1. Gelotology: the study of laughter Doc Talks-Maui 2017 Jacob Schor, ND, FABNO

2. Gelotology Greek gelos, geloto: meaning laugh, laughter, laughing.
Gelotology: The study of laughter
Gelotology is the study of laughing and laughter, its effects on the human body, and of medical abnormalities of laughing. It is also the psychological and physiological study of laughter. The word is from the Greek gelos, geloto meaning laugh, laughter, laughing.
Probably not related to gelato but gelato is a good way to remember this….

3. Norman Cousins ~1976
Research on laughter dates back to Norman Cousins. The story goes that having been diagnosed with ankylosing spondylitis Cousins developed his own program of treatment that was a combination of megadoses of Vitamin C, along with a positive attitude, and laughter that he induced by watching Marx Brothers films. "I made the joyous discovery that ten minutes of genuine belly laughter had an anesthetic effect and would give me at least two hours of pain- free sleep," he reported. "When the pain-killing effect of the laughter wore off, we would switch on the motion picture projector again and not infrequently, it would lead to another pain-free interval."
Much of this story is now in doubt. Whether he really had AS.
Though Cousins is associated with laughter, he was a serious journalist and liberal activist. He was named editor-in-chief of the Saturday Review in 1942, a position he would hold until An outspoken proponent of nuclear disarmament he was instrumental in bringing the he Hiroshima Maidens to the US for medical treatment. These were a group of twenty-five young Japanese women who were seriously disfigured as a result of the atomic bomb dropped on Hiroshima on the morning of August 6, 1945.

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

5. Hiroshima
Cousins spent much of his life and work concerned about the threat of nuclear war, it’s intriguing or is it ironic, that we now associate him with laughter.

6. Why do we laugh?

7. Laughter evolved early
Laughter evolved early in primate societies.

8. Hajime Kimata
Starting in 2001a fascinating series of studies were doneby Dr. Hajime Kimata, an allergist at Unitika Central Hospital in Uji-City, Japan.
The first mention Kimata made of this therapeutic intervention was in a letter to JAMA in Kimata had a series of studies published over a 9 year period.
In his letter he gives credit to Norman Cousins for giving him the idea for his research.

9. JAMA. 2001 Feb 14;285(6):738. Effect of humor on allergen-induced wheal reactions. Kimata H.
Atopic dermatitis: allergies to dustmites, cedar and cat dander.
72 hours without medication.
Skin prick tests before and after watching Modern Times.
Size of the skin wheals were measured.
Identical procedure weeks later after watching the weather station.
Watching Charlie Chaplin significantly decreased size of the wheals.
In this first trial, 26 patients with atopic dermatitis who were all allergic to dust mites and most of whom were also allergic to cedar pollen and cat dander were studied. After going 72 hours with no medication, they underwent skin prick tests before and after viewing Modern Times. The size of the resulting wheal was measured. A similar procedure was repeated before and after an 87-minute video featuring weather information. The wheal responses to dust mites, cedar pollen and cat dander were significantly reduced after watching Chaplin and the effect lasted for hours. Watching the weather had no effect on the wheal size.

10. here is a chart that depicts the change in wheal size before and after watching modern times. See the vertical line on the left? Mean is about 12 or 13. Then on the right, the mean is about 5, maybe 6.

11. Charlie Chaplin studies
I refer to Kimata’s series of studies, at least in my mind, as the Chaplin Studies. In most of his studies, Dr. Kimata had participants watch Charlie Chaplin’s movie Modern Times as the therapeutic intervention.

12. Watching Mr. Bean decreased allergic reactivity….
No comment

13. Emotion with tears decreases allergic responses to latex in atopic eczema patients with latex allergy. PMID:
This study complicates things. It’s not just laughter that decreases allergic responses. In this paper Kimata had 60 patients with atopic eczema triggered by latex allergies. He had them watch Kramer vs Kramer or the weather station. As expected watching the weather did nothing; it didn’t make people cry or change their allergic responses. People who cried while watching the movie though, 44 out of 60 patients, reduced skin wheal size when challenged with latex.

14. Effect of viewing a humorous vs
Effect of viewing a humorous vs. nonhumorous film on bronchial responsiveness in patients with bronchial asthma. PMID:
“….. These findings indicate that viewing a humorous film may be useful in the treatment and study of BA.” PMID:
Actually two studies: all people with bronchial asthma. In the first study, 20 healthy people, and 20 with bronchial asthma triggered by dust mites. In the second, 15 normal participants and 15 with bronchial asthma triggered by epigallocatechin gallate (ie green tea). Patients watched either a humorous or non-humorous move. Immediately after viewing the movie study participants were exposed to their allergen. Viewing a humorous film significantly reduced the bronchial response to the allergens.

15. Mozart does the same
Listening to Mozart reduces allergic skin wheal responses and in vitro allergen-specific IgE production in atopic dermatitis patients with latex allergy PMID:
Laughter counteracts enhancement of plasma neurotrophin levels and allergic skin wheal responses by mobile phone-mediated stress PMID:
Kimata reported on a similar study in These patients were allergic to latex rather than dust mites. Instead of humorous movies he had the patients listen to classical music. A positive response was seen in patients who listened to Mozart music, but interestingly, no response was seen in patients who listened to Beethoven.
Let’s bring cell phones into the equation. This study tested specific blood parameters , plasma neurotrophin levelsin people with atopic dermatitis either watching Mr. Bean, weather information or writing text messages on a cell phone. Rowan Atkinson's The Best Bits of Mr. Bean reduced the plasma nerve growth factor, neurotrophin-3 levels, and allergic skin wheal size. Weather information did not. Text messaging increased the plasma nerve growth factor, neurotrophin-3 levels, and allergic skin wheal responses. Mr. Bean neutralized the increase of plasma neurotrophins and allergic skin wheal responses, watching the weather channel did nothing.
Text messaging “causes stress and enhances allergic responses with a concomitant increase in plasma neurotrophins that are counteracted by laughter”

16. Viewing humorous film improves nighttime wakening in children with atopic dermatitis PMID:
INTRODUCTION: Patients with atopic dermatitis suffered from night-time wakening, but the exact mechanism of it was not known. Ghrelin was involved in growth hormone secretion, regulation of appetite, anxiety, night-time wakening and stress. METHODS: Thus salivary ghrelin levels during the night were measured in 40 healthy children or 40 patients with atopic dermatitis with night-time wakening. Salivary ghrelin levels at 02:00 h were markedly elevated in patients with atopic dermatitis compared to those in healthy children. RESULTS: Neither viewing control non-humorous film nor viewing humorous film had any effect on healthy children. In contrast, viewing humorous film improved night-time wakening and reduced elevation of salivary ghrelin levels in patients with atopic dermatitis, while viewing control film failed to do so. CONCLUSION: Viewing humorous film may be useful in the treatment of night-time wakening in patients with atopic dermatitis.
One theory why this works is a chemical called ghrelin. Ghrelin levels were higher in kids with atopic dermatitis than in healthy kids. Watching funny movies doesn’t change ghrelin levels in normal kids but lowers it in kids with atopic dermatitis. Watching the funny movies helped them sleep better.

