Health-Related Benefits of Humor and Laughter

Presented By

Brian King, Ph.D.

Disclosure Neither Dr. Brian King, the presenting speaker, nor the activity planners of this program are aware of any actual, potential or perceived conflict of interest.

Sponsored By

Institute for Brain Potential

PO Box 2238 Los Banos, CA 93635

COURSE OBJECTIVES

Participants completing this program should be able to describe: 1. How humor and laughter can be good for the brain and body. 2. The benefits of the appropriate use of humor and laughter in medical settings. 3. The benefits of humor for improving psychological health. 4. The application of humor to promote healthful habits Health-Related Benefits of Introducing Dr. Brian King Humor and Laughter  A psychologist who also performs stand-up comedy, or  A comedian with a PhD Instructor:  Tours the US discussing happiness, Brian E King, PhD health, and positivity  Practices what he preaches (mostly)

Contact Info:

“I wish my name was Brian because maybe  [email protected] sometimes people would misspell my name and call me Brain. That's like a free compliment and you don't even gotta be smart to notice it.”  Contact IBP for most admin, logistic, CEU specific questions – Mitch Hedberg, Comedian

Course Reminders Objectives

 Silence cell phones  Be able to describe:  Keep conversations to a minimum 1. How humor and laughter can be good for the brain and body.  No Heckling! 2. The benefits of the appropriate use of humor  Hold all questions for the break periods and laughter in medical settings.  Please observe the 2 drink minimum 3. The benefits of humor for improving  The more you drink, the funnier we get psychological health.  Don’t take today so seriously 4. The application of humor to promote healthful  Seriously, don’t stress habits.

1 The Amygdala plays an important role in threat appraisal.

Health-Related Benefits of Humor and Laughter THE BRAIN AND STRESS (IN BRIEF)

The Amygdala Detects “Threat” Threat Appraisal

 Involved in detecting and learning what  Appraisals first ignite responses in the body parts of our environment are important and  Sympathetic Nervous System impulses have emotional significance. traveling at 250 mph  Critical for the production of emotion,  Initial response: changes in galvanic skin particularly negative emotions. response  Instantaneous Threat Appraisal:  Precedes reported feelings by 400-550  Safe or dangerous milliseconds (conscious awareness)  Pleasant/unpleasant

Stress gets our body ready for action. Threat Based Decisions

 Physical Effects  Instantaneous evaluation: include:  Safe or dangerous  Cortisol release  Adrenaline release  Pleasant/unpleasant  Heart rate increase  Is action needed?  Bladder relaxation  Which action? Fight, fly or freeze?  Tunnel vision  Dilated pupils  Shaking  Slowed digestion  Turning green

2 The Nucleus Accumbens influences The Nucleus Accumbens influences behavioral reactions to stress. behavioral reactions to stress.

 Informed by the Amygdala, it selects among well learned reactions  i.e. “Habits”  Involved in the experience of goal-directed positive emotion.

The brain receives feedback from the The Prefrontal Cortex interprets and body to interpret its emotional state. regulates stress reactions.

 James-Lange Theory

 Pencil holding  “Give yourselves a round of applause”

Resilience is a function of the Resilience prefrontal cortex.

 Psychological toughness  Resilience associated with relatively greater  Successful coping activity in the left frontal  Recover, adjust, and grow area than right  Following misfortune and change  Sends inhibitory signals to the amygdala  Strong correlate of  How fast you recover from adverse events HAPPINESS (Davidson, 2012).  “Fast to recover” to “Slow to recover”

3 Can the brain be changed?

“You can’t stay mad at someone who makes you  Many structural elements of the brain are laugh.” significantly modified by life experiences – Jay Leno, Comedian early in life and throughout the lifespan.  Potentials for Neuroplasticity  Neurogenesis: birth of new neurons  Dendrite proliferation  Synaptogenesis  Re-routing & strengthening neural networks

“Start every day off with a smile and get it over with.” ― W. C. Fields, Comedian

Health-Related Benefits of Humor and Laughter WHY HUMOR IS GOOD FOR THE BRAIN AND BODY

Why Humor is Good for the Brain and Body

 Why We Laugh: why being able to laugh and to make others laugh is a sign of brain health.  Stress-Related Hormones: humor reduces hormones associated with acute stress (norepinephrine and epinephrine), chronic stress (cortisol) and improves trust (oxytocin).  Immune Health: laughter increases activity of natural killer cells and improves surveillance of pathogens.  Brain Health: inability to laugh at humorous words (left Health-Related Benefits of Humor and Laughter hemisphere) or images (right hemisphere) are signs of humor deficit disorders; ability to laugh at oneself is a sign of mental WHY WE LAUGH health.

