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Therapeutic Benefits of Laughter in Mental Health: A Theoretical Review

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Abstract

In modern society, fierce competition and socioeconomic interaction stress the quality of life, causing a negative influence on a person’s mental health. Laughter is a positive sensation, and seems to be a useful and healthy way to overcome stress. Laughter therapy is a kind of cognitive-behavioral therapies that could make physical, psychological, and social relationships healthy, ultimately improving the quality of life. Laughter therapy, as a non-pharmacological, alternative treatment, has a positive effect on the mental health and the immune system. In addition, laughter therapy does not require specialized preparations, such as suitable facilities and equipment, and it is easily accessible and acceptable. For these reasons, the medical community has taken notice and attempted to include laughter therapy to more traditional therapies. Decreasing stress-making hormones found in the blood, laughter can mitigate the effects of stress. Laughter decreases serum levels of cortisol, epinephrine, growth hormone, and 3,4-dihydrophenylacetic acid (a major dopamine catabolite), indicating a reversal of the stress response. Depression is a disease, where neurotransmitters in the brain, such as norepinephrine, dopamine, and serotonin, are reduced, and there is something wrong in the mood control circuit of the brain. Laughter can alter dopamine and serotonin activity. Furthermore, endorphins secreted by laughter can help when people are uncomfortable or in a depressed mood. Laughter therapy is a noninvasive and non-pharmacological alternative treatment for stress and depression, representative cases that have a negative influence on mental health. In conclusion, laughter therapy is effective and scientifically supported as a single or adjuvant therapy.
Potential Therapeutic Benets of Laughter in Mental Health 243Tohoku J. Exp. Med., 2016, 239, 243-249
243
Received April 7, 2016; revised and accepted June 27, 2016. Published online July 16, 2016; doi: 10.1620/tjem.239.243.
Correspondence: JongEun Yim, DSc., Department of Physical Therapy, Sahmyook University, Hwarangro 815, Nowon-gu, Seoul 139-
742, Republic of Korea.
e-mail: jeyim@syu.ac.kr
Review
Therapeutic Benets of Laughter in Mental Health: A Theoretical
Review
JongEun Yim1
1Department of Physical Therapy, Sahmyook University, Seoul, Republic of Korea
In modern society, fierce competition and socioeconomic interaction stress the quality of life, causing a
negative inuence on a person’s mental health. Laughter is a positive sensation, and seems to be a useful
and healthy way to overcome stress. Laughter therapy is a kind of cognitive-behavioral therapies that
could make physical, psychological, and social relationships healthy, ultimately improving the quality of life.
Laughter therapy, as a non-pharmacological, alternative treatment, has a positive effect on the mental
health and the immune system. In addition, laughter therapy does not require specialized preparations,
such as suitable facilities and equipment, and it is easily accessible and acceptable. For these reasons,
the medical community has taken notice and attempted to include laughter therapy to more traditional
therapies. Decreasing stress-making hormones found in the blood, laughter can mitigate the effects of
stress. Laughter decreases serum levels of cortisol, epinephrine, growth hormone, and 3,4-dihydrophenylacetic
acid (a major dopamine catabolite), indicating a reversal of the stress response. Depression is a disease,
where neurotransmitters in the brain, such as norepinephrine, dopamine, and serotonin, are reduced, and
there is something wrong in the mood control circuit of the brain. Laughter can alter dopamine and
serotonin activity. Furthermore, endorphins secreted by laughter can help when people are uncomfortable
or in a depressed mood. Laughter therapy is a noninvasive and non-pharmacological alternative treatment
for stress and depression, representative cases that have a negative influence on mental health. In
conclusion, laughter therapy is effective and scientically supported as a single or adjuvant therapy.
Keywords: alternative treatment; depression; laughter; mental health; stress
Tohoku J. Exp. Med., 2016 July, 239 (3), 243-249. © 2016 Tohoku University Medical Press
Introduction
Recently, there has been increased interest in noninva-
sive and non-pharmacological therapy. Laughter therapy in
the media has grown and many researchers have conducted
a variety of studies on laughter (Cho and Oh 2011).
Moreover, as laughter therapy does not require specialized
preparations such as suitable facilities and equipment, is not
prohibited by cost, does not depend on when or where it
happens, and is easily accessible and acceptable, the medi-
cal world has also introduced it into treatment programs
(Mora-Ripoll 2010; Ko and Youn 2011). Laughter therapy
physiologically reduces the level of stress hormones,
increases the level of health promoting-hormones such as
endorphins, and strengthens the immune system by increas-
ing the number of T-lymphocytes through activation of nat-
ural killer cells, which multiplies white blood cells in the
body, and Ig A, G, and M, which raises immunity in the
body (Bennett and Lengacher 2006; Hayashi et al. 2007;
Bennett and Lengacher 2009). In addition, it also has an
effect of reducing blood pressure by controlling vasocon-
striction by lowering the degradation of the vasorelaxant
substance, nitric oxide, and reducing cortisol thus raising
blood sugar (Bennett and Lengacher 2008; Hasan and
Hasan 2009). As for the mental effects of the laughter ther-
apy, it helps reduce unpleasant feelings such as tension,
anxiety, hatred, and anger, alleviates stress and depression,
aids better interpersonal relationships, and improves insom-
nia, memory failure, and dementia (Takeda et al. 2010; Ko
and Youn 2011; Bains et al. 2015).
In modern society, high levels of stress are caused by
erce competition and socioeconomic stressors. As this
stress has a negative impact on self-esteem, which affects
quality of life and personal motivation, it increases depres-
sion and leads to a harmful inuence on a person’s mental
health. Furthermore, a potential mental health problem
may lead to the affected person having many difculties in
maintaining a good lifestyle at home and work life (Bast
and Berry 2014). Moreover, there are many problems
related to the elderly in society due to the nature of an aging
J.E. Yim
244
society. In particular, problems regarding the mental health
of elderly people are being magnied. Depression, second-
ary to loneliness and physical discomfort due to aging, is a
most important emotional problem in old age and requires
social attention and positive intervention. In addition to
depression, another remarkable change in the mental func-
tion of the elderly is the loss of intellectual ability (Takeda
et al. 2010; Ko and Youn 2011). This disorder of cognitive
function can put a high burden on a person, their family,
and society as a whole. The patient, and their family, can
suffer from physical and psychological stress. Laughter, as
part of the solution to these mental health problems, might
provide a desirable noninvasive and non-pharmacological
therapy that restores their happiness, by making the human
body and soul healthy, and improving quality of life and
self-esteem.
