Laughter as Therapy

As part of the Psychology Essay Contest, hosted by RVU’s Mental Health and Wellness Counselors, students were given several questions to answer in an essay format. The following essay, written by third-year osteopathic medical student Pariss D’Spain, received the distinction of honorable mention for discussing current practices for overcoming addiction and the benefits of laughter as therapy.

I started listening to comedy shortly after starting my first year of medical school. It became an essential outlet for me, something that could take me out of a negative spell brought on by the hours of studying and taking exams. Whenever I felt pessimistic thoughts begin to consume my mind, I’d turn to Maria Bamford or Tig Nataro for a laugh; their sets gave me a jolt of positivity and enough energy to keep going. Listening to comedy would bring me a momentary relief that made my days feel more balanced and gave me a sense of spiritual well-being. I started sharing humor with friends and family and found that they too seemed to get a mental boost from it.

During my peer support hours in the counselor’s office, I even used comedy to help my classmates through rough days of school. I found that genuine laughter served to reset the mind and allow the person to change their perspective and outlook on their stressful situation. Of course, using comedy as a kind of therapy is more or less situational. Still, I’ve become more aware of the value that laughter can have on a person’s well-being when presented appropriately.

In light of National Recovery Month in September, I decided to look into the prevailing research and real-life stories that show laughter’s influence on therapeutic outcomes among those suffering from addiction. Currently, relapse rates range between 50% and 81% across outpatient and inpatient programs that use common psychotherapeutic and pharmacologic treatments (Baldus et al., 2018). Why is there such a high relapse rate?

One prominent reason is that fighting addiction is intense, especially after the body becomes physically dependent on the substance. For many drugs, physical dependence is so strong that those who are mentally ready to quit face a debilitating pain that can quickly become a medical emergency. Brian Pennie, a recovering addict, describes his experience of withdrawal: “it seemed like time would be my only savior, but for the first time in my life, I was unsure if I would make it. I didn’t specifically think of suicide, but there was no end in sight, and I couldn’t see a way out. Now I knew why they locked the knives up at night. I’m not even mildly religious, but that’s when I decided to pray; it was all I had left” (Pennie, 2018). Not only is the mental dependence a hard one to overcome, but the physical hardship is what hinders many from quitting. This reality brought me to my next question: Once the cycle of addiction is broken, how can sobriety be maintained?

Current therapeutic programs implement medication and psychotherapy to help clients break habits and learn skills to abstain from using again. However, I believe that some key elements are missed in current practices of care. A while ago, I stumbled upon a podcast named Dopey. It was hosted by two recovering addicts who met while attending a “12 Steps” meeting. In their podcast, the two use an ironic sense of humor when discussing their addiction stories. For example, one of the stories Chris shared is one from when he escaped rehab. He says that he got high for three days while on the run and stole a whole-cooked turkey just before the cops caught up to him on his fourth day. The cops drove him back to the rehab facility, but instead of walking him in, they dropped Chris off across the street, in front of the building. Chris laughs and says he just stood there, in front of the rehab facility, eating this whole-turkey for a while. After contemplating whether or not to go inside, he dropped the turkey and walked away.

A few days later, Chris admits he ran out of money and, out of desperation, called his family and asked them to get in touch with his caseworker to drive him back to rehab. Chris’s caseworker, Steve, picked him up and on their way back to the facility, turned to him and said, “Chris, you look so bad, if you were out there any longer, you’d be eating shit like that,” while pointing at the same turkey Chris was eating the other day and that was now decaying on the side of the road. Chris laughed and replied, “that’s mine from the other day!” (Chris & Dave, 2016).