4 Humor

“There seems to be no lengths to which  The tendency of particular cognitive humorless people will not go to analyze experiences to provoke laughter and humor. It seems to worry them.” amusement. – Robert Benchley, Humorist  Can be verbal, audial, visual, physical  Can reflect reality or include misdirection  Exaggeration  Possibly 45 different types

There are many techniques to achieving humor. Benign Violation Theory of Humor

LANGUAGE LOGIC IDENTITY ACTION Allusion Absurdity Before/After Chase  Humor occurs when three conditions are Bombast Accident Burlesque Slapstick satisfied: Definition Analogy Caricature Speed Exaggeration Catalogue Eccentricity  Something threatens one’s sense of how the Facetiousness Coincidence Embarrassment world “ought to be” Insults Comparison Exposure Infantilism Disappointment Grotesque  The threatening situation seems benign Irony Ignorance Imitation  A person sees both interpretations at the same Misunderstanding Mistakes Impersonation Over Literalness Repetition Mimicry time Puns/Wordplay Reversal Parody Repartee Rigidity Scale Ridicule Theme & Var. Stereotype Sarcasm Unmasking Satire

Humor Vs. Jokes

“Tragedy is when I cut my finger. Comedy is  Jokes are actions with humorous intent. when you fall into an open sewer and die.”  Different forms ― Mel Brooks, Filmmaker  Single thought or gesture  Seriously?  Take my wife, please.  Question-answer  Why did the [BLANK] cross the road?  Short story  A guy walks into a bar…  May use irony, sarcasm, word play  Traditional jokes use punchlines  “Seriously, the joke is dead.” – Warren St. John, Journalist

5 Humans aren’t the only species with a sense of humor.

 Forms of play and “To thrive in life you need three bones. A laughter existed in wishbone. A backbone. And a funny bone.” other animals long – Reba McEntire, Singer before humans.  Many mammals make play sounds.

Why is humor important?

 Relief Theory  Laughter is a homeostatic mechanism to reduce tension  Humor as a Defense Mechanism  Overt expression of ideas and feelings too unpleasant or terrible to talk about that gives Health-Related Benefits of Humor and Laughter pleasure to others. LAUGHTER  Humor elicits LAUGHTER (hopefully)

Laughter is universal.

“If love is the treasure, laughter is the key.” – Yakov Smirnoff, Comedian

6 ROFL Laughter Helps:

 The body’s response to humor  Reduce certain stress hormones such as  includes a subjective appreciation cortisol and adrenaline  Gestures and sound  Increase the response of tumor- and  Involves 15 different facial muscles disease-killing cells such as Gamma-  Larynx half closes, making it difficult to breathe interferon and T-cells and creating the irregular air intake (sound)  Very regular sound waves, unlike speech  Defend against respiratory infections–even  Struggle for oxygen activates tear ducts reducing the frequency of colds–by  Bodily muscle contractions, limbs, diaphragm, immunoglobulin in saliva. back

“We are paying very a high price for taking life seriously. Now it’s time to take laughter seriously.” – Madan Kataria, Founder of Laughter Yoga

Health-Related Benefits of Humor and Laughter STRESS-RELATED HORMONES

Much of our stress response is mediated by cortisol release. Beneficial Effects of Cortisol

 Increase in glucose (energy)  Increased cardiac output  Emotion regulation

7 Laughter reduces threat and However, long term stress… increases trust.

 In response to humor, the amygdala releases oxytocin, a hormone connected to nursing, bonding, and trust.

Stress Reduction Threat Reduction

 Laughter reduces:  Amygdala releases oxytocin; reducing the  Cortisol potential for a stress response.  Epinephrine  There are many social benefits of sharing a  Growth hormone laugh.

Figure from Bennett, et al., 2003.

Laughter boosts the immune system.

 Increases natural killer (NK) cell activity, a protection against illness and cancer. Health-Related Benefits of Humor and Laughter IMMUNE HEALTH

Figure from Bennett, et al., 2003.

8 Laughter has many benefits to the immune system.

 Increases natural killer (NK) cell activity  Increases the response of tumor- and disease-killing cells such as Gamma- interferon and T-cells

 Defends against respiratory infections by Health-Related Benefits of Humor and Laughter immunoglobulin in saliva  Also reduces the frequency of colds BRAIN HEALTH

“I used to think that the brain was the most “Humor is the most significant activity of the wonderful organ in my body. Then I realized human brain.” who was telling me this.” — Edward De Bono, Physician – Emo Philips, Comedian

The effects of humor on the brain Hemispheric Specialization are fast.

 Left side handles language functions like  Less than half a second after exposure, electrical grammar, vocabulary, and literal meaning activity is observed in the cortex.  Analyzes the words and structure of language  The left hemisphere analyzes the words and structures of the joke  Humor is right side dominant  The right hemisphere “gets” the joke  Right side helps interpret intent of communication;  Visual sensory area of the occipital lobe creates e.g., Lie vs joke images  Right hemisphere “gets” the joke  Limbic areas makes you happier  Inability to laugh and humor deficit disorders  Motor sections make you smile or laugh may be indicative of damage.  Inability to stop laughing is less understood.

