Upswings in Cheerful Mood and Disease Activity in Patients with Rheumatoid Arthritis

Effect of Humor on Pain and Anxiety in Patients With Rheumatoid Arthritis: A Prospective, Randomized Controlled Study

Humor can contribute to nursing practices for relieving pain and anxiety in patients with rheumatoid arthritis (RA) during intravenous (IV) biologic treatment. This study used a prospective, randomized controlled study design to investigate the effect of humor on pain and state anxiety in patients with RA receiving IV infusion therapy. Two sample groups were formed: the intervention group (watching a comedy movie) (n = 18) and the control group (usual care) (n = 18). Both groups received IV biologic therapy. A significant difference was found between the groups' pain mean scores, but the effect size was small (P < .001, η² = 0.032). The mean visual analog scale scores decreased in both groups after the treatment; however, it decreased more in the intervention group (P < .001, Md = 2.44) than in the control group (P = .017, Md = 0.83). No significant difference was found between the groups' mean state anxiety scores, and the effect size was irrelevant (P > .05, η² = 0.001). There was a significant decrease in the anxiety levels of both groups (P < .001). During IV biologic infusion therapy, watching comedy movies is recommended as a nursing care intervention for reducing pain in patients with RA in cooperation with other health professionals.

The effect of flaxseed with or without anti-inflammatory diet in patients with rheumatoid arthritis, a randomized controlled trial

PURPOSE

Beneficial effect of long-chain ω-3 fatty acids against symptoms of rheumatoid arthritis (RA) has been indicated in previous studies. We examined the effect of flaxseed and anti-inflammatory diet in patients with RA.

METHODS

The 12-week intervention was performed on 120 patients with RA who were randomized to three groups of flaxseed (30 g/day) plus anti-inflammatory diet (AIF group), flaxseed (30 g/day) plus regular diet (RF group), and roasted wheat (30 g/day) plus regular diet (RW group). Disease Activity Score 28-joints (DAS28), health assessment questionnaire (HAQ) disability and pain, quality of life, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), rheumatoid factor, and anti-cyclic citrullinated peptides (anti-CCP) were measured before and after trial. Analysis was performed using per-protocol and intention-to-treat (ITT) approaches.

RESULTS

One hundred and two patients completed the protocol. Flaxseed decreased DAS28 in RF group compared to RW (- 0.87 ± 1.11 vs. - 0.24 ± 0.78; P = 0.014). Pain severity (P ≤ 0.001), morning stiffness (P < 0.05), and disease feeling (P < 0.01) decreased significantly in AIF and RF groups. HAQ disability and quality of life measurements improved in all 3 groups, with a greater extent in AIF and RF groups (P < 0.001) compared to RW. Between-group differences were significant for DAS28, pain scores, and physical and mental health variables. ESR, CRP, anti-CCP, and rheumatoid factor were not different between groups. Results of ITT analysis did not cause much difference.

CONCLUSIONS

In conclusion, flaxseed may be used as a helpful adjuvant therapy for patients with RA. Calls are open for examining the effect of anti-inflammatory diet on RA symptoms.

TRIAL REGISTRATION NUMBER

Registered at irct.ir as IRCT20190923044858N1, February 6, 2020.

The State-Trait Cheerfulness Inventory State Version-Short Form (STCI-S18): An Examination of Language Use and Psychometric Properties

The State-Trait Cheerfulness Inventory-State Version (STCI-S) measures three states of cheerfulness, seriousness, and bad mood as the temperamental basis of humor. The present study investigates (1) the development and psychometric validation of a newly developed short version and (2) test-criterion validity with state measures and language use. Study 1 (N = 933) confirmed the three-dimensional structure, and both the short and standard versions demonstrated strong psychometric properties. Study 2 (N = 617) replicated these findings in a separate sample. Study 3 (N = 750) demonstrated expected intercorrelations with self-report state measures (i.e., inspiration, self-esteem, depression, anxiety). Participants were randomized to expressive writing conditions (i.e., writing about a retrospective cheerful, serious, or bad mood scenario). Unacquainted judges' and participants' ratings of three states in their respective scenarios converged (.44 < r < .62). Retrospective states cheerfulness, seriousness, and bad mood were associated with linguistic categories (e.g., emotional tone, clout, achievement, insight) identified in the Linguistic Inquiry and Word Count (LIWC) software. The impact of personality states on word usage may only be evident in specific contexts and situations. Presence of distinctive language use in these writing samples further demonstrated test-criterion validity and practicality of the STCI-S18.

The Italian Version of the State-Trait Cheerfulness Inventory Trait Form: Psychometric Validation and Evaluation of Measurement Invariance

The State-Trait Cheerfulness Inventory–Trait Version (STCI-T60) measures the temperamental basis of sense of humor involving theoretically derived personality dispositions of cheerfulness, seriousness, and bad mood. The reliability and validity of the newly developed STCI-T60 Italian version were assessed in a sample of Italian speakers ( N = 683). Proper fit for a three-dimensional factor structure observed in previous studies was replicated and each factor demonstrated acceptable internal consistency and test–retest reliability. The associations between the STCI subscales and major personality dimensions, optimism, resilience, stress, and general well-being were further examined and results were in the expected directions (e.g., cheerfulness and bad mood being positively and negatively associated with well-being variables, respectively). Cross-cultural invariance examination was conducted to provide more validity data for the Italian STCI. Metric invariance was found between Italian and Canadian English speakers ( N = 632), but scalar invariance was not shown.

