Laughter Yoga Proves Laughter is the Best Medicine

Note: All photos in this blog post are credited to Cathy Greenblat, photographer and author of Alive with Alzheimer's.

Names have been changed.

As many of you know, I visited Lakeview Ranch in November, along with Laurence and Kathy Harmon of Great Places and the photographer Cathy Greenblat.

Cathy was on a mission when she visited Lakeview. Come hell or high water, she was intent on having a Laughter Yoga session with a group of Lakeview residents with dementia and had arranged for a lady to come to Lakeview Ranch to lead the session. Judy Berry, the owner of Lakeview Ranch, was all for it, as Judy is open to any new activities that will help her residents do and feel their best.

"Laughter what?," you might ask.

I'll start off by telling you that there are 6,000 Laughter Yoga groups in 60 countries around the world, so you know it's the real thing. Started by Dr. Madan Kataria and his wife Madhuri Kataria, Laughter Yoga is built on the principle that the body does not know when laughter is genuine and involuntary, or when laughter is fake and forced; the psychological and physiological benefits to the body are the same. Laughter lowers the level of stress hormones (epinephrine, cortisol, etc) in the blood. It fosters a positive and hopeful attitude, reduces stress and lessens feelings of depression and helplessness.

Laughter Yoga makes people laugh through a series of exercises to simulate laughter, intermingled with deep breathing exercises that might be familiar to those who practice yoga. Eventually though, participants are having so much fun that they can't help but laugh naturally. You won't find any lotus positions here. Instead you will find yourself miming daily activities such as answering the telephone, eating or riding a bicycle. You will exaggerate your actions and accompany each action with sounds, such as HO HO HO or hahahahahah. And at the end you will find yourself less stressed and much more positive. I was on a high for at least two days after our Lakeview session.

So why would you do Laughter Yoga with a group of people with dementia, some of whom are in wheelchairs and many of whom are fairly unresponsive? Well, there was something about the type of movement and the vocalizations that just seemed to make it an ideal exercise activity for a group of people with dementia. First, people do not need to be able to walk around or lie on an exercise mat to participate. Most of the exercises are done sitting in a chair, with the occasional exercise for those who can walk around slowly. Second, the movements are exaggerated as are the facial expressions, making these great connection tools between participants. Third, no long soliloquies are needed; just a "ho ho" if you can manage it. In addition, participants don't need to be able to remember anything: no objects, no memories, no long complicated strings of instructions, no reading... even if you are not quite sure what a "telephone" is and why you should answer it, (and better yet, why you should answer one that clearly doesn't exist), the actions only need to be mimicked, and everyone else seems to be having fun... so why not join in?

What also makes Laughter Yoga an ideal activity for people with dementia is that everything takes place in the moment and is geared towards ensuring a feeling of success and accomplishment for all participants. Most importantly, the activity reduces stress and depression without the use of medication. The positive "I can do" feeling lasts for hours afterwards, very important for people with dementia. How do you feel after having a had a riotous laugh? Pretty good, right? People with dementia feel that too. Caregivers of people with dementia who have participated in regular yoga sessions report that their loved one is more "present" for a couple of hours afterward. Now add laughter and imagine the impact!

A wonderful Laughter Yoga group leader by the name of Jody Ross from Minneapolis led our group at Lakeview Ranch. Young, approachable, positive and full of infectious energy, Jody was the ideal person to lead. Eight residents with dementia participated, along with Judy Berry, a few caregivers and nurses, a visiting family member, Laurence and Kathy Harmon and me. Cathy Greenblat alternated between joining in and taking photos, while Judy's husband Julius shot some video footage from the sidelines.

We sat in a circle, some in chairs and some in wheelchairs. Jody led us through warm-up exercises and we all felt a little silly, but willing to try more. We weren't sure how all this would pan out. Would the group have the patience to sit through it? Would they rebel? Would there be a mad dash for the doors? Would they start yelling at Jody? Everyone has sat through a painfully long group session, presentation, play or comedy or singing act where you just know it's not working out, to the point that it gets embarrassing and you just want it all to end and end quickly. That's not what happened here. Jody was prepared for a 20-minute session. But no one wanted to stop. Everyone was having too much fun. We went for almost an hour before we started to get the feeling that we'd all had enough; better to leave the party while you're still having fun!

I was seated between Chuck and Mel. Both had been part of hardworking farmer families, living on local farms and engaging in care for livestock, crops, family life and fishing. Both Chuck and Mel have what I would term "moderate" dementia. They were well able to carry out a conversation and Chuck in particular was very mobile and liked to be busy. They just weren't always living in the same reality as other people. Cal was sitting a few seats down. Cal had once had a brain tumor removed with the knowledge that the operation could eventually cause dementia, which it did. A tall strong man, Cal was (you guessed it) a one-time farmer, now pretty much restricted to his wheelchair and prone to dozing off in the middle of things.

Sitting next to Jody, the leader, was Anna, who liked to sit in her chair and pick up imaginary threads. I've included some photos here, taken by Cathy Greenblat, and in particular you can see the transformation of Anna, who started off thinking that this was all most disagreeable, and ended up hugging Jody!