9 Being able to laugh and make others laugh is an indication of brain health. Humor Processing Task example

 Deficits in Humor associated with:  “Martin had just started his own company. When a visitor came into the office, Martin picked up the  Language center impairment telephone. He pretended to be discussing a multi-  Asperger Syndrome million-pound deal. Eventually he put the phone down  Depression and said to the visitor: “Can I help you?”  Damage to the right hemisphere  Possible endings:  The visitor said: “Yeah, I've come to connect up your  Agenesis of the corpus callosum telephone.”  Deficits in humor perception present in  The visitor said: “The color of this wallpaper matches my tie.” schizophrenics  “Martin's chair suddenly collapsed and he fell on the floor.”  “The visitor said: ‘Yes, I'm looking for a job in your new company.’”

Uekermann, et al., 2008.

Humor modulates activity in the Women show greater reward cortex and reward center. response to humor than men.

Mobbs, et al., 2003. Azim, et al., 2005.

Gender differences in Humor

 It is widely believed that men have a stronger sense of humor than women.  Depends on how it is defined

Health-Related Benefits of Humor and Laughter SIDEBAR: GENDER DIFFERENCES

10 In conversation, women laugh more often than men but men elicit more laughter than women.

Speaker Audience % Speaker % Audience “I love people who make me laugh. I honestly Laughter Laughter think it's the thing I like most, to laugh. It cures Female Female 86% 50% a multitude of ills. It's probably the most Male 88% 39% important thing in a person.” Male Female 66% 71% – Audrey Hepburn, Actress Male 76% 60%

 But why?

Provine, R. R. (2014). Laughter a scientific investigation. New York: Penguin Books.

Cross culturally, women desire humor in Why do women value humor more potential mates more than men. than men?

What men seek in women What women seek in men  Some theories: % Top 3 % Top 3 Intelligence 49% Humor 53%  May be perceived as a trait related to Good looks 43% Intelligence 44% intelligence Humor 42% Honesty 39%  Associated with health benefits (healthier Honesty 29% Kindness 36% partner) Facial Attractiveness 26% Values 21% Kindness 28% Communication 19%  Stress relief and management Values 18% Dependability 19%  Boredom relief Communication 14% Good looks 17% Dependability 13% Facial Attractiveness 12%  All good reasons to desire humor, but do Age 6% Ambition 8% not explain gender difference

Data from 102,961 men & 82,819 women across 53 countries (Lippa, 2007).

Women show greater reward response to humor than men. Stand up comedy is male dominated.

Comedy Club Performers/Performances by Sex 100% 80% 82% 80%

60%

40% 20% 18% 20%

0% Male Female Performers (n=607) Shows (3,580)

Azim, et al., 2005. King, B. (2011). Wharf Room Comedy Booking 2009-2011. Unpublished raw data.

11 “Laughter is the best medicine. But if you're laughing for no reason, you need medicine.”

Health-Related Benefits of Humor and Laughter HUMOR AND LAUGHTER IN MEDICAL SETTINGS

Humor and Laughter in Medical Settings

“Laughter is the best medicine.”  Acute Pain: the patient’s experience of threat prior to a medical or dental procedure can be reduced by appropriate use of humor; – Believed to have originated in the Bible laughter and elevation of pain-reducing endorphins.  Chronic Pain: how humor breaks the link between pain, insomnia, depression and immune suppression.  Heart-Warming Humor: the ability to laugh is associated with lower blood pressure, fewer arrthymias, reduced risk of angina and disease of the coronary arteries.  Cancer: how laughter and humor increases resilience, reduces the adverse effects of cancer treatment and promotes recovery.

Norman Cousins (1915-1990)

“The human race has only one really effective  Diagnosed with a form of arthritis weapon and that is laughter.”  Unresponsive to medication, – Mark Twain, Author the stressful hospital environment  Developed his own “treatment” based on mood elevation through laughter  Candid Camera, Marx Brothers  Recovered some and lived 26 more years  Controversial, but good story.

12 The Norman Cousins Program

 Although Norman’s story is controversial, “Each patient carries his own doctor inside there is benefit. him.”  Daily exposure to humor can reduce pain. — Norman Cousins, Journalist  Many studies have shown an effect.

Dental Pain Reduction

 Nitrous Oxide, “Laughing Gas”  Dopamine is elevated by nitrous oxide; distinguishing between trance in dental medication and transcendental meditation.

Health-Related Benefits of Humor and Laughter  Dr Brian King apologizes for the above joke. ACUTE PAIN

Laughter can help reduce pain in a dental setting. Acute Pain Relief

 Helps reduce stress, helps patients have  Laughing at, not just watching, humorous patience films or live performances elevates pain  Used effectively by pediatric dentists as threshold systematic desensitization  Effect appears to be due to laughter, not elevated mood.  Humorous video clips help reduce anxiety during anesthesia induction  More pronounced in a social setting than alone.  More effective than other distraction techniques  Social laughter could help reduce need for analgesics.

13 Leaving Patients In Stiches:

 Reduces preoperative anxiety in children and adults  And postoperative pain Health-Related Benefits of Humor and Laughter CHRONIC PAIN

Reducing Chronic Pain

 Humor can help break the cycle between “A good laugh and a long sleep are the two pain, sleep loss, depression and immune best cures for anything.” suppression. – Irish Proverb  Humor may help moderate stress and disability for chronic pain patients

Something to uplift broken situations

 Providing the gift of laughter to people in need  Homeless shelters, prisons, abused children facilities, etc.