Theory
Laughter
Laughter is a physical reaction seen in humans and
some other species of primates, consisting typically of
rhythmic, often audible, contractions of the diaphragm and
other parts of the respiratory system. It is a response to cer-
tain external or internal stimuli. Laughter can arise from
activities such as being tickled, or from humorous stories or
thoughts (Stearns 1972; Schultz and Horibe 1974). Most
commonly, it is considered the expression of a number of
positive emotional states, such as joy, mirth, happiness,
relief, etc. On some occasions, however, it may be caused
by contrary emotional states such as embarrassment, apol-
ogy, or confusion, for example, nervous laughter. Age,
gender, education, language, and culture are all factors as to
whether a person will experience laughter in a given situa-
tion (Omwake 1937).
Dr. Miletus in the 4th century said, Laughter is gelos in
Greek, and the root of this word is Hele, which means
Health.; philosophers in the 16th century, Laughing is also
like taking physical exercise.; Kant in the 18th century,
Laughter has a great inuence on keeping balance in physi-
cal health.; Spencer in the 19th century, Laughter helps ease
tension and recover health (Dean and Gregory 2004;
Hyeong Woo 2010). The word, laughter, comes from
‘hliehhan’ in Old English. The word imitated sounds of
laughter. Laughter might be represented by the regular con-
tinuation of syllables made with short vowels such as “ha-
ha”, “ho-ho”, and “he-he” in English. Laughter is also a
general feature of people that occurs instinctively when
socially talking to each other (Provine 2000). Laughter is
the expression of one’s joyful heart or feeling when their
desire is satised; it can be a spontaneous expression of
their emotion when they have a joyful feeling or heart,
physical stimulus or pleasure, or a heart or feeling physi-
cally arousing when they feel ridiculous of an odd word,
behavior or appearance. It can also be a phenomenon of
expressing a heart or feeling that shows one’s pleasant men-
tal activities; it physically shows the working of one’s own
mind and the state of their consciousness.’ Laughter is
laughing pleasantly, briskly, and loudly, and it is a natural
phenomenon that happens in reaction to one’s senses or
heart, or to a word or behavior that makes another laugh
(Bennett and Lengacher 2006).
Laughter Theories
There are three categories in the theories of laughter:
arousal, discrepancy, and superiority (Apte 1985; Lefcourt
and Martin 2012). First, the arousal theory is concerned
with the cognitive aspects of laughter; stress increases
arousal, while laughter is able to reduce stress by easing
arousal and tension. This theory says if people laugh in a
stressful situation their physical arousal state declines and
the stressful situation is no longer as negative or detestable.
That is to say, the theory suggests that laughter shows a
complicated interaction of mind and body between cogni-
tion and emotion, rooted in the brain and nervous system.
Freud (1928) also considered laughter as a mechanism that
can block the attacks of another, and stated that it reduces
negative emotional responses or unpleasant feelings (Freud
1928). Second, discrepancy theory is concerned with the
cognitive aspect, which says laughter starts from the dith-
ered process, situation, or thought apart from the knowledge
or logic that people commonly know. This theory says peo-
ple laugh when they realize there is discrepancy between
the actual situation and their general knowledge of it. The
theory has a viewpoint emphasizing logical, linguistic, and
cognitive aspects. Laughter happens at the moment misun-
derstanding and bewilderment arouse in communication,
deviating from the smooth course of the cognitive process.
Laughter occurs at the moment cognitive imbalance — that
is, the point of discrepancy or disharmony — disappears
and balance recovers. Laughter at this moment is an
expression of pleasant enlightenment. According to the dis-
crepancy theory, people can laugh not only when they meet
something different from their expectation but also when
they meet something in discord with their expectation
(Keith-Spiegel 1972). Third, the superiority theory says
that laughter occurs when people look down on others more
than who they are actually, or when they have a feeling or
thought that they are superior to others. The theory says
laughter restricts the external environment and raises con-
dence (MacGhee and Pistolesi 1979). By raising content-
ment without going against the grain, laughter allows peo-
ple to take adequate action against stress and increases
condence (Martin 2010).
Categories of Laughter
Five large categories can be summarized from a medi-
cal and therapeutic point of view: (1) genuine or spontane-
ous laughter; (2) simulated laughter; (3) stimulated laugh-
ter; (4) induced laughter; and (5) pathological laughter
(Table 1). Spontaneous laughter, unrelated to one’s own
free will, is triggered by different (external) stimuli and
positive emotions. It has been reported that spontaneous
Potential Therapeutic Benets of Laughter in Mental Health 245
laughter causes typical contractions of the muscles around
the eye socket (Ekman et al. 1990). Simulated laughter is
triggered by oneself at will (self-induced), with no specic
reason (purposeful, unconditional), and therefore not elic-
ited by humor, fun, other stimuli, or positive emotions.
Stimulated laughter happens as a result of the physical con-
tact or action (reex) of certain external factors (i.e. to be
ticklish, specific facial or bodily motions, by pressing
laughter bones) (García-Rodera 2007). Induced laughter is
a result of the effects of specic drugs or substances (i.e.
alcohol, caffeine, amphetamines, cannabis, lysergic acid
diethylamide or LSD, nitrous oxide or ‘‘laughing gas’’, and
more). Lastly, Pathological laughter is secondary to inju-
ries to the central nervous system caused by various tempo-
rary or permanent neurological diseases and may also occur
with certain psychiatric disorders. Pathological laughter is
developed with no specic stimulus, is not connected with
emotional changes, has no voluntary control of its duration,
intensity or facial expression, and sometimes comes with
‘‘pathological crying’ (Wortzel et al. 2008).
Physiological and Psychological Effects of Laughter
Laughter has numerous effects involving the muscular,
cardiovascular, respiratory, endocrine, immune, and central
nervous systems (Table 2). The effects of laughter on cer-
tain physiological outcomes are as follows: laughter (1)
exercises and relaxes muscles, (2) improves respiration, (3)
stimulates circulation, (4) decreases stress hormones, (5)
increases the immune system’s defenses, (6) elevates pain
threshold and tolerance, and (7) enhances mental function-
Table 1. Main characteristics of ve large categories of laughter.