17. Laughter elevates the levels of breast-milk melatonin. 2007
Laughter elevates the levels of breast-milk melatonin PMID:
•Patients with atopic eczema (AE) often complain of sleep disturbance. N= 48 infants.
Half (n=24) of the mothers of these infants were patients with AE, while another 24 mothers were healthy subjects. The mothers viewed either an 87-min humorous DVD (Modern Times, featuring Charlie Chaplin) or an 87-min nonhumorous weather information DVD at 2000 h. After viewing, breast milk was collected and the levels of breast-milk melatonin were measured. In addition, skin wheal responses to HDM and histamine were studied in infants.
•RESULTS: Laughter increased the levels of breast-milk melatonin in both mothers with AE and healthy mothers. In addition, allergic responses to latex and HDM of infants were reduced by feeding with breast milk after laughter of mothers with AE or of healthy mothers.
Laughter increased the levels of breast-milk melatonin in both mothers with AE and healthy mothers, and feeding infants with increased levels of melatonin-containing milk reduced allergic responses in infants. Thus, laughter of mothers may be helpful in the treatment of atopic dermatitis in infants

18. “Donald Trump never laughs.” Al Franken
NY Times December 13, 2016
Not sure what to do with this one….

19. Increase in dermcidin-derived peptides in sweat of patients with atopic eczema caused by a humorous video PMID:
Dermcidin (DCD)-derived peptide is an antimicrobial peptide produced by the sweat glands. However, the levels of DCD-derived peptide in sweat were decreased in patients with atopic eczema Viewing a humorous video increased DCD-derived peptide in sweat of patients with AE, and thus, it may be helpful in the treatment of skin infection of AE.

20. Viewing a control non-humorous weather information had no effect.
Elevation of testosterone and reduction of transepidermal water loss by viewing a humorous film in elderly patients with atopic dermatitis PMID:
n=36 men, mean 70 yo
Viewing a humorous film (The Best Bits of Mr. Bean) slightly but significantly (P<0.05), elevated salivary testosterone levels and reduced transepidermal water loss (TEWL) values in healthy men. It markedly elevated salivary testosterone levels and reduced TEWL values in elderly patients with AD
Viewing a control non-humorous weather information had no effect.
Melatonin is not the only hormone changed by laughter. This 2007 study looked at old guys. 36 elderly male people and 36 elderly male people with atopic dermatitis.Kimata measured both testosterone and how dry the skin was, transepidermal water loss (TEWL)
“Viewing a humorous film (The Best Bits of Mr. Bean, Universal studios, 1996) slightly, but significantly (P<0.05), elevated salivary testosterone levels and reduced TEWL values in elderly healthy people, while viewing a control non-humorous film (weather information) failed to do so. Similarly, but more pronouncedly, viewing a humorous film markedly elevated salivary testosterone levels and reduced TEWL values in elderly patients with AD, while viewing a control non-humorous film failed to do so. These finding indicate that viewing a humorous film may be useful in the study of testosterone and TEWL, and treatment for dry skin in elderly people with or without AD.”

21. Erectile dysfunction
2008. Short-term improvement of erectile dysfunction by viewing humorous films in patients with atopic dermatitis.
PMID:
n= 36 ED/AD patients & wives
Watched humorous films on three consecutive days
significantly improved erectile function, orgasmic function, sexual desire, intercourse satisfaction, overall satisfaction in association with increased serum testosterone levels and decreased serum estradiol levels…
2008 study: Short-term improvement of erectile dysfunction by viewing humorous films in patients with atopic dermatitis.
Subjects: 36 AD patients with ED and their healthy wives
Intervention: viewed humorous films on three consecutive days (Days 1-3). After 2 weeks, they viewed control nonhumorous weather information films on three consecutive days (Days 1-3).
Viewing humorous films significantly improved the erectile function, orgasmic function, sexual desire, intercourse satisfaction, overall satisfaction in association with increased serum testosterone levels and decreased serum estradiol levels…

22. Short acting
However, this effect was short-term. By day 7, 3 days after finishing the movies, the effects had worn off.
However, this effect was short-term. By day 7, 3 days after finishing viewing the movies, the effects had worn off.
[***before switching slides?] 滴ow many of you run poop tests: great smokies, doctors data, any of these labs. How long does it take to change bowel flora? Say you give them big doses of probiotics, berberine, tannalbits etc?�

23. In AD pts. viewing humorous films:
Modulation of fecal polyamines by viewing humorous films in patients with atopic dermatitis PMID:
viewing humorous films on fecal flora and fecal levels of polyamines. 7 days.
n = 24 healthy and 24 patients with atopic dermatitis
In AD pts. viewing humorous films:
(i) increased colonization with lactobacilli and bifidobacterium,
(ii) decreased colonization with S. aureus and Enterobacteria, and
(iii) increased fecal levels of polyamines
nonhumorous films had no affect on AD pts.
Fecal Polyamines: This is the most recent Kimata paper published and may be one of the most interesting. They measured fecal polyamines. Bacteria like klebsiella, staphyloccocus and other unwanted species produce more polyamines in the gut than the bacteria we rank as good guys.
(Continued)
viewed either seven control non-humorous films or seven humorous films sequentially for 7 days.
In AD pts. viewing humorous films:
(i) increased colonization with lactobacilli and bifidobacterium,
(ii) decreased colonization with S. aureus and Enterobacteria, and
(iii) increased fecal levels of polyamines
nonhumorous films had no affect on AD pts.
Eur J Gastroenterol Hepatol Jun;22(6): Modulation of fecal polyamines by viewing humorous films in patients with atopic dermatitis. Kimata H.
intestinal flora is involved in atopic dermatitis. Patients with atopic dermatitis have less Lactobacilli or Bifidobacterium, and more Staphylococcus aureus or Enterobacteria. Consequently, fecal levels of bacterial polyamines are lower. Stress impairs intestinal barrier function. We studied the effect of viewing humorous films on fecal flora and fecal levels of polyamines.
n = 24 healthy and 24 patients with atopic dermatitis