I know instinctively that activity, particularly activity that promotes one-on-one interaction, can "bring back" a person with dementia, even if only temporarily. But even I was amazed at the effect of Laughter Yoga on this group, that started off sitting quietly, wondering what was going on, or dozing, or gazing disagreeably at the rest of the group.

In particular I recall Chuck and Mel doing the fishing exercise. During this exercise participants lean forward in their chairs and mimic the actions of "casting out" their fishing line. While they do it they shout "ho ho ho" or something like that. Then they "feel" something nibbling at their line and reel it in, while shouting "ha ha ha." When they land their "fish" they hold it up and laugh at it because it's so teeny, while gigggling and pointing at it and looking at everyone else's fish -- "hee hee hee!!!"


Of course anything to do with fishing went over well with this group of expert fisherpeople, and even Cal woke up for this one. In fact, Cal was alert for most of the time. In between exercises, Jody would have the group say "Ho Ho, HA HA HA" as a breathing exercise disguised as laughter.

At one point, Mel noticed a group of staff members standing behind some glass doors, watching us, and she leaned over to me and say "They must think we're crazy!" I loved this. Not only was Mel saying something so ironic, because it is the misfortune of people with dementia that most of Society WOULD call them crazy, even when not doing Laughter Yoga. But moreover, this person with moderate dementia noticed some people standing behind a glass door, knew that they were watching her, formed an opinion about how she felt about people watching her (didn't much like it), and made a comment to laugh it off. That's a lot of neurons processing. She was indeed coming alive.

Here is my most favourite moment. Anna, as I mentioned, had on her disagreeable face. I know this face well as it's the face my mother wore when she was unsure of the whole situation and wanted to hide her uncertainty and vulnerability behind a facade of distaste. Anna is fairly immobile, so she was in the circle and wasn't going anywhere, and she did not talk much at all. However, as the session progressed, she started to get more and more into it, and attempted some of the actions along with everyone else, and even started to make some of the sounds. Then Jody started the "Amazing" exercise. Part of Laughter Yoga is affirmation... affirming the value of each person in the room as a person with something important to contribute. This is not expressed explicitly, but is an obvious byproduct. As such, those of us who were able to get out of our chairs and walk around the circle, were to go to each person in turn and do the following: Lean down (important to get at eye level with people with dementia), point at yourself and yell "I'M AMAZING!" Then, point at the other person and yell "YOU'RE AMAZING!" Finally, put your arms in the air as if you were doing the Wave in a stadium and yell "WE'RE AMAZING!!" Then go on to the next person. Both people are doing this at the same time, so around the room you have alternating twosomes pointing and yelling about being absolutely amazing. When I went round to Anna, not only did she do the pointing, but she YELLED, and I mean YELLED, "I'M AMAZING, YOU'RE AMAZING, WE'RE AMAZING!!!!" Wow. Yeah, let's just write off all people with dementia, ok?

Here's a picture of Anna doing the AMAZING routine with Kathy Harmon. Amazing, huh?

Even George, sitting with his daughter, who had not woken up for the entire program, gave a laugh at the end. Every moment is precious; that moment meant the world to his daughter and to us, because for one second she had her father back.

After the whole upbeat feeling started to wane a bit, Jody pulled the session to its natural conclusion, with everyone agreeing that they wanted to do it again sometime.

At the end, Jody thanked everyone for participating, and in fact, I seem to recall going around and looking each person in the eye, bowing and saying "Thank You," and everyone saying "thank you" in return. Too often we assume that the person with moderate to advanced dementia does not know what's going on and so does not need to be addressed directly; we tend to talk around and over them. Saying "thank you" to each person in the group is important, because people with moderate to advanced dementia need to know that they have contributed something positive to your life, and that the "thanks" is genuine.

Mel and Cal, who was very awake by this time, decided it was time for coffee. Coffee and rural Minnesota go together like chocolate and peanut butter, so coffee was just a natural thing to have after Laughter Yoga. I went in search of coffee, poured two mugs and brought them over to.... Mel and Chuck. Sorry Cal. And who has memory loss here? I'll never forget his disgruntled look sitting over at the other table all by himself. Ahhh the guilt.

Jody, Judy, Kathy, Cathy, Laurence, Julius and the nurses and caregivers had a bit of a confab afterward about what had worked and what didn't work. I was busy pouring coffee (or rather, forgetting to pour coffee) so I missed out. However, between us we are putting together recommendations on how to adapt a Laughter Yoga session for people with dementia. To the best of our knowledge (and to Dr. Kataria's knowledge as Cathy had been in direct contact with him) it was the first time Laughter Yoga had been done with people with dementia as participants. But I can assure you it won't be the last.

If you are interested in learning more about Laughter Yoga, go to the main Laughter Yoga web site at http://www.laughteryoga.org/. Click on the "Find Clubs" link to find a Laughter Club near you. To date there is no central "Laughter Yoga for People with Dementia" resource, but we are working on it... However, you may be able to find a leader who has experience working with this population or with seniors. Before asking someone to lead a session for your group of people with dementia, I urge you to attend one or two sessions with the proposed leader and talk about the special needs of your community.