by Julia Wilkins, PhD and Amy Janel Eisenbraun, MS at Academia.edu
There are 3 main theories used to explain the functions of humor: (1) the relief theory, (2) the incongruity theory, and(3) the superiority theory. While these theories focus on the specific role that humor plays for people in situationssuch as dealing with misfortune, making sense of rule violations, and bonding with others, we propose thatunderlying each of these theories are the physiological benefits of laughter. We draw on findings from empiricalstudies on laughter to demonstrate that these physiological benefits occur regardless of the theory that is used toexplain the humor function. Findings from these studies have important implications for nurse practitioners workingin hospice settings, long-term care facilities, nursing homes, and hospitals.
Humor and laughter have long been recognized ascentral to the human condition; in fact, their benefitswere noted in some of the world’s earliest printedtexts. A hymn from the Rig Veda, the earliest of the4 Hindu religious scriptures, theVedas(c. 1200–900BC
), refers to “fun making for the creation of laughter”(IX.112.4). Gruner 1 points out that humans laughedbefore they told jokes, for there was a time whenhumans did not have language, but were capable of laughter. The universal expression of laughter is upheldby many theorists as evidence of laughter’s biologicalroots. Studies of joking relationships in differentcultures (eg, Radcliffe-Brown 2) indicate that theserelationships serve to maintain social harmony andstability. The fact that one cannot tickle oneself andevoke genuine laughter further suggests that laughter is controlled by social cues and interactions.
3–5
From an evolutionary perspective, laughter, like alltraits that are passed on through natural selection,must have survival value. Laughter serves manyfunctions essential to human survival—a bondingfunction, a peacemaking function, and ahealth-boosting function. McDougall 6proposed thatlaughter evolved as a protective shield, not as a copingmechanism for people’s own misfortune, but because humans needed to have empathy for others in order for the human race to survive. In addition to developingthis theory of the evolutionary functions of laughter,McDougall7 was also one of the first psychologists tobring attention to the physiological benefits of laughter. The physiological benefits that haveimplications for nursing practice will be exploredwithin the framework of humor theories after reviewing laughter’s use as a coping mechanism.
LAUGHTER AS A COPING MECHANISM
Some theorists suggest that laughter and humor areinstinctive coping mechanisms that help people dealwith the disappointments and struggles of life.8,9 Specifically, it is believed that by finding humor instressful or potentially threatening situations, peoplecan replace negative with positive affect, therebygiving them an increased ability to cope with negativestates of affairs.10–12
Humor based on incongruities, or things that appear inappropriate for their context, isparticularly well suited to reappraising negativesituations from different, less threateningperspectives.13
By being in touch with their patients’emotions and sense of psychological well-being, nursepractitioners can decide when it might be useful toencourage their patients to engage in positivereframing. As Dossey and Keegan 14explain, nursescan help relieve their patients’ stress by helping themto find humorous perspectives in their problems. Thatbeing said, it is also important to be sensitive topatients’ reactions to humor. Just as 2 clients with thesame symptoms may not always get the samemedication, different patients may require differentdoses and different types of humor.Throughout history, oppressed people have usedhumor as a survival tool. Referring to its use in NativeAmerican communities, Luna et al commented,In Indian humor, you can make fun of anything andeven at the worst times. . .
I think what I came torealize is that it’s a way of easing the pain, thatlaughter is a good cure and that maybe if we didn’tlaugh so much, we would be depressed.15
Likewise, in “Man’s Search for Meaning,” Frankl16 documented his and his fellow prisoners’ use of jokingand humor while imprisoned in Nazi concentrationcamps. In the words of Vereen et al, “Peopleconsistently see [humor’s] value in shaping their perspective in times of difficulty and in helping themto adjust to stressful situations.”17(p10)
Suchperspective shaping might be particularly useful for patients suffering with debilitating diseases or for family members dealing with uncertainty about thefuture outcomes of loved ones. So as not to be viewedas unprofessional when using humor to lighten theseriousness of patients’ conditions, nurses shouldprovide a brief explanation of the role of humor inhelping to reframe situations along with informationon the health benefits of humor. 14
