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Therapeutic use of humour

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Alice Hortop

on 4 April 2016

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Transcript of Therapeutic use of humour

Did you hear the one about the
funny occupational therapist?
Humour Therapy

Alice Hortop
Senior Occupational Therapy Lecturer
UWE

"The laughter makes the depression less heavy to carry"
So why laughter?
It feels good...
What makes something funny?
Is complex...
Humour preference needs to be identified

The timing is crucial and needs to be perceived as 'caring' (Mallet, 2001) Validation will probably be required first!!

People laugh for a multitude of different functions e.g. social skill, coping strategy and amusement

There is a perception that humour can only be spontaneous or is frivolous associating with time is being wasted

You risk causing offense

Is assumed to be laughter yoga
"You've got far
with your
humour stuff"
Can be offensive, particularly from an
external perspective:

Rally driving team of soldiers injured in war preparing for the Dakar Rally were interviewed on top gear, series 17 and episode 6.

They described pranks they would play on each other including:

Swapping a wheelchair for an office chair with castors on it whilst the person slept.
Padlocking wheelchairs to the beds.
Swapping all the Manchester United shirts for Liverpool shirts of a recently visually impaired soldier.
Is also exciting...
Can be beneficial for staff as well as service users, particularly in times of high stress and austerity

There are humour scales and assessment tools

Free, accessible and vastly adaptable.. formats I have used include a 6 week 2 hour workshop, maintenance groups, therapy weekend, one offs, warm ups, hand outs etc

Is applicable to a wide variety of health and social care services and more e.g. sex education and health promotion

Is increasingly popular and there are abundant resources all around e.g. humour4OT
Why?
Remember?

Holding your cheeks?
Rocking forward to ease your stomach muscles?
Mascara running?
Ugly mouth?
Snorting?
Wheezing?

And the final sigh....
There is evidence that suggests:
Laughter reduces pain perception (Weisenberg, Tepper and Schwarzwald, 1995) (Cueva et al, 2006)

Jocularity increases our immunity in 6 different ways (Berk, Tan and Fry, 1998)

Chuckling lowers blood sugar after a meal for people with or without diabetes (Hayashi , Hayashi and Iwanaga , 2003)

Guffawing exercises your abdominals (prepare for a six pack), diaphragm, respiratory (lung), facial, leg and back muscles (Miller and Fry, 2009)

Finding the funny improves the cardiovascular system (Clark, Seidler and Miller, 2001) (Miller and Fry, 2009)

The brain is unable to produce feel good endorphins and stress hormones at the same time, so laughing can reduce the impact of an anxiety provoking stimuli. The brain cannot distinguish between false and genuine laughter. (Hoare, 2004)

Activity is registered in the limbic system when we ‘get’ a joke, this is associated with the reward response and dompamine release. This release will vary on the percieved funniness of the joke to the individual (Mobbs cited in Elkan, 2010)

Heightened brain activity was identified in the frontal and cingulate cortex. This indicates that humour is involved in “association formation, learning and decision making.” (Watson cited in Eklan, 2010 p 41)
References:
Berk. L, Tan. S, and Fry. W, (1998) American Journal of Medical Science. Neuroendrocrine and stress hormone changes during mirthful laughter. 298(6) pp 390-396.

Clark .A, Seidler. A and Miller. M. (2001) International Journal Cardiology. Inverse association between sense of humor and coronary heart disease. 80(1) pp 87-88.

Cueva, M., Kuhnley, R., Manier, A. and Dignan, M (2006) Healing hearts: Laughter and learning. Journal of Cancer Education, 21 (2) pp 104-107

Eklan, D. (2010) New Scientist. The Comedy Circuit. 205 (2745) pp 40-43

Friedler, S (2006) in Bose, A. (2010) Elephants on acid and other bizarre experiments. Pan Macmillan: London.

Henman (2008) Humor as a coping mechanism: Lessons from Prisoners Of war. International Journal of Humor Research. Volume 14, Issue 1, Pages 83–94

Hayashi K, Hayashi T, Iwanaga S (2003) Diabetes Care. Laughter lowered the increase in postprandial blood glucose. 26 (5) pp 1651- 1652.

