Can laughter therapy improve the quality of life of people with kidney disease on dialysis? It is a question Paul Bennett, RN and Associate Professor in Nursing at the University of South Australia (UniSA), has been researching for a decade.
A hospital-trained nurse who graduated in the 1980s, Professor Bennett developed an interest in caring for patients with kidney disease early on and has worked on supporting the cohort to live happier lives ever since.
People on dialysis spend four to five hours a day, three times a week, attached to a dialysis machine. They often describe the dialysis life as bleak and lonely.
“It’s a chronic disease that can dominate people’s lives,” Professor Bennett explains.
“Our interest in laughter and dialysis was stimulated by people receiving dialysis spending so much time together. They often suffer disease-related symptoms that contributes to a sedentary lifestyle. As a nurse caring for people receiving dialysis, it was frustrating we couldn’t do anything to help.”
To increase morale, dialysis nurses have tried to employ a number of strategies, including bingo sessions, laughter therapy or exercise. Anything to improve the gruelling hours.
Such practices spurred Professor Bennett to shift into education and research and begin investigating ways to improve the lives of dialysis patients through interventions. Initially, boosting patients’ levels of physical activity was his main area of study.
People on dialysis, like lots of people, do not always embrace exercise, so researchers looked at finding fun ways for them to exercise. Enter laughter therapy.
At the time, Professor Bennett, then at Deakin University in Melbourne, conceded he did not know anything about laughter therapy and, like many, was sceptical.
However, after teaming up with Laughter and Wellness experts, Professor Bennett developed laughter therapy exercises with the potential to work in the group settings of dialysis clinics.
Laughter clubs are common across Australia and typically involve groups of people who meet regularly to take part in communal laughing for the therapeutic effect.
“Laughter is infectious,” Professor Bennett says.
“You laugh and the person next to you might laugh just because you’re laughing, even though they don’t know what’s funny.”
Dialysis clinics usually treat anywhere between 10 to 20 patients at a time. Patients sit in a circle, hooked up to machines, around a nursing station, and eye each other for four or five hours per session.
For that reason, Professor Bennett says the dialysis clinic environment offered an opportunity to test out the benefits of laughter therapy.
With the help of a small grant, Deakin researchers brought in laughter therapists to every dialysis session at Monash Health clinics for one month. Most patients and nurses enjoyed the experience, which led Professor Bennett to widen his research scope.
Over the past six years, he has been working on measuring markers such as lung function, immunity, and mental health, to gauge whether laughter therapy can indeed help dialysis patients lead happier and better lives.
So how does it all work?
Professor Bennett says sessions are conducted by trained laughter therapists who know how to develop a rapport with patients. A session typically runs between 30 and 45 minutes.
“You start off with warm-up exercises, deep breathing exercises and a type of meditation, because laughter is a lot about breathing, it’s using your lungs to full capacity.”
“Then you go through laughter exercises, which can be anything, such as an alphabet laughter. That might take a minute and then you repeat that again.
“You might do a riding your bicycle laughter where you’re pretending you’re riding your bicycle and you’re laughing at the same time. In between these defined exercises, you do this chant, which is ‘ho ho, ho, ha, ha, ha’.”
While the practice begins as forced laughter, where you know that you are not really laughing because something is funny, Professor Bennett says after an extended period, the laughter becomes natural and contagious.
Laughter has long been recognised for its health benefits and Professor Bennett’s research supports the belief.
A randomised controlled trial he led compared mental health markers, focusing on depression and anxiety, to determine if laughter therapy could have a positive impact.
When people laugh, Professor Bennett says stress-relieving hormones such as dopamine, serotonin and oxytocin are released into the body, triggering mental health benefits and, potentially, an improved quality of life.
The trial of 150 patients found the markers of depression decreased in the laughter group more than those in the non-laughter control group.
“People with depression markers at the beginning of the trial, if they had laughter therapy, were far less likely to show signs of depression. If they weren’t in the laughter group, they were more likely to show signs of depression.”
“What we know from other chronic diseases is that laughter can increase pain thresholds, which decreases pain, it improves stress and can actually improve markers such as blood pressure and pulse for people with heart failure,” Professor Bennett adds.
“There are cardiovascular and mental health advantages of stimulating dopamine, endorphins, oxytocin and serotonin. Laughter also has some effect on natural immunity through an increase in NK levels when you laugh, which has a protective effect.”
Professor Bennett, whose research has included working in the US at Stanford University and Satellite Healthcare, a company that provides dialysis to over 8000 people, acknowledges that more research is required into many of these areas.
Nevertheless, he firmly believes laughter therapy is one of many important interventions.
He concedes acceptance of the complementary therapy among the medical community remains challenging, but having seen the benefits first-hand, is committed to championing its impact.
At some of the more progressive places, such as The University of California, San Francisco (UCSF) Osher Center for Integrative Medicine, which employs a dedicated full-time laughter nurse to help chronic disease patients through laughter, the therapy is fully supported.
“I’ve seen the benefits and the impact it can have on people, particularly those with chronic kidney disease and on dialysis,” he says.
“One nurse said: ‘that old guy hadn’t smiled or laughed in 10 years and here he is having a good time’. That’s the sort of story that you see and experience that has led me to continue this research.”
While general nurses do not conduct laughter therapy sessions themselves, they often take part in the experience to support and better connect with their patients.
Professor Bennett says nurses work in dynamic and stressful environment, and would too benefit from laughter therapy.
“It’s just one example of a suite of tools that you can use to decrease your anxiety and depression,” he suggests.
“I would encourage all people, whether they are a nurse or not, to seek out a laughter group in their own city or town and give it a go. It’s not for everyone but we know from our patients and some of our staff that about 80% of people love it once they start doing it.”
Looking ahead, Professor Bennett’s research will continue to focus on physical activity for people with kidney disease, especially meditation and laughter therapy.
“We’re looking for as many tools as we can garner and develop to improve people’s lives with kidney disease because it’s such a chronic disease and they have particularly unique issues that they have to deal with, such as high medication burden and high levels at fatigue,” Professor Bennett says. “Like everyone, different strategies will suit different people, so if we can work with people on dialysis, together we can make a positive difference to their lives”.