Anecdotal accounts of the stress-reducing effects of humor are supported by research on humor’seffectiveness in reframing stressors. Cann and Etzel, 18for example, used a sample of 176 university studentsto examine the relationship between individuals’ senseof humor and their perceived personal stress. Theparticipants completed 3 measures of sense of humor,in addition to 3 positive personality measures relatedto happiness, hope, and optimism. It was found thathaving a sense of humor was associated with lower perceptions of stress and higher levels of optimism,hope, and happiness.Different aspects of humor, such as turningnegatives into positives, being optimistic, and havinghope in life, are all effective coping strategies.Research shows that believing in the benefits of laughter alone is sufficient for the body to experiencephysiological benefits, such as decreased pain.Mahony et al19conducted a study to determineexpectation benefits of laughter on pain thresholdlevels. The participants included 100 undergraduatestudents who were informed that humor would either decrease or increase their discomfort. After viewing aSeinfeldepisode, participants completed humor ratings, and their pain discomfort thresholds weremeasured. Participants who were informed that theywould experience decreased discomfort thresholdsshowed lower blood pressure valve readings ( M=128.17 mm Hg) in response to a blood pressure cuff treatment. Participants who were told that their paindiscomfort thresholds would increase had higher paindiscomfort levels ( M=152.4 mm Hg). The higher pressure readings for those who were told that their pain discomfort thresholds would increase indicatethat people’s expectations of being able to tolerate paininfluence their actual ability to tolerate it. Interestingly,it was also found that watching humorous videosraised pain tolerance thresholds regardless of theexpected outcomes, indicating interplay between theactual physiological benefits of laughter and effectsbased on expectations. It is worth noting thathumor-related increases in pain tolerance have beenconfirmed in several controlled experiments.20–23
A Japanese study on the benefits of laughter involving 23 individuals with type 2 diabetes and anunaffected control group found that laughter decreasedthe level of blood prorenin in individuals with diabetesand neuropathy by 196.6–166.7 ng/L and inindividuals with diabetes without neuropathy by93.4–60.4 ng/L.24
Prorenin receptor genes, which arebonding agents that result in elevated levels of protein,increased with laughter by 1.49 fold in participantswith diabetes, whereas there were no significantchanges in participants without diabetes. Theresearchers noted that there is a close relationshipbetween diabetic complications and anxiety anddepression. In addition, the renin-angiotensin system(RAS) and diabetes are closely related, and imbalanceof the RAS may contribute to depression-likebehaviors. The results of this study suggest thatlaughter can prevent exacerbation of diabeticneuropathy, and by extension may also serve to lessensymptoms of anxiety and depression associated withdiabetic complications or depression-like behaviorsassociated with imbalance of the RAS.Elevated mood results from increased serotoninrelease and synthesis caused by motor activity. 25
Happiness levels have also been correlated withserotonin synthesis, suggesting a mutual interactionbetween serotonin synthesis and mood.26
Recent research shows that the physical act of laughter iscomparable to mild aerobic exercise and can,therefore, improve mood in the same way that exercise Humor Theories and the Physiological Benefits of Laughter 351 does.27Szabo28compared mood effects in individualsafter watching a 20-minute comedy video, running ona treadmill for 20 minutes, and watching anonhumorous documentary video. It was found thatthe comedy video produced similar outcomes to theaerobic exercise in terms of positive mood increasesand emotional distress decreases. Gutwirth 29cautioned that “scientific speculationmeets up with folk wisdom in the confidentidentification of laughter with health and well-being.”However, research from the medical fielddemonstrates that there is nothing speculative aboutlaughter’s contribution to health and well-being. Thereis empirical evidence supporting laughter’s ability to (a) increase pain tolerance,19(b) increase energyexpenditure, 30(c) reduce the effects of bronchialasthma, 31
(d) decrease skin-related allergicreactions, 32 and (e) decrease exacerbation of diabetic neuropathology.33
These findings haveparticularly important implications for nursepractitioners.
THEORIES OF HUMOR
Three main theories explain the functions of humor:the relief theory, which focuses on physiologicalrelease of tension; the incongruity theory, whichfocuses on contradictions between expectations andexperiences; and the superiority theory, which focuseson sense of supremacy over others. Each theoryaccounts for the role of humor in specific situations:relief humor for relaxing tensions during socialinteractions, incongruity humor for presenting newperspectives, and superiority humor for criticizingopposition or unifying a group. The purpose thathumor serves in any given situation may be open tointerpretation, but the physiological effects are not.Cognition is needed to understand humor, but it is notneeded for the physiological effects of laughter tooccur. In other words, individuals will experiencesimilar bodily reactions regardless of whether theylaugh due to tension release or through appreciation of incongruities. The following section demonstrateshow the physiological benefits of laughter underlie the3 main theories about the functions of humor.
Relief theory
According to the relief theory, people experiencehumor and engage in laughter because they sense thatstress is reduced in doing so.33,34
Alternately, peoplemay laugh at something humorous, which then resultsin a feeling of mirth and sense of relief. Relief mayinvolve a cognitive release from anxiety or a physicalrelease of tension.
