healing with happiness free pdf

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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

ACKNOWLEDGEMENTSInHappiness 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 GeeMy 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.

I’d 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 government’s 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. Kataria’s 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 world’s 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.

Owner, 05/13/11,

This sentence needs a rewrite

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.

We’re 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.

Let’s make the 21st century the Age of Happiness.

Johannesburg, South Africa — April 2011

Preface: Malik JafferI 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 ISN’T IT OUT THERE?

As I experienced the power of laughter and happiness to improve life, I was amazed that we don’t 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 weren’t 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. I’m grateful, humbled and fortunate to have had the opportunity to serve others and positively impact on the lives of millions.

I’ve seen happiness and joy in the eyes of children around the world. Their eyes glow and faces radiate the same way everywhere.

It doesn’t 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 someone’s 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 program’s 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.

It’s 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: [email protected] 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 Attribution-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

http://www.joygym.org/the-happiness-shop.htm

H E A L I N G W I T H H A P P I N E S S

Re-discovering HappinessTwenty-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’. They’re 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 SUCCESSTwentieth 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

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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 HEALTHHappiness improves health dramatically.

We don’t 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.

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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 LONGEVITYHappy 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

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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 “Don’t 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 DON’T KNOW.”

A TWENTIETH CENTURY FABLE

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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 don’t want to be normal, we want to be happier!”

POSITIVE PSYCHOLOGYPsychology 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 WORLDSEach 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.

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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 CHOICEMany 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 John’s level of happiness.

The reality is quite different. There is no one with a remote control and wicked sense of humor that decides, “I’m going to make John wake up miserable this morning.” Or tomorrow decides, “He’ll wake up happy, but at noon I’ll 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 MEASUREDWe can’t manage what we don’t measure.

A range of assessments can measure aspects of happiness and unhappiness separately and in combination.

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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.

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HAPPINESS IS CONTAGIOUSBoth happiness and unhappiness are contagious.

Get on a bus where someone won’t stop complaining about something, and chances are that we’ll 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 we’ll 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 one’s 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 SOCIALHappy people have more friends, and lonely people are less likely to be happy.

This isn’t 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, we’re less likely to have lots of friends and more likely to be lonely.

That’s also simple: when we feel unhappy, we interact with people in a negative way and they avoid us to protect their happiness.8


Beware. Unhappiness and loneliness are also contagious.POSITIVITYPositivity 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 AFFECTPositive 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 AFFECTDecreasing 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 DISCOVERYA 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.

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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 NORMALOur happiness level is not fixed — it’s 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 — let’s say we win the lottery — then we’ll suddenly become much happier.

But studies of lottery winners show that they may be happier for a while, but they soon revert to normal.

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The opposite is also true. Victims of crippling accidents reported short-term unhappiness, after which their happiness tended to revert to normal.

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THE NUDGE EFFECTCan 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 won’t 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 we’ll achieve lasting change and a happier, healthier you.

Happiness MythsA 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 when’s…

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It’s 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. It’s 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 LIEAnother 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 we’ve met are among the poorest, and most of the deeply unhappy people we’ve met are those with the most money.

Real success isn’t measured in money.

It’s 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.

Don’t confuse net worth with self worth.

Wealth and success are what we believe them to be.

They come from a happy life well lived.

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EMPTY PROMISESTwentieth 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.

It’s 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 we’ll feel happier.

It’s an empty promise.

Any flashes of gratification we may experience don’t contribute to our Happiness Intelligence.

BUYING HAPPINESSAdvertising 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 planet’s natural resources to manufacture products that are almost all (99%) thrown away within 6 months.

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This ridiculous lie is based on the false value that our worth is based by on how much we spend.

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 don’t have enough money to pay for a roof, food and basics, then more money will buy us happiness.

Once we’re past that threshold, more money doesn’t buy happiness. In fact in most cases it causes stress and worry that can reduce happiness.

There’s 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.

JOYFULNESSThis 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.

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Joy is pure positive affect.

Find out what gives you joy and practice it often.

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POSITIVITY RATIOThe 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.

OPTIMISMTry 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. Let’s call it a counterfact.

Let’s say we bite into an apple and there’s a worm in it. What’s the counterfact?

If it is: “Why me? That’s disgusting!” then we’ve turned that event into a negative affect that will make us unhappier.

If we think: “Wow, I’m glad I got that apple and not my guest” then we’ve 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

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Many people rush through life like someone running blindfolded through a forest, just bouncing off the trees and bushes they happen to run into.

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.

SATISFACTIONWe 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 isn’t about living in a bigger house — it’s about living in a happy house.

Happiness lies in being satisfied with what we have.

STRENGTHS AND FLOWEvery one of us is gifted with special talents and strengths.