Categories Characteristics
Spontaneous laughter Unrelated to one’s own free will, is triggered by different (external) stimuli and
positive emotions.
Simulated laughter
Is triggered by oneself at will (self-induced), with no specific reason (purposeful,
unconditional), and therefore not elicited by humor, fun, other stimuli, or positive
emotions.
Stimulated laughter
Happens as a result of the physical contact or action (reflex) of certain external
factors (i.e. to be ticklish, specific facial or bodily motions, by pressing laughter
bones).
Induced laughter
Is a result of the effects of specific drugs or substances (i.e. alcohol, caffeine,
amphetamines, cannabis, lysergic acid diethylamide or LSD, nitrous oxide or
‘‘laughing gas’’, and more).
Pathological laughter
Is secondary to injuries to the central nervous system caused by various temporary
or permanent neurological diseases and may also occur with certain psychiatric
disorders.
Physiological outcomes Psychological outcomes
Exercises and relaxes muscles
Improves respiration
Stimulates circulation
Decreases stress hormones
Increases the immune system’s defenses
Elevates pain threshold and tolerance
Enhances mental functioning
Reduces stress, anxiety, and tension, and
counteracts symptoms of depression
Elevates mood, self-esteem, hope, energy,
and vigor
Enhances memory and creative thinking
Improves interpersonal interaction
Increases friendliness and helpfulness
Promotes psychological well-being
Improves quality of life and patient care
Intensifies mirth and is contagious
Table 2. Physiological and psychological effects of laughter.
J.E. Yim
246
ing (Martin and Lefcourt 2004; Sahakian and Frishman
2007; Ripoll and Rodera 2008).
The psychological effects of laughter relate primarily
to both its use as a coping mechanism and, to a lesser
extent, its enhancement of interpersonal relationships. The
research reviewed in this area, greater in volume and
strength than the evidence for physiological health benets,
can be summarized as follows: laughter (1) reduces stress,
anxiety, and tension, and counteracts symptoms of depres-
sion; (2) elevates mood, self-esteem, hope, energy, and
vigor; (3) enhances memory, creative thinking, and problem
solving; (4) improves interpersonal interaction, relation-
ships, attraction, and closeness; (5) increases friendliness
and helpfulness and builds group identity, solidarity, and
cohesiveness; (6) promotes psychological well-being; (7)
improves quality of life and patient care; and (8) intensies
mirth and is contagious (Scholl and Ragan 2003; Gelkopf et
al. 2006; Arminen and Halonen 2007).
Laughter Therapy
Laughter therapy is a kind of communication that
arouses laughter, smiling, pleasant feelings, and enables
interaction. Laughter therapy uses laughter for the purpose
of treatment to promote leading a desirable life, by keeping,
recovering, and preventing physical, psychological, social,
mental and spiritual functions through spontaneous and
nonspontaneous laughter (Mora-Ripoll 2010). This is a dif-
ferent approach from general medical treatments; it focuses
on the approach that both body and mind can be healthy
only when the psychological aspects of the brain are
changed, beyond just physical treatment. According to the
American Association for Therapeutic Humor (AATH),
laughter therapy refers to an activity that improves a
patient’s health and welfare using interesting experiences
and expressions. Therefore, laughter therapy can be a series
of cognitive-behavioral therapies that helps make physical,
psychological, and social relationships healthy and ulti-
mately improves the quality of life (Ko and Youn 2011). It
has taken a very long time for laughter to become a recog-
nized medical therapy. Although it started with Hippocrates
and Aristotle, laughter therapy was not again acknowledged
until the 20th century. Norman Cousins in the mid-20th cen-
tury established the effects of laughter in a modern setting
and brought the naissance of laughter therapy. He was the
editor-in-chief of the ‘Saturday Review’ of America.
Cousins suffered from ankylosing spondylitis, and realized
at the age of 50 that he did not feel pain for 2 hours when
he laughed while watching TV comedy programs.
Discovering this fact, he was invited by the California
University Hospital and began to earnestly study the medi-
cal effects of laughter and acknowledged the clinical effects
of laughter. In his book, ‘Anatomy of an Illness’, Cousins
stated ‘laughter is like a bulletproof vest’, and wrote about
the apparently remarkable power of afrmation and laugh-
ter therapy. He later went on to become a professor and
studied the effectiveness of laughter on health, and is often
referred to as the father of laughter therapy (Cousins 1989).
Since then, theses reporting that laughter helps relieve
stress and helps cure illness began to be released and laugh-
ter therapy spread in North America. Over the course of 40
years of study, Dr. William Fry of Stanford University
School of Medicine developed a theory of laughter therapy,
and found that humor and laughter produced natural pain-
killers in pituitary, such as endorphins, improved blood cir-
culation, and decreased stress (Fry and Salameh 1987). In
addition, in 1996 Prof. Lee Berk of Loma Linda University
School of Medicine in California, found that ‘laughter
increases immune globulin 3 times and interferon 200
times’; he found after 18 years of study that natural killer
cells were activated by laughter (Berk et al. 1989b; Berk
and Tan 1995).
Laughter and Stress
Stress became an ofcial term when the Canadian doc-
tor, Hansselye, rst presented a theory of general adaptation
syndrome, based on the results of various kinds of animal
testing (Evans 1982). The root of the word stress is from
‘stringer’ in Latin, which means ‘tighten’. In the 17th cen-
tury, it was used to describe pressure or physical tension; in
the 20th century, stress evolved to mean the psychological
pressure and tension that people receive from the outside
(Ivancevich and Matteson 1980; Sonnentag and Frese
2003).
Lazarus and Folkman (1984) considered stress as the
specic relation between an individual and the environment
when people think that a personal resource is lacking and
their comfort is at risk (Lazarus and Folkman 1984). Stress
can be classied into three kinds: stress as a stimulus, as a
response, and as an interaction. First, stress as a response is
interested in the psychological and physiological response
to surroundings; it considers stress a certain response to the
break or change in physiological, physical, behavioral, and
emotional equilibrium or the response trying to maintain
homeostasis in the face of various stimuli. Second, stress
as a stimulus is to receive a stimulus from a special image
or form; it includes various stimuli from the surroundings
such as the external environmental conditions and internal
physiological phenomena. Third, stress as an interaction
consists of the individual’s response to a stimulus from the
surroundings; not only can an individual connect a stimulus
element of the surroundings with a response, but personal
characteristics can also affect the surroundings. From the
interactional perspective, psychological stress can be a cer-
tain relation between an individual and their environment,
which is evaluated to exceed the personal resource and
threatens their comfort (Lazarus and Folkman 1984).