The physiological benefits of laughter most closely align with this theoreticalperspective as many negative health conditions areexacerbated by stress, and laughter has been shown toreduce the symptoms of such conditions. Inindividuals with bronchial asthma, for example,negative emotional states can induce airwayconstriction, while positive emotional states canrelieve airway constriction. Thus humor and laughter,and the resulting emotion, mirth, can unite the bodyand mind.
Kimata 31 conducted 2 experiments to assess theeffects of viewing humorous videos on bronchialresponsiveness to methacholine—an allergy-inducingmedication. The participants in the first experimentconsisted of 20 healthy individuals and 20 individualswith house dust mite allergic bronchial asthma.Methacholine challenge tests were administeredbefore and after participants watched a humorous or nonhumorous film. It was found that bronchialresponsiveness to methacholine was significantly( P<.01) reduced for individuals with house dustmite–sensitive bronchial asthma. In the secondexperiment, bronchial responsiveness to theepigallocatechin gallate (EGCg) allergen was tested in15 healthy individuals and 15 individuals with EGCgbronchial asthma before and after viewing a humorousor nonhumorous film. It was found that bronchialresponsiveness to EGCg was again significantly ( P<.01) reduced because of watching the humorous film.Kimata concluded that pulmonary function inindividuals with bronchial asthma was improved bypositive emotional states—which could be activatedthrough the cognitive functions of humor and thephysical acts of laughter—and was aggravated bynegative emotional states associated with thesymptoms of bronchial asthma.In another study, Kimata32examined the role of laughter in reducing stress responses in 52 individualswith atopic dermatitis and allergies to house dustmites, Japanese cedar pollen, and histamine.Participants were divided into 2 groups in which theywatched either a humorous or a nonhumorous video.To assess the effects of laughter on stress, allparticipants typed cell phone text messages for 2 hoursimmediately following the video viewing. Allergicskin wheal responses, plasma nerve growth factors,and neurotrophin-3 blood levels were then measuredin response to allergen skin prick tests. Compared withindividuals who had watched the nonhumorous video,levels on all measures were lower in individuals whohad viewed the humorous video. These findingsindicate that the relief theory of humor has somemedical basis; humor can indeed aid in the reductionof the physiological effects of stress.Thereareafewotherstudiesthatindicatethathumor can help reduce anxiety states and mood disturbances.For example, Szabo et al35investigated the effectsof humor, exercise, music, and sitting on anxietyand total mood disturbances in 20 healthy women.Each participant was tested for anxiety and totalmood disturbances for 5 minutes before and 5 minutesafter each intervention, which involved watchinga humorous video, cycling at 50% of maximumheart rate, listening to music, or sitting quietly.Effect size changes of anxiety state between pre-and posttreatments demonstrated that compared withexercise, music, and sitting, humor had the greatestimpact on reducing anxiety state and total mooddisturbances. This finding is particularly noteworthy,given the accepted function of aerobic exerciseas an antidepressant and the protective role suchexercise plays against the harmful effects of stress.26
Incongruity theoryThe incongruity theory purports that people laugh atthings that surprise them or at things that violate anaccepted pattern—with a difference close enough tothe norm to be nonthreatening, but different enoughfrom the norm to be remarkable. The incongruitytheory emphasizes cognition; individuals must haverationally come to understand typical patterns of reality before they can notice differences. A humoroussituation must involve the perceiver simultaneouslyhaving in mind one view of the situation that seemsnormal and another view of the situation in whichthere is a violation of the natural order.36
This theoryhas support in neuroimaging research, which showsthat the parts of the brain involved in resolvingincongruities are activated while processing cartoons.37–39
Although the incongruity theory does not focus onthe physiological benefits of laughter evoked throughexperiencing incongruities, it is clear that suchlaughter does have physiological benefits. Buchowskiet al 30used 94 friend dyads to study the effects of heart rate and energy expenditure during genuinelaughter. Participants watched a series of film clipsintended to elicit either laughter or a neutral response.Prior to viewing the clips, baseline energy expenditureand heart rate were measured. Laughter, heart rate,and rate of energy expenditure were analyzed at1-minute intervals throughout the intervention.Findings indicated statistically significant ( P<.001)increases in participants’ energy expenditure and heartrate during laughter as compared with periods of rest.Specifically, during laughter, energy expenditureincreased by up to 20% above resting. This increase inenergy expenditure translated to an annual weight lossof 0.5 to 2 kg.In addition to the promising implications of laughter’s contribution to weight loss, it is also worthnoting that laughter was likely to have been evoked inthis study through participants’ experiences of incongruity. Participants were asked to bring a friendto the testing site so as to make “The social context of the testing environment. . .
conducive to elicitinglaughter.” 30
Participants were not aware thatlaughter was the focus of the study, and once theyentered the test site—an environmentally controlledairtight room—they were told to sit passively and notto talk to their friends. To test participants’ restingenergy expenditure, the video began with a 30-minuteclip of England’s landscape. This clip was followed bya series of humorous and nonhumorous video clips. Itis quite likely that much of the laughter evoked duringthis testing session resulted from the incongruitiesexperienced by participants; they were told to bring afriend to the test site, but when they arrived they wereinstructed not to talk to their friends (but rather to sitpassively next to them). In addition, participants mostlikely experienced surprise at viewing humorousvideos following a video of England’s landscape. Asparticipants were not aware of the purpose of thisstudy, these situations would have activatedincompatible frames of reference—in other words,they typified incongruities.
