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Laughter helps patients communicate
emotion in therapy sessions
Physiologic measurements suggest
shared laughter may help build empathy
BOSTON - October 14, 2004 - Laughter may be the best medicine,
but the role laughter plays in psychotherapy has been disputed since
the days of Freud. Some early therapists believed that laughter
could have a harmful effect, while more recent thinking has held
that, if used non-judgmentally, laughter can help support the therapeutic
partnership. But none of those theories have been based on objective
data.
In the October issue of The Journal of Nervous and Mental Diseases,
researchers from Massachusetts General Hospital (MGH) report the
first physiologic evidence of the role of laughter during psychotherapy.
The researchers found that patients use laughter to communicate
emotional intensity to psychotherapists, much like an exclamation
point at the end of a sentence. In addition, patients' and therapists'
laughing together magnifies that intensity and may contribute to
feelings of rapport between them.
"Current research on laughter in general shows it is more about
communicating emotion than about humor," says Carl Marci, MD,
the director of Social Neuroscience in the MGH Department of Psychiatry,
the paper's lead author. "Many therapists have been caught
up in the old notion that laughter only signifies humor, even ridicule,
and have questioned whether using laughter in therapy is appropriate.
We wanted to take an objective look at the occurrence of laughter
during therapy and measure its physiologic effect."
As part of a larger on-going study of psychophysiology and empathy,
the researchers videotaped therapeutic sessions and took physiologic
measurements of both members of ten unique patient-therapist pairs.
The patients were being treated for common outpatient mood and anxiety
disorders in previously established patient-therapist relationships.
Participating therapists practiced psychodynamic therapy, an approach
that uses the therapeutic relationship to help patients develop
insight into their emotions.
Throughout the therapy sessions, physiologic responses were measured
for both patient and therapist using skin conductance recordings.
Skin conductance is a commonly used measure of the activity of the
sympathetic nervous system, which controls physiologic arousal and
increases such parameters as blood pressure and heart rate. Earlier
studies have shown that laughter increases arousal and that elevated
skin conductance is associated with increased empathy between therapists
and patients. Following the sessions, the videotapes were reviewed
by independent observers who identified each laugh episode according
to who was speaking prior to the laughter and whether the other
person laughed as well.
In the ten recorded sessions, the observers identified 145 episodes
of laughter, some involving both patient and therapist. On average,
patients laughed more than twice as often as therapists did and
were most likely to be laughing in response to their own comments.
Therapists also were more likely to laugh in response to what patients
had said. The skin conductance measurements showed that laughter
produced physiologic arousal in both patients and therapists, with
arousal strongest when both laughed together.
"We were surprised to find how common laughter was in therapy,"
Marci says. "Taken together with the current understanding
of laughter outside of psychotherapy, our findings suggest that
the patient who is laughing is trying to say more than has been
expressed verbally to the therapist. Laughter is an indication that
the subject is emotionally charged."
The rare occurrence of laughter among therapists and the fact that
they almost always laughed in response to patient comments reflects
the focus of therapy on the patient's emotions, according to Marci.
He also notes that therapists showed a physiologic reaction to patients'
laughter even when not laughing themselves, indicating an empathic
response to their patients. When therapists did laugh, patients'
physiologic responses went even higher, supporting the well-known
contagion of laughter and suggesting that, when therapists laugh
with patients, the patients feel validation of the emotions they
are expressing. "The clinical implications of the findings
support the need for therapists to pay closer attention to when
patients laugh during psychotherapy. Therapists should explore the
meaning of what is said immediately preceding laughter," says
Marci, an instructor in Psychiatry at Harvard Medical School.
The researchers' next step is a longer-term study, examining how
the occurrence of laughter evolves as the therapeutic relationship
develops with the ultimate goal of finding any significant relationship
between laughter and improved mental health for patients. Marci's
co-authors are Erin Moran of MGH and Scott Orr, PhD, of MGH and
the Veteran's Affairs Medical Center in Manchester, N.H. The study
was supported by grants from the National Institutes of Health and
the MGH Endowment for the Advancement of Psychotherapy.
Massachusetts General Hospital, established in 1811, is the original
and largest teaching hospital of Harvard Medical School. The MGH
conducts the largest hospital-based research program in the United
States, with an annual research budget of more than $400 million
and major research centers in AIDS, cardiovascular research, cancer,
cutaneous biology, medical imaging, neurodegenerative disorders,
transplantation biology and photomedicine. In 1994, MGH and Brigham
and Women's Hospital joined to form Partners HealthCare System,
an integrated health care delivery system comprising the two academic
medical centers, specialty and community hospitals, a network of
physician groups, and nonacute and home health services.
Media Contact: Sue
McGreevey, MGH Public Affairs
Physician Referral Service: 1-800-388-4644
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