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The Effect of Mirthful Laughter on Stress and Natural Killer Cell Activity Western Kentucky University TopSCHOLAR® Nursing Faculty Publications School of Nursing 2003 The ffecE t of Mirthful Laughter on Stress and Natural Killer Cell Activity Mary P. Bennett Western Kentucky University, [email protected] Janice M. Zeller Lisa Rosenberg Judith McCann Follow this and additional works at: http://digitalcommons.wku.edu/nurs_fac_pub Part of the Alternative and Complementary Medicine Commons, Nursing Commons, and the Oncology Commons Recommended Repository Citation Bennett, Mary P.; Zeller, Janice M.; Rosenberg, Lisa; and McCann, Judith. (2003). The Effect of Mirthful Laughter on Stress and Natural Killer Cell Activity. Alternative Therapies in Health and Medicine, 9 (2), 38-45. Available at: http://digitalcommons.wku.edu/nurs_fac_pub/9 This Other is brought to you for free and open access by TopSCHOLAR®. It has been accepted for inclusion in Nursing Faculty Publications by an authorized administrator of TopSCHOLAR®. For more information, please contact [email protected]. original research THE EFFECT OF MIRTHFUL LAUGHTER ON STRESS AND NATURAL KILLER CELL ACTIVITY Mary P. Bennett, DNSc, RN, Janice M. Zeller, PhD, RN, FAAN, Lisa Rosenberg, PhD, RN, Judith McCann, DNSc, RN Mary P. Bennett is associate professor and assistant dean, function postintervention (t16 =2.52 P=.037) and compared with the Indiana State University School of Nursing in Terre Haute, Ind. remaining participants (t32=32.1; P=.04). Humor response scale scores Janice M. Zeller is professor, Department of Adult Health correlated with changes in NK cell activity (r16=.744;P =.001). Nursing and associate professor, Department of Conclusion • Laughter may reduce stress and improve NK cell activity. As Immunology/Microbiology; and Lisa Rosenberg is assistant pro- low NK cell activity is linked to decreased disease resistance and increased fessor, Department of Community and Mental Health Nursing morbidity in persons with cancer and HIV disease, laughter may be a useful and associate dean, Student Affairs, College of Nursing, at Rush cognitive-behavioral intervention. University, Chicago, Ill. Judith McCann is associate professor, Department of Adult Health Nursing, Rush University College of Nursing and research scientist, Rush Institute for Healthy Aging, ver the past 20 years, psychoneuroimmunological Rush-Presbyterian-St. Luke’s Medical Center, Chicago, Ill. (PNI) research has repeatedly documented that various types of stressors lead to interactions among the neurological, endocrine, and immune Context • A recent survey of rural Midwestern cancer patients revealed systems, which can decrease immune functioning that humor was one of the most frequently used complementary therapies. and disease resistance.1-3 However, research is limited as to the inter- Psychoneuroimmunology research suggests that, in addition to its estab- Oventions that effectively modify the effects of stress on immune lished psychological benefits, humor may have physiological effects on function. Despite this lack of data, a number of interventions have immune functioning. been developed and marketed to the public with little or no docu- Objective • To determine the effect of laughter on self-reported stress mentation of their effectiveness or mechanisms of action. and natural killer cell activity. According to a survey of rural Midwestern cancer patients, Design • Randomized, pre-post test with comparison group. more than 87% of the respondents were currently using at least 1 Setting • Indiana State University Sycamore Nursing Center, which is a complementary or alternative intervention in addition to main- nurse-managed community health clinic in a mid-sized, Midwestern city. stream medical care.4 The most common intervention cited was Participants • 33 healthy adult women. prayer, followed by humor. Fifty percent of the respondents report- Intervention • Experimental subjects viewed a humorous video while ed already using humor-intervention, and an additional 13% stated subjects in the distraction control group viewed a tourism video. that they would consider using the method.4 Women were more Main Outcome Measures • Self-reported stress and arousal interested in use of humor than men in this survey study of local (Stress Arousal Check List), mirthful laughter (Humor Response cancer patients.4 Consequently, we originally envisioned a study of Scale), and immune function (chromium release natural killer [NK] the effects of humor in women with breast cancer. cell cytotoxicity assay). The use of humor as an intervention has been emphasized in Results • Stress decreased for subjects in the humor group, compared both consumer5-7 and professional publications.8-15 Unfortunately, with those in the distraction group (U32=215.5; P=.004). Amount of despite the popularity of humor as a cognitive-behavioral interven- mirthful laughter correlated with postintervention stress measures for tion, there appears to be little scientific documentation to support the persons in the humor group (r16 =-.655; P=.004). Subjects who scored use of humor in