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We should discover our strengths and exercise them in our work, our family life and our play.

By exercising our strengths we’ll get more done and have more fun doing it.

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 we’re doing and lose track of time and other things happening around us.

Exercising our strengths is a sure way to happiness.

SOCIAL EXCHANGEWe 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 they’re not rocks stars or famous, they’re probably also the happiest people you know.

The more happiness we spread, the more it comes back.

VOLUNTEERINGGiving 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. We’ll 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 PURPOSEAre you drifting through life without a rudder — without meaning and purpose?

Think about it. What are your values?

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Don’t just accept what we’ve 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.

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-BEINGLook 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 LIVEDImagine 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?

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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.

Let’s review these ‘unhappifiers’, then look deeper into the dangers of stress and depression.

StressStress 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

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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.

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.

That’s 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 STRESSTwentieth 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 doesn’t make people work harder or better, rather, it reduces productivity, boosts absenteeism, and increases health care costs.

THE STRESS RESPONSEThe human stress response is controlled by the amygdala — part of our limbic brain that acts as our body’s security control center and scans all our senses for danger 24 hours a day.

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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.

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 BODYThese 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.

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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 STRESSOur immune system is also reset by the stress messengers.

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 don’t 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

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means that it is triggered almost continuously, causing chronic health problems that build unhappiness.

THE STRESS-MONKEY RESPONSEStress 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.

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 EMOTIONSThe stress response can shift us from happiness into a negative emotional state in an instant.

Imagine you are driving — it’s 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.

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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 VALUESThe 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.

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 can’t 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.

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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 RESPONSEOur 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.

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 HEALINGThe 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 nature’s 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.

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MODERN LIFE AND THE DE-STRESS RESPONSEIf your boss or a customer says something to upset you, do you hit them and start a fight?

If you’re 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.

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 OPTIONSWe 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 we’re 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 world’s leading corporations maintain their health and keep their brains sharp for peak decision making under stress by exercising in their office or private gym.

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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 MEASURESProactive 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.

UnhappifiersAnxiety, burnout, trauma and grief account for a great deal of unhappiness

ANXIETYAnxiety 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.

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BURNOUTToo 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.

TRAUMA AND GRIEFPsychological 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 people’s 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.

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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.

DepressionDepression 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.

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 PROBLEMA hundred years ago, the chance of experiencing major depression during one’s 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.

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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 1½ years old.

STRESS AND DEPRESSIONDepression 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.

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 Parkinson’s 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. 32


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 PREGNANCYDepression 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 person’s ‘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.

Because the child’s 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 children’s 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

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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.

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DEPRESSION IN HIV AND SERIOUS ILLNESSThe 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.

ANTIDEPRESSANTSWe know very little about how antidepressants work.

Antidepressant medications provided under the guidance of a medical professional can be helpful—even life-saving in cases of severe depression.

They provide some symptomatic relief but don’t 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.

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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.

OVERCOMING DEPRESSION NATURALLYTraditional 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 here’s the second dirty little secret. Almost always the effects are what is technically called, ‘small’…recurrence 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.

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The How of Happiness Can we increase our happiness?

Yes.

It is surprisingly easy.

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 INTELLIGENCEIntelligence 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

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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.

Don’t 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 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;

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Application: recycling waste, lifestyle changes, activism.

INTELLIGENCES SHAPE USWe are the sum of our intelligences.

Intelligences shape the way that we perceive and interact with the world and make decisions.

EDUCATIONIntelligences can be learned.

The purpose of education is to build intelligence.

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 INTELLIGENCEIn 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!

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LAW INTELLIGENCELaw 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.

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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 SUCCESSEmotional 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 HAPPINESSMany 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:

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Intrapersonal intelligences include self-regard, emotional self-awareness, assertiveness, independence, and self-actualization;

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 INTELLIGENCECan 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,

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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 Happiness Intelligence.

Happiness Intelligence can be learned and increased.

Let’s review the components of HQ.

HAPPINESS SKILLSSome 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 KNOWLEDGEThere 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

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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.

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 PASSIONWhile 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 APPLICATIONFor 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 WORLDVIEWDeveloping 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.

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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. We’ll be considering factors like the potential to exercise our strengths, flexibility, stress levels, corporate culture, the people and manager we work with, and the potential for meaning and fulfillment.

Building Happiness Intelligence is life changing.

Building HappinessWe’ve helped tens of thousands of people to develop and increase Happiness Intelligence.

Here are some important aspects we want to share.

HAPPINESS IS PERSONALWe 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.

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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 WORKThere is no pill or magic wand that builds instant happiness.

It takes work to increase our Happiness Intelligence and resulting happiness.