Kimata (2007) Laughter elevates the levels of breast-milk melatonin. Journal of Psychosomatic Research. 62 pp 699– 702

Miller, M. and Fry, W. (2009) Med Hypotheses. The Effect of Mirthful Laughter on the Human Cardiovascular System 73(5): p 636-643.

Maxwell, W. (2003) The use of gallows humor and dark humor during crisis situations. International Journal of emergency mental health. 5 (2) pp 93-98 .

Weisenberg. M, Tepper. I and Schwarzwald J. (1995) Pain journal. Humor as a cognitive technique for increasing pain tolerance. 63(2) pp 207-212.
Laughter and breast feeding?
A study of 48 infants aged 5-6 months allergic to latex and dust mites. 1/2 mothers were healthy and 1/2 also had allergic reactions. 1/2 group viewed 87 minutes of a humorous DVD and other 1/2 watched a weather info DVD. Breast milk was collected every 2 hours sequentially. All the mothers who watched the comedy DVD had an increase in breast milk 'melatonin' levels and the allergic response in those children was reduced.
(Kimata, 2007)
The effect of medical clowning on in-vitro fertilisation and embryo transfer treatment abstract of 22nd Annual Meeting of the European Society of Human Reproduction and Embryology. Poster 563. i216
(Friedler cited in Boese, 2010)
Bringing in the clowns during coitus?
93 women undergoing invitro-fertilisation were invited to enjoy a "personal encounter with a professional medical clown" who performed magic tricks and told jokes.
33 successfully conceived at a rate of 35.5% compared to 18 of the 93 comparison group at a rate of 19%
The use of gallows humor and dark humor during crisis and challenging situations.
(Maxwell, 2003) (Henman, 2008)
Freud in 1928 described his view of humour as one of the healthiest defense mechanisms that allows you to maintain a detached perspective in the face of adversity and misfortune.

Humour is an effective coping strategy that is closely linked with resilience, described as enabling people to 'fight back and take control'. Humour has been shown to be a strong communication, rapport building and social support tool. Interviews with over 50 of the Vietnam prisoners of war indicated they considered humor to be one of the constructs of their resilience.
A sense of humor is
important for rebounding from many different types of adversity.
Subjective viewpoint and intention are key
Each week: Ground rules, smile warm up, quick re-cap, homework feedback, break with graded food games and homework.

Week 1: Introduction, discreet humour evaluation, ice breakers

Week 2: More detail on the science, life balance & laughter coping strategies (adapted CBT, triggers, positively playing etc)

Week 3: Honing their comedy skills and trying out different humour styles including stand up techniques & previous week's coping strategies

Week 4:Exploring their occupational history, social and physical environments

Week 5: Where and with who do you laugh? (From week 4 to now.. What next?) Week 6 prep.

Week 6: Celebration, rag mag, certificate etc

Maintenance workshops.. Linked to SWOCN qualification.
All graduates had a drop in H.A.D. scores by at least 1-5 on the anxiety scores and all had a drop of 3 of the depression scores bar 1. Qualitative data included increases in confidence, motivation, insight, increased social interactions, increased occupational engagement and coping strategies.
Example of 6 week workshop:
Individual work:
The extent of the reward response is partially dependent on their neurological structures and also potentially due to the individual’s life experiences. Indicating that the humour needs to be tailored to the intended audience. (Eklan, 2010)

Example: humour diary.
Group work:
Humour is a social phenomenon usually associated with shared, subjective experiences that are often spontaneous. (Vergeer and MacRae, 1993)

People laugh more than 30 times more when they were in a social setting rather than alone or without a social surrogate i.e. TV. (Provine, 1996)

15% of humour response was related to the joke. (Provine, 1996)

The humorousness of the stimuli had less bearing than the social setting. (Provine, 1996)

The social situation stimulates more laughter and therefore group work would be encouraged to generate laughter
(Mehu and Dunbar, 2008)
Congruence resolution:

‘resolvable humour’ also known as incongruity-resolution humour, where there is a clarity of full comprehension of the incongruity, for example ‘Friends’ where the viewer is generally in no doubt of the reason for their amusement
Nonsense:
‘nonsense humour’ where there may be a partial understanding of the incongruity between two concepts, for example ‘Monty Python’s Flying Circus’ where the viewer is amused, but not always fully sure why.
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