Health-Related Benefits of Humor and Laughter HEART-WARMING HUMOR

14 Heart-Warming Humor Type 2 Diabetes

 Laughter assists with vascular function.  Daily exposure to comic films improves  Acts on the inner lining of blood vessels post-meal serum glucose, reduces risk of (endothelium) causing vessels to relax and microvascular complications and diabetic expand neuropathy.  Lowers blood pressure  Laughter reduces blood sugar levels,  Laughter reduces epinephrine, implicated increasing glucose tolerance in both in arrhythmias, hypertension, and heart diabetics and non-diabetics. attack

Cancer

 Laughter and humor increase resilience and acceptance  Benefits for immune health

Health-Related Benefits of Humor and Laughter CANCER

“Laughter is the shortest distance between two people.” ― Victor Borge, Comedian

Health-Related Benefits of Humor and Laughter USING HUMOR IN YOUR PRACTICE BY PRACTICING HUMOR

15 Using Humor in Your Practice by Practicing Humor But first…

 Reducing Generalized Anxiety: how to use humor to stop the cycle of “what if” thinking that perpetuates anxiety.  Don’t “Use” humor, be yourself.  Depression: how adding humor to psychological therapies can facilitate recovery.  Interpersonal Therapy: how humor shifts perspective, diffuses tension, reduces  If you are funny, be funny confrontations, and improves communication.  Cognitive-Behavioral Therapy: helping patients revise maladaptive thoughts so  If you aren’t funny, well… they can view them as unrealistic and humorous.  Positive Psychology: how to use humor to enhance the practice of positive psychology.  Acceptance and Commitment: how to use humor to improve stress resilience and to accept flaws in self and others that are unlikely to change.  Enhancing Mindfulness: when we laugh, we are in a positive state.  Difficult Conversations and Situations: guidelines for using humor to improve the health and wellbeing of clients and health professionals.

Reducing Anxiety

 Generalized Anxiety:  How to use humor to stop the cycle of “what if” thinking that perpetuates anxiety.  Social Anxiety:  Fear of ridicule and being laughed at; the healing power of laughing at oneself. Health-Related Benefits of Humor and Laughter REDUCING GENERALIZED ANXIETY

Generalized Anxiety Social Anxiety

 Use humor to stop  Instead of fearing the cycle of “what if” ridicule and being thinking that laughed at, perpetuates anxiety. recognize the healing power of “If I don’t finish all this laughing at oneself. work I might lose this job I hate.”

16 Lifetime Rates of Emotional Disorders

 In the USA:  Anxiety Disorders: 19%  Affective Disorders: 15%  Of the rest, half suffer from occasional mild depression. Health-Related Benefits of Humor and Laughter DEPRESSION

Many consider depression as an epidemic. Treatment of Depression

 Rates of depression have been on the rise  Psychopharmacology in the past 50 years  Personality changes  Age of onset decreasing  Shortcut?  Largest burden on society in the USA (4th  Side effects in the world)  Works best for severe symptoms  Reduced years of healthy life  Efficacy is questionable for mild/moderate  WHO predicts depression will be 2nd  Something else is needed. leading cause of death by 2020.

Depressed Adults Humor Therapy Movement

 Adding humor to psychological therapies  Mixed findings, but can’t hurt facilitates recovery.  Most beneficial for patients with most  Humor Therapy Movement severe symptoms  Positive doctor-patient relationship  Life affirming  Increases social cohesion  Reduces stress

17 Laughter is both:

 An expression of “We don't laugh because we're happy, we're happiness, and happy because we laugh.”  A contributor to – William James, Psychologist (duh) happiness

The brain receives feedback from the body to interpret its emotional state. Laughter makes us happy.

 James-Lange Theory  Nobody is happy all of the time.  Some people are generally happier more often than others.  How we feel involves habitual reactions to memories associated with:  Hurt, anger, sadness, anxiety, shame  Pencil holding  Positive memories related to trust, joy and love  “Give yourselves a round of applause”

Positive emotions can affect life expectancy. Fake it until you make it!

 Baseball Smile Study (Abel & Kruger,  Producing smiles 2010) and laughs elevates  Smile intensity related to longevity mood  Those smiling in their photos lived 7 years  Suppressing smiles longer curtails it

18 Late Life Depression

“The most radical act anyone can commit is to  Humorous interventions elevate mood, be happy.” improve life satisfaction and sleep. – Patch Adams, Physician & Clown  Happier people are less likely to develop tau tangles and amyloid plaque related to cognitive decline.  Laughter and Exercise  Laughter IS exercise!  PLAY

Social Benefits of Laughter

 Laughter is social  30 times more likely to laugh in a social situation than alone  Strengthens interpersonal relationships  Promotes group bonding Health-Related Benefits of Humor and Laughter INTERPERSONAL THERAPY  Facilitates cooperation / teamwork  Defuses conflict