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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 can’t manage what we don’t 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 you’re 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.

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Delivering Happiness It’s 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 aren’t 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 PILLSPharmaceutical 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 aren’t 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

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It’s imperative that the new science of happiness is introduced into schools urgently so that the next generations develop Happiness Intelligence at an early age.

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 SOLUTIONSWhile 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.

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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.

HAPPINESS COACHINGWe 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 THERAPYHealing 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 doesn’t need psychologists or social workers to provide effective psychosocial support where it is desperately needed.

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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.

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TIER THREE: COMMUNITY HAPPINESSThe 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 DELIVERYThe 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.

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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-BASEDJOYGYM 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.

FLEXIBLEJOYGYM 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 LICENSESJOYGYM programs are available for worldwide license.

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This model has been chosen to ensure:

Consistency: ensuring that programs are delivered consistently builds confidence and works to deliver predictable results

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 HappinessThe 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.

ACTIVITYHumans 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

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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.

It has been called ‘shock treatment for happiness’.

Aerobic Laughter therapy is discussed in greater detail in the following chapters.

EDUCATIONA 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 COACHINGPositive 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 MANAGETo 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.

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PLAYEngaging 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.

RESTSleep 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 MINDFULNESSWe 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.

SERVICEService 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

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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.

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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.

DEVELOPMENTAerobic 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 program’s 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.

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Owner, 05/13/11,

Three or four, we need to standardize


RESEARCHInHappiness 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 LAUGHTERThe San people of southern Africa, one of the oldest groups of early humans to have survived with their original culture and

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language. Their culture is thought to be between 70,000 and 150,000 years old.

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 SERIOUSNESSToday, 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 LAUGHTERChildren 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.

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This brain is not a deep thinker, but it has a wonderful talent for natural laughter!

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SOCIETAL RESTRICTIONDuring 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 “don’t laugh in class”, “don’t laugh while we’re talking”, “don’t laugh at the dining table”, “don’t 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 it’s 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 it‘s 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 FREQUENCYSocial 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.

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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!

DISCIPLINEThe 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 they’re 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 that’s why most cultures today regard seriousness as socially acceptable and good, and laughter and spontaneity as bad.

INVENTED LAUGHTEREven 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 it’s 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 LAUGHTERWhile natural laughter is joyful and is associated with positive emotions, intellectual laughter is often triggered by and associated with negative emotions.

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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.

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Is Laughter the Best Medicine?For generations Reader’s 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 we’re with.

Most people would struggle to fill their laughter prescription.

MORE PROBLEMS WITH HUMORThe 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.

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Can the owner get his staff to laugh together every day?

Probably not.

If we rely on jokes and comedy to trigger laughter, then laughter can’t be used as a medicine.

THE GOOD NEWSOur 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 they’re with close friends or under the influence of alcohol or drugs.

When last did you have a good laugh for no reason?

AEROBIC LAUGHTERIn 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.

IT’S NOT ROCKET SCIENCEOne 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.

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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 doesn’t 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 It’s interesting to understand how laughter creates joyfulness and positive affect using our body’s hardwired circuits.

When we see another person smile, our ‘mirror neurons’ automatically trigger a response smile.

Try smiling at people next time you’re at the mall.

Most will respond-smile right back at you. If they don’t, it means that they have suppressed their respond-smile.

If you watch carefully, you’ll spot a little twitch next to their eyes. That’s their smile muscles preparing to respond-smile before their brain overrides the smile.

When our face breaks into smile, our brain senses that we’re 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.

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Research from Oxford University shows that group exercise boosts happiness more - try to practice laughter in a group whenever possible.

DE-STRESS Laughter triggers the human de-stress response that’s 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,

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joyfulness, exercise, or triggering our de-stress response and homeostatic healing system?

Research will tell.

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 EXERCISELaughter provides a powerful no-impact cardio and aerobic workout that doesn’t 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 HAPPINESSLaugh 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).

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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.

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 HAPPINESSAerobic Laughter has helped many people to overcome chronic health problems. Science hasn’t 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.

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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.

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 HAPPINESSStress 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 body’s first line of defense against respiratory illness; increases levels of interferon-gamma that activates T cells, B

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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, 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 HAPPINESSAerobic 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,

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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 PERFORMANCEThe 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 HAPPINESSAerobic 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. 74


THE MORE WE LAUGH, THE MORE WE LAUGHPracticing 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’.

Don’t be surprised if you laugh more and more often after starting Aerobic Laughter practice.

THE GIFT OF HAPPINESSLaughter 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 ChildrenNatural 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.

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One of the most interesting results of learning Aerobic Laughter is how it changes our relationship with children.

