The Use Of Humor And Laughter In Therapy

(3 hours $19)

INTRODUCTION

Mental health and medical professionals alike are increasingly propagating the value of laughter therapy in the healing of mind and body. The question whether there is a firm scientific basis to this has initially haunted the medical and psychology fraternities. This is understandable – the possibility of being denounced as non-serious and petty is one of the foremost fears in the mind of every serious researcher or healer. Until recent years, the psychology of humor had been an elusive and mysterious phenomenon. It was viewed as a taboo and trivial topic for serious, systematic inquisition by psychologists and mental health researchers.1 However, there is increasing evidence being found in favor of this rapidly emerging form of treatment.

The Association for Applied and Therapeutic Humor (AATH) succinctly defines therapeutic humor as ‘any intervention that promotes health and wellness by stimulating a playful discovery, expression, or appreciation of the absurdity or incongruity of life's situations. This intervention may enhance work performance, support learning, improve health, or be used as a complementary treatment of illness to facilitate healing or coping, whether physical, emotional, cognitive, social, or spiritual’. In essence, laughter therapy is the art of using humor to aid in the healing of those with physical and mental illnesses.

The benefits of laughter were recorded as far back as the Old Testament in the book of Proverbs: “a cheerful heart is good medicine.” In the fourteenth century, French surgeon Henri de Mondeville wrote, "Let the surgeon take care to regulate the whole regimen of the patient's life for joy and happiness, allowing his relatives and special friends to cheer him, and by having someone tell him jokes." The theologian and Protestant reformer, Martin Luther, used humor as part of his pastoral counseling and encouraged parishners suffering with depression to surround themselves with friends who could joke and make them laugh.2

The Scientific Basis Of Laughter Therapy
As early as 1989, Lars Ljungdahl reported in an article for the Journal of the American Medical Association 3 that the regular inducement of the laughter reflex can have profound positive effects on a patient’s symptoms. He went on to state that a patient who is given the benefit of laughter therapy will invariably experience an upward curve in the general quality of life.

As already stated, there is now sufficient scientific basis to validate such findings. It has been found that hearty laughter – induced or naturally-occurring – produces biological effects comparable with the much-publicized and highly cherished ‘jogger’s high’. In other words, it causes the release of endorphins, which are the body’s very own painkilling and depression-combating chemicals. They have an effect comparable to that of opiates; they cause a radical upward swing in mood that can often attain euphoric heights. This effect is, of course, a strictly temporary one, but it can be replicated with regular application of the stimulus that produced them.

Other studies have revealed that laughter involves the amygdale and the hippocampus, sectors of the limbic system that are closely linked in emotional coping and survival. This would seem to indicate that laughter is, in fact, an act of survival. It is also significant that nitrous oxide, or ‘laughing gas’, is often used as a pain reliever. When subjected to laughter therapy, drug and alcohol dependent patients undergoing the painful ‘withdrawal period’ invariably report substantial relief from their physical and mental anguish.

There are still, of course, many an eyebrow raised at such an unconventional form of treatment. The primary problem with establishing verifiable test results that would convince the more procedure-oriented academia is not lack of success of humor in treatment of physical and emotional disorders, but rather the fact that such success is based on spontaneous therapeutic situations that can often not be replicated under test conditions. However, in an article for the Journal of General Psychology4 Louis R. Franzini confirms that the popularity of humor as a therapeutic tool is on the increase despite the fact that a lot of research still remains to be done.

