Humor and Laughter for Health with Sherry Hilber (cont.)

Dr. Stuber: There are a number of different approaches that could be done. I think that the most immediate things that we could look at would be looking at the immediate changes in the body, both chemically and immunologically in response to humor. I think that what will be most interesting will be to see if we actually can have more sustained changes in the body as a result of these kinds of interventions. David Spiegel, who is a psychiatrist and professor at Stanford and is on advisory board for Rx Laughter, has done some studies looking at lasting impact on health in adults with very advanced illness with a relatively short series of interventions, in that case not so much geared toward humor as feeling more in control, but those are some of the kinds of things we'd want to look at.

Dr. Zeltzer: It's interesting that many years ago, in the early 1980s, when I was studying the impact of children using their imagination to control severe medical procedure pain, many children would spontaneously imagine themselves watching a favorite TV program, and almost invariably these imaginary programs were funny. Many of these children would be smiling or even giggling during the procedure, and when asked they would describe the funny things they were seeing on their imaginary program. Children who did this had significantly less pain and discomfort during the medical procedures.

Hilber: I think also another important aspect is that -- my hope is that not only will they enjoy the funny video and hopefully this will help in healing, but that the next time they have to come back to the doctor, it'll be a less frightening memory and they'll be more apt to be okay with coming back.

Dr. Stuber: One of the things we know is that the first association that you have with an event is going to color the way you think about that experience or that place or those people. Absolutely, if we can make the hospital and doctors and even the treatments less frightening and painful from the very start, we reduce the anxiety for the children always after that.

Hilber: Working with children and adolescents with this is very rewarding of a more positive memory of going to a doctor, because we're looking at a whole lifetime of preventive check-ups and things of that nature. I know if I had had more positive memories as a young child, I would probably be much less fearful as an adult and therefore would be more apt to want to get those regular check-ups. I can only speak from a creative standpoint and children love physical humor. I think adults love physical humor, too, and that's why the Marx Brothers and Abbot and Costello and others have been for all ages. They withstood the test of time and also children and adults have enjoyed them. And in terms of the types of tapes that will be used for the children in Rx Laughter, I would say much of it is for physical humor.

Dr. Stuber: I think it's an excellent question and I'm not sure we know. What I'd like to address as a piece of that is that there are lots of physiologic differences between children and adolescents and adults that can change a lot as children mature and develop because of the maturation of their brain and of changing hormonal levels. You can't even talk about the way children respond. There's also another element of complexity here, and that's that individuals respond in different ways to humor and laughter. We were struck with that in some of our preliminary parts of this research, observing some children watching the tape. We had two girls, same age, sitting next to each other and one of them was laughing 2 to 3 times as much as the other. They were both rating the program the same as to humorousness. Does it make a difference if you're somebody who laughs easily? I think we're going to have find some of those things out.

Hilber: I agree, and I think the most interesting thing, creatively, is here is a segment that isn't laugh-out-loud continuous funny but is humorous, and should that be included in the project? Yes, they are, and will be just to see what Dr. Stuber is talking about.

Dr. Zeltzer: I also think that we don't know, as Dr. Stuber said, whether just finding something funny has the same effect as the physical act of laughing out loud. Does that do something different to the body in relation to pain, health and illness? What are the individual differences in ease of laughing out loud? If it's found that the actual act of laughing aloud is an important component in impacting the immune or cardiovascular systems, can those children less prone to laughing aloud be trained to laugh more readily? As Dr. Stuber was saying, throughout childhood, the central nervous system and the brain are developing and changing. Early on, there is much more plasticity -- the ability to change -- than there is in adulthood. We know that young children experience significant pain or events that can alter their system and make them more sensitive to pain. When looking at the role of laughter in reducing pain, we're looking at the potential of altering the nervous system in a more fortified way, maybe to guard against the development of chronic pain. The excitement of studying children, both early on and in adolescence, is that it really will inform us to a great degree about what might be done in a preventive way in dealing with adult chronic pain and adult chronic illnesses in general.

Dr. Stuber: I absolutely agree. Coming from a different angle, I would say very similar things about the prevention of some of the kinds of brain and central nervous system changes that we see in post traumatic disorder. We know that some of those changes are dependent on the way that somebody responds emotionally at the time of the event, that a traumatic event is only traumatic if you experience it that way. In most things, there is some room for interpretation and to the extent that we can make something like a medical procedure less frightening, we can actually make a difference in the way that that memory gets laid down in the brain and make a difference in the way that they approach medical procedures, but also in just their whole level of anxiety or arousal, how much they respond to things they see as threat. We could make a difference in somebody's developing brain. Dr. Zeltzer and I originally met 15 years ago around our mutual interest in hypnosis and other kinds of interventions that could be used for children going through painful procedures. There are a number of interventions that have been tested, and there is evidence that you can get somebody to think about something else during the procedure.