GOGO, I DIDN’T 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 didn’t 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 couldn’t 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 moment’s silence he exclaimed, “Gogo, I didn’t know you could laugh!”

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, we’ve all been fluent in this joyful language. It’s 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.

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SURPRISE YOUR KIDS Children are so used to the fact that adults don’t speak natural laughter, they are amazed when they encounter adults who can speak it.

Imagine you’re travelling alone and find yourself in a remote village in Thailand, Greece or China where nobody speaks English. You find ways to manage, but it’s 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.

That’s 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.

Working as a HIV caregiver is extremely stressful. By the time they get home they’re often emotionally exhausted.

When the kids come running noisy and excited because mom’s home, they’re chased away with a typical adult response: “Can’t you see we’re talking!”, or simply “Be quiet! Go and play outside/in your room.”

In interviews they often confess that they’ve hardly spent time with their kids, sometimes for years. They’re so burnt out and exhausted when they get home, they often don’t 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.

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If she gets home tired and tries to be grumpy, the kids start the exercises and soon mom is howling in laughter with them.

We’ve 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.

It’s 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 How often do we tell kids to ‘stop laughing!’, or to ‘stop behaving like a child!’

This is a crime against humanity.

We shouldn’t 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 don’t need justification to laugh. They need a reason not to laugh.

Do kids laugh at jokes?

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Don’t be ridiculous, most can’t even tell a joke properly. They crack up before the punch line.

If kids tell adults a joke it’s not because they understand the joke — that part of their brain is not working yet. It’s 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. It’s 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.

BASELINE ASSESSMENT If we want to lose weight, we start by getting on a scale.

If we’re starting an Aerobic Laughter program, we recommend that we start by assessing our happiness.

We’ll provide questionnaires that measure our happiness and unhappiness to provide a baseline for later comparison.

When we repeat the measures later we’ll see our progress.

We can’t manage something if we don’t measure it.

EDUCATION79


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 LAUGHTraining is normally done in groups because it’s 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 LAUGHTERAfter 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 we’ll 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.

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LAUGHTER STRATEGIESDifferent 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 LAUGHTEROnce we’ve 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.

It’s hard for most adults to understand the joy and empowerment that comes with this skill.

DEVELOPING YOUR LAUGHTER SKILLS

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As we become more accomplished, we’ll 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 can’t 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.

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DEEP LAUGHTER THERAPYDeep 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 doesn’t 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 ProgramsJOYGYM 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

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This two-day course provides a foundation for developing Happiness Intelligence.

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 ADULTSYoung 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 COACHINGCancer 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.

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INDIVIDUAL COACHING AND THERAPY Private coaching and therapy is available by arrangement.

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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 PREGNANCYPregnancy 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 PRESCHOOLJOYGYM 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.

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The low-cost JOYGYM pre-school program can provide lifelong benefits.

JOYGYM FOR LONGEVITYIt'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 AdvantageIn today’s 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.

Today’s 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 HAPPINESSTwenty-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.

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British economist Andrew Oswald has shown that happy people are 25% more productive.

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.

COLLABORATIONThe 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 GOODBenefiting 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

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companies that don’t 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.

Employees that believe your organization is authentic and is a force for good will be proud, engaged and productive.

GIVING BACKInvesting 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 WORKPLACEIn 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.

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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.

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HAPPY CUSTOMERSIt’s 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 we’re on our way to success.

ENGAGED CUSTOMERSThe most successful companies move beyond customer happiness to customer engagement.

Treat customers as part of the team, ask them how you’re 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 ProgramsHappiness based organizational development programs can help you to change your corporate culture and develop the happiness advantage.

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JOYGYM evidence-based programs provide measurable results.

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MANAGEMENT DEVELOPMENTManagers 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.

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CALL CENTER AND CUSTOMER SATISFACTIONCall 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 can’t 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.

You’ll build loyalty and repeat business and get the happiness advantage.

HAPPINESS CONSULTING

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Developing happiness advantage to grab market share and build sustainable twenty-first century success requires strategic planning and careful measured implementation.

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 you’re ready to develop the happiness advantage we want to help build your success.

ACTIVE CORPORATE SOCIAL INVESTMENTThe 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.

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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.

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 children’s education and training.

Perhaps an orphan that you sponsor will one day become your company’s chief executive officer or the next president.

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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 SERVICEThere are many real advantages to giving time for nonprofit work.

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 we’re best at we can build happiness and well being while helping others.

BUILDING SKILLS AND CHARACTERWith 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 GOODHelping 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.

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Working with people less fortunate helps develop gratitude for what we have.

SOCIAL BENEFITSVolunteers 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!

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BUILDING EMPLOYABILITYVolunteer 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 BENEFITSA recent study found that volunteering promotes good health.

