F E AT U R E S

Humor Theories and the Physiological

Benefits of Laughter
Julia Wilkins, PhD Amy Janel Eisenbraun, MS

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 situations
such as dealing with misfortune, making sense of rule violations, and bonding with others, we propose that
underlying each of these theories are the physiological benefits of laughter. We draw on findings from empirical
studies on laughter to demonstrate that these physiological benefits occur regardless of the theory that is used to
explain the humor function. Findings from these studies have important implications for nurse practitioners working
in hospice settings, long-term care facilities, nursing homes, and hospitals. KEY WORDS: humor, laughter,
physiological benefits Holist Nurs Pract 2009;23(6):349354

Humor and laughter have long been recognized as
central to the human condition; in fact, their benefits
were noted in some of the worlds earliest printed
texts. A hymn from the Rig Veda, the earliest of the
4 Hindu religious scriptures, the Vedas (c. 1200900
BC), refers to fun making for the creation of laughter
(IX.112.4). Gruner1 points out that humans laughed
before they told jokes, for there was a time when
humans did not have language, but were capable of
laughter. The universal expression of laughter is upheld
by many theorists as evidence of laughters biological
roots. Studies of joking relationships in different
cultures (eg, Radcliffe-Brown2 ) indicate that these
relationships serve to maintain social harmony and
stability. The fact that one cannot tickle oneself and
evoke genuine laughter further suggests that laughter
is controlled by social cues and interactions.35
From an evolutionary perspective, laughter, like all
traits that are passed on through natural selection,
must have survival value. Laughter serves many
functions essential to human survivala bonding
function, a peacemaking function, and a
health-boosting function. McDougall6 proposed that
laughter evolved as a protective shield, not as a coping
mechanism for peoples own misfortune, but because
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 Ave
South, St Cloud, MN 56301 (wilkin6@clemson.edu).
humans needed to have empathy for others in order for
the human race to survive. In addition to developing
this theory of the evolutionary functions of laughter,
McDougall7 was also one of the first psychologists to
bring attention to the physiological benefits of
laughter. The physiological benefits that have
implications for nursing practice will be explored
within the framework of humor theories after
reviewing laughters use as a coping mechanism.
LAUGHTER AS A COPING MECHANISM
Some theorists suggest that laughter and humor are
instinctive coping mechanisms that help people deal
with the disappointments and struggles of life.8,9
Specifically, it is believed that by finding humor in
stressful or potentially threatening situations, people
can replace negative with positive affect, thereby
giving them an increased ability to cope with negative
states of affairs.1012 Humor based on incongruities, or
things that appear inappropriate for their context, is
particularly well suited to reappraising negative
situations from different, less threatening
perspectives.13 By being in touch with their patients
emotions and sense of psychological well-being, nurse
practitioners can decide when it might be useful to
encourage their patients to engage in positive
reframing. As Dossey and Keegan14 explain, nurses
can help relieve their patients stress by helping them
to find humorous perspectives in their problems. That
being said, it is also important to be sensitive to