Interpersonal Therapy

 Humor: “Laughter gives us distance. It allows us to  Shifts perspectives step back from an event, deal with it and then  Diffuses tensions move on.”  Reduces confrontations – Bob Newhart, Comedian  Helps convey complex messages concisely  Helpful in systematic desensitization  Arachnophobia

Clip: Case Study

19 Cognitive-Behavioral Therapy

 Help patients frame their maladaptive thoughts in terms that are absurd and ridiculous to reduce anxiety and to elevate mood.  Cognitive restructuring can help overcome Health-Related Benefits of Humor and Laughter perceived obstacles COGNITIVE-BEHAVIORAL  “It’s just a flesh wound” (Monty Python) THERAPY

“I was going to write that I’m a really bad “What alone remains is the last of human procrastinator, but actually I’m quite good at it. freedoms, the ability to choose one's attitude Stay positive!” in a given set of circumstances” –DrBrian – Viktor Frankl, Neurologist & Psychiatrist

Humor can improve stress resilience.

 Coping mechanisms, ability to bounce back

Health-Related Benefits of Humor and Laughter POSITIVE PSYCHOLOGY

20 The Stress-Resistant Mindset

 Stress resilient people view problems as predictable and controllable  Protection against the toxic effects of cortisol on the heart, immune system, and the brain (e.g., impaired short-term Health-Related Benefits of Humor and Laughter memory) ACCEPTANCE AND COMMITMENT

Acceptance

 Acceptance of Others  Accept traits in others that are unlikely to change.  Attain the self-healing gift of forgiveness.  Acceptance of Self Health-Related Benefits of Humor and Laughter  Humor helps tame the “inner critic” that demands unattainable standards ENHANCING MINDFULNESS

Mindfulness Mindfulness Meditation Example

 Experiencing moment-to-moment Twice a day for 5 to 10 minutes: awareness of thoughts and feelings without 1. Choose a time of day when you are most awake and judgment; alert. Sit upright, keeping the spine straight. 2. Focus on your breathing, the sensations it triggers.  How resilient people take the time to lose Notice how your abdomen moves with each breath. track of time. 3. Focus on the tip of the nose, the different sensations from each breath. 4. If you become distracted, return your focus to your breathing.

21 Research on Mindfulness

 Associated with greater acceptance “You should sit in meditation for 20 minutes a  Increased resilience day, unless you're too busy. Then you should  In the brain: sit for an hour”  Helps reduce activity in the amgydala and – Zen proverb orbitofrontal cortex  Increased prefrontal activity  Thicker insular cortex

Difficult Conversations and Situations

A guy is in the hospital with two broken legs. The nurse comes in and tells him that there's good news and bad news.

The guy asks for the bad news first.

The nurse says, "We're going to have to remove your legs."

Health-Related Benefits of Humor and Laughter Then the guy asks for the good news. DIFFICULT CONVERSATIONS The nurse says, "The guy beside you wants to buy your sneakers." AND SITUATIONS

“Bad humor is an evasion of reality; good humor is an acceptance of it.” ― Malcolm Muggeridge, Journalist

Health-Related Benefits of Humor and Laughter USING HUMOR TO PROMOTE HEALTHFUL HABITS

22 Using Humor to Promote Healthful Habits Enhancing Willingness to Change

 Enhancing Willingness to Change: how to use humor to improve  When we laugh we develop positive associations and the way people develop positive associations and emotional positive emotional expectations associated with the expectations. message.  The Humor-Habit: how being able to reframe daily hassles in a humorous ways reduces everyday stress and improves the  Exercise / eating healthy is boring / hard vs. fun / play willingness to initiate and maintain health-promoting practices.  Reducing Apprehension: calming emotions before they are “up and running.”  Changing How We Feel By Changing How We Think: revising habitual narratives that perpetuate shame, hurt, isolation, incompetence, inferiority, sadness, worry and perfectionism.  Calming An Overactive Brain: how to find and share humor to help relieve daily hassles as a happiness-enhancing habit.

Humor can assist in learning new habits. The Humor-Habit

 Brain-Derived Neurotropic Factor (BDNF)  Find Humor In Everyday Life  Supports existing neurons, encourages growth of  Take seriously the healing power of humor and new neurons & synapses laughter to reduce stress and to elevate mood.  Influenced by experiences:  Decreased by stress, can lead to atrophy of the Hippocampus & depression  Increased by: Some psychiatric drugs, such as Antidepressants, Intellectual stimulation, and exercise  Benefits of laughter include stress reduction, intellectual stimulation, and exercise.

Changing How We Feel By Changing Reducing Apprehension How We Think

 Breaking the habit of “what if” thinking that  Prefrontal functions perpetuates anxiety. include:  Systematic desensitization  Resilience  Emotional regulation

23 Calming An Overactive Brain

“If you don’t like the way you feel, change  Find and share humor to relieve daily your thoughts.” stressors as a happiness-increasing habit. – Dr Brian King  Humor helps reduce unwanted thoughts, facilitate well-being and improve sleep.

Ways you can apply humor at home and at work.