Volunteers live longer, have lower rates of depression and heart disease, and show higher functional ability.

UNEMPLOYMENTThe 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 YOUNGChildren are best introduced to volunteer work at an early age.

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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.

SENIORSPeople 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.

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Happiness VolunteersThe 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 CLUBSHappiness 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.

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Healing with HappinessHealing 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 program’s 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 EXPLOSIONBy 1990, there were approximately 8 million people diagnosed with HIV. By 2010 this number had exploded to about 33 million.

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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, 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 IMPACTHIV 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 can’t 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.

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The Caregiver ExplosionPalliative 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.

BOOMThe HIV and AIDS pandemic caused an explosion in the need for care services.

Existing palliative care services couldn’t 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.

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Today most HIV care giving is provided at the patient’s 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 SUPPORTCaring 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 FUNDINGThere 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 FOUNDToday new ways exist to provide psychosocial support on a wide

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scale, but there are no funds.

Caregivers want it, caregiver organizations want it. But there’s 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, 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.

Let’s look at some of the most common components and effects.

WHAT GOES UPCaregivers 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 DOWN109


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

Productivity

Satisfaction with life

Physical health

RISKS TO PHYSICAL HEALTHCaregiver Syndrome increases the risk of cancer, Alzheimer’s, depression, hypertension, diabetes, heart disease, arthritis and other serious medical problems.

A GLOBAL PROBLEMCaregiver 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 PROFESSIONALSCaregiving 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.

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SUPPORTCaregiver 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 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 EMOTIONSMost 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.

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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.

DEPRESSIONIncidence 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 to reduce immune function, speed disease progression and increase mortality in cancer, HIV and other diseases.

IMPACT ON TREATMENT AND CAREPatient 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 PATIENT’S NETWORKTherapy and treatment are provided for the patient, but what about the patient’s network?

The patient’s 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

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coping with the patient’s unhappiness and disrupted socialization.

In some cases they also provide caregiving service.

Problems can be especially daunting for the patient’s children and spouse.

Members of the patient’s network also have a strong need for psychosocial support.

PSYCHOSOCIAL SUPPORTPsychosocial 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 Here we address a crisis that could impact generations if left untreated.

ORPHANSImagine 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 CHILDRENChildren require safety for happy healthy development.

Families provide children with protection.

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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.

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EARLY TRAUMAMost 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 one’s life.

A CRISIS IN THE MAKINGIf 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 country’s 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.

PSYCHOSOCIAL SUPPORTChildren are naturally resilient and can heal quickly.

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Robust psychosocial support provided quickly and consistently can prevent and heal OVC Syndrome.

OVC Psychosocial support programs need to be funded and provided 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

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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 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.

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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.

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 couldn’t 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.

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The Case StudyDuring 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.

SHOWTIMEIn 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 program’s 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 CENTERA 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

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management programs, primarily for HIV and cancer patients

OVC CARE: An OVC Daycare Center for 52 HIV and AIDS infected and 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 program’s impact across a representative range of care services.

PRIMARY PARTICIPANTSThe 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 PARTICIPANTSThe 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

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Case Study: Roll OutAll 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 ASSESSMENTSStandard 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

AssessmentDates:

30 Oct2009

3 Dec2009

19 Jan

2010

10 Mar

2010

12 May2010

Intensive one-day training was provided on 17 November 2009.125


EXTENDED ASSESSMENTSExtended 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

AssessmentDates:

30 Oct2009

3 Dec2009

19 Jan

2010

10 Mar

2010

12 May2010

Notes on the Case Study SAMPLE SIZEWhile 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 QUESTIONNAIRESelf-report assessment results were obtained using JOYGYM Self-Report Questionnaires developed by InHappiness for this program.

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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 Intelligence) correlate with Self-Report Questionnaire results.

INFORMED CONSENTParticipants 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 FACTORSThe 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.

DISCUSSIONSome 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.

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ANALYSISThe 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 Happiness Coaching on each of the measured variables.

LANGUAGE AND STYLEThe 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 128


BASELINELevels 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.

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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 ASSESSMENTThe 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

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and significant decreases in unhappiness after two weeks and four months.

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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: INTERVIEWSParticipants 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.

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RESULTS: MANAGEMENT FEEDBACKAfter 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: DISCUSSIONParticipants 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 LAUGHTERHappiness 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 INTELLIGENCEAfter the dramatic increases in happiness seen at two weeks and two months, we believe that much of the continued increase can

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be attributed to the participants’ ongoing development and application of

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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

Emotional Intelligence

Work relationships

Home and family relationships

Mindfulness

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Adaptability

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 body’s 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.