24. pediatric atopic is increasing in the United States.
Atopic dermatitis in children in the United States, : visit trends, patient and provider characteristics, and prescribing patterns. PMID:
pediatric atopic is increasing in the United States.
In 1997 there were 620,000 pediatric visits for atopic dermatitis.
In 2003, the number had more than doubled to 1,700,000
Kimata in these studies has focused on atopic dermatitis in these studies. Incidence of atopic dermatitis cases, at least in children, has increased. Back in 1997 there were an estimated 620,000 pediatric visits for atopic dermatitis. Six years later, in 2003, the number had more than doubled to 1,700,000
Pediatrics Sep;120(3):e Atopic dermatitis in children in the United States, : visit trends, patient and provider characteristics, and prescribing patterns. Horii KA, Simon SD, Liu DY, Sharma V.
Incidence of pediatric atopic dermatitis cases has increased in the United States.
In 1997 there were an estimated 620,000 pediatric visits for atopic dermatitis.
Six years later, in 2003, the number had more than doubled to 1,700,000

25. Violence depicted on TV has increased during this time:
1993 to 2001, incidents of physical violence increased by 378 % [1]
Between 1998 and 2002 violence displayed on television increased: [2]
41% increase in depictions of violence during the 8:00 to 9:00 pm Family Hour
134% increase during the 9:00 to 10:00 pm time slot.
[1] PMID:
[2] TV Bloodbath: Violence on Primetime TV. The Parents Television Council. 2002
Violence on TV has increased during this same time. I suspect if we were to graph out the data, number of cases of atopic dermatitis and violence on TV, we might see two lines that seem to move in parallel. There are no publshed data to support these conjectures.
One must also wonder about cell phone text messaging during this same period. I do not think it has decreased.

26. Dysbiosis, etc. Humor should also be considered in the treatment of :
Low melatonin
Low testosterone
Dry skin
Erectile dysfunction
Dysbiosis
Diabetes, whoops need to add those studies…..
Increasing NK Killer cell activity, etc.

27. The bus driver joke
A lady, she’s carrying a little baby gets on a bus.
The bus driver, looks at her, looks at the baby and says Lady, that’s the ugliest baby I’ve ever seen. The woman is horrified and plumps herself into a seat. The fellow sitting next to her looks at her expression and asks, ‘Did that bus driver just insult you?’
She nods yes. ‘Did you say anything back to him?’ She shakes her head no.
‘You can’t let him get away with this. If you don’t speak up for yourself and keep this hurt inside, it will make you sick. You should go tell him off. Will you do that?’
She nods yes.
‘Here you go tell him what you think, I’ll hold that monkey.’

28. update
Kimata was in the news last year for winning a prize.
He confirmed that 30 minutes of kissing with a lover or spouse behind closed doors while listening to soft music can reduce allergic reactions among atopic and allergic patients,
PMID:
Kissing reduces allergic skin wheal responses and plasma neurotrophin levels.

