Cancer Treatment Centers of America

The humor prescription

Author: Nancy Christie

Robbie Robinson was feeling significantly fatigued in the wake of chemotherapy and radiation treatments to treat the non-Hodgkin’s lymphoma he had been diagnosed with at age 47. Though the treatment had been successful, the side effects had him struggling to get through each day. Looking for relief and for a distraction, he found himself sitting in on a Laughter Club session at Cancer Treatment Centers of America® (CTCA) in Zion, Illinois. “I was grasping at every straw that I thought would help me,” he says of his choice to attend the club that day.

Although Robbie admits that he was initially unsure of the connection between laughter therapy and cancer, his doubts were dispelled after he watched the impact of the session on another patient. “She was slumped over in a wheelchair, feeling horrible because she had just gotten out of treatment—but within 15 minutes she was sitting up and laughing. I realized she had forgotten about her pain, forgotten about the cancer. And I thought, Wow, taking your mind off that for just a few minutes can really help! I saw it was a powerful tool to help people get through their treatment and the aftercare.”

From that point on, Robbie was a Laughter Club convert, regularly attending the sessions. “Amidst all this misery, you wonder, What’s so funny about [cancer]? I’m almost dying, and, if I don’t die, I’m put through hell to stay alive. So what’s so funny about this whole thing?” he says, thinking back. “But laughter is very universal. I don’t care what language you speak or where you’re born. It’s one of those few things that we all have the ability to do.”

Laughter is universal

It’s the universality of laughter and humor that can connect patients and family members and distract them from the challenges of a cancer diagnosis and related treatment. Participating in a Laughter Club session reminds everyone that there are still other parts of life that can be enjoyed together, explains Katherine Puckett, PhD, MS, MSW, LCSW, director of mind-body medicine at CTCA in Zion and national director of mind-body medicine at CTCA.

The concept of therapeutic laughter sessions is based on the work of Madan Kataria, MD. Inspired by Norman Cousins’s book, Anatomy of an Illness as Perceived by the Patient, Dr. Kataria developed laughter yoga in the 1980s for use with his chronically ill patients. A 1998 meeting in India between Dr. Kataria and Ohio psychologist Steve Wilson led to Wilson’s bringing the concept back to the United States, where, together with Karyn Buxman, he formed the World Laughter Tour, which provides Certified Laughter Leaders (CLL) training.

After completing CLL training, Dr. Puckett started the Laughter Club at CTCA in Zion in 2004, and since then Laughter Clubs have been incorporated at other CTCA locations. While there’s no denying that patients find the onehour sessions enjoyable, Dr. Puckett emphasizes that Laughter Club is not just an hour of funny jokes but is actually based around a carefully structured format to provide the maximum positive effect, both physically and psychologically.

A typical Laughter Club session begins with a warm-up of deep breathing and simple body movements, including participants practicing laughter sounds using the three basic laugh centers of the body: “he-he-he” for the head area, “haha- ha” for the heart area, and “ho-hoho” for the belly area. At that stage, Dr. Puckett says, “people are already laughing because it’s silly and so contagious. And I’ve had people say to me at the end of Laughter Club, ‘I didn’t even think about cancer in the past hour!’ When you’re laughing it’s very much a here-and-now activity. It distracts people from the stress of cancer, which is the main reason we are offering it here—as a way for people to de-stress.”

But laughter therapy offers much more than distraction, including some specific physiological benefits that are supported by research. For example, studies have shown that laughter can lower blood pressure, improve overall levels of anxiety, and boost the immune system by increasing natural killer cell activity, gamma-interferon, and immunoglobulins.

Humor is also a recognized tool in pain management, possibly because it helps the body release endorphins and induces a relaxation response in the autonomic nervous system. And, as Laughercise (a term coined by researchers Lee S. Berk, DrPH, MPH, and Stanley Tan, MD, PhD), it can generate the same reactions as moderate physical exercise: enhancing mood, decreasing stress hormones, lowering LDL (low-density lipoprotein, the “bad” cholesterol), and raising HDL (high-density lipoprotein, the “good” cholesterol)—whether the laughter is spontaneous, simulated, or controlled.

Dr. Puckett has felt the impact of laughter therapy herself since becoming a Laughter Leader. “In general, since I’ve been doing it, I think I just laugh more in my life. I’m more open to seeing the humor in something that before I might not have seen—now I can laugh about it.