There have been literally hundreds of published articles on the relationship between exercise and mental health over the last three decades. Many of these studies endorse the use of exercise for positive changes in mood and the reduction of anxiety, however, only a few studies have compared the benefits of exercise to other forms of treatment. A study by Szabo (2003) published in the Journal for Leisure Research compared the affective benefits of exercise to that of humor. Thirty-nine university students were tested using three treatments: self-paced jogging, watching a stand-up comedy routine, and watching a documentary video. The documentary video treatment produced negative psychological results (perhaps boring), while: ‘20 minutes of humor and 20 minutes of running or jogging, at a self-selected pace, had positive effects on the participants' mood and state anxiety.’ The author concluded the following:

Both humor and exercise had an equally positive effect on psychological distress and positive well-being. However, humor exerted greater anxiety-lowering effect than exercise. Based on these results, it is tentatively concluded that humor could induce positive psychological changes that are at least comparable if not superior to the effects of exercise. [Szabo 2003] 5

There is no scientific evidence that laughter therapy can produce anything as dramatic as remission of cancer or other serious ailments. Though it definitely does produce highly beneficial metabolic changes, including on the cellular level, it would be premature to state that it can actually reverse a degenerative biological process. It is without doubt an enormously helpful adjunctive line of treatment in certain organic diseases. The established fact that laughter promotes the production of endorphins in the body makes it an invaluable tool in the pain management of arthritis, rheumatism and other painful degenerative ailments. Moreover, there is sufficient documentation to substantiate its validity in the field of mental health.

Laughter Therapy In Mental Health
Freud and other classic psychoanalysts were hesitant to use humor with clients because they believed it to be an impediment to the analytic process. Psychoanalysts have often viewed humor as a disguised expression or countertransference of hostile or sexual impulses. However, some analysts have used humor with success. An article by Bader in the Psychoanalytic Quarterly (1993) reports that many clients view the times in which their analysts used humor as some of the most memorable and cherished moments of the therapeutic process. In the same article, a study is reported where clients were read two humorous clinical vignettes regarding the analyst’s attitude and view of the client. The result was that humor actually enhanced the therapeutic process by disconfirming false expectations and putting clients at ease. The deliberate use of humor by the analyst resulted in clients feeling less inhibited to face painful emotions. The article suggests that although humor has been avoided by many classical analysts, it may have its place. In fact, the author of the article indicates that a lack of any humor by the analyst may have harmful effects on clients.6

A review of the literature by Saper in 1988 cautioned that much more research needed to be under taken before professionals could take confidence in the aphorism “laughter is the best medicine.” Saper indicated that studies on the effects of mirth on the physiology of the body needed much better verification due to the meager amount of evidence supporting its salubrious effects. And, in regard to the psychological benefits, he states:

…despite numerous claims, in the context of behavioral or psychosomatic medicine, that a joyful, optimistic, or humorous attitude can render a salubrious effect, almost to the extent of preventing illness and curing physical disease, the jury is still out and issuing dire warnings regarding too ready acceptance of this largely anecdotal evidence. Much careful clinical trial research needs to be mounted to determine the conditions under which humor works best, if at all.

Other factors such as the type and severity of illness, the kind of humor, and the psychosocial contexts were suggested to be considered before using humor in a whole-sale, ‘one-shoe fits all’ fashion7. Since 1988, there has been considerable research on the use of humor in the therapeutic setting, however, it is still difficult to make definitive statements about when, how, and by whom it should be used. Many, but not all, studies indicate the benefit of using humor with clients in psychiatric settings.

Humor has been shown to have a significant response with patients suffering from severe and psychotic depressions. In a double blind study, 18 women were tested in a four day series of intravenous drip infusions. Some were given a placebo and others the drug nialamide, a strong antidepressant. The MMPI and Beck Depression Inventory were used before, during and after the series to determine whether riddles and jokes could elicit a positive change in these subjects. The results showed promising data to support that a humor response in patient can be used to evaluate change in a depressed patient.8

A study by Kaplan and Boyd studied the function of humor on an open psychiatric ward. Humor had specific functions on the ward that are similar to its use in other uncomfortable social situations. They write:
Group integration is facilitated by such mechanisms as the use of humor as negative sanction for violation of group norms, as the common expression of sentiment, as expressions of support or comradeship, and in the initiation of new members to the group. Group adaptation to the wider environment is fostered insofar as the hostility felt is expressed through humor rather than in a more disruptive manner, and the use of humor reflects staff values.