Modern society is composed of numerous stressors.
That nothing can be done without stress means that stress
may be an origin of many illnesses. To sum up the study
results of the medical and psychological world on stress, it
is an indisputable established theory that most of the ill-
nesses mankind develops, at least in part, are due to stress
Potential Therapeutic Benets of Laughter in Mental Health 247
or that stress aggravates the situation. People look for alco-
hol and recreational drugs or use coffee or cigarettes to
relieve stress; however, certain items of personal preference
for stress relief can produce bigger stresses and destroy
their health.
One non-medical method of stress reduction is laugh-
ing and being in pleasant environments. Laughter is a posi-
tive sensation, and seems to be a useful and healthy way to
overcome stress. Decreasing stress-making hormones
found in the blood, laughter can mitigate the effects of
stress (Farifteh et al. 2014). A popular theory for under-
standing laughter includes its evolution as a relief of ner-
vous energy, potentially making it an ideal antidote for
stressful situations. This is supported by the empiric obser-
vation that laughter decreases serum levels of cortisol, epi-
nephrine, growth hormone, and 3,4-dihydrophenylacetic
acid (a major dopamine catabolite), indicating a reversal of
the stress response (Berk et al. 1989a). In a previous study,
33 subjects viewed a humorous video and, subsequently,
stress level and immune function (natural killer cell activ-
ity) were recorded. As a result, stress level decreased and
immune function increased in the experimental group com-
pared with the control group (Bennett et al. 2003).
Since 1970, laughter has been regarded as a comple-
mentary and alternative therapy (Cousins 1976). As laugh-
ter is a noninvasive complementary/alternative therapy, the
use of laughter therapy has spread rapidly. Currently, there
are several laughter therapy clubs around the world in
which people gather to practice laughter and laughing on
purpose; this fake laughter gradually becomes effective in
releasing “anti-stress and joyful hormones” (Ghodsbin et al.
2014).
Laughter and Depression
The word ‘melancholia’ started to be used by at least
B.C. 400, when Hippocrates rst recorded and described it.
‘Depression’, typically used synonymously with ‘melan-
cholia’, first began to be used when Bleuler (1911)
described it, and that overall depression includes phenom-
ena such as kinetic phenomena occurring as a result of all
mental actions, such as mind, mood, and consciousness that
feels depression, excitement, and satisfaction, or, more
loosely, it refers to the element that occurs to the mind try-
ing to accomplish something and is forcibly oppressed (Ko
and Youn 2011).
Depression has a very high rate of prevalence and is
one of the most common mental disorders. It can be
dened as the depressed state of the pathological level.
That is to say, depression refers to a kind of mental disease
where people are seized by a sense of inadequacy, of isola-
tion, of futility and of guilt and suicidal impulse in a
depressed mood and in demotivation; it is different from a
temporary depressed feeling (Shahidi et al. 2011). A
depressed feeling is an emotional response of being sad,
hopeless, frustrated, or dispirited, which are almost relieved
when situations improve, but depression is a disease, where
neurotransmitters in the brain, such as norepinephrine,
dopamine, and serotonin, are reduced and there is some-
thing wrong in the mood control circuit of the brain. It is a
disease that weakens both mind and body, including physi-
cal symptoms, moods, and thoughts (Cho and Oh 2011).
Specically, when people feel severely down, the symptom
can be called depression. It is termed clinical depression
when pent-up, inactive, and worried feelings continue at
least 2 weeks, not allowing an individual to lead a normal
life. Clinical depression also requires drug treatment; there-
fore, depression needs to be divided into the general
depressed feeling and severe depression. Unlike the tempo-
rary depressed feeling, depression does not vary according
to situation and can continue for years if not cured (Caspi et
al. 2003).
Laughter helps people endure stressful processes or
situations, reduces depression, helps people judge their
problems objectively, and improves problem-solving ability
by increasing insight. Therefore, laughter helps people pre-
vents themselves from being inuenced by the environment
and control themselves (Wooten 1996). There is also an
opinion that laughter is a pleasant stress, which means
laughter is a stress that has a positive aspect and gives fresh
and powerful energy. Thus, laughter is used to reduce neg-
ative cognitive responses and relieves stress (Bennett 2003;
MacDonald 2004). It is reported laughter has the best effect
among methods that can relieve stress, and that if we keep
practicing even a forced laugh, our body will react to it and
become more pleased and healthy (Ekman 1984; Lefcourt
and Martin 2012). A positive mood can be gained through
the forced laugh, and a bad mood, personality, or thought
can be changed somewhat into a positive direction (Isen
and Means 1983). According to the latest precedent stud-
ies, reduction in secretion of the neurotransmitters, dopa-
mine and serotonin, is the representative of one of the many
causes of depression; therefore, if the secretion of those
substances reduces, there will be a disorder in mood control
in the brain and depression will develop (Brown and
Gershon 1993). However, a positive attitude and forced
laughter can help maintain dopamine activity (Ashby et al.
1999). Furthermore, endorphins secreted by laughter can
help when people are uncomfortable or in a depressed
mood (Lebowitz 2002). Moreover, in a study on the effects
of laughter therapy on depression in middle-aged women
and their blood serotonin concentration, blood serotonin
concentration showed the lowest result in the group with
the severest depression. After laughter therapy, serotonin
increased in all three groups (the group without depression,
with a little depression, and with severe depression) except
the control group, and the group with severe depression
showed the greatest change (Cha and Hong 2015).
Serotonin is a control hormone, which controls impulsivity
and tension to maintain calmness and activate the limbic
system, so that it becomes a source of the will to live and
vitality. Therefore, it is a substance that acts in opposition
to depression (Lee 2010). Due to this characteristic, sero-
J.E. Yim
248
tonin is drawing people’s attention in its role in healing
anxiety, stress, antisocial behavior, and mental diseases. In
particular, serotonin is known to be activated by continuous
exercise or yoga (Kim 2006). As exercise or yoga increases
the positive energy and vitality of the body and activates
serotonin in the blood, so laughter has a similar inuence to
adequate exercise or yoga by increasing our pulse and lung
capacity and helping the digestive system (Dolgoff-Kaspar
et al. 2012). Therefore, as it increases blood dopamine and
serotonin concentration, laughter therapy may be very
effective in reducing depression as a non-pharmacological,
alternative treatment.
