Bill Jee Malik Jafer - Healing-With-Happiness

Earnings
from this book and our other
happiness building programs and activities
sponsor Healing with Happiness programs for
orphans and vulnerable children, people living
with HIV, hospice patients, the needy, and their
caregivers did you know that caregivers are angels?

InHappiness International Happiness Institute
ACKNOWLEDGEMENTS
InHappiness takes this opportunity to thank
the following organizations. Their help and support
enabled the development of the JOYGYM Happiness System.
USAID/PEPFAR (United States Agency for International Development,
The United States President's Emergency Plan for AIDS Relief)
University of the Witwatersrand Center for Excellence in Palliative Care
Department of Education Gauteng Province (South Africa)
HPCA (Hospice Palliative Care Association of South Africa)
SACBC (Southern African Catholic Bishops' Conference)
Department of Social Development (South Africa)
Hospice in the West (Krugersdorp South Africa)
Matlosana Hospice (Klerksdorp South Africa)
Laughter Yoga International (Mumbai, India)
Hospice Association of the Witwatersrand
(Johannesburg & Soweto, South Africa)
AngloGold Ashanti (South Africa)
Xstrata Minerals (South Africa)
FHI (Family Health International)
EAP Association (South Africa)

Standard Bank (South Africa)
Sparta Foods (South Africa)
Cotlands (South Africa)
DEDICATIONS
From the Authors
We dedicate this book to all children.
May you have long, healthy and happy lives.
From Bill
To Peter and Lillian Webber and Sannie Grobler.
Your lives taught me Happiness Intelligence.
From Malik
To my compass and rudder. Thank you Ambereen for your love,
joy, happiness and laughter. Thank you for accepting this adventure
with me, and for putting up with me along the way. I love you.
From Memory
To my children a constant source of fun and happiness in my life
and to the memory of my late mother. Thank you for believing in me.
ABOUT US
InHappiness International Happiness Institute was founded
in Mumbai, India and currently works from Johannesburg, South
Africa to build global Happiness Intelligence. We are non-profit

all monies earned go to sponsoring happiness programs for orphans
and vulnerable children, people living with HIV, hospice patients,
others in need and their caregivers.
Happiness Intelligence helps us develop a more fulfilling,
happier, healthier, and longer life. Build your Happiness
Intelligence and happiness will follow.
JOYGYM Happiness System is a proven positive psychology
based system to help build Happiness Intelligence. JOYGYM is
delivered in two streams: Aerobic Laughter (practical training or
therapy) and Happiness Coaching.
Aerobic Laughter a powerful cognitive behavioral therapy
and one of the most effective positive psychology interventions.
Happiness Coaching education, self discovery, and positive
psychology techniques are delivered with guidance, support and
encouragement to help build Happiness Intelligence.
HappyMetrics All our programs are evidence based.
HappyMetrics provides happiness assessment to track your
happiness, measure changes, and monitor your results.
Healing with Happiness Is a JOYGYM psychosocial support
program helping tens of thousands of orphans and vulnerable
children, people living with HIV, hospice patients, the needy, and
their caregivers to lead happier and healthier lives.
Happiness University Happiness-U.org opens online mid-
2011 with online Happiness Coaching to build Happiness
Intelligence in all corners of the world.
Happyness Advantage corporate happiness consulting and
coaching service. JOYGYM can boost productivity, engagement,
sales, and profit. Happiness provides a real business advantage.
Natural Laughter spontaneous joyful laughter and non-verbal
emotional communication native to children. Aerobic Laughter
enables adults to reconnect with this beneficial laughter.
Unhappifiers the bad guys responsible for most unhappiness
today: stress, anxiety, depression, burnout, grief, trauma and
post-traumatic stress disorder.
JOYGYM Experience one-day happiness and laughter
adventure introducing Happiness Intelligence, Aerobic Laughter,
and the new science of happiness.
JOYGYM Foundation two-day training in Aerobic Laughter
practice and kick starting Happiness Intelligence.
African Happiness our charitable program to bring Healing
with Happiness psychosocial support to 15 million orphans and
vulnerable children, people living with HIV, hospice patients,

people in need and their caregivers. We need your help to make
this dream come true!
Happiness Volunteers Trained happiness volunteers provide
Happiness Coaching and therapy to build community happiness.
Start or join a Happiness Volunteer Club in your company or
community.
Happiness Shop your can buy happiness! Visit our online
shop at WWW.HAPPINESSSHOP.ORG to buy courses, coaching,
materials and sponsor happiness programs.
VISIT US ONLINE AT WWW.JOYGYM.ORG
Preface: Bill Gee
My journey into spreading happiness started when I joined Dr. Madan
Kataria, founder of Laughter Yoga International in Mumbai, India.
Laughter s potential to heal the damage caused by modern stress excited
me. It became my mission.
Id been a casualty of stress and felt its destructive power.
I left my comfortable south-east Asian island life and moved to the
colorful bedlam of Mumbai, India.
Dr. Kataria was a gifted teacher. His work with deaf children, mentally
challenged children, and street kids was an inspiration.
In my work as a director of Laughter Yoga International I collaborated

with laughter professionals around the world a terrific opportunity to
exchange ideas and learn from their experience.
We re-imagined Laughter Yoga training, researched the benefits of
laughter on health and in the workplace, trained the governments
disabled support organization, and arranged worldwide training tours.
We worked with schools to transform the learner and teacher experience
and boost academic results, and collaborated with a Canadian laughter
professional that introduced Laughter Yoga into aged care facilities.
As I leant more about the power of laughter to heal, I was saddened
because laughter s therapeutic power was not taken seriously.
I dreamed of laughter and happiness healing individuals and improving
business, healthcare, the armed forces, government, and education.
Making that dream come true became my purpose.
UNHAPPINESS IN AFRICA
In 2007 I travelled with Dr. Kataria to bring Laughter Yoga to Africa.
Hospice workers told of the extreme and widespread unhappiness caused
by the African HIV and AIDS pandemic, and the heavy toll inflicted on
caregivers, victims and the community.
Later that year I moved to Africa with Dr. Katarias blessing to bring
laughter and happiness to those wounded by HIV.
Two-thirds of all people infected with HIV live in sub-Saharan Africa.

More than 15 million have died here 1.3 million children and adults in
the last year.
Imagine the suffering of their families and the impact on the economy.
While treatment is starting to reduce the impact, Africa will pay a
terrible price for generations to come.
HEALING WITH HAPPINESS
I founded InHappiness International Happiness Institute to develop a
happiness system combining positive psychology and laughter therapy.
Four years later we are proud to offer:
JOYGYM a proven positive psychology evidence-based happiness
teaching and coaching system
Aerobic Laughter a powerful cognitive behavioral therapy, one of
the most effective positive psychology interventions
Healing with Happiness a successful psychosocial support program
helping tens of thousands of orphans and vulnerable children, people
living with HIV, hospice patients and their caregivers to lead happier
and healthier lives
JOYGYM programs have been presented at scientific conferences, been
adopted by some of the worlds leading NGOs, and have gained the
support of USAID for orphans and vulnerable children programs.
HAPPINESS INTELLIGENCE
As we rolled out our programs we saw that we were not simply providing
knowledge and effective new skills.
Our trainees were changing in a deep and fundamental way.
They developed a new consciousness a moment to moment awareness
of how events and relationships were impacting on their happiness.
They used their new skills to manage events and relationships to reduce
unhappiness and increase happiness in themselves and others.
They internalized the knowledge of how happiness affects their body,
mind, immune system, emotions, values and beliefs, and became
fiercely protective of their happiness.
They developed Happiness Intelligence!
This exciting insight crystallized our understanding and provided clear
direction for our work: Happiness Intelligence is the key to happiness.
If we could help people to build happiness Intelligence, then happiness
would follow.
DELIVERING HAPPINESS INTELLIGENCE
InHappiness is dedicated to building Happiness Intelligence.
Were developing innovative new programs and delivery channels.
Healing with Happiness provides effective, low cost psychosocial support
on a large scale.
Our business programs help organizations develop Happiness

Intelligence.
Happiness-U, an online university will provide Happiness Coaching and
build Happiness Intelligence worldwide.
I hope our work will raise and earn money to deliver the Healing with
Happiness program to the tens of millions children and adults suffering
as a result of the AIDS pandemic.
Lets make the 21st century the Age of Happiness.
Johannesburg, South Africa April 2011
Preface: Malik Jaffer
I first encountered Aerobic Laughter therapy during the Hospice
Palliative Care Association annual conference in 2008, where Bill spoke
and ran an Aerobic Laughter workshop.
I tend to be skeptical and analytic, but found myself intrigued. I
somehow recognized that happiness and laughter have a powerful
potential for healing and decided to explore this further.
I began to study happiness and positive psychology, and read books,
scientific papers, news articles, and blogs everything I could get my
hands on.
Guess what I learned?
Happiness and laughter are good for us.
This learning and knowledge provided the analytical base to substantiate

what I intuitively knew to be true.
I committed that my family and I would live a life filled with laughter
and happiness, through good and rough times.
WHY ISNT IT OUT THERE?
As I experienced the power of laughter and happiness to improve life, I
was amazed that we dont all practice happiness in our everyday lives.
Many people feel anger, pessimism and despair as their primary emotions
rather than happiness, optimism and hope.
Positive psychology shows that happiness can be built and learned.
Science shows the clear benefits of happiness.
Aerobic Laughter provides a fun and easy way to beat stress and build
joyfulness.
Why werent we all using these tools to build happiness in everyday life?
MY JOURNEY
My experience with mind, body, spirit interaction began when I was very
young. In my early years I learned the value and practice of meditation.
I also learned mind improvement techniques and read The Power of
Positive Thinking. These impacted me in ways that I still carry with me.
As I grew older, there were times when I became engrossed in the
material aspects of life and my mind, body, spirit alignment went
dormant.
My choice of career in Public and International Health has been a
catalyst in getting me re-aligned.
In 25 years I have had worked and visited more than 50 countries. Im
grateful, humbled and fortunate to have had the opportunity to serve
others and positively impact on the lives of millions.
Ive seen happiness and joy in the eyes of children around the world.
Their eyes glow and faces radiate the same way everywhere.
It doesnt matter what their clothes or house look like, where they live
happiness sparkles equally in the eyes children of all ages.
There is nothing more satisfying than seeing happiness on someones
face.
For all who read this book and for those who are touched by those who
read the book, my wish is that you are blessed every day of your life
with happiness.
I hope we motivate you to pursue and build your Happiness Intelligence.
I pray we can touch millions with happiness, one person at a time.
Johannesburg, South Africa April 2011
Preface: Memory Matanda
I discovered Aerobic Laughter therapy in 2009.
A SKEPTIC
I intuitively grasped that laughter was beneficial, but as a psychologist I

found it hard to believe the results I was shown. I grappled with the lack
of empirical scientific evidence to back up these benefits.
I joined InHappiness to help develop a solid evidence-based scientific
approach and assessment program.
I soon attended my first Aerobic Laughter therapy training sessions to
oversee the implementation of the Healing with Happiness assessment
program.
When we returned two weeks later for follow up assessment, I was
amazed by the obvious and visible transformation. The sad and gloomy
caregivers I had met were now lively, playful, happy and energetic. They
greeted us with warm laughter and a spring in their step.
Our assessments confirmed significant reduction in stress and
depression. The challenges these caregivers faced had not disappeared
or changed, but their outlook towards these challenges was far more
positive.
The stories of personal transformation that I had not believed were
playing out before my eyes.
They were assimilating our training and techniques to build Happiness
Intelligence and transform their lives.
I was humbled to receive testimonies from caregivers who had not been
coping and were now upbeat about their lives. I could see visible
changes by the end of their one-day training.
I watched this process repeated at the next group, and then at dozens of
groups where we introduced the Healing with Happiness program.
I found that the program was responsible for profound changes in
severely stressed people. Healing with Happiness helped them to
overcome severe stress, depression, burnout, grief, trauma and post-
traumatic stress disorder, to identify and reframe their stressors, and to
bounce back very quickly from adversity.
I was overjoyed when we received funding to extend our Healing with
Happiness monitoring and evaluation from two weeks to six months.
We gained deeper insights and evidence of the programs impact on
caregivers and downstream participants. We saw significant life
improvements and dramatic increases in Emotional Intelligence continue
throughout the six month period.
A BELIEVER
I have worked in the HIV and AIDS sector in Africa since 1988 and seen
the extreme psychosocial suffering it has caused firsthand.
Healing with Happiness cannot stop that suffering, but it can vastly
improve the quality of life of all people affected by the HIV and AIDS
pandemic.
Its like a happiness virus that takes root in caregivers and quickly
spreads to the adults and children they care for, and then to their
families and friends and into the communities.
We need to spread this happy virus through the HIV and AIDS networks,
and through other caregivers to those they care for around the world.
It is my prayer that the JOYGYM system will spread happiness while
helping us to fund the task of bringing happiness and healing to more
than 15 million children orphaned by AIDS and others suffering from the
AIDS pandemic.
Johannesburg South Africa April 2011
First edition published May 2011 ISBN 978-0-9870062-0-2
Published and distributed by Happiness University Press.

PO Box 91096, Auckland Park 2006, Johannesburg, South Africa.
Email: press@happiness-u.org Website: www.happiness-u.org.
Printed by Ultra Litho, Johannesburg
The following terms are trademarks of InHappiness
(International Happiness Institute):, Aerobic Laughter,
Happiness University, Happiness-U, HappyMetrics,
Healing with Happiness, InHappiness, and JOYGYM.
The authors do not dispense medical advice or prescribe the use of any
technique as a form of treatment for physical, emotional, or medical problems
without the advice of a medical practitioner. The intent of the authors is to
offer information of a general nature to help you in your quest for happiness.
Printed on paper
manufactured from
sugar cane fiber
and CoC certified
sustainably grown
timber produced with
chorine free eco-
friendly bleaching.
www.sappi.com
This work is licensed under the Creative Commons At ribution-

NonCommercial-ShareAlike 3.0 Unported License. To view a copy of this
license, visit http://creativecommons.org/licenses/by-nc-sa/3.0/ or send a
letter to Creative Commons, 444 Castro Street, Suite 900, Mountain View,
California, 94041, USA.
You are free to Share to copy, distribute and transmit the work, to Remix
to adapt the work, under the following conditions:
Attribution You must attribute the work in the manner specified by the
author or licensor (but not in any way that suggests that they endorse you or
your use of the work).
Noncommercial You may not use this work for commercial purposes.
Share Alike If you alter, transform, or build upon this work, you may
distribute the resulting work only under the same or similar license to this one.
With the understanding that:
Waiver Any of the above conditions can be waived if you get permission
from the copyright holder.
Public Domain Where the work or any of its elements is in the public
domain under applicable law, that status is in no way affected by the license.
Other Rights In no way are any of the following rights affected by the
license:
Your fair dealing or fair use rights, or other applicable copyright exceptions
and limitations; The author's moral rights;
Rights other persons may have either in the work itself or in how the work is
used, such as publicity or privacy rights.
Notice For any reuse or distribution, you must make clear to others the
license terms of this work. The best way to do this is with a link to http:/
creativecommons.org/licenses/by-nc-sa/3.0/.
CONTENTS
Section 1: HAPPINESS
Re-discovering Happiness .................................... 1
The New Science of Happiness .............................. 4
Happiness Myths .............................................. 10
Happiness ...................................................... 13
Unhappiness ................................................... 18
Stress ........................................................... 18
Unhappifiers .................................................. 26
Depression ..................................................... 27
The How of Happiness ....................................... 32
Emotional Intelligence ...................................... 36
Happiness Intelligence....................................... 37
Building Happiness ........................................... 40
Delivering Happiness ........................................ 41
Happiness University ........................................ 43
JOYGYM Happiness System ................................. 46
Elements of Happiness ...................................... 47
Aerobic Laughter ............................................. 50
Understanding Laughter .................................... 51
Is Laughter the Best Medicine? ............................ 55

Natural and Organic ......................................... 57
Laughing with Children ...................................... 64
Learning Aerobic Laughter .................................. 68
JOYGYM Programs ............................................ 71
The Happiness Advantage ................................... 74
Organizational Programs .................................... 77
Happiness through Service ................................. 81
Happiness Volunteers ........................................ 83
Section 2: HEALING WITH HAPPINESS
Healing with Happiness ..................................... 89
The AIDS Pandemic ........................................... 89
The Caregiver Explosion .................................... 91
Caregiver Syndrome ......................................... 93
Patient Syndrome ............................................ 95
OVC Syndrome ................................................ 97
Our Commitment ............................................. 99
Defining the Goals ........................................... 99
Development ................................................ 100
Section 3: HEALING WITH HAPPINESS CASE STUDY
The Case Study .............................................. 105
Roll Out ....................................................... 107

Notes on the Case Study ................................... 108
Does HWH Build Happiness? ............................... 110
Happiness .................................................... 110
Yes. HWH builds Happiness ............................... 114
Can HWH Heal Caregivers? ................................ 114
Stress and Depression ...................................... 115
Coping ........................................................ 121
Resilience .................................................... 123
Burnout ....................................................... 125
Emotional Intelligence ..................................... 126
Work Relationships ......................................... 129
Home/Family Relationships ............................... 134
Mindfulness .................................................. 138
Adaptability ................................................. 140
Positivity ..................................................... 142
Well-Being ................................................... 144
Physical Health .............................................. 146
Life Change .................................................. 148
Yes. HWH Heals Caregivers ................................ 150
Can HWH Improve Care? ................................... 150
Absenteeism and Presenteeism........................... 151

Productivity ................................................. 154
Quality of Care .............................................. 156
Yes. HWH Improves Care .................................. 158
Can HWH Heal Patients? ................................... 158
Healing Patients ............................................ 159
Yes. HWH Helps Heal Patients ............................ 162
Can HWH Heal Orphans and Vulnerable Children? .... 163
Healing Orphans and Vulnerable Children .............. 163
Yes. HWH Helps Heal Children ........................... 169
In Their Own Words ........................................ 169
Section 4: BUILDING HAPPINESS
The Next Steps .............................................. 175
You Can Help ................................................ 177
Thank you ................................................... 179
REGISTER YOUR COPY ONLINE (registration code)................. 180
ABOUT THE AUTHORS ................................................... 181
EXPRESSION OF GRATITUDE ............................................ 182
RESOURCES AND REFERENCES ......................................... 184

H E A L I N G W I T H H A P P I N E S S
Re-discovering Happiness
Twenty-first century science has developed amazing new tools and
technology.
For the first time we are able to look inside the human mind and body
and watch what is happening in real time.
What researchers and scientists are seeing is often very different from
accepted knowledge. Theyre creating a new understanding of how our
bodymind works.
The distinction between body and mind is fast disappearing we are
one interlinked and interdependent system.
One of the most surprising discoveries is the importance of happiness,
and the powerful effects of both happiness and unhappiness on our
bodymind.
Happiness is a major determinant of our mental and physical health, our
success in all aspects of life, and even how long we live.
Our happiness level is much more important than we believed.
HAPPINESS DRIVES SUCCESS
Twentieth century wisdom told us that success would bring us
happiness.
We created a work ethic that increased chronic stress to the highest
levels in history and made us increasingly unhappy.
The new science shows that stressing to become successful is likely to

lead to failure, poor health, and even an early death.
The truth is that happiness drives success.
Happy people are more successful. They make better decisions, earn
more enjoy better mental health, and better marriages.
A study that considered results from more than 275,000 people
worldwide showed that happier people enjoy greater job satisfaction,
have enhanced social relationships, have more friends, receive more
support and assistance from coworkers and supervisors, suffer less
depression, and are less likely to use drugs than their unhappy peers.
Happy people tend to have more positive perceptions of themselves and
others, are more sociable, active, likeable and cooperative, are more
adept at solving problems, have higher energy levels and show increased
creativity.
They cope better with stress, are better negotiators and are better at
conflict resolution. Happy people are better and more efficient decision
makers.
Happy people are the first to be employed, get promoted faster, perform
better, earn more money, have greater influence on group decisions, and
perform more helpful acts of kindness. Happy people are more

successful in education. They learn faster, retain knowledge longer, are
better at applying knowledge, and perform better in tests and
examinations.
The research is in increased happiness will make us a better and more
successful brother, sister, mother, father, parent, child, friend,
volunteer, student, employee, manager or boss.
It is human nature to seek and enjoy happiness.
The new science of happiness shows that building Happiness Intelligence
is the natural way to achieve happiness.
HAPPINESS DRIVES GOOD HEALTH
Happiness improves health dramatically.
We dont yet fully understand how this happens. We know that happiness
profoundly affects the immune system, and perhaps activates and boosts
our natural (homeostatic) healing system.
Scientists are quickly uncovering and beginning to understand the
secrets of bodymind medicine.
Happiness therapy is a powerful tool for prevention, healing and
maintaining good health.
Happy people enjoy improved mental and physical health.
They are less likely to suffer from anxiety, social phobias, and depression
and are better at coping with stress and bouncing back from adversity.
Happy people report better health and fewer unpleasant physical
symptoms. They take fewer days off work for health problems, are
relatively more energetic and more likely to engage in physical exercise.
Happy people have lower blood pressure and a lower incidence of
cardiovascular disease. They heal and recover from surgery faster.
They are less likely to engage in harmful and unhealthy behaviors
including smoking, unhealthy eating, drug and alcohol abuse, and risky
sexual behavior.
Happy people have stronger immune function that protects against colds
and flu and provides increased resistance to infection. A study of nearly
ten thousand adults in Australia confirmed that happiness has a positive
effect on general health.
Sick people that are happier are more compliant with treatment and
experience less pain. Happiness can slow disease progression and reduce
mortality in a wide range of conditions including chronic heart disease,
cancer and HIV and AIDS.
Studies confirm that happy people survive longer after serious illness.
Happier patients with terminal renal disease survive longer. Women with
breast cancer recurrence who manifest joy are more likely to survive.
Happier spinal cord injury patients live longer. Optimistic men are less
likely to die of coronary heart disease.
HAPPINESS DRIVES LONGEVITY
Happy people live longer.
The connection between happiness and longevity has been confirmed in
studies around the world, with happier people shown to live from 7 to 12
years longer than their unhappier peers.
European research into twenty-eight studies on happiness and longevity
showed that happiness predicts longevity among healthy populations.
Happiness extended life the same amount as not smoking. A Yale study of
660 seniors confirmed that happier people lived 7.5 years longer.
All-cause death rates for happy people are lower. Lower death rates are
noted from causes ranging from traffic accidents to cancer, and from HIV
to suicides.
A study of the lives of 180 Catholic nuns in convents showed that their
happiness levels when young (average 22 years old) accurately predicted
how long they lived. The happiest 25% of these nuns lived almost eleven
years longer than the least happy quarter.
Another study rated photographs of 230 American baseball players taken
in 1952 on the intensity of their smile. Gloomy players lived an average
of 72.9 years, while those that looked happiest lived to 79.9 years
seven years longer.
Researchers found that happiness reduced blood pressure and
cholesterol levels in a sample of nearly 100,000 women. The happier
women had developed 9% less heart disease and their risk of dying from
any cause after eight years was 14% lower.
A study titled Dont worry, be happy followed 1,739 adults in their
mid-forties for ten years. On a one-to-five happiness scale, every one-
point increase reduced the risk of coronary heart disease including heart
attack by 22%.
The desire to live longer has fascinated us since the beginning of time.
The Use of proven techniques to build Happiness Intelligence, may add
seven, ten or perhaps even more happy healthy years to our lives.
The New Science of Happiness
SCIENTISTS, ARMED WITH NEW TECHNOLOGY RE-DISCOVER THE

IMPORTANCE OF
HAPPINESS.
LOGICALLY, THEY TURN TO PSYCHOLOGISTS AND ASK HAPPINESS
IS REALLY IMPORTANT. HOW CAN WE BECOME HAPPIER?
UHMMM, SAID THE PSYCHOLOGISTS. WE DONT KNOW.
A TWENTIETH CENTURY FABLE
Twentieth century psychology focused on helping damaged or unhappy
people to become normal.
When science discovered the importance of happiness, normal was no
longer good enough. We dont want to be normal, we want to be
happier!
POSITIVE PSYCHOLOGY
Psychology quickly responded. At the 1999 annual conference, American
Psychology Association president Martin Seligman announced the launch
of positive psychology a new discipline focused on making people
happier and more positive.
Positive psychologists around the world turned to the study of happiness.
For the first time, scientific method is being applied to find out how to
make humans happier.

Before this turn of events, anyone could say take my course, buy my
product, follow me, and you will become happier.
Now positive psychologists have scientifically assessed thousands of
happiness techniques and interventions to verify which ones really help
to build happiness or reduce unhappiness. Those that work are further
assessed to understand how they work and how they can best be
applied.
Positive psychology has progressed quickly over the past decade with
important new discoveries being made weekly.
DIFFERENT WORLDS
Each of us lives in a different world.
When we are happy, our world can be a great place, filled with fun,
satisfaction and people that we enjoy interacting with.
On the other hand when we are unhappy or angry or depressed, our
world can be a miserable place full of annoyances and disappointments.
We may feel that other people are there just to make us unhappy, and
we even wish that they would go away and leave us alone.
Where would you rather live? Most people choose the happy world.
Positive psychology tells us that we have the power to decide which of
these worlds to inhabit. Given the right techniques and training we can
take control of our own happiness.

HAPPINESS IS A CHOICE
Many people take a fatalist view of happiness:
You seem sad today John.
Yes, I got out on the wrong side of bed.
This attitude implies that there is some outside person or force
determining Johns level of happiness.
The reality is quite different. There is no one with a remote control and
wicked sense of humor that decides, Im going to make John wake up
miserable this morning. Or tomorrow decides, Hell wake up happy,
but at noon Ill crash his mood.
Mood is a choice that we have the power to control.
All we need is the right tools and the determination to use them well.
HAPPINESS AND UNHAPPINESS
Happiness and unhappiness are separate emotional forces that exist and
act on us independently.
The term positive affect is used to describe things that make us
happier, and negative affect is used to describe things that make us
unhappier.
Good things and bad things happen, and that triggers an emotional
response in us.
The degree to which these things make us happy or unhappy depends on
how we choose to respond to them.
With the right tools the power is ours.
HAPPINESS CAN BE MEASURED
We cant manage what we dont measure.
A range of assessments can measure aspects of happiness and
unhappiness separately and in combination.
Reliable measures exist for anxiety, burnout, coping, depression,
Emotional Intelligence, happiness, gratitude, meaning in life, negative
affect, positive affect, positivity ratio, resilience, satisfaction with life,
stress, well being and more.
Other assessments can help us to measure physiological variables that
are clearly linked to aspects of happiness.
Measuring these variables before, during and after different happiness
interventions shows us how well they work, and helps us to create a
clear and accurate evidence base.
HAPPINESS IS CONTAGIOUS
Both happiness and unhappiness are contagious.

Get on a bus where someone wont stop complaining about something,
and chances are that well get off the bus more stressed and unhappy
than when we climbed aboard.
Get on another bus where someone is celebrating a wonderful event or
cracking happy jokes, and chances are well get off feeling happier.
American professors from Harvard University and the University of
California published a study that followed 4,739 individuals from 1983 to
2003 to track how happiness spreads.
They found that happiness is contagious up to three degrees of
separation (for example, to the friends of ones friends friends).
People surrounded by happy people are more likely to become happy in
the future.
Nearby mutual friends that become happy increase our probability of
happiness by 63%.
Similar increases are seen when co-resident spouses, family members
and next door neighbors become happier.
When a friend living within half a mile becomes happy, our chances of
happiness increase by 42%. Increase the distance to a mile (about 1.6
km) and this reduces to 25%. At two miles it drops to 22%, and drops
further at greater distances.
HAPPINESS IS SOCIAL
Happy people have more friends, and lonely people are less likely to be
happy.
This isnt rocket science. Happiness is contagious. We seek out and
spend time with happy people because it makes us happier.
That means that happy people are more popular. They enjoy a richer
social life and have more friends.
If we are unhappy, were less likely to have lots of friends and more
likely to be lonely.
Thats also simple: when we feel unhappy, we interact with people in a
negative way and they avoid us to protect their happiness.
Beware. Unhappiness and loneliness are also contagious.
POSITIVITY
Positivity is really important to our happiness.
Research shows that we pay more attention to bad things that happen to
us and make us unhappy (negative affect) than to good things that make
us feel happy (positive affect).
We also dwell on bad things for longer than on good things.
Positive psychologists calculate that we need three or more good things
to compensate for every bad thing.

A ratio of three positives for every negative provides a happy balance in
our lives where we can operate well and flourish.
This ratio of positive affect to negative affect is called positivity ratio
an important measure of happiness, health and success.
INCREASING OUR POSITIVE AFFECT
Positive psychology has discovered many proven ways to increase our
positive affect.
This sounds easy, but not every technique works for everyone. It takes
commitment to learn and try different ways and find those that work
best for you, then discipline to practice them and create new happy
habits.
DECREASING OUR NEGATIVE AFFECT
Decreasing our negative affect is a bit more difficult, but provides
greater increases in positivity and happiness.
Most negative affect is related to stress, anxiety, depression, burnout,
trauma, post-traumatic stress disorder and grief the unhappifiers.
Positive psychology has developed proven new techniques to prevent and
counter these without the use of pharmaceuticals.
SELF DISCOVERY
A good place to start is using a process of self discovery to identify
personal unhappifiers. Once we know our enemies it is easier to find

ways to deal with them.
Self discovery can also help to build mindfulness, a powerful tool for
reducing negative affect.
JOYGYM is a powerful system that combines stress reduction, stress
prevention and stress management techniques that build resilience and
coping skills, techniques that help us reframe stressors, and even
techniques that help us to prepare for known stressful events like
presentations, job interviews and exams.
Finding the techniques that work best for you and incorporating them
into your life can make a dramatic difference to your happiness levels.
WHAT DETERMINES YOUR HAPPINESS LEVEL?
It turns out that each of us has our own unique level of happiness.
About 50% of our happiness level is determined genetically.
If we tend towards happiness, we should thank our parents.
A further 10% of our happiness level is determined by life factors that
are quite difficult to change, for example place of birth, career and
marriage status. It is possible to change these factors, but making
changes can be disruptive and stressful.
The remaining 40% of our happiness level is up to us!

That changes the game.
We alone are responsible for our own happiness.
REVERT TO NORMAL
Our happiness level is not fixed its dynamic and subject to change.
When good things happen it increases, and vice versa.
In most cases, changes in happiness level are short lived. We tend to
revert to our normal happiness level.
We believe that if something amazing and wonderful happens lets say
we win the lottery then well suddenly become much happier.
But studies of lottery winners show that they may be happier for a
while, but they soon revert to normal.
The opposite is also true. Victims of crippling accidents reported short-
term unhappiness, after which their happiness tended to revert to
normal.
THE NUDGE EFFECT
Can we change our normal happiness level?
Yes we can.
By working to increase our positive affect and decrease our negative
affect we can increase and slowly raise our normal happiness to a higher
level.
This is not an overnight process.
Working at it for a few days or weeks may induce temporary change, but
the effects wont last.
Work and dedication are required to find the changes that work for us
individually and then practice them until we create new happy habits.
This change in lifestyle and continued practice can slowly nudge our
set point up a little every day. Eventually well achieve lasting change
and a happier, healthier you.
Happiness Myths
A few happiness myths that have gained wide acceptance can actually
cause great unhappiness.
HAPPINESS IS NOT WHEN
You will be happy when
you finish school, get your degree, get your first car, move out of
home, graduate, grow up, get your first paycheck, get married,
lose your virginity, have a child, buy a house, get that raise, and
so many more whens
10
Its a lie.
Some of these events might increase our happiness for a short time, but
this boost soon disappears.
How long does the thrill of that new car last? Generally as long as the
new car smell. Then we get used to it and life returns to normal.
Happiness is not a when. When is a destination.
Happiness lies in the journey. Happiness lies in every minute of every
day. Its up to us to seek it out, nurture and enjoy it.
Forget the destination and enjoy every minute of the journey.
THE STRIVING FOR SUCCESS LIE
Another lie is that success brings happiness.
In this lie, success is measured in Dollars or Pounds or Rupees.
We authors have visited, lived in or worked in more than 60 countries
interacting with people at all levels of income.
Most of the happiest people weve met are among the poorest, and most
of the deeply unhappy people weve met are those with the most money.
Real success isnt measured in money.

Its time we realize that real wealth comes from a life well lived, from
the satisfaction of working to increase our own happiness and the
happiness of others.
In these terms, many poor fishermen and farmers are wealthier than
lots of millionaires.
The quest for money drives stress and can easily become an obsession
that robs our mindful enjoyment of each moment.
Dont confuse net worth with self worth.
Wealth and success are what we believe them to be.
They come from a happy life well lived.
11
EMPTY PROMISES
Twentieth century advertising implies that we are miserable and will
always remain miserable, and are probably are not deserving of
happiness.
Unless we buy
this washing powder, dishwashing liquid, insurance, banking, or
brand of fashion, cosmetics, accessories, car, ketchup, computer,
phone, pad, political party, candidate
Ads work hard to show cool, hip and happy people that achieve a
blissful state by making the right purchase.
Its a lie!
Those are actors modeling in cleverly written, styled and produced
fiction.
Advertisers spend millions to produce these ads hoping to influence our
next purchase.
Do you think they care about our happiness?
Or taking our money?
The clever psychological programming built into ads really can convince
us that well feel happier.
Its an empty promise.
Any flashes of gratification we may experience dont contribute to our
Happiness Intelligence.
BUYING HAPPINESS
Advertising promotes the myth of buying happiness.
This lie led to an explosion of wasteful consumerism that has gobbled up
planetary resources, made a few people very wealthy, and tricked huge
populations into working harder and harder to try to buy their way to
happiness.
In the past 30 years we have consumed one-third of the planets natural
resources to manufacture products that are almost all (99%) thrown

away within 6 months.
This ridiculous lie is based on the false value that our worth is based by
on how much we spend.
12
We urge you to visit www.storyofstuff.org, a remarkable website that
will help you to start developing real consumer intelligence and reduce
your part in this wasteful road to unhappiness.
Research is pretty clear on money and happiness.
If we dont have enough money to pay for a roof, food and basics, then
more money will buy us happiness.
Once were past that threshold, more money doesnt buy happiness. In
fact in most cases it causes stress and worry that can reduce happiness.
Theres one way we can buy happiness: invest time or money to help
others become happier.
Happiness
Everyone is different and unique, which means that there is no universal
formula for happiness.
Having said that, we are learning a lot about what makes most people
happy.
JOYFULNESS
This wonderful happy feeling is familiar to people who laugh or play a
lot, genuinely have fun, or practice Aerobic Laughter.
Joy is a raw and powerful feeling that lifts our spirits and our mood
instantly. Joyfulness can melt away stress, leave us cheerful and build
resilience.
We often experience flashes of joy, but there are ways to stretch that
feeling and elevate our state of happiness.
Joy is pure positive affect.
Find out what gives you joy and practice it often.
13
POSITIVITY RATIO
The ratio of positive to negative events in our life reflects directly on
our happiness and ability to flourish.
When positivity ratio reaches 3 we become happier, and also much
better at relationships and performance.