this role. According to Fry, “as with most grass-roots greater than 25 on the humor response scale had increased immune movements, there is little laboratory, statistical, analytic, or otherwise scientific evidence to justify scientifically the huge degree of enthusi- asm for uses of humor in this context.”16(p119) Several reports have demonstrated the use of humor to reduce stress, relieve pain, or as an Reprint requests: InnoVision Communications, 169 Saxony Rd, Suite 104, Encinitas, CA 92024; 17-21 phone, (760) 633-3910 or (866) 828-2962; fax, (760) 633-3918; e-mail, alternative.therapies@ adjuvant therapy to improve overall quality of life. According to innerdoorway.com. these studies, laughter appears to improve mood, reduce psychologi- 38 ALTERNATIVE THERAPIES, mar/apr 2003, VOL. 9, NO. 2 The Effect of Mirthful Laughter cal measures of stress, and reduce perception of pain. The mecha- ability would have helped to assess the reliability of the results. nisms that underlie these effects may involve release of psychological In a study of 5 healthy male medical students, NK cell activity tension, which could act as a buffer of stressful events on affect. was significantly increased following a humorous video.41 For the However, it is also possible that physiological factors may be experimental conditions, subjects viewed a 60-minute humorous involved. For example, laughter can lead to changes in heart rate, skin video; control conditions were met by having the subjects sit quiet- temperature, blood pressure, pulmonary ventilation, skeletal muscle ly in the same room for the same length of time a few days later. activity, and brain activity, which may improve overall well-being.16 Samples for NK cell activity were drawn at baseline and immediate- Laughter may improve immune function by blocking produc- ly after the movie or the quiet time. Because 2 separate assays were tion of stress hormones, such as cortisol, and by increasing the conducted for the experimental versus the control conditions, the release of immunoenhancers, such as beta-endorphin.22-25 However, between-groups data were subject to possible interassay variability. data to support this aspect of humor therapy are scant. In fact, However, this would not affect the pre-post data from either condi- according to a published interview with Steven Locke, a psychoim- tion, so the findings concerning NK cell activity could be consid- munologist at Harvard, “if there’s anything newsworthy about this ered valid using a strictly pre-post methodology. subject, it’s how little research has been done, considering how In a third study, the effect of both humor and exam stress on widely accepted the ideas are.”26 T-cell subset percentages and NK cell activity was determined in 8 According to PNI theory and some humor studies, humor may healthy male medical students.43 The immune parameters were influence health through moderation of stress chemicals and/or measured before and after an examination and before and after immunoenhancement.27-34 A handful of studies have demonstrated watching a humorous video. Contrary to findings from other stud- that exposure to a humorous stimulus can result in immunoenhance- ies of stress and immune function,44-46 there was no significant ment, as evidenced by increased levels of salivary immunoglobulin A change in either of the immune parameters following the exam, (IgA).32,35-37 However, use of salivary IgA as a measure of immune func- and NK cell activity was decreased immediately following the tion has been challenged by some investigators38,39 because of varia- humorous video.43 Limitations of this study include the use of a tions in individual salivary flow rate and the use of stimulated versus small, all male sample and lack of a control group. nonstimulated samples in some studies. In addition, the clinical signif- In the most recently reported study, the effect of exposure to icance of increased levels of salivary IgA is questionable. For this study, a 60-minute humorous video on the activity of NK cells was exam- natural killer (NK) cell activity was used as the measure of immune ined in a controlled study of 12 healthy male medical students.31 function because NK cell activity assays provide some of the clearest Results showed that only members of the humor group had a sig- and most replicable results in this type of research.1,40 nificant increase in post-NK cell activity levels. Similar to the earli- er study by this group, the sample was limited to a small number EFFECT OF LAUGHTER ON NK CELL ACTIVITY of male medical students. According to earlier work,27 subjects who laughed while viewing a Research on the effects of laughter on stress and immune humorous video had decreased levels of glucocorticoids. Because ele- function is still in the early phases. In addition, all previous work in vated glucocorticoid levels have been demonstrated to reduce NK cell this area, with the exception of 1 unpublished dissertation, was activity,41 it appears plausible that laughter may influence NK cell activ- conducted using all male subjects. In light of these findings, a clini- ity.
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