Poor control of interference from negative content hampers the effectiveness of humour as a source of positive emotional experiences

The brain-based ability to direct attention away from interfering negative information may co-determine to which degree one may benefit from humour as a source of positive emotional experiences. This should be particularly relevant when it comes to humour that implicates a target the joke makes fun of, which inherently entails rivalry between positive and negative emotional representations. One hundred healthy individuals completed a pictorial negative affective priming task and a nonverbal humour processing task. In line with the notion that during the elaborative processing of malicious jokes, interference from negative emotional representations hampers the experience of amusement, participants took more time to judge their amusement evoked by malicious compared to benign jokes. Lesser ability to distract attention from interfering negative emotional representations was associated with slower judgements of amusement following the processing of malicious jokes, as well as with lower amusement ratings. The time it took participants to comprehend the punch-lines was not affected, neither was the immediate, short-lived pleasure after having comprehended the humour, measured by characteristic transient cardiac activation. The findings suggest that the effective use of humour as a source of positive emotional experiences requires the ability to overcome the dark side of typical humour.

Assessing the Temperamental Basis of the Sense of Humor: Adaptation of the English Language Version of the State-Trait Cheerfulness Inventory Long and Standard Form

The State-Trait Model of Cheerfulness assesses the temperamental basis of the sense of humor with the traits and respective states of cheerfulness, seriousness, and bad mood. Cheerfulness is a dominant factor in current measures of the sense of humor and explains both, the disposition to engaging in smiling and laughter, as well as humor behaviors, and trait seriousness and bad mood are antagonistic to the elicitation of amusement (albeit for different reasons). Several studies have shown the validity and reliability of the STCI questionnaire in German and other language versions (i.e., Spanish). In this study, the English language version with 106 items (STCI-T <106>) was translated, checked for its item and scale characteristics, and tested with a confirmatory factor analysis approach (N = 1101) to investigate the factorial validity of the STCI-T <106> scale. Results show good psychometric characteristics, good internal consistencies, and a fit to the postulated underlying structure of the STCI-T. Then, the standard form with 60 items (STCI-T <60>) was developed and the psychometric characteristics initially tested. In an independent sample (N = 169), the characteristics of the standard form were compared to the parent form and German equivalent. It showed good psychometric characteristics, internal consistencies, as well as a good self- and peer-report congruence. To conclude, the STCI-T <106> is the measure of choice for the assessment of the temperamental basis of the sense of humor and the separate facets of the traits, while the standard form (60 items) allows of an economic assessment of cheerfulness, seriousness, and bad mood, free of context-saturated items and humor preferences.

Are You Ready to Have Fun? The Spanish State Form of the State-Trait-Cheerfulness Inventory

Although cheerfulness, seriousness, and bad mood as traits have been widely studied as the basis of sense of humor, data are scarce regarding the same dimensions as states. In this study, we adapted the state form of the State-Trait-Cheerfulness Inventory (STCI-S) into Spanish. At the same time, we empirically tested new predictions. We assessed 5 independent samples accounting for 1,029 participants (647 women) with ages ranging from 18 to 78 years. We confirmed the 3-dimensional structure as well as a strong measurement invariance between men and women. The internal consistency of the scale was satisfactory, the expected intercorrelations emerged, and the convergence between states and traits was corroborated. We also confirmed that the STCI-S's items were sensitive to affective changes in the environment. A longitudinal stability study of the state-trait dimensions using latent state-trait (LST) models revealed that all three trait measures capture mostly stable interindividual differences, with occasion-specific effects mainly in the state dimensions. Finally, we found that the STCI-S dimensions were related to state well-being. The results suggest that the STCI-S is a valid option for measuring the state basis of sense of humor in the Spanish population.

Trait Cheerfulness Does Not Influence Switching Costs But Modulates Preparation and Repetition Effects in a Task-Switching Paradigm

Many studies have shown the beneficial effect of positive emotions on various cognitive processes, such as creativity and cognitive flexibility. Cheerfulness, understood as an affective predisposition to sense of humor, has been associated with positive emotions. So far, however, no studies have shown the relevance of this dimension in cognitive flexibility processes. The aim of this research was to analyze the relationship between cheerfulness and these processes. To this end, we carried out two studies using a task-switching paradigm. Study 1 aimed at analyzing whether high trait cheerfulness was related to better cognitive flexibility (as measured by reduced task-switching costs), whereas Study 2 aimed at replicating the pattern of data observed in Study 1. The total sample was composed of 139 participants (of which 86 were women) selected according to their high versus low scores in trait cheerfulness. In a random way, participants had to judge whether the face presented to them in each trial was that of a man or a woman (gender recognition task) or whether it expressed anger or happiness (expressed emotion recognition task). We expected participants with high versus low trait cheerfulness to show a lower task-switching cost (i.e., higher cognitive flexibility). Results did not confirm this hypothesis. However, in both studies, participants with high versus low trait cheerfulness showed a higher facilitation effect when the stimuli attributes were repeated and also when a cue was presented anticipating the demand to perform. We discuss the relevance of these results for a better understanding of cheerfulness.