[Part 1]

This article continues the discussion of why laughter is a great form of complementary therapy that deserves to be included in your Parkinson’s disease treatment plan. It was written after the implementation phase of a Laughter Yoga class for people living with Parkinson’s and their carers. The laughter session was arranged for a Parkinson Support Group in Sydney, Australia, so that group members would be offered an uplifting and enjoyable experience. The key messages of the session were about positivity and ways to manage anxiety.

Here is anecdotal evidence gathered through observations during the class, as well as personal interviews with participants afterwards. This was a 50 minutes class.




What the laughter session looked like
During the introduction, participants were presented with information about how a therapeutic approach to laughter, such as laughter yoga, may help people living with Parkinson’s. For example, laughter yoga reduces stress and anxiety because it involves laughter and deep breathing exercises, both of which activate the body’s relaxation response and reduce cortisol (stress hormone) levels in the body. It was explained that we receive some benefit every time we laugh, but in order to attain more of the benefits, we need to laugh for at least 10-15 minutes and the laughter needs to come from the diaphragm. This can be achieved through an exercise program, such as laughter yoga, because the benefits of laughter are too important to leave to chance.

Participants moved from a table setting into a seated circle and were informed that the class would involve clapping exercises, deep breathing exercises, laughter exercises and playfulness. They were given information about how to get the most out of the session, for example by using eye contact, being enthusiastic and by listening to their body to make sure there was no new pain. Participants were given the opportunity to assess how they felt at this point in time for their own self-awareness. They closed their eyes, tuned in to how they felt and ranked how they felt on a scale of 1-10 with one being the lowest and ten being the highest.

Participants were guided through warm up exercises, for example they smiled and inhaled as they raised the shoulders and exhaled as they relaxed them again. They were taught two clapping exercises – the ho ho, ha ha ha rhythmic clapping exercise and the Very Good, Very Good Yah affirmative clapping exercise. These clapping exercises would signal the end of laughter exercises. Participants were informed that by clapping with the hands parallel, for palm to palm, finger to finger contact, they would be able to stimulate acupressure points in the hands and increase energy levels. But they were also told to do the best they could and if something felt uncomfortable, to do what felt right for them or just smile and enjoy the sound of laughter around them.

The group was then guided through a breathing exercise. Participants inhaled, raised the arms and smiled then exhaled and brought them down again. On the third exhalation, they laughed the breath out. Other breathing exercises that worked well during the seated session included placing the palms together at the front of the body and making crocodile teeth with the fingers, inhaling and moving the arms apart, exhaling and bringing them back together then turning the palms and repeating the process. Also, bringing the palms out in front, making fists and inhaling arms towards the body then exhaling and letting go.

When participants were informed that we would now move into a laughter exercise, someone joked that the group may be laughing at him. It was important to establish that in laughter yoga, we laugh with people, not at them because that does not spread joy. From this point on, exercises alternated between laughter exercises, clapping exercises and breathing exercises. The first laughter exercise was a safe, non-contact greeting laugh – Namaste Laugh. The second laughter exercise involved safe, physical contact – handshake laugh. The third was more playful – electric shock laugh. The next round of laugher exercises involved a sequence designed by Merv Neal, master trainer from Melbourne Australia, to open the body and get the laughter to really come from the diaphragm. The following laughter exercises were designed around the theme of ‘Tea with Friends’.

The next segment was called ‘‘What Upsets You?’’ As mentioned to participants during the introduction, one of the benefits of laughter is that it allows unpleasant feelings to be released from the body. This segment provided the opportunity to create laughter exercises about things that may be experienced in everyday life that are unpleasant, but not too deep. Then by creating a laughter exercise about it, participants would have the opportunity to release unpleasant feelings stored in the body. An example was provided about someone who pushed in at the shops and then the offer was extended to the group. When presenting to a different seniors group, several participants shared their ideas, mentioned this part at the end and said that now they would just laugh in situations that annoyed them like when someone took their parking spot. No-one in this group volunteered to share ideas and that was okay. Every group is different and my personal preference for a long time was to release unpleasant feelings through more private exercises too. In the subsequent exercise, participants were invited to ‘dust off’ anything that they needed to get rid of, in order to feel lighter and happier, as they laughed.

Following the laughter workout, participants were led through a guided relaxation. After this, they closed their eyes again, noticed how they felt and ranked how they felt on a scale of 1-10. Participants opened their eyes and were invited to share their feelings. Words such as happy, positive and relaxed came up and these words formed the basis of the affirmation at the end of the session.





Parkinson Disease TreatmentTwo interviews were conducted by me, with participants who were keen to speak with me. The rest were conducted by the Group Facilitator two days later, whom I also later interviewed.