349
350 HOLISTIC NURSING PRACTICE NOVEMBER/DECEMBER 2009
patients reactions to humor. Just as 2 clients with the
same symptoms may not always get the same
medication, different patients may require different
doses and different types of humor.
Throughout history, oppressed people have used
humor as a survival tool. Referring to its use in Native
American communities, Luna et al commented,
In Indian humor, you can make fun of anything and
even at the worst times . . . I think what I came to
realize is that its a way of easing the pain, that
laughter is a good cure and that maybe if we didnt
laugh so much, we would be depressed.15
Likewise, in Mans Search for Meaning, Frankl16
documented his and his fellow prisoners use of joking
and humor while imprisoned in Nazi concentration
camps. In the words of Vereen et al, People
consistently see [humors] value in shaping their
perspective in times of difficulty and in helping them
to adjust to stressful situations.17(p10) Such
perspective shaping might be particularly useful for
patients suffering with debilitating diseases or for
family members dealing with uncertainty about the
future outcomes of loved ones. So as not to be viewed
as unprofessional when using humor to lighten the
seriousness of patients conditions, nurses should
provide a brief explanation of the role of humor in
helping to reframe situations along with information
on the health benefits of humor.14
Anecdotal accounts of the stress-reducing effects of
humor are supported by research on humors
effectiveness in reframing stressors. Cann and Etzel,18
for example, used a sample of 176 university students
to examine the relationship between individuals sense
of humor and their perceived personal stress. The
participants completed 3 measures of sense of humor,
in addition to 3 positive personality measures related
to happiness, hope, and optimism. It was found that
having 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 turning
negatives into positives, being optimistic, and having
hope in life, are all effective coping strategies.
Research shows that believing in the benefits of
laughter alone is sufficient for the body to experience
physiological benefits, such as decreased pain.
Mahony et al19 conducted a study to determine
expectation benefits of laughter on pain threshold
levels. The participants included 100 undergraduate
students who were informed that humor would either
decrease or increase their discomfort. After viewing a
Seinfeld episode, participants completed humor
ratings, and their pain discomfort thresholds were
measured. Participants who were informed that they
would experience decreased discomfort thresholds
showed lower blood pressure valve readings (M =
128.17 mm Hg) in response to a blood pressure cuff
treatment. Participants who were told that their pain
discomfort thresholds would increase had higher pain
discomfort levels (M = 152.4 mm Hg). The higher
pressure readings for those who were told that their
pain discomfort thresholds would increase indicate
that peoples expectations of being able to tolerate pain
influence their actual ability to tolerate it. Interestingly,
it was also found that watching humorous videos
raised pain tolerance thresholds regardless of the
expected outcomes, indicating interplay between the
actual physiological benefits of laughter and effects
based on expectations. It is worth noting that
humor-related increases in pain tolerance have been
confirmed in several controlled experiments.2023
A Japanese study on the benefits of laughter
involving 23 individuals with type 2 diabetes and an
unaffected control group found that laughter decreased
the level of blood prorenin in individuals with diabetes
and neuropathy by 196.6166.7 ng/L and in
individuals with diabetes without neuropathy by
93.460.4 ng/L.24 Prorenin receptor genes, which are
bonding agents that result in elevated levels of protein,
increased with laughter by 1.49 fold in participants
with diabetes, whereas there were no significant
changes in participants without diabetes. The
researchers noted that there is a close relationship
between diabetic complications and anxiety and
depression. In addition, the renin-angiotensin system
(RAS) and diabetes are closely related, and imbalance
of the RAS may contribute to depression-like
behaviors. The results of this study suggest that
laughter can prevent exacerbation of diabetic
neuropathy, and by extension may also serve to lessen
symptoms of anxiety and depression associated with
diabetic complications or depression-like behaviors
associated with imbalance of the RAS.
Elevated mood results from increased serotonin
release and synthesis caused by motor activity.25
Happiness levels have also been correlated with
serotonin synthesis, suggesting a mutual interaction
between serotonin synthesis and mood.26 Recent
research shows that the physical act of laughter is
comparable to mild aerobic exercise and can,
therefore, improve mood in the same way that exercise