 Don’t take life too seriously! “I am serious, so I laugh a lot. You need to  Learn to identify intent of communication laugh. You don't laugh enough. I don't trust  Tell when someone is anyone who doesn't laugh.” joking  Don’t take life too seriously! – Maya Angelou, Poet  Engage your playful side  Seriously, DON’T TAKE LIFE TOO SERIOUSLY!  Seek professional help

“A person who knows how to laugh at himself Stay in touch! will never cease to be amused.” – Shirley MacLaine, Actress [email protected]

24 References

Abel, E. L., & Kruger, M. L. (2010). Smile intensity in photographs predicts longevity. Psychological Science, 21(4), 542‐544.

Abrami, L. M. (2009). The healing power of humor in logotherapy. International Forum for Logotherapy, 32(1), 7‐12.

Adams, E., & McGuire, F. (1986). Is laughter the best medicine? A study of the effects of humor on perceived pain and affect. Activities, Adaptation and Aging, 8, 157‐175.

Ando, V., Claridge, G., & Clark, K. (2014). Psychotic traits in comedians. The British Journal of Psychiatry, 341‐345.

Azim E., Mobbs, D., Jo, B., Menon, V., & Reiss, A. (2005). Sex differences in brain activation elicited by humor. Proceedings of the National Academy of Sciences of the United States of America, 102 (45).

Bennett, M. P., Zeller, J. M., Rosenberg, L., & McCann, J. (2003). The effect of mirthful laughter on stress and natural killer cell activity. Nursing Faculty Publications, 9.

Berger, A. A., (2013). Forty five Ways to Make 'Em Laugh. Israeli Journal of Humor Research, 3.

Berk, L. S., Tan, S. A., Fry, W. F., Napier, B. J., Lee, J. W., Hubbard, R. W., ... & Eby, W. C. (1989). Neuroendocrine and stress hormone changes during mirthful laughter. The American journal of the medical sciences, 298(6), 390‐396.

Berk L, Tan S, Nehlsen‐Cannarella S, Napier B, Lewis J, Lee J, et al. Humor associated laughter decreases cortisol and increases spontaneous lymphocyte blastogenesis. Clin Res ( 1988;) 36:: 435A.

Berk, R. (2001). The active ingredients in humor: psycho physiological benefits and risks for older adults. Educational Gerontology, 27, 323‐339.

Berkowitz, B. A., Finck, A. D., & Ngai, S. H. (1977). Nitrous oxide analgesia: reversal by naloxone and development of tolerance. Journal of Pharmacology and Experimental Therapeutics, 203(3), 539‐547.

Berns, G. S. (2004). Something funny happened to reward. Trends in cognitive sciences, 8(5), 193‐194.

Blumenthal, J. A., Babyak, M. A., Moore, K. A., Craighead, W. E., Herman, S., Khatri, P., … & Krishnan, K. R. (1999). Effects of exercise training on older patients with major depression. Archives of Internal Medicine, 159(19), 2349‐56.

Brown, W. S., Paul, L. K., Symington, M., & Dietrich, R. (2005). Comprehension of humor in primary agenesis of the corpus callosum. Neuropsychologia, 43(6), 906‐916.

Brownell, H.H., Michel, D., Powelson, J., & Gardner, H. (1983). Surprise but not coherence: Sensitivity to verbal humor in right‐hemisphere patients. Brain and Language, 18, 20–27.

25

Buijzen, M., Valkenburg, P. M. (2004). "Developing a Typology of Humor in Audiovisual Media". Media Psychology, 6, 147‐167.

Cousins, N. (1979). Anatomy of an Illness as Perceived by the Patient: Reflections on Healing and Regeneration. WW Norton & Company.

De Dreu, C. K., Greer, L. L., Van Kleef, G. A., Shalvi, S., & Handgraaf, M. J. (2011). Oxytocin promotes human ethnocentrism. Proceedings of the National Academy of Sciences, 108(4), 1262‐1266.

Dolgoff‐Kaspar, R., Baldwin, A., Johnson, M.S., Edling, N., Sethi, G. K. (2012). Effect of laughter yoga on mood and heart rate variability in patients awaiting organ transplantation: a pilot study. Alternative Therapies in Health and Medicine, 18(5).

Dunbar, R. I. M., Baron, R., Frangou, A., Pearce, E., van Leeuwin, E. J., Stow, J., ... & van Vugt, M. (2011). Social laughter is correlated with an elevated pain threshold. Proceedings of the Royal Society B: Biological Sciences.

Epp, L. R. (1998). Why aren't they laughing?: The clinical significance of a hypothesized "humor deficit disorder" among at‐risk adolescents: An exploratory study. Dissertation Abstracts International Section A: Humanities and Social Sciences, 735.

Fredrickson, B. L. (2001). The role of positive emotions in positive psychology: The broaden and build theory of positive emotions. American Psychologist, 56, 218‐226.

Fry, W. (1977). Respiratory components of mirthful laughter. Journal of Biological Psychology, 19, 39‐50.

Fry, W. (1994). The biology of humor. Humor: International Journal of Humor Research, 7, 111‐126.

