Depression & The Benefits of Laughter

By Lynn Santa Lucia







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It’s no joke—Start laughing to help your depression.

By Lynn Santa Lucia

When you don’t have your laughter, you’ve lost your soul,” says Tanaz B., 57, of Indiana.

Tanaz lived with severe depression, in and out of hospitals for a decade, until “laughter became my mission,” she says. Now she not only makes it a point to laugh regularly, she teaches others how to do the same—and this is no joke—as a certified Laughter Yoga teacher and ambassador.

It turns out there’s some truth to the old saying that laughter is the best medicine—or at least a pretty good one. Tanaz’s psychiatrist, Suhayl J. Nasr, MD, has come to see laughter as a powerful coping mechanism and possibly a natural antidote for stress and severe depression.

“The therapeutic action of laughter on depression is striking,” says Nasr, medical director of Memorial Hospital’s psychiatric center. “[Talk] therapy does help a lot, but laughter has an interesting way of changing brain chemistry.”

In several small studies on biochemical changes due to laughter, researchers from Loma Linda University School of Medicine in California found that watching humorous videos affected levels of cortisol, dopamine and other hormones implicated in stress and mood. Among their conclusions: laughter counteracts the stress response and improves markers of physical well-being.

Italian researchers who set out to examine the interrelationship between laughter and depression also found that laughter appears to stimulate brain regions involved in depression and mediating stress, suggesting that laughter “can counteract efficiently depressive symptoms.” Their study, published in 2010, also noted that both the immune system and social relationships can be strengthened by laughter, leaving individuals more able to cope with their mood disorder.

And Robert Provine, PhD, says laughter may also promote the release of endorphins, which promote feelings of pleasure and blunt the perception of pain.

Provine is a professor of psychology and neuroscience at the University of Maryland, Baltimore County, and author of Laughter: A Scientific Investigation and the recently released Curious Behavior: Yawning, Laughing, Hiccuping, and Beyond.

“Laughter has no obvious downside, so we need not wait on FDA approval to laugh,” he points out. “Isn’t that enough?”

Science takes note

There’s a boatload of research telling us that a good belly laugh does wonders for lightening our mental load and improving overall health. On a basic level, laughing enhances the intake of oxygen, stimulates circulation, and gives the diaphragm and abdominal muscles a workout, helping to soothe tension.

Furthermore, science is finding that as a targeted treatment tool for depression, laughter achieves positive results.

A Korean study of laughter therapy, published in Geriatrics & Gerontology International in July 2011, found the approach eased depressive symptoms and improved sleep in a group of elderly patients. Meanwhile, Iranian researchers who compared group exercise to a program called Laughter Yoga found they had similar benefits for reducing depression and improving quality of life. That study appeared in the International Journal of Geriatric Psychiatry in March 2011.

Many forms of laughter therapy, such as that employed with cancer patients, rely on sparking laughs from something people find funny. Some therapists try to cultivate a sense of playfulness or incorporate silly antics into sessions.

In Laughter Yoga, laughing can be a purely physical activity. A typical meeting involves some warm-up clapping and chanting (“Ho ho ha ha ha”), a few deep breaths with prolonged exhalation, 15 to 20 minutes of laughter exercises interspersed with deep breathing and stretching, followed by 15 minutes of meditation.

Just as we laugh because we feel happy, we can feel happy because we laugh.

Duncan Cook, 48, was diagnosed with depression in 1997. He benefits from standard treatment, including medication, but gives guided laughter high marks as a kind of complementary therapy.

Cook has led Laughter Yoga sessions in Guelph, Ontario, since 2005. When he first tried it, he recalls, “the feel-good benefits” happened instantly.

He was invited to laugh for just one minute, “no explanations on the methodology, just laugh or not,” he explains. “The release of pent-up energy was amazing. After the minute was up, I felt energized, calm and peaceful all at the same time.”

Now, he says, “I’ve come to realize that my ability to engage in genuine feel-good laughter is a reliable indicator of my emotional and psychological state—like a kind of barometer. If my capability is low, then I know I need to attend to something or other to regain a more agreeable state.”

Plus, not instead

Critics emphasize that laughter clubs should not be seen as a substitute for professional care.

“This is not a studied or effective form of ‘treatment,’” says Barbara L. Milrod, MD, a psychiatry professor at Weill Cornell Medical College in New York City who specializes in anxiety disorders. “Depression is a serious, treatable illness that responds to competent, responsible treatment delivered by well-trained professionals. It is not a joke.”

Milrod also warns that someone with a mood disorder who tries group laughter and finds that the chortling doesn’t come easily may end up feeling inadequate, which “may contribute to the anxiety or depression they already feel.”

When Tanaz decided to attend a Laughter Yoga training in 2004, she says, “Everyone was laughing, but I didn’t feel it.”

Despite her unremarkable first encounter, she persisted at home by watching videos of groups doing the program. After about a year, she says, “laughter exercises were making a big difference in how I felt—I was more upbeat, more at peace.” Her whole outlook on life improved, and in 2006 she founded her own laughter club.

