Laughter has what seems like inherent therapeutic potential. It’s no mystery why so many of us turn to watching silly cartoons or calling our funniest friend when we are feeling particularly stressed or down — laughter actually induces changes in our body that cause us to feel more relaxed. A good laughing fit stimulates blood circulation, helps our muscles relax, and decreases both heart rate and blood pressure. But can humor also be used to help treat people with serious mental illness? While there is limited research on this topic, some recent studies say it can.
Benefits of Humor in Psychotherapy
In his 2011 article “The Use of Humor in Serious Mental Illness: A Review,” Marc Gelkopf discusses the growing application of humor and laughter interventions for people with severe mental illness (SMI). He notes that while typical interventions for individuals with SMI often include medication along with various therapies and psychosocial education, these interventions are often limited in their abilities to help clients to regain interpersonal and vocational skills and are not focused on empowering or instilling hope in clients.
This is where humor can come in. Humor interventions can be used in tandem with conventional treatments to help facilitate client empowerment, to help clients cope with symptoms, and to help improve their emotional, cognitive, and social capacities.
Below are some of the benefits of using humor interventions with patients with SMI, according to Gelkopf.
- “Laughter can both reduce excessive anxiety and facilitate the expression of emotions [36, 37] such as feelings of hostility  that would otherwise become self-defeating. Laughter can also be a mind-relaxing tool, helping to reach emotional content that the patient is neurotically or psychotically protecting, or as a phase in initiating systematic desensitization .”
- “Humor can foster self-observation by initiating the reorganization of attitudes (e.g., in regard to specific subjects such as sex, ridicule, or the debunking of catastrophe scripts), and by temporarily suspending taboos and distancing oneself from obsessive thoughts, humor can offer a sense of proportion  as well as promote different perspectives towards problems . Humor can also facilitate a pleasurable and hedonistic approach to problems, in stark contrast to depressive or suicidal thinking [33, 39, 40].”
- “Humor can promote the use of a potential space of play, where themes can be explored and shared in a non-defensive way .”
- “Humor and laughter can release rigid defenses, promoting communication with unconscious processes, widening the repertory of available coping options and strengthening the ego .
- “Humor in the therapeutic relationship may help deepen the therapeutic alliance, as the use of humor can strengthen the feeling of acceptance, enhancing empathy and a sense of belonging . Therapists can show their humanness and break down barriers that often exist within the therapeutic context—especially within psychiatric institutions . The therapist’s spontaneous laughter can improve the patient’s trust in the therapist and therapeutic process .”
[Related: Stress relief from laughter? It’s no joke]
Examples of Humor Interventions
While comprehensive studies on humor-related therapeutic interventions are limited, there are many different kinds of therapeutic approaches that have been developed and are currently used in clinical settings.
Through the therapeutic art of play and humor, medical clowns aim to help patients and their families reduce fear and anxiety while increasing their strength and motivation to cope with illness. Medical clowns use expressive therapy modalities as part of the healing process with patients and aim to provide empowerment, a supportive relationship, and an opportunity for patients to play. In a six-week intervention pilot project involving the use of medical clowns in a locked psychiatric ward, a close look at the results showed that after the intervention, fewer people attempted to escape the ward, there was less agitation and less aggression toward staff, less self-injury, less fighting and noncooperation, and an overall reduction of disruptive behavior.
Humor in Group Therapy
Because of the contagious nature of laughter, using humor as an intervention in group settings can help to enhance social relations and increase group cohesiveness. In one six-month study, schizophrenic patients were offered humorous renderings and interpretations of their most prominent complaints in a group setting, encouraging a light atmosphere and allowing for a humorous self-analysis. This intervention was found to be more efficient in reducing psychopathological symptoms than more typical interventions performed on the same group of people.
In another study, a clinician worked with a group of clients in a psychiatric ward for four years, providing playful and jovial weekly sessions that encouraged clients to make jokes and engage in spontaneous humor. Clients also engaged in humorous activities such as games, songs, or skits during which they engaged playfully with others in the group. Participants in this group displayed improved communication skills, improved regulations of their thoughts and feelings, as well as reduced stress and enhanced coping skills.
Stand-up comedy can be used as a therapeutic practice centered on the restorative power of laughter. The most well-known intervention that uses stand-up comedy to promote humor as a therapeutic tool is Stand Up for Mental Health. Stand Up for Mental Health aims to empower individuals with mental illness using humor training and public performances, working to reduce the stigma around mental illness and educate the public about this stigma.