Gorman, J. (2006). Dogs May Laugh, but Only Cats Get the Joke, The New York Times, September 5, 2006 available at http://www.nytimes.com/2006/09/05/science/05side.html (retrieved August 27, 2015).

Guéguen N. (2010). Men's sense of humor and women's responses to courtship solicitations: an experimental field study. Psychological Reports, 107, 145‐56.

Hirosaki, M., Ohira, T., Kajiura, M., Kiyama, M., Kitamura, A., Sato, S., & Iso, H. (2013). Effects of a laughter and exercise program on physiological and psychological health among community‐dwelling elderly in Japan: Randomized controlled trial. Geriatrics & gerontology international, 13(1), 152‐160.

Hirsch, R. D., Junglas, K., Konradt, B., & Jonitz, M. F. (2010). [Humor therapy in the depressed elderly: results of an empirical study]. Zeitschrift fur Gerontologie und Geriatrie, 43(1), 42‐52.

Horowitz, S. (2009). Effect of positive emotions on health: Hope and humor. Alternative and Complimentary Therapies, 15(4), 196‐202.

Johansen, A. B., & Cano, A. (2007). A preliminary investigation of affective interaction in chronic pain couples. Pain, 132, S86‐S95.

26

Kahn, S. (1981). The anatomy of Norman Cousins" illness. The Mount Sinai journal of medicine, New York, 48(4), 305.

Kataria, Madan (2002), Laugh For No Reason (2 ed.). Mumbai: Madhuri International.

King, B. E. (2011). Wharf Room Comedy Booking 2009‐2011. Unpublished raw data.

King, B. E., & Alexander, G. M. (2000). Pain sensitivity and individual differences in self‐reported sexual behavior. Journal of Comparative Psychology, 114(2), 193‐199.

Klein, A. (1989). The healing power of humor: Techniques for getting through loss, setbacks, upsets, disappointments, difficulties, trials, tribulations, and all that not‐so‐funny stuff. JP Tarcher.

Kohn, N., Kellermann, T., Gur, R. C., Schneider, F., & Habel, U. (2011). Gender differences in the neural correlates of humor processing: implications for different processing modes. Neuropsychologia, 49(5), 888‐897.

Lefcourt, H. M., Davidson, K., Prkachin, K. M., & Mills, D. E. (1997). Humor as a stress moderator in the prediction of blood pressure obtained during five stressful tasks. Journal of Research in Personality, 31(4), 523‐542.

Lewis, M. B., & Bowler, P. J. (2009). Botulinum toxin cosmetic therapy correlates with a more positive mood. Journal of cosmetic dermatology, 8(1), 24‐26.

Lichtigfeld, F. J., & Gillman, M. A. (1996). Role of dopamine mesolimbic system in opioid action of psychotropic analgesic nitrous oxide in alcohol and drug withdrawal. Clinical neuropharmacology, 19(3), 246‐251.

Lippa, R.A. (2007). The preferred traits of mates in a cross‐national study of heterosexual and homosexual men and women: An examination of biological and cultural influences. Archives of Sexual Behavior, 36, 193‐208.

Martin, R. A. (2010). The psychology of humor: An integrative approach. Academic press.

McComas, H. C. (1923). The origin of laughter. Psychological Review, 30(1), 45‐55.

McGraw, P., & Warren, C. (2010). Benign Violations Making Immoral Behavior Funny. Psychological science, 21(8), 1141‐1149.

McGraw, P., & Warner, J. (2015). The humor code: A global search for what makes things funny. Simon and Schuster.

Meyer, J. C. (2000). Humor as a double edged sword: Four functions of humor in communication. Communication Theory, 10(3), 310‐331.

Mifflin, K. A., Hackmann, T., & Chorney, J. M. (2012). Streamed video clips to reduce anxiety in children during inhaled induction of anesthesia. Anesthesia & Analgesia, 115(5), 1162‐1167.

27

Miller, M., & Fry, W. F. (2009). The effect of mirthful laughter on the human cardiovascular system. Medical hypotheses, 73(5), 636‐639.

Miller, M; Mangano, C; Park, Y; Goel, R; Plotnick, GD; Vogel, RA (2005). "Impact of cinematic viewing on endothelial function". Heart 92 (2): 261–2

Mobbs, D., Greicius, M. D., Abdel‐Azim, E., Menon, V., & Reiss, A. L. (2003). Humor modulates the mesolimbic reward centers. Neuron, 40(5), 1041‐1048.

Morse, D. R. (2006). Use of humor to reduce stress and pain and enhance healing in the dental setting. Journal of the New Jersey Dental Association, 78(4), 32‐36.

Nehlsen‐Cannarella S, Napier B, Lewis J, Lee J, et al. Humor associated laughter decreases cortisol and increases spontaneous lymphocyte blastogenesis. Clin Res ( 1988;) 36:: 435A.

Nevo, O., & Shapira, J. (1988). The use of humor by pediatric dentists. Journal of Children in Contemporary Society, 20(1‐2), 171‐178.

Parvizi, Anderson, Damasio & Damasio, (2001). Pathological laughing and crying: a link to the cerebellum. Brain, 124, 1708‐19.