Superiority theory The superiority theory proposes that laughing at faultybehavior can reinforce unity among group members.40
It is believed that superiority humor serves 2 importantsocietal functions: it maintains social order as laughter,rather than aggression, is invoked toward those whorefuse to comply with rules and through laughingtogether at others, it reinforces group unity.41,42
Whilethe latter may seem like a malicious form of humor, it Humor Theories and the Physiological Benefits of Laughter is one that we encounter surprisingly often. There aremany television shows based on this very form of humor—Candid Camera and the multitude of spin-offs, for example, base their comedy on peoplecaught in foolish and embarrassing situations.Gutwirth 29
provides a classic example of this typeof humor in Chaplin’s filmLimelight
The imperturbable Keaton, who has the sole comicrole in the film, goes on playing as the music sheetsbecome scrambled, as the piano disintegrates. Thecomedy in this pointedly ignored disaster scene lies inhis imperviousness. It makes calamity a joy for theonlooker. . .
We can laugh to our heart’s content. To further explain the source of humor in thisChaplin film, Dixon 43states that it is based on “theexaggerated perspective and reduction of elements totheir iconic or cartoon level.” In other words, theactor’s exaggerated foolishness is a source of humor,and according to the superiority theory, it is funny toviewers precisely because they are not part of thecalamity; all those on the other side of the humorousevent become connected over their shared experienceas fellow onlookers.Research supports these bonding functions of laughter. Smoski and Bachorowski 44conducted astudy of 204 pairs of friends and strangers while theyplayed games and watched movies together. It wasfound that members of the friend pairs exhibited morelaughs than members of the stranger pairs whileengaged in these activities, and the degree at whichantiphonal laughter was produced varied significantly (P<.01) depending on the pairings. The researchers concluded that positive experiences in socialsettings were more related to people’s experiencesof antiphonal laughter than to the funniness of events.Laughter is a method of communication thatpromotes affiliative and cooperative behavior, andantiphonal laughter—laughter that co-occurs or immediately follows that of a social partner— specifically, has the potential to reinforce mutuallypleasurable experiences.45
As well as conveyingemotional information about oneself, laughter elicitssimilar emotions in others and therefore serves abonding function. Provine46 noted from observationsof 1200 episodes of laughter expressed by peopleinteracting in public places that most laughter occurred during routine comments rather than inresponse to joke-telling, which provides further evidence of the bonding functions of laughter.If laughter serves a social bonding function, itshould be no surprise that it also serves to increasepeople’s likeability. Reysen found that viewers ratedindividuals who were laughing in photographs andvideo clips as higher on likeability than individualswho were not laughing, and it did not matter if thelaughter was genuine or fake. In addition, individualswho displayed genuine laughter in the videos andphotographs were rated significantly (P<.001) higher on likeability than were those with neutral expressions.Overall, findings from these studies indicate thatlaughter plays an important role in social interactions,both in terms of unifying members of a group, as thesuperiority theory suggests, as well as in influencingpeople’s perceptions of others as likeable. If thephysiological benefits of this situation are notimmediately obvious, consider the role of socialsupport in maintaining people’s sense of well being.47
Low social support has been associated with highlevels of stress and depression and negative moodhostility is a risk factor for the development of coronary heart disease (CHD) and poor survival of those with coronary artery disease (CAD). 48,49
Peoplewith negative mood hostility are likely to have lowlevels of social support and people who are liked byothers are likely to have high levels of social support. 51
Loneliness has been related to unhappiness and a rangeof mental and physical problem. 50
Conversely, peoplewho are liked tend to be happy–an emotional state thathas been associated with numerous positive outcomes,including immunity and physical well-being. 51
Author Affiliations
: Department of Special Education, St Cloud State Uni-versity, Education Bldg B129, 720 Fourth Ave South, St Cloud, Minnesota.
Corresponding Author:
Julia Wilkins, PhD, Department of Special Edu-cation, St Cloud State University, Education Bldg B129, 720 Fourth AveSouth, St Cloud, MN 56301 (wilkin6@clemson.edu).