Increasing our positivity ratio is not just about making more good things
happen in our life. Reducing the bad things increases our positivity ratio
even more.
Reducing stress and negativity is a great investment.
Our attitude and mood play a strong role here because we tend to get
back what we give. If we are miserable to others then they are more
likely to be miserable back to us.
Improving our attitude and optimism and taking steps to increase the
happiness of those around pays big positivity ratio dividends.
OPTIMISM
Try to see things in a positive way.
Our brain judges things by comparing them to other things.
When things happen to us (the fact), our brain invents or provides an
alternative to compare that event to. Lets call it a counterfact.
Lets say we bite into an apple and theres a worm in it. Whats the
counterfact?
If it is: Why me? Thats disgusting! then weve turned that event into a
negative affect that will make us unhappier.
If we think: Wow, Im glad I got that apple and not my guest then
weve managed to turn that event into a positive affect.
Remember that counterfact is a choice. By mindfully choosing worse-

case counterfacts, we can build optimism, positivity and happiness.
Make this a habit and you can change from a glass half empty to a
glass half full person.
MINDFULNESS
Many people rush through life like someone running blindfolded through
a forest, just bouncing off the trees and bushes they happen to run into.
14
Mindfulness can change that.
Being mindful means opening our eyes to the repercussions of all that we
do, and of all that happens to us. Being a non-judgmental observer
creates a new awareness of how people and events influence us - and we
influence them.
The practice of mindfulness brings wisdom and opens our eyes in the
forest so we can decide what we to bump into or avoid.
Because we are all unique, the valuable lessons of mindfulness can only
be found through self discovery.
Once we learn what makes us feel happy, what makes us feel stressed,
and how our actions make other people feel happy or stressed, we can
take control of our life in a new and masterful way.
SATISFACTION
We are as happy as we feel.
Joe who lives in a $75,000 house in a suburb of $50,000 houses probably
feels much happier than Jack who lives in a $75,000 house in a suburb of
$100,000 houses.
Much of our happiness comes from subjective comparison.
Even though they both live in $75,000 houses, Joe is more satisfied with
his house, because Jack compares his house to the bigger and better
houses around him.
Comparing ourselves or our situation with other better situations will
make us unhappy.
Understand that people in the bigger houses are not necessarily happier.
Happiness isnt about living in a bigger house its about living in a
happy house.
Happiness lies in being satisfied with what we have.
STRENGTHS AND FLOW
Every one of us is gifted with special talents and strengths.
We should discover our strengths and exercise them in our work, our
family life and our play.
By exercising our strengths well get more done and have more fun doing
it.
15
Intensively doing things we enjoy and are good at energizes us and
induces a wonderful state called flow.
During flow we become immersed in what were doing and lose track of
time and other things happening around us.
Exercising our strengths is a sure way to happiness.
SOCIAL EXCHANGE
We are social by nature.
While some people may find happiness in solitude, for most of us
loneliness brings unhappiness.
A rich social network provides support and builds happiness.
How we interact with people whether we contribute to their
happiness drives our social network.
Think about the most popular people you know. If theyre not rocks stars
or famous, theyre probably also the happiest people you know.
The more happiness we spread, the more it comes back.
VOLUNTEERING
Giving service to others is a fast track to happiness.
There are countless opportunities to help others. Voluntary service
makes the world a better and happier place. Well also learn new
skills and meet new people.

If we contribute to the happiness of others, happiness shall be returned
to us in spades.
MEANING AND PURPOSE
Are you drifting through life without a rudder without meaning and
purpose?
Think about it. What are your values?
Dont just accept what weve been told or what you think is right or
politically correct. Consider them seriously as if your life depends on it.
One day it may.
We should discover what we really, really believe in.
Life is a series of decisions. Making decisions can be stressful.
16
Five or ten values that we believe in can transform our life.
Clear values act as signposts to guide our decisions and move our life in
a consistent and meaningful direction.

Values create purpose.
Meaning and purpose provide a deep and lasting happiness.
HEALTH AND WELL-BEING
Look after yourself.
Happiness drives good health, and good health builds happiness.
Learn to eat healthy. A well balanced diet can prevent health problems.
Exercise. Walk when you can, swim and get active. We were designed to
be active. A recent study showed that too much sitting increases the risk
of cancer.
Learn about and cut down on the chemicals we are exposed to.
Get into nature, stop rushing and make time to rest and relax.
Our bodies are a wondrous instruments, be kind to it, love it and it will
contribute to our happiness.
A LIFE WELL LIVED
Imagine being near the end of your life looking back.
How will you feel about your life?
Did we learn from our mistakes and grow stronger, care about those
around us, work to bring happiness to others, look after our health,
improve ourselves and the impact of our actions, exercise our strengths,
and live a life of meaning and purpose?
Will we feel proud and satisfied with a life well lived?

Will we feel happy?
17
Unhappiness
Imagine a new virus that shortened our lifespan by ten years.
It would be a global health emergency. Governments would scramble to
discover and roll out a cure.
Yet unhappiness is allowed to drive ill health and early death and nobody
appears to notice.
UNDERSTANDING UNHAPPINESS
Happiness and unhappiness coexist as separate forces. Both spread
through emotional contagion.
Happiness can improve our life and health, and even give us extra happy
years.
Unhappiness often driven by stress, anxiety, depression, grief, trauma,
post-traumatic stress disorder and burnout affects us the opposite

way.
Lets review these unhappifiers, then look deeper into the dangers of
stress and depression.
Stress
Stress plays a leading role in global unhappiness.
Chronic stress grinds away at our mental health causing emotional
damage and physical illness. Long-term stress even rewires our brain,
leaving us more vulnerable to everyday pressure and less able to cope.
Over time, chronic stress can cause anxiety, depression, eating
disorders, and substance abuse.
Long-term stress can cause serious health problems as it disrupts nearly
every system in our body. It can raise blood pressure, suppress our
immune system, increase the risk of heart attack and stroke, contribute
to infertility and speed aging.
18
Stress causes or accelerates most illness and disease.
Stress levels have been increasing steadily over the past century with no
end in sight.
Although stress related illness, disease and conditions are known killers,
we seem to accept stress as a fact of life to which there is no solution.

Thats not true. There are many natural ways to reduce stress exercise
and meditation are growing in popularity. There is a desperate need for
education on how stress works and how to manage it naturally.
Through education and building stress mindfulness we can live much
better and longer lives.
WORKPLACE STRESS
Twentieth century management strategy can be paraphrased as if you
want people to work harder, stress them.
As a result, workplace stress is skyrocketing. Ever-increasing stress levels
are costing companies and governments billions of dollars every year in
lost turnover and reduced productivity, and costing individuals their
health and happiness.
New science clearly shows that stress doesnt make people work harder
or better, rather, it reduces productivity, boosts absenteeism, and
increases health care costs.
THE STRESS RESPONSE
The human stress response is controlled by the amygdala part of our
limbic brain that acts as our bodys security control center and scans all
our senses for danger 24 hours a day.
When the amygdala senses danger, it triggers our stress response,
instantly releasing a cocktail of stress chemicals, hormones, and

neuropeptides into our bloodstream.
These chemical messengers race through our bloodstream to deliver
instructions to every organ and body system on how to react to the
perceived stress.
This fight or flight response prepares us to cope with perceived dangers
and maximizes our chances of survival.
Thousands of years ago the danger might have been an angry lion
threatening to attack.
19
Imagine yourself armed with a stick facing an angry and roaring 500-
pound cat with big fangs and sharp claws you have little chance of
running away. A response that enables you to run faster, hit harder and
jump higher than ever before, to fight or flee would really improve your
chances of survival.
Our body still responds to stress in exactly the same way.
The chemical messengers cause some of our body systems to become
turbocharged for maximum performance, while body systems and
organs not needed to survive the life or death struggle are slowed or
even switched off so all our energy is available for the intense action of
fighting or fleeing.
STRESS AND OUR BODY
These chemical messengers instruct our body systems to act in order to
maximize our chances of surviving the attack.
Adrenaline pumps up our major muscles to give us almost superhuman
physical abilities.
Our liver releases reserves of glucose into the blood to provide fuel for
action, and our lungs start pumping short sharp breaths to quickly
deliver more oxygen. Our heart pumps furiously to deliver the fuel and
oxygen to all parts of our body.
Blood vessels constrict to reduce blood loss in case we are wounded.
Body systems not needed for the expected action are switched off or
slowed, including our digestive system, sexual/ reproductive system, and
our circadian clock.
This hardwired sequence of events plays out in our body even for minor
stresses, and not only for a lion attack.
Did you spot the underlying causes of diabetes, heart disease, high blood
pressure, digestive, sexual/ reproductive and sleep problems in the
above sequence?
As stress levels continue to increase, these diseases and conditions
increase to their highest levels ever.
IMMUNE STRESS
Our immune system is also reset by the stress messengers.
20
Think of the immune system as a team with many different specialized
players, with each player working, dying and constantly being
replenished by the body.
Immune cells dont live long constantly replenishing them uses
significant energy.
To maximize this energy for fight or flight, the stress messengers disable
(or reduce production of) most of these team players, leaving us
susceptible to colds, flu and other infection.
A few immune team members are not switched off in fact they are
turbocharged to help prevent infection and reduce bleeding in case we
are wounded.
Without the rest of the team members to guide them, these players can
rampage and attack healthy parts of our body, causing autoimmune
diseases like arthritis, eczema, fibromyalgia, inflammation, irritable
bowel syndrome, multiple sclerosis, lupus, psoriasis, rheumatoid arthritis
and more.
An imbalanced immune system can result in serious allergic reactions
and asthma.
A recent study showed how stress disrupts the immune system, resulting
in inflammation that can lead to asthma, rheumatoid arthritis,
cardiovascular disease, depression, and certain types of cancer. Another
study shows that building happiness and reducing stress extends the
lifespan of our immune cells, boosting our natural protection system for
better health.
This immune stress response is a great reaction if we were facing an
occasional lion attack, but the chronic stress of modern life means that
it is triggered almost continuously, causing chronic health problems that
build unhappiness.
THE STRESS-MONKEY RESPONSE
Stress can make monkeys of us by reducing our brain function.
The brain parts we use to make reasoned decisions, practice Emotional
Intelligence, communicate and empathize, innovate and be creative, are
slowed or switched off by the stress messengers.
Our cortex is a powerful reasoning and decision-making tool, but it takes
longer to receive sensory information, process it, take decisions and act
upon them than our amygdala and limbic brain.
21
Because we need the fastest responses possible to cope with a lion

attack, the stress response chemically shuts down our cortex during
the stress response.
Intelligent people often become incoherent during job interviews, well-
prepared students can freeze up and perform badly in examinations, and
many people are immobilized when asked to speak to a large audience
or to meet new people.
The stress response can leave us behaving like monkeys.
The chronic stress of modern life leaves us functioning with reduced
mental capacity for extended periods.
SWITCHING EMOTIONS
The stress response can shift us from happiness into a negative
emotional state in an instant.
Imagine you are driving its a wonderful day, you're feeling happy,
enjoying the sunshine and singing along to your favorite song. Suddenly,
the driver ahead of you brakes sharply.
The amygdala senses danger and triggers the stress response. It helps us
to stop the car in time, but switches us instantly into a state of negative
emotions.
We may respond with anger and even aggression or violence.
Even at our happiest, the stress response can switch us into negative
emotions like anger, anxiety, bitterness, fear, frustration, jealousy,

panic, rage and righteous indignation.
Even small stresses can negatively impact on our mood.
The ever increasing levels of chronic stress we live with make negativity
and mood swings more prevalent, wiping the smile off our faces, and
driving us towards depression.
DISCONNECTING FROM OUR VALUES
The stress response can disconnect us from our deeply held values and
beliefs.
Consider a dog lover walking with their young child. Suddenly an
unknown dog runs up barking and growling. Under the influence of the
stress response they may lash out violently towards the dog, perhaps
injuring or killing it.
22
Consider the non-violent nice guy who explodes with road rage.
Consider a nation of people who love their neighbors, but when faced
with the stress of a threatened attack by another country will urge their
leaders to declare war and even send their sons and daughters into
battle.
These people are driven to act in ways contrary to their values and
beliefs by stress.
Our self image is based on our beliefs.
We may believe that we are nice people, or gracious, or open to change,
but stress can cause us to behave in ways contrary to those beliefs.
Disconnected from values and beliefs, the stress response can cause us
to live in ways that cause deep long term unhappiness.
TOXIC STRESS
The stress response is hardwired and involuntary once it starts we
cant stop the release of the stress cocktail that prepares us to fight or
flee.
These substances are powerful. If they remain in our body for too long or
in high concentrations they can be harmful and even toxic.
Major stresses trigger their release in large quantities, but even small
quantities triggered by smaller stressors can rapidly accumulate to levels
where they can cause lasting harm.
THE DE-STRESS RESPONSE
Our body is also hardwired with a system that can quickly clear the
stress cocktail from our blood and reverse the ill effects of the stress
response.
The human de-stress response is triggered automatically after the
intense physical activity of fighting or fleeing is over.
After strenuous exertion from running to escape the danger, or struggling

to overcome and chase the lion away, we are left gasping for air using
our entire lungs to take deep breaths using our diaphragm.
The deep diaphragmatic breathing signals our amygdala that the danger
is past, and it triggers our de-stress response.
23
In addition to quickly metabolizing and reducing stress substance levels,
the de-stress response triggers the release of natural pain killers into our
blood.
These endorphins natural opiates and muscle relaxants and
endocannabinoids powerful pain killers and mood elevators relax
tense or sore muscles, alleviate pain from injury or muscle strain, and
restore a positive emotional state.
HOMEOSTATIC HEALING
The de-stress response triggers our natural (homeostatic) healing system
that scans our body then acts to return all our systems to a normal well-
functioning state.
Our heart rate slows, blood pressure and blood sugar levels normalize,
and the digestive, sexual reproductive and circadian clock return to full
operation.
The de-stress response is natures perfect antidote to the stress

response.
It clears toxic stress substances from our blood, resets our body systems,
deals with any pain caused during our fight or flight, and leaves us
relaxed and feeling happy.
MODERN LIFE AND THE DE-STRESS RESPONSE
If your boss or a customer says something to upset you, do you hit them
and start a fight?
If youre late for a meeting, stuck in traffic and become stressed, do you
leap out of the car and start running?
Modern life has socially reprogrammed us not to engage in the physical
exertion of stress-induced fight or flight actions.
While this makes it easier for us to live together and get along, it means
that we no longer trigger our natural de-stress response.
The combination of ever-increasing stress levels and this lack of de-
stress is causing chronic high concentrations of stress chemicals in our
bodies that are driving huge increases in stress related illness and
disease.
24
Levels of heart disease, hypertension, depression, diabetes, asthma,
allergies, sleep problems, digestive problems, sexual/ reproductive

problems, arthritis and other illness are soaring.
Stress is killing us.
DE-STRESS OPTIONS
We need to find and practice new ways to reduce stress levels or face
ever increasing unhappiness, health problems and costs.
Exercise can mimic fight or flight activity and trigger our natural de-
stress response. Strenuous exercise that gets our heart pumping and
results in diaphragmatic breathing is the best way to naturally de-stress.
Instead of regular exercise were increasingly abandon active movement
for the convenience of sitting, driving or using public transport and
waving a remote control at our television.
Our amygdala may be telling us to exercise, but our cortex finds excuses
to put it off. We need to get to the gym, run or find other ways to
exercise strenuously to reduce the levels of stress cocktail in our blood.
CEOs of some of the worlds leading corporations maintain their health
and keep their brains sharp for peak decision making under stress by
exercising in their office or private gym.
Hearty laughter has the same effect, triggering diaphragmatic breathing
and the de-stress response and boosting joyfulness.
Massage, yoga, meditation, time spent in nature, relaxing and sleeping
also reduce stress levels to a lesser degree, but perhaps not enough to
counter our lifestyle of chronic stress.
PROACTIVE STRESS MEASURES
Proactive interventions can significantly reduce stress.
Improving stress management and coping skills and building resilience
are good investments.
Work to build new lifestyle skills and habits that increase happiness,
mindfulness and Emotional Intelligence.
Positive psychology provides interventions to teach these skills, and is
searching for new ways to deliver this knowledge on a vast scale.
25
Unhappifiers
Anxiety, burnout, trauma and grief account for a great deal of
unhappiness
ANXIETY
Anxiety is a mental state that results from a stress or difficult challenge
for which we have insufficient coping skills.
Anxiety is a normal reaction to stress. Thinking about stressors can help
us to deal with tense situations, study harder for an exam, or keep
focused on an important issue.
But anxiety can also become a source of stress, causing a vicious circle
with increasing levels of stress and worry.
Physical symptoms of anxiety include ongoing worry and tension,
irritability, muscle tension, headaches, sweating, difficulty
concentrating, frequent bathroom visits, tiredness, sleep problems, and
being easily startled.
Reducing stress and working to build happiness can provide a solid
defense against this dangerous and disabling disorder.
BURNOUT
Too much stress for too long can lead to burnout a state of emotional,
mental, and physical exhaustion that can leave us feeling disillusioned,
helpless, hopeless, cynical, resentful, and completely worn out. Burnout
reduces our productivity and saps our energy.
Workplace burnout is becoming a serious health and productivity
problem. In a UK study more than half the workforce reported symptoms
of burnout within the previous six months.
Burnout is most prevalent in relational and service professions that
involve emotional contact with customers or patients.
High risk occupations include health care, teaching, law, and call center,
sales, and customer service occupations.
The incidence of burnout is on the rise globally with cases of burnout
being identified across communities including students, housewives, and

people with illness, disease or medical conditions.
26
TRAUMA AND GRIEF
Psychological trauma occurs as a result of a traumatic event.
Grief is a type of trauma caused by the loss of someone or something to
which an emotional bond existed.
Trauma can affect peoples ability to cope with stress in their life,
causing a dangerous condition known as post-traumatic stress disorder.
These conditions are more frequent in southern Africa due to the high
incidence of HIV and AIDS and violent crime.
Trauma manifests in the lives of people living with HIV and other serious
illness, often resulting from confirmation of their HIV status or illness.
Orphans and vulnerable children are particularly vulnerable to trauma
and grief. Many have witnessed one or both parents die from what can
be a long illness. Stigma, isolation and having to move to a new home or

institution can compound the trauma leading to post-traumatic stress
disorder, regression or withdrawal.
Grief affects caregivers when they lose patients they cared for. They can
struggle to get back into their normal routine after the loss of a patient.
Unresolved grief may result in post-traumatic stress disorder and spill
over into their personal lives.
There is an urgent need for psychosocial support to prevent, counter and
heal these problems.
Depression
Depression is one of the fastest growing and most dangerous human
diseases.
More than 120 million people worldwide are affected.
Depression drives more than 850,000 people to suicide a year, and is the
leading cause of disability worldwide measured by years lost to
disability.
27
In addition to causing deep feelings of unhappiness, depression stops the
brain from experiencing positive affect and happiness.
Brain scans of depressed people show little or no activity in the
happiness processing areas, and high levels of activity in areas that

process negative emotions.
In prolonged depression, happiness processing areas in the prefrontal
cortex and hippocampus areas can shrink, while the unhappiness and
stress controlling amygdala increases in physical volume and activity.
AN INCREASING PROBLEM
A hundred years ago, the chance of experiencing major depression
during ones lifetime was only 2-3%. The incidence of depression has
steadily increased to ten to 25% today.
In one country 60% of locally born residents were found to experience
depression.
A hundred years ago depression typically started around the age of 35.
After World War I depression was starting by age 15. After World War II
depression was seen in children as young as 5 years old.
Today even toddlers are depressed.
Studies have discovered depression in preschoolers. A Danish study
identified mental health problems in 16-18% of children 1 years old.
STRESS AND DEPRESSION
Depression is a complex disease that can occur as a result of a multitude
of factors.
For some, depression occurs due to a loss of a loved one, a change in
one's life, or after being diagnosed with a serious medical disease. For
others, depression just happens, possibly due to their family history.
Stress and depression are closely related. While stress may not be the
only cause for depression, it is often tightly bound with other causes
such us grief, personal disputes, physical, sexual, or emotional abuse,
serious illness, substance or emotional abuse, and social isolation.
CO-MORBID DEPRESSION
Depression is seen in physically healthy people, but often together with
other medical problems.
28
In the US for example, depression is found in 25% of cancer patients, up
to 27% of post stroke patients, substance abusers, and diabetics, 1 in 3
heart attack and HIV patients, 50% of Parkinsons disease patients, up to
75% of eating disorder patients.
THE UNHAPPINESS ACCELERATOR
Stress can contribute towards or accelerate depression.
Depression reduces our ability to cope with and bounce back from stress,
while causing additional stress.
Both stress and depression act to accelerate many diseases and medical
conditions and can increase mortality.
Worsening health can increase both stress and depression.

This combination of cause and effect can result in a dangerous spiral of
increasing levels of debilitating stress and depression.
It is important that depression is quickly diagnosed and treated before it
causes serious health damage and unhappiness.
Unfortunately few cases of depression are diagnosed perhaps less than
20% and of those, even fewer receive treatment.
DEPRESSION IN PREGNANCY
Depression in pregnancy is risky for both mother and child.
Depressed women often take poor care of themselves. They may smoke,
drink to excess, or neglect proper diet.
Their babies are often irritable and lethargic, with irregular sleep
habits, and may grow into infants who are underweight, slow learners,
and emotionally unresponsive with behavior problems such as
aggression.
In the same way that a new scale needs to be set to zero, a fetus
natural (homeostatic) healing system is setting its zero point that will
comprise this new persons normal.
If the mother is depressed during pregnancy, the fetus adopts the
elevated levels of stress hormones and other disruptions in blood
chemistry as being normal and is born with a profile that mimics its
mothers prenatal state with elevated cortisol, lower levels of dopamine

and serotonin, greater relative right frontal electroencephalograph
activation and lower vagal tone.
29
Because the childs homeostatic system regards these levels as normal,
they may experience sleep problems at 18 and 30 months and lifelong
problems in coping with stress and difficulties in emotional control.
Perinatal depression is associated with infants and childrens
vulnerability to depression, reduced brain development, affective and
interpersonal functioning, electroencephalograph and neuroendocrine
abnormalities.
Mothers depressed during pregnancy were four times as likely to have
children who were violent at age sixteen.
YOUTH DEPRESSION
One in five teens will suffer from depression before adulthood. At any
one time 10-15% show symptoms and 5% suffer from major depression.
Episodes of teen depression typically last 8 months and recur in more
than 70% of cases.
Depressed teens are at high risk for other problems: 30% develop
substance abuse problems, have fewer friends, get sick more often, are
less likely to be successful in their education and careers, and more

likely to struggle with relationships, have trouble at school and in jobs,
and engage in risky sexual behavior.
Depression in teens can significantly reduce their chances of a happy,
healthy and successful life.
Untreated depression is the major cause of teen suicide and the third
leading cause of teen deaths. Depressed teens are twelve times more
likely to attempt suicide.
Teens have to rely on their parents, caregivers and teachers to identify
symptoms of depression and refer them for treatment.
In the US it is estimated that less than a third of depressed teens get
help. In Africa this figure is far lower.
Orphans and vulnerable children are at higher risk of depression as they
have been exposed to trauma and grief, and in some cases stigma,
relocation, life in an institutionalized setting and other prime indicators
for depression.
30
DEPRESSION IN HIV AND SERIOUS ILLNESS
The World Health Organization estimates the incidence of depression in
people suffering from diabetes at 27%, hypertension at 29%, stroke at
31%, cancer at 33%, HIV at 44%, and TB at 46%.

Depression in this group is characterized by poor self care, poor
adherence to medication, increased reporting of symptoms, poor
relations with their family, friends and caregivers, poor attendance of
support groups, lack of hope, energy and by chronic fatigue.
Studies show faster disease progression and increased mortality in
depressed patients in HIV, lung cancer, breast cancer, rheumatoid
arthritis, and lupus.
ANTIDEPRESSANTS
We know very little about how antidepressants work.
Antidepressant medications provided under the guidance of a medical
professional can be helpfuleven life-saving in cases of severe
depression.
They provide some symptomatic relief but dont cure the underlying
problem and/or provide a long-term solution.
ANTIDEPRESSANT EFFECTIVENESS
Antidepressants can cause significant side effects and dangers, and
recent studies have raised questions about their effectiveness.
A 2006 study showed that fewer than 50% of people became symptom-
free on antidepressants, even after two different medications. Many of
those who do respond to medication slip back into major depression
within a short while, despite sticking with drug treatment.

In some cases antidepressants can cause an increase in suicidal thoughts
or behavior in children, adolescents and young adults.
Studies show that their benefits have been exaggerated, with some
researchers concluding that antidepressants are only slightly more
effective than placebos for mild to moderate depression.
Patients already battling the side effects of medications for HIV, cancer
and other conditions may not tolerate additional antidepressants side
effects and discontinue their use.
The use of antidepressants during pregnancy is not recommended.
31
OVERCOMING DEPRESSION NATURALLY
Traditional psychotherapy for depression is less used today due to high
costs and a limited number of practitioners.
Excellent results may be achieved using cognitive behavioral therapy and
lifestyle changes, especially in cases of early detection.

In his new book Flourish, Dr. Martin Seligman the father of positive
psychology directly challenges traditional approaches to depression,
saying, The dirty little secret of biological psychiatry and of clinical
psychology is that they have both given up the notion of cure and
heres the second dirty little secret. Almost always the effects are what
is technically called, smallrecurrence and relapse are the rule.
In contrast, he offers evidence and exercises from positive psychology,
explaining that they are fun and easy-to-do, and self-reinforcing over
time.
In his tests positive psychotherapy provided dramatic results: depressive
symptoms decreased into non-depressed ranges and remained there for
the year of study.
He says, Positive psychotherapy relieved depressive symptoms on all
outcome measures better than treatment as usual and better than
drugs.
The JOYGYM Happiness System has achieved similar dramatic results in
overcoming depression using Aerobic Laughter, a cognitive behavioral
therapy.
The How of Happiness
Can we increase our happiness?
Yes.
It is surprisingly easy.
32
BUILDING HAPPINESS
Happiness is an intelligence.
To increase happiness we need to increase our Happiness Intelligence.
Happiness Intelligence, like many other intelligences, can be learned,
developed and strengthened.
WHAT IS INTELLIGENCE
Intelligence is not IQ.
IQ is a measure of cognitive abilities. We recommend that another name
be found for this assessment, perhaps cognitive ability scale?
Intelligence is the ability to reason, form concepts, and solve problems
within the context of a particular field of human endeavor.
The components of an intelligence are field, skill, knowledge,
mindfulness, passion and application.
FIELD
The area of human endeavor under consideration.
For example, we can define musical intelligence, mathematical
intelligence, woodworking intelligence, Emotional Intelligence and
countless more.
Fields of intelligence may be narrow or broadly defined. Broadly defined
intelligences often incorporate many narrower fields.
SKILL
Skills within the field may be natural gifts or learned skills. Skills
generally require practice to be improved and maintained.
KNOWLEDGE
The breadth and depth of our acquired knowledge within the field.
Knowledge may be acquired through introspection, observation, insight
and through study.
Dont confuse knowledge with intelligence. We may learn about music
but not be able to play an instrument.
MINDFULNESS
The ability to see life though the filter of this knowledge and skill is key
to developing an intelligence. For example, a person with woodworking
33
intelligence may see a chest of drawers quite differently, understanding
the quality of materials, how the joints work, the difficulties of
assembly, artistry and more.
PASSION
Powerful and compelling emotions about a field of endeavor drive the

compulsion to develop and improve an intelligence.
It is possible to develop musical skill and knowledge, but without passion
it is unlikely to develop into a strong intelligence.
APPLICATION
The ability to apply the skills and knowledge in a masterful way reflects
the level of an intelligence.
For example, ecological or green intelligence may comprise:
Skills: cycling or using public transport, purchasing goods and
services with low ecological impact, growing organic
vegetables;
Knowledge: understanding the theory and practice of
sustainability;
Mindfulness: seeing goods, services and activities in terms of the
energy they use, potential for recycling and their impact on
our planet;
Passion: the desire to slow the destruction of our planet;
Application: recycling waste, lifestyle changes, activism.
INTELLIGENCES SHAPE US
We are the sum of our intelligences.
Intelligences shape the way that we perceive and interact with the
world and make decisions.

EDUCATION
Intelligences can be learned.
The purpose of education is to build intelligence.
34
For example, successful engineering education will strive to develop
engineering intelligence.
People with engineering intelligence will grow their knowledge and
skills, and start to see the world through an engineering filter that will
change the ways that their brains are wired.
With passion and application they have the ability to become great
engineers, and to achieve happiness and fulfillment through the practice
and continual development of their engineering intelligence.
AUDITING INTELLIGENCE
In his wonderful book The Happiness Advantage positive psychologist
Shawn Achor sheds light on this subject.
Auditors can spend 8 to 14 hours a day scanning accounts and forms
looking for mistakes. As they develop their auditing intelligence, their
brains rewire and develop powerful neural pathways that help them to
perform their fault finding faster and ever more efficiently.
Their world view changes and they start seeing their world through the
filter of their auditing intelligence.
Shawn gives an example of a tax auditor who revealed an excel
spreadsheet listing all the mistakes his wife had made during the past six
weeks.
Auditing intelligence may not be conducive to happy marriage!
LAW INTELLIGENCE
Law is another profession with a powerful intelligence that can lead to
unhappiness.
Lawyers are trained to doubt, to look for flaws in arguments, and to
avoid trust. They are also trained to manage their time ruthlessly to
maximize billable hours.
As lawyer intelligence develops, these characteristics spread into all
areas of their life. The inability to trust others and fixation on money
can spoil their personal and family life.
It is not surprising that the legal profession has some of the highest rates
of stress, depression, divorce, burnout and suicide.
35
Emotional Intelligence (EQ)
Emotional Intelligence is the ability to recognize emotions in ourselves
and others and to manage them intelligently.

Emotional Intelligence, sometimes called social intelligence, was
popularized by Daniel Goleman in a popular series of books.
EQ is a universal and important intelligence that is closely allied to
happiness.
We respond emotionally to events and relationships in our life.
Our level of Emotional Intelligence influences our success in
relationships and to what degree they have a positive or negative affect
on us.
The higher our EQ the better we manage our relationships and cope with
emotions.
EQ AND SUCCESS
Emotional Intelligence is one of the strongest predictors of success in all
aspects of life.
EQ plays an important role in educational success. It moderates the
impact of stress, builds emotional resilience that drives educational and
career success, builds coping skills, reduces the negative impact of
trauma, helps to reduce stress and anxiety on the workplace, and can
reduce damaging behaviors such as smoking, drinking and risk taking.
Emotional Intelligence has been widely recognized as increasing
performance. Many employers seek out employees with higher EQ and
invest in programs to build employee EQ levels.

EQ AND HAPPINESS
Many studies including our own work confirm a strong and direct link
between Emotional Intelligence and happiness.
The most respected scale of Emotional Intelligence, developed by Dr.
Reuven Bar-On, includes measures that impact directly on happiness:
Intrapersonal intelligences include self-regard, emotional self-
awareness, assertiveness, independence, and self-actualization;
36
Interpersonal intelligences include empathy, social responsibility, and
interpersonal relationships;
Stress management intelligences include stress tolerance and impulse
control;
Adaptability intelligences include reality-testing, flexibility and
problem-solving;
General mood intelligences include optimism and happiness.

Higher EQ can make us better husbands, wives, parents, partners,
children, students, co-workers and friends, while reducing unhappiness
and increasing our social skills.
BUILDING EMOTIONAL INTELLIGENCE
Can we increase our Emotional Intelligence?
Yes. Knowledge can be assimilated and skills can be developed.
Many programs and exercises exist to help people to increase EQ in the
workplace, in education and for self improvement.
Emotional Intelligence is so closely linked to happiness that happiness
building programs can also significantly increase EQ.
Happiness Intelligence (HQ)
Happiness Intelligence is the ability to recognize the potential for
happiness and unhappiness in events, actions and relationships, and to
manage these intelligently to build and maintain the happiness of
individuals and groups.
Increase Happiness Intelligence and happiness will follow.
Individuals, groups and even governments around the world are
recognizing the importance of happiness and working to increase their
37
Happiness Intelligence can be learned and increased.
Lets review the components of HQ.
HAPPINESS SKILLS
Some people are naturally happier and gifted with natural happiness
skills than others.
Many happiness skills can be learned and improved with positive
psychology interventions.
With practice we can develop and hone our happiness skills to
significantly increase our Happiness Intelligence.
HAPPINESS KNOWLEDGE
There has been an
explosion in happiness
research and knowledge
since Martin Seligman
launched the positive
psychology movement.
The knowledge base is
developing very rapidly
with new studies and
interventions being
announced continuously.
Because we are all unique,
some of the happiness
knowledge needed to build Happiness Intelligence must be found
through self discovery.
HAPPINESS MINDFULNESS
One of the most important elements in building HQ is learning to view
events in our life, our relationships, plans and goals through the filter of
how they may impact on our happiness.
We are constantly surprised at how protective people become about
their personal happiness as their happiness mindfulness and intelligence
develops.
38
Happiness Intelligence provides them with tools to take action to avoid
or prevent unhappiness and to build happiness even in adverse
conditions, and to prevent stress, depression and other unhappifiers.
HAPPINESS PASSION
While the pursuit of happiness has long been recognized as an important
human goal and purpose, a lack of knowledge about what makes us
happy has dimmed and in some cases misdirected our passion for
happiness.
In our own work we see passion for happiness increase very quickly when
people learn more about the science of happiness and how quickly and
powerfully unhappiness can reduce our health and longevity.
HAPPINESS APPLICATION
For muggles like us there is no magic wand or spell available to create
instant happiness.
Like any intelligence, we need to practice and apply our happiness

knowledge and skills, creating new happy habits and changing our
lifestyle in ways that pay happiness dividends.
Building Happiness Intelligence requires application and determination,
but the increased happiness, health, success and well being that result
make it a truly worthwhile journey.
HAPPINESS INTELLIGENT WORLDVIEW
Developing Happiness Intelligence means entering a new world where
happiness myths no longer apply and we start to live with a new
perspective.
We make life choices based on how they will affect our happiness and
well being.
We focus will turn from money and consumerism to happiness, work-life
balance, spending quality time with our friends and family, exercising
and stretching our strengths, sharing happy times and experiences with
others, and perhaps starting to volunteer time to make the world a
better place.
Intelligent career choices will be based on our strengths and values and
the happiness potential of the career path. Well be considering factors
like the potential to exercise our strengths, flexibility, stress levels,
39
corporate culture, the people and manager we work with, and the
potential for meaning and fulfillment.
Building Happiness Intelligence is life changing.
Building Happiness
Weve helped tens of thousands of people to develop and increase
Here are some important aspects we want to share.
HAPPINESS IS PERSONAL
We are all unique and different and respond in different ways to
happiness interventions.
An intervention that hardly affects one person may transform the life
and contribute to meaningful happiness for another.
Some interventions can take time to start working. Give each
intervention sufficient time before deciding that it works for you.
Positive psychologists have assessed hundreds, perhaps thousands of

different interventions. We use interventions that have been proven to
significantly increase happiness or decrease unhappiness in most people.
Understand that you may need to try many interventions to discover the
techniques that work best for you, and can help you to live a
significantly happier life.
HAPPINESS TAKES WORK
There is no pill or magic wand that builds instant happiness.
It takes work to increase our Happiness Intelligence and resulting
happiness.
40
To build Happiness Intelligence, we need to:
Study and develop understanding of how happiness and unhappiness
work
Learn about ourselves and what makes the unique you happier or
unhappier
Build happiness mindfulness
We need to trial different happiness techniques sometimes for weeks
or months to give them time to work to discover which ones work for
us, and then change our lifestyle to incorporate new habits.
With determination we will start building lasting and meaningful

increases in our happiness.
MEASURE AND MANAGE
We cant manage what we dont measure.
If we are serious about happiness, find ways to measure happiness and
track the impact of what we learn and apply.
Measure your happiness before you start this journey.
Because changes in happiness happen gradually, we might not be aware
of them. Measuring happiness allows us to track the impact of our
happiness program.
The Happiness University coaching service includes baseline assessment,
and reassessment at regular intervals.
If youre serious about happiness we recommend you take the Bar-On
Emotional Intelligence measure. This includes a wide range of accurate
and informative information.
The internet provides a range of free happiness measures. You can
complete free happiness assessments at authentichappiness.com.
The Happiness University happymetrics.org website offers happiness and
unhappiness assessments that will securely store your results so you can
track your progress.
HappyMetrics is integrated with Happiness University programs.
41
Delivering Happiness
Its great to know that we can develop Happiness Intelligence and work
to increase our happiness, but how?
Few people have access to the new happiness knowledge.
How can we learn these important new lessons and how to apply them in
our lives?
DELIVERING OLD PSYCHOLOGY
Psychology was traditionally delivered in private consultation between
professionals and patients.
Professionals paid for years of expensive training and charged high fees
to recover their investment. Patients were mostly very unhappy and
hoped to become normal.
This model is expensive and there arent enough professionals to deliver
the new knowledge to all the people that need it.
We need to find new ways to deliver the new science of happiness.
HAPPY PILLS
Pharmaceutical companies developed drugs to try to eliminate
unhappiness.
Prescribing a pill is much faster and cheaper than therapy.
Patients dream of a quick fix.