The laughter yoga class involved 12 participants including:

  • 7 people living with Parkinson’s
  • 3 carers (spouses)
  • The Facilitator of the Parkinson Support Group, a care administrator at the retirement village where the session took place, whose father also has Parkinson’s
  • 1 visitor, who joined the class half-way through
At the start of the class, it was important to establish safety within the group. Participants were encouraged to do the best they could and if something didn’t feel comfortable, to do what felt right for them or just smile and enjoy the sound of laughter around them. Early on, a participant joked that the group may be laughing at him. It was also important to establish that in laughter yoga, we laugh with people, not at them. We can laugh at ourselves or with someone who is laughing at him or herself, but not at people because that does not spread joy.

At the start of the class and at the end of the class, participants were asked to close their eyes, notice how they felt and to rank how they felt on a scale of 1-10 with one being the lowest and ten being the highest.




Participants feedback

Here is some of the feedback shared by participants:

  • ‘‘There was something for everyone. It took me a while to get warmed up but I liked everyone’s enthusiasm.’’
  • ‘‘I liked that the whole group came together. My score went up.’’
  • ‘‘I thought that the exercises were good, beneficial and I found it a positive experience.’’
  • ‘‘I came in feeling really down. When you came in and made us laugh, it was hard at first. Especially with Parkinson’s, you feel like your smile is forced. I came in here feeling a 4/10. After I felt a 7 or an 8. It seemed to relax me. The whole group relaxed. They lost their embarrassment and engaged readily. I found the laughter very infectious.’’





None of the participants reported any negative feelings from the session.

One particular participant needed to leave the session promptly due to his routine, so I was not able to speak with him afterwards. I was however, able to speak with his wife. She said, ‘‘With Parkinson’s, you can’t express what you really feel. People say ‘Look at that angry man out there.’ When this participant shared his feedback with the Group Facilitator days later, he said, ‘‘I loved the hand exercises. My mood was up and I thought about the session all of that day and the next.’’ In addition, he wanted to pass the following document A letter for my friends onto me and I would like to share it too.




Observations

The Group Facilitator, who invited me to present to the group, observed several benefits of the class. For example, it was seen to:

  • Improve Mood. ‘‘With chronic illness, it’s doom and gloom all the time. When you have an allied health professional come in, they often talk about the negative symptoms of the condition. People in the group may think, ‘Is that going to happen to me?’ The laughter session lifted the mood and brought the group together.’’ (Read more on how laughter helps uplift mood-states.)
  • Reduce Anxiety. Laughter yoga involves laughter exercises and deep breathing techniques that lower cortisol (stress hormone) levels in the body and activate the body’s relaxation response. According to the Group Facilitator, ‘‘The most crippling part of Parkinson’s can be the anxiety. Laughter yoga focuses on positive ways of managing symptoms.’’ (Read more on how laughter alleviates anxiety and stress.)
  • Provide Rhythm through Rhythmic Clapping. Laughter yoga also involves rhythmic clapping. One of the clapping exercises is to the rhythm of ho ho, ha ha ha – which are sounds that come from the diaphragm. The Group Facilitator said, ‘‘People who freeze need a rhythm. When someone freezes, we get beside them and we march to the rhythm of 123, 123 and this helps them to get moving again. I suspect the rhythm of the clapping may help in the same way and reduce freezing.’’
  • Increase Voice Volume. Symptoms of Parkinson’s may include speech and voice disorders, such as speaking with a soft voice. The Group Facilitator felt that the deep breathing exercises and laughter exercises, that encouraged participants to use the diaphragm, were helpful. She said, “Laughing from the diaphragm encouraged people to increase their volume or maintain their volume because they have to use the diaphragm to increase volume.’’
  • Initiate Movement. Certain laughter exercises involve safe, physical contact such as a handshake. The Group Facilitator stated, ‘‘People with Parkinson’s may have trouble initiating movement. By you reaching out to shake someone’s hand, that initiates movement.’’
  • Exercise Facial Muscles. Another symptom of Parkinson’s is decreased facial expression or ‘masked face’ and people may find it difficult to use their facial muscles. ‘‘Getting people to laugh encourages them to use their facial muscles. It shows you can laugh even though you may not be able to use all the facial muscles’’, the Group Facilitator expressed.

It was clear from this initial session that the overall mood of the group improved and many group members reported that they had a positive experience. From this experience, it seems that further research on Laughter As A Complementary Therapy For People With Parkinson’s would be beneficial, particularly to determine whether the results could be sustained over a period of time.




Parkinson’s resources

Relevant links

Is laughter part of your Parkinson’s disease treatment plan? Join the conversation by leaving a comment below!