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Humor is no laughing matter to the psychologists who study its potential as a healthcare intervention. To date, the medical and dental academic communities do not teach the implementation of humor formally as an aspect of patient care. Yet, the distress experienced by many prior to their interactions with dentists and physicians make it worthy of consideration. Below, experts weigh-in on the connection between mood and the perception of emotional and physical pain.
Evidence shows anxious parents are “emotionally infectious.” For example, parental stress contributes to heightened pain and anxiety in preschoolers during immunization.1
There is also evidence that dental patients benefit from distraction techniques. In fact, a new study shows that prior to induction of anesthesia preceding ambulatory surgery, viewing cartoons and sit-coms reduces anxiety for a smooth transition to an anesthetized state.2 This randomized controlled study of 89 children consisted of a treatment group (funny video) and a control group (traditional distraction technique). The video group had significantly less anxiety than the control group. One of the coinvestigators of that study, Jill Chorney, a psychologist at the Centre for Pediatric Pain Research at IWK Health Centre in Nova Scotia, Canada, said: “It was shocking to see how incredibly powerful our intervention effect was — about the same pharmacological effect as taking a benzodiazepine. The brain can only do so many things at once, so if it’s fully engaged by a distractor, it’s harder to process pain signals neurologically.”
A 2012 pilot study of six participants awaiting life-saving organ transplants at the University of Arizona Health Sciences Center, Tucson, measured clinical health outcomes of 20 minutes of laughter.3 Psychological measures (Profile of Mood States, Beck Anxiety Inventory, Beck Depression Inventory-II) and physiological measures (heart rate, attenuated heart rate variability, blood pressure) were taken at baseline, after one week of no treatment, and again after two weeks of 20 minutes simulated laughter approximately every other day. The laughter group had improved mood (vigor, activity, friendliness), less anxiety and decreased heart rate variability. While its small size isn’t statistically meaningful, its findings warrant a follow-up study.
Rod A. Martin, PhD, CPsych, a professor and author of The Psychology of Humor: An Integrative Approach jokes with clients. “When laughing at something, you’re not as likely to be afraid of it,” he explained. His own dentist uses self-depreciating humor such as “making fun of his personal characteristics about his Italian heritage,” Dr. Martin said, “but he never jokes about his expertise or competence as a dentist.” Dr. Martin explained research has demonstrated humor’s analgesic effect. “When people are laughing at something funny they actually experience less pain, likely due to increased production of endorphins in the brain. At the same time, though, I think humor needs to be used judiciously. If a dentist is constantly cracking jokes, patients may be concerned that he or she isn’t very competent, is not really taking their fears seriously, or will not respond very sympathetically when they’re experiencing pain.”
A 2012 Stanford University study found that the experience of funniness for highly socially anxious individuals is complex.4 Appreciating a joke depends on who is doing the telling. The dental team should, therefore, formally ask or indirectly determine whether or not each patient would appreciate hearing jokes during their visits and make a note in their records.
Dentists can tell funny stories about things that have happened to them, or that they heard in the news or seen on the internet. Ideally, humor with patients is spontaneous, genuine, and not forced.
A mask and goggles conceals the facial cues patients subconsciously rely on to evaluate their safety. At times like these, patients may appreciate a joke to desterilize the situation. The good kind of groans — ones at a bad joke — can be elicited from even an overtold pun.
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1. Bearden DJ, Feinstein A, Cohen LL. The influence of parent preprocedural anxiety on child procedural pain: mediation by child procedural anxiety. J Pediatr Psychol 2012;37(6):680-686.
2. Mifflin KA, Hackmann T, Chorney JM. Streamed video clips to reduce anxiety in children during inhaled induction of anesthesia. Anesth Analg Oct. 9, 2012.
3. Dolgoff-Kaspar R, Baldwin A, Johnson S, Edling N, Sethi GK. Effect of laughter on mood and heart rate variability in patients awaiting organ transplantation: a pilot study. Altern Ther Health Med 2012;18(4):53-58.
4. Samson AC, Lackner HK, Weiss EM, Papousek I. Perception of other people's mental states affects humor in social anxiety. J Behav Ther Exp Psychiatry 2012;43(1):i625-631.
A tradition of working for the dental profession. The Chicago Dental Society was organized in 1864 and incorporated in 1878. The objective of the Chicago Dental Society is to encourage the improvement of the health of the public, to promote the art and science of dentistry and to represent the intrest of the members of the profession and the public that it serves.
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