Huge increases in depression have boosted demand for antidepressants
to such high levels that even doctors that arent trained in psychology
are prescribing them.
While antidepressants may have some use in controlling symptoms of
depression, and may help some people to regain a semblance of
normality, they have little place in a serious quest for happiness.
HAPPINESS IN SCHOOLS
Its imperative that the new science of happiness is introduced into
schools urgently so that the next generations develop Happiness
Intelligence at an early age.
42
We hope to see the universal practice of laughter starting in pre-school
and continuing through formal and informal education, adulthood and
into later life.
Developing Happiness Intelligence in children will enable and empower

them to factor life happiness into important life choices.
We can help them to identify and develop their strengths and values.
The new science of happiness can forever change how future generations
live their lives.
NEW SOLUTIONS
While psychologists play a key role in developing the new science of
happiness, they no longer need to be involved in delivering it.
How can we deliver these wonderful lessons, skills and knowledge from
academics and researchers to the rest of the human population?
We need to find new ways to deliver the new science of happiness and
build Happiness Intelligence.
Happiness University
The authors have co-founded a new Happiness University dedicated to
promoting and developing Happiness Intelligence in all corners of the
world.
The university will not initially offer degree courses, but will focus on
bringing the new science of happiness to as many people as possible in
new and innovative ways.
We are committed to making all our programs evidence-based so that
participants see scientifically measured results.
Happiness-U is working to find effective new solutions to deliver

happiness science efficiently at low cost.
43
HAPPINESS COACHING
We believe that Happiness Coaching is an excellent way to deliver the
new science of happiness.
Coaching can provide happiness education, teach proven happiness
techniques and provide the guidance, encouragement and support
needed to practice and incorporate them into a happier new lifestyle.
Specialized coaching programs for specific groups must be continuously
updated with the results of ongoing research.
Happiness Coaching must incorporate ongoing happiness measurement to
monitor progress and ensure real results.
InHappiness recently completed a four-year program Healing with
Happiness, to develop a low cost psychosocial support system for adults
and children affected by the HIV and AIDS and their caregivers.
The Healing with Happiness psychosocial support program uses an
innovative new three-tier happiness delivery system:
TIER ONE: PEER-TO-PEER THERAPY
Healing with Happiness teams train caregivers (primary participants) to
practice daily happiness therapy in short peer-to-peer sessions.

Caregivers receive knowledge and skills to become effective happiness
therapists in just one day.
Peer-to-peer therapy doesnt need psychologists or social workers to
provide effective psychosocial support where it is desperately needed.
A three-person Healing with Happiness team can train 16 groups of 20-30
caregivers a month, or 5,000 caregivers a year.
TIER TWO: PATIENT HAPPINESS THERAPY
Caregivers in the Healing with Happiness program are empowered to
deliver happiness therapy to their patients.
These skills are provided during their one-day training.
The short training time is made possible by tailoring the skills exactly to
the needs of the caregivers and their patients.
Tens of thousands of orphans from AIDS, people living with HIV, and
hospice patients are already enjoying the benefits of happiness therapy
through the Healing with Happiness program.
44
TIER THREE: COMMUNITY HAPPINESS
The Healing with Happiness program spreads from caregivers and
patients into the community like a happy virus.
Caregivers start to practice happiness therapy with their kids and family
the evening after training. The kids take the exercises to school and
often caregivers are called by teachers requesting that they introduce
the program in the school.
Caregivers often volunteer to introduce the therapy into community
groups and in some cases even at the companies where their spouses
work.
Adult and child patients often receive therapy with other members of
their families and continue to practice with them.
Some patients develop Healing with Happiness skills in support groups
and go on to spread happiness others.
TIERED HAPPINESS DELIVERY
The Healing with Happiness tiered delivery system represents a
breakthrough in the delivery of psychosocial support to poor and rural
communities.
In Africa there are not enough psychologists and social workers to deliver
traditional psychosocial support.
Tiered delivery makes it possible to provide effective psychosocial
support to millions of rural people affected by HIV for the first time.
The program can be rolled out quickly and economically.
One team of 5,000 caregivers can provide psychosocial support to
100,000-150,000 adults and children in their care.

Based on the three degrees of happiness contagion, this training team
could boost the happiness of more than half a million community
members annually.
The cost per direct patient of this psychosocial support program is
around $2.50 per month roughly equal to the cost of one minute of
consultation with a psychologist.
45
JOYGYM Happiness System
JOYGYM is a proven positive psychology based Happiness Coaching
system that provides knowledge, tools and support to build Happiness
Intelligence and lasting happiness.
JOYGYM is powerful.
To date, a large number of participants who were on medication for
depression, hypertension and diabetes when entering the program have
been taken off medication by their doctors within three months as their
conditions have improved or disappeared.
More than 30,000 South Africans are already enjoying greater happiness,
health and life success through JOYGYM programs.
EVIDENCE-BASED
JOYGYM includes happiness measures to track individual and group

progress and confirm real results.
Scientific measures clearly illustrate increased happiness, positivity,
energy, Emotional Intelligence and productivity, decreased stress,
depression, and better health.
Results from a six-month group program are presented later in this book.
FLEXIBLE
JOYGYM comprises twelve elements of happiness that can be combined
in different ways according to group or individual needs.
Happiness University creates custom programs according to the
requirements of different groups, working to match features and needs
in compact and economical programs.
A wide range of delivery options are available.
JOYGYM LICENSES
JOYGYM programs are available for worldwide license.
This model has been chosen to ensure:
Consistency: ensuring that programs are delivered consistently builds
confidence and works to deliver predictable results
46
Professionalism: licensees are carefully selected, receive training and
are monitored to ensure best practice maintenance and develop
confidence in the system
Evidence-based: JOYGYM programs are evidence-based with
monitoring and evaluation services provided centrally by JOYGYM
HappyMetrics
Funding: most license revenue will be used to sponsor Healing with
Happiness programs for abused, abandoned, HIV-infected, orphaned
and terminally ill children, people living with HIV, hospice patients,
the needy and their caregivers
Elements of Happiness
The JOYGYM Happiness System includes twelve elements that build
Happiness Intelligence and develop happiness.
Elements can be combined in different ways to build specialized
programs according to group and individual needs.

ACTIVITY
Humans are designed to be active.
Activity and exercise are important for general good health and for
keeping a positive state of mind.
Regular exercise lowers blood pressure, improves strength and
endurance, trims physique, builds confidence, boosts energy and mental
alertness, and reduces our chances of cancer, diabetes and heart
disease.
AEROBIC LAUGHTER
A powerful natural cognitive behavioral therapy that harnesses
hardwired body systems triggered by natural laughter.
47
It provides a powerful and joyful aerobic and cardio workout, even for
people confined to bed or a wheelchair.
Aerobic Laughter quickly and dramatically increases happiness, reduces
stress, and triggers our natural healing system for better physical and
mental health.
It has been called shock treatment for happiness.
Aerobic Laughter therapy is discussed in greater detail in the following
chapters.
EDUCATION
A solid understanding of the science of happiness and unhappiness and
how they affect our live provides the knowledge and motivation needed
to make and maintain happy lifestyle changes.
HAPPINESS COACHING
Positive psychology happiness building techniques and interventions are
presented with guidance, support and encouragement to help each
individual to discover those that work best and to incorporate them as
new lifestyle habits.
MEASURE AND MANAGE
To improve our golf or tennis we track our scores.
HappyMetrics provides a range of measures to track your happiness and
unhappiness, measure your progress, and provide tangible results.
NUTRITION
We are what we eat and how we eat.
Healthy eating can prevent chronic diseases, which now kill more people
worldwide than communicable diseases.
Nutritional mindfulness helps build a healthy foundation for a happy life.
PLAY
Engaging leisure is important in a healthy balanced life.
Personally expressive leisure activities reflect our goals, provide an

opportunity to practice our strengths and build happiness.
48
REST
Sleep and rest have a powerful and direct impact on our health, mood,
happiness and well being.
Sleep rejuvenates, refreshes, and restores.
A lack of adequate rest and sleep is a fast track to unhappiness.
SELF DISCOVERY AND MINDFULNESS
We are all different and unique.
To build lasting happiness we must learn what makes us happy and
unhappy.
Self discovery builds mindfulness, a key component of Happiness
Intelligence.
SERVICE
Service to others provides powerful benefits that reach across all aspects
of our life and happiness.
JOYGYM encourages us to find community service that best fits our
strengths and adds rich new dimensions to our life.
STRENGTHS
Character strengths are morally valued styles of thinking, feeling, and

acting that contribute to a fulfilling life.
Knowing our strengths and applying them in all aspects of our life
provides us with the opportunity to achieve flow and build self esteem,
confidence, energy and happiness.
VALUES
Values are the signposts that guide us through life and help to build
meaning and satisfaction.
JOYGYM helps us to discover and consider our core values and to bring
our life into alignment with them.
49
Aerobic Laughter
Aerobic Laughter is a powerful natural cognitive behavioral therapy that
harnesses hardwired body systems triggered by natural laughter.
It provides a powerful and joyful aerobic and cardio workout, even for
people confined to bed or a wheelchair.
Aerobic Laughter quickly and dramatically increases happiness, reduces
stress, and triggers our natural healing system for better physical and
mental health.
DEVELOPMENT
Aerobic Laughter therapy is the result of a four year development

program led by laughterologist Bill Gee.
The goal was to create a standardized, professional, evidence-based
therapeutic laughter program that provides proven and predictable
results.
The act of laughing triggers a number of separate involuntary responses
with side effects that deliver powerful benefits.
The program uses techniques that avoid culturally dependant humor,
allowing hearty extended laughter to be prescribed.
Elements from laughter pioneers Osho, Oki, and Goodheart have been
combined with practices from laughter yoga and assessed among people
of a dozen cultures and language groups to ensure the programs
universal reliability.
Elements from mindfulness training and positive psychology
strengthened the program, and a number of proprietary improvements
were developed to significantly improve adherence, sustainability and
benefits.
The effects of Aerobic Laughter practice have been measured in more
than a thousand subjects and results have been presented at a number
of international scientific conferences.
Aerobic Laughter is the first laughter therapy shown to deliver consistent
results in large samples across multiple cultures.

50
RESEARCH
InHappiness encourages and supports formal research into the benefits
of Aerobic Laughter therapy.
Areas of particular interest include:
The alleviation of depression, cardiovascular illness, hypertension,
diabetes, sleep and digestive disorders, chronic fatigue and pain,
rheumatoid arthritis and lupus.
The impact of Aerobic Laughter therapy on HIV progression and
mortality, increasing adherence to medication, reducing depression
and risky behavior, motivating HIV testing, and improving AIDS
education.
The use of Aerobic Laughter therapy in the armed forces to inoculate
against stress and depression, build resilience, and post-traumatic
stress disorder prevention and treatment.

The use of Aerobic Laughter therapy in education to improve
engagement and academic performance, reduce stress and depression,
and reduce teacher burnout and attrition.
The use of Aerobic Laughter therapy in business to reduce stress, boost
performance, productivity and sales, and increase motivation,
cooperation and teamwork.
Understanding Laughter
It is thought that laughter is a form of human communication that
predates spoken language .
ANCIENT LAUGHTER
The San people of southern Africa, one of the oldest groups of early
humans to have survived with their original culture and language. Their
culture is thought to be between 70,000 and 150,000 years old.
51
Laughter is an important part of San life, often practiced for large parts
of the day. They laugh freely with or without jokes or humor, and say
that they have been laughing from the time before language.
They regard laughter as spiritual and healing.
More recently, laughter has played an important role in the development
and practice of Buddhism and Zen.

MODERN SERIOUSNESS
Today, most cultures regard seriousness as normal.
To be unhappy, stressed, or depressed is not remarked on, while
excessive laughter in adults, especially laughter without apparent
reason, is frowned upon and regarded as a form of madness.
This is unfortunate, as laughter has more physical and mental health
benefits than seriousness.
Laughing more could help us to undo many of the negative effects of
modern life.
NATURAL LAUGHTER
Children are blessed with the gift of natural laughter .
This spontaneous form of laughter is freely expressed during childhood.
Kids can laugh 300-500 times a day without the need for jokes or
comedy!
Do children laugh because they are happy, or are they happy because
they laugh?
Natural laughter is certainly an expression of joy, and remains an
important form of non-verbal emotional communication.
Natural laughter resides in our limbic brain, the brain children rely on
while the cortex develops.
The limbic brain is impulsive and responds very quickly to sensory input.
It has direct connections to our senses and acts as our security control
center, constantly scanning the senses for danger.
This brain is not a deep thinker, but it has a wonderful talent for natural
laughter!
52
SOCIETAL RESTRICTION
During adolescence two momentous changes occur that serve to restrict
our practice of natural laughter.
First, our cortex develops and comes on stream. This super-computer
brain has massive powers of intellect and reasoning, but is much slower
in operation that the limbic brain.
Second, social conditions are imposed on our natural laughter. Parents,
teachers, our family and tribe start telling us dont laugh in class,
dont laugh while were talking, dont laugh at the dining table,
dont laugh in church, and to stop behaving like a child!
This behavioral conditioning has serious implications.
Once we are conditioned, every time we feel our natural laughter
bubbling up spontaneously, we override and delay the impulse to laugh
while checking with the cortex if its OK to do so.
The cortex is good at reasoning and judging and searches our memory
banks for examples of when it is OK or not to laugh, compares them with
our current situation, and decides if we can proceed to laugh or not.
The process of deciding whether its OK to laugh in the current situation
takes time (is it OK to laugh in front of these people or to laugh in this
place, is it politically correct to laugh about this, what are the social
implications of laughing in this group, if we laugh should we chuckle or
howl?...).
Our natural laughter is suppressed and fades while we wait for the
decision. Even if the cortex gives us permission to laugh, the moment for
laughter may have passed by the time the decision is made.
Slowly but surely our natural laughter slowly stops expressing.
LAUGHTER FREQUENCY
Social conditioning serves to dramatically reduce the frequency of our
laughter.
Fifty years ago adults laughed perhaps 30-40 times a day. Today adults
laugh an average of 10-15 times a day.
In South Africa with its high stress levels, thousands of adults have told
us that they hardly laugh at all perhaps 3 to 5 times on a really good
day!
53
DISCIPLINE
The social restriction of laughter is imposed by people of authority in the
name of discipline.
The San people have survived for thousands of generations without
leaders that impose behavioral control. They remain creative,
innovative, well-organized and able to work together in groups and take
effective cooperative decisions. And theyre still laughing.
Cultures ruled through power and controls do not like laughter. When
people are laughing their spirits are free and they are unpredictable and
difficult to control.
Perhaps thats why most cultures today regard seriousness as socially
acceptable and good, and laughter and spontaneity as bad.
INVENTED LAUGHTER
Even after our natural laughter is silenced through conditioning our body
knows that we need to laugh.
Laughter reduces levels of cortisol and stress chemicals that can damage
our brain and body in times of stress.
We find another way to trigger laughter by inventing jokes and
comedy. These techniques attempt to meet our laughter conditions so
that its OK to laugh.
This adult or intellectual laughter is physically the same as natural

laughter and triggers the same physiological reactions and benefits, but
its emotional underpinning and impact is often very different.
NEGATIVE LAUGHTER
While natural laughter is joyful and is associated with positive emotions,
intellectual laughter is often triggered by and associated with negative
emotions.
Adult jokes and comedy are often based on ridicule, cruelty, insults,
rudeness, hatred, demonization, racism and shame.
These negative emotions may cancel or reduce laughter s positive
emotional and mental health benefits.
54
Is Laughter the Best Medicine?
For generations Readers Digest has proclaimed laughter as the best
medicine.
There is no doubt that laughter can be a powerful healing force, but is it
a medicine? Medicines can be prescribed.
If a patient visits a laughter therapist for treatment they may prescribe
twenty minutes of hearty laughter in the morning, practiced daily for
three weeks.
How are they to fill the prescription?

Adult laughter relies on a sense of humor . It is only triggered if a joke
or comedy meets the particular laughter conditions programmed into the
patient as a child.
To fill the prescription, they could find joke books and YouTube videos
that work for their sense of humor, but most jokes are only funny the
first time so they would need lots of jokes to laugh for the prescribed
seven hours.
To make matters worse, our reaction to jokes depends on our mood,
where we are, and who were with.
Most people would struggle to fill their laughter prescription.
MORE PROBLEMS WITH HUMOR
The next patient to visit the laughter therapist is a businessman that
owns a small company with twenty employees in danger of closing down
due to lack of sales.
In this case the prescription calls for him to laugh with his entire staff
for fifteen minutes every morning for three weeks.
In culturally diverse South Africa, his staff probably come from four or
more different cultures, each with its own language and customs.
Each culture has programmed their adolescents with different laughter
conditions, resulting in different senses of humor .
While the Zulus may find a joke funny, the Xhosa and Venda staff might
not.
Can the owner get his staff to laugh together every day?
Probably not.
55
If we rely on jokes and comedy to trigger laughter, then laughter cant
be used as a medicine.
THE GOOD NEWS
Our natural laughter does not disappear. We never lose our ability to
laugh like children.
In adults this ability is securely locked down by cognitive programming
that alerts our cortex to control and override spontaneous laughter.
In some people, natural laughter surfaces occasionally in unbridled
laughter, often when theyre with close friends or under the influence of
alcohol or drugs.
When last did you have a good laugh for no reason?

AEROBIC LAUGHTER
In Aerobic Laughter we use techniques that trick the cortex into
releasing control and allowing our natural laughter to burst forth.
Most people are surprised how quickly they can reconnect with their
natural laughter and laugh like a child again, even for extended periods.
Aerobic Laughter allows us to fill those laughter prescriptions.
ITS NOT ROCKET SCIENCE
One of the advantages of Aerobic Laughter therapy is how quickly it can
be taught.
Groups can practice peer-to-peer therapy sessions for years after just
one day of training.
Most individuals can start daily self-practice after two or three days of
training.
56
Natural and Organic
Aerobic Laughter works by activating natural body systems that deliver a
host of remarkable benefits.
The impact is dramatic and immediate.
Most people feel happy and experience energy and
lightness, reductions in stress, headaches, and body
pain after their first therapy session.
Like other happiness interventions, Aerobic Laughter
doesnt work equally well for everyone.
Most people reconnect with their natural laughter
and laugh freely without jokes and comedy within
ten minutes, but some need multiple sessions to get
the knack of it.
JOYFUL NOW
Its interesting to understand how laughter creates
joyfulness and positive affect using our bodys
hardwired circuits.
When we see another person smile, our mirror
neurons automatically trigger a response smile.

Try smiling at people next time youre at the mall.
Most will respond-smile right back at you. If they dont, it means that
they have suppressed their respond-smile.
If you watch carefully, youll spot a little twitch next to their eyes.
Thats their smile muscles preparing to respond-smile before their brain
overrides the smile.
When our face breaks into smile, our brain senses that were happy, and
triggers the release of happy chemicals into blood that makes us feel
happier.
Laugh exercises the smile muscles to trigger this response strongly,
releasing joy juice and lifting our spirits and our mood.
It is impossible to feel unhappy, worried, sad or depressed while we are
laughing.
Research from Oxford University shows that group exercise boosts
happiness more - try to practice laughter in a group whenever possible.
57
DE-STRESS
Laughter triggers the human de-stress response thats hardwired into all
of us. This involuntary response is triggered by deep diaphragmatic
breathing.
Triggering de-stress causes our body to metabolize and reduce levels of
stress-related substances including cortisol in our bloodstream.
De-stress also triggers the release of natural pain killers that relax our
muscles to reduce tension, relieve headaches and body pain, and act as
mood elevators.
Over the years we have seen that Aerobic Laughter counters stress in a
unique combination of ways:
Provides a vigorous aerobic workout that reduces stress
Reduces blood levels of cortisol, adrenalin and others stress related
substances with fight or flight
Assists development of stress mindfulness that builds Happiness
Intelligence
Enables stress reduction through stressor reframing
Promotes the cathartic release of trauma and negative emotional
memories and experiences
Can reprogram the limbic response to specific known stressors
Teaches effective techniques to prepare for known stress
Develops the power to choose our mood and mental state
A 2008 study shows that even the anticipation of laughter significantly
reduces stress levels.
UN-DEPRESSION
Regular Aerobic Laughter practice quickly counters depression and
prevents recurrence in most people.
The exact mechanism whereby Aerobic Laughter practice helps people to
overcome depression is not clear. Is it stress reduction, joyfulness,
exercise, or triggering our de-stress response and homeostatic healing
system?
Research will tell.
58
InHappiness has recorded many cases of people on antidepressants being
removed from medication by their doctors after a period of regular
Aerobic Laughter practice because they are no longer depressed.
LAUGHTER AS EXERCISE
Laughter provides a powerful no-impact cardio and aerobic workout that
doesnt require special clothes or equipment.
Thirty seconds of laughter can double our heart rate for 3-5 minutes,
exercises all the core muscles, and massage the major organs -
especially the lymphatic system.
Twenty minutes of laughter a day can provide much needed exercise for
heart health. It stimulates circulation and beneficial oxygenization of
the body, necessary for health and to prevent premature aging.

Short periods of intense laughter throughout the day can enable us to
maintain concentration and focus for longer periods, and improve
circulation. This can speed healing in conditions such as venous leg
ulcers.
Researcher William Fry calls laughter stationary jogging and confirms,
When you laugh your chest, thorax and abdominal muscles, as well as
your diaphragm, heart lungs and possibly your liver contract.
Aerobic Laughter can provide workouts for people with conditions that
inhibit mobility such as arthritis, fibromyalgia, lupus, and for those
confined to bed or a wheelchair.
CARDIOVASCULAR HAPPINESS
Laugh for a happy heart.
In addition to reducing stress that can damage the heart, laughter
significantly reduces blood pressure, provides important cardio exercise,
lowers bad cholesterol and systolic blood pressure, and raises good
cholesterol (HDL).
Leading heart researcher Michael Miller says "the ability to laugh
either naturally or as learned behavior may have important
implications in societies such as the U.S. where heart disease remains
the number one killer.
Miller found that laughter increased blood flow through arteries by 22%,
while stress decreased flow by 35%. A stressed person who starts
laughing can experience a 73% increase in arterial blood flow.
59
Miller goes on to say that "You can release daily stress, which is harmful
to the endothelium, by laughing. A good, hearty, emotional laugh for 15
minutes a day is good for cardiac health."
Aerobic Laughter practice can significantly reduce blood pressure and
counter hypertension. Many hypertensive people have been removed
from medication by their doctors after a period of regular Aerobic
Laughter practice.
Widespread laughter practice could reduce the incidence of strokes, the
leading cause of adult disability in the USA and Europe and the second
leading cause of death worldwide.
United States researcher Lee Burke found that laughter reduced the
chance of a second heart attack in recovering heart patients by more
than 80%. Patients treated with laughter experienced fewer arrhythmias
and required less medication.
Heart patients often suffer from depression. Even mild depression
increased deaths by 44% in a study of 1,005 heart failure patients.
The benefits of a session of hearty laughter have been found to last for
24 hours, so learning to practice laughter daily can literally save our life.
PHYSICAL HAPPINESS
Aerobic Laughter has helped many people to overcome chronic health
problems. Science hasnt yet discovered how this works, but many
people are grateful for the results.
Aerobic Laughter triggers the de-stress response that activates our
natural (homeostatic) healing system. This system scans our body and
works to reset it for optimal health.
Chronic stress often causes chronic fatigue. Regular laughter energizes
us and will in many cases overcome chronic fatigue.
Stress can cause headaches, migraine, and muscular tension, particularly
in the neck and shoulders. Many people find that laughter reduces or
eliminates these problems, even when they have been chronic for
extended periods. People suffering from chronic pain may also find
relief.
Stress increase blood sugar levels and laughter practice reduces them.
Many people with pre-diabetes and diabetes have experienced partial or
complete relief after a period of daily laughter practice.
60
The stress response switches off or interferes with the digestive

system. This can lead to digestive problems including chronic
constipation, diarrhea, reflux, gas, irritable bowel syndrome and ulcers.
Regular laughter practice often reverses these problems, even in cases
where they have been chronic for extended periods.
The stress response interferes with the sexual reproductive system,
sometimes causing sexual dysfunction and fertility problems. Regular
laughter practice can help to reverse these problems.
Many illnesses and conditions are triggered or aggravated by stress. This
is especially true for arthritis, lupus, asthma, acne and allergies, herpes,
pre-menstrual syndrome, cancer and HIV. Laughter practice can provide
relief in many cases.
Stress can interfere with our circadian clock and result in sleep
problems. Regular practice of Aerobic Laughter has helped many people
to reduce or eliminate sleep problems.
IMMUNE HAPPINESS
Stress reduces immune system function, eliminating our natural
protection against viral and bacterial infection. It also accelerates the
progression of many illnesses including arthritis, types of cancer, and HIV
and can significantly increase mortality.
Many studies confirm the profound impact of laughter on the immune
system. Laughter increases the amount of activated T-lymphocytes and

the number and activity of natural killer cells that help fight diseases;
increased levels of salivary immunoglobulin A (S-IgA), a vital immune
system protein which is the bodys first line of defense against
respiratory illness; increases levels of interferon-gamma that activates T
cells, B cells, immunoglobulin, and natural killer cells, helps to fight
viruses, regulate cell growth and also fights against tumorous cancer
cells; and even shrank skin welts in allergy patients .
An important new University of California Los Angeles study determined
that stress directly causes an immune system response that results in
inflammation that is known to promote cancer and other serious
conditions including depression, diabetes, asthma, cardiovascular
disease and obesity.
Chronic inflammation is also an important causal factor in accelerated
aging, allergy, Alzheimer's, anemia, aortic valve stenosis,
atherosclerosis, congestive heart failure, digestive system diseases,
61
fibromyalgia, fibrosis, heart attack, heart valve dysfunction, kidney
failure, lupus, pancreatitis, psoriasis, rheumatoid arthritis, and stroke.
Chronic inflammation has recently been shown to be dangerous for
people living with HIV, resulting in accelerated disease progression and

increased mortality.
Incorporating Aerobic Laughter into daily routine could help prevent a
host of medical problems, from colds and flu through stress-related
lifestyle diseases such as depression, diabetes, hypertension, asthma,
stroke, heart attack and even cancer.
By boosting the immune system, reducing stress and depression laughter
practice could significantly reduce healthcare costs. The World Health
Organization estimates that healthcare costs for depressed people are
more than 4 times higher than the normal population.
Proactive prevention is especially important for people with a genetic
predisposition to medical conditions and illness.
HEALING WITH HAPPINESS
Aerobic Laughter therapy can help to improve mental state and quality
of life for people living with chronic and life threatening medical
conditions and diseases.
Laughter therapy is widely offered in US cancer clinics and is helping to
improve the life of tens of thousands affected and infected with HIV.
Mental health benefits of laughter therapy include reducing stress,
depression and trauma, improving relations with family, friends and
healthcare professionals, better adherence to medications, better self
care and helping to alleviate pain.

Laughter therapy has recently been shown to speed and improve stroke
recovery.
Quality of life can be improved by reducing stress in people with
fibromyalgia, lupus, arthritis, chronic fatigue and other conditions
aggravated by stress.
This field needs further research, but indications are that Aerobic
Laughter practice could be beneficial for people suffering from most
illness, mental and physical disabilities.
MENTAL PERFORMANCE
62
The stress response switches off or disrupts the parts of our brain that
we use to reason and make intelligent decisions, communicate and
empathize, and for creative thought and innovation.
Aerobic Laughter triggers the de-stress response that quickly re-
activates these parts of the brain and provides plentiful supplies of fuel
and oxygen for optimal functioning.
Laughter can even be used to prepare for known stressful events such as
presentations, public speaking, exams, and job interviews and reviews.
By triggering the de-stress response shortly before such events, we can
achieve peak performance even in high stress situations.

SPIRITUAL HAPPINESS
Aerobic Laughter works to align our behavior with our values and beliefs.
During the stress response we act without thought or consideration,
often in ways that conflict with our values and beliefs.
In chronic stress this can continue for extended periods, causing us to
behave in ways that are contrary to our nature.
Disconnecting with our values and beliefs in this way can result in long
term dissatisfaction and unhappiness.
Aerobic Laughter helps to bring our behavior back into line with our
values and beliefs.
THE MORE WE LAUGH, THE MORE WE LAUGH
Practicing Aerobic Laughter reconnects us with our natural laughter. Re-
learning to laugh naturally empowers us to enjoy hearty laughter more
often.
Most people practicing Aerobic Laughter laugh more often, particularly
when stressed. Laughter frequency often continues to increase as people
laugh for pleasure, to enjoy the resulting joyfulness, and to trigger
laughter in family, friends and strangers.
Because hearty laughter without apparent reason is not socially
acceptable, practitioners often develop a more active sense of humor to
allow them to laugh with others.

The result: the more we laugh, the more we will laugh.
Dont be surprised if you laugh more and more often after starting
Aerobic Laughter practice.
63
THE GIFT OF HAPPINESS
Laughter is universal and powerfully contagious
When we laugh we give the gift of happiness to all that hear us.
As we start to laugh more often, we spread viral happiness to more and
more people, helping to make the world a happier place.
Laughing with Children
Natural laughter is a non-verbal language used by kids to communicate.
During the adolescence we disconnect from our natural laughter and lose
our ability to speak that language.
One of the most interesting results of learning Aerobic Laughter is how it
changes our relationship with children.

GOGO, I DIDNT KNOW YOU COULD LAUGH
We were training a group of volunteer HIV caregivers in a small town in
northern South Africa. Most caregivers were granny aged, known as
gogos in the local language.
As the group didnt have a meeting room we were training in a church.
By midmorning we were deep into an extended laughter session when I
noticed a small boy walk in.
He was walking past the church when he heard laughter, and couldnt
understand why a group of kids were laughing in church. He decided to
investigate, and crept into the church quietly.
He was astonished to see a group of gogos laughing amongst them his
own grandma!
His jaw dropped. After a moments silence he exclaimed, Gogo, I didnt
know you could laugh!
64
NATURAL LAUGHTER
Natural laughter is a language that all children understand and speak
fluently.
I have spoken natural laughter with kids of all ages in many countries
and cultures it is universal.

As we were all children, weve all been fluent in this joyful language.
Its amazing that as we pass through adolescence and become adult, not
only do we disconnect with natural laughter, but we cease to speak,
understand and respond to it.
RE-LEARNING NATURAL LAUGHTER
Aerobic Laughter is natural laughter.
During training we use techniques that help us to reconnect with our
natural laughter.
Like learning to ride a bicycle, it is a skill that we never forget. As we
start to practice, it comes back and we become more fluent. Eventually
we are able to laugh at will.
SURPRISE YOUR KIDS
Children are so used to the fact that adults dont speak natural laughter,
they are amazed when they encounter adults who can speak it.
Imagine youre travelling alone and find yourself in a remote village in
Thailand, Greece or China where nobody speaks English. You find ways to
manage, but its difficult you end up in the restaurant kitchen pointing
to try to order a meal.
Suddenly one of the locals walks up speaking fluent English you are
flooded with relief and happiness you feel an instant bond with this
person.
Thats what happens when kids find an adult who can speak natural
laughter. First amazement, then an instant happy bond.
Be warned. Once kids realize you can laugh with them, they never ever
forget, or let you forget.
CHILD THERAPISTS
Most HIV caregivers that we train are women with kids at home.
65
Working as a HIV caregiver is extremely stressful. By the time they get
home theyre often emotionally exhausted.
When the kids come running noisy and excited because moms home,
theyre chased away with a typical adult response: Cant you see were
talking!, or simply Be quiet! Go and play outside/in your room.
In interviews they often confess that theyve hardly spent time with
their kids, sometimes for years. Theyre so burnt out and exhausted
when they get home, they often dont even eat and go straight to bed.
After Aerobic Laughter training, most go straight home and teach their
kids the laughter exercises.
The kids are amazed that mom or grandma has suddenly learned to
laugh. They take to the exercises intuitively, mastering them in minutes
The next morning and every morning thereafter the kids wake up and
run to laugh with mom.
If she gets home tired and tries to be grumpy, the kids start the
exercises and soon mom is howling in laughter with them.
Weve seen this happen time and again.
As soon as kids learn the Aerobic Laughter exercises they become little
therapists, making sure that mom get daily doses of laughter.
Its wonderful.
ADULT HUMOR
Adults laugh for a reason. They need justification to laugh.
They invent jokes and comedy to meet their laughter conditioning so
they feel justified in laughing. They call this humor, and talk about their
sense of humor.
Laughter without justification scares adults. It feels like madness,
something crazy people would do.
Ask an adult why they laughed at something and they can explain it.
They are scared to laugh without a cognitive reason.
Considering that adults spent their first decade laughing without reason,
this really seems ridiculous.
STOP LAUGHING
66
How often do we tell kids to stop laughing!, or to stop behaving like a
child!
This is a crime against humanity.
We shouldnt tell kids to stop. When we hear them laughing at play, we
should stop our adult foolishness and ask them if we can join in.
Natural laughter is a magical experience that melts away stress and
worries and brings joy and happiness. We need more of it.
NATURAL HUMOR
Kids dont need justification to laugh. They need a reason not to laugh.
Do kids laugh at jokes?
Dont be ridiculous, most cant even tell a joke properly. They crack up
before the punch line.
If kids tell adults a joke its not because they understand the joke that
part of their brain is not working yet. Its because they want the adults
to laugh.
Kids are optimists. They keep hoping that they get adults to laugh and
understand their laughter language to lighten up and get happy.
Imagine how much fun that would be!
Kids use natural humor, which is very different from adult humor. Its the
humor of play and uses laughter, mimicry, surprise and incongruity to
raise a laugh.
Even very young children respond to natural humor. But adults seldom
do.
Learning Aerobic Laughter
How do we teach adults to laugh like children?
There are distinct stages in Aerobic Laughter training.
67
BASELINE ASSESSMENT
If we want to lose weight, we start by getting on a scale.
If were starting an Aerobic Laughter program, we recommend that we
start by assessing our happiness.
Well provide questionnaires that measure our happiness and
unhappiness to provide a baseline for later comparison.
When we repeat the measures later well see our progress.
We cant manage something if we dont measure it.

