Talk turned serious -- painfully so, at times -- during the two hours of a Proactive Pain Solutions class at Sacramento's Mercy Midtown Medical Building.
Dr. Topher Stephenson, sitting ramrod-straight in the physician's archetypal white coat, knitted his brows and focused his empathetic brown eyes on three patients, one using a cane and another wearing a back brace. Chronic pain not only can affect the physical, the patients explained, it can decimate quality of life.
At one point, patient Eric Haynes couldn't help but cry.
"I'm just trying to deal with the pain and keep going," he told the group. "I don't want to do anything. ... But I don't want to give up on life, either."
On it went, sad stories of lives turned upside down, while Stephenson and Mercy behavioral health coordinator Pat Hanson offered soothing words and concrete coping skills. But near the end of the session, Stephenson looked at his watch and decided what everybody needed was a good laugh.
Seriously. Stephenson, who specializes in physical medicine and runs the spine program at Mercy in Sacramento, also has become something of an adherent to a trend in integrative medicine known as laughter yoga, which promises to do for the psyche what bikram yoga does for muscles.
So he tells the group members to gird for a brief but restorative session of mirth. He has them extend an imaginary string with both hands across their mouths and says to raise it a bit and laugh.
"Ha-ha-ha-ha-ha ... "
"OK, that was a nice and easy warm-up," Stephenson said. "I don't want to hear belly laughs yet. Just keep your teeth closed and do two more."
"Ha-ha-ha ..."
"Now, I want you to really let it rip, OK?"
"HA-HA-HA-HA-WHOA-HA-HA-HA ..."
Laughter reigned. The whole vibe of the room changed from sorrow to joy, at least for a minute. Everyone was smiling and chuckling after Stephenson finished and dismissed the group.
"This has really helped me," said Haynes, who is unable to work because of a chronic back condition. "And it's fun to do."
Research looking at the connection between mind and body suggests that repeated doses of laughter can indeed lead to positive physical changes. Building on the lay research by 1970s best-selling author Norman Cousins, who eased his autoimmune disease by watching "Candid Camera" episodes, doctors at Loma Linda University in Southern California have documented the effects of laughter in double-blind studies.
In a paper presented at the April meeting of the American Physiological Society, they found that the hormones beta-endorphins (which elevate mood) and human growth hormone (which builds immunity) increased significantly in patients exposed to "mirthful laughter."
Another study by the same doctors found that laughter reduced three key stress hormones -- cortisol, epinephrine and dopac -- by 38 percent to 70 percent. Significantly high levels of those three hormones have long been linked to compromised immune systems.
Stephenson was won over even before he became familiar with the scientific literature. In a break before starting medical school in the late 1990s, he attended clown college (Mooseburger University in Oklahoma) and graduated with honors. Using his alter ego, Bobo Doodlemeyer, Stephenson started a clown-care unit at the University of New Mexico Children's Hospital.
"When you get down to it, laughter promotes all kinds of good endorphins, which helps reduce pains and promotes deep breathing. A lot of these folks who are hurt just don't breathe well. Their breathing pattern is (shallow). Laughter gives you little squirts of dopamine, the feel-good reward chemical in the brain," Stephenson says
Erin Cote and Shannon Plaster, a Sacramento couple who attended the school, recently launched a business. It's called ULaugh, and it offers classes and workshops at local hospitals, businesses and even has a weekly telephone laughter therapy session.
They've made the rounds at places such as Sutter General Hospital in Sacramento, Mercy San Juan Pulmonary Rehab Center in Carmichael, the California Department of Health and American Lung Association of California.
When they worked with respiratory patients at Mercy San Juan, Cote and Plaster said they could see a noticeable change in the mood and look of patients after the session.
"People, when they walk in, are in the mode of their chronic illness," Plaster said. "They look a little tired, rundown, their energy is low. By the end of the class, they are beaming."
Cote says skeptics sometimes infiltrate their laughter sessions. Mostly, she said, they win the skeptics over.
"I find that when there's tension in the air, laughter relieves it," she said.
Outside of a medical setting is a different dynamic for the couple. They've done sessions with company human-resources departments -- a tough crowd to crack up.
So, aside from helping people with chronic pain, does laughter help with work stress or other psychic worries?
"We stress the habit of noticing and laughing with it or at the situation,"
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