“The most important thing,” she adds, “was realizing I still had the capacity for joy.”

Tanaz hasn’t abandoned medication and other coping strategies, but her doctor gives the laughter routine a lot of credit.

“It took me a while to warm up to the idea that laughter therapy does really help,” says Nasr, “but the remarkable change in the course of Tanaz’s illness made a believer out of me…. I am convinced that laughter yoga was essential to the fact that she has not relapsed in years, despite many social stressors.”

Nasr sees laughter as a kind of adjunct tool, an add-on to medication for patients who “need something additional to reach that level of wellness and feel happy, rather than just keep their illness under control.”

He adds, “Just as we laugh because we feel happy, we can feel happy because we laugh.”

Home improvement

Participants in a laughter club meeting progress through various exercises—greeting laughter, hearty laughter, open-mouthed silent laughter and so forth—with each type of laughter sustained for up to a minute. Simulated laughter may erupt into genuine giggles and guffaws, “even if only because of the recognition of how ridiculous it is,” says Cook.

If getting out of bed is a challenge, much less getting out of the house, you can find videos of group laughter sessions on YouTube or purchase an instructional DVD.

There’s an even easier way to get started, says wellness coach Nira Berry: “Just open your mouth into a wide smile and force the breath out with a ‘ho ho ha ha.’ Then repeat.”

Berry, a breast cancer survivor, says she was “really down” after going through her medical treatment. She discovered laughter exercises on the Internet while researching ways to combat her low mood.

“Sometimes I would just lie in bed and watch my stomach move up and down as I laughed a few times. I noticed that it did make me feel more upbeat and reduced my pain,” she recalls.

She expanded her laughter routine to the shower, the car, and eventually to LaughingRx classes she leads in Bethesda, Maryland. She also produced her own DVD, called Laugh Off Stress, to reach people who are too depressed to come to a class or don’t feel comfortable in a group.

Berry makes a point of laughing as much as possible every day to create a “joy-filled life.” Cook also finds he has more joy in his life now, laughing naturally with his wife and friends in a way that wasn’t possible when he was depressed.

When necessary, though, Cook practices the laughter techniques on his own—“to relieve anxiety, stimulate energy, or just for fun…. It doesn’t take much for a shift in my physiology and temperament to take place.”

Fake it ’til you make it

When it comes to elevating mood, does genuine laughter in response to something funny equal the prompted chuckles of laughter therapy?

Rod A. Martin, PhD, CPsych. a psychology professor at Western University in Ontario and author of The Psychology of Humor: An Integrative Approach, votes no.

“Laughter without mirth is not likely to have much benefit. The emotion of mirth is linked with activation of dopamine in the brain, to produce feelings of pleasure.”

Research has shown that the funnier something is to a person, the more strongly the pleasure center part of the brain is activated. In effect, Martin suggests, “mirth is the important element to feeling uplifted, not laughter per se.”

Of course, depression tends to put the kibosh on spontaneous mirth. But Madan Kataria, MD, the founder of Laughter Yoga, insists that you don’t need joy, jokes, or a sense of humor to laugh. Laughter can come from the body itself instead of the mind, he says, and still produce all the mental and physical benefits of “real” laughter.

Kataria, a family physician in India, launched the first laughter club in 1995. His method includes deep breathing and playful tension-releasing movements, such as arm swinging and rhythmic clapping.

“When your mind is trapped with emotions, your breath gets trapped, too,” he says. “By freeing your breath you can free your mind.”

Charles Schaefer, PhD, a psychology professor at Fairleigh Dickinson University, argues that the body doesn’t know when laughter is fake.

“Once the brain signals the body to laugh, the body doesn’t care why,” says Schaefer, who has documented that both manufactured laughter and self-imposed smiling enhance mood. “It’s going to release endorphins, it’s going to relieve stress as a natural physiological response to the physical act of laughing.

“Forced laughter is a powerful way to boost one’s mood and psychological well-being.”

Starter kit

Here are some solo exercises that can help get you started:

Hand-on-belly laughter: Put your hands on your abdomen while sitting or lying down. Feel your belly rise and fall as you utter “ho ho, ha ha” over and over. Start with one-minute sessions and extend a little longer each time you practice.

Pillow laughter: Sit on the floor with a pillow on your lap. Take a deep breath and think, “I am going to laugh no matter what it takes.” On the exhale, bend over, bury your face in the pillow and laugh.



Gradient laughter: Start by smiling, then release a gentle chuckle. Increase the intensity until you’ve achieved a hearty laugh. Gradually bring the laugh down to a smile again.



Lion laughter: Thrust out the tongue, widen the eyes, and stretch the hands out like claws while laughing.

Silent laughter: Open your mouth wide and laugh without making a sound.

Phone call laughter: Hold a phone to your ear and pretend someone just told you the funniest joke ever.

Tandem laughter: Actually call someone on the phone, and say, “Let’s laugh for 2 minutes together.” Do it.

Printed as “The Laugh Track”, Fall 2012