EDUCATION
Understanding how stress and depression influence us is important and
helps us to build Happiness Intelligence and make lifestyle changes to
increase our happiness.
We introduce the new science of happiness, the science of stress and
depression, and the science of laughter.
PREPARING TO LAUGH
Training is normally done in groups because its easier to learn Aerobic
Laughter with others.
We start with a series of fun warm up exercises that prepare us to laugh.
The warm-ups:
Coax our cognitive brain to release its control over our natural
laughter
Teach us important skills help our laughter practice
Accelerate emotional contagion in the training group
Help us develop playfulness
Give us permission to behave in ways we might normally consider silly
Warm us up for the exercise that lies ahead
Aerobic Laughter warm up exercises have been are in use by tens of
thousands of people and have been proven. They make it easier to laugh
naturally.
STRUCTURED LAUGHTER
68
After the warm up we use a series of structured laughter exercises to
help trigger natural laughter.
Hundreds of different exercises keep sessions fresh and teach specific
skills.
Initially well use exercises that help overcome mental barriers to help
us to reconnect with our natural laughter.
As we rediscover our natural laughter we guide you through exercises to
extend the range and strengthen laughter fitness.
Hours of training are divided into sessions to allow time to savor the
effects and learn through discussion.
LAUGHTER STRATEGIES
Different laughter exercises can be used to develop skills according to
your goals and needs, for example to:
Vary the aerobic intensity
Build interpersonal and relationship skills
Teach different ways of coping with stress
Help reprogram limbic response to specific stressors
Build emotional resilience

Develop self acceptance and self confidence
Counter sadness and depression
Increase happiness and joyfulness
Boost mental performance under stress
Provide physiotherapeutic benefits and extend movement range and
flexibility
Promote the cathartic release of negative emotional memories and/or
trauma
Natural laughter is a powerful brain language that can help to achieve
rapid physiological and mental changes.
FREE LAUGHTER
69
Once weve re-developed our ability to laugh like a child, we help you to
stretch and develop this ability until you can laugh without structured
exercises.
We call this free laughter.
Free laughter empowers us to break into hearty laughter at will when we
need to de-stress or feel happier.
Participants learn techniques to enjoy laughter in public places like a
busy shopping center or on a bus without being thought crazy.

Its hard for most adults to understand the joy and empowerment that
comes with this skill.
DEVELOPING YOUR LAUGHTER SKILLS
As we become more accomplished, well learn self practice skills and
how to introduce natural laughter to our family and groups of friends.
If you are learning to practice peer-to-peer therapy with a group your
training period may be just one or two days.
If you plan to practice on your own a longer training period is
recommended.
AEROBIC LAUGHTER PRACTICE
Aerobic Laughter is a powerful cognitive behavioral therapy that can
help us change to our behavior and our lifestyle.
Like any life changing skill, it needs regular practice.
We cant lose weight by dieting one day a week, or get fit by exercising
occasionally.
We advise you on frequency of practice to meet your goals.
As a rule of thumb, expect to spend 15-20 minutes a day five days a
week practicing Aerobic Laughter to achieve and maintain life changing
results.
70
DEEP LAUGHTER THERAPY
Deep laughter is a powerful meditational and mindfulness therapy that
can achieve significant physiological and mental changes.
It is especially useful for releasing trauma, post-traumatic stress
disorder and negative emotional memories.
Deep laughter therapy doesnt require you to verbalize or reveal the
details of trauma to others.
Therapy is provided by trained professionals over a period of days in
residential retreats.
JOYGYM Programs
JOYGYM is a flexible system and can be configured to provide different
programs according to individual needs, delivery requirements and
objectives.
JOYGYM EXPERIENCE
This one-day happiness and laughter adventure provide a great

introduction to the new science of happiness and includes two hours of
Aerobic Laughter therapy.
The program is a great way to start your happiness journey and is
recommended for individuals, couples and entire families.
The JOYGYM Experience road show visits major cities. Visit
WWW.JOYGYM.ORG to register or bring JOYGYM Experience to your city.
JOYGYM FOUNDATION
This two-day course provides a foundation for developing Happiness
Intelligence.
71
Learn the science of happiness and unhappiness, Aerobic Laughter self-
practice and how to practice with small groups of family and friends.
The course provides skills to counter stress, depression and unhappiness,
improve relationships and improve health.
People completing the JOYGYM Experience and JOYGYM Foundation
courses receive HLV (happiness and laughter volunteer) certification,
become eligible to join the Happiness Volunteer program and may apply
for professional training.
JOYGYM YOUNG ADULTS
Young adulthood is a period of intense change. JOYGYM can help boost

confidence, positivity, Emotional Intelligence, Happiness Intelligence and
build a happy foundation for a great future.
This special course helps build Happiness Intelligence and develops a
perspective to make happiness based life and career choices.
FAMILY HAPPINESS
A special course has been designed to help families wishing to improve
relationships, and where a family member suffers from a chronic or life
threatening illness or condition.
Therapy and training groups may include family members, friends,
extended family, caregivers and co-workers.
CANCER COACHING
Cancer and other serious illness create stress, anxiety and trauma for
the affected person and for family members and others close to them.
Coaching can be provided individually or for the family group.
Similar programs are available to people suffering from heart problems,
hypertension, diabetes, arthritis, lupus, stroke and other conditions.
INDIVIDUAL COACHING AND THERAPY
Private coaching and therapy is available by arrangement.
72
SPORTS COACHING
Happiness Coaching and Aerobic Laughter therapy can give competitors
and teams the happiness advantage.
The programs can build trust, team spirit, energy, commitment,
motivation, working together to common purpose, knowledge sharing,
reduced conflicts and better performance.
UNEMPLOYMENT COACHING
Studies confirm that happy people get employed first.
JOYGYM can help to overcome unemployment related stress, anxiety and
depression and rebuild a winning outlook that can help bring happiness
back into our life and improve our chances of finding a new job or
career.
CAREER COACHING
The Harvard Business Review confirms that happy people earn more
money, get promoted faster and have greater influence in group
decisions.
We spend more waking hours at work than at home and with our family.
If we're not happy at work JOYGYM can help us to find direction and
make changes to build happiness.
JOYGYM FOR PREGNANCY
Pregnancy is one of the most important periods in human development.
Parent stress or depression can harm the child and cause mental health
problems that can last a lifetime.
JOYGYM can help to reduce stress for a happy pregnancy and build the
basis for happy parenting, a happy childhood and future success.
JOYGYM FOR PRESCHOOL
JOYGYM can help children to develop a happy disposition, build coping
skills, counter depression (yes, it starts early these days) and develop
their emotional and Happiness Intelligence for life success.
The low-cost JOYGYM pre-school program can provide lifelong benefits.
73
JOYGYM FOR LONGEVITY
It's never too early (or too late) to start increasing our Happiness
Intelligence.
Research shows that happy people live an average of 7-12 years longer,
have more friends, and enjoy better health and quality of life.
JOYGYM can help reduce stress and overcome anxiety and depression for
a more fulfilled and longer life.
The Happiness Advantage
In todays highly competitive world the happiness advantage can help
companies and organizations to survive and prosper.
The twentieth century paradigms of stressing or paying employees to
work harder have been scientifically discredited.
Todays successful companies develop a happiness culture in which
managers are responsible for building and maintaining employee
happiness and employees are responsible for building and maintaining
customer happiness.
EMPLOYEE HAPPINESS
Twenty-first century industry leaders like Zappos and Google in America,
Semco in Brazil, and IT consulting company EC in Japan share a strong
focus on building employee happiness.
Happiness factors including job satisfaction, empowerment, flexibility,
engagement, responsibility, working to strengths, twenty-first century
management, company attitude and authenticity, meaning, and doing
good are more important that salary in attracting, motivating and
keeping the best employees.
British economist Andrew Oswald has shown that happy people are 25%
more productive.
74
Happy employees are better at what they do, more committed, take less
sick days, and less likely to leave the company.
They are more creative, innovative and better communicators.
COLLABORATION
The twenty-first century work is less about being a cog in a wheel and
more about extended collaboration.
Collaboration requires individuals to contribute in different and more
complex ways. Employees must make intelligent, well-informed
decisions with less guidance from the hierarchy.
Emotional Intelligence, trust, motivation, an understanding of the
context of their work, and good judgment are key to successful
collaboration.
Happy employees are more likely to display these qualities and give their
best.
CORPORATE VALUES
Collaborative environments increasingly require employees to make
decisions. Clear corporate values guide decisions and reduce stress.
Establishing clear corporate values and holding managers and staff
accountable for maintaining them in all activities provides common

focus, ensures that everyone is moving towards the same goals, and
boosts business success.
AUTHENTICITY AND DOING GOOD
Benefiting people, communities, society, the environment and future
generations is the new way to business success.
Exploding access to information and instant communication is increasing
transparency, making companies take responsibility for their actions.
Companies engaging in exploitation, selling products or services that are
inferior or may damage health or the environment, and companies that
dont care about customer happiness will find it increasingly difficult to
succeed.
In the twenty-first century company culture will replace branding and
advertising as the basis for customer support.
75
Employees that believe your organization is authentic and is a force for
good will be proud, engaged and productive.
GIVING BACK
Investing time and profit into giving back to our community is becoming
increasingly important to business success.
Corporate social investment is no longer a public relations exercise. It is

becoming fundamental to how an organization is perceived by employees
and customers.
Make sure that every employee and customer understands the corporate
social investment program. Ask them for their advice, opinions and
input.
Corporate social investment programs that align with your company,
employee and customer values enhance loyalty, happiness and success.
THE HAPPY WORKPLACE
In the twentieth century many employees lived a Jekyll and Hyde
existence, adopting one persona at work and another real personality
in their private life.
Twenty-first century success lies in eliminating this division so employees
can feel real at work, and match their strengths and beliefs to their
job in a way that builds satisfaction, engagement and happiness.
Most people spend more time at work than with their family.
If they are not happy at work, their quality of life will suffer, with
resulting unhappiness and poor performance at work and in their
personal life.
A workplace where everyone is alone together is seldom happy or
productive. Encourage staff to develop personal relationships and
friendships with their co-workers.

Better relationships boost empathy, trust and communication and result
in more effective teamwork and productivity.
The right business culture is achieved when most of our employees wake
up looking forward to going to work.
76
HAPPY CUSTOMERS
Its no secret that people prefer to buy from happy people.
When people call our business they can hear a real caring smile and
respond to it well.
Empowering salespeople and customer service staff to go that extra mile
for your customers and take decisions that will build customer happiness
is a far better way than forcing them to strictly follow rigid procedures.
If our employees are happy and empowered to make sure that the
customers are happy were on our way to success.
ENGAGED CUSTOMERS
The most successful companies move beyond customer happiness to
customer engagement.
Treat customers as part of the team, ask them how youre doing, and
how you could do better. Find ways to communicate with and listen to
them.
Customer engagement builds loyalty and reduces service costs. Engaged
customers become evangelists for your business.
Customer engagement helped Zappos grow sales from zero to a billion
dollars in a tough economy and overtraded market sector.
Organizational Programs
Happiness based organizational development programs can help you to
change your corporate culture and develop the happiness advantage.
JOYGYM evidence-based programs provide measurable results.
77
MANAGEMENT DEVELOPMENT
Managers that care about employee happiness can build sustainable
business success.
Twenty-first century managers act as coaches to nurture and build their
team's happiness, and lead the way in transforming company culture to
develop the happiness advantage.

STRESS REDUCTION AND MANAGEMENT
Reducing stress is a fast and efficient way to boost happiness and
performance.
JOYGYM Aerobic Laughter and positive psychology coaching programs
apply twenty-first century happiness science to counter stress, anxiety,
depression and burnout.
HappyMetrics can pre-screen employees to identify those with high
degrees of stress, depression and burnout for more additional targeted
therapy.
TEAM BUILDING AND DEVELOPMENT
Good team work is key to corporate success.
JOYGYM programs powerfully develop teamwork and cooperation and
dramatically increase happiness, trust, cooperation and communication,
creativity and innovation.
Inter staff conflict and workplace violence and bullying can be
dramatically reduced.
Cross-cultural team building and the integration of teams after mergers
and acquisitions can be effectively accomplished.
PRODUCTIVITY ENHANCEMENT
JOYGYM programs effectively build Happiness Intelligence and reduce
causes of unhappiness.
Happiness is shown to significantly boost productivity, with studies in the
UK showing increases of 25%.
JOYGYM programs have achieved productivity increases of more than
50% with similar reductions in absenteeism and sick leave.
78
CALL CENTER AND CUSTOMER SATISFACTION
Call centers provide a powerful opportunity to build customer happiness
and loyalty and to drive company success.
Zappos became one of the most successful companies in history with
almost no advertising or marketing by transforming customer interaction
during calls to maximize employee and customer happiness.
Customers can hear a smile and respond to enthusiasm and genuine
care. Delighted customers can become evangelists and boost your
business.
Ensure that your call center team is happy, motivated and empowered to
go that extra mile to ensure customer happiness and your company could
be the next Zappos.
SALES HAPPINESS
Customers enjoy buying from happy and caring people, and will keep
coming back for more of that happy experience.

Stressed sales teams cant compete with a happy sales team.
Optimistic salespeople can outperform their pessimistic counterparts by
50% or more.
A happy sales team empowered and motivated to go that extra mile for
customers drives long term loyalty and repeat business.
Use JOYGYM program to boost sales happiness before your competitor
does.
RETAIL AND HOSPITALITY HAPPINESS
Customers are shopping for happiness.
Welcome them with a genuine smile and develop your processes deliver
an authentic and stand-out happiness experience.
Youll build loyalty and repeat business and get the happiness advantage.
HAPPINESS CONSULTING
Developing happiness advantage to grab market share and build
sustainable twenty-first century success requires strategic planning and
careful measured implementation.
79
JOYGYM can help us to develop Happiness Intelligence in leadership and
build strategies to refocus our business around building happiness.
Re-thinking corporate values based on clear goals that include building

happiness, then working to ensure that all processes and decisions
throughout the organization further those values can simplify the
process of changing your culture to build success.
HappyMetrics measures can help identify areas of unhappiness that
require the most urgent intervention.
JOYGYM interventions increase adaptability and openness to change and
Happiness Coaching can help to educate and motivate teams to accept
and support culture transformation.
If youre ready to develop the happiness advantage we want to help
build your success.
ACTIVE CORPORATE SOCIAL INVESTMENT
The JOYGYM Happiness Volunteer program provides an opportunity to
bring managers, employees and customers together through active
community service.
Volunteers are trained to deliver happiness and laughter therapy and
work in clubs to build happiness in pre-schools and schools, and for
seniors, orphans, and people living with depression, hypertension, heart
disease, pain, cancer, HIV and other serious conditions.
Volunteers develop their Happiness Intelligence, learn valuable skills,
build their network and enjoy the wonderful benefits of providing
service to others in need.

Companies that sponsor happiness volunteer training and clubs and
encourage employee and customer participation can reap a wide range
of significant benefits.
The JOYGYM Happiness Volunteer program is discussed later in this book.
CORPORATE HAPPINESS SPONSORSHIP
More than 15 million orphans and vulnerable children have experienced
the trauma of losing one or both parents and resulting upheavals in their
lives.
Research shows that unresolved trauma at this age can result in lasting
damage that can significantly reduce their capacity for reaching their
full potential.
80
Consequences may include an inability to cope with stress, reduced
abilities to engage in gainful employment, tendencies towards risky
behavior, a life of violence and crime, or poor health and early death.
The JOYGYM Healing with Happiness program provides psychosocial care
that can heal the trauma and equip these kids for a full and happy life.
The cost of happiness sponsorship is only $2.50 per child per month.
Your company can make a real difference by sponsoring Healing with
Happiness programs for children in your community.
Sponsorships are made through leading international non-profits and
sponsors are offered the opportunity to engage with the children and
become involved in program delivery.
Companies can provide additional sponsorship and take an interest in the
childrens education and training.
Perhaps an orphan that you sponsor will one day become your companys
chief executive officer or the next president.
Happiness through Service
People around the world are hearing the call of service and discovering
the rich rewards of volunteering.
As a former community organizer, President Barak Obama advocates
public service and encourages American volunteering. World leaders are
following his example.
Research shows that the benefits of volunteering are not only felt by the
beneficiaries.
Volunteers reap huge benefits and rewards from serving.

THE JOY OF SERVICE
There are many real advantages to giving time for nonprofit work.
81
Whether you are a student, working or a stay-at-home mom,
volunteering is an excellent way to gain work experience and broaden
your social network.
EXERCISING YOUR STRENGTHS
Exercising our character strengths is key to developing a sense of
purpose and satisfaction with life.
By choosing a volunteer position that allows us to do what were best at
we can build happiness and well being while helping others.
BUILDING SKILLS AND CHARACTER
With companies scaling back hiring, volunteering provides school and
university leavers with a positive alternative to unemployment, endless
job applications and internships.
Volunteering can provide experience to make new entrants more
competitive in the job market.
DOING GOOD
Helping others builds our sense of accomplishment and personal
fulfillment and improves our sense of well-being and self esteem.

This can help to counter anxiety and depression.
Working with people less fortunate helps develop gratitude for what we
have.
SOCIAL BENEFITS
Volunteers can meet interesting and diverse new people and extend
their social network.
We meet people who share our interests and have the opportunity to
improve our social and communication skills.
Many volunteers develop deep caring relationships with others through
their charity work.
Volunteering can be a good way to make new friends, business contacts
or even new romantic interests!
82
BUILDING EMPLOYABILITY
Volunteer work broadens our horizons and develops new skills that can
be beneficial in our career.
Volunteer work sets us apart and demonstrates character and a multi-
dimensional personality.
Volunteer positions show potential employers our drive and dedication,
demonstrate initiative, personal will, leadership skills, social

responsibility and the ability to work as part of a team.
HEALTH BENEFITS
A recent study found that volunteering promotes good health.
Volunteers live longer, have lower rates of depression and heart disease,
and show higher functional ability.
UNEMPLOYMENT
The worldwide economic downturn is driving high rates of
unemployment.
Not working can result in financial pressures and limit activities which
enhance independence and wellbeing.
Unemployment may be associated with stigma, social exclusion, poverty,
poor housing conditions, and risk taking behaviors including alcohol and
drug misuse.
People suddenly faced with unemployment face a real risk of falling into
despondency, self pity, depression and a negative attitude that can harm
their chances of finding new employment.
Volunteer work can provide activity and a sense of purpose to counter
stress and depression, maintain self esteem and a cheerful disposition.
Contacts made through volunteer work may lead to employment
opportunities.
STARTING YOUNG
Children are best introduced to volunteer work at an early age.
83
Volunteering is a rewarding experience through which they gain
independence and confidence, meet new people, and develop new
skills.
Youth volunteers reap personal benefits that will positively impact them
throughout their lives.
Volunteering teaches respect for themselves and others. They learn to
be helpful and kind and can develop leadership skills and patience.
Youth volunteers are 50% less likely to abuse alcohol, cigarettes, become
pregnant, or engage in self destructive behaviors. They are more likely
to do well in school and graduate.
SENIORS
People are living longer and healthier lives.
Volunteering can provide fulfilling and fun activities that allow seniors to
meet other people and stay active in their community. It allows them to
share the company of others and can lead to new friendships and caring
relationships.
It can provide opportunities for seniors to pass on their knowledge and
experience and to share their story with others.
84
Happiness Volunteers
The JOYGYM Happiness Volunteers program helps people to build
Happiness Intelligence while spreading happiness in their community.
Happiness volunteers undergo happiness and laughter volunteer (HLV)
training and receive ongoing Happiness Coaching.
GIVING BACK TO THE COMMUNITY
We dream of an international network of happiness volunteer clubs
spreading happiness in every suburb.
Working together in clubs, happiness volunteers provide happiness
building services to seniors, pre-schools, schools, orphans, and people
living with depression, hypertension, heart disease, pain, cancer, HIV
and other serious conditions.
Clubs promote the benefits of Happiness Intelligence and work to spread
happiness awareness.
COMPANY HAPPINESS CLUBS
Happiness volunteer clubs offer opportunities for companies and
organizations to build happiness.
Clubs can be started by groups of employees, their family members and
friends, and their clients to provide service to their community.
Companies can also sponsor training, programs and venues for happiness
volunteers in community clubs.
For more information about JOYGYM Happiness Clubs visit
WWW.JOYGYM.ORG.
85
86
87
88
Healing with Happiness
Healing with Happiness is a JOYGYM program developed to provide
powerful low-cost psychosocial support and healing for abused,
abandoned, HIV-infected, orphaned and terminally ill children, people
living with HIV, hospice patients, the needy, and their caregivers.
We are extremely proud to have successfully met this challenge and that
the program is being adopted by international NGOs.
The journey of this programs development results achieved take up the
rest of this book.
Healing with Happiness is a groundbreaking new program that can be
applied to transform the entire healthcare industry.
The program is ready for large scale roll out within the AIDS sector and
for all medical and care facilities including hospitals, clinics, hospices,
orphanages and care facilities for seniors, cancer, Alzheimer s, the
mentally and physically disabled and more.

The AIDS Pandemic
The AIDS pandemic is one of the great challenges of this generation and
has caused widespread unhappiness and suffering among those infected,
those affected, and those providing care.
The impact of AIDS will be felt for generations to come.
THE HIV AND AIDS EXPLOSION
By 1990, there were approximately 8 million people diagnosed with HIV.
By 2010 this number had exploded to about 33 million.
Two-thirds of people living with HIV more than 22 million are living
in sub-Saharan Africa.
Think of the countless number of people affected: family members,
89
friends, co-workers, and especially the traumatized children who can
carry psychological impairment forward for generations.
More than 15 million African children have been orphaned by HIV.

Perhaps double that number is currently watching their parents die.
FAR REACHING IMPACT
HIV is not just a health issue.
It spreads unhappiness far and wide:
HEALTH SECTOR: Doctor and nurse numbers are reduced by those dying
of AIDS. Increased healthcare costs are crippling economies.
HOUSEHOLDS: Many people cant work due to illness or caring duties and
lack money for basic necessities including food and housing. Funeral
expenses are wiping out savings.
EDUCATION: Teacher numbers are reduced by those who die from AIDS.
Children are pulled out of school to provide care. Fewer children receive
basic primary education. This is especially true for girls.
ECONOMY: Poor health, increased absenteeism for medical appointments
or illness means plummeting productivity. Illness and death means
increased staff turnover and training costs. Decreased corporate profits
means less taxes paid and less money to fund health care, education and
development.
CHILDREN: 1,000 children are infected every day. About 2.5 million
children are living with HIV. Many leave school to work to feed their
families or look after other children or family members.
It is not uncommon for people in Africa to attend 3 funerals a month.

Sometimes caregivers attend 3 funerals in a week.
Grief and trauma are reducing levels of happiness at a national and
regional scale.
90
The Caregiver Explosion
Palliative care focuses on improving quality of life and managing
symptoms and pain primarily for people facing end of life or life-
threatening illness.
Before HIV, the need for palliative care was small.
It was provided in a handful of hospices, at hospitals and at home with
hospice support, mostly to old people and terminal cancer patients.
BOOM
The HIV and AIDS pandemic caused an explosion in the need for care
services.
Existing palliative care services couldnt cope. New ways to provide care
on a vast new scale had to be found.
Today hundreds of thousands of caregivers provide support to people
infected and affected by HIV.
Nobody is quite sure how many caregivers there are. There may be more
than half a million in sub-Saharan Africa.

Caregivers can include health care professionals, lay workers or family
and friends.
Very few are well trained, a few have some training, and many are
untrained.
Most are unpaid, some receive a small stipend, and very few receive a
small salary.
Very few caregivers work in hospitals or hospices. There was no way to
increase the number of beds to house all the new AIDS patients.
Today most HIV care giving is provided at the patients home using a
system called home based care. This adds caregiver stress as they must
travel large distances between patients, often on foot.
Caregivers frequently have little equipment or support and must cope
with very high patient numbers.
They have to deal with the death of their patients.
Somehow.
PSYCHOSOCIAL SUPPORT
91
Caring for people through the process of dying and death elicits a heavy
toll on the mental and physical health of caregivers.
We call the typical caregiver afflictions Caregiver Syndrome.
Before HIV and AIDS it was recognized caregiving was potentially a high
risk occupation. Caregivers were provided with psychosocial support to
moderate the negative occupational impact.
Psychosocial support was provided by psychologists and social workers,
and included de-briefing sessions an opportunity to unload the
burdens combined with therapy.
In many countries it was law. Caregivers had to receive psychosocial
support.
Psychosocial was a basic human right for caregivers.
The AIDS explosion changed all that.
PSYCHOSOCIAL SUPPORT FUNDING
There are not enough psychologists and social workers to provide

traditional psychosocial support for half a million or more caregivers.
Because there was no way to deliver traditional psychosocial support,
little or no funds were allocated to provide it.
Psychosocial support funding was mortally diminished.
FUNDING MUST BE FOUND
Today new ways exist to provide psychosocial support on a wide scale,
but there are no funds.
Caregivers want it, caregiver organizations want it. But theres little to
no money in the budgets to pay for it.
Psychosocial support is still a basic human right for caregivers.
Funding must be found.
Caregiver Syndrome
For millions of caregivers around the world, stress, anxiety, depression,
92
burnout and declining health are normal.
Caregiver Syndrome is about serious unhappiness.
It is dangerous and can lead to death.
This unhappy condition is not yet formally acknowledged by medical
authorities, but it needs recognition and treatment.
Lets look at some of the most common components and effects.

WHAT GOES UP
Caregivers Syndrome is characterized by increases in:
Stress, anxiety, mood swings, depression and burnout
Coping and emotional resilience
Negative emotions including anger and fear
Grief and trauma
Compassion fatigue
Risk of illness through reduced immune function
Exhaustion and chronic fatigue
Absenteeism and presenteeism
Workplace conflict
Home and family problems
Post-traumatic stress disorder
WHAT GOES DOWN
Caregivers Syndrome is characterized by decreases in
Happiness Intelligence
Happiness, hope, joyfulness, general mood
Positivity, general mood and optimism
Emotional Intelligence
Decision making ability and problem solving skills
Mindfulness
Adaptability
Meaning and purpose in life
93
Productivity
Satisfaction with life
Physical health
RISKS TO PHYSICAL HEALTH
Caregiver Syndrome increases the risk of cancer, Alzheimer s,
depression, hypertension, diabetes, heart disease, arthritis and other
serious medical problems.
A GLOBAL PROBLEM
Caregiver Syndrome reduces the health, quality of life, and caregivers
ability to function effectively and productively.
In Africa most caregivers provide care for people infected or affected by
HIV.
But Caregiver Syndrome also affects caregivers providing care for people
living with Alzheimer s and dementia, cancer, arthritis, the physically
and mentally and disabled, seniors and more.
AMATEURS AND PROFESSIONALS
Caregiving services are not only provided by trained professionals.

Often family members including children, friends and neighbors find
themselves providing care.
In Africa the majority of caregivers are volunteers.
All caregivers are susceptible to the severe consequences of Caregiver
Syndrome.
SUPPORT
Caregiver Syndrome is aggravated by a lack of support.
Support is the best way to prevent and counter Caregiver Syndrome.
Because most Caregiver Syndrome related problems are emotional and
psychological, psychosocial support is the most important support for
caregivers to receive.
Training, equipment and resources to help caregivers work more
effectively is another important aspect of support.
Caregivers may also require medical support to help cope with health
94
problems that arise from their chronically stressful work.
Patient Syndrome
Being told that we have a disease that is trying to kill us is one of the
most traumatic and stressful events a human can face.
Persons living with chronic or potentially fatal illness also suffer from a
syndrome that creates powerful unhappiness that can accelerate their
disease, increase the chance of death, interfere with their treatment
and support, and multiply the negative impact for the people around
them.
We call it Patient Syndrome.
NEGATIVE EMOTIONS
Most of us are not properly equipped to cope with the threat of death or
disability and consequently suffer from high stress levels, mood swings,
anxiety, trauma and depression.
We learned earlier that stress causes negative emotions.
The extreme chronic stress experienced in Patient Syndrome can result
in a flood of negative emotions that ranging from why me? to self pity,
from anger to rage and even despair.
These negative emotions are often directed at the people around us
including family, friends and caregivers.
If not treated, these problems can extend for long periods and result in
anxiety, depression, emotional burnout, and post-traumatic stress
disorder.
DEPRESSION
Incidence of depression is very high in people living with chronic or life
threatening illness.
When depression sets in it can become chronic.
Depression is a dangerous part of Patient Syndrome as it has been shown
95
to reduce immune function, speed disease progression and increase
mortality in cancer, HIV and other diseases.
IMPACT ON TREATMENT AND CARE
Patient Syndrome can result in lack of self care including proper diet,
poor adherence to medication, and poor compliance with therapy
including missing appointments and support groups.
Good adherence to medication is critical to slowing and overcoming
many diseases. Depression is noted as one of the primary drivers for lack
of adherence to medication.
Depression increases both the need for, and burden on, caregivers.
If not treated, Patient Syndrome can accelerate disease progression and
result in hospitalization.
Patient Syndrome can significantly increase healthcare costs.
IMPACT ON THE PATIENTS NETWORK
Therapy and treatment are provided for the patient, but what about the
patients network?
The patients family, friends, caregivers, co-workers, neighbors and
others are also strongly impacted by Patient Syndrome.
Unhappiness is as contagious as happiness.
This group has double trouble: they must cope with their own shock a
lesser version of Patient Syndrome as well as coping with the patients
unhappiness and disrupted socialization.
In some cases they also provide caregiving service.
Problems can be especially daunting for the patients children and spouse.
Members of the patients network also have a strong need for
psychosocial support.
Psychosocial support can reduce negative affect and boost positive
affect and address problems such as stress and depression.
Appropriate psychosocial support can radically improve quality of life for
patients, their family, friends, and caregivers.
OVC Syndrome
96
Here we address a crisis that could impact generations if left untreated.
ORPHANS
Imagine a child watching their mother or father slowly lose energy, lose
weight, lose the capacity to care and provide, then watching them die.
Over 15 million children have lost one or both parents, and sometimes
siblings also, to HIV.
They may be left in child headed households or find themselves moved
to the care of grandparents, foster parents, other siblings.
These kids may also be removed from their community and placed in a
care institution or a foster home.
Orphans are defined as children having lost one or more parents.
If this loss is due to AIDS, they are orphans from AIDS.
VULNERABLE CHILDREN
Children require safety for happy healthy development.
Families provide children with protection.
When families are disrupted or split through circumstance, illness or
death, children may lose their protection and become vulnerable.
These are vulnerable children.
Sick children may be especially vulnerable.
ORPHANS AND VULNERABLE CHILDREN (OVC)

Some orphans lose their safety and become vulnerable. Other children
with parents may become vulnerable through circumstance.
Both orphans and vulnerable children share many serious problems that
require care and healing.
For the purpose of arranging and providing care, these children are
called OVC orphans and vulnerable children.
97
EARLY TRAUMA
Most OVC are traumatized.
Childhood is our most important developmental phase.
Trauma during childhood causes tremendous emotional upheaval and can
severely disrupt normal development.
Children who are orphaned due to AIDS often experience greater trauma
as they may have watched family members die long and painful deaths.
Traumatized children are at high risk for adverse psychological outcomes
that can last a lifetime.
Untreated early trauma can result in long term mental and physical
health problems that can undermine their ability to lead a happy,
healthy and productive life.
Even excessive or persistent early crying may lead to poor school

performance, increased risk of attention deficit hyperactivity disorder
and long term inabilities to cope with stress and depression.
Childhood trauma can shorten life by between 7-15 years by impacting
immune response in the latter part of ones life.
A CRISIS IN THE MAKING
If OVCs are not treated and healed, their countries will suffer serious
consequences that could last for more than half a century.
Results could include widespread learning problems, high incidence of
risky behavior, widespread movement into crime, reduced cognitive
ability, lack of ability to hold gainful employment, physical health
problems.
They could become a severe drain on their countrys resources.
Children are the future it is desperately important that these kids are
healed so they can re-establish a healthy childhood and develop a solid
foundation as contributors to a bright future.
Children are naturally resilient and can heal quickly.
Robust psychosocial support provided quickly and consistently can
prevent and heal OVC Syndrome.
OVC Psychosocial support programs need to be funded and provided
98
urgently.
We have to do it.
Our Commitment
As InHappiness learnt more about the ravages of the HIV pandemic in
Africa, we became increasingly committed to helping to find a solution.
We believe the JOYGYM Happiness System provides the tools to prevent
and heal Caregiver Syndrome, Patient Syndrome and OVC Syndrome.
In addition to alleviating untold hardship, tackling these problems would
provide an ideal test for JOYGYM.
If JOYGYM could help to heal these groups which included some of the
unhappiest people in the world then it was ready for widespread roll
out to help other unhappy people.
We decided to devote all our energy and resources to developing a
psychosocial program that could do the job we named it Healing with
Happiness.
Defining the Goals
InHappiness consulted with major stakeholders to help us to define what
an ideal psychosocial program would look like.
Together with our colleagues at USAID/PEPFAR, the Hospice and
Palliative Care Association of South Africa, the University of the
Witwatersrand Palliative Care Center for Excellence, Family Health
International, the Southern African Catholic Bishops' Conference, and
99
from a number of South African hospices and care centers, we started to
define the goals.