does.27 Szabo28 compared mood effects in individuals
after watching a 20-minute comedy video, running on
a treadmill for 20 minutes, and watching a
nonhumorous documentary video. It was found that
the comedy video produced similar outcomes to the
aerobic exercise in terms of positive mood increases
and emotional distress decreases.
Gutwirth29 cautioned that scientific speculation
meets up with folk wisdom in the confident
identification of laughter with health and well-being.
However, research from the medical field
demonstrates that there is nothing speculative about
laughters contribution to health and well-being. There
is empirical evidence supporting laughters ability to
(a) increase pain tolerance,19 (b) increase energy
expenditure,30 (c) reduce the effects of bronchial
asthma,31 (d) decrease skin-related allergic
reactions,32 and (e) decrease exacerbation of
diabetic neuropathology.33 These findings have
particularly important implications for nurse
practitioners.
THEORIES OF HUMOR
Three main theories explain the functions of humor:
the relief theory, which focuses on physiological
release of tension; the incongruity theory, which
focuses on contradictions between expectations and
experiences; and the superiority theory, which focuses
on sense of supremacy over others. Each theory
accounts for the role of humor in specific situations:
relief humor for relaxing tensions during social
interactions, incongruity humor for presenting new
perspectives, and superiority humor for criticizing
opposition or unifying a group. The purpose that
humor serves in any given situation may be open to
interpretation, but the physiological effects are not.
Cognition is needed to understand humor, but it is not
needed for the physiological effects of laughter to
occur. In other words, individuals will experience
similar bodily reactions regardless of whether they
laugh due to tension release or through appreciation of
incongruities. The following section demonstrates
how the physiological benefits of laughter underlie the
3 main theories about the functions of humor.
Relief theory
According to the relief theory, people experience
humor and engage in laughter because they sense that
Humor Theories and the Physiological Benefits of Laughter 351
stress is reduced in doing so.33,34 Alternately, people
may laugh at something humorous, which then results
in a feeling of mirth and sense of relief. Relief may
involve a cognitive release from anxiety or a physical
release of tension.14 The physiological benefits of
laughter most closely align with this theoretical
perspective as many negative health conditions are
exacerbated by stress, and laughter has been shown to
reduce the symptoms of such conditions. In
individuals with bronchial asthma, for example,
negative emotional states can induce airway
constriction, while positive emotional states can
relieve airway constriction. Thus humor and laughter,
and the resulting emotion, mirth, can unite the body
and mind.14
Kimata31 conducted 2 experiments to assess the
effects of viewing humorous videos on bronchial
responsiveness to methacholinean allergy-inducing
medication. The participants in the first experiment
consisted of 20 healthy individuals and 20 individuals
with house dust mite allergic bronchial asthma.
Methacholine challenge tests were administered
before and after participants watched a humorous or
nonhumorous film. It was found that bronchial
responsiveness to methacholine was significantly
(P < .01) reduced for individuals with house dust
mitesensitive bronchial asthma. In the second
experiment, bronchial responsiveness to the
epigallocatechin gallate (EGCg) allergen was tested in
15 healthy individuals and 15 individuals with EGCg
bronchial asthma before and after viewing a humorous
or nonhumorous film. It was found that bronchial
responsiveness to EGCg was again significantly (P <
.01) reduced because of watching the humorous film.
Kimata concluded that pulmonary function in
individuals with bronchial asthma was improved by
positive emotional stateswhich could be activated
through the cognitive functions of humor and the
physical acts of laughterand was aggravated by
negative emotional states associated with the
symptoms of bronchial asthma.
In another study, Kimata32 examined the role of
laughter in reducing stress responses in 52 individuals
with atopic dermatitis and allergies to house dust
mites, Japanese cedar pollen, and histamine.
Participants were divided into 2 groups in which they
watched either a humorous or a nonhumorous video.
To assess the effects of laughter on stress, all
participants typed cell phone text messages for 2 hours
immediately following the video viewing. Allergic
skin wheal responses, plasma nerve growth factors,
352 HOLISTIC NURSING PRACTICE NOVEMBER/DECEMBER 2009
and neurotrophin-3 blood levels were then measured
in response to allergen skin prick tests. Compared with
individuals who had watched the nonhumorous video,
levels on all measures were lower in individuals who
had viewed the humorous video. These findings
indicate that the relief theory of humor has some
medical basis; humor can indeed aid in the reduction
of the physiological effects of stress.
There are a few other studies that indicate that humor
can help reduce anxiety states and mood disturbances.
For example, Szabo et al35 investigated the effects
of humor, exercise, music, and sitting on anxiety
and total mood disturbances in 20 healthy women.
Each participant was tested for anxiety and total
mood disturbances for 5 minutes before and 5 minutes
after each intervention, which involved watching
a humorous video, cycling at 50% of maximum
heart rate, listening to music, or sitting quietly.
Effect size changes of anxiety state between pre-
and posttreatments demonstrated that compared with
exercise, music, and sitting, humor had the greatest
impact on reducing anxiety state and total mood
disturbances. This finding is particularly noteworthy,
given the accepted function of aerobic exercise
as an antidepressant and the protective role such
exercise plays against the harmful effects of stress.26
Incongruity theory
The incongruity theory purports that people laugh at
things that surprise them or at things that violate an
accepted patternwith a difference close enough to
the norm to be nonthreatening, but different enough
from the norm to be remarkable. The incongruity
theory emphasizes cognition; individuals must have
rationally come to understand typical patterns of
reality before they can notice differences. A humorous
situation must involve the perceiver simultaneously
having in mind one view of the situation that seems
normal and another view of the situation in which
there is a violation of the natural order.36 This theory
has support in neuroimaging research, which shows
that the parts of the brain involved in resolving
incongruities are activated while processing
cartoons.3739
Although the incongruity theory does not focus on
the physiological benefits of laughter evoked through
experiencing incongruities, it is clear that such
laughter does have physiological benefits. Buchowski
et al30 used 94 friend dyads to study the effects of
heart rate and energy expenditure during genuine
laughter. Participants watched a series of film clips
intended to elicit either laughter or a neutral response.
Prior to viewing the clips, baseline energy expenditure
and heart rate were measured. Laughter, heart rate,
and rate of energy expenditure were analyzed at
1-minute intervals throughout the intervention.
Findings indicated statistically significant (P < .001)
increases in participants energy expenditure and heart
rate during laughter as compared with periods of rest.
Specifically, during laughter, energy expenditure
increased by up to 20% above resting. This increase in
energy expenditure translated to an annual weight loss
of 0.5 to 2 kg.
In addition to the promising implications of
laughters contribution to weight loss, it is also worth
noting that laughter was likely to have been evoked in
this study through participants experiences of
incongruity. Participants were asked to bring a friend
to the testing site so as to make The social context of
the testing environment . . . conducive to eliciting
laughter.30(p132) Participants were not aware that
laughter was the focus of the study, and once they
entered the test sitean environmentally controlled
airtight roomthey were told to sit passively and not
to talk to their friends. To test participants resting
energy expenditure, the video began with a 30-minute
clip of Englands landscape. This clip was followed by
a series of humorous and nonhumorous video clips. It
is quite likely that much of the laughter evoked during
this testing session resulted from the incongruities
experienced by participants; they were told to bring a
friend to the test site, but when they arrived they were
instructed not to talk to their friends (but rather to sit
passively next to them). In addition, participants most
likely experienced surprise at viewing humorous
videos following a video of Englands landscape. As
participants were not aware of the purpose of this
study, these situations would have activated
incompatible frames of referencein other words,
they typified incongruities.
Superiority theory
The superiority theory proposes that laughing at faulty
behavior can reinforce unity among group members.40
It is believed that superiority humor serves 2 important
societal functions: it maintains social order as laughter,
rather than aggression, is invoked toward those who
refuse to comply with rules and through laughing
together at others, it reinforces group unity.41,42 While
the latter may seem like a malicious form of humor, it