Conclusion
Laughter therapy as a non-pharmacological, alterna-
tive treatment does not require specialized preparations
such as suitable facilities and equipment, is not prohibited
by cost, does not depend on when or where it happens, and
is easily accessible and acceptable (Mora-Ripoll 2010; Ko
and Youn 2011). For these reasons, the medical world has
taken notice and attempted to include it to more traditional
therapies. Laughter therapy gives our body various physio-
logical changes, and has an inuence on the physical tem-
perature, blood pressure, lung capacity, heart rate, muscles
in the musculoskeletal system, and brain activity, so it can
have an overall effect in promoting health (Hayashi et al.
2007; Bennett and Lengacher 2009). Mentally, laughter
therapy helps reduce unpleasant feelings such as tension,
anxiety, hatred, and anger, alleviates feelings of depression,
aids better interpersonal relationships, and improves insom-
nia, memory failure, and dementia (Takeda et al. 2010;
Bains et al. 2015). As modern society has an issue with the
effect that erce competition and socioeconomic problems
have on quality of life and that stress and depression from
these problems can have a negative inuence on a person’s
mental health, the promotion of mental health through
laughter therapy can be a very effective and meaningful
approach (Bast and Berry 2014). Laughter therapy for
stress and depression, representative cases that have a nega-
tive inuence on mental health, is a noninvasive and non-
pharmacological alternative treatment. Laughter is a posi-
tive sensation, and seems to be a useful and healthy way to
overcome stress. Decreasing stress-making hormones
found in the blood, laughter can mitigate the effects of
stress (Farifteh et al. 2014). There is also an opinion that
laughter is a pleasant stress, which means laughter is a
stress that has a positive aspect and gives fresh and powerful
energy. Thus, laughter is used to reduce negative cognitive
responses and relieves stress (Bennett 2003; MacDonald
2004). Therefore, it is effective and scientically supported
as either a single or adjuvant therapy. At the same time, it
can also provide a comprehensive approach that can
improve the quality of life and social relationships.
Acknowledgments
This study was supported by Sahmyook University.
Conict of Interest
The author declares no conict of interest.
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... Stretching-relaxation techniques include laughter and deep-breathing exercises [20,30]. It has been reported that laughter yoga physiologically increases breathing in the body; relaxes muscles; strengthens mental function by reducing the level of stress hormones; reduces burnout, depression, and anxiety levels; positively affects quality of life; improves sleep quality; and provides psychological well-being by increasing interpersonal relationships and social interaction [28,31,32]. In addition, it has been emphasized that laughter yoga stimulates the immune system, increases endorphin levels, reduces the production of stress hormones, such as cortisol and epinephrine, accelerates the circulatory system, and has vasodilation effects in the veins [29,31,32]. ...
... It has been reported that laughter yoga physiologically increases breathing in the body; relaxes muscles; strengthens mental function by reducing the level of stress hormones; reduces burnout, depression, and anxiety levels; positively affects quality of life; improves sleep quality; and provides psychological well-being by increasing interpersonal relationships and social interaction [28,31,32]. In addition, it has been emphasized that laughter yoga stimulates the immune system, increases endorphin levels, reduces the production of stress hormones, such as cortisol and epinephrine, accelerates the circulatory system, and has vasodilation effects in the veins [29,31,32]. ...
... The most important of these is to help individuals cope with stress and reduce their anxiety [41]. It has been noted that the body physically responds to laughter, such as through an increase in the level of beta-endorphins, a decrease in stress hormones such as adrenaline, noradrenaline, and cortisol, an improvement in mental processes, and a decrease in blood pressure and muscle tension [32,42]. In the literature, studies have reported that laughter yoga also provides a significant decrease in salivary cortisol, which is considered a biological marker of stress [43][44][45][46]. ...
Article
Background A randomized controlled study was conducted on the effects of laughter yoga in reducing the perceived stress and burnout levels in nurses during the pandemic and in increasing their life satisfaction. Materials and methods The study was conducted with 101 (51 in the experimental group, and 50 in the control group) nurses providing care for patients with COVID-19. A total of eight sessions of laughter yoga were applied to the nurses in the experimental group for four weeks, twice a week. The Introductory Information Form, Perceived Stress Scale, Maslach Burnout Inventory, and Life Satisfaction Scale were used during data collection. Results The difference between the pre- and posttest Perceived Stress Scale, Maslach Burnout Inventory, and Life Satisfaction Scale score averages of the nurses in the experimental group were found to be statistically significant (p < 0.05), whereas the difference between the pre- and posttest score averages of the nurses in the control group was not significant (p > 0.05). Conclusion Laughter yoga is an effective method to reduce perceived stress and burnout while also increasing life satisfaction. Clinicaltrials.gov id NCT05317091.
... [5][6][7] The growing importance of humour as a health strategy in our society is largely due to the various psychological, physical, and social benefits attributed to it in the scientific literature. [8][9][10] In the healthcare setting, humour has proven to be a very useful tool in the treatment of patients who are not only in a healthcare setting, but also in a social environment. [8][9][10] In health care, humour has demonstrated major benefits in improving the work environment; in coping with complicated situations; in communication with colleagues, managers, and patients, and in job satisfaction, in addition to the reduction of stress and anxiety, among others. ...
... [8][9][10] In the healthcare setting, humour has proven to be a very useful tool in the treatment of patients who are not only in a healthcare setting, but also in a social environment. [8][9][10] In health care, humour has demonstrated major benefits in improving the work environment; in coping with complicated situations; in communication with colleagues, managers, and patients, and in job satisfaction, in addition to the reduction of stress and anxiety, among others. [11][12][13][14][15][16] These positive effects in the healthcare professional have been shown to produce a positive effect on the patient's quality of care. ...