Pfeifer, K. (1994). Laughter and pleasure. Humor: International Journal of Humor Research, 7(2), 157‐ 172.

Polimeni, J., & Reiss, J., (2006). Humor perception deficits in schizophrenia, Psychiatry Research, 141, 229‐232.

Provine, R. R. (2001). Laughter: A scientific investigation. Penguin.

Richman, J. (1995). The lifesaving function of humor with the depressed and suicidal elderly. The Gerontologist, 35(2), 271‐275.

Ruderman, F. A. (1980). A placebo for the doctor. Commentary (New York, NY), 69(5), 54.

Samson, A. C., & Hegenloh, M. (2010). Stimulus characteristics affect humor processing in individuals with asperger syndrome. Journal of Autism and Developmental Disorders, 40(4), 438‐447.

Seligman, M. (2012). Flourish: A visionary new understanding of happiness and well‐being. Free Press.

Shahidi, M., Mojtahed, A., Modabbernia, A., Mojtahed, M., Shafiabady, A., Delavar, A., & Honari, H. (2011). Laughter yoga versus group exercise program in elderly depressed women: a randomized controlled trial. International journal of geriatric psychiatry, 26(3), 322‐327.

Sugawara, J., Tarumi, T., & Tanaka, H. (2010). Effect of mirthful laughter on vascular function. The American journal of cardiology, 106(6), 856‐859.

28

Tan, S. A., Tan, L. G., Lukman, S. T., & Berk, L. S. (2006). Humor, as an adjunct therapy in cardiac rehabilitation, attenuates catecholamines and myocardial infarction recurrence. Advances in mind‐body medicine, 22(3‐4), 8‐12.

Trafton, JA, Gordon, WP and Misra, S. (2011) Training Your Brain to Adopt Healthful Habits: Mastering the Five Main Brain Challenges. Institute for Brain Potential: Palo Alto, CA

Uekermann, J., Channon, S., Lehmkämper, C., Abdel‐Hamid, M., Vollmoeller, W. & Daum, I. (2008). Executive function, mentalizing and humor in major depression. Journal Of The International Neuropsychological Society, 14, pp 55‐62.

Ventis, W. L., Higbee, G., & Murdock, S. (2001). Using Humor in Systematic Desensitization to Reduce Fear. The Journal of General Psychology, 241‐253.

Walter, M., Hänni, B., Haug, M., Amrhein, I., Krebs‐Roubicek, E., Müller‐Spahn, F., & Savaskan, E. (2007). Humour therapy in patients with late‐life depression or Alzheimer's disease: a pilot study. International Journal Of Geriatric Psychiatry, 22(1), 77‐83.

Watson, K. K., Matthews, B. J., & Allman, J. M. (2007). Brain activation during sight gags and language‐ dependent humor. Cerebral Cortex, 17(2), 314‐324.

Weems, S. (2014). Ha!: The Science of When We Laugh and Why. Perseus Books Group.

Weisenberg, M., Tepper, I., & Schwarzwald, J. (1995). Humor as a cognitive technique for increasing pain tolerance. Pain, 63(2), 207‐212.

Whipple, B., & Komisaruk, B. R. (1985). Elevation of pain threshold by vaginal stimulation in women. Pain, 21, 357‐367.

Wilkins, J., & Eisenbraun, A. J. (2009). Humor theories and the physiological benefits of laughter. Holistic nursing practice, 23(6), 349‐354.

Yazdani, M., Esmaeilzadeh, M., Pahlavanzadeh, S., & Khaledi, F. (2014). The effect of laughter Yoga on general health among nursing students. Iranian journal of nursing and midwifery research, 19(1), 36.

IBP programs are designed to be based on the best available evidence from current scientific research. However, the interpretation of evidence-based research may vary among researchers. The views and opinions expressed in this program are those of the presenter and do not necessarily reflect the views and opinions of IBP.

29

Self-Test

1. Humor can be achieved via which mode of stimulation? a. Verbal b. Visual c. Physical d. All of the above

2. According to which theory, humor occurs when our expectations are broken in a nonthreatening way and we recognize the discrepancy. a. Benign Violation Theory b. Expectation Theory c. Joke Theory d. Big Bang Theory

3. Humans are the only species that exhibits a sense of humor. a. True b. False c. Chickens are hilarious

4. Happiness is: a. An affective state b. A blanket c. A habit

5. The benefits of laughter include all but which of the following? a. Lower blood pressure b. Exercise c. Lower credit score d. Increased memory

6. Humor deficits are associated with a. Damage to the right hemisphere b. Lower blood sugar c. Military training d. Loneliness

7. Which of the following are associated with greater capacity for happiness? a. Being slow to recover from adversity b. Being very resilient c. Social intuition d. Being self-opaque 8. Laughter reduces a. Cortisol b. Epinephrine c. Growth hormone d. All of the above

9. In general, men and women respond to humor the same a. True b. False

10. Laughter and humor therapy have been used to a. Reduce pain in dental settings b. Reduce chronic pain c. Reduce need for analgesics d. All of the above