The authors indicate that less consideration was given in their study, and in the literature in general, to the possible negative aspects of humor such as being used to deny reality, confuse relevant material, and too greatly reducing emotions that need to be dealt with. The article indicates that humor, whether efficacious or producing a negative effect, may indicate the issues of concern and strain among patients that need to be addressed by therapists and administrators.9

In a study by Peterson and Pollio, group therapy sessions were videotaped with the hope to document whether humor increased or decreased therapeutic effectiveness. Physical signs such as smiling were used as the independent variable. The results were that over 50% of the humorous comments in the group therapy sessions were negative in tone. Humorous comments tended to have a negative effect when directed to others in the group while ones targeted to those outside the group tended to have positive effects therapeutically. Self-targeted humorous remarks had inconsistent effects.10

Humor has been studied in its use as a tool in treating patients with Chronic Schizophrenia. In a study conducted in an in-patient setting consisting of patients hospitalized for protracted periods of time, humor was added to patient’s treatment regimen that included an unchanging drug routine. The treating psychiatrist included humor in the interpretations about various treatment issues given to these patients. The results of the study indicated that:
The patients felt that they had the option of adopting the doctor's humorous manner. This approach appealed to them and raised self-esteem; they likewise gained confidence in their own ability to form judgments. They cooperated better with the doctor in issues pertaining to treatment.

The study also concluded that patients adopted improved coping skills as a result of the psychiatrist’s humorous approach11.

An article in the Journal of Rational-Emotive & Cognitive-Behavior Therapy attributes steady doses of humor to emotional health and over-coming such problems as the perfect person syndrome12. Although perfectionism is not a specific DSM diagnosis, it is a key element in many psychiatric disorders. The tendency to make demands and ‘awfulize’ when these demands are not met reflects the mind set of many clients who are ‘perfectionistic’ and internally and externally troubled. Many perfectionists end up in a therapist’s office due to the interpersonal and intrapersonal conflicts their dogmatic beliefs about how things ‘must be’ have led to. Humor can provide a gentle way of revealing the self-defeating and irrational beliefs behind perfectionism by creating more realistic expectations and helping clients refuse to damn themselves and others for real or imagined mistakes and flaws they perceive as ‘catastrophic.’ Saper points out that:

The literature of the past two decades, based on careful experimental research as well as on more subjective clinical experience, tend to support the following conclusions: A well-developed sense of humor provides a beneficial ingredient to the patient's coping or adjustive ability. The salutary physiological effects of laughter are the same for adolescents and adults. In terms of psychosocial factors, individual rather than developmental stage differences in the patient's personality, psychopathology and humor preference will alter the effectiveness of humor application.

Saper recommends that therapists be formally trained in the use of humor in the clinical setting for maximum effectiveness.13

In an article entitled ‘Using Humor in the Counseling Relationship’14 Steven M. Sultanoff, Ph.D. is unequivocal in his assertion that humor has profound beneficial effects on a patient’s feelings, behaviors, thinking and biochemistry. These areas encompass the width and breadth of almost all known mental illnesses. However, he goes on to lay down strict parameters on how it should be employed. He stresses that the use of humor should be part of the therapist’s dedicated arsenal, thereby implying that the therapist himself should believe in its efficacy. He also points out that a regimen of laughter/humor therapy should be planned in accordance with the patient’s own level of understanding and ability to respond to it.

According to Sultanoff, a psychotherapist who has accurately gauged the patient’s response patterns can employ spontaneous humor to great strategic advantage. A lot depends on the therapist’s insight into the patient’s case, as well as the means he has at his disposal to evoke a humorous response at short notice. While some patients respond well to light hearted banter or other interactive means, others might react more favorably to stimuli such as cartoons and the narration of anecdotes.

In yet another article entitled Using Humor For Treatment and Diagnosis:
A Shrinking Perspective,15 Sultanoff maintains that manipulating one area of a patient’s mental environment can have direct and favorable bearing on a corresponding area. In terms of treating a mental ailment, this has enormous significance. It means that by the application of laughter therapy to upgrade a patient’s emotions, that patient’s behavior can be effectively modified.