As a podcast listener, I got a real sense of Chris and Dave’s struggles on their road to recovery. More so, I listened as a bystander to conversations that became invaluable to the many listeners that called into their show expressing their gratitude to them for starting a platform on which they too could speak honestly about their drug addiction with a relatable and non-judgmental community. Chris and Dave point out that conversations like theirs have been happening for decades, such as in group circles in rehab, in the street between two active addicts, or by chance encounters between two like-minded people. The important thing to them was that these conversations made them feel better and get better too. Chris explains, “the therapeutic value of one addict helping another is unparalleled, and for many of us the means to that therapy is comedy and identification” (Chris & Dave, 2018).

An essential part of addiction therapy is getting clients to confront and accept the truth of their addiction. This part of the process is crucial and can often be the reason why clients resist therapy. For example, if the moment of confrontation comes with too much force, it can invoke feelings of shame, guilt, or denial. If the approach is taken too lightly, then the client’s addiction may remain unchallenged throughout the therapeutic process. One study explored the role laughter plays in addiction group therapy. They found that laughter had demonstrated a beneficial means of therapeutic interaction between therapist and client and was a critical element that allowed those who suffered from addiction to share their stories. Moreover, they showed that laughter plays a recurring role in sensitive confrontation practices in addiction therapy and encourages a shared sentiment in group settings (Arminen & Halonen, 2007).

In another study, researchers measured self-esteem, anxiety, and happiness in patients with addictive disorders who had participated in an integrative laughter therapy program. They found that including humor-based intervention amidst standard care made a significant positive impact on the participant’s self-esteem and decreased their anxiety levels compared to those who received usual care alone (de Francisco et al., 2019). This new insight brings truth to the saying that laughter is the best medicine. However, because the disease of addiction is so complex, it’s very hard-pressed to say that adding laughter sessions into a therapeutic program’s curriculum would be an ultimate cure.

Despite the podcast’s successes, co-host Chris died of an overdose in 2018, sending an important yet frightening message; relapse can still happen even with all the progress one can make on their path to sobriety. Despite the tragedy of losing his friend and co-host, Dave continues to host Dopey and says that he loves making new episodes of the podcast, and he loves his life in recovery (Dave & Chris, 2018). Dave and Chris are real examples of the truth that one is never truly cured of addiction; instead, every day becomes a meaningful step towards recovery. The takeaway here is that even though laughter can’t resolve one’s addiction, it can help open clients up to their therapist and help others build relationships that forge a stronger support system. I still use comedy for myself and the patients I see during my third year of medical school. And after learning of the research and real-life effects laughter has on recovering addicts, I plan to continue to use humor as a therapeutic tool when I’m a practicing physician.

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Sources:

1. Arminen I, Halonen M. Laughing with and at Patients: The Roles of Laughter in Confrontations in Addiction Group Therapy. Qual. Rep. 2007;12(3):484-513. Available at:
http://www.nova.edu/ssss/QR/QR12-3/arminen.pdf.

2. Baldus C, Mokros L, Daubmann A, et al. Treatment effectiveness of a mindfulness-based inpatient group psychotherapy in adolescent substance use disorder – Study protocol for a randomized controlled trial. Trials 2018;19(1):1-12. doi:10.1186/s13063-018-3048-y.

3. Unknown, C. and Unknown, D., 2016. First IV Heroin. [Dopey]. Available at <https://www.dopeypodcast.com/2017/03/episode-one-turkey-story-video/> [Accessed 13 October 2020].

4. Unknown, C. and Unknown, D., 2018. About Us. [Dopey]. Available at:<https://www.dopeypodcast.com/about-us/> [Accessed 13 October 2020].

5. de Francisco S, Torres C, de Andrés S, et al. Effectiveness of integrative laughter therapyto reduce anxiety, improve self-esteem and increase happiness: A naturalistic study at a day hospital for addictive disorders. Int. J. Environ. Res. Public Health 2019;16 (21):1-10.doi:10.3390/ijerph16214194.

6. Pennie B. 15 Years Of Addiction: An Intense Account Of Heroin Withdrawal Mission Orig. 2018:1. doi: November 5, 2018.