29. 2011
Medical clowning increases pregnancy rates after in vitro fertilization, 36% vs 20%. PMID:
four weekly sessions of laughter therapy reduced depression and increased cognitive function and sleep quality in seniors. (n=109) PMID:
2011 study conducted in Israel reported on the effect of medical clowning on pregnancy rates after in vitro fertilization and embryo transfer. Apparently clowning around, in contrast to just fooling around, increases pregnancy rates. The research group reported, “… that the pregnancy rate in the intervention group was 36.4%, compared with 20.2% in the control group (adjusted odds ratio, 2.67; 95% confidence interval, ). Medical clowning as an adjunct to IVF-ET may have a beneficial effect on pregnancy rates and deserves further investigation”
Another 2011 study, this one conducted in Korea, reported that four weekly sessions of laughter therapy reduced depression and increased cognitive function and sleep quality in seniors. (n=109)
Two other studies of interest were published in One tells us that laughter decreases post-partum fatigue in Korean women (n=67). A second study found that laughter therapy was associated with improved quality of life and resilience in breast cancer survivors (n=37). In the first of these studies, therapy consisted with 60-minute group sessions twice a week for two weeks, a total of 4 hours of treatment. In the breast cancer study, women had twice weekly 60-minute sessions for a total of eight hours of group therapy.
Fertil Steril May;95(6): doi: /j.fertnstert Epub 2011 Jan 6.
The effect of medical clowning on pregnancy rates after in vitro fertilization and embryo transfer.
Friedler S1, Glasser S, Azani L, Freedman LS, Raziel A, Strassburger D, Ron-El R, Lerner-Geva L.
Author information
1Infertility and IVF unit, Assaf Harofeh Medical Center, Zrifin, Israel.
Abstract
This experimental prospective quasi-randomized study examining the impact of a medical clowning encounter after embryo transfer (ET) after in vitro fertilization (IVF) found that the pregnancy rate in the intervention group was 36.4%, compared with 20.2% in the control group (adjusted odds ratio, 2.67; 95% confidence interval, ). Medical clowning as an adjunct to IVF-ET may have a beneficial effect on pregnancy rates and deserves further investigation.
Copyright © 2011 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.
PMID: DOI: /j.fertnstert
Geriatr Gerontol Int Jul;11(3): doi: /j x. Epub 2011 Jan 17.
Effects of laughter therapy on depression, cognition and sleep among the community-dwelling elderly.
Ko HJ1, Youn CH.
AIM:
To investigate the effects of laughter therapy on depression, cognitive function, quality of life, and sleep of the elderly in a community.
METHODS:
Between July and September 2007, the total study sample consisted of 109 subjects aged over 65 divided into two groups; 48 subjects in the laughter therapy group and 61 subjects in the control group. The subjects in the laughter therapy group underwent laughter therapy four times over 1 month. We compared Geriatric Depression Scale (GDS), Mini-Mental State Examination (MMSE), Short-Form Health Survey-36 (SF-36), Insomnia Severity Index (ISI) and Pittsburgh Sleep Quality Index (PSQI) between the two groups before and after laughter therapy.
RESULTS:
There were no significant differences in baseline characteristics between the two groups. Before laughter therapy, the GDS scores were 7.98 ± 3.58 and 8.08 ± 3.96; the MMSE scores were ± 3.90 and ± 4.00; total scores of SF-36 were ± and ± 21.31; the ISI scores were 8.00 ± 6.29 and 8.36 ± 6.38; the PSQI scores were 6.98 ± 3.41 and 7.38 ± 3.70 in laughter therapy group and control groups, respectively. After laughter therapy, the GDS scores were 6.94 ± 3.19 (P=0.027) and 8.43 ± 3.44 (P=0.422); the MMSE scores were ± 3.53 (P=0.168) and ± 3.85 (P=0.068); total scores of SF-36 were ± (P=0.347) and ± (P=0.392); the ISI scores were 7.58 ± 5.38 (P=0.327) and 9.31 ± 6.35 (P=0.019); the PSQI scores were 6.04 ± 2.35 (P=0.019) and 7.30 ± 3.74 (P=0.847) in both groups, respectively.
CONCLUSION:
Laughter therapy is considered to be useful, cost-effective and easily-accessible intervention that has positive effects on depression, insomnia, and sleep quality in the elderly.
J Korean Acad Nurs Jun;41(3): doi: /jkan
[Effects of laughter therapy on postpartum fatigue and stress responses of postpartum women].
[Article in Korean]
Shin HS1, Ryu KH, Song YA.
PURPOSE:
The purpose of this study was to examine the effects of laughter therapy on postpartum fatigue and stress responses of postpartum women.
The research design was a nonequivalent control group non-synchronized design. The participants were 67 postpartum women who agreed to participate in this study, selected by convenience sampling: (experiment group-33 and control group-34). The data were collected from August 5 to September 30, The experimental group received laughter therapy from a laughter therapy expert for 60 min, twice a week for 2 weeks, a total of 4 sessions. To evaluate the effects of laughter therapy, postpartum fatigue by self-report questionnaire and cortisol concentration in breast milk were measured. The data were analyzed using the SPSS WIN 13.0 Program.
The first hypothesis that "the degree of postpartum fatigue in the experimental group participating in laughter therapy would be lower than that of the control group" was accepted. These findings indicate that laughter therapy has a positive effect on decreasing postpartum fatigue.
The finding provides evidence for use of complementary and alternative nursing in Sanhujori facilities and obstetric units to reduce postpartum women's fatigue.
PMID: DOI: /jkan
[PubMed - indexed for MEDLINE] Free full text
J Korean Acad Nurs. 2011 Jun;41(3): doi: /jkan
[Effects of laughter therapy on depression, quality of life, resilience and immune responses in breast cancer survivors].
Cho EA1, Oh HE.
In this study, the effects of laughter therapy on levels of depression, quality of life, resilience and immune responses in breast cancer survivors were examined.
A quasi-experimental nonequivalent control group, pretest-posttest design was used. Participants (n=37) included breast cancer survivors who finished chemotheraphy and radiation therapy: 16 in the experiment group and 21 in the control group. Data were collected from August to November The experimental group participated in laughter therapy eight times, twice a week for 60 min per session. Questionnaires were used to measure pretest and posttest levels of depression, quality of life and resilience. A blood test was used to analyze changes in Total T cell, T helper, T suppressor, Th/Ts ratio, Total B cell, T cell/B cell ratio and NK cell for immune responses.
The results showed that laughter therapy was effective in increasing the quality of life and resilience in breast cancer survivors. but depression and immune responses did not differ significantly between the groups.
The results of the study indicate that laughter therapy may be an effective nursing intervention to improve quality of life and resilience in breast cancer survivors.
PMID:
DOI:
/jkan
[PubMed - indexed for MEDLINE] 
Free full text

30. 2011 (cont)
laughter decreases post-partum fatigue in Korean women (n=67) PMID:
with improved quality of life and resilience in breast cancer survivors (n=37) PMID:
Two other studies of interest were published in One tells us that laughter decreases post-partum fatigue in Korean women (n=67). A second study found that laughter therapy was associated with improved quality of life and resilience in breast cancer survivors (n=37). In the first of these studies, therapy consisted with 60-minute group sessions twice a week for two weeks, a total of 4 hours of treatment. In the breast cancer study, women had twice weekly 60-minute sessions for a total of eight hours of group therapy.

31. sneaky
There is something a bit sneaky about telling jokes. People who laugh lose their defense or resistance against persuasion. Thus an advertisement for a commercial product is more effective if it makes the viewer laugh. The researchers report that the effect of humor on resistance follows a two-step process: first via a cognitive mechanism and then via an affective mechanism. Humor first forestalls the development of negative brand associations because of its distractive properties (cognitive mechanism), and then engenders positive brand associations because of its positive emotional outcomes (affective mechanism). These effects of humor on brand associations jointly promote brand preference. The next time you find yourself laughing at a commercial, remember that the purpose wasn’t to entertain you, but to sell you something.
J Exp Psychol Appl Jun;18(2): doi: /a Epub 2012 May 7.
Those who laugh are defenseless: how humor breaks resistance to influence.
Strick M1, Holland RW, van Baaren RB, van Knippenberg A.
Author information
Abstract
Three experiments illustrate that humor in advertisements prevents the development of negative brand associations due to resistance. Previous research on humor in advertising suggested that humor can counter negative responses during ad processing, but less is known about the effect of humor on the development of negative brand associations in memory. Brand associations are important because there is often a time delay between ad exposure and brand decisions. We separately manipulated two typical aspects of humor processing, that is, distraction and positive affect, and examined their effects on the development of respectively negative and positive brand associations. All experiments were conducted with university students as participants. The results showed that resistance causes negative brand associations (Experiments 1 and 2), and humor prevents the development of these negative brand associations more than nondistracting positive stimuli and neutral stimuli (Experiment 2 and 3). The prevention of negative brand associations was caused by the distractive properties of humor. Irrespective of resistance, the positive affect engendered by humor enhanced positive brand associations. Experiment 3 showed that distraction and positive affect in humor uniquely contribute to brand preference. Together, these results illustrate that the effect of humor on resistance follows a two-step process: humor forestalls the development of negative brand associations because of its distractive properties (cognitive mechanism), and engenders positive brand associations because of its positive emotional outcomes (affective mechanism). These effects of humor on brand associations jointly promote brand preference.
PMID: DOI: /a