The Healing with Happiness program needed to have the following
characteristics:
POWERFUL: The program had to deliver powerful results to address a
broad range of psychosocial problems
ECONOMICAL: There was little or no budget for psychosocial support
and funding resources were already stretched
EVIDENCE BASED: The program must incorporate simple but effective
monitoring and evaluation to confirm results
LOW-TECH: Many communities in urgent need of psychosocial support
were rural without electricity or access to technology
CROSS-CULTURAL: South Africa has eleven languages and multiple
cultures, 1,500 languages are spoken across Africa
SUSTAINABLE: Only a program that is well received and effective will
be continued in the long run
SCALEABLE: It must be capable of rolling out quickly on a very wide
scale to service tens of millions of people in need
Healing with Happiness would have to operate well without hands-on
social workers or psychologists, and be effective in modern hospices and
the most rural settings alike.
We had our challenge.
Development
We started training HIV caregivers in 2007 and started program
development work early in 2008.
It was decided at an early stage to deliver the program through
caregivers themselves. We would train them to provide therapy to each
other and to their patients and community.
100
We designed and tested and redesigned training systems and techniques,
trainer and trainee group sizes, monitoring and evaluation techniques
and more.
In our first week in rural Mpumalanga we provided training in seven
different languages and discovered that some caregivers couldnt read or
write.
Developing reliable ways to provide training and capture data under
these conditions was a wonderful and rewarding adventure that deserves
a book of its own.
We were blessed to find trainers that loved the program, were resilient,
and who helped us to solve problems that occasionally seemed
insurmountable.
By August 2009, we had travelled thousands of kilometers to remote
settings and trained more than a thousand caregivers across South

Africa.
We had presented our program and results at a Hospice and Palliative
Care conference and an international AIDS conference and received a
warm response and excellent feedback.
The program was providing solid psychosocial support for tens of
thousands of caregivers, adult patients and OVCs.
It quickly and effectively countered Caregiver Syndrome and appeared to
counter Patient Syndrome and OVC Syndrome.
We believed we had developed a psychosocial support program that
could be rolled out across Africa to the millions of caregivers, patients
and OVCs in need.
The cost per adult or child patient was below $2.50 per month a tiny
fraction of the costs of caring for broken individuals for a lifetime.
Healing with Happiness was ready.
101
102
103
104
The Case Study
During the development period it was not possible to conduct testing
using proven scientific measures.
The wide range of languages spoken and caregiver educational levels
precluded the use of validated psychometric assessments.
We had developed a Self Report Questionnaire that allowed monitoring
and evaluation of program results, but these had not been validated.
Healing with Happiness needed rigorous evaluation.
SHOWTIME
In September 2009 the Hospice Palliative Care Association of South Africa
agreed to help us to test the program.
They commissioned us to provide an extended Healing with Happiness
program at a Regional Care Center.
The objective was to submit the program to detailed scientific
assessment and accurately assess the programs performance and
efficacy over a period of six months.
The program was to be carried out in a semi-urban setting with
participants having a more advanced educational background that would
enable the use of validated scientific assessments and techniques.
We were overjoyed.
This was the opportunity we had been waiting for.
CARE CENTER
A Care Center was chosen in a moderate sized city in South Africa.
It is the sole care provider for a region of 3,500 sq km /1,300 sq miles
with a mining and agriculture based economy supporting a population of
almost 400,000 people.
The Care Center includes:
PALLIATIVE CARE: Six adult and two pediatric in-patient beds
offering end of life care and two-week pain and symptom
management programs, primarily for HIV and cancer patients
OVC CARE: An OVC Daycare Center for 52 HIV and AIDS infected and
105
affected children providing food, clothes, mental stimulation and
medication where necessary
HOME BASED CARE: An extensive home based care program covering

the entire region
This center provided the opportunity to measure the programs impact
across a representative range of care services.
PRIMARY PARTICIPANTS
The 27 primary participants ranged in age from 28 years to 67 years
including:
15 staff including the CEO, nursing director, training manager,
fundraising manager, nurses, home based care supervisors, and
caregivers
7 OVC Daycare Center staff including the manager and admin
manager, head teacher, and assistant teachers
Support staff including the craft manager, driver and handyman,
general worker and cook
DOWNSTREAM PARTICIPANTS
The primary participants provide care for more than 1,500 downstream
recipients including
People in hospice care
Children in day care
People receiving home care
People attending support groups
106
Case Study: Roll Out
All primary participants received intensive one-day training together and
started daily peer-to-peer therapy sessions the next day in groups
according to workplace and shift times:
Care Center: managers, administrators and support staff
In-patient care: caregivers and staff
OVC Daycare Center: manager, child caregivers and staff
Home based care unit: entire team
The Healing with Happiness (HWH) training was well received and daily
peer-to-peer practice was warmly embraced. Most participants initiated
HWH therapy practice at home on the evening of training.
Voluntary peer-to-peer practice was well sustained for the first four
months, after which it became more intermittent. The effects of this
drop-off can be seen in a number of the results.
After reviewing the six-month program results management decided to
institutionalize daily HWH therapy practice to maintain maximum
program benefits.
STANDARD ASSESSMENTS
Standard HWH program measures included the JOYGYM Self-Report
Questionnaire and individual and group interviews (qualitative

assessment) by HappyMetrics.
These were conducted during all site visits.
Standard Assessments
Baseline
2 week
2 mo.
4 mo.
6 mo.
JOYGYM Self-Report
Questionnaires
Individual & group
interviews
Assessment
30 Oct
3 Dec
19 Jan
10 Mar
12 May
Dates:
2009
2009
2010
2010
2010
Intensive one-day training was provided on 17 November 2009.
107
EXTENDED ASSESSMENTS
Extended assessments for this program included a range of psychometric
assessments and the Bar-On EQ-i Emotional Intelligence assessment
conducted by independent research contractors.
Psychometric assessment was conducted at each site visit, with EQ-i
assessment conducted at baseline and after two and six months.
Extended Assessments
Baseline
2 week
2 mo.
4 mo.
6 mo.
Psychometric
assessment
EQ-I assessment
Assessment
30 Oct
3 Dec
19 Jan
10 Mar
12 May
Dates:
2009
2009
2010
2010
2010
Notes on the Case Study
SAMPLE SIZE
While clear trends can be seen in the results, the sample size of 27
primary participants is too small to extrapolate that results will be
exactly duplicated in other groups.
SELF-REPORT QUESTIONNAIRE
Self-report assessment results were obtained using JOYGYM Self-Report

Questionnaires developed by InHappiness for this program.
The questionnaire had previously provided consistent results with more
than 500 program caregivers across five provinces of South Africa.
Results from the extended assessments (psychometric and Emotional
108
Intelligence) correlate with Self-Report Questionnaire results.
INFORMED CONSENT
Participants were clearly informed that their participation in the
monitoring and evaluation was voluntary. Consent was obtained in
accordance with World Health Organization guidelines.
EXCLUSION OF EXTERNAL FACTORS
The results shown can reliably be considered to stem from the Healing
with Happiness program.
The environment at the Care Center had been stable for months prior to
implementation and remained stable throughout the six-month HWH
period. No changes in psychosocial support were made, and no other
programs were introduced that would impact on the measured outcomes
during this period.
In light of significant changes continuing in a sustained manner over the
six-month period, the Hawthorne effect is not considered to have

significantly influenced results.
DISCUSSION
Some of the two-month results do not follow the trend. This may be
attributed to daily therapy not being practiced during the Christmas
holidays, and also to changes in levels of stress, depression and
relationship problems after spending holidays with their family.
Some of the six-month results appear to reflect the decrease in daily
peer-to-peer therapy practice that occurred during the previous two
months. This is especially evident in increased measures of perceived
stress and depression, in self-reported family home problems and days
worried per month, and in decreased measures of Impulse Control EQ
and Adaptability EQ.
ANALYSIS
The JOYGYM program has two delivery streams: Aerobic Laughter
therapy and Happiness Coaching. The Healing with Happiness program
incorporates both streams.
In the sections that follow we provide a separate analysis (where
applicable) of the relative impact of Aerobic Laughter therapy and
109
Happiness Coaching on each of the measured variables.
LANGUAGE AND STYLE
The following presentation of program results adopts the somewhat
more formal style used by HappyMetrics.
Baseline is the term used to denote results measured before the program
started.
Does HWH Build Happiness?
The first and most important question we addressed was does the
Healing with Happiness program boost primary participant happiness?
Happiness
BASELINE
Levels of happiness and joy were low as participants were suffering from
chronic stress, depression and many symptoms of burnout.
Emotional negativity and feelings of doom and gloom were widespread.
Care Center staff and patients looked stressed and unhappy.
110
RESULTS: SELF-REPORT QUESTIONNAIRE
Big increases in happiness scores were seen after two weeks and again
after four months (after falling off slightly in the post-holiday period).
Hope scores showed a significant increase after two weeks, with
continued increases until the last result (perhaps due to reduced daily
practice).
Feelings of joy increased after two weeks, then again after six months.
RESULTS: PSYCHOMETRIC ASSESSMENT
The Fordyce Emotion Questionnaire asks the percent of time I feel
happy, and the percent of time I feel unhappy.
Results showed continued and significant increases in happiness and
significant decreases in unhappiness after two weeks and four months.
111
RESULTS: EMOTIONAL INTELLIGENCE (EQ)
General Mood EQ covers the areas of general mood, optimism and
happiness and measures the ability to enjoy life, outlook on life, and
overall feeling of contentment. Higher scores mean cheerful, positive,
hopeful and optimistic people who know how to enjoy life.
Optimism EQ reflects the ability to look at the brighter side of life and
maintain a positive attitude in the face of adversity.
Happiness EQ reflects the ability to enjoy life and have fun.
All measures show a dramatic increase after two months with a further
significant increase after six months.
The General Mood EQ and Optimism EQ scores after six months were
higher than the national average for people of similar age and
background.
This is a considerable achievement given the nature of their work.
RESULTS: INTERVIEWS
Participants reported a major increase in personal happiness after two
weeks, describing a newfound sense of lightness.
They noted that even if they arrived at work moody or depressed, after
the morning Aerobic Laughter therapy practice any negativity
disappeared and they started the workday happy and energized.
112
RESULTS: MANAGEMENT FEEDBACK
After two weeks managers highlighted a positive shift in workplace mood
and ambience, noting that people were happier and that laughter was
often heard.
After two months they confirmed that a new pervading sense of
happiness was evident throughout the Care Center.
RESULTS: DISCUSSION
Participants experienced fast and dramatic increase in happiness and
decreases in unhappiness, with new levels of optimism and mood even
higher than the national average.
After two months the increased happiness could be felt when we arrived
at the Care Center. These were very different people to those we had
met ten weeks before. They were happy, even playful and very quick to
smile and laugh.
This wonderful level of happiness was maintained for the duration of the
program.
A recent visit 14 months after training confirmed that Care Center
remains a happy center with a warm and welcoming attitude.
ANALYSIS: THE ROLE OF LAUGHTER
Happiness Coaching increases measured happiness variables, but Aerobic

Laughter therapy dramatically speeds and multiplies these results.
Aerobic Laughter practice provides a strong dose of joyfulness that
raises happiness levels, increases optimism and hopefulness, and acts to
improve general mood. It also acts powerfully to reduce stress-related
unhappiness.
ANALYSIS: THE ROLE OF HAPPINESS
INTELLIGENCE
After the dramatic increases in happiness seen at two weeks and two
months, we believe that much of the continued increase can be
attributed to the participants ongoing development and application of
113
Yes. HWH builds Happiness
Happiness
Healing with Happiness dramatic increases in
happiness after just two weeks, with continued

increases across the six-month period.
Can HWH Heal Caregivers?
The next important question we wanted to address was does the
Healing with Happiness program overcome widespread incidence of
Caregiver Syndrome?
To answer this question we measured indicators of mental and physical
health including:
Stress and depression
Coping
Resilience
Burnout
Work relationships
Home and family relationships
Mindfulness
Adaptability
114
Positivity
Well-being
Happiness Intelligence
Physical health
Stress and Depression
Stress is a normal physical response to events that make us feel
threatened or upset and affect our balance in some way.
The stress response is the bodys way of protecting itself. Stress helps us
stay focused, energetic, and alert. However, beyond a certain point,
stress stops being helpful and starts causing damage to health, mood,
productivity, relationships, and quality of life.
Chronic stress grinds away at mental and physical health, causing
emotional damage in addition to physical ailments. Long-term stress can
even rewire the brain, leaving us more vulnerable to everyday pressures
and less able to cope. Over time, stress can lead to mental health
problems such as anxiety, depression, eating disorders and substance
abuse.
BASELINE
Self-report results showed high levels of stress, mood swings,
depression, and of physical stress indicators including stress-related
body pain, headaches and migraines, digestive problems such as
constipation and diarrhea, and sleep problems.
Psychometric results showed high levels of perceived stress. Depression
scores indicated widespread clinical depression.

Stress Management EQ scores showed low stress management and
impulse control, and low stress tolerance.
In interviews almost all participants reported:
Very high stress levels
Feelings of low self esteem
Feelings of hopelessness
Frequent mood swings, anger and conflict
115
High levels of anxiety
High levels of recurring depression that in some cases were under
treatment with medication
Feeling over-burdened with issues in their personal lives and

concerns about their ability to cope with these issues
Physical indicators of stress as noted above, and also exhaustion
(low energy levels) and difficulty keeping up with job demands
A significant number of participants reported being under treatment for
medical conditions including depression, high blood pressure, and
diabetes.
The problems noted were not recent, but had built up and continued
over an extended period of time. Participants coping mechanisms were
overstretched and we saw widespread evidence of burnout.
Some managers complained of feeling over-burdened with work and
responsibilities, particularly reporting requirements.
Dramatic reductions in levels of stress and depression were seen after
two weeks. Reductions continued as participants become more
proficient in HWH therapy techniques and found new ways to
incorporate them into their work and personal life.
Depression levels rose briefly after the Christmas holiday period.
Physical stress indicators reduced over the entire period, with major
reductions after two weeks in all indicators except sleep problems which
116
reduced sharply after two months.
The Perceived Stress Scale (PSS) is widely used to measure the
perception of stress and how unpredictable, uncontrollable, and

overloaded respondents find their lives.
The Center for Epidemiologic Studies Depression Scale (CES-D) is widely
used to test for depression.
Perceived stress results confirmed the reductions seen in the Self-Report
Questionnaire.
The initial CES-D score of 19.92 suggests that participants were in or
close to clinical depression before the program. After 2 weeks the score
117
was down to 16.64 (slightly above the danger threshold). After two
months scores no longer indicated clinical depression.
Notice how both stress and depression levels increase after six months
due to a drop off in daily HWH therapy practice.
RESULTS: EMOTIONAL INTELLIGENCE

High scores on Stress Management EQ show an ability to withstand stress
without falling apart or losing control. High scorers are generally
calm, rarely impulsive, and work well under pressure.
Stress Tolerance reflects the ability to withstand adverse events and
stressful situations without falling apart by confidently coping with
stress.
Impulse Control reflects the ability to resist or delay an impulse, drive or
temptation to act or react.
Stress Management EQ results show significant increases in stress
management, stress tolerance and impulse control.
RESULTS: INTERVIEWS
The majority of participants reported:
Dramatic reductions in stress levels after two weeks, with a new
feeling of lightness from relief of chronic stress. Further
reductions were confirmed after two, four and six months.
Feelings of low self esteem and hopelessness reduced after two
weeks, and were seldom evident after two months.
Mood swings, anger and levels of anxiety reduced after two weeks,
118
and were seldom evident after the two months.

Feelings of depression reduced after two weeks, with further
decreases after two months. After four months chronic depression
was no longer evident, and participants had been taken off
antidepressant medication by their doctors.
The severity of high blood pressure and diabetes under treatment
was reduced after two months, and treatment was stopped by
their doctors within four months.
RESULTS: MANAGEMENT INTERVIEWS
Even though most managers were not interacting with patients, they
reported unusually high stress and depression levels before the program.
This may be attributed to emotional contagion and difficulties in
managing and motivating highly stressed staff. Managers stress levels
reduced in line with group levels, with some managers reporting
significant increases in their performance.
RESULTS: DISCUSSION
Healing with Happiness therapy counters stress in a number of ways:
Fast reduction of physiological and mental stress levels through
daily Aerobic Laughter therapy practice
Teaches and builds effective new coping skills
Helps participants to reframe regular stressors in ways that they
cease to be stressful, thereby reducing perceived stress

Develops stress-mindfulness that enables participants to override
the bodys stress response in real time
Dangerous levels of stress and depression were dramatically reduced.
While we would expect increases in the measured happiness variables
with Happiness Coaching alone, there is no doubt that Aerobic Laughter
therapy acts to dramatically speed and multiply these results.
The rapid reduction in bloodstream levels of cortisol and other stress-
related substances plays a major role in the reduction of stress.
This effect is known to last for 8 hours or longer after laughter practice.
119
By scheduling therapy sessions at start of shift this benefit is maximized.
Aerobic Laughter acts as a powerful positive affect to reduce negative
mood and similarly reduces mood swings.
There is increasing evidence that depression is caused and exacerbated

by stress. Reduced levels of cortisol and stress-related substances in the
bloodstream act powerfully to reduce depression.
Caregivers are exposed to high levels of trauma and grief that can result
in pent-up negative emotions which may contribute to depression.
Aerobic Laughter promotes the cathartic release of pent-up negative
emotions, thereby alleviating this problem.
Stress management and tolerance are increased as a result of Aerobic
Laughter therapy triggering the de-stress response that works to
metabolize cortisol and stress-related substances in the bloodstream.
This acts as a buffer for stress triggered in the following hours as cortisol
is reduced by being rapidly metabolized.
INTELLIGENCE
Healing with Happiness educates, empowers and encourages participants
to build stress mindfulness, an important component in Happiness
Intelligence.
The resulting stress-consciousness allows participants to recognize and
reframe major and/or chronic stressors in ways that are no longer
stressful.
Stress mindfulness creates the ability to recognize stressors in real time
and to override the stress response.

The continued reductions in stress reflect participants ongoing progress
in developing and exercising their Happiness Intelligence.
Coping
Coping is the ability to withstand adverse events and stressful situations
120
without falling apart.
Coping is especially important in healthcare where the ability to keep a
level head and continue to operate in crisis and emergency situations is
crucial.
BASELINE
Stress Tolerance EQ results indicated very low coping ability.
In interviews participants reported
A lack of ability to cope with personal issues
Difficulty coping with death and dying of those in their care
Feeling overburdened with work and life pressures
The interviewer felt that caregivers coping mechanisms were
overstretched.
Stress Tolerance EQ measures indicate a dramatic increase in coping
ability after two months, with a further similar increase after 6 months
(see previous section for scores).
RESULTS: INTERVIEWS
After two weeks participants reported significant improvements in their
ability to cope with issues in their work and personal lives.
After two months they no longer felt that coping with personal issues
was a problem or major source of stress for them.
Participants reported that they were now coping more effectively with
death and the loss of those in their care. Further improvements were
reported after four and six months.
Participants found it easier to cope with their workload and work
responsibilities.
The resident part-time psychologist attached to the Care Center
confirmed the remarkable and sudden improvement in participant
coping skills.
121
Interviews with management confirmed significant and general increases
in the participants ability to cope with major stressful life events such
as death and trauma.
A significant improvement in coping with the volume of work was

reported by one manager.
RESULTS: DISCUSSION
HWH therapy specifically empowers participants with improved coping
skills. These continued to improve for approximately four months and
were maintained during the program.
The increase in happiness levels appears to assist participants in
reframing their responses to stressors. The incidences of trauma
associated with loss did not drop during the program, but participants
perception of these stressful events changed.
The impact of HWH therapy on coping skills appears to include:
A dramatic increase in the ability to cope with issues of a personal
nature
Improved ability to cope with death and dying of those under their
care
A new ease in coping with work and life pressures
The caregivers are now coping well with stress and adversity.
The ability to cope with stress is increased as Aerobic Laughter therapy
triggers the de-stress response that works to metabolize cortisol and
stress-related substances in the bloodstream. This serves to increase the
ability to cope with stress during the following hours.

INTELLIGENCE
Most of the improvement in coping ability is attributed to increased
122
Resilience
Resilience is the ability to bounce back from adversity.
Lack of resilience can result in high levels of stress and depression that
may reduce the ability to carry out duties effectively.
In addition to the death of patients for whom they are caring, South
Africans are exposed to a very high number of deaths among family and
friends due to the very high incidence of HIV and AIDS.
BASELINE
Initial interviews showed that caregivers experienced difficulty bouncing
back from adversity, particularly from the death of those they cared for,
and from the death of family or friends.

RESULTS: INTERVIEWS
After two months many participants expressed surprise at their
newfound ability to bounce back from adversity and from the death of
persons in care to whom they had become emotionally attached.
After four months their ability to bounce back had further increased.
Participants reported a new understanding that death was an
unavoidable and inevitable part of their work, and of how they had
previously allowed death to impact negatively on their emotions and
health.
This motivated them to become fiercely protective of their own
happiness and health, and to reprogram their response to death to be
more accepting and less damaging to their happiness.
While they still experienced sadness and grief, many were able to
reduce the period of intense negative emotions from weeks to days or
hours.
Two participants experienced multiple deaths of close friends and family
and were able to bounce back within a matter of days. Both reported
123
that before the HWH program they would have been out of action for
weeks.
Management confirmed that lack of resilience was a significant problem
before the program, with managers and staff frequently taking time off
or experiencing high levels of presenteeism after the death of patients
or family/friends.
They reported that the increased resilience was reducing group stress,
absenteeism and presenteeism and increasing productivity.
RESULTS: DISCUSSION
Significant increases in the ability to bounce back from adversity were
seen. The dramatic and widespread increase in emotional resilience is
one of the most significant results of the program.
Stress and adversity often result in powerful negative emotions. Aerobic
Laughter provides tools that allow the cathartic release of negative
emotions, thereby building resilience.
Many of the caregivers displayed signs of post-traumatic stress disorder
resulting from accumulated trauma and grief not released. By releasing
these pent-up negative emotions post-traumatic stress disorder was
reduced, thereby increasing their ability to cope with further stress and
adversity.
Cognitive behavioral therapy acts to develop and strengthen specialized

neural circuits and build behavior habits. Regular practice of Aerobic
Laughter therapy develops the ability to release negative emotions
rather than bottling them up. This also acts to build resilience.
INTELLIGENCE
As participants built their Happiness Intelligence, they developed a new
ability to recognize and understand the impact of adversity and death on
their happiness, and to manage it in more intelligent ways.
124
Burnout
Burnout is a state of physical, emotional and mental exhaustion caused
by long-term exposure to demanding work situations. Burnout is the
cumulative result of stress.
Caregivers experience high levels of stress, perceived stress, high
workload, and a support base that is often regarded as inadequate.

In addition to causing poor work performance, absenteeism and
presenteeism, burnout may contribute to depression, staff turnover and
serious health problems.
Studies have shown that burnt-out women and depressed men are at a
greater risk of future inflammation-related diseases, including diabetes,
heart disease and strokes compared with their non-burnt out and non-
depressed counterparts.
Caregivers participating in previous Healing with Happiness programs
consistently reported increased energy and vitality in their work, study
and life.
BASELINE
Evidence of burnout was observed in most participants during baseline
interviews.
The following symptoms provided cause for concern: high stress levels,
negativity and depression, low emotional resilience and Emotional
Intelligence and a high incidence of hypertension and diabetes.
It was evident that these symptoms had not developed recently, but had
accumulated over an extended period.
RESULTS: INTERVIEWS
Participants reported significant increases in energy and motivation after
two weeks, whilst coping skills improved.

125
Further reductions in burnout and higher motivation were observed after
two months. After four months no evidence of burnout was seen.
RESULTS: DISCUSSION
Rapid reduction of widespread long term burnout was seen among
caregivers. Burnout was eradicated in most participants within two
months and in all participants within four months.
Aerobic Laughter therapy acts to increase levels of energy and happiness
and to reduce stress, thereby reducing burnout.
INTELLIGENCE
Happiness Intelligence further enables participants to increase happiness
and reduce stress, thereby reducing burnout.
Emotional Intelligence, also known as emotional quotient (EQ) is defined
as a set of competencies that demonstrate a persons ability to
recognize emotions in themselves and others and to manage them
intelligently.
People with higher EQ tend to demonstrate good self-motivation, goal
management and balance between work, home, and recreational life.
They tend to avoid procrastination, self-doubt, and low achievement.
A strong Emotional Intelligence can help to build positive relationships
with colleagues and improve performance - the ideal formula for
workplace success.
Increases in Emotional Intelligence can help to significantly reduce stress
from home and social relationships.
126
High stress levels are associated with low EQ.
Emotional Intelligence can be taught and developed.
The authors agree with Reuven Bar-Ons view that Emotional Intelligence
is an integral and important part of positive psychology.
127
BASELINE
A low level of Emotional Intelligence was observed in the majority of
participants. Pre-intervention EQ scores were well below the national
average with the following subscales indicating areas for concern:
Problem Solving EQ
Adaptability EQ
Reality Testing EQ
Stress Management and Stress Tolerance EQ
The BarOn EQ-i Emotional Intelligence scale measures an array of non-
cognitive abilities, competencies, and skills that influence our ability to
succeed in coping with environmental demands and pressures.
EQ-i assessment was performed at baseline and after 2 months and 6
months of the HWH therapy program. Eighteen individuals with
educational levels higher than Grade 10 were included.
Raw EQ-i scores are transformed into scaled scores with a mean of 100
and a standard deviation of 15. Scores that fall between 85 and 115 are
considered within the effective functioning range. South African norms
are shown according to age and gender.
The main EQ-I scale and subscales are shown here. More detailed EQ-i
subscales have been used to illustrate changes in other chapters.
128
Total Emotional Intelligence showed a dramatic increase after two
months and a further increase at six months.
Results for other subscales are discussed separately.
RESULTS: DISCUSSION
Significant increases in caregivers Emotional Intelligence were seen
after two months, with further increases after six months.
High stress levels are associated with low EQ.
Aerobic Laughter therapy acts to increase EQ by reducing stress.

INTELLIGENCE
Emotional Intelligence and Happiness Intelligence are largely
intertwined and interdependent.
EQ is concerned with recognizing, understanding and managing emotions
while HQ (Happiness Intelligence) is concerned with recognizing,
understanding and managing happiness.
We believe that working to increase either of these intelligences will
129
impact positively on the other.
Work Relationships
Working well with others is an important and integral part of job
success. Caregivers work as a cooperative group or team to accomplish
daily tasks.
Effective teams show greater productivity, sharing of workload,
increased work pace, greater opportunities to learn and faster learning,
shared responsibility, better quality of work, less dishonesty, fewer
mistakes, mutual creativity and problem solving, greater job satisfaction
and greater mutual support.
Good teamwork and cooperation is built on trusting and considerate
relationships in a spirit of mutual respect.

BASELINE
Participants ability to cooperate and communicate was reduced and
needed reinforcement.
Many participants reported frequent instances of conflict and anger,
particularly with other staff. This appeared to be a way of venting their
stress and externalizing blame.
One manager reported that they spent most of their time and energy
resolving interpersonal conflict between staff. Most of these conflicts
were regarded as frivolous, often along the lines of I dont want to work
with X anymore. She never returns my greetings. She doesnt like me
and I dont like her. If she cant be civil then I cant and wont work with
her anymore! Other managers reported similar problems to a lesser
degree.
One participant was involved in consistent and multiple daily conflicts
with others.
Conflict behavior spread negative emotions throughout the workplace
and contributed greatly to management load.
Some instances of long term relationship problems were found, with
significant animosity between pairs of people.
RESULTS: INTRAPERSONAL INTELLIGENCE
A strong Intrapersonal Intelligence positions us for success: higher scores

indicate individuals who are in touch with their feelings, feel good about
130
themselves, and feel positive about what they are doing in their lives.
High scoring individuals are able to express their feelings, are
independent, strong, and confident in conveying their ideas and beliefs.
Self-regard EQ indicates an ability to look at and understand oneself,
respect and accept oneself, and accept ones perceived positive and
negative aspects as well as ones limitations and possibilities.
Emotional self-awareness EQ is the ability to recognize and understand
ones feelings and emotions, differentiate between them, and to know
what caused them and why.
Assertiveness EQ is the ability to express feelings, beliefs and thoughts,

and to defend ones rights in a non-destructive way.
Independence EQ reflects the ability to be self-reliant and self-directed
in ones thinking and actions and to be free of emotional dependency.
Self-actualization EQ describes the ability to realize ones potential
capacities and to strive to do that which one wants to do and enjoys
doing.
A significant increase in Intrapersonal Intelligence was seen at 2 months
with further increases at six months.
Self Regard EQ increased after two months to higher than average levels
with a further increase at 6 months.
A significant increase in Emotional Self-Awareness EQ was seen after two
months and maintained over the six month period.
131
There was little change in Assertiveness EQ after two months, but a
large increase in assertiveness was seen after six months.
Independence EQ scores were initially low, but showed some increase at
two months and significant increase after 6 months.
Self-actualization EQ scores increased after two months and maintained
the increase after six months.
RESULTS: INTERPERSONAL INTELLIGENCE
Interpersonal EQ taps into interpersonal skills and functioning. Higher
scores indicate responsible and dependable individuals who have good
social skills - they understand, interact, and relate well to others.
Empathy EQ reflects the ability to be attentive to, to understand and to
appreciate the feelings of others. It is being able to emotionally read
other people.
Social EQ responsibility is the ability to demonstrate oneself as a co-
operative, contributing, and constructive member of ones social group.
Interpersonal relationship EQ scores indicate the ability to establish and
maintain mutually satisfying relationships that are characterized by
intimacy and by giving and receiving affection. This intelligence helps in
building a bond of friendship and unity among team members. In some
employees, this bond of friendship lasts for a life time and can make
work easier and goals more attainable.
A significant increase in Interpersonal Intelligence was seen at 2 months
with further increases at six months.
132
A small drop in Empathy EQ is seen after two months. This may be
attributed to increased Assertiveness EQ (see above), or result from
measurement occurring after the Christmas holiday period. Empathy EQ
scores were back to normal after six months.
A significant increase in Social Responsibility EQ was seen with the score
climbing to a higher than average level.
The interpersonal relationships score increased after two months, with a
significant further increase at six months.
RESULTS: INTERVIEWS
Significant improvements in cooperation and communication were
reported after two weeks with improvement continuing throughout the
period. A significant number of participants reported an increase in the
quality of their work relationships and increased incidences of
colleagues voluntarily helping each other.
Levels of conflict and anger were considerably reduced after two weeks.
Participants became more mindful of their stress and its causes, and
implemented effective ways to deal with it.
The staff member who previously initiated the largest number of
conflicts lost her antagonism and became so cooperative that she was
promoted to a position with greater responsibility and higher pay.
Long term personality clash-type conflicts between participants were
completely resolved, with one exception where one party did not
participate in HWH training.
While conflicts continued to occur, they were less serious and occurred
less often. In almost all cases conflicts were now resolved within the
team without recourse to supervisors or management.
Newfound mutual respect and trust was evident between team
members. Many remarked on the happy new spirit of cooperation.
Management reported a marked increase in cooperation, communication
and bonding between staff and between staff and management. It was
further reported that HWH therapy brought people together in mutual
trust and respect and resulted in closer friendships and the resolution of
long-standing personality clashes.
The dramatic decrease in conflict within this group resulted in a
133
meaningful reduction in management load. One manager reported a
decrease in resolving time-consuming conflicts from previous levels of 3-
5 conflicts per day to just one conflict over a two month period.
Management reported that team members seeing another person with a
heavy workload were now voluntarily stepping in to help them, even
when this was outside the boundaries of their job description.
In group discussions managers noted:
Significant improvements in interpersonal staff relationships
Faster resolution of conflicts between staff members, with most
conflicts now being resolved without recourse to management
Greater rapport and communication between staff and
management
A significantly happier and less stressed work ambience
Management feedback confirmed that the Healing with Happiness
program impacted positively on the running of the Care Center.
RESULTS: DISCUSSION
HWH therapy removes barriers to communication between participants
including supervisors and managers and allows honest open
communication in a positive atmosphere of trust and mutual respect.
It promotes team spirit, innovation and creativity and taking
responsibility for reaching common goals and objectives.

New holistic relationships developed between team members. Others
were now regarded compassionately and appreciated as whole people
with their own personality and problems, rather than simply as sources
of conflict.
The high degree of workplace conflict was effectively eliminated.
Natural laughter is a form of non-verbal communication that taps into
hardwired brain circuits to promote trust and cooperation and to reduce
aggression and conflict. This can be clearly observed in the social
interaction of young children and also in animals that laugh.
During Aerobic Laughter therapy participants practice natural laughter
together in groups. It is not surprising that this results in reduced
conflict and increased cooperation.
134

INTELLIGENCE
As Happiness Intelligence increased participants were able to recognize
the underlying reasons for frequent work conflicts and also their
damaging negative emotional impact on the individuals in conflict and
on the group.
This new consciousness allowed them to adjust their behavior to reduce
conflict and also to enlist the groups assistance to quickly resolve
conflicts and restore a positive and happy workplace atmosphere
conducive to personal happiness.
Home/Family Relationships
Home and family problems have a significant impact on workplace
productivity, and can be a leading driver of stress, presenteeism, and
absenteeism.
BASELINE
The majority of participants indicated that challenges in their family and
home lives were their main source of stress. These problems negatively
affected their work performance.
Challenges reported included relationship problems with children,
spouse or partner, delinquent children, and social relationship problems.
Many complained of unsatisfactory relations with their children. When
their children approached them for company or to play they would shout
at them to be quiet or send them to play elsewhere because by the time
they arrived home they were too emotionally and physically exhausted
to put up with the childrens demands, noise and playfulness.
Many reported similar problems with their spouse/partner and admitted
that this impacted negatively on their home and sex life and was a major
source of worry for them.
135
Relationship problems with the spouse/partner dropped markedly after
two weeks and were further reduced at 4 months. We believe the
increase in problems at two months to be related to post-Christmas
emotional stress and the reduction in HWH therapy practice over the
holidays.
After two weeks, participants self-reported a major reduction in
problems with their children/grandchildren. Further improvement was
reported at two and four months.
Sexual problems increased after the Christmas holiday period, with
significant reductions seen at four months.
The reduction in HWH therapy practice in the last two-month period is
reflected in the slight increase in all problems.
RESULTS: INTERVIEWS
After two weeks dramatic decreases were reported in family and home
related stress. After two months, participants no longer reported family
and home challenges as a major source of stress.
While a number of caregivers continued to live in taxing home
circumstances, they reported a new ability to reframe their perceptions
of these situations, eliminating them as major stressors.
Participants reported that they started practicing Aerobic Laughter with
their children immediately in most cases when they arrived home from
the HWH therapy training day. Children in all cases responded
enthusiastically they love it, and it became a regular feature of their
136
day, with many practicing with their kids in the morning and evening.
They reported that this brought them much closer to their children and
completely changed their previous behavior.
Interestingly, children quickly adopted the Aerobic Laughter therapy
exercises and initiated them when they saw the parent getting moody or
irritable, thus promoting Aerobic Laughter practice as a way of
preventing or short-circuiting stress.
Many were able to initiate Aerobic Laughter with their spouse /partner
and also with other family members and friends, and reported that their
home was now a much happier place with less conflict and more loving
fun.
Participants confirmed both a reduction in sexual problems and an
increase in sexual frequency.
RESULTS: DISCUSSION
"There is nothing either good or bad, but thinking makes it so" William
Shakespeare.
Before program implementation caregivers were under severe chronic
stress at work. The resulting negative emotions impacted negatively on
family life. The reduction of stress at work due to HWH therapy practice
resulted in less negativity in the family.
New skills in reframing stress resulted in a change in perception of

home/family problems as no longer being sources of stress.
This in turn reduced stressful behavior at home. The resulting
improvement in behavior reduced tension and improved home/family
relationships.
Home and family related problems that were regarded as the number
one source of worry and stress are no longer a notable source of stress
for these caregivers.
Adults practicing natural laughter with younger children find their
relationship is positively transformed.
The benefits previously discussed whereby the practice of Aerobic
Laughter therapy acts to reduce stress, depression and burnout, to
increase coping, resilience, and Emotional Intelligence, and to improve
137
CASE STUDY
One caregiver was extremely stressed by the behavior of her grown son
living with her. He had been drifting into drug abuse, associating with
delinquents, generally displaying wayward behavior. , was seldom home
for meals and was stealing money and household items to sell in order to
support his drug habit and lifestyle. She worried this would soon lead to
his being thrown in jail or death.
His behavior was the major source of stress in her life. They engaged in
frequent screaming matches. She constantly nagged him about his
behavior, was often unable to sleep at night, and sometimes unable to
focus on her work.
This had a major impact on her ability to perform her tasks and led to
exhaustion and symptoms of burnout.
She reported that the Healing with Happiness program empowered her
to recognize the negative impact of this stress and to release it. She
informed her son that his behavior was up to him, and that she was no
longer concerned with what he did. She ceased worrying, went home,
laughed and played with her grandson (his son) and enjoyed her sleep.
This reframing of a major stressor had a huge positive impact on her
life and work. She gained energy, her stress levels dropped and she
became more engaged and motivated in her work.
Her change of attitude had a remarkable effect on her son. When she
stopped arguing and shouting, her son started spending more time at
home with his son, stopped stealing, reduced his drug intake and
stopped seeing his criminal friends. The change continued and after a
period she reported that he was clean of drugs and leading a normal
happy family life.