BASELINESelf-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

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Frequent mood swings, anger and conflict

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. 137


Physical stress indicators reduced over the entire period, with major reductions after two weeks in all indicators except sleep problems which reduced sharply after two months.

RESULTS: PSYCHOMETRIC ASSESSMENTThe 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.

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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 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

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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, 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 INTERVIEWSEven 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: DISCUSSIONHealing 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 body’s stress response in real time

Dangerous levels of stress and depression were dramatically reduced.

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ANALYSIS: THE ROLE OF LAUGHTERWhile 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. 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.

ANALYSIS: THE ROLE OF HAPPINESS INTELLIGENCEHealing 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

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real time and to override the stress response.

The continued reductions in stress reflect participants’ ongoing progress in developing and exercising their Happiness Intelligence.

CopingCoping is the ability to withstand adverse events and stressful situations 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.

BASELINEStress 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.

RESULTS: EMOTIONAL INTELLIGENCE 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

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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.

RESULTS: MANAGEMENT INTERVIEWSInterviews 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: DISCUSSIONHWH 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.

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ANALYSIS: THE ROLE OF LAUGHTERThe 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.

ANALYSIS: THE ROLE OF HAPPINESS INTELLIGENCEMost of the improvement in coping ability is attributed to increased

ResilienceResilience 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.

BASELINEInitial 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 144


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 that before the HWH program they would have been ‘out of action’ for weeks.

RESULTS: MANAGEMENT INTERVIEWSManagement 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: DISCUSSIONSignificant 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.

ANALYSIS: THE ROLE OF LAUGHTERStress and adversity often result in powerful negative emotions. Aerobic Laughter provides tools that allow the cathartic release of negative emotions, thereby building resilience.

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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.

ANALYSIS: THE ROLE OF HAPPINESS INTELLIGENCEAs 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.

BurnoutBurnout 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,

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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.

BASELINEEvidence 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.

Further reductions in burnout and higher motivation were observed after two months. After four months no evidence of burnout was seen.

RESULTS: DISCUSSIONRapid 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.

ANALYSIS: THE ROLE OF LAUGHTERAerobic Laughter therapy acts to increase levels of energy and happiness and to reduce stress, thereby reducing burnout.

ANALYSIS: THE ROLE OF HAPPINESS INTELLIGENCEHappiness Intelligence further enables participants to increase happiness and reduce stress, thereby reducing burnout.

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Emotional IntelligenceEmotional Intelligence, also known as emotional quotient (EQ) is defined as a set of competencies that demonstrate a person’s 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.

High stress levels are associated with low EQ.

Emotional Intelligence can be taught and developed.

The authors agree with Reuven Bar-On’s view that Emotional Intelligence is an integral and important part of positive psychology.

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BASELINEA 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

RESULTS: EMOTIONAL INTELLIGENCE 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.

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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: DISCUSSIONSignificant increases in caregivers’ Emotional Intelligence were seen after two months, with further increases after six months.

ANALYSIS: THE ROLE OF LAUGHTERHigh stress levels are associated with low EQ.

Aerobic Laughter therapy acts to increase EQ by reducing stress.

ANALYSIS: THE ROLE OF HAPPINESS INTELLIGENCEEmotional 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

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will impact positively on the other.

Work RelationshipsWorking 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.

BASELINEParticipants’ 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 don’t want to work with ‘X’ anymore. She never returns my greetings. She doesn’t like me and I don’t like her. If she can’t be civil then I can’t and won’t 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

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feelings, feel good about 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 one’s perceived positive and negative aspects as well as one’s limitations and possibilities.

Emotional self-awareness EQ is the ability to recognize and understand one’s 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 one’s rights in a non-destructive way.

Independence EQ reflects the ability to be self-reliant and self-directed in one’s thinking and actions and to be free of emotional dependency.

Self-actualization EQ describes the ability to realize one’s 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

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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.

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 one’s 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.

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A significant increase in Interpersonal Intelligence was seen at 2 months with further increases at six months.

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: INTERVIEWSSignificant 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

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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.

RESULTS: MANAGEMENT INTERVIEWSManagement 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 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

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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.

ANALYSIS: THE ROLE OF LAUGHTERNatural 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.

ANALYSIS: THE ROLE OF HAPPINESS INTELLIGENCEAs 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 group’s assistance to quickly resolve conflicts and restore a positive and happy workplace atmosphere conducive to personal happiness.

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Home/Family RelationshipsHome and family problems have a significant impact on workplace productivity, and can be a leading driver of stress, presenteeism, and absenteeism.

BASELINEThe 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 children’s 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.


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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: INTERVIEWSAfter 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 day, with many practicing with

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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.

ANALYSIS: THE ROLE OF LAUGHTERAdults 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

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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.