32. Laughter is good for the heart:
The effect of mirthful laughter on the human cardiovascular system. Miller and Fry PMID:
Laughter is good for the heart:
Increases release of nitric oxide in the endothelium
Serves as a counterbalance against mental stress having an opposing effects on endothelial
a. Increases release of nitric oxide in the endothelium
Laughter serves as a counterbalance against mental stress having an opposing effects on endothelial
Med Hypotheses Nov;73(5): doi: /j.mehy Epub 2009 May 27.
The effect of mirthful laughter on the human cardiovascular system.
Miller M1, Fry WF.
Author information
Abstract
It has become increasingly recognized and more widely acknowledged during the past several decades, that a complex relationship exists between behavior associated with emotion and the human cardiovascular (CV) system. Early studies focused on the interplay between negative emotions and elevated CV risk, an effect that has in large part been attributed to increased adrenergic activity. Thus, a variety of adverse CV effects ranging from sudden cardiac death triggered by natural disasters such as earthquakes to transient myocardial stunning resulting from heightened sympathetic overload have been identified in response to acute emotional distress. In fact, the biologic interplay between emotion and CV health has been greatly enhanced through studies of the vascular endothelium. As the largest organ in humans, the inner blood vessel lining serves as a conduit for the transfer of blood cells, lipids and various nutrients across the lumen to neighboring tissues. Healthy endothelial cells secrete vasoactive chemicals, most notably endothelial-derived relaxing factor or nitric oxide (NO), that effects smooth muscle relaxation and vessel dilation via a cyclic guanosine monophosphate (cGMP) dependent protein kinase signaling pathway. In addition, endothelial derived NO may reduce vascular inflammation by attenuating or inhibiting leukocyte adhesion and subendothelial transmigration as well as decreasing platelet activation via cGMP mediated pathways. Taken together, studying the endothelium provides an exceptional opportunity to advance our understanding of the potentially important interrelationship between emotions and the vasculature. Premised on the identification of physiological and biochemical correlates, the former was demonstrated after intracoronary administration of acetylcholine yielded paradoxical endothelial vasoconstriction in response to mental stress exercises. More recently, the brachial artery reactivity test (BART) has permitted endothelial function to be assessed in a non-invasive manner. In addition to traditional CV risk factors, exposure to negative emotions including mental stress and depression have been associated with reduced endothelial vasoreactivity as measured by BART. Whether mirthful laughter has the opposite effect garnered consideration following the discovery that mu3 opiate receptors were expressed in the vascular endothelium. Because mirthful laughter induces the release of beta-endorphins which in turn have high affinity for mu3 opiate receptors, we hypothesize that such positive emotions lead to the direct release of NO and associated biological consequences. Indeed, our studies have demonstrated opposing effects on endothelial vasoreactivity between those previously established (e.g., mental stress induced by negative visual and/or auditory stimuli) and those induced after mirthful laughter, thereby providing a potential mechanistic link between positive emotions and beneficial effects on the vasculature. This article reviews the relevant physiology and comments on the potentially wider clinical implications in the integration of this process to improve vascular health.
PMID: PMCID: PMC DOI: /j.mehy
[PubMed - indexed for MEDLINE] Free PMC Article