On this subject, president of The Laughter Remedy, Paul E. McGhee, PhD16 refers to Candace Pert’s assertion17 that emotions – the state of which dictates a person’s mental wellbeing – are the key to a healthy connection between mind and body. The neurochemicals called neuropeptites produced by the body decide whether the person is well or not. From a mental as well as holistic health point of view, this means that the brain and the body are in constant communication with each other by means of these chemicals. According to her, laughter therapy ensures that the messages sent via these neuropeptites are positive and beneficial.

Paul McGee goes on to confirm his belief that overall physical and mental wellbeing is directly related to a person’s attitudes, thoughts, moods and emotions. Our immunity to disease of any kind is directly related to the positive emotions such as optimism, caring - and humor, and the presence of physical or mental sickness is often traceable to negative emotions such as hate, suspicion and humorlessness. This phenomenon, known as psychoneuroimmunology, seems to encompass the premise that laughter promotes physical, mental and spiritual health.

His findings substantiate those of other researchers the world over, as well as a fact known to astute observers from the beginnings of recorded medical history - laughter promotes muscle relaxation, stress reduction and immunity to mental and physical disease. Mental health treatment that includes humor therapy is obtaining amazing results in institutions all over the world now, and the medical community is taking note. Bernard Saper 18 notes that ‘a well-developed sense of humor provides a beneficial ingredient to the patient's coping or adjustive ability’.

Practical Implementation Of Laughter Therapy
Like any other form of structured treatment, laughter therapy can and must be integrated into the overall therapeutic module. While spontaneous humor definitely has its merits in a patient-therapist relationship, it is far from predictable and cannot be counted on to reap definite and progressive results. Unless the therapist is a gifted humorist in his or own right, bringing laughter into the treatment process is a matter of planning and strategy.

The process begins with an analysis of the patient’s or patient groups overall receptivity. Introducing humor into a therapeutic community consisting of chronic melancholics is obviously not an easy task. In such circumstances, a lot depends on a ‘never-say-die’ attitude on the part of the therapist. Patients generally take some time to warm up to lightheartedness, especially in the face of serious illnesses such as cancer or major depression. In the case of the latter, a pharmaceutical approach to making a patient less self-involved and more open to the humor stimulus may be opted for.

In certain cases, the concept may well have to be explained to a therapeutic community. Vancouver-based mental health counselor and stand up comedian David Granirer notes that he found a less than favorable response with his mentally ill patients to begin with. In his Stand Up For Mental Health courses, he involves them in regular workshops that propagate an appreciation for laughter – and perhaps instill the ability to laugh in the first place. Since most people do have at least a nominal sense of humor, such extreme measures are not usually called for.

However, the level of trust between therapist and patient will decide how effective laughter therapy will be in that particular case. If it exists sufficiently, much can be achieved. As Sylvia Mauger correctly observes in her article for Stress News 19 – ‘(Humor) is based on caring and empathy. An invitation to laugh is an invitation to share and, as such, it is supportive and so builds confidence between two people. This can be as true in a group situation as that of one-to-one counseling.’

Induced versus Spontaneous Laughter
Induced therapeutic laughter is not based on spontaneous or ‘genuine’ laughter. Rather, it is purely a physical process where you laugh for no reason. It soon becomes infectious and real. Some consider this to be much deeper and powerful than laughter coming from jokes and comedies. It is unlikely that any contemporary human being will find it possible to laugh with real mirth for the 10 to 15 minutes that are required to produce beneficial results. Jokes and humor are not employed in his method.

Proponents of induced laughter suggest that it "reduces stress, increases respiration, increases heart rate (three to five minutes of hearty laughter is equivalent to three minutes of strenuous activity on a rowing machine), decreases high blood pressure, boosts the immune system, reduces hardening of the attitudes" and makes them feel and look younger.20

Induced (non-spontaneous) laughter as a valid form of therapy is supported by the findings of Norman Cousins 21 in alleviating the symptoms of his ankylosing spondylitis (a painful disease causing the disintegration of the spinal connective tissue). These were investigated by medical professionals, who confirmed that vigorous, self-induced laughter performed regularly seemed to have biologically reversed some of Cousins’ symptoms and even certain physical manifestations of the disease. Inflammation levels were dramatically decreased and had helped him to sleep soundly.