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ANALYSIS: THE ROLE OF HAPPINESS INTELLIGENCEAs Happiness Intelligence increased participants were able to recognize 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.

MindfulnessMindfulness 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

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coping ability

Accepting our mistakes and weaknesses without reduced self-worth or self esteem

Increased stability during periods of change

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RESULTS: PSYCHOMETRIC ASSESSMENT 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: INTERVIEWSFindings 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

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very fast and lasting increase in mindfulness.

ANALYSIS: THE ROLE OF LAUGHTERMindfulness 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.

ANALYSIS: THE ROLE OF HAPPINESS INTELLIGENCEHealing with Happiness therapy emphasizes building specific aspects of mindfulness, especially emotional, stress and happiness mindfulness.

AdaptabilityThe ability to adapt to new and changing situations is important for workplace success.

BASELINEHigh stress had undermined this group’s 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.

RESULTS: EMOTIONAL INTELLIGENCE 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

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this composite scale identify those who are generally flexible, realistic, effective in understanding complex situations and competent at finding adequate solutions.

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 one’s 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.

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ANALYSIS: THE ROLE OF LAUGHTERStress, 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 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.

BASELINEParticipants 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.

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RESULTS: POSITIVITY RATIOPositivity 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 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 SCALEThe 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.

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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.

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.

ANALYSIS: THE ROLE OF LAUGHTERPracticing natural laughter provides powerful positive affect and acts to reduce negative affect.

Well-BeingA 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.168


Life satisfaction is seen as an accurate indicator of subjective well-being and happiness.

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RESULTS: PSYCHOMETRIC ASSESSMENTThe 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: INTERVIEWSFeedback 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: DISCUSSIONThe 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.

ANALYSIS: THE ROLE OF LAUGHTERAerobic Laughter practice triggers powerful feelings of joyfulness that act to increase happiness and subjective well being.

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ANALYSIS: THE ROLE OF HAPPINESS INTELLIGENCEHappiness Intelligence brings awareness of life’s meaning and purpose and helps to make life changes to increase this importance driver of happiness.

Physical HealthTo what extent does eliminating Caregivers Syndrome reflect in the physical health of the caregiver group?

BASELINEThe 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.

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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: INTERVIEWSAfter 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

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depression, high blood pressure, diabetes and asthma.

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.

ANALYSIS: THE ROLE OF LAUGHTERThe results confirm the impact of Aerobic Laughter therapy on physical health as discussed earlier in this book.

ANALYSIS: THE ROLE OF HAPPINESS INTELLIGENCEHappiness 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 ChangeAll 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

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Added self-confidence changes life completely

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 I’m a superwoman. No more

that sickly woman who got tired very easily, walking slowly like a donkey. Now I jump — I’m a grasshopper now, jumping and full of energy and happy!” Professional Nurse

“It’s wonderful. I’m turning 65 next month, and this is the first time I am able to accept my life as it is. That I’m also pretty, clever, good. I’m really very happy. Healing with Happiness has helped me to accept everything about my terrible past. I’m 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

“I’m 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’s such fun to be a child and be silly sometimes, it really makes a difference.” Nursing Director

“This therapy has changed my life. It’s 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 I’m angry I just laugh and feel released.” Assistant Teacher

“Healing with Happiness changed my life. I look and feel younger now. I’m active and happy. I don’t have a dull moment. It’s a good idea.” Professional Nurse

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Yes. HWH Heals CaregiversThe program effectively countered all indicators of Caregiver Syndrome.

Stress and depression Coping Resilience Burnout Emotional Intelligence Work relationships Home and family relationships Mindfulness Adaptability Positivity Well-being Life change Physical health

Healing with Happiness can eliminate Caregiver Syndrome.

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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:

Absenteeism and Presenteeism

Productivity

Quality of Care

Absenteeism and PresenteeismThe 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.

BASELINECaregivers 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

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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.

RESULTS: SELF-REPORT QUESTIONNAIRE Participants were asked to rate the number of days that they felt worried, sick, stressed and depressed.

The results show dramatic reductions in all indicators sick, stressed and depressed reveal dramatic reductions after just two weeks.

RESULTS: REDUCTIONS IN ABSENTEEISM

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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: INTERVIEWSParticipants 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 participant’s asthma was reported.

RESULTS: MANAGEMENT INTERVIEWSManagement 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.

ANALYSIS: THE ROLE OF LAUGHTERMassive 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.

ANALYSIS: THE ROLE OF HAPPINESS INTELLIGENCEThe impact of Happiness Intelligence is seen in the continued

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reduction in indicators of absenteeism and presenteeism over the six month period, particularly in feelings of depression.

ProductivityThe 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.

BASELINEAccording to management the productivity at baseline was ‘normal’ and seldom fluctuated.