is one that we encounter surprisingly often. There are
many television shows based on this very form of
humorCandid Camera and the multitude of
spin-offs, for example, base their comedy on people
caught in foolish and embarrassing situations.
Gutwirth29 provides a classic example of this type
of humor in Chaplins film Limelight,
The imperturbable Keaton, who has the sole comic
role in the film, goes on playing as the music sheets
become scrambled, as the piano disintegrates. The
comedy in this pointedly ignored disaster scene lies in
his imperviousness. It makes calamity a joy for the
onlooker . . . We can laugh to our hearts
content.29(p107)
To further explain the source of humor in this
Chaplin film, Dixon43 states that it is based on the
exaggerated perspective and reduction of elements to
their iconic or cartoon level. In other words, the
actors exaggerated foolishness is a source of humor,
and according to the superiority theory, it is funny to
viewers precisely because they are not part of the
calamity; all those on the other side of the humorous
event become connected over their shared experience
as fellow onlookers.
Research supports these bonding functions of
laughter. Smoski and Bachorowski44 conducted a
study of 204 pairs of friends and strangers while they
played games and watched movies together. It was
found that members of the friend pairs exhibited more
laughs than members of the stranger pairs while
engaged in these activities, and the degree at which
antiphonal laughter was produced varied significantly
(P < .01) depending on the pairings. The researchers
concluded that positive experiences in social
settings were more related to peoples experiences
of antiphonal laughter than to the funniness of
events.
Laughter is a method of communication that
promotes affiliative and cooperative behavior, and
antiphonal laughterlaughter that co-occurs or
immediately follows that of a social partner
specifically, has the potential to reinforce mutually
pleasurable experiences.45 As well as conveying
emotional information about oneself, laughter elicits
similar emotions in others and therefore serves a
bonding function.13 Provine46 noted from observations
of 1200 episodes of laughter expressed by people
interacting in public places that most laughter
occurred during routine comments rather than in
response to joke-telling, which provides further
evidence of the bonding functions of laughter.
Humor Theories and the Physiological Benefits of Laughter 353
If laughter serves a social bonding function, it
should be no surprise that it also serves to increase
peoples likeability. Reysen5 found that viewers rated
individuals who were laughing in photographs and
video clips as higher on likeability than individuals
who were not laughing, and it did not matter if the
laughter was genuine or fake. In addition, individuals
who displayed genuine laughter in the videos and
photographs were rated significantly (P < .001) higher
on likeability than were those with neutral expressions.
Overall, findings from these studies indicate that
laughter plays an important role in social interactions,
both in terms of unifying members of a group, as the
superiority theory suggests, as well as in influencing
peoples perceptions of others as likeable. If the
physiological benefits of this situation are not
immediately obvious, consider the role of social
support in maintaining peoples sense of well being.47
Low social support has been associated with high
levels of stress and depression and negative mood
hostility is a risk factor for the development of
coronary heart disease (CHD) and poor survival of
those with coronary artery disease (CAD).48,49 People
with negative mood hostility are likely to have low
levels of social support and people who are liked by
others are likely to have high levels of social support.51
Loneliness has been related to unhappiness and a range
of mental and physical problem.50 Conversely, people
who are liked tend to be happyan emotional state that
has been associated with numerous positive outcomes,
including immunity and physical well-being.51
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