Humor In Cognitive Therapy

The web-site for the American Psychological Association promotes the use of ‘silly humor’ as part of a technique for defusing rage. The APA web-site points out that the impetus for much destructive anger originates from a belief that things ‘must’ be a certain way. Clients who hold these types of inflexible beliefs often believe they are morally right and that any blocking of their demands is an unbearable event. Clients can challenge dogmatic beliefs that foster inappropriate anger by practicing humorous imagery. For instance, the client can vividly imagine himself to be a supreme ruler who always gets his way; whose subjects always bow to his demands and ask ‘how high?’ when he says ‘jump’. After an outburst of anger, the client may later visualize the literal name he used to describe someone while in a state of rage.

For example, if he has called someone a “dirtbag”, he can picture the person as a large bag of dirt. These techniques use humor as a direct method for confronting extreme beliefs and help clients achieve a more balanced perspective by refusing to take themselves too seriously. According to the APA web-site, humorous imagery is different from using humor to just “laugh off” a situation, or using it in a harsh and sarcastic manner, which are just other forms of unhealthy anger.22

As described in the APA article, humorous imagery can be especially useful within the context of cognitive therapy. The founder and ‘guru’ of cognitive therapy and Rational Emotive Behavior Therapy, Albert Ellis, has been a prolific user of humor in therapy since the 1950s. Ellis has combined his own humorous lyrics with well known tunes, such as Yankee Doodle, to point out the ‘musting’ and ‘awfulizing’ beliefs clients often bring to therapy which sabotage their well-being. An example of Ellis’ lyrics sung to the tune of Yankee Doodle that addresses the irrational beliefs behind morbid jealously is conveyed in one of Albert Ellis’ songs entitled Love Me, Love Me, Only Me!:

(Tune: “Yankee Doodle”)

Love me, love me, only me
Or I will die without you!
O, make your love a guarantee
So I can never doubt you!
Love me, love me totally – really, really try, dear!
But if you demand love, too,
I’ll hate you till I die, dear!
Love me, love me all the time,
Thoroughly and wholly!
My life turns into slushy slime
Unless you love me solely!
Love me with great tenderness,
With no ifs or buts, dear.
If you love me somewhat less,
I’ll hate your guts, dear!

(Lyrics by Albert Ellis, copyright by Albert Ellis Institute)23
This is one of many songs Ellis has used to help clients identify faulty thinking patterns. In addition to humorous songs, Ellis may directly confront irrational beliefs with sarcastic humor. For example, he may point out that a client is upset because he thinks the world “must” be fair at all times. Ellis may then dispute this belief with something like: “Well, too bad that you don’t get what you want when you want it.” The humor used by Ellis may be considered more harsh and sarcastic at times than that promoted by the APA, but the goal is the same; to dispute irrational beliefs that create problematic emotions.24

The process of desensitizing a patient from a certain fear, phobia or neurosis is an essential part of cognitive therapy. There are various approaches, but the classic module described by McKay, Davis and Fanning 25 outlines the process of ‘learn(ing) to relax while imagining scenes that are progressively more anxiety provoking’. A phobia is the fear of a relatively commonplace object or situation the threat of which is multiplied infinitely in the phobic client’s mind. It could be the fear of spiders (arachnophobia), the fear of enclosed spaces (claustrophobia) or any number of other things.

As illogical as they may seem, phobias can have an extremely debilitating effect on the phobic. For example, Dr. Edmund J. Bourne 26 describes some common phobias faced by executives in the corporate world –such as the fear of giving presentations. In all cases, however, the process of desensitization involves making the patient imagine progressively more threatening situations associated with the object of the phobia within a safe, therapeutic setting. In this manner, the patient is confronted with the baselessness and self-defeating nature of his or her phobia and is effectively relieved to a great or even complete extent of the burden of that phobia.