33. laughter improves short-term memory in older adults
2014 Loma Linda University
learning ability improved by 38.5%
delayed recall improved by 43.6%
salivary cortisol, ….significant and borderline decreases for the humor group
PMID:
Two studies from Loma Linda University in California suggest laughter improves short-term memory in older adults. The first was published in 2014 and enrolled 20 normal, healthy, older adults. Half of the participants watched their choice of 20 minute humorous videos (either Red Skeleton of America’s Home Videos) while the control groups sat quietly. Learning ability improved by 38.5% and 24.0% in the humor and control groups, respectively (P = .014). Delayed recall improved by 43.6% and 20.3% in the humor and control groups, respectively (P =.029). Within the humor group, delayed recall (43.6%) was significant compared with learning ability (38.5%) (P = .002). At 3 predetermined time points, significant decreases in salivary cortisol were observed in the humor group (P = .047, P = .046, and P = .062, respectively).
A second Loma Linda report was published in 2015, this time with 30 participants, but in this case 10 of the participants had type-2 diabetes. They were given the same choice of videos again for only a single twenty-minute viewing session. In the humor, diabetic, and control groups, (1) learning ability improved by 38.5%, 33.4%, and 24.0%, respectively (P = .025); (2) delayed recall improved by 43.6%, 48.1%, and 20.3%, respectively (P = .064); and (3) visual recognition increased by 12.6%, 16.7%, and 8.3%, respectively (P = .321).
Adv Mind Body Med Spring;28(2):16-24.
Perhaps if a student has to cram for a test, watching something humorous might be a productive time investment?
The effect of humor on short-term memory in older adults: a new component for whole-person wellness.
Bains GS, Berk LS, Daher N, Lohman E, Schwab E, Petrofsky J, Deshpande P.
For older adults, the damaging effects of aging and stress can impair the ability to learn and sustain memory. Humor, with its associated mirthful laughter, can reduce stress and cortisol, a stress hormone. Chronic release of cortisol can damage hippocampus neurons, leading to impairment of learning and memory.
CONTEXT:
Abstract
The primary goal of this study was to determine whether watching a humorous video had an effect on short-term memory in an older population.
OBJECTIVES:
SETTING:
The research team designed a randomized, controlled trial.
DESIGN:
PARTICIPANTS:
The study took place at Loma Linda University in Loma Linda, California.
The humor group (n = 10, mean = 69.3 ± 3.7 y) self-selected 1 of 2 humorous videos--a Red Skelton comedy or a montage of America's Funniest Home Videos--and watched it for 20 min. A control group (n = 10, mean = 68.7 ± 5.5 y) sat calmly for 20 min and were not allowed to read, sleep, or talk on a cell phone.
INTERVENTION:
The research team recruited 20 normal, healthy, older adults, 11 males and 9 females.
OUTCOME MEASURES:
Learning ability improved by 38.5% and 24.0% in the humor and control groups, respectively (P = .014). Delayed recall improved by 43.6% and 20.3% in the humor and control groups, respectively (P =.029). Within the humor group, delayed recall (43.6%) was significant compared with learning ability (38.5%) (P = .002). At 3 predetermined time points, significant decreases in salivary cortisol were observed in the humor group (P = .047, P = .046, and P = .062, respectively).
RESULTS:
The Rey Auditory Verbal Learning Test was used to assess short-term memory--learning ability, delayed recall, and visual recognition. Salivary cortisol levels were measured at predetermined times.
The study's findings suggest that humor can have clinical benefits and rehabilitative implications and can be implemented in programs that support whole-person wellness for older adults. Learning ability and delayed recall are important to these individuals for a better quality of life--considering mind, body, spirit, social, and economic aspects. Older adults may have age-associated memory deficiencies. However, medical practitioners now can offer positive, enjoyable, and beneficial humor therapies to improve these deficiencies.
CONCLUSION:
Bains GS, Berk LS, Lohman E, Daher N, Petrofsky J, Schwab E, Deshpande P.
Humors Effect on Short-term Memory in Healthy and Diabetic Older Adults.
Altern Ther Health Med May-Jun;21(3):16-25.
With aging, the detrimental effects of stress can impair a person's ability to learn and sustain memory. Humor and its associated mirthful laughter can reduce stress by decreasing the hormone cortisol. Chronic release of cortisol can damage hippocampal neurons, leading to impairment of learning and memory. Objectives • The study intended to examine the effect of watching a humor video on short-term memory in older adults. Design • The research team designed a randomized, controlled trial.
The study took place at Loma Linda University in Loma Linda, CA, USA.
The study included 30 participants: 20 normal, healthy, older adults-11 males and 9 females-and 10 older adults with type 2 diabetes mellitus (T2DM)-6 males and 4 females.
The study included 2 intervention groups of older adults who viewed humorous videos, a healthy group (humor group), aged 69.9 ± 3.7 y, and the diabetic group, aged 67.1 ± 3.8 y. Each participant selected 1 of 2 humorous videos that were 20 min in length, either a Red Skeleton comedy or a montage of America's Funniest Home Videos. The control group, aged 68.7 ± 5.5 y, did not watch a humor video and sat in quiescence.
A standardized, neuropsychological, memory-assessment tool, the Rey Auditory Verbal Learning Test (RAVLT), was used to assess the following abilities: (1) learning, (2) recall, and (3) visual recognition. The testing occurred twice, once before (RAVLT1) and once after (RAVLT2) the humorous video for the humor and diabetic groups, and once before (RAVLT1) and once after (RAVLT2) the period of quiescence for the control group. At 5 time points, measurements of salivary cortisol were also obtained. The Kruskal-Wallis test was used to measure significance of the data based on the 3 groups.
In the humor, diabetic, and control groups, (1) learning ability improved by 38.5%, 33.4%, and 24.0%, respectively (P = .025); (2) delayed recall improved by 43.6%, 48.1%, and 20.3%, respectively (P = .064); and (3) visual recognition increased by 12.6%, 16.7%, and 8.3%, respectively (P = .321). For levels of salivary cortisol, the research team found significant and borderline decreases for the humor group between baseline and (1) post-RAVLT1 (P = .047), (2) postvideo (P = .046), and (3) post-RAVLT2 (P = .062). The diabetic group showed significant decreases between baseline and (1) post-RAVLT1 (P = .047), (2) postvideo (P = .025), and (3) post-RAVLT2 (P = .034). The study found no significant changes for the control group.
The research findings supported potential clinical and rehabilitative benefits for humor that can be applied to whole-person wellness programs for older adults. The cognitive components-learning ability and delayed recall-become more challenging as individuals age and are essential to older adults for providing a high quality of life: mind, body, and spirit. Because older adults can experience age-related memory deficits, complementary, enjoyable, and beneficial humor therapies should be implemented for them.
PMID:

34. Cancer patients undergoing radiation therapy, three hour long laughter sessions significantly reduced mood disturbances (n=62). PMID:
Middle aged severely depressed Chinese women, it took just ten laughter therapy sessions to significantly increase their serotonin levels and their quality of life measurements. (n=64) PMID:
A 2015 randomized controlled trial reported that in cancer patients undergoing radiation therapy, three hour long laughter sessions significantly reduced mood disturbances (n=62).
In randomized controlled trial of 64 middle aged severely depressed Chinese women, it took just ten laughter therapy sessions to significantly increase their serotonin levels and their quality of life measurements.
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J Altern Complement Med Apr;21(4): doi: /acm
The effects of laughter therapy on mood state and self-esteem in cancer patients undergoing radiation therapy: a randomized controlled trial.
Kim SH1, Kook JR, Kwon M, Son MH, Ahn SD, Kim YH.
Author information
Abstract
BACKGROUND:
To investigate whether laughter therapy lowers total mood disturbance scores and improves self-esteem scores in patients with cancer.
DESIGN/SETTING:
Randomized controlled trial in a radio-oncology outpatient setting.
PATIENTS:
Sixty-two patients were enrolled and randomly assigned to the experimental group (n=33) or the wait list control group (n=29).
INTERVENTIONS:
Three laughter therapy sessions lasting 60 minutes each.
OUTCOME MEASURES:
Mood state and self-esteem.
RESULTS:
The intention-to-treat analysis revealed a significant main effect of group: Experimental group participants reported a point reduction in total mood disturbance, while the wait list control group showed a 1.21-point reduction (p=0.001). The per-protocol analysis showed a significant main effect of group: The experimental group reported a point decrease in total mood disturbance, while controls showed a 0.19-point reduction (p<0.001). The self-esteem of experimental group was significantly greater than that of the wait list control group (p=0.044).
CONCLUSIONS:
These results indicate that laughter therapy can improve mood state and self-esteem and can be a beneficial, noninvasive intervention for patients with cancer in clinical settings.
PMID: DOI: /acm
[PubMed - indexed for MEDLINE]
J Korean Acad Nurs. 2015 Apr;45(2): doi: /jkan
[Effect and Path Analysis of Laughter Therapy on Serotonin, Depression and Quality of Life in Middle-aged Women].
[Article in Korean]
Cha MY1, Hong HS2.
PURPOSE:
This study was done to examine how laughter therapy impacts serotonin levels, QOL and depression in middle-aged women and to perform a path analysis for verification of the effects.
METHODS:
A quasi-experimental study employing a nonequivalent control group and pre-post design was conducted. Participants were 64 middle-aged women (control=14 and experimental=50 in 3 groups according to level of depression). The intervention was conducted five times a week for a period of 2 weeks and the data analysis was conducted using repeated measures ANOVA, ANCOVA and LISREL.
Results showed that pre serotonin and QOL in women with severe depression were the lowest. Serotonin in the experimental groups increased after the 10th intervention (p=.006) and the rise was the highest in the group with severe depression (p=.001). Depression in all groups decreased after the 5th intervention (p=.022) and the biggest decline was observed in group with severe depression (p=.007). QOL of the moderate and severe groups increased after the 10th intervention (p=.049), and the increase rate was highest in group with severe depression (p<.006). Path analysis revealed that laughter therapy did not directly affect depression, but its effect was indirectly meditated through serotonin variation (p<.001).
CONCLUSION:
Results indicate that serotonin activation through laughter therapy can help middle-aged women by lessening depression and providing important grounds for depression control.
KEYWORDS:
Depression; Laughter therapy; Middle-aged women; Quality of life; Serotonin
PMID:
DOI:
/jkan
[PubMed - indexed for MEDLINE] 
Free full text