Laughter is a coping tool to help manage loss, a setback, or a disappointment.”

Part of an integrated plan

All jokes aside, Dr. Puckett emphasizes that “we take cancer very seriously at CTCA,” describing where laughter therapy fits into the bigger picture of cancer treatment, as a mind-body medicine tool. “It’s basically another wellness practice,” she says of the modality. “There’s a term they use on the World Laughter Tour called ‘goodhearted living,’ and laughter therapy is a goodhearted-living practice. It’s one piece and something that everyone can do.”

The benefits for patients who choose to participate in laughter therapy can be significant and can offer welcome relief and distraction during the sometimeschallenging road that follows a cancer diagnosis, Dr. Puckett says. “Carol Burnett said, ‘Comedy is tragedy plus time.’ Sometimes we can look back on things or learn to see the lighter side of something, not because we don’t take it seriously but because we need a break from stress. And that’s what mind-body medicine is all about—helping people be less stressed while they are going through this journey.”

Robbie Robinson can attest to the benefits Dr. Puckett describes. Now, 10 years later, he still relies on the techniques he learned to help him manage the after effects of his treatment, from fatigue to neuropathy-related pain, as well as those “low” moments that he still experiences on occasion. “The first four years after treatment, I had no energy whatsoever. It was very difficult. A lot of times, I woke up and was hurting and fighting depression. It was such a struggle sometimes to keep going through the day. Laughter had a lot to do with keeping my spirits up and helping me believe that I could get to the point where I could have control. But just like anything else, you have to keep applying it. Practicing the laughing techniques can help.”

In fact, Robbie believes so strongly in humor therapy that he also attended the course to become a Laughter Leader and now leads sessions in a variety of locations, from nursing homes to libraries to schools. “It is one more tool that I can use to help people and myself through this. I just enjoy doing it and seeing other people benefit from it,” he says, adding, “It takes so little to do for others, and the return is so much greater than the effort that you put in to help somebody.”

Laughter resources and organizations

Founded in 1998 by Sherry Dunay Hilber, the California-based nonprofit Rx Laughter creates humor-based therapeutic educational and research projects that use entertainment to help children and adults battling serious illnesses and trauma such as cancer and post-traumatic stress disorder. Board members include leaders in science and medicine, families of classic comedy legends such as Charlie Chaplin and Buster Keaton, and well-known entertainers and actors such as Ray Romano, Kevin James, and Goldie Hawn. The organization’s research projects, conducted in collaboration with respected researchers at medical and academic centers worldwide, focus on how humor can potentially improve immune function and reduce pain and anxiety to provide doctors and other health care professionals with strategies to use with patients as part of healing and recovery.

The Comedy Cures Foundation
Founded in 1999 by cancer survivor Saranne Rothberg, the Comedy Cures Foundation brings joy, laughter, and therapeutic humor programs to kids and grown-ups living with illness, depression, trauma, and disabilities. Through large- and small-scale, awardwinning, multimedia comedy events, the organization entertains and educates patients and caregivers about the power of a comic perspective and the positive benefits of laughter on the body, mind, and spirit, to date helping 750,000 people at 760 live events.

The World Laughter Tour Steve Wilson
World Laughter Tour is the leader in professional and lay-person training for therapeutic laughter, with resources, information, ideas, and news about healing with laughter and dedicated advocacy of the role of emotions and attitudes in health and happiness. The organization helps people achieve their fullest potential through enjoyable, systematic, lifeaffirming, self-care strategies.

Association for Applied and Therapeutic Humor
The Association for Applied and Therapeutic Humor (AATH) is a nonprofit, member-driven, international community of humor and laughter professionals and enthusiasts. Formed in 1987 by Alison L. Crane, RN, the organization provides its members with the education, cutting-edge resources, and supportive community they need to excel in the practice and the promotion of healthy humor while serving as a clearinghouse for information on humor and laughter as they relate to well-being. AATH also promotes and conducts research investigating the roles that humor and laughter play in well-being, and it reports on innovative programs incorporating the therapeutic use of humor.

The Humor Project, Inc.
The Humor Project, Inc., focuses full-time on the positive power of humor. Its mission is to make a difference by being a unique, pioneering, and cutting-edge organization that touches the lives of individuals, organizations, and nations, seeking to help people get more smileage out of their lives and jobs by applying the practical, positive power of humor and creativity.