When laughter therapy is used in desensitization, the patient is also guided through a process of imaginary threatening situations under controlled therapeutic conditions.

However, here the element of humor is introduced and used to progressively lessen the provoked anxiety response. In other words, the fear or phobia is gently ridiculed. W. Larry Ventis, Garrett Higbee and Susan A. Murdock 27 quote the finding of Koestler, who proposed that ‘laughter serves to relieve physiological arousal associated with the emotions of aggression or apprehension’.

They add that such findings have not been clinically proven; however, they are in favor of a desensitization process that does not expose the patient to needless suffering. In the normally understood format, desensitization requires the patient to undergo a great amount of emotional and mental discomfort as he or she is confronted with mental imagery with escalating levels of danger and distress. In laughter therapy, such negative emotions are kept to the minimum – instead, the patient may, by definition, even enjoy the process of confronting a long-standing fear. This can have significant bearing on patient attrition rates in therapy groups where traditional desensitization techniques are employed. A patient who is offered an opportunity to laugh while being weaned off a long-standing fear is certainly less likely to drop out of therapy than one who is subjected to increasingly more discomforting mental imagery.

These researchers conducted a study with 40 undergraduate psychology students who professed a fear of spiders to varying degrees. Thirty-nine of these participated in the study from beginning to end. The object was to desensitize this control group using an American tarantula using humor as well as traditional desensitization techniques, and to compare the resultant findings in order to establish whether the former was more effective than the latter. Though the study could not establish such a hypothesis, it did confirm that both humor desensitization and traditional desensitization result in a significant reduction in fear responses, while leaving the patient untreated with any kind of desensitization at all shows no significant improvement in the fear response.

While the primary research hypothesis that ‘humor desensitization’ was far more effective in reducing the fear response in clients with phobias than the more conventional methods of desensitization could not be confirmed there were nevertheless some interesting findings. One subject in the case study responded favorably to humor desensitization where traditional techniques had failed completely, while yet another subject displayed significant improvement in the phobic response in a single humor desensitization session. The study involved having the subjects associate humorous contexts to the object of their phobia (i.e. the tarantula). They were also provided with humorous props such as a squeaking rubber tarantula to further help them in modifying their fear response.

Louis R. Franzini 28 advocates the inclusion of humor in the formal training curriculum for therapists and offers some convincing arguments in favor of this. Furthermore, he reiterates what many therapists who employ humor therapy in their regular treatment modules have found to be true – that the benefits of using humor therapy are mutually shared by both therapist and patient. In essence, it has been found that it reduces the normally high stress levels among professional therapists and greatly reduces the early onset of ‘professional burnout’ (sic).

Aaron T. Beck 29 describes the confrontative nature that traditional cognitive therapy can sometimes assume, and points out that the patient can often experience the feeling that he or she is being trapped for contradictions by the therapist. In contrast, a therapist who has been trained in the skillful use of humor during the treatment process is equipped to defuse this fear with a patient. Beck points out the importance of eliminating feelings of being ridiculed or belittled by the therapist – therefore, it makes a lot of sense that the therapist be trained in the best possible use of humor under treatment conditions, since unskilled use of this tool can have adverse rather than beneficial effects and erode the necessary bond of trust between patient and therapist.

Summary
Laughter has been recognized as a curative treatment tool since ancient times. Healers from the East have employed it to counter the detrimental effects of a number of ailments, both physiological and psychological. Many other ancient therapeutic disciplines had remained in use only by obscure practitioners whose teachings were not scientifically established. However, there has been a general awakening to alternative treatment methods in the last century, and laughter therapy has now become a matter of serious research.

The findings of Dr. Lee Berk 30 and Dr. Stanley Tan of Loma Linda University, California have published papers on the subject of neuroimmunology that are very definite on the beneficial effects of laughter on the immune system. Briefly, they have found that laughter produces physiological responses that are directly opposed to those produced by stress. The state produced by mirthful laughter, also known as the ‘eustress state’, is typified by healthy and positive emotions. They go on to enumerate all the positive metabolic changes produced by laughter – a reduction in blood pressure and stress hormones, increased muscle flexion, enhanced production of disease-countering T and B-cells and increased production of endorphins, among others.