Article
Aim The objective of this study was to develop an instrument for measuring humor in health professionals. Methods Observational, transversal and descriptive study of mixed methodology. The instrument was designed in several phases: literature review, item generation, determination of the scale format, review by the expert panel, pilot study, reevaluation by the expert panel, and test-retest. The pertinence, relevance and comprehension of the items were analyzed. Interobserver agreement was calculated with Kappa and the intraclass correlation coefficient considering values ≥ 0.61. Pared sample Student's t test and Pearson's correlation coefficient were used. A level of statistical significance was established at P < 0,05. Results The Three-Dimensional Scale of Humor in Health Professionals consists of 50 items measured with a 5-point Likert scale based on the degree of agreement. Experts’ panel evaluated the global scale with 3.57 (0.79) points out of 5. An interobserver reliability of 0.69 (P < 0.001) was obtained in the pilot study. A Pearson correlation coefficient of 0.71 (P = 0.002) and an intraclass correlation coefficient of 0.69 (P = 0.001) resulted in the test-retest. No statistically significant differences were observed between test-retest scores. Conclusion The Three-Dimensional Scale of Humor in Health Professionals is an innovative tool for measuring humor in the health context. This scale is created specifically for health professionals. It’s necessary its validation in future studies.
... It carries information on the behavioural intentions of the agent, and the identity and hierarchical position of the recipient. In addition, following a fortunate perspective initiated by James [9], the physical act of laughing, along with its interoceptive feedback, is conceived to be a quintessential element in the constitution of our perceived sense of happiness which, in turn, downregulates social anxiety and negative emotions [10][11][12]. Interpreting laughter as a genuine socio-emotional complex behaviour, rather than a peripheral consequence of humour appreciation, makes a case for its complex cerebral representation, moving beyond subcortical structures and potentially encompassing several regions of the social and emotional brain. ...
... A possible answer comes from studies showing that emotional laughter downregulates anxiety, stress, depression and other negative emotional states [10][11][12]. In line with royalsocietypublishing.org/journal/rstb Phil. ...
Article
According to an evolutionist approach, laughter is a multifaceted behaviour affecting social, emotional, motor and speech functions. Albeit previous studies have suggested that high-frequency electrical stimulation (HF-ES) of the pregenual anterior cingulate cortex (pACC) may induce bursts of laughter—suggesting a crucial contribution of this region to the cortical control of this behaviour—the complex nature of laughter implies that outward connections from the pACC may reach and affect a complex network of frontal and limbic regions. Here, we studied the effective connectivity of the pACC by analysing the cortico-cortical evoked potentials elicited by single-pulse electrical stimulation of pACC sites whose HF-ES elicited laughter in 12 patients. Once these regions were identified, we studied their clinical response to HF-ES, to reveal the specific functional target of pACC representation of laughter. Results reveal that the neural representation of laughter in the pACC interacts with several frontal and limbic regions, including cingulate, orbitofrontal, medial prefrontal and anterior insular regions—involved in interoception, emotion, social reward and motor behaviour. These results offer neuroscientific support to the evolutionist approach to laughter, providing a possible mechanistic explanation of the interplay between this behaviour and emotion regulation, speech production and social interactions. This article is part of the theme issue ‘Cracking the laugh code: laughter through the lens of biology, psychology and neuroscience’.
... La importancia creciente que está cobrando el humor como estrategia de salud en nuestra sociedad se debe en gran parte a los diversos beneficios psíquicos, físicos y sociales que se le atribuyen en la literatura científica [8][9][10] . En el entorno sanitario, el humor ha demostrado importantes beneficios en la mejora del entorno de trabajo, en el afrontamiento de situaciones complicadas, en la comunicación con compañeros, gestores y pacientes, y en la satisfacción laboral, así como en la reducción del estrés y la ansiedad, entre otros [11][12][13][14][15][16] . ...
Article
Resumen Objetivo Diseñar un instrumento de medida del humor en los profesionales sanitarios. Método Estudio descriptivo, observacional y transversal de metodología mixta. Se elaboró el instrumento en varias fases: revisión bibliográfica, generación de los ítems, determinación del formato, evaluación por panel de expertos, estudio piloto, reevaluación por panel de expertos y test-retest. Se analizó la pertinencia, la relevancia y el grado de comprensión de los ítems. Se calculó la validez interobservador con el índice kappa y el coeficiente de correlación intraclase, considerándose los valores ≥ 0,61. Se utilizó la t de Student para muestras relacionadas y el coeficiente de correlación de Pearson. Para todas las pruebas se aceptó un valor de p < 0,05. Resultados La Escala Tridimensional del Humor en Profesionales Sanitarios consta de 50 ítems medidos con una escala Likert de 5 puntos en función del grado de acuerdo. El panel de expertos valoró la escala global con 3,57 (0,79) puntos sobre 5. Se obtuvo una fiabilidad interobservador de 0,69 (p < 0,001) en el estudio piloto, un coeficiente de correlación de Pearson de 0,71 (p = 0,002) y un coeficiente de correlación intraclase de 0,69 (p = 0,001) en el test-retest. No se observaron diferencias estadísticamente significativas entre las puntuaciones del test-retest. Conclusión La Escala Tridimensional del Humor en los Profesionales Sanitarios es una herramienta innovadora en la medida del humor en el contexto sanitario, creada específicamente para profesionales sanitarios. Antes de su utilización, es necesario analizar su validez y fiabilidad en futuros estudios.
... Our laughter-therapy program effectively reduced depression in inpatients with TB. This supports previous findings that laughter contributes to positively transforming negative mental health states, such as anxiety, stress, poor QOL, and depression [30], by stimulating serotonin secretion in the gastrointestinal tract and reducing cortisol production [29,31]. Specifically, the effects of our laughter therapy on depression were greater than that of simple laughter therapy used in previous studies. ...
Article
Full-text available
This study evaluated the effects of simulated laughter therapy on physical symptoms, pulmonary function, depression, and health-related quality of life (HRQOL) among pulmonary tuberculosis patients. This quasi-experimental study assigned tuberculosis patients of hospital A to a laughter group (n = 26) and those of hospital B to a control group (n = 26). The eight-week laughter therapy, held twice a week in a 60-min group session, included laughter, entertainment, music-related chorusing, breathing exercises, and meditation. The values of physical symptoms, pulmonary function, depression, and HRQOL from before and after the therapy were analyzed using the paired t-test and the Mann–Whitney U-test. To verify group differences between the experiment and control group, the Wilcoxon signed-rank test and the analysis of covariance (ANCOVA) were employed. Unlike the control group, laughter therapy decreased physical symptoms (t = 7.30, p < 0.01) and increased pulmonary function (t = −3.77, p < 0.01). Psychological health also improved, including depression (t = 10.46, p < 0.01) and HRQOL (t = −9.31, p < 0.01) in the experimental group but not in the control group. Group differences of changes in physical symptoms, pulmonary function, depression, and HRQOL were also significant. Simulated laughter therapy can help moderate depression and physical symptoms and enhance pulmonary function among tuberculosis patients.