RESULTS: PRODUCTIVITYThe 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.

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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: INTERVIEWSOne 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.

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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.

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.

Oswald’s findings that stress decreases productivity and happiness increases productivity are well demonstrated by these results.

Quality of CareThe 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.

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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.

BASELINEParticipants 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: INTERVIEWSA 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.

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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

Yes. HWH Improves CareThe program effectively countered all indicators of Caregiver Syndrome.

Absenteeism and Presenteeism

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.

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Healing PatientsThe 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 PATIENTSParticipants 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

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ACCEPTANCEBeing told that one has a life threatening illness like HIV causes untold 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. One’s mind is then open to acquiring new information, accepting and thereby managing that condition, and future planning.

RESULTS: SELF-REPORT QUESTIONNAIRE 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

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been caring for the same patients for extended periods, and other factors reported in interviews indicates that these ratings had some validity.

RESULTS: INTERVIEWSCaregivers reported that HWH therapy had a powerful positive impact on 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.

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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.

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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 PatientsThe 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.

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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 ChildrenHigh degrees of stress, trauma and depression at an early age can impact heavily on children’s future, with lifelong negative impact on their ability to enjoy a normal and successful childhood and adult life.

NATURAL LAUGHTERHappy 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 wouldn’t survive childhood in good physical and mental health.

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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 LAUGHTERMajor trauma and grief of the kind that orphans from AIDS experience can severely reduce, or in some cases terminate, a child’s 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

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achieve success, are prone to substance abuse and crime, are less healthy and live shorter lives.

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RESTORING NATURAL LAUGHTER AFTER TRAUMAThe results from this and other Healing with Happiness programs clearly demonstrate that the program is able to restore these children’s 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 ROLLOUTDaily 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.

BASELINEMany 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.

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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:

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

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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.

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 HEALTHCaregivers and management reported

Significant and continued reductions in the children’s 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: COPINGIt was clear that the children were coping much better in all areas.

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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.

RESULTS: SOCIALIZATIONInitial 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

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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.

Yes. HWH Helps Heal ChildrenThe 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“It’s 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 I’m talking to a patient I notice that they’re not really listening. I start laughing and that gets their attention

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— after that they lighten up and pay attention.” Professional Nurse

“In the past, after seeing so many patients I was tired. I didn’t 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. I’m eating well. My asthma is much better. I was feeling like an old person because of these illnesses. Now I’m 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 don’t 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

“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 I’m 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 that’s gone - it’s over. I’m 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 don’t suffer hypertension anymore.” OVC Center Manager

“I don’t 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 couldn’t understand it, so I went to the

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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

“I’m turning 65 next month, and this is the first time I am able to accept my life as it is. That I’m also pretty, clever, good. Laughter therapy has helped me to accept everything about my terrible past. I’m 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

“I’m 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. It’s 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 I’m angry I do the laughter chorus and feel released.” Assistant Teacher

“I look and feel younger now. I’m active and happy. I don’t have a dull moment. It’s a good idea.” Professional Nurse

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The Next StepsThe 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.

PROPAGATIONTo 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 HEALAs 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

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caregivers, patients and OVCs.”

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 HEALWe 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 HEALIn 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

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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.

Our goal is to sponsor Healing with Happiness for a million people during 2012.

With your help we can do it.

You Can HelpIf you bought a copy of this book you’ve 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.

Let’s look at a few before we finish.

SPREADING HAPPINESSBuilding your happiness is a great way to increase world happiness.

Build your Happiness Intelligence and your happiness will follow.

We’d 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

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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 — you’ll 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

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 — that’s 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. We’ll be happy to hear from you!

LICENSING HAPPINESSWe’re making the JOYGYM Happiness System available worldwide under license.

Licensing seems the best way to help as many people as possible to build Happiness Intelligence.

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 208


Healing with Happiness program.

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Thank youBefore we say good bye we’d 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 — we’d love to have you as a friend.

You can learn more about our projects and register for regular updates.

We really hope that: You’ve had as much fun reading as we’ve had writing this for

you

We’ve motivated you to start building your Happiness Intelligence

You’ll help us spread happiness to all corners of this wonderful world

In happiness,

Bill Gee, Malik Jaffer, and Memory Matanda

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REGISTER YOUR COPY ONLINERegister 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

It’s free, and we’d really like to get your feedback.

To register visit WWW.HAPPINESS-U.ORGand click REGISTER MY BOOK on the menu.

WE’RE LOOKING FORWARD TO HEARING FROM YOU!

Your special registration code is:

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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 JafferMalik 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 MatandaAn 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.

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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.

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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.

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A Note of thanks from Bill GeeI 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 O’Meara, 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,

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