Humor therapy is also findings increasing application in pain management. A study was conducted by Henderson 31 to suggest the possibility that humor therapy programs could be developed to relieve pain. The findings, though limited by the small numbers and the lack of a control group, were nevertheless significant - pain decreased in 13 of 15 different pain types. This is extremely noteworthy, since it suggests an alternative avenue of treatment in a field presently dominated by analgesics. If laughter therapy offers itself as even a marginal substitute for pharmacological solutions in pain management (and it certainly seems to) then the quality of life and survival rate among patients suffering from painfully degenerative diseases can be boosted by its use. In other words, though it can assuredly not be claimed that laughter therapy can reverse the ravages of cancer or rheumatism, they can certainly benefit from such a non-medicinal solution to pain management.

The efficacy of laughter therapy in the treatment of mental illness is an established and highly documented fact. While much depends on the training and skill of the therapist, and while there are certainly limitations on the scope of its applicability in this field, mental treatment centers and professionals the world over are now including laughter therapy in their treatment modules for chronically depressed patients.

There is some controversy as to whether induced (non-natural) laughter such as is employed in the ancient Indian discipline of Haasya Yoga is as therapeutically beneficial as spontaneous laughter. Indeed, therapists who have the ability to produce spontaneous laughter in their patients report excellent results. However, the very fact that spontaneous laughter can, by its very nature rarely be planned for makes its efficacy difficult to document under controlled scientific study conditions. Emerging alternative therapists like Dr. Madan Kataria do not depend on spontaneous laughter in their methods of treatment; yet the benefits derived by members of ‘Laughing Clubs’ seem to be real and inarguable. This offers a useful guidepost to therapists who are confused as to whether they can actually elicit genuine laughter in their patients on a regular and therefore therapeutically useful basis. The beneficial effects of therapeutically ‘planned’ laughter have been extensively mapped and verified by various serious researchers.

One area where laughter has proved an immensely useful tool is that of systematic desensitization. Patients suffering from a certain neuroses and phobias that prove to be detrimental to the quality of their life have been successfully treated by application of humor desensitization techniques. So far, it has not been established that this form of treatment is more efficacious than conventional desensitization modules. However, the use of humor in cognitive therapy has certainly produced some dramatic and even unprecedented results.

End of text. Now take the course quiz.

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18. The therapeutic use of humor for psychiatric disturbances of adolescents and adults, Bernard Saper (Department of Psychology at Florida International University)
19. The Use Of Humor In Stress Management, Stress News July 2001 Vol.13 No.3
20. Ayurvedic Dictionary on Laughter Therapy
21. Anatomy of an Illness As Perceived by the Patient, Norman Cousins (1979)
22. Controlling Anger Before It Controls You, American Psychological Association, 750 First Street, NE, Washington, DC 20002-4242. Accessed online at the AMA web-site at: http://www.apa.org/topics/controlanger.html
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25. Thoughts & Feelings: The Art of Cognitive Stress Intervention, by McKay, Davis, & Fanning, chapter 6.
26. The Anxiety & Phobia Workbook, by Dr. Edmund J. Bourne
27. Using Humor in Systematic Desensitization to Reduce Fear, W. Larry Ventis, Garrett Higbee and Susan A. Murdock, Journal of General Psychology, April, 2001.
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29. Cognitive Therapy of Depression, by Aaron T. Beck, page 71
30.  

1. "New Discoveries in Psychoneuroimmunology" an interview with Dr. Lee Berk, Humor & Health Letter, Humor & Health Letter, vol 3, no. 6, 1994
2. "The Laughter-Immune Connection: New Discoveries," Lee S. Berk, DPH, Humor and Health Journal, vol. 5, no. 5, 1996.

End of text. Now take the course quiz.