... Humor buffers their sense of well-being, self-esteem, and life satisfaction against their loss of mobility, independence, social groups, personal possessions, privacy, physical space, and control. Humor releases endorphins in the brain that quickly reduce stress and pain(Yim, 2016;Agarwal, 2014). Laughter helps lower blood pressure, fights depression, boosts the immune system, and promotes fitness. ...
Article
Full-text available
Humor and laughter are universal occurrence-across different age levels irrespective of language, religion, ethnicity, or culture. The characteristics, context, types, functions, or themes of humor may vary. Their comprehension or appreciation can be different. Several immense benefits of a few laughs every day are recorded especially for the elderly. There is no single overarching theory to explain humor across all age groups. However, a few of them carry implications for explaining their humor. This review attempts to outline the observations or tenets of humor in seniors before surmising the need for more empirical data-backed evidence-based research in the future in this less opted area of study.
... Moreover, based on the monoaminergic hypothesis of depression, monoamine reuptake inhibitors have been developed as antidepressants [7]. Specifically, ample studies show that a 5-HT deficiency may influence mood in a way that leads to depression and the role of 5-HT in the antidepressant response has been highlighted [5,8]. In addition, glutamate (GLU) and gamma-aminobutyric acid (GABA) as the major excitatory and inhibitory neurotransmitters, respectively, their changes causing the excitatory/inhibitory (E/I) imbalance during the brain development may result in abnormalities in the GABAergic pathway, which contribute to the recurrences and refractoriness of MDD at a later stage [6]. ...
Article
Full-text available
Neurotransmitter metabolism plays a critical role in the pathophysiology of major depressive disorder (MDD). However, whether the neurotransmitter metabolism in adolescent MDD is differentiated from adult MDD is still elusive. In the current study, plasma concentrations of monoamine and amino acid neurotransmitters as well as their metabolites, including tryptophan (TRP), kynurenine (KYN), kynurenic acid (KYNA), serotonin (5-HT), 5-hydroxyindoleacetic acid (5-HIAA), dopamine (DA), 3,4-dihydroxyphenylacetic acid (DOPAC), homovanillic acid (HVA), norepinephrine (NE), vanillylmandelic acid (VMA), 3-methoxy-4-hydroxyphenylglycol (MHPG), glutamine (GLN), glutamate (GLU) and gamma-aminobutyric acid (GABA), were measured and compared in two cohorts of subjects (adult cohort: 31 first-episode MDD vs. 35 healthy controls; adolescent cohort: 33 first-episode MDD vs. 30 healthy controls). To assess the effects of antidepressant treatment, we also analyzed the concentrations of these indexes pre- and post-treatment in adult and adolescent cohorts. At baseline, the deficits of neurotransmitter metabolism in adult MDD were manifested in all the neurotransmitter systems. In contrast, for adolescent MDD, the dysregulation of neurotransmission was mainly indicated in the catecholaminergic systems. After antidepressant treatment, adult MDD showed increased TRP, KYN, KYNA and GLU levels, together with decreased levels of 5-HIAA and DOPAC. Adolescent MDD illustrated an increased level of 5-HT and decreased levels of TRP and GABA. The improvements of Hamilton total scores correlated with the changes in plasma TRP and the turnover of KYN/TRP after treatment in all MDD patients. However, these correlations were only manifested in the adult MDD rather than in adolescent MDD patients. The findings highlight the shared and distinguished neurotransmitter pathways in MDD and emphasize the different antidepressant responses between adults and adolescents. Potentially, the neurotransmitters above could serve as diagnostic biomarkers and provide a novel pharmacological treatment strategy for MDD.
Article
Main aim of this study is to determine what causes humor, and secondarily, to find out why rhythmic laughter is its expression. In this review, we have analyzed the characteristics of humor and laughter, their effects on health and social behavior, and their correlations with several areas of the brain. Then, we have described the features of laughter, its rhythmic shape and its correlations with other rhythmic human behaviors. We have noticed that the most plausible theory for humor is that of incongruity/resolution, where a) an incongruous event or object provokes a sense of wonder, and b) it is followed by something that reassures the bystanders about its innocuity; but c) not all incongruities provoke humor, but just those that introduce something stiff and stereotyped into a vital and fluid event. What this study adds to what is known, is that not all incongruities produce humor, but only those between a living process and any stereotipy or stiffness we find in it. Laughter is the stigmatization of this unnatural incongruity, through its loud and rhythmic shape, as a sort of signal of ceased alert after the shock induced by what seems hazardous to the fluidity of life.
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Dampak pandemi COVID-19 di seluruh dunia sangat serius karena meluas ke berbagai aspek kehidupan, mencemaskan dan merenggut nyawa teramat banyak sehingga dikatakan sebagai situasi amat sulit, bahkan dapat dikatakan sebagai situasi ekstrim. Secara khusus, pandemi COVID-19 ini sangat berdampak buruk terhadap kesehatan mental. Terdapat sejumlah cara yang dapat ditempuh untuk menjaga mental tetap sehat, salah satu di antaranya adalah humor. Humor memberikan banyak kemanfaatan fisik, psiko-sosial, bahkan ekonomis. Selera humor dapat dilatih menjadi kebiasaan dengan mengikuti beberapa tahap praktis yang diharapkan dapat menjadi strategi penanggulangan stress yang efektif dalam situasi pandemi bahkan situasi ekstrim lainnya.
Article
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Humor and laughter are ecumenical phenomena. Jokes, wit, funny narratives, irony, satire, sarcasm, the ludicrous, puns, double entendres, slips of the tongue, and comical have universal appeal across all ages and different cultures. Even as the subjects covered by humor vary, all of them have a few typical characteristics and unique functions. Several immense benefits of a few laughs every day are recorded. There are no overarching theories to explain humor across all age groups. Broadly, there are classified by their content and source of origin. This review attempts to outline as many of them before summing the need for more empirical data-backed evidence-based research in the future in this less opted area of study.
