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The Effect of Mirthful Laughter on Stress and Natural Killer Cell Cytotoxicity

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The Effect of Mirthful Laughter on Stress and Natural Killer Cell Cytotoxicity THE EFFECT OF MIRTHFUL LAUGHTER ON STRESS AND NATURAL KILLER CELL CYTOTOXICITY by Mary Payne Bennett B.S., Indiana State University, 1989 M.S., Indiana State University, 1990 Submitted to Rush University in Partial fulfillment of the requirements for the degree of Doctor of Nursing Science © Copyright by Mary Payne Bennett, 1997 All Rights Reserved Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. DISSERTATION APPROVAL FORM The undersigned have examined the dissertation entitled: The Effect of Mirthful Laughter on Stress and Natural Killer Cell Cytotoxicity. presented by: Mary Payne Bennett a candidate for the degree of Doctor of Nursing Science and hereby certify that in their judgement it is worthy of acceptance. C{signature) c? (date) (signature) (dale) ' Name Name Rank Rank Department Department ^signature) / (date) '(signature)/ Name Name Rank Rank Department Department University University Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. Title of Dissertation: The Effect of Mirthful Laughter on Stress and Natural Killer Cell Cytotoxicity Mary Payne Bennett 1997 Dissertation directed by: Janice Zeller RN, PhD, Professor, Department of Medical-Surgical Nursing and Associate Professor, Department of Immunology/Microbiology Signature of Dissertation Advisor ABSTRACT A survey of local cancer patients revealed that humor was a frequently used complementary therapy which helped them cope with stress. Introductory research has suggested that humor can decrease the perception of stress and perhaps improve the immune system’s response to disease causing agents. However, there are a very limited number of rigorous intervention studies which document these effects. Using psychoneuroimmunology as a framework, the effect of mirthful laughter on stress and natural killer (NK) cell cytotoxicity was measured. Since the beneficial effect of laughter on NK activity has limited documentation in healthy males and no documentation in females, a clinical study would have been premature. Therefore, thirty-three healthy adult women were randomly assigned to either a control or humor group. Subjects in the humor group viewed a humorous video, whereas subjects in the control (distraction) group viewed a tour video. Instruments included the Life Experiences Survey, Stress-Arousal Check List Situational Humor Response Questionnaire, Multidimensional Humor Scale, Humor Response Scale (HRS), and chromium release NK assay. Data revealed that stress scores decreased more in the humor group than in the distraction group (U = 215.5 p = 0.004); HRS scores correlated with post stress for persons in the humor group (r = -0.655 p = 0.004). Persons who laughed more had less stress following the video. Viewing a humorous video, in and of itself, did not significantly change NK activity (t = 1.52 p = 0.138), however, subjects who scored s25 on the HRS had significant increases in NK cytotoxicity over their baseline values (t = 2.52 p = 0.037), and as compared to the remaining participants (t = 2.1 p = 0.04). HRS scores significantly correlated with changes in NK cytotoxicity (r = 0.744 p = 0.001). Persons who laughed more had greater improvement in NK cytotoxicity. These findings indicate that laughter has the potential to reduce stress and temporarily improve NK activity in healthy women. As low NK activity has been linked to metastases and poorer prognosis, it is plausible that humor may be a useful complementary therapy in the care of persons with cancer. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. TABLE OF CONTENTS INTRODUCTION............................................................................................................. 1 Significance .............................................................................................. 1 Conceptual Framework ............................................................................ 4 REVIEW OF LITERATURE.............................................................................................. 7 Immune Function and Cancer ...................................................................7 Stress and Immune Function ................................................................... 11 Negative Life Events and Development/Progression o f Illness ................16 Stress, NK Activity and Illness ................................................................. 18 Sense of Humor and S tre ss .....................................................................21 Laughter and Stress ................................................................................ 25 Physiological Effects of Laughter ........................................................... 27 Summary of Review of Literature .............................................................40 METHODOLOGY........................................................................................................... 42 Research A im s ........................................................................................ 42 Participant Recruitment and Screening ...................................................42 Human Subjects Requirem ents ...............................................................48 Use of Videos as a Stimulus ...................................................................49 Instruments .............................................................................................. 52 Humor Response Scale ..................................................... 52 Measuring Sense of H u m o r ......................................................... 53 Measurement of Negative Life Events and S tre s s ....................... 56 Depression ................................................................................ 59 Considerations for NK Research in Hum ans ........................................... 60 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. Sample Collection Procedures ................................................... 61 Timing of Sample Collection and Assay Procedures ................. 62 Methods to Control for Day to Day Variability ............................. 63 Use of Daily Control Samples ..................................................... 64 Supplies and Equipment ............................................................. 65 Summary of NK Assay Control Measures ............................................. 66 Summary of Methodology ................................................................................ 68 RESULTS...................................................................................................................... 70 Data A nalysis.........................................................................................70 Sample Demographics ........................................................................... 71 NK Assay Control Data ........................................................................... 71 Results for Research Aim s ..................................................................... 74 The Effect of Laughter on NK Cell Cytotoxicity .... ....................................74 The Effect of Mirthful Laughter on S tress-A rousal ..................................76 Relationships Among Life Events, Sense o f Humor, Laughter, Stress, Arousal, and NK Cytotoxicity ..................................................... 79 Post Intervention Correlations ............................................................... 80 Summary of R e su lts ........................................................................................... 82 DISCUSSION................................................................................................................. 84 Test of PNI Proposition 1: The Effect of Exposure to a Humorous Stimulus and Mirthful Laughter on Stress and Immune F unction .................................. 84 Exposure to Humor and Stress ............................................................. 84 Laughter and S tre s s ............................................................................... 85 Exposure to a Humorous Video, Laughter, and Immune Function ...........85 Sense of Humor, Stress, Laughter, and ImmuneFunction .....................87 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. Stress and Immune Function .................................................................. 88 Possible Mechanisms for Changes in NK Activity Following Laughter... 89 Proposition 2. Relationships Among the Baseline Variables ..................................92 Negative Life Events and Depression ..................................................... 92 Depression, Stress, and Arousal .............................................................93 Arousal and Baseline NK Cytotoxicity ..................................................... 94 Sense of H um o r .......................................................................................94 Strengths, Limitations, and Recommendations ................................................... 95 CONCLUSION................................................................................................................98 Need for Further Humor Research ...........................................................99 REFERENCES.............................................................................................................
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