35. Australia Elder Clowns in nursing homes (35)
9-2 weekly sessions (n=189)
six month period (26 weeks), those who participated in the humor therapy session were measurably less agitated and exhibited longer durations of happiness. PMID:
Australia. The effects of laughter and humor therapy was measured using observational methods in a large project known as the SMILE cluster randomized trial. Professionally trained “ElderClowns” conducted humor therapy sessions in 35 nursing homes in Sydney Australia. These 9-12 weekly humor therapy sessions were augmented by trained staff. Seventeen nursing homes (n=189) received the humore therapy interventions and 18 homes (n=209) received usual care. Over a six month period (26 weeks), those who participated in the humor therapy session were measurably less agitated and exhibited longer durations of happiness. J Am Med Dir Assoc Aug;15(8): doi: /j.jamda Epub 2014 May 9.
The effects of humor therapy on nursing home residents measured using observational methods: the SMILE cluster randomized trial.
Low LF1, Goodenough B2, Fletcher J2, Xu K2, Casey AN2, Chenoweth L2, Fleming R3, Spitzer P4, Bell JP5, Brodaty H2.
Author information
Abstract
OBJECTIVES:
To evaluate the effects of humor therapy assessed using observational methods on agitation, engagement, positive behaviors, affect, and contentment.
DESIGN:
Single-blind cluster randomized controlled trial.
SETTING:
A total of 35 Sydney nursing homes.
PARTICIPANTS:
All eligible residents within geographically defined areas within each nursing home were invited to participate.
INTERVENTION:
Professional "ElderClowns" provided 9 to 12 weekly humor therapy sessions, augmented by resident engagement by trained staff "LaughterBosses." Controls received usual care.
MEASUREMENTS:
The Behavior Engagement Affect Measure (BEAM) touchpad observational tool was used to capture real-time behavioral data. The tool assesses the duration in seconds of agitation, positive behavior toward others, engagement, and affect (angry, anxious, happy, neutral, sad).
RESULTS:
Seventeen nursing homes (189 residents) received the intervention and 18 homes (209 residents) received usual care. Over 26 weeks, in comparison with controls, the humor therapy group decreased in duration of high agitation (effect size = and at 13 and 26 weeks, respectively) and increased in duration of happiness (effect size = 0.4 and at 13 and 26 weeks, respectively).
CONCLUSION:
We confirmed that humor therapy decreases agitation and also showed that it increases happiness. Researchers may consider evaluating impacts of nonpharmaceutical interventions on positive outcomes. Computer-assisted observational measures should be considered, particularly for residents with dementia and when the reliability of staff is uncertain.
Copyright © 2014 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.
KEYWORDS:
Dementia; behavior; long-term care; observational data

36. COPD = contraindication
Sense of humor among patients with COPD is associated with positive psychological functioning and enhanced quality of life, but ….
laughing aloud may cause acute deterioration in pulmonary function secondary to worsened hyperinflation. PMID:
No laughing out loud for copd patients.
contraindication to using laughter therapy has come up recently, chronic obstructive pulmonary disease, (COPD).
A study was conducted to see what effects laughter and humor had on lung function in 46 older patients with COPD. Sense of humor among patients with COPD is associated with positive psychological functioning and enhanced quality of life, but laughing aloud appeared to cause acute deterioration in pulmonary function secondary to worsened hyperinflation.
Heart Lung Jul-Aug;40(4): doi: /j.hrtlng
Effects of humor and laughter on psychological functioning, quality of life, health status, and pulmonary functioning among patients with chronic obstructive pulmonary disease: a preliminary investigation.
Lebowitz KR1, Suh S, Diaz PT, Emery CF.
Author information
Abstract
OBJECTIVE:
Previous research indicates the beneficial effects of humor among healthy adults. Little is known about the physical and psychological effects of sense of humor and laughter among patients with chronic obstructive pulmonary disease (COPD).
METHODS:
Patients with COPD (n = 46; mean age ± SD, 66.9 ± 9.9 years) completed assessments of sense of humor, depression, anxiety, quality of life, and recent illness. A subset of patients (n = 22) completed a laughter induction study and were randomly assigned to view either a humorous or a neutral video. Pulmonary function, mood state, and dyspnea were assessed before and after the video.
RESULTS:
Sense of humor was associated with fewer symptoms of depression and anxiety and an enhanced quality of life. However, the induction of laughter led to lung hyperinflation.
CONCLUSION:
Sense of humor among patients with COPD is associated with positive psychological functioning and enhanced quality of life, but laughing aloud may cause acute deterioration in pulmonary function secondary to worsened hyperinflation.
Copyright © 2011 Elsevier Inc. All rights reserved.
PMID:

37. Laughter should be considered a therapeutic tool for patients with allergic conditions
Atopic Dermatitis
Atopic Eczema
Allergic Asthma
Night-waking in allergic infants
1. Laughter should be considered a therapeutic tool for patients with allergic conditions:
a. Atopic Dermatitis
b. Atopic Eczema
c. Allergic Asthma
d. Night-waking in allergic infants

38. What makes people laugh?
Holist Nurs Pract Nov-Dec;23(6): Humor theories and the physiological benefits of laughter. Wilkins J, Eisenbraun AJ.
There are 3 main theories used to explain the functions of humor:
(1) the relief theory
(2) the incongruity theory
(3) the superiority theory.
But….
Holist Nurs Pract Nov-Dec;23(6): Humor theories and the physiological benefits of laughter. Wilkins J, Eisenbraun AJ.
There are 3 main theories used to explain the functions of humor:
(1) the relief theory
(2) the incongruity theory
(3) the superiority theory.

39. It doesn’t really matter
“…these physiological benefits occur regardless of the theory that is used to explain the humor function.”
In other words, the benefits occur whether the joke is ‘polite’ or not. Whatever makes people laugh is useful for our purposes….
But, it doesn’t matter if we understand these theories:
“…these physiological benefits occur regardless of the theory that is used to explain the humor function.”
In other words, the benefits occur whether the joke is ‘polite’ or not. Whatever makes people laugh is useful for our purposes….

40. How to prescribe laughter:
“What movies make you laugh?”
“Watch them daily”
Start with a loading dose…. 1.5 to 2 hours and then a daily maintenance dose, 1/2 to 1 hour
How do you get people to laugh more/
“What movies make you laugh?”
“Watch them daily”
Start with a loading dose…. 1.5 to 2 hours and then a daily maintenance dose, 1/2 to 1 hour

41. Jokes:
Tell them jokes.
Get them to tell jokes.
Make them practice.

42. Other uses for laughter:
We need to talk about painful subjects with our patients. Laughter makes it easier.
Laughter provides a teaching opportunity: patients may hear a message embedded in a joke easier than alone.
What homeopathic remedy is the bus joke about?
Laughter can shift our attitude, our viewpoint.

43. The hunters: funniest American Joke:
Two hunters are out in the woods when one of them collapses. He doesn't seem to be breathing and his eyes are glazed. The other guy whips out his phone and calls the emergency services. He gasps, "My friend is dead! What can I do?". The operator says "Calm down. I can help. First, let's make sure he's dead." There is a silence, then a shot is heard. Back on the phone, the guy says "OK, now what?"
The bus driver joke is considered the funniest joke in Great Britain. This joke is thought to be the funniest joke in the US.

44. Another US joke:
A man and a friend are playing golf one day at their local golf course. One of the guys is about to chip onto the green when he sees a long funeral procession on the road next to the course. He stops in mid-swing, takes off his golf cap, closes his eyes, and bows down in prayer.
His friend says: “Wow, that is the most thoughtful and touching thing I have ever seen. You truly are a kind man.”
The man then replies: Yeah, well we were married 35 years.
A man and a friend are playing golf one day at their local golf course. One of the guys is about to chip onto the green when he sees a long funeral procession on the road next to the course. He stops in mid-swing, takes off his golf cap, closes his eyes, and bows down in prayer.
His friend says: “Wow, that is the most thoughtful and touching thing I have ever seen. You truly are a kind man.”
The man then replies: Yeah, well we were married 35 years.

45. Canada
When NASA first started sending up astronauts, they quickly discovered that ballpoint pens would not work in zero gravity. To combat the problem, NASA scientists spent a decade and $12 billion to develop a pen that writes in zero gravity, upside down, underwater, on almost any surface including glass and at temperatures ranging from below freezing to 300ｰC The Russians used a pencil.
IN Canada the funniest joke is one that makes fun of Americans: i. Canada: When NASA first started sending up astronauts, they quickly discovered that ballpoint pens would not work in zero gravity. To combat the problem, NASA scientists spent a decade and $12 billion to develop a pen that writes in zero gravity, upside down, underwater, on almost any surface including glass and at temperatures ranging from below freezing to 300ｰC The Russians used a pencil.

46. Laughter counteracts enhancement of plasma neurotrophin levels and allergic skin wheal responses by mobile phone-mediated stress. Behav Med Winter;29(4):
Decreased
Skin wheal responses
Neve growth factor
Neurotrophin-3
Bean versus Weather info
text messaging made these measures worse
Laughter caused by viewing a comic video (Rowan Atkinson's The Best Bits of Mr. Bean) reduced the plasma nerve growth factor, neurotrophin-3 levels, and allergic skin wheal responses in patients with atopic dermatitis, whereas viewing a nonhumorous video (weather information) failed to do so. In contrast, stress induced by writing mail on a mobile phone enhanced the plasma nerve growth factor, neurotrophin-3 levels, and allergic skin wheal responses. However, previewing the comic video counteracted mobile phone-mediated enhancement of plasma neurotrophins or allergic skin wheal responses, whereas previewing the weather information failed to do so. Taken together, these results suggest that, in patients with atopic dermatitis, writing mail on a mobile phone causes stress and enhances allergic responses with a concomitant increase in plasma neurotrophins that are counteracted by laughter. These results may be useful in the study of pathophysiology and treatment of atopic dermatitis.
Let’s bring cell phones into the equation. This study tested specific blood parameters , plasma neurotrophin levelsin people with atopic dermatitis either watching Mr. Bean, weather information or writing text messages on a cell phone. Rowan Atkinson's The Best Bits of Mr. Bean reduced the plasma nerve growth factor, neurotrophin-3 levels, and allergic skin wheal size. Weather information did not. Text messaging increased the plasma nerve growth factor, neurotrophin-3 levels, and allergic skin wheal responses. Mr. Bean neutralized the increase of plasma neurotrophins and allergic skin wheal responses, watching the weather channel did nothing.

47. Text messaging “causes stress and enhances allergic responses with a concomitant increase in plasma neurotrophins that are counteracted by laughter”
Text messaging “causes stress and enhances allergic responses with a concomitant increase in plasma neurotrophins that are counteracted by laughter”
“no editorial commentary is needed here”