She attributes this change in his behavior directly to the change in her
behavior.
work relationships also apply in improving relationships with a
partner/spouse.
INTELLIGENCE
As Happiness Intelligence increased participants were able to recognize
138
the underlying reasons for their home/family problems and also their
damaging negative emotional impact on all family members.
This new consciousness allowed them to adjust their behavior to reduce
conflict, or where the situation could not be changed, to reframe the
cause of stress in a way that it ceased to be stressful.
Mindfulness
Mindfulness has been described as an intentional focused awareness a

way of paying non-judgmental attention on purpose in the present
moment.
The importance of mindfulness in the workplace cannot be
overemphasized.
Ellen Jane Langer, professor of psychology at Harvard University states
that mindfulness increases charisma and productivity, decreases burnout
and accidents, and increases creativity, memory, attention, positive
affect, health, and even longevity .
Specific benefits of mindfulness in the workplace include:
Overall improvements in workplace functioning
Greater accuracy and fewer mistakes an important attribute for
medical personnel who dispense medication
Superior ability to focus and shut out distractions
Reduced anxiety, tension and frustration
Increased tolerance to others with lower skills, maturity or coping
ability
Accepting our mistakes and weaknesses without reduced self-worth
or self esteem
Increased stability during periods of change
139
The Mindful Awareness Attention Scale (MAAS) is a 15-item scale
designed to assess a core characteristic of dispositional mindfulness,
namely, open or receptive awareness of and attention to what is taking
place in the present. Higher scores reflect higher levels of dispositional
mindfulness.
Significant increases in the scores for mindfulness were seen after two
weeks again after four months. A reduction was seen after the Christmas
holiday period and a small reduction after HWH therapy practice became
intermittent during the last period.
RESULTS: INTERVIEWS
Findings were consistent with the assessment results in showing
increased general mindfulness, particularly regarding improvements in
workplace functioning, an improved ability to focus, decreased anxiety,
tension and frustration, increased tolerance and acceptance of mistakes

and weaknesses without lowered self-worth or self esteem.
Importantly, stress and happiness mindfulness developed quickly and
continued developing. This enabled caregivers to understand and control
their stress response.
RESULTS: DISCUSSION
HWH therapy contributed to significant increases in general and stress
mindfulness.
With increased mindfulness, tension and anxieties were reduced and
there was greater tolerance and acceptance of their own mistakes and
the mistakes of others.
Caregivers practicing Aerobic Laughter therapy experienced a very fast
and lasting increase in mindfulness.
140
Mindfulness is often developed thought the use of meditation. Aerobic

Laughter is similar to meditation in that it brings us instantly into the
present and silences worry and mind chatter.
INTELLIGENCE
Healing with Happiness therapy emphasizes building specific aspects of
mindfulness, especially emotional, stress and happiness mindfulness.
Adaptability
The ability to adapt to new and changing situations is important for
workplace success.
BASELINE
High stress had undermined this groups Adaptability EQ, especially their
problem solving ability.
Scores for Adaptability EQ, Reality Testing EQ, and Problem Solving EQ
were low and regarded as a cause for concern.
The very low Problem Solving score was especially worrying and
healthcare professionals are often called upon to solve problems in
stressful or emergency situations.
Adaptability EQ helps reveal how successfully a person is able to cope
with environmental demands by effectively sizing up and dealing with
problematic situations. Average to high scores on this composite scale

identify those who are generally flexible, realistic, effective in
understanding complex situations and competent at finding adequate
solutions.
141
Reality Testing EQ reflects the ability to assess the correspondence
between what is experienced (the subjective) and what exists in reality
(the objective).
Flexibility EQ reflects the ability to adjust ones emotions, thoughts and
behaviors to changing situations and conditions.
Problem Solving EQ reflects the ability to identify and define problems
as well as to generate and implement potentially effective solutions.
Significant improvements in Adaptability and Reality Testing EQ scores

were seen after two months with some reduction after 6 months,
possibly due to a reduction in the frequency of HWH therapy practice.
Problem Solving EQ increased dramatically after two months, with the
increase maintained at six months.
RESULTS: DISCUSSION
The increase in participants Adaptability EQ is consistent with and a
factor in many other significant changes including the reduction in
inter-staff conflict, their improved coping abilities and their capacity to
overcome adversity.
The dramatic increase in Problem Solving EQ is important to success in
the workplace and in other aspects of life.
Stress, depression and burnout act to reduce problem solving ability.
Because change requires decisions that can be stressful, people in this
condition often try to avoid change and become less flexible and
142
adaptable.
Increased levels of cortisol are known to inhibit cognitive decision
making ability. Reducing cortisol levels through Aerobic Laughter restores
cognitive ability.
By reducing stress, depression and burnout, Aerobic Laughter works to
significantly improve decision making ability.
Positivity
Positivity is the quality of being confident, optimistic, and cooperative.
It is a key to success.
This personal attribute can be enhanced and strengthened in the same
way that we can learn optimism and happiness.
Positivity is a reflection of our emotional state. It is influenced by
negative emotions or events, and positive emotions or events.
Negative emotions are major contributors to stress, depression and
unhappiness. Their effects last longer and carry greater weight than
positive emotions. Positive psychology research shows that three positive
emotions are required to balance or offset one negative emotion.
BASELINE
Participants were found to be exposed to a constant and severe flow of
negative emotions in their work.

A low degree of positivity was found certainly not enough to counter
the weight of negative emotions they experienced.
RESULTS: POSITIVITY RATIO
Positivity ratio is an important new measure in positive psychology that
compares the number of positive and negative emotions that we
experience.
Positivity ratio has been shown to accurately predict workplace
143
performance.
At positivity ratios of 3:1 or higher people begin to flourish and find
greater meaning in life.
A dramatic increase in positivity ratio was observed after two weeks as a
result of the daily positive affect of HWH therapy.
This reduced somewhat at two and four months, but increased at 6
months.
RESULTS: POSITIVE AND NEGATIVE AFFECT SCALE
The positive and negative affect scale was implemented as a measure of
positivity.
Two broad, general factors typically labeled positive affect and
negative affect have emerged reliably as the dominant dimensions of
emotional experience.
These account for most of the variance in self-rated affect. Together
they account for roughly half to three-quarters of the common variance
in mood.
NA and PA reflect dispositional dimensions, with high NA epitomized by
subjective distress and unpleasurable engagement, and low NA by the
absence of these feelings.
By contrast, PA represents the extent to which an individual experiences
pleasurable engagement with the environment. Thus, emotions such as
enthusiasm and alertness are indicative of high PA, whilst lethargy and
sadness characterize low PA.
144
A significant increase in positive affect is seen at two weeks, with
further increases at two and four months.
HWH therapy practice did not significantly reduce the strong negative
affect resulting from the nature of caregiver work.
DISCUSSION
HWH therapy helped to increase happiness and positive affect
significantly.
Practicing natural laughter provides powerful positive affect and acts to

reduce negative affect.
Well-Being
A sense of meaning and purpose in life is regarded as an indicator of a
healthy and positive mental state, and acts as a predictor of well-being.
Life satisfaction is seen as an accurate indicator of subjective well-being
and happiness.
145
The meaning in life questionnaire assesses the degree to which
respondents feel their lives have meaning and purpose.
The satisfaction with life scale is a widely used to quantify subjective
well-being.
Consistent improvements in meaning in life scores indicate HWH therapy

practice impacted positively on caregivers sense of meaning and
purpose.
Improvements in life satisfaction are indicative of the positive impact of
HWH therapy practice.
RESULTS: INTERVIEWS
Feedback confirmed that HWH therapy practice had helped participants
find increased meaning and purpose, and that they experienced
improved levels of happiness and well-being.
RESULTS: DISCUSSION
The majority of caregivers reported that HWH therapy practice had
assisted them in finding meaning and purpose.
HWH therapy helped this group to achieve significant improvements to
these measures in six months.
Aerobic Laughter practice triggers powerful feelings of joyfulness that
act to increase happiness and subjective well being.
146
INTELLIGENCE
Happiness Intelligence brings awareness of lifes meaning and purpose
and helps to make life changes to increase this importance driver of
happiness.
Physical Health
To what extent does eliminating Caregivers Syndrome reflect in the
physical health of the caregiver group?
BASELINE
The majority of participants reported that they suffered from chronic
fatigue, body pains, digestive problems, headaches, migraines and sleep
problems.
Many reported being under treatment for stress-driven medical
conditions including depression, high blood pressure, diabetes and
asthma.
147
SELF-REPORT QUESTIONNAIRE
Self-rated responses indicated significant reductions in stress-related
physical conditions including body pain, headaches and migraines,
digestive issues and sleep problems.
RESULTS: INTERVIEWS
After 2 weeks participants reported that they were generally feeling
much better physically with significantly increased energy levels.
After two months significant improvements in overall health were
reported.
Participants who were (or had been) under treatment for depression,
hypertension, diabetes and asthma reported that HWH therapy had
helped them to control these conditions.
RESULTS: DISCUSSION
HWH therapy practice resulted in a speedy and significant increase in
energy levels and reduction in minor but debilitating stress-related
health issues.
Numerous caregivers experienced significant reductions, and in some
cases control over, conditions under treatment including depression, high
blood pressure, diabetes and asthma.
148
Dramatic reductions in physical stress indicators were experienced.
Those with depression, hypertension and diabetes consistently reported
that these conditions had been largely or completely controlled as a
result of HWH therapy practice.

The results confirm the impact of Aerobic Laughter therapy on physical
health as discussed earlier in this book.
INTELLIGENCE
Happiness Intelligence and Aerobic Laughter combined to dramatically
reduce stress and the unhappifiers that drive so much illness.
Happiness Intelligence also created an awareness that physical health
and exercise play an important role in happiness and motivated
participants to be more active.
Life Change
All participants reported that the Healing with Happiness program
changed their life in a meaningful and positive way.
The changes most reported were:
Understanding of how dangerous stress and depression are and how
importance happiness is to health and the health of family
members and patients
Stress can be a choice and is not driven by people or events
The power to change moods and happiness levels this is
wonderful
Boosting happiness yields energy
Added self-confidence changes life completely

149
Relationships with family and patients are so much better
Positive outlook and looking forward to day
The changes reflect their new happiness consciousness and intelligence,
and also show how they are using Aerobic Laughter techniques to control
their unhappifiers.
IN THEIR OWN WORDS
It has changed my life. Now Im a superwoman. No more that
sickly woman who got tired very easily, walking slowly like a
donkey. Now I jump Im a grasshopper now, jumping and full of
energy and happy! Professional Nurse
Its wonderful. Im turning 65 next month, and this is the first
time I am able to accept my life as it is. That Im also pretty,
clever, good. Im really very happy. Healing with Happiness has
helped me to accept everything about my terrible past. Im so

grateful and have forgiven all the people who have hurt me over
all those years. Professional Nurse
The program changed me a lot. Healing with Happiness has
helped me. I thought it was magic come inside me. Every time I
get upset, I laugh and my stress disappears. Assistant Teacher
Im not so serious any more. I laugh a lot more. I have fewer
headaches. I have more energy. My relationship with my children
moved to a complete new level. Its such fun to be a child and be
silly sometimes, it really makes a difference. Nursing Director
This therapy has changed my life. Its given me a better outlook
on life in general. Nursing Sister
Before I was moody and very emotional. Now I can see the change
in me even if Im angry I just laugh and feel released. Assistant
Teacher
Healing with Happiness changed my life. I look and feel younger
now. Im active and happy. I dont have a dull moment. Its a good
idea. Professional Nurse
150
Yes. HWH Heals Caregivers
The program effectively countered all indicators of Caregiver Syndrome.
Stress and depression
Coping
Resilience
Burnout
Work relationships
Home and family relationships
Mindfulness
Adaptability
Positivity
Well-being
Life change
Physical health
Healing with Happiness can eliminate Caregiver
Syndrome.
Can HWH Improve Care?
The next big question to address was does the Healing with Happiness
program improve the care offered?
To answer this question we measured quality and quantity of care
indicators:
151
Absenteeism and Presenteeism
Productivity
Quality of Care
The problems discussed in the previously are major drivers of
absenteeism and presenteeism.
Presenteeism is the lack of productivity that occurs when people are at
work, but not fully engaged and productive because of health and life
distractions. By some estimates, presenteeism is estimated to be up to
7.5 times more costly to employers than absenteeism in loss of
productivity.
Harvard Business Review reports that presenteeism can cut individual

productivity by one-third or more.
BASELINE
Caregivers reported high levels of burnout and other major drivers of
absenteeism and presenteeism including:
Trauma and grief from the death of patients in care
Distracting interpersonal workplace conflict
Stress-related illness including depression, hypertension and
diabetes
Before the program participants reported:
Feeling worried 14 workdays days a month
Feeling sick 7 workdays a month
Feeling stressed 6 workdays a month
Feeling depressed 5 workdays per month
Levels of absenteeism over the previous seven months averaged at 14.1
days of sick leave per month among 37 staff members.
Participants were asked to rate the number of days that they felt
worried, sick, stressed and depressed.
152
The results show dramatic reductions in all indicators sick, stressed and
depressed reveal dramatic reductions after just two weeks.
RESULTS: REDUCTIONS IN ABSENTEEISM
153
Levels of absenteeism dropped from 14.1 days per month to 6.8 days per
month among 37 staff members when measured across a six month
period after HWH program introduction.

This represents a reduction of 52.3 percent in sick leave.
RESULTS: INTERVIEWS
Participants confirmed that they were feeling much less worried,
stressed and depressed.
After two weeks a dramatic reduction in home and family related stress
was reported, with a further large reduction at two months. This
resulted in a drop in worry that would impact positively on absenteeism
and productivity.
Many participants reported that their depression, hypertension and
diabetes had been partially or completely controlled by HWH therapy
practice, and a significant improvement in one participants asthma was
reported.
Management confirmed that significant reductions in stress, worry, and
depression were evident in their own life and in their staff. This
contributed to better work engagement and focus.
They further confirmed that no other training or programs had been
introduced during that period that would impact on levels of sick leave,
and that staff changes would also not account for the change.
Massive decreases in indicators of absenteeism and presenteeism after

two weeks can be directly attributed to the impact of Aerobic Laughter
therapy.
Decreases in depression, hypertension and diabetes are attributed to
Aerobic Laughter therapy.
INTELLIGENCE
The impact of Happiness Intelligence is seen in the continued reduction
in indicators of absenteeism and presenteeism over the six month
154
period, particularly in feelings of depression.
Productivity
The twentieth century approach to greater productivity was increase
worker stress to make them work harder.

New science shows that continued high stress reduces our ability to
make intelligent decisions and reduced productivity.
Reducing stress and increasing happiness boosts productivity.
A recent study by leading UK economist Andrew Oswald shows happy
workers performing 25% more work than their stressed counterparts.
BASELINE
According to management the productivity at baseline was normal and
seldom fluctuated.
RESULTS: PRODUCTIVITY
The number of patient visits per month by nurses was monitored.
During the three months prior to the HWH program, the four nursing
staff visited 903 patients at home, an average of 75 patients each per
month.
155
After HWH therapy started the same nursing staff visited 1,411 patients
over three months, an average of 118 patients each per month.
Healing with Happiness increased home-based care visits by 56%.
No other changes or training was implemented during that period.
RESULTS: INTERVIEWS
One of the home care nurses reported that in the past after seeing her
morning patients she was physically and mentally exhausted. Completing
patient files after morning visits gave her a headache or migraine she
normally went home not wanting to return to work ever again.
Since the Healing with Happiness program started, her burnout
disappeared. She felt energized and was able to see her morning
patients, complete their files, then go back and see more patients
feeling unstressed and happy.
Another of the home care nursing sisters reported that chronic high
blood pressure, asthma and diabetes left her tired and unable to see too
many patients.
156
She later reported that her hypertension and diabetes were fully
controlled, her asthma was significantly improved, and that she was
bursting with new energy and seeing far more patients.
A manager noted that she was getting much more work done in far less
time. To keep up with her workload she had previously often arrived at
work an hour early, skipped lunch and worked late, and was in the habit
of taking work home at night.
After HWH therapy she found she was able to get more work done in a
shorter time and no longer came in early and left late. She now took
daily lunch breaks and seldom took work home major lifestyle
improvement.
RESULTS: DISCUSSION
Participants are getting more done with less stress and greater
happiness.
Participants are now delivering a significantly greater quantity of care.
Oswalds findings that stress decreases productivity and happiness
increases productivity are well demonstrated by these results.
Quality of Care
The provision of high quality palliative care requires caring and
compassion and the ability to make good social, emotional and
intellectual decisions all qualities that are known to be negatively
affected by high levels of stress, depression and burnout.
Caregiver burnout may result in a change in attitude from positive and
caring to negative and unconcerned.
Research shows that highly stressed and depressed caregivers may
provide reduced levels of care, and in some cases act hostile to patients.
157
BASELINE
Participants reported that they often attended to patients while highly
stressed, in a state of depression, lethargy and even burnout.
They felt that they were not able to provide a high level of care in this
state and in many cases their unhappiness contributed to patient
depression and hopelessness.
It was apparent that depressed and burnt out caregivers were being sent
to provide care for stressed and depressed patients.
RESULTS: INTERVIEWS
A significant improvement in caregivers attitude towards patients and
their relationships with patients was reported after two weeks.
Improvement continued at two and four months and was maintained at
six months.
Participants reported that:
They were now in a much more positive and happy state of mind
when attending to patients, and that this impacted positively on
patients mood and to their response to advice and treatment
They were now more caring and attentive to their patients and
gave them greater support
Many patients remarked on how much happier they seemed

patients felt happier after being attended to and looked forward to
caregiver visits
This new ability to uplift patient mood and happiness is ascribed to
emotional contagion.
Caregivers reported that HWH therapy provided them with an important
and powerful new tool for connecting with patients and gaining their
trust and cooperation.
RESULTS: DISCUSSION
There is no doubt that stress, depression and burnout had negatively
influenced the quality of care and that practicing and providing HWH
therapy enabled these caregivers to provide a significantly higher quality
158
Yes. HWH Improves Care
The program effectively countered all indicators of Caregiver Syndrome.
Productivity
Quality of Care
Healing with Happiness can significantly improve the
quality and quantity of care offered without other
organizational or infrastructure changes.
Can HWH Heal Patients?
The next big question to address was does the Healing with Happiness
program reduce Patient Syndrome?
To answer this question we interviewed these experienced caregivers
about their patients over the six month period.
159
Healing Patients
The overwhelming majority of adults receiving care from participants
are people living with HIV and AIDS, although palliative care is also
provided to cancer patients and others in need.
The impact of happiness and positive outlook (as opposed to
unhappiness, stress and depression) on persons suffering from HIV and
other life threatening conditions has been the subject of much research.
Stress and depression impact negatively on immune function thereby
allowing the development of opportunistic diseases in HIV patients.
High levels of stress and depression act to accelerate the development
of HIV and increase mortality.
Stress, depression and unhappiness negatively influence patients
Attitude towards and acceptance of their illness
Behavior towards those around them
Feelings of self esteem and self worth
Self care and adherence to medication
Trust in and cooperation with palliative care workers
Energy levels
General attitude towards life
ROLLOUT TO PATIENTS
Participants were empowered to implement Healing with Happiness

therapy with patients.
HWH therapy was provided in a number of ways including:
One on one and group HWH practice with patients and
family/home groups during home and clinic visits
HWH practice with in-patients where appropriate
HWH practice in support group meetings
ACCEPTANCE
Being told that one has a life threatening illness like HIV causes untold
160
anxiety.
For most people it takes a lot of courage to go for an HIV test.
Once told they are living with HIV they move through a process which
includes denial, bargaining, and then (hopefully) acceptance.

Accepting that one has a life threatening illness can be liberating in that
one then is able to confront the fears that go with that condition. Ones
mind is then open to acquiring new information, accepting and thereby
managing that condition, and future planning.
Participants were asked to rate levels of patient stress, mood swings and
depression.
A dramatic decrease in patient depression and mood swings is seen after
two weeks.
A smaller but significant reduction in stress was seen after two weeks.
Reduced levels are maintained throughout the six month period.
It was not possible to determine to what degree these changes were
affected by the reductions in caregiver depression and unhappifiers. The
fact that the caregivers in most cases had been caring for the same
patients for extended periods, and other factors reported in interviews
indicates that these ratings had some validity.
RESULTS: INTERVIEWS
Caregivers reported that HWH therapy had a powerful positive impact on
161
patients, rapidly improving their attitude towards their illness, and

reducing their stress, mood swings and depression.
The implementation of HWH therapy with patients by caregivers was a
gradual process. Some patients were introduced to Aerobic Laughter
therapy quickly and embraced it quickly, even initiating practice at
home with their families.
A few patients initially resisted Aerobic Laughter therapy practice but
with perseverance most came to enjoy and look forward to laughing with
caregivers.
Caregivers reported important HWH impact on patients including:
Reductions in patient stress, mood swings and depression and
resulting increases in patient happiness
Increased happiness and appetite for life
Increased energy
Improved relationships with caregivers including significant
increases in trust and cooperation some patients started getting
out of bed and dressing to welcome them on visit days
Major reduction in complaints and care-related demands
Better relations with their family, friends and community
Significant improvement in adherence to medication
Enhanced self care with some patients gaining weight
Attendance at support groups increased by 3 to 5 times when

arriving to open venues they now found enthusiastic patients
waiting to enjoy HWH therapy
RESULTS: DISCUSSION
HWH therapy has reduced or eliminated Patient Syndrome.
As a result of the Healing with Happiness program many patients:
Demonstrate an improved mental state which has been shown to
slow the progression of HIV and some cancer and reduce mortality
Enjoy enhanced quality of life and outlook
Significantly improve their adherence to medication
Patients are responding better to the care provided.
162
RESEARCH REQUIRED
We believe that patient benefits from HWH therapy have the potential
to become a very important extension of positive psychology and
happiness treatment and to extend happiness therapy into patient
treatment.
InHappiness encourages and is ready to cooperate in research to expand
these exciting preliminary results and develop accurate measures.
Yes. HWH Helps Heal Patients
The program effectively countered all indicators of Patient Syndrome.
Healing patients
Healing with Happiness can significantly improve
patient outlook, quality of life, cooperation with and
adherence to treatment.
Healing with Happiness may provide an exciting new
tool for slowing illness and reducing mortality.
163
Can HWH Heal Orphans and
Vulnerable Children?
The final big question we addressed was does the Healing with
Happiness program reduce or overcome OVC Syndrome and help to heal
these very important children?
To answer this question we interviewed these experienced caregivers
about the children they cared for and conducted interviews with center
management.
Healing Orphans and
Vulnerable Children
High degrees of stress, trauma and depression at an early age can
impact heavily on childrens future, with lifelong negative impact on
their ability to enjoy a normal and successful childhood and adult life.
NATURAL LAUGHTER
Happy healthy children are blessed with the gift of natural laughter
the ability to laugh 300-500 times a day.
Natural laughter is closely allied to, and interwoven with play. Both are
crucial for healthy child development.
Childhood is a difficult period during which we are subjected to the
stress of physically growing, learn and absorb vast amounts of
knowledge, and learn social and so many other skills.
Without the many stress-reducing, pain-reducing, immune-boosting and
other benefits of natural laughter, we probably wouldnt survive
childhood in good physical and mental health.
164
Natural laughter also allows the cathartic release of powerful negative
emotions so they their negative effect is not stored. This is important as
stored negative emotions can cause stress, extreme unhappiness, and
lead to depression.
Natural laughter is important as a form of non-verbal social
communication, and together with group play, is critical to the
development of social skills and social and emotional intelligence.
Most of us enjoy natural laughter until we reach adolescence when we
are disconnected from our natural laughter and playfulness through
social programming.
Disconnecting with natural laughter and playfulness radically slows, and
in some cases may terminate, our social learning and the development
of social and emotional intelligence.
THE IMPACT OF TRAUMA ON NATURAL LAUGHTER
Major trauma and grief of the kind that orphans from AIDS experience
can severely reduce, or in some cases terminate, a childs natural
laughter and playfulness.
This can have a terrible impact on child development:
Removing natural laughter s stress-reducing benefits while they are
exposed to extreme stress caused by illness, death, stigma and
relocation can cause extreme stress to reset their body and brain
chemistry and permanently reduce their ability to cope with stress
Removing natural laughter s ability to discharge negative emotions
through cathartic release can cause them to be stored and continue to
generate negative affect and stress for years or even a lifetime
Stopping or severely reducing social development before adolescence
can leave children socially impaired and with low social and emotional
intelligence this can make it difficult for them to maintain gainful
employment or achieve success later in life, and also impair their
ability to enter into and maintain friendly and loving relationships
Many studies confirm that children exposed to severe unresolved stress

and trauma at an early age become social misfits, do not achieve
success, are prone to substance abuse and crime, are less healthy and
live shorter lives.
165
RESTORING NATURAL LAUGHTER AFTER TRAUMA
The results from this and other Healing with Happiness programs clearly
demonstrate that the program is able to restore these childrens natural
laughter and playfulness, help them to release the negative emotions of
grief and trauma, and restore them to a natural childhood.
While Healing with Happiness cannot restore their parents and family
home, it can provide them with coping skills to come through their
changed circumstances as happy, healthy, well-formed individuals.
OVC ROLLOUT
Daily practice of Healing with Happiness therapy was implemented at
the OVC Daycare Center with the 52 children of 0-6 years immediately
after training.
Because the school year starts in January, baseline evaluation was
carried out in November and January. Practice with children started in
January and further evaluation was conducted after two and four
months.
Evaluation was carried out through interviews with child caregivers,
management and support staff.
Participants and children practice HWH therapy together as part of their
daily morning assembly. Further child-initiated spontaneous practice
occurs throughout the day.
The following information is based on caregiver and center management
interviews.
BASELINE
Many children were suffering from chronic stress as a result of trauma
resulting from the death of parents, siblings and family members
High degrees of stress also resulted from living in homes with sick or
dying relatives or parents, and from having to cope with relocation to a
new home, and in some case from being separated from siblings and
other family members.
Many of the children experienced ongoing stress from their home
situation. Some were living with sick or dying relatives or parents, while
others had been moved to foster homes in the care of:
166
Grandparents or older people with different values and habits
Family members
Foster parents receiving a government payment for providing shelter
In many cases these foster homes housed many children.
Problems reported included:
Lack of love and attention
Inadequate living conditions
Inadequate provision of food
Home conflict including fighting and arguments
Inadequate care including cleanliness problems and lack of food
While there were no known cases of abuse or stigmatization, caregivers
did not have sufficient contact with foster parents to rule these out.
These problems often resulted in quiet, withdrawn behavior. In some
cases they found expression in antisocial behavior including bullying and
violence towards toys, caregivers and other children.
Some children were obviously unhappy, stressed and withdrawn when
they were collected by caregivers in the morning. Some children who
displayed a good mood during the daycare displayed unhappy, stressed
and withdrawn behavior when it was time to return home.
In summary, many of these children were bruised, damaged and
traumatized.
It is noted that a number of teacher/caregivers expressed concern that
the introduction of laughter exercises would be disruptive and have a

negative effect on discipline.
RESULTS: ACCEPTANCE
Most children quickly took to the Aerobic Laughter exercises and
engaged fully and enthusiastically. It was immediately apparent that
they loved every minute of it.
They quickly learnt the exercises and competed for the opportunity to
lead exercises the duty of leading Aerobic Laughter exercises was soon
handed over completely to the children.
Some of the more subdued children had initially not participated, but
after a week or two most were engaging fully.
167
In addition to the structured morning therapy session, Aerobic Laughter
exercises continued throughout the day:
Exercises were often spontaneously initiated by the children
Children often asked the teacher if they could do laughter now
sometimes quite insistently
It is clear that these kids needed to re-start their natural laughter and
that they loved to laugh.
RESULTS: MENTAL HEALTH
Caregivers and management reported

Significant and continued reductions in the childrens levels of stress,
depression and anxiety
Significant and continued reductions in crying, mood swings and fear
Reduced approval seeking which indicates increased self-confidence
Reduction in trauma and grief
Increased self confidence, independence, grooming and self regard
were widely noted
HWH therapy impacted significantly on all children, but the most
dramatic positive effects were reported amongst the most stressed and
traumatized children.
RESULTS: COPING
It was clear that the children were coping much better in all areas.
There was less crying, tantrums and conflict.
The behavior of children who were previously stressed and withdrawn on
collection in the morning, and on their return home in the afternoon,
changed over the space of one or two weeks.
In the mornings they were happier, running up to the vehicle already
smiling, happy or even laughing, and in the afternoon laughing and
playing until and after being dropped off.
The home situation that had previously stressed them did not change,
but their change in behavior demonstrates a newfound ability to cope

with these stresses.
168
RESULTS: SOCIALIZATION
Initial concerns that the laughter would make children harder to control
were wrong.
Relations between the children and care workers improved
significantly with improved cooperation and communication, and a
corresponding reduction in disciplinary problems
Relations between children improved, with increased play and the
development of new friendships
In many cases relationships with foster parents improved
Children who were previously withdrawn or engaged in antisocial
behavior showed a marked improvement one previously withdrawn
child who had bullied his classmates for two years started to laugh,
play and socialize and stopped his aggressive behavior
RESULTS: LIFE CHANGING
Caregivers describe the Healing with Happiness program as
transformational and said that the children were now behaving like
normal children full of fun but even better behaved.
The center manager reported that the introduction of HWH therapy

practice had a powerful and dramatic positive impact on the children in
many ways, saying thank you so much you have given them their
childhood back.
DISCUSSION
Reports from child caregivers and the OVC center manager leave little
doubt that the Healing with Happiness program can help to heal
traumatized children and assist in restoring the happy childhood and
future that they deserve.
Levels of trauma, grief, stress and depression have been significantly
reduced and levels of happiness and positive emotions have been
significantly increased in this group of orphans and vulnerable children
as a result of HWH therapy practice.
Research indicates that this could significantly improve the future that
they now look forward to.
169
Yes. HWH Helps Heal Children
The program effectively countered all indicators of OVC Syndrome.
Healing children
Healing with Happiness can help to heal traumatized
children and help restore the happy healthy childhood
and future that they deserve.
In Their Own Words
Its hard for a depressed caregiver to help a depressed patient. I find
that patients are much happier when I leave them now. I think my being
happy helps to lift their mood. Nursing Director
Sometimes when Im talking to a patient I notice that theyre not
really listening. I start laughing and that gets their attention after that
they lighten up and pay attention. Professional Nurse
In the past, after seeing so many patients I was tired. I didnt want to
return to work the next day. Doing patient files gave me a headache.
Now I see patients, do the paperwork, and go straight back to see more
patients. No stress, no complaints. Professional Nurse
I had high blood pressure, asthma and diabetes. Since laughter therapy
my hypertension is gone. Im eating well. My asthma is much better. I
was feeling like an old person because of these illnesses. Now Im feeling
very young and full of energy. I am a grasshopper! Professional Nurse

Laughter therapy has had a good impact on my health. I measure my
blood pressure at home in the mornings. My hypertension just dropped
I dont know where it went. It was very high, and used to be 150-170,
but now it is normal at 120-116. These days 130-138 is high for me.
Professional Nurse
170
My hypertension is gone blood pressure is normal. I am diabetic but
my sugar is down from 15-17 to 6.4 8.3. I used to suffer chronic back
pain but it has virtually disappeared. Laughter therapy has changed by
life. Nursing Sister
I used to get lots of headaches and migraines. I still get some but
seldom need pain tablets now. Nursing Director
In the past I was very stressed and angry and always sick. Since
laughter therapy Im not stressed and almost never sick. I no longer need
to take tablets for blood pressure. My manager told me last week how
happy I look. Assistant Teacher
I have more energy. Before laughter therapy I often felt heavy like I
just wanted to sleep, but thats gone - its over. Im healthier than
before, I feel light. Training Manager
Even with tablets my blood pressure was too high. Since laughter
therapy my blood pressure is perfect, I dont suffer hypertension
anymore. OVC Center Manager
I dont get migraines as often anymore. Body pains and aches are less.
Fundraising Manager
I am diabetic - was on 1000 mg of medication twice a day. After
laughter therapy my blood sugar started dropping at 10:00 a.m. in the
morning and I couldnt understand it, so I went to the doctor. He
stopped my medication my diabetes is gone. My blood sugar is 5-6 all
the time now. Professional Nurse
Laughter therapy has had a big impact on my life. After we started my
blood sugar dropped. Driver
Im turning 65 next month, and this is the first time I am able to accept
my life as it is. That Im also pretty, clever, good. Laughter therapy has
helped me to accept everything about my terrible past. Im so grateful
and have forgiven all the people who have hurt me over all these years.
Professional Nurse
Laughter therapy has helped me. I thought it was magic come inside
me. Every time I get upset, I laugh and my stress disappears. Assistant
Teacher
Im not so serious any more. I laugh a lot more. I have fewer
headaches. I have more energy. My relationship with my children moved

to a complete new level. It really makes a difference. Nursing Director
Laughter therapy has changed my life. Its given me a better outlook on
life in general. Nursing Sister
171
Before, I was moody and very emotional. Now I can see the change in
me even if Im angry I do the laughter chorus and feel released.
Assistant Teacher
I look and feel younger now. Im active and happy. I dont have a dull
moment. Its a good idea. Professional Nurse
172
173
174
175
The Next Steps
The case study was a success.
The Healing with Happiness psychosocial support programs met the
objectives we set and is ready to be rolled out on a large scale.
The success of this program provides validation for Aerobic Laughter
therapy and the JOYGYM Happiness System.
Now comes the job of getting Healing with Happiness out there.
It has to happen.
PROPAGATION
To roll the Healing with Happiness program out on a large scale we need
the support and cooperation of the largest caregiving management and
funding organizations.
InHappiness is working with USAID to provide Healing with Happiness
education to leading NGOs providing services to OVC.
We are actively presenting the program at international conferences and
USAID partner meetings and will present four papers at the 2011 AIDS
conference in South Africa.
We are in talks with organizations that manage and fund tens of
thousands of caregivers.
While organizations are very keen to implement Healing with Happiness

there is one common stumbling block.
The problem is funding.
FIGHTING FOR DOLLARS TO HEAL
As previously stated, very little funding is currently allocated for
psychosocial support funding for caregivers, patients and OVCs.
Psychosocial support funding dwindled as there was no feasible way to
deliver the service on the required scale.
Now that there is a way, there is ever increasing competition for
funding. Many people think if we got this far in tackling HIV and AIDS
without psychosocial support, why start now?
We say that: psychosocial support is a basic human right for caregivers,
patients and OVCs.
176
Perhaps the increasing evidence that happiness is good, and the
increasing evidence from positive psychology that happiness is a good
investment will help us in the looming battle for funding.
It will be a tough battle but we will continue to educate, run pilot
programs, and lobby until the breakthroughs are made.
We must get psychosocial support to the many caregivers, patients and
children in need.
It has to happen.
RAISING THE DOLLARS TO HEAL
We are working with leading NGOs to tailor attractive sponsorship
opportunities to allow individuals, schools, companies and other groups
to fund Healing with Happiness programs.
We are in early stages of creating non-profit fundraising organizations in
the United States and Europe that will work to raise money to help these
kids, adults and caregivers to build a happier healthier future.
If you are ready to help us in any way please visit our website
WWW.JOYGYM.ORG.
We have to raise the money to help children, patients and caregivers.
EARNING THE DOLLARS TO HEAL
In addition to fundraising, InHappiness has decided to adopt a novel and
somewhat different approach to funding this program.
We intend to earn the money to provide psychosocial support and
Happiness Coaching to hundreds of thousands, perhaps millions of
orphans and vulnerable children and to people living with HIV.
The process of gearing up to provide JOYGYM programs to individuals,
companies and organizations for payment has started.
As a non-profit, we are determined to maximize earnings and minimize
costs to provide service to as many individuals as possible.