Article
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In Minnesota treatment, the therapists aim at breaking clients' denial to encourage them to accept their addiction. However, the confrontation is risky since, instead of making the patient ready for a change, it may strengthen resistance against the diagnosis of addiction and the treatment recommendations. We will explore the role of laughter in confrontational practices. The study is based on conversation analysis of group therapy sessions in an inpatient addiction treatment clinic in Finland (7.5 hours of data altogether). The laughter prevails in three different kinds of practice: laughing off the troubles, strengthening the confrontation by laughing at the patient, and ameliorating the confrontation. Laughter is a flexible device for preventing or resolving the possible risks of confrontation.
Article
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This study was done to examine how laughter therapy impacts serotonin levels, QOL and depression in middle-aged women and to perform a path analysis for verification of the effects. A quasi-experimental study employing a nonequivalent control group and pre-post design was conducted. Participants were 64 middle-aged women (control=14 and experimental=50 in 3 groups according to level of depression). The intervention was conducted five times a week for a period of 2 weeks and the data analysis was conducted using repeated measures ANOVA, ANCOVA and LISREL. Results showed that pre serotonin and QOL in women with severe depression were the lowest. Serotonin in the experimental groups increased after the 10th intervention (p=.006) and the rise was the highest in the group with severe depression (p=.001). Depression in all groups decreased after the 5th intervention (p=.022) and the biggest decline was observed in group with severe depression (p=.007). QOL of the moderate and severe groups increased after the 10th intervention (p=.049), and the increase rate was highest in group with severe depression (p<.006). Path analysis revealed that laughter therapy did not directly affect depression, but its effect was indirectly meditated through serotonin variation (p<.001). Results indicate that serotonin activation through laughter therapy can help middle-aged women by lessening depression and providing important grounds for depression control.
Book
Research on humor is carried out in a number of areas in psychology, including the cognitive (What makes something funny?), developmental (when do we develop a sense of humor?), and social (how is humor used in social interactions?) Although there is enough interest in the area to have spawned several societies, the literature is dispersed in a number of primary journals, with little in the way of integration of the material into a book. Dr. Martin is one of the best known researchers in the area, and his research goes across subdisciplines in psychology to be of wide appeal. This is a singly authored monograph that provides in one source, a summary of information researchers might wish to know about research into the psychology of humor. The material is scholarly, but the presentation of the material is suitable for people unfamiliar with the subject-making the book suitable for use for advanced undergraduate and graduate level courses on the psychology of humor-which have not had a textbook source.
Context: With aging, the detrimental effects of stress can impair a person's ability to learn and sustain memory. Humor and its associated mirthful laughter can reduce stress by decreasing the hormone cortisol. Chronic release of cortisol can damage hippocampal neurons, leading to impairment of learning and memory. Objectives • The study intended to examine the effect of watching a humor video on short-term memory in older adults. Design • The research team designed a randomized, controlled trial. Setting: The study took place at Loma Linda University in Loma Linda, CA, USA. Participants: The study included 30 participants: 20 normal, healthy, older adults-11 males and 9 females-and 10 older adults with type 2 diabetes mellitus (T2DM)-6 males and 4 females. Intervention: The study included 2 intervention groups of older adults who viewed humorous videos, a healthy group (humor group), aged 69.9 ± 3.7 y, and the diabetic group, aged 67.1 ± 3.8 y. Each participant selected 1 of 2 humorous videos that were 20 min in length, either a Red Skeleton comedy or a montage of America's Funniest Home Videos. The control group, aged 68.7 ± 5.5 y, did not watch a humor video and sat in quiescence. Outcome measures: A standardized, neuropsychological, memory-assessment tool, the Rey Auditory Verbal Learning Test (RAVLT), was used to assess the following abilities: (1) learning, (2) recall, and (3) visual recognition. The testing occurred twice, once before (RAVLT1) and once after (RAVLT2) the humorous video for the humor and diabetic groups, and once before (RAVLT1) and once after (RAVLT2) the period of quiescence for the control group. At 5 time points, measurements of salivary cortisol were also obtained. The Kruskal-Wallis test was used to measure significance of the data based on the 3 groups. Results: In the humor, diabetic, and control groups, (1) learning ability improved by 38.5%, 33.4%, and 24.0%, respectively (P = .025); (2) delayed recall improved by 43.6%, 48.1%, and 20.3%, respectively (P = .064); and (3) visual recognition increased by 12.6%, 16.7%, and 8.3%, respectively (P = .321). For levels of salivary cortisol, the research team found significant and borderline decreases for the humor group between baseline and (1) post-RAVLT1 (P = .047), (2) postvideo (P = .046), and (3) post-RAVLT2 (P = .062). The diabetic group showed significant decreases between baseline and (1) post-RAVLT1 (P = .047), (2) postvideo (P = .025), and (3) post-RAVLT2 (P = .034). The study found no significant changes for the control group. Conclusion: The research findings supported potential clinical and rehabilitative benefits for humor that can be applied to whole-person wellness programs for older adults. The cognitive components-learning ability and delayed recall-become more challenging as individuals age and are essential to older adults for providing a high quality of life: mind, body, and spirit. Because older adults can experience age-related memory deficits, complementary, enjoyable, and beneficial humor therapies should be implemented for them.
Article
Pathological laughing and crying (PLC) is characterized by frequent, brief, intense paroxysms of uncontrollable crying and/or laughing due to a neurological disorder. When sufficiently frequent and severe, PLC may interfere with the performance of activities of daily living, interpersonal functioning, or both, and is a source of distress for affected patients and their families. PLC is also often misunderstood by patients and their families, and is under-recognized by the clinicians caring for patients with this disorder. However, this syndrome is easily recognized when understood properly and is highly responsive to treatment with a variety of pharmacological agents. This review aims to facilitate the diagnosis and treatment of patients with PLC, and begins by providing definitions of mood and affect that will help clinicians distinguish between mood disorders, such as major depression and mania, and disorders of affect, such as PLC. In addition, the various terms used to describe this syndrome are reviewed and a recommendation for the use of the term PLC is made. The core clinical features of PLC are also presented and the epidemiology of this syndrome is reviewed. A discussion of the pathophysiology of PLC, including the neuroanatomic and neurochemical bases, is provided. Finally, the evaluation and treatment of patients with PLC is described. Based on the pathophysiology of PLC and on a detailed review of published treatment studies, SSRIs are recommended as first-line pharmacotherapy for this disorder. When SSRIs are ineffective or poorly tolerated, other treatment options, including TCAs, noradrenergic reuptake inhibitors, novel antidepressants, dopaminergic agents and uncompetitive NMDA receptor antagonists may be useful second-line treatments.