Perhaps I know best why it is man alone who laughs; he alone suffers so deeply that he had to invent laughter.

Frederick W. Nietzche

The most wasted of all days is one without laughter.

E E Cummings

We don’t laugh because we’re happy, we are happy because we laugh.

William James

Your body cannot heal without play. Your mind cannot heal without laughter. Your soul cannot heal without joy.

Catherine Rippenger Fenwick

Sometimes your joy is the source of your smile, but sometimes your smile can be the source of your joy.

Thich Nhat Hanh

 

A Take Home Message

There is promising evidence that laughter and smiling produce physical, cognitive, and emotional health benefits.

It is applicable in a range of settings, populations, and cultural contexts. There are no negative side effects or contraindications.

While research supports these benefits, experts do not suggest substituting laughter for scientifically proven medical treatments. Scientists will continue to explore the complex interplay of how laughter impacts health.

In the meantime, it is clear that everyone, regardless of their current state of health, would benefit from cultivating more laughter in their lives. Consider adding more of this universal, free, positive, enhancing, accessible resource to contribute to your quality of life and wellbeing. While it is no magic bullet, why not self-medicate?

 

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About the Author

Karen Doll, Psy.D., L.P. is a Consulting Psychologist based in Minneapolis, Minnesota. She has spent 20+ years of her career helping people develop through leadership assessment and coaching. She is grateful for having the opportunity to learn about people, be invited into their lives, and witness them working at becoming the best thriving, flourishing version of themselves. In her spare time, she builds resilience through raising her five teenagers.

Comments

  1. Derek Rooney

    I had COPD for 9 years. My first symptoms were dry cough, chest tightness and shortness of breath. My first chest x-ray only showed bronchitis. Finally I went to a pulmonologist and was diagnosed with COPD.i have used all the medication yet they don’t work, last year December I was told by a formal emphysema patient to use  totalcureherbsfoundation.com herbal treatment which I really did,i was surprise the herbal products effectively get rid of my COPD totally. When you get where you cannot breathe it may be too late. Good luck to each and every one that will be trying their herbal treatment .

    Reply
  2. Maggie McGrane

    Thank you, Karen. I was browsing on my iPad while eating breakfast and followed an article about positive psychology. Long ago and far away I got a degree in psy. I had been an RN for 30+ years and had always been interested in people, what makes us tick etc. both in people with mental health problems and us perfectly fine people. How could our lives be better. I smile a lot, always have. I’m happy. I love jokes and am an avid funny paper fan. Luckily I benefit from all of those therapeutic modalities. I’ve been restlessly looking for some thing to do for the rest of my life and I think you’ve put me on the right path. Here’s a little smile for you. What did zero say to 8?…….”.nice belt” and what happened when the balloons met the unicorns?………no balloons. Kind of corny, but they made me smile. And that’s a beginning.

    Reply
  3. Che Gon

    Dear Karen good day. This is so good an article.
    Thank you for sharing
    Best regards
    Che Gon

    Reply
  4. Ross A Graham

    In September of ‘03, when I was diagnosed with Multiple Myeloma and advised by my Oncologist that, due to several factors, I probably had 3 years to live. I suggested to him that we should put a zero after the 3 and negotiate from there. When he gave me the all clear less than 2.5 years later, he admitted that the key factors in my survival was me maintaining my quirky sense of humour coupled with my positive mental attitude.
    I now deliver a keynote presentation called: The Curative Powers of Humour.
    I empathise that I’m not suggesting that a sense of humour will cure cancer, but it will assist you in maintaining your focus on the things you DO want to happen to you and off the things you DON’T want to happen. Being happy, laughing and smiling changes your body language and demeanour.
    A scripture in the Bible was brought to my attention, Proverbs 17:22…A merry heart does good like medicine, but a broken spirit dries the bones.
    I thought that was quite appropriate for someone with bone marrow cancer.

    Reply

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