Every $30 we earn will fund a year s Healing with Happiness program for
one more beautiful wonderful child or other person in need.
Last year we earned enough to sponsor a Healing with Happiness for
Cotlands an organization that provides loving care to more than 8,000
beneficiaries.
177
Our goal is to sponsor Healing with Happiness for a million people during
2012.
With your help we can do it.
You Can Help
If you bought a copy of this book youve already helped. Thank you.
The price includes a year s sponsorship for one OVC.
There are lots more ways you can help us spread happiness.
Lets look at a few before we finish.
SPREADING HAPPINESS
Building your happiness is a great way to increase world happiness.
Build your Happiness Intelligence and your happiness will follow.
Wed love to help you.
Sign up at the Happiness University for online Happiness Coaching
the program is designed to help you build your Happiness Intelligence
Come laugh with us learn Aerobic Laughter at a JOYGYM Experience
event you may decide to train further for self practice, group
practice, to become a Happiness Volunteer, or even a laughter or
happiness professional
Become a Happiness Volunteer youll get to give the gift of laughter
and happiness to your community and make a real difference your
training cost will sponsor Healing with Happiness
Get your class to adopt a caregiver or OVC group and sponsor their
Healing with Happiness program what a great way to make the
world a better place
178
Help us spread the word about happiness and Happiness Intelligence
tell your friends, invite us to speak to your group, write about us on
your blog or facebook, twitter about JOYGYM
Visit the Happiness Shop WWW.HAPPINESSSHOP.ORG to buy our books,
DVDs and CDs as gifts or just sponsor Healing with Happiness for one
or more OVCs
Give your company the Happyness Advantage thats the name of our
corporate happiness and contracting business all net proceeds go to
sponsoring Healing with Happiness
Get your company to start a Happiness Volunteer Club or to sponsor
the Healing with Happiness program, spread happiness, and give back
to the community
The ways you can help are limited only by your imagination.
If you have a great idea let us know. Well be happy to hear from you!
LICENSING HAPPINESS
Were making the JOYGYM Happiness System available worldwide under
license.
Licensing seems the best way to help as many people as possible to build
We provide know-how and training, centralized monitoring and

evaluation services, and the right to use our brands.
Licensees provide JOYGYM programs to our high professional standards
and pay fees based on their income that sponsor the Healing with
Happiness program.
179
Thank you
Before we say good bye wed like to thank you for reading this book.
If you want to keep up with our progress or interact in any way please
visit WWW.JOYGYM.ORG wed love to have you as a friend.
You can learn more about our projects and register for regular updates.
We really hope that:
Youve had as much fun reading as weve had writing this for you
Weve motivated you to start building your Happiness Intelligence
Youll help us spread happiness to all corners of this wonderful world
In happiness,
Bill Gee, Malik Jaffer, and Memory Matanda
180
REGISTER YOUR COPY ONLINE
Register your copy online using the number below to
Write reviews of this book
Discuss the book with the authors
and other readers
Get news updates,
early order opportunities, and
special discounts on our next books
Its free, and wed really like to get your feedback.
To register visit WWW.HAPPINESS-U.ORG
and click REGISTER MY BOOK on the menu.
WERE LOOKING FORWARD
TO HEARING FROM YOU!

Your special registration code is:
181
ABOUT THE AUTHORS
Bill Gee Laughterologist, Happiness Coach, and speaker has a
passion for, and broad knowledge of, positive psychology.
Previously a director of Laughter Yoga International, Bill founded
InHappiness to develop professional, consistent, science-backed laughter
therapy and happiness programs.
Born in Argentina, Bill has worked, lived, and energized audiences in far
flung corners of the world.
Bill is chairman of InHappiness and is happiest when enjoying a fine
meal, laughing, training and writing.
Malik Jaffer
Malik Jaffer was born a sixth generation Kenyan in Nairobi to parents of
East Indian decent and migrated to San Diego, California in 1969.
Malik holds a Masters Degree in Public Health from the Boston University
School of Public Health. He is also a Reiki master and painter.
He has worked for Red Cross, Project Hope and the Aga Khan Foundation
in Tanzania, Nigeria, Afghanistan, Pakistan, Kenya, Cambodia, Albania
and other countries.

He currently advises governments in HIV and AIDS programs and policy.
Memory Matanda
An educational psychologist by profession and development worker by
inclination, Memory holds an MSc in Educational Psychology.
She taught Psychology, Counseling and Special Education at Zimbabwe
Open University (2000-2008) and worked in HIV and AIDS program
development and implementation and research and development.
Memory has a passion for working with marginalized communities
especially orphans and vulnerable children and their caregivers.
She migrated with her family to South Africa from Zimbabwe in 2009 and
heads JOYGYM HappyMetrics as a director of InHappiness.
182
EXPRESSION OF GRATITUDE
InHappiness would like to thank leading positive psychologists including
Martin Seligman, Christopher Peterson, Barbara Fredrickson, Sonja
Lyubomirsky, Jonathan Haidt, Mihaly Csikszentmihalyi, Ed Diener, Robert
Biswas-Diener, Tal Ben-Shahar, Shawn Achor, Karen Reivich, Marcus
Buckingham and Julie Norem.
Their insights and discoveries have helped us to improve the
effectiveness and efficacy of the JOYGYM Happiness System.

Thanks also to laughter researchers that helped inspire and guide the
development Aerobic Laughter therapy: Normal Cousins, William Fry, Lee
Berk, Stanley Tan, Michael Miller, Kazuo Murakami, Christian Barnard,
Keiko Hayashi, Takashi Hayashi, Sue McGreevey, Robert Provine, Jaak
Panksepp, Anthony Joshua, Mary Bennet, Shevach Friedler, Gita Suraj-
Narayan, Hajime Kimata, Nancy Yovetich, Willibald Ruch, Paul McGhee,
Ilona Papousek, Irina Falkenberg, Paul Devereux, Patty Wooten, Heidi
Beckman and Madan Kataria.
In South Africa we have been fortunate to receive help from many
special people. We would like to single out Penny Makhelemele, Letty
Ndebele, Nicola Taylor, Jopie van Rooyen, Nicky Jackman, Rachel
Compaan, Dr. Liz Gwyther, Elizabeth Scrimgeour, Nkosazana Ngidi,
Mamaki Mlangeni, Marisa Wolheim, Joan Moira de Jong, Estelle du Toit,
Anita Savvas, Gita Suraj-Narayan, Hector Rakhetsi, Neil Orr, Mona
Maharaj, Basil Kransdorff, Tim Boyd, Sue Grealy, Sue Jameson, Daniel
Bakken, Johan Emerson Grobler, Charmaine Sparrow, Shareen Richter,
Fritz Holscher, Jason Wasenaar, Dr. Natalya Dinat, Masi Makhelemele,
Mona Maharaj, Nigel Unwin, Nina du Toit and Sarah Davids, Jacky
Schoeman, Bonnie Haack, JP Gernaat, Janine Grobler, Lebo, Jude, Fifi
for sincere thanks.
Finally thanks to our volunteer editors especially Johan Grobler, Pierre

Ah-Fat, Pieter Uys, Tara Denby, Andrea Daniels, and Ambereen Jaffer.
To those that have helped us but are not mentioned, we apologize for
the omission and give our thanks.
183
A Note of thanks from Bill Gee
I would like to personally thank Dr. Madan Kataria of Laughter Yoga
International who shared his knowledge and provided the opportunity to
engage with thousands of laughter yoga leaders and teachers in many
countries, and also his wife Madhuri.
My thanks to Laughter Yoga staff and professionals too numerous to
mention including Yeshwan Taki, Kamlesh Masalawala, Jeffrey Briar, Allan
OMeara, Billy Strean, Laura Gentry, Sue Ansari, Tosha Tobias, Moon
Byeong-Kyo, Ursula Kirchner, Michaela Schaeffner, Malcolm Robertson,
Ana Banana, Jackie Curran, Avi Liran, Bronwyn Roberts, Linda Leclerc,
Mary Tadokoro, Lotte Mikkelsen, Elina Papa, Anu Saari, Neville Wadia,
Dilzan Wadia, Ira Flynn, Laura Toffolo, Caty Escadell, Denise Rackett,
Cristina Martinez, David Cronin, Lisa Booth, Sinikka Poikonen, Helen
Thyrvin, Doug Dvorak, and Majid Pezeshki,
184
RESOURCES AND REFERENCES
The following resources were directly referenced or were important in
the development of the material in this book. Our thanks to the authors
for their work.
Abel E, Kruger M. (2010). Smile intensity in photographs predicts longevity.

Psychological Science, 21, 542-544.. PMID 20424098
DOI:10.1177/0956797610363775.
Achor S. (2010). The Happiness Advantage: The Seven Principles of Positive

Psychology That Fuel Success and Performance at Work. New York, Crown
Business.
Ader R. (2007). Psychoneuroimmunology (4th Edition). Elsevier Academic

Press.
Agence France-Presse. (2006). Laughter may well be the best medicine.

Retrieved from
http://www.theage.com.au.
Arnsten A. (1998). Development of the Cerebral Cortex: XIV. Stress Impairs

Prefrontal Cortical Function. J Am Acad Child Adolesc Psychiatry, 37(12):
1337-1339, 1998.
Arnsten A, Shansky R. (2004). Adolescence: Vulnerable Period for Stress-

Induced Prefrontal Cortical Function. Introduction to Part IV. Ann N Y Acad
Sci. 2004 Jun;1021:143-7. DOI:
10.1196/annals.1308.017. PMID: 15251883.
Bakker H. (2007). Report Quick Scan on Care and Care for Caregivers, South
Africa. Retrieved from http://www.cordaidpartners.com/.
Baldauf S. (2010). South Africa AIDS orphans overwhelm social work

services. The Christian Science Monitor, retrieved from
http://www.csmonitor.com/layout/set/print/content/view/print/299347.
Balick M, Lee R. (2003). The role of laughter in traditional medicine and its
relevance to the clinical setting: Healing with ha! Altern Ther Health. Med
2003;9:8891.
Bar-On R. Emotional intelligence: an integral part of positive psychology.

South African Journal of Psychology, 40(1), pp. 54-62.
Beckman, Regier, Young. (2007). Workplace laughter and personal efficacy.

The Journal of Primary Prevention.
Ben- Shahar T. (2010). EVEN HAPPIER: A Gratitude Journal for Daily Joy
and Lasting Fulfillment.
Mcgraw Hill .
Bennett M, Zeller J, Rosenberg L, McCann J. (2003). The effect of mirthful

laughter on stress and natural killer cell activity. Altern Ther Health Med.
2003;9(2):38-45.
Bennett MP, Lengacher CA. (2006). Humor and laughter may influence health.
I. History and
background. Evidence-Based Complementary and Alternative Medicine, 3(1):

61-63.
Bennett M, Lengacher CA. (2006). Humor and Laughter May Influence Health:
II. Complementary
Therapies and Humor in a Clinical Population. eCAM 2006;3(2)187190

doi:10.1093/ecam/nel014
Bennett MP, Lengacher CA. (2007). Humor and Laughter May Influence Health
IV. Humor and Immune Function. Laughter and Health Outcomes. Evid Based
Complement Alternat Med 2007
Ben-Shahar T. (2007). Learn the Secrets to Daily Joy and Lasting Fulfillment
HAPPIER. New York: Mcgraw-Hill.
Ben-Shahar T. (2009). EVEN HAPPIER: A Gratitude Journal for Daily Joy

and Lasting Fulfillment.
McGraw-Hill.
Berk L, Tan S, Fry W, Napier B, Lee J, Hubbard R, Lewis R, Eby W. (1989).

Neuroendocrine and Stress Hormone Changes During Mirthful Laughter," The
American Journal of the Medical Sciences, vol. 298, no. 6, 1989.
185
Berk L, Tan S, Nehlsen-Cannarella S, Napier B, Lewis J, Lee J, Eby W. (1988)

Humor associated laughter decreases cortisol and increases spontaneous
lymphocyte blastogenesis. Clin Res. 36:435A Berk L. (2006). Just the
expectation of a mirthful laughter experience boosts endorphins 27
percent, HGH 87 percent. 3-Apr-2006 Press Release: American Physiological

Society.
Berk L, Felten D, Tan S, Bittman B, Westengard J. (2001). Modulation of

neuroimmune parameters during the eustress of humor-associated mirthful
laughter. Altern Ther HealthMed. 7(2):6272. 74
76.
Berk L, Tan S. (1995). Eustress of mirthful laughter modulates the immune

system lmyphokine
interferon-gama Annals of Behavioral Medicine. Supplement, Proceedings of

the Society of
Behavioral Medicine's 16th Annual Scientific Sessions. 17: pp. C064.
Berk L, Tan S. (2006). Endorphin and HGH increase are associated with both
the anticipation and experience of mirthful laughter. The FASEB Journal.
20:A382.
Berk L, Tan S, Fry W. (1993). Eustress of Humor associated laughter

modulates specific immune system components Annals of Behavioral
Medicine. Supplement, Proceedings of the Society of
Behavioral Medicine's 16th Annual Scientific Sessions. 15: pp. S111.
Berk L, Tan S, Fry W, Napier B, Lee J, Hubbard R, Lewis J, Eby W. (1989).

Neuroendocrine and stress hormone changes during mirthful laughter. Am J
Med Sci. 298 (6): 3906.
Berk L, Tan S, Napier B, Eby W. (1989). Eustress of mirthful laughter

modifies natural killer cell activity. Clin Res 37:115, 1989.
Berk L,Tan S, Berk D. (2008). Cortisol and Catecholamine Stress Hormone

Decrease Is Associated with the Behavior of Perceptual Anticipation of
Mirthful Laughter. 121st Annual Meeting of the American Physiological
Society.
Berk, et al (1993). Laughter triggers significant increase in immunoglobulin

M levels and
complement 3 levels. Annals of Behavioral Medicine.
Berk L, Tan S, et al. (1991). Immune System Changes During Humor

Associated Laughter. Clinical Research. Vol. 39, 1991, (p.124A).
Berk L, Tan S. (1996). "The Laughter-Immune Connection." Humor and Health

Journal, vol. 5, no. 5, 1996.
Berk, Tan, Fry, et al. (1989). Serum cortisol, growth hormone and plasma
dopac all decreased during laughter. Am J Med Sci.
Berk, Tan, Napier, Erby. (1989). Laugher stimulates the immune system and
counteracts stress by lowering serum cortisol levels, increasing the amount of
activated T-lymphocytes, and increasing the number and activity of natural
killer cells. Loma Linda University School of Medicine's
Department of Clinical Immunology.
Biswas-Diener R, Dean B. (2007). Positive Psychology Coaching Putting the

Science of Happiness to Work for Your Clients. New Jersey, John Wiley and
Sons.
Boone T, Hansen S,. Erlandson A. (2000). Cardiovascular Responses to

Laughter: A Pilot Project.
Applying Nursing Research 13, no. 4 (Nov. 2000): 2048.
Bottonari K. (2008). The impact of life stress, coping style, and depressive
symptomatology on HIV
treatment adherence. Thesis: State University of New York at Buffalo. 115

pages; AAT 3307640.
Bottonari K, Roberts J, Ciesla J, Hewitt R. (2005). Life Stress and Adherence to

Antiretroviral Therapy among HIV-Positive Individuals: A Preliminary
Investigation. AIDS Patient Care and STDs.
Volume 19, Number 11, 2005. PMID: 16283832.
Boyle T, Fritschi L, Heyworth J, Bull F. (2011). Long-Term Sedentary Work

and the Risk of Subsite-specific Colorectal Cancer. American Journal of
Epidemiology.
Brickman P, Coates D, Janoff-Bulman R. (1978). Lottery winners and accident

victims: Is happiness relative? Journal of Personality and Social Psychology.
August 36(8):917-27.
186
Brinkhof M, Boulle A, Weigel R, Messou E, Mathers C, Orrell C, Dabis F,

Pascoe M, Egger M. (2009).
Mortality of HIV-infected patients starting antiretroviral therapy in sub-

Saharan Africa: comparison with HIV-unrelated mortality. PLoS Medicine,
2009; 6 (4): e1000066 DOI:
10.1371/journal.pmed.1000066.
Brown S, Nesse R, Vonokur A, Smith D. (2003). Providing Social Support

May Be More Beneficial than Receiving It: Results from a Prospective Study of
Mortality. Psychological Science, 14(4): 320327.
Brown W, Consedine N, Magai C. (2005). Altruism Relates to Health in an

Ethnically Diverse Sample of Older Adults. Journals of Gerontology, Series B:
Psychological Sciences and Social Sciences.
60B(3): P143-52.
Buckingham M, Clifton D. (2001). Now Discover Your Strengths. New York,

The Free Press.
Burt K, Obradovic J, Long J, Masten A. (2008). The Interplay of Social

Competence and
Psychopathology Over 20 Years: Testing Transactional and Cascade Models.

Child Development.
March/April 2008, Volume 79, Number 2, Pages 359 374.
Byakika-Tusiime J, Crane J, Oyugi J, Ragland K, Kawuma A, Musoke P,

Bangsberg D. (2009).
Longitudinal Antiretroviral Adherence in HIV+ Ugandan Parents and Their

Children Initiating HAART
in the MTCT-Plus Family Treatment Model: Role of Depression in Declining

Adherence Over Time.
AIDS Behav. Oct;13(5):969-72. DOI 10.1007/s10461-009-9546.
Cacioppo J, Fowler J, Christakis N. (2009). Alone in the Crowd: The Structure

and Spread of
Loneliness in a large social network. J Pers Soc Psychol. Dec;97(6):977-91.
Candace P, Marriot N (2006). Everything You Need to Know to Feel Go(o)d.

2006 Carlsbad ,
California, Hay House Inc.
Carter M. (2011). Third of HIV diagnoses in UK still occurring late, when risk
of AIDS is high.
NAM/AIDSMAP.
Casey P. (2009). The Effects of Emotional Intelligence on Happiness and Well-

being: Can E.I predict significant life outcomes? Psychology Undergraduate
thesis. Downloaded from
http://hdl.handle.net/1842/3540.
Celano M, Bakeman R, Gaytan O, Smith C, Koci A, Henderson S. (2008).

Caregiver depressive
symptoms and observed family interaction in low-income children with

persistent asthma. Fam
Process. Mar;47(1):7-20.
Chaouloff F, Dubreucq S, Bellocchio L, Marsicano G. 2011. Endocannabinoids

and Motor Behavior: CB1 Receptors Also Control Running Activity.
Physiology. 26: 76 77, 2011;
doi:10.1152/physiol.00050.2010.
Chapman A. (1975). Humorous laughter in children. Journal of Personality

and Social Psychology.
Volume 31, Issue 1, January 1975, Pages 42-49. doi:10.1037/h0076235.
Chaya MS, Kataria M, Nagendra H, Nagarathna R, Manjunath N, Raghavendra

R. (2007). The effects of Hearty Extended Unconditional (HEU) Laughter
using Laughter Yoga techniques on physiological, psychological and
immunological parameters in the workplace: a randomized control trial. The
Journal of Primary Prevention. Volume 28, Number 2.
Chida Y, Hamer M, Wardle J, Steptoe A. (2010). Do stress-related psychosocial

factors contribute to cancer incidence and survival? Nat Rev Clin Oncol.
May;7(5). doi: 10.1038/ncponc1134-c1.
Ciarrochi J, Deane F, Anderson S. (2002). Emotional intelligence moderates

the relationship between stress and mental health. Personality and Individual
Differences. Volume 32, Issue 2, 19 January 2002, Pages 197-209.
Ciesla J, Roberts J. (2001). Meta-analysis of the relationship between HIV

infection and risk for depressive disorders. Am J Psychiatry. 158: 725-730.
Cluvera L, Gardnera F, Operarioc D. (2008). Poverty and psychological health

among AIDS-orphaned children in Cape Town, South Africa. AIDS Care. Vol.
0000, No. 0, Month 2008, 0_00, DOI:
10.1080/09540120802511885.
187
Coates J. (2006). Talk in a play frame: More on laughter and intimacy. Journal
of Pragmatics.
Volume 39, Issue 1, January 2007, Pages 29-49.

doi:10.1016/j.pragma.2006.05.003.
Cogan R, Cogan D, Waltz W, McCue M. (1967). Effects of laughter and

relaxation on discomfort thresholds. Journal of Behavioral Medicine. 10(2)
139-144.
Cohen S, Doyle W, Turner R, Alper C, Skoner D. (2003). Emotional style and

susceptibility to the common cold. Psychosom Med. Jul-Aug;65(4):652-7.
PMID: 12883117.
Cohen S, Pressman S. (2006). Positive Affect and Health. Current Directions in

Psychological Science.
Vol. 15 no. 3 122-125. doi: 10.1111/j.0963-7214.2006.00420.x.
Cole S. (2008), Psychosocial Influences on HIV-1 Disease Progression:

Neural, Endocrine, and Virologic Mechanisms. Psychosomatic Medicine.
70:562-568 (2008). DOI:
10.1097/PSY.0b013e3181773bbd.
Ct J, Delmas P, Delpierre C, Sylvain H, Delon S, Rouleau G. (2009). Factors
Related to Quality of Life in Treatment-Adherent, Successfully Treated HIV
Patients in France. Open Nurs J. 3: 1017.
doi: 10.2174/1874434600903010010. PMCID: PMC2698420.
Cousins N. ( 1979). Anatomy of an illness as perceived by the patient. Toronto:

Bantam.
Cousins N. (1990). The Laughter Prescription. The Saturday Evening Post.

October:34ff.
Csikszentmihalyi M (1990). Flow: The Psychology of Optimal Experience.

New York HarperCollins Publishers.
Csikszentmihalyi M. (1990). The Psychology of Optimal Experience. New

York: HarperCollins
Publishers.
Dalai Lama, Cutler H. (2009). The Art of Happiness in a Troubled World.

Harmony (October 6, 2009) Danner D, Snowdon D, Friesen W. (2001).
Positive Emotions in Early Life and Longevity: Findings from the Nun Study.
Journal of Personality and Social Psychology. Vol. 80, No. 5, 804-813. doi:
10.1037//0022-3514.80.5.80.
Davidson K, Mostofsky E, Whang W. (2010). Dont worry, be happy: positive

affect and reduced 10-year incident coronary heart disease: The Canadian
Nova Scotia Health Survey. European Heart Journal.
DesCamp K, Thomas C. (1993). Buffering Nursing Stress through Play at

Work. Western Journal of Nursing Research. Vol 15(5), Oct 1993, 619-627.
doi: 10.1177/019394599301500508.
DHSSPS (2004). STRESS, MENTAL HEALTH & SUICIDE: EMPLOYMENT

STATUS. Equality and Inequalities in Health and Social Care: A Statistical
Overview Report. Accessed from
http://www.dhsspsni.gov.uk/mentalhealthunemployment.pdf
Diener E, & Seligman M. (2002). Very happy people. Psychological Science.
13, 81 84.
Diener E, Chan M. (2010). Happy People Live Longer: Subjective Well-Being

Contributes to Health and Longevity. Applied Psychology: Health and Well-
Being, Forthcoming. Retrieved from SSRN:
http://ssrn.com/abstract=1701957.
Diener E, Nickerson C, Lucas R, Sandvik E. (2002). Dispositional affect and

job outcomes. Social Indicators Research, 59, 229 259.
Dillon K, Minchoff B, Baker K. (1985). Positive emotional states and

enhancement of the immune system. International Journal of Psychiatry in
Medicine. 15(1). 13-18.
Dillon K, Minchoff B. (1985). Laughter increased levels of salivary

immunoglobulin A(S-IgA), a vital immune system protein, which is the bodys
first line of defence against respiratory illness. Int J
Psychiatr Med.
Druss B, Rosenheck R. (1999). Patterns of Health Care Costs Associated With

Depression and
Substance Abuse in a National Sample. Psychiatric Services. Vol. 50 No. 2.
188
Duff S. (1999). Unresolved Grief can be Costly. Employee Benefit News, July.
Retrieved from
http://www.americanhospice.org/_articles/unresgrief.pdf.
Dugan D. (1989). Laughter and Tears: Best Medicine for Stress. Nursing
Forum 24.1. 18-26.
Egger HL, Angold A. (2006).Common emotional and behavioral disorders in

preschool children:
presentation, nosology, and epidemiology. J Child Psychol Psychiatry. Mar-

Apr;47(3-4):313-37. PMID: 16492262.
Fariselli LFreedman J, Ghini M, Valentini F. (2008). Stress, Emotional

Intelligence and Performance in Healthcare. Six Seconds White Paper.
Retrieved from
http://www.6seconds.org/sei/media/WP_Stress_EQ.pdf
Farmer AKorszun AOwen MCraddock NJones LJones IGray JWilliamson

RMcGuffin P. (2008). Medical disorders in people with recurrent depression.
The British Journal of Psychiatry. 192: 351-355. doi:
10.1192/bjp.bp.107.03838.
Field TDiego MHernandez-Reif M. (2006). Prenatal depression effects on the

fetus and newborn: a review. Infant Behavior & Development. 29 (2006) 445
455. doi:10.1016/j.infbeh.2006.03.00.
Fitzgerald H. (2002). Managing Stress for Hospice Professionals. American

Hospice Foundation.
Retrieved from http://www.americanhospice.org/articles-mainmenu-8/grief-at-

work-mainmenu-
11/54-managing-stress-for-hospice-professionals.
Flamerzi S, Al-Emadi N, Al-Kuwari M, Ghanim I, Ahmad A. (2008).

Prevalence and determinants of depression among primary health care
attendees in Qatar 2008. World Family Medicine Journal.
March 2010- Volume 8, Issue 2. Retrieved from

www.mejfm.com/March2010/depression.htm.
Fowler J, Christakis N. (2008). Dynamic spread of happiness in a large social

network: longitudinal analysis over 20 years in the Framingham Heart Study.
British Medical Journal.337;a2338.
Fredrickson B. (2009). Positivity: Groundbreaking Research Reveals How to

Embrace the Hidden Strength of Positive Emotions, Overcome Negativity, and
Thrive Hardcover.
Fredrickson B, Losada M. (2005). Positive Affect and the Complex Dynamics

of Human Flourishing.
American Psychologist, Vol 60(7), Oct 2005, 678-686. doi: 10.1037/0003-

066X.60.7.678
Friedler S, Glasser S, Azani L, Freedman L, Raziel A, Strassburger D, Ron-El

R, Lerner-Geva L (2011).
The effect of medical clowning on pregnancy rates after in vitro fertilization

and embryo transfer.
Fertil Steril. 2011 May;95(6):2127-30. Epub 2011 Jan 6.
Fry W. ( 1971). Mirth and oxygen saturation levels of peripheral blood.

Psychother Psychosom.
19:7684.[ISI][Medline].
Fry W. ( 1977). The respiratory components of mirthful laughter. J Biol

Psychol. 19:3950.
Fry W. (1971). Laughter: Is It the Best Medicine? Stanford M.D. 10: 16-20.
Fry W. (1984). Laughter and Health. Encyclopaedia Britannica Medical and

Health Annual. Pages259-262.
Fry W. (1992). The physiological effects of humor, mirth, and laughter. J Am

Med Assoc.
1992;267:18578. 11
Fry W. (1994). The biology of humor. Humor: Int J Humor Res.7:11126.
Fry W, Savin W. (1988). Mirthful Laughter and Blood Pressure. HUMOR:

International Journal of Humor Research. 1.1: 49-62.
Garg P, Rastogi R. (2009). Emotional Intelligence and Stress Resiliency: A

Relationship Study.
International Journal of Educational Administration. Volume 1 Number 1. pp.

1-16.
Gelkopk M, Kreitler M, Shulamith M, Sigal M. (1993). Laughter in a

Psychiatric Ward. The Journal of Nervous and Mental Disease. pp 283-288.
189
Gianaros P, Jennings J, Sheu L, Greer P, Kuller L, Matthews K. (2006).

Prospective reports of chronic life stress predict decreased grey matter volume
in the hippocampus. NeuroImage. 35 (2007) 795
80. doi:10.1016/j.neuroimage.2006.10.04.
Gilham C, Peto J, Simpson J, Roman E, Eden T, Greaves M, Alexander F.

(2005). Day care in infancy and risk of childhood acute lymphoblastic
leukaemia: findings from UK case-control study. 1294 BMJ
volume 330 4 June 2005.
Goleman D. (1996). Emotional Intelligence: Why It Can Matter More Than IQ.
Bantam Books. ISBN
978-0553383713.
Goodheart A. (1994). Laughter Therapy: How to Laugh About Everything in

Your Life That Isn't Really
Funny. Andrew J. Lesser, MD; ISBN-10: 0936941057.
Goodman S, Rouse M, (2010). Perinatal Depression and Children: A

Developmental Perspective.
Encyclopedia on Early Childhood Development. Published February 2010.

Retrieved from
http://www.child-encyclopedia.com/documents/Goodman-RouseANGxp.pdf.
Gore-Felton C, Koopman C., (2008). Behavioral Mediation of the Relationship
Between Psychosocial Factors and HIV Disease Progression. Psychosomatic
Medicine 70:569574 (2008) 569. DOI:
10.1097/PSY.0b013e318177353e.
Greenfield E, Marks N. (2004) Formal Volunteering as a Protective Factor

for Older Adults
Psychological Well-Being. The Journals of Gerontology, Series B, 59(5):

S258-S264.
Gretchen R. (2009). The Happiness Project or Why I Spent a Year Trying to

Sing in the Morning, Clean My Closets, Fight Right, Read Aristotle, and
Generally Have More Fun. New York: HarperCollins Publishers.
Haidt J (2006). The Happiness Hypothesis: Finding Modern Truth in Ancient

Wisdom. Basic Books ISBN-10: 9780465028023 ISBN-13: 978-0465028023.
Hajime Kimata. (2001). Effect of Humor on Allergen-Induced Wheal

Reactions. JAMA. 285(6):738.
doi: 10.1001/jama.285.6.738.
Hand G, Phillips K, Dudgeon W. (2006). Perceived stress in HIV-infected

Individuals: Physiological and psychological correlates. AIDS Care 18(8),
1011-1017. PMID: 17012093.
Harvard (2002). Depression during pregnancy and after. Harvard Mental

Health Letter, September 2002 issue. Retrieved from
www.health.harvard.edu/newsweek/Depression_during_pregnancy_and_after_0405.htm.
Hayashi K, Hayashi T, Iwanaga S, Kawai K, Ishii H, Shoji S, Murakami K.

(2003). Laughter Lowered the Increase in Postprandial Blood Glucose.
Diabetes Care 26:1651-1652, 2003. PMID: 12716853.
Hayashi T, Tsujii S, Iburi T, Tamanaha T, Yamagami K, Ishibashi R, Hori M,

Sakamoto S, Ishii H,
Murakami K. (2007). Laughter up-regulates the genes related to NK cell
activity in diabetes.
Biomedical Research 28(6) 281-285.
Hayashi T, Urayama O, Hori M, Sakamoto S, Nasir U, Iwanaga S, Hayashi K,

Suzuki F, Kawai K,
Murakami K. (2007). Laughter modulates prorenin receptor gene expression

in patients with type 2
diabetes. Journal of Psychosomatic Research, Volume 62, Issue 6, June 2007,

Pages 703-706.
doi:10.1016/j.jpsychores.2007.01.010.
Hayashi, Murakami, et al (2008). Laughter relatively up-regulated 39 genes,

among which 14 genes were found to be related to natural killer cell activity.
Biomed Res. Dec.
Hayashia, Murakamia, et al. (2006). Laughter regulates gene expression in

patients with type 2
diabetes. Psychotherapy and Psychosomatics. 75:62-65.
Heim C, Nater U, Maloney E, Boneva R, Jones J, Reeves W. (2009). Childhood

Trauma and Risk for Chronic Fatigue Syndrome Association with
Neuroendocrine Dysfunction. Arch Gen Psychiatry/Vol 66.
(no. 1), Jan 2009. Retrieved from www.archgenpsychiatry.com, on January 5,

2009.
190
Heim C, Nemeroff C, (2001). The Role of Childhood Trauma in the

Neurobiology of Mood and Anxiety Disorders: Preclinical and Clinical
Studies. Biol Psychiatry 1033 2001; 49:10231039. PMID: 11430844.
Herzog A, Franks M, Markus H, Holmberg D. (1998). Activities and Well-
Being in Older Age: Effects of Self-Concept and Educational Attainment.
Psychology and Aging, 13(2): 179-185.
Hsieh T. (2007). Delivering Happiness: A Path to Profits, Passion, and Purpose.

Published by Business Plus.
Hudson A, (2005). Burnt out Britain Raising the Alarm for Employers.
Hudson Employee Burnout Report. Retrieved from
http://ae.hudson.com/documents/uk-burnout-britain-exec-summary.pdf.
Hunt N, Evans D., (2004). Predicting traumatic stress using emotional

intelligence. Behaviour Research and Therapy 42 (2004) 791798.
Hysenbegasi A, Hass S, Rowland C. (2005). The Impact of Depression on the

Academic Productivity of University Students. The Journal of Mental Health
Policy and Economics 8, 145-151 (2005).
Ickovics J, Milan S, Boland R, Schoenbaum E, Schuman P, Vlahov D. (2007).

Psychological resources protect health: 5-year survival and immune function
among HIV-infected women from four US cities.
AIDS. 2006 Sep 11;20(14):1851-60.
Ickovics J, Hamburger M, Vlahov D, Schoenbaum E, Schuman P, Boland R,

Moore J. (2001). Mortality, CD4 Cell Count Decline, and Depressive
Symptoms among HIV-Seropositive Women .1466 JAMA,
March 21, 2001Vol 285, No. 11.
Inoue S, Nitta A, Luo Z. (1999). Emotions and Sleep: Effects of Laughter on

Nocturnal Sleep and Emotional Changes during Naps. Presented at World
Federation of Sleep Research Societies 3rd International Congress, Dresden
Germany October 1999. Retrieved from
www.bfl.co.jp/research/seminar/seminar007.html.
Ironson G, Hayward H. (2008). Do Positive Psychosocial Factors Predict

Disease Progression in HIV-1?
A Review of the Evidence. Psychosomatic Medicine. 70:546-554).
Ironson G, OCleirigh C, Fletcher M, Laurenceau J, Balbin E, Klimas N,

Schneiderman N, Solomon G.
(2005). Psychosocial factors predict CD4 and viral load change in men and
women with human
immunodeficiency virus in the era of highly active antiretroviral treatment.

