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appears that activation of the sympathetic nervous system was involved, as in Averill’s study (9).

Research examining how laughter influences stress hormones is somewhat conflicting. One early study looked at the results of viewing four different films on urinary excretion of epinephrine and norepinephrine in 20 female subjects (11). The four films were chosen to elicit different emotions. The first was a natural-scenery film, which was expected to be very bland and not to elicit any strong emotions. A second film was funny, and elicited mirth and laughter. A third film was a war movie and was used to elicit feelings of tragedy and sadness. The fourth film was a horror story chosen to elicit anxiety. All of the subjects viewed each film and served as their own control mechanism in a pre–post-test design. Urinary hormone levels were measured during a 90 min control period before each film, during each film, and finally during a 90 min post-film session. Urinary epinephrine levels decreased significantly during the natural-scenery film (P50.01). Urinary epinephrine

levels increased significantly during the war (P50.05). Urinary epinephrine and norepinephrine

increased significantly during the humorous (P50.05). Urinary epinephrine increased the dramatically during the anxiety provoking

film both film most film

(P50.05), and norepinephrine levels significantly during this film (P50.001),

also increased see Fig. 1 (11).

The authors concluded that there is a correlation between increased urinary excretion of epinephrine and strong emotional arousal, independent of the type of emotion being elicited. However, the lack of a control group, the use of an all female subject group, and the methodology involving the subjects all viewing the films in the same order, are weaknesses in this study. The results obtained could be due to the order of the films, as the first film lead to the lowest levels of hormone excretion, while the last film lead to the highest levels.

Building on this earlier work, a more recent project examined the effect of viewing a humorous film on a wide variety of stress hormones, using direct testing of hormone levels in serum (12). Subjects in the treatment group viewed a humorous video, while those in control


Film type



Post NE Pre NE Post Epi Pre Epi


  • 0


10 15 Mean urinary output



Figure 1. Histogram represents hormonal response to viewing four different film types by healthy women. Bars indicate mean urinary output of epinephrine and norepinephrine pre- and post-stimulus (11).

eCAM 2008;5(1)


group were kept in a quiet room for the same amount of time. Endocrine testing was performed pre, during and post stimuli. The results demonstrated that serum cortisol (P ¼ 0.011), growth hormone (P ¼ 0.0005) and plasma



of dopamine

(P ¼ 0.025),


decreased with laughter. There was no significant change in serum prolactin, beta-endorphins, plasma epinephrine or plasma norepinephrine in either the experimental or the control group. The control group demonstrated no significant changes in any of the endocrine measures used. The authors concluded that laughter decreases stress hormones, and could theoreti- cally act to buffer the effects of stress on the immune system. Because cortisol is immunosuppressive, the authors theorized that laughter could act as an immu- noenhancer by decreasing levels of this particular stress hormone (12, 13). This study, while controlled, used a rather small sample (n ¼ 10) and included male subjects only. It should also be noted that while some media releases have claimed that laughter makes people feel good because it increases beta-endorphins, this study did not support this proposed result.

In summary, the materials reviewed in this section support that the act of laughter can lead to immediate increases in heart rate, respiratory rate, respiratory depth and oxygen consumption. These increases are then followed by a period of muscle relaxation, with a corresponding decrease in heart rate, respiratory rate and blood pressure. The effect of laughter on the so called ‘stress hormones’ of epinephrine, norepinephrine and cortisol is equivocal, with the few studies conducted thus far demonstrating some conflicting results. This is important because it is theorized that if laughter does, in fact, decrease stress hormones, this would be one mechanism that might explain the proposed connection between laughter and immune function, and from there to improved health outcomes. The investigation into the effects of laughter on the endocrine system and the immune system is clearly an area in which additional research is needed. The next article in this series will review the evidence available thus far concerning how laughter influences various immune system components.


1. Bennett MP, Lengacher CA. Humor and laughter may influence health. I. History and background. Evid Based Complement Alternat

Med 2006;3:61–3.










influence health. II Complementary therapies and humor in a

clinical population. 2006;3:187–90.






  • 3.

    Paskind J. Effects of laughter on muscle tone. Arch Neurol Psychiatry 1932;28:623–8.

  • 4.

    Overeem S, Taal W, Ocal Gezici E, Lammers G, Van Dijk J. Is motor inhibition during laughter due to emotional or respiratory influences? Psychophysiology 2004;41:254–8.

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