Psychosomatic Medicine 67:1013-1021 (2005). PMID: 1631460.
Ishigami, Nakajima, et al. (2005). The level of serum GH significantly

decreased after mirthful laughter. Clin Exp Rheumatol. Sep-Oct.
Ishihara S, Nohara R, Makita S, Imai M, Kubo S, Hashimoto T. (1999).

Immune function and
psychological factors in patients with coronary heart disease . Jpn Circ J. Sep;
63(9):704-9.
Itami J, et al. (1994). Laughter and immunity. Japanese Journal of

Psychosomatic Medicine, 34, 565-571.
Iverson R, Olekalns M, Erwin P. (1998). Affectivity, organizational stressors,

and absenteeism: A causal model of burnout and its consequences. Journal of
Vocational Behavior, 52, 1-23.
Jacobs T, Epel E, Lin J, Blackburn E, Wolkowitz O, Bridwell D, Zanesco A,

Aichele S, Sahdra B, MacLean K, King B, Shaver P, Rosenberg E, Ferrer E,
Wallace B, Saron C. (2010). Intensive meditation training, immune cell
telomerase activity and psychological mediators. Psychoneuroendocrinology.
doi:10.1016/j.psyneuen.2010.09.0.
Judeh A. (2007). Emotional Intelligence and its Relationship with Happiness

and Self-Confidence among Al-Aqsa University Students. An-Najah University
Journal for Research - Humanities, Volume 21, Issue 3, 2007.
Kagee A. (2008). Adherence to antiretroviral therapy in the context of the

national roll-out in South Africa: Defining a research agenda for psychology.
South African Journal of Psychology, 38(2), pp.413-428.
191
Kalichman S. (2008). Co-occurrence of Treatment Nonadherence and

Continued HIV Transmission
Risk Behaviors: Implications for Positive Prevention Interventions.

Psychosomatic Medicine. 70:593
597.
Kalichman S, Grebler T. (2010). Stress and Poverty Predictors of Treatment

Adherence among People with Low-Literacy Living with HIV/AIDS. P
sychosom Med. 201
0 October; 72(8): 810816.
doi: 10.1097/PSY.0b013e3181f01be3.
Kamei T, Kumano H, Masumura S. (1997). Changes of Immunoregulatory

Cells Associated with
Physiological Stress and Humor. Perceptual and Motor Skills 3.2 (1997):
1296-1298.
Kangethe S. (2009). Critical coping challenges facing caregivers of persons

living with HIV/AIDS and other terminally ill persons: The case of Kanye care
program, Botswana. Indian J Palliat Care, 2009, Volume 15, Issue 2, 115-121.
Retrieved from: http://www.jpalliativecare.
com/text.asp?2009/15/2/115/58456. DOI: 10.4103/0973-1075.58456.
Kaplan A. (1999). Implications of Stress, Psychosocial Factors on the Immune

System. Psychiatric Times 16 (Oct. 1999): 10.
Kapornai K, Vetr . (2008). Depression in children. Current Opinion in
Psychiatry: January 2008, Volume 21 - Issue 1 - p 1-7. doi:
10.1097/YCO.0b013e3282f25b01.
Kataria M. (2007). Laugh For No Reason. Mumbai, Madhuri International.
Kataria M, Gee B. (2006-2007). Reduced incidence and severity of viral and

bacterial infections and cancer is reported by thousands of members of
laughter yoga clubs. Laughter Yoga International, India.
Kaufman J, Charney D. (2001). Effects of Early Stress on Brain Structure and

Function: Implications for Understanding the Relationship Between Child
Maltreatment and Depression, Developmental
Psychopathology. 2001 Summer; 13(3):451-471.
Keltner D, Bonanno G. (1997). A Study of Laughter and Dissociation: Distinct

Correlates of Laughter and Smiling During Bereavement. Journal of
Personality and Social Psychology, Volume 73, Issue 4,
October 1997, Pages 687-702.
Kiecolt-Glaser J, Gouin J, Weng N, Malarkey W, Beversdorf D, Glaser R.

(2010). How stress kills: Assessing the damage and various remedies.
American Psychological Association 118th Annual
Conference.
Kimata H. (2001). Effect of humour on allergen-induced wheat reactions.

Journal of the American Medical Association 2001 Feb 14; 285(6):738.
Kimata H. (2004). Differential effects of laughter on allergen-specific

immunoglobulin and
neurotrophin levels in tears. Percept Mot Skills 2004; 98(3 Pt 1): 901-908.
Kimata H. (2004). Effect of viewing a humorous vs. non humorous film on

bronchial responsiveness in patients with bronchial asthma. Physiology &
Behavior, Volume 81, Issue 4, June 2004, Pages 681-684.
doi:10.1016/j.physbeh.2004.03.010.
Kimata H. (2004). Laughter counteracts enhancement of plasma neurotrophin
levels and allergic skin wheal responses by mobile phone-mediated stress.
Behav Med 2004; 29(4): 149-152.
Kimata H. (2008). Short-term Improvement of Erectile Dysfunction by

Viewing Humorous Films in
Patients with Atopic Dermatitis. J. Sex Med. 2008 Feb. 4 18266651 Cit2. DOI:
10.1111/j.1743-6109.2007.00767.x.
Klein A. (1998). The Courage to Laugh: Humor, Hope, and Healing in the Face
of Death and Dying.
New York, NY: Tarcher/Putnam.
Koivumaa-Honkanen H, Honkanen R, Viinamki H, Heikkil K, Kaprio J,

Koskenvuo M. (2000). Self-reported Life Satisfaction and 20-Year Mortality in
Healthy Finnish Adults. Am J Epidemiol Vol. 152, No. 10.
192
Koivumaa-Honkanen H, Koskenvuo M, Honkanen R, Viinamki H, Heikkil K,

Kaprio J. (2004) . Life dissatisfaction and subsequent work disability in an 11-
year follow-up. Psychological Medicine, 34, 22122.
Langer E. (2009). Counterclockwise: Mindful Health and the Power of

Possibility. Ballantine Books.
ISBN-10: 9780345502049.
Latham M. (2003). Young Volunteers: The Benefits of Community Service.

University of Nevada
Factsheet Fact Sheet-03-23. Accessed at
http://www.unce.unr.edu/publications/files/cd/2003/FS0323.pdf.
Leserman J. (2008). Role of Depression, Stress, and Trauma in HIV Disease

Progression.
Psychosomatic Medicine. 70:539-545.
Leserman J, Ironson G, O'Cleirigh C, Fordiani J, Balbin E. (2008). Stressful

Life Events and Adherence in HIV. AIDS Patient Care STDS. 22(5): 403411.
doi: 10.1089/apc.2007.0175. PMCID: PMC2567910.
Leserman J, Petitto J, Golden R, Gaynes B, Gu H, Perkins D, Silva S, Folds J,

Evans D. (2000). Impact of Stressful Life Events, Depression, Social Support,
Coping, and Cortisol on Progression to AIDS. The American Journal of
Psychiatry.157:12211228. PMID: 10910783.
Leserman J, Temoshok L. (2008). A Road Well Traveled (Although Not Yet a

Super Highway).
Psychosomatic Medicine. 70:521522 (2008). DOI:

10.1097/PSY.0b013e31817b8ef9.
Llewellyn D, Lang, Langa K, Huppert F. (2008). Cognitive function and

psychological well-being: findings from a population-based cohort. Age and
Ageing 2008; 15 C. doi: 10.1093/ageing/afn194.
Luby J, Belden A. (2008). Clinical Characteristics of Bipolar vs. Unipolar

Depression in Preschool Children: An Empirical Investigation. J Clin
Psychiatry. 2008 December ; 69(12): 19601969.
Lyubomirsky S. (2007). The How of Happiness: A Scientific Approach to

Getting the Life You Want.
Penguin Press.
Lyubomirsky S, King L, Diener E. (2005) The benefits of frequent positive

affect: Does happiness lead to success? Psychological Bulletin, 131, 803-855.
Mahony D, Burroughs W, Lippman L. (2002). Perceived attributes of health-

promoting laughter: a cross-generational comparison. The Journal of
Psychology. Mar; vol 136 (issue 2) : pp 171-81.
Malangu N. (2008). Self-reported adverse effects as barriers to adherence to

antiretroviral therapy in HIV-infected patients in Pretoria. SA Fam Pract
2008;50(5):49
Mallett J. (1993). The Use of Humour and Laughter in Patient Care. British
Journal of Nursing.
2:172-175.
Marci C, Moran E, Orr S. (2004). Physiologic Evidence for the Interpersonal

Role of Laughter During Psychotherapy. The Journal of Nervous and Mental
Disease. Volume 192, Number 10, October 2004.
DOI: 10.1097/01.nmd.0000142032.04196.63.
Marcus B, Donald C. (2001). Now discover your strenghts. New York: The
Free Press.
Marcus S, Lopez J, McDonough S, MacKenzie M, Flynn H, Neal C, Gahagan S,

Vollingh B, Kacirotic N, Vazquez D. (2010). Depressive symptoms during
pregnancy: Impact on neuroendocrine and neonatal outcomes. Infant Behavior
and Development. doi:10.1016/j.infbeh.2010.07.002. PMID: 21035873.
Marques-Deak A, Sternberg E. (2004). Psychoneuroimmunology - The

relation between the central nervous system and the immune system. Revista
Brasileira de Psiquiatria, vol.26 no.3 So Paulo Sept. 2004. doi:
10.1590/S1516-44462004000300002.
Martin R, Dobbin J, et al. (1998). Sense of Humor, Hassles, and

Immunoglubulin A: Evidence for a Stress-Moderating Effect of Humor.
International Journal of Psychiatry in Medicine. 18.2: 93-105.
Martnez K, Prez E, Ramrez R, Canino G, Rand C. (2009). The role of

caregivers depressive symptoms and asthma beliefs on asthma outcomes
among low-income Puerto Rican children. J
Asthma, 2009 March; 46(2): 136141. doi: 10.1080/02770900802492053.

PMCID: PMC2717719.
193
Massachusetts General Hospital (2009). Why HIV Progresses Faster In Women

Than In Men With Same Viral Load. ScienceDaily. Retrieved from
http://www.sciencedaily.com
/releases/2009/07/090713131549.htm.
Mastekaasa A. (1994). Marital status, distress, and well-being: An international

comparison. Journal of Comparative Family Studies. 25, 183205.
Matsuzaki TNakajima A, Ishigami S. (2006). Mirthful laughter differentially

affects serum pro- and anti-inflammatory cytokine levels depending on the
level of disease activity in patients with rheumatoid arthritis. Rheumatology
2006; 45:182-186.
McComas H. (1923). The Origin of Laughter. Psychological Review, Volume

30, Issue 1, January 1923, Pages 45-55. doi:10.1037/h0073921
Mcewen B. (2006). Protection and Damage from Acute and Chronic Stress:
Allostasis and Allostatic Overload and Relevance to the Pathophysiology of
Psychiatric Disorders. Annals of the New York Academy of Sciences. Volume
1032, Biobehavioral Stress Response: Protective and Damaging Effects pages
17, December 2004. DOI: 10.1196/annals.1314.001.
Meisler G, Vigoda-Gadot E. (2010). Emotions in Management and the

Management of Emotions: the Impact of Emotional Intelligence and
Organizational Politics on Public Sector Employees. Public Administration
Review. January-February 2010.
Miller G, Chen E, Zhou E. (2007). If It Goes Up, Must It Come Down? Chronic
Stress and the
Hypothalamic-Pituitary-Adrenocortical Axis in Humans. Psychological

Bulletin, 2007, Vol. 133, No. 1, 2545 0033-2909/07/$12.00. DOI:
10.1037/0033-2909.133.1.25.
Miller M, Mangano C, Park Y, Goel R, Plotnick G, Vogel R. (2006). Impact of

cinematic viewing on endothelial function. Heart 2006;92:261-262
doi:10.1136/hrt.2005.061424.
Milstein J, Gerstenberger A, Barton S. (2002). Healing the caregiver. J Alt
Compl Med 2002; 8: 917920 doi:10.1089/10755530260511919.
Moen PDempster-McClain D, Williams R. (1992). Successful Aging: A Life

Course Perspective on Womens Multiple Roles and Health. American Journal
of Sociology.
Moore D. (2000). Make them laugh. Therapeutic humor for patients with grief-
related stress or anxiety. Adv Nurse Pract. Aug;8(8):34-7.
Moosa M, Jeenah F. (2007). Treating depression in HIV/AIDS. Volume 13 No.

3 August 2007 SAJP
pages 86-88]. Retrieved from

http://www.sajp.org.za/index.php/sajp/article/viewFile/20/18.
Moskowitz J. (2003). Positive Affect Predicts Lower Risk of AIDS Mortality.

Psychosomatic Medicine 65:620626 (2003).
Nezu A, Nezu C, Blissett S. (1988). Sense of Humor as a Moderator of the

Relation between Stressful Events and Psychological Distress: A Prospective
Analysis. Journal of Personal and Social Psychology 54.3 (1988): 520-525.
NIH News in Health (2007). National Institutes of Health, US Department of

Health and Human
Services. Retrieved from

http://newsinhealth.nih.gov/2007/January/docs/01features_01.htm.
OConnor T, Caprariello P, Blackmore E, Gregory A, Glover V, Leming P,

ALSPAC Study Team. (2007).
Prenatal Mood Disturbance Predicts Sleep Problems in Infancy and

Toddlerhood. Early Hum Dev. 2007
July; 83(7): 451458. PMCID: PMC2853892. doi:

10.1016/j.earlhumdev.2006.08.006.
O'Connor N, Hermelin B. (1998). Low Intelligence And Special Abilities.

Journal of Child Psychology and Psychiatry Volume 29, Issue 4, pages 391
396, July 1988 DOI: 10.1111/j.1469-610.1988.tb00732.x.
Oki M. (1977). Healing Yourself through Okido Yoga. Tokyo Japan, Japan
Publications INC.
Olisah V, Baiyewu O, Sheikh T. (2010). Adherence to highly active

antiretroviral therapy in depressed patients with HIV/AIDS attending a
Nigerian university teaching hospital clinic. Afr J Psychiatry 2010; 13:275-
279.
194
Olley B, Seedat S, Stein D. (2004). Changes and factors associated with

depression in recently diagnosed HIV patients in South Africa: a 6 month
follow-up study. International Conference on AIDS
(15th : 2004 : Bangkok, Thailand).
Olley B, Seedat S, Stein D. (2006). Persistence of psychiatric disorders in a

cohort of HIV/ AIDS
patients in South Africa: a 6-month follow-up study. J Psychosom Res 2006;

61: 479-484.
Orr N, Patient D. (2006). Absenteeism & HIV/AIDS: A hospitality industry case

study. Empowernment Concepts. Retrieved from
http://www.empow.co.za/absenteeism-study.htm.
Osho. (2009). Life, Love, Laughter: Celebrating Your Existence. Publisher:

St. Martin's Griffin.
Oswald A, Proto E, Sgroi D. Happiness and Productivity. Warwick Economic.

IZA Discussion Paper 4645.
Panksepp J, Burgdorf J. Laughing rats and the evolutionary antecedents of

human joy? Physiology
& Behavior (2003) 79:533-547. psych.umn.edu.

Pasquali E. (1990). Learning to laugh: humor as therapy. J Psychosoc Nurs
Ment Health Serv. 1990
Mar; 28(3):31-5.
Patton G, Tollit M, Psycha E, Romaniuk H, Spence S. Sheffield J, Sawyer M.

(2011). A prospective study of the effects of optimism on adolescent health
risks. Pediatrics 2011; 127: 308-316. doi:10.1542/peds.2010-0748.
Pau A, Croucher R, Sohanpal R, Muirhead V, Seymour K. (2004). Emotional

intelligence and stress coping in dental undergraduates a qualitative study.
British Dental Journal 197, 205 209.
DOI:10.1038/sj.bdj.4811573.
Pearson S, Katzelnick D, Simon G, Manning W, Helstad C, Henk H. (1999).

Depression Among High Utilizers of Medical Care. Journal of General
Internal Medicine, Volume 14, Number 8, 461-468, DOI: 10.1046/j.1525-
1497.1999.06278.x.
Peltzer K, Mashego T, Mabeba M. (2003). Short communication: Occupational

stress and burnout among South African medical practitioners. Stress and
Health, Volume 19, Issue 5, pages 275280, December 2003. DOI:
10.1002/smi.982.
Pence B. (2009). The impact of mental health and traumatic life experiences on
antiretroviral treatment outcomes for people living with HIV/AIDS. Journal of
Antimicrobial Chemotherapy
Volume63, Issue4Pp. 636-640. doi: 10.1093/jac/dkp006.
Peterson B, Warner V, Bansal R, Zhu H, Hao X, Liu J, Durkin K, Adams P,

Wickramaratne P, Weissman M. (2009). Cortical thinning in persons at
increased familial risk for major depression. Proc Natl Acad Sci U S A. 2009
Apr 14;106(15):6273-8. PMID: 19329490.
Peterson C. (2006). A Primer in Positive Psychology New York, Oxford

University Press.
Peterson K. (1992). "The Use of Humor in AIDS Prevention, in the Treatment

of HIV-Positive Persons, and in the Remediation of Caregiver Burnout." AIDS
Prevention and Treatment: Hope, Humor, and Healing. New York: Hemisphere,
1992, 37-57.
Pettigrew J. (2010). Laughter abolishes binocular rivalry. Optometrists

Association Australia, Volume
88, Issue 1, pages 3945, January 2005. DOI: 10.1111/j.1444-

0938.2005.tb06662.x.
Pittenger C, Duman S. (2008). Stress, Depression, and Neuroplasticity: A

Convergence of
Mechanisms. Neuropsychopharmacology REVIEWS (2008) 33, 88109.
Provine R. (2001). Laughter: a scientific investigation. Penguin books

ISBN0141002255,
9780141002255.
Quinn P, Duckworth A. (2007). Happiness and academic achievement:

Evidence for reciprocal
causality. Poster session presented at the annual meeting of the American

Psychological Society.
Ramesar S, Koortzen P, Oosthuizen R. (2009). The relationship between

emotional intelligence and stress management. The relationship between
emotional intelligence and stress management. SA 195
Journal of Industrial Psychology/ SA Tydskrif vir Bedryfsielkunde, 35(1), Art.

#443, 10 pages. DOI: 10.4102/sajip.v35i1.443.
Ranucci M. (2005). Positive and Negative Affect: Differential Impact of

Optimism, Pessimism, and Coping in People Living with HIV/AIDS. Thesis,
University of North Texas. UNT Digital Library.
Retrieved from http://digital.library.unt.edu/ark:/67531/metadc4804.

Reid S, Dwyer J.(2005). Insomnia in HIV Infection: A Systematic Review of
Prevalence, Correlates, and Management. Psychosomatic Medicine 67:260-269
(2005).
Reynolds N, Testa M, Marc L, Chesney M, Neidig J, Smith S, Vella S, Robbins

G. (2004). Protocol Teams of ACTG 384, ACTG 731 and A5031s Factors
Influencing Medication Adherence Beliefs and Self-Efficacy in Persons Naive
to Antiretroviral Therapy: A Multicenter, Cross-Sectional Study. AIDS and
Behavior, Volume 8, Number 2, 141-150, DOI:

10.1023/B:AIBE.0000030245.52406.bb.
Robinson-Whelen S, Tada Y, MacCallum R, McGuire L,Kiecolt-Glaser J.

(2001). Long-term caregiving:
what happens when it ends? Journal of abnormal psychology. Vol. 110, no. 4:
573-84.
doi:10.1192/bjp.bp.107.03838. PMID: 11727947.
Rosner F. (2002). Therapeutic efficacy of laughter in medicine. Cancer Invest.

2002;20(3):434-6..
Sachs-Ericsson N, Blazer D, Plant E, Arnow B. (2005). Childhood Sexual and

Physical Abuse and the One-Year Prevalence of Medical Problems in the
National Comorbidity Study. Health Psychol. 2005
Jan;24(1):32-40. PMID: 1563156.
Sala F. (2003). Laughing All the Way to the Bank. Harvard Business Review.
September 2003.
Salami S. (2010). Emotional intelligence, self-efficacy, psychological well-

being and students
attitudes: implications for quality education. European Journal of Educational

Studies 2(3), 201.
Salaycik K, Kelly-Hayes M, Beiser A, Nguyen A, Brady S, Kase C, Wolf P.

(2007). Depressive symptoms and risk of stroke. The Framingham Study.
Stroke, 2007, vol. 38, pp. 1621. PMID: 17138952.
Samaras K, Gan S, Peake P, Carr A, Campbell L. (2008). Pronflammatory

Markers, Insulin Sensitivity, and Cardiometabolic Risk Factors in Treated HIV
Infection. Obesity. (2008) 17 1, 5359.
doi:10.1038/oby.2008.500.
Sauter D, Eisner F, Ekman P, Scott S. (2010). Cross-cultural recognition of

basic emotions through nonverbal emotional vocalizations. 24082412 | PNAS
| February 9, 2010 | vol. 107 | no. 6
www.pnas.org/cgi/doi/10.1073/pnas.0908239106.
Sauter D, Eisner F, Ekman P, Scott S. (2010). Laughter is universal and

contagious: Cross-cultural recognition of basic emotions through nonverbal
emotional vocalizations. 24082412 | PNAS |
February 9, 2010 | vol. 107 | no. 6

www.pnas.org/cgi/doi/10.1073/pnas.0908239106
Save the Children. (2006). Small Also Have Something to Say: A report on
research into the effects of HIV/AIDS on children in six Asian countries. Save
the Children Publication.
Scanlan J M, Vitaliano P. (1998). CD4 and CD8 Counts Are Associated With
Interactions of Gender and Psychosocial Stress. Psychosomatic Medicine
60:644-653.
Schore, A. (1996). The Experience-Dependent Maturation of a Regulatory

System in the Orbital Prefrontal Cortex and the Origen of Developmental
Psychopathology. Development and
Psychopathology 8: 59 87.
Schulz R, Visintainer P, Williamson G. (1990). Psychiatric and physical

morbidity effects of care giving. J Gerontol. 45:: 18191.
Scott S (2010). Everybody laughs, everybody cries: Researchers identify

universal emotions.
PHYSorg.com. 25 Jan 2010.
Seligman M. (1991). Learned Optimism: How to Change Your Mind and Your
Life. 1991, New York
Random House INC.
Seligman M. (2002). Authentic Happiness: Using the New Positive Psychology

to Realize Your
Potential Fr Lasting Fulfillment .New York, Free Press.
196
Seligman M. (2002). Using the New Positive Psychology to Realize Your

Potential For Lasting
Fulfillment Authentic Happiness. New York: Free Press.
Seligman, M. (2011). Flourish: A Visionary New Understanding of Happiness

and Well-being. Free Press, ISBN-10: 1439190755
Seligson, M, Peterson K. (1992). AIDS Prevention and Treatment: Hope,

Humor, and Healing. New York: Hemisphere, Series B: Psychological Sciences
and Social Sciences, 60B(3): P143-52.
Siahpush M, Spittal M, Singh G. (2008). Happiness and life satisfaction

prospectively predict self-rated health, physical health, and the presence of
limiting, long-term health conditions. American Journal of Health Promotion,
23(1), 2008.
Silick T, Schutte N. (2006). Emotional intelligence and self-esteem mediate

between perceived early parentallove and adult happiness. E-Journal of
Applied Psychology.
Slade B, Slade M, Kunkel S, Kasl S. (2002). Longevity Increased by Positive

Self-Perceptions of Aging.
Journal of Personality and Social Psychology, 2002, Vol. 83, No. 2, 261270.
DOI: 10.1037//00223514.83.2.261.
Slavich G, Way B, Eisenberger N, Taylor S. (2010). Neural sensitivity to social

rejection is associated with inflammatory responses to social stress. PNAS,
August 17, 2010, vol. 107, no. 33, 148171482.
http://www.pnas.org/content/107/33/14817.
Smith M, Jaffe-Gill E, Segal J. (2010). Understanding Stress: Signs,

Symptoms, Causes, and Effects.
Helpguide. Retrieved from http://www.helpguide.org/mental/stress_signs.htm.
Sorgen C. (2005). Natural Panic Attack Treatments. Retrieved from
http://www.medicinenet.com/script/main/art.asp?articlekey=52116.
Steptoe A. (2010). Handbook of Behavioral Medicine: M. Springer, New York,

Dordrecht, Heielberg, London.
Steptoe A, Wardle J, Marmot M. (2005). Positive affect and health-related

neuroendocrine, cardiovascular, and inflammatory processes. PNAS May 3,
2005 vol. 102 no. 18 6508-6512.
doi:10.1073/pnas.0409174102PNAS.
Strean W. (2009). Laughter prescription. Canadian Family Physician Le

Mdecin de famille
canadien Vol 55.
Stuber M, Dunay Hilber S, Libman Mintzer L, Castaneda M, Glover D, Zeltzer

L. (2009). Laughter, humor and pain perception in children: A pilot study.
Evidence-Based Complementary and
Alternative Medicine. eCAM, Oct 2007. doi:10.1093/ecam/nem097
Sunil K, Rooprai K. (2009). Proceedings of the ASBBS Annual Conference:

Las Vegas.
Suraj-Narayan G. (2008). Private discussions with Bill Gee. University of
Kwazulu-Natal South Africa.
Takahashi K, Iwase M, Yamashita K, Tatsumoto Y, Ue H, Kuratsune H, Shimizu

A, Takeda M. (2001).
The elevation of natural killer cell activity induced by laughter in a crossover

designed study. Int J
Mol Med 8:645650, 2001.
The Childrens Society (2008). UK Failing To Meet Children's Mental Health

and Well-Being Needs.
Retrieved from
http://www.childrenssociety.org.uk/whats_happening/media_office/latest_news/7092_pr.htm
Thompson H. (2005). The Impact of Stress on the BarOn EQ-I Reported

Scores and A Proposed Model of Inquiry. High Performing Systems, Inc.,
Technical Report 15-5. Accessed from
http://www.hpsys.com/PDFs/EQ-i_and_Stress_JUN%2005.pdf.
Tindle H, Chang Y, Kuller L, Manson J, Robinson J, Rosal M, Siegle G,

Matthews K. (2009). Optimism, cynical hostility, and incident coronary heart
disease and mortality in the Women's Health Initiative.
Circulation. 2009 Aug 25;120(8):656-62. Epub 2009 Aug 10. PMID:

19667234.
Toda M, Kusakabe S, Nagasawa S, Kitamura K, Morimoto K. (2007). Effect of

laughter on salivary endocrinological stress marker chromogranin A. Biomed
Res 2007;28(2):1158.
197
Toker S, Shirom A, Shapira I, Berliner S, Melamed S. (2005). The Association

Between Burnout, Depression, Anxiety, and Inflammation Biomarkers: C-
Reactive Protein and Fibrinogen in Men and Women. Journal of Occupational
Health Psychology 2005;10(4) 344-362.
Triant V. (2002). The Recognition and Determinants of Depression at a South

African Primary Care Clinic. Thesis Submitted to the Yale University School
of Medicine.
UNAIDS Report on The Global AIDS Epidemic (2010). Global report:

UNAIDS report on the global AIDS
epidemic 2010. UNAIDS/10.11E, JC1958E.
University Of Michigan (2005). Positive Emotions Slash Bias, Help People

See Big Picture
Details. ScienceDaily. Retrieved from http://www.sciencedaily.com-
/releases/2005/02/050205124340.htm.
Unutzer J, Katon W, Fan M, Schoenbaum M, Lin E, Della Penna R, Powers D.

(2008). Long-term Cost Effects of Collaborative Care for Late-life
Depression. Am J Manag Care. 2008;14:95-100. PMID: 18269305.
USAID. (2009). Mental Health and HIV/AIDS Technical Brief. 2010. Aidstar-
One AIDS Support and Technical Assistance Resources. Retrieved from
http://www.aidstar-one.com/focus_areas/care_and_
resources/case_study/mental_health_vietnam##tab_1.
Van der Bijl H, Oosthuizen P. (2007). Anxiety, depression, health attitudes and
coping strategies in doctors and teachers in a Cape Town setting. Volume 13
No. 2 June 2007 SAJP.
Van Dyk A. (2007). Occupational stress experienced by caregivers working in

the HIV/AIDS field in South Africa. African Joumal of AIDS Research 2007,
6(1): 49-66.
Veenhoven R. (2008). Healthy happiness: effects of happiness on physical

health and the
consequences for preventive health care. Journal of Happiness Studies. Volume
9, Number 3, 449-469, DOI: 10.1007/s10902-006-9042-1.
Vranceanu A, Safren S, Lu M, Coady W, Skolnik P, Rogers W, Wilson I.

(2008). The Relationship of Post-traumatic Stress Disorder and Depression to
Antiretroviral Medication Adherence in Persons with HIV. AIDS Patient Care
and STDs, Volume 22, Number 4, 2008. DOI: 10.1089/apc.2007.0069.
Wang X, Chai H, Lin P, Yao Q, Chen C. (2009). Roles and mechanisms of HIV
protease inhibitor Ritonavir and other anti-HIV drugs in endothelial
dysfunction of porcine pulmonary arteries and human pulmonary artery
endothelial cells. Am J Pathol, 2009, 174: 771-781.
Warren J, Sauter D, Eisner F, Wiland J, Dresner M, Wise R, Rosen S, Scott S.

(2006). Positive Emotions Preferentially Engage an AuditoryMotor "Mirror"
System. The Journal of
Neuroscience, December 13, 2006, 26(50):13067-13075;

doi:10.1523/JNEUROSCI.3907-06.2006.
WebMD Medical Reference. Heart Disease and Caregiver Burnout. Reviewed

by Robert J Bryg, MD on September 15, 2009. Accesed at
http://www.webmd.com/heart-disease/guide/heart-disease-recognizing-
caregiver-burnout on 10 May 2011.
Weisenberg M, Tepper I, Schwarzwald J. (1995). Humor as a cognitive

technique for increasing pain tolerance. Pain 1995; 63(2): 207-212.
Weissman M, et al. (1992). The Changing Rate of Major Depression: Cross-

National Comparisons.
JAMA. 1992;268(21):3098-3105. doi: 10.1001/jama.1992.03490210080039.
Whetten K, Reif S, Whetten R, Murphy-Mcmillan L. (2008). Trauma, Mental

Health, Distrust, and Stigma Among HIV-Positive Persons: Implications for
Effective Care. Psychosomatic Medicine 70:531
538 (2008) 531. DOI: 10.1097/PSY.0b013e31817749dc.
Wolke D, Rizzo P, Woods S. (2002). Persistent Infant Crying and Hyperactivity

Problems in Middle Childhood. Pediatrics, 2002; 109:1054-1060. PMID:
12042542.
World Health Organization (2001). The World Health Report 2001: Mental
Health : New
Understanding, New Hope. Retrieved from

http://www.who.int/whr/2001/en/whr01_en.pdf.
198
World Health Organization (2005). Psychotherapeutic Interventions in Anti-

retroviral therapy: for second level care. World Health Organization 2005,
ISBN 92 4 159309 1.
World Health Organization (2007). World Health Survey on Health and Health-
Related Outcomes and their Determinants in Adults Aged 18 Years and Older.
Retrieved from www.who.int via
http://www.sajp.org.za/index.php/sajp/article/viewFile/24/22.
World Health Organization. (2010). Priority interventions: HIV/AIDS

prevention, treatment and care in the health sector. WHO HIV Guidelines
2010ISBN 978 92 4 150023 4.
World Health Organization (2011). Mental Health: What is Depression?

Retrieved from
http://www.who.int/mental_health/management/depression/definition/en/.
Yovetich N, Dale A, Hudak M. (1990). Benefits of humor in reduction of

threat-induced anxiety.
Psychol Rep. 66:518.
Yudofsky S, Hales R. (2008). The American Psychiatric Publishing textbook of

Neuropsychiatry and Behavioral Neurosciences. American Psychiatric Pub.
Yun L, Maravi M, Kobayashi J, Barton P, Davidson A. (2005). Antidepressant

treatment improves adherence to antiretroviral therapy among depressed HIV-
infected patients. J Acquir Immune Defic Syndr. 38: 432-438. PMID:
15764960.
Ziv A. (1976). Facilitating effects of humor on creativity. Journal of

Educational Psychology
Volume 68, Issue 3, June 1976, Pages 318-322.
199

Bill Jee Malik Jafer - Healing-With-Happiness

Загружено:

Сведения о документе

Оригинальное название

Авторское право

Доступные форматы

Поделиться этим документом

Поделиться или встроить документ

Параметры публикации

Этот документ был вам полезен?

Это неприемлемый материал?

Авторское право:

Доступные форматы

Bill Jee Malik Jafer - Healing-With-Happiness

Загружено:

Авторское право:

Доступные форматы

Earnings

from this book and our other

happiness building programs and activities

sponsor Healing with Happiness programs for

orphans and vulnerable children, people living

with HIV, hospice patients, the needy, and their

caregivers did you know that caregivers are angels?

the following organizations. Their help and support

enabled the development of the JOYGYM Happiness System.

USAID/PEPFAR (United States Agency for International Development,

The United States President's Emergency Plan for AIDS Relief)

University of the Witwatersrand Center for Excellence in Palliative Care

Department of Education Gauteng Province (South Africa)

HPCA (Hospice Palliative Care Association of South Africa)

SACBC (Southern African Catholic Bishops' Conference)

Department of Social Development (South Africa)

Hospice in the West (Krugersdorp South Africa)

Matlosana Hospice (Klerksdorp South Africa)

Laughter Yoga International (Mumbai, India)

Hospice Association of the Witwatersrand

(Johannesburg & Soweto, South Africa)

AngloGold Ashanti (South Africa)

Xstrata Minerals (South Africa)

FHI (Family Health International)

EAP Association (South Africa)

Sparta Foods (South Africa)

Cotlands (South Africa)

From the Authors

We dedicate this book to all children.

May you have long, healthy and happy lives.

To Peter and Lillian Webber and Sannie Grobler.

Your lives taught me Happiness Intelligence.

To my compass and rudder. Thank you Ambereen for your love,

To my children a constant source of fun and happiness in my life

InHappiness International Happiness Institute was founded

in Mumbai, India and currently works from Johannesburg, South

Africa to build global Happiness Intelligence. We are non-profit

and vulnerable children, people living with HIV, hospice patients,

others in need and their caregivers.

Happiness Intelligence helps us develop a more fulfilling,

happier, healthier, and longer life. Build your Happiness

Intelligence and happiness will follow.

JOYGYM Happiness System is a proven positive psychology

based system to help build Happiness Intelligence. JOYGYM is

delivered in two streams: Aerobic Laughter (practical training or

therapy) and Happiness Coaching.

Aerobic Laughter a powerful cognitive behavioral therapy

and one of the most effective positive psychology interventions.

Happiness Coaching education, self discovery, and positive

psychology techniques are delivered with guidance, support and

encouragement to help build Happiness Intelligence.

HappyMetrics All our programs are evidence based.

HappyMetrics provides happiness assessment to track your

happiness, measure changes, and monitor your results.

Healing with Happiness Is a JOYGYM psychosocial support

program helping tens of thousands of orphans and vulnerable

Happiness University Happiness-U.org opens online mid-

2011 with online Happiness Coaching to build Happiness

Intelligence in all corners of the world.

Happyness Advantage corporate happiness consulting and

coaching service. JOYGYM can boost productivity, engagement,

sales, and profit. Happiness provides a real business advantage.

Natural Laughter spontaneous joyful laughter and non-verbal