Implementation of a manual-based training of humor abilities in patients with depression: a pilot study

Do humour styles moderate the association between hopelessness and suicide ideation? A comparison of student and community samples

Research has found that humour styles can moderate the relationship between various facets of mental health and well-being. Most of these studies have used college student samples, however, and the generalizability of these findings has not been firmly established. This study examined how humour styles moderate the relationship between hopelessness and suicide ideation in both student and community samples. Community participants from the U.S. and Canada (n = 554) and student participants from a Canadian university (n = 208) completed several self-report measures including the Humor Styles Questionnaire. Analyses revealed differences in humour styles between the samples, as well as differences in humour styles between men and women. Regression analyses showed that self-defeating humour moderated the relationship between hopelessness and suicide ideation for student participants but not for community participants. Conversely, self-enhancing humour moderated the relationship between hopelessness and suicide ideation for community participants but not for student participants. These results suggest that high levels of self-defeating humour and self-enhancing humour may be uniquely maladaptive for these respective samples. These and other findings point to the necessity of recruiting diverse samples to better understand the beneficial and detrimental associations between humour styles and mental health. The potential to use measures of humour style as a tool to help identify at-risk individuals and to inform the development of intervention programs is discussed.

Corrigendum: "Beyond laughter": a systematic review to understand how interventions utilise comedy for individuals experiencing mental health problems

[This corrects the article DOI: 10.3389/fpsyg.2023.1161703.].

"Beyond laughter": a systematic review to understand how interventions utilise comedy for individuals experiencing mental health problems

Introduction

There is evidence for the impact of comedy and humour for mental health and wellbeing. Existing systematic reviews have concluded laughter has a positive impact on wellbeing, however other potential benefits of comedy interventions have remained under explored. The aim of the current study was to synthesise current evidence for comedy/humour interventions and evaluate mechanisms through which comedy interventions may impact upon the recovery of those experiencing psychological distress, using the Connectedness, Hope, Identity, Meaning and Purpose and Empowerment (CHIME) framework.

Methods

Five electronic databases were searched for studies exploring the impact of interventions using comedy on wellbeing and mental health recovery, from earliest record until January 2023. Grey literature was obtained via contacting experts in comedy interventions for mental health and supplemented by an internet search for comedy interventions. To be eligible for inclusion, studies had to include primary data, published in English or German, and explore a population of adults, with self-reported distress or a self-reported/diagnosed mental health condition. Studies included only explored interventions which utilised comedy as the main intervention and aimed to induce 'simulated' laughter, in response to a stimulus. 17 studies were included in the review.

Results

Studies were found to have positive impact on mental health symptoms and several mechanisms of the CHIME framework for recovery, including connectedness, hope, identity and empowerment. Potential theorised mechanisms for change included confidence in new skills, promotion of social skills, opportunities for social interaction, laughter, vulnerability, and cognitive flexibility. The current review found that comedy/humour interventions are beneficial for mental health recovery and wellbeing and found preliminary evidence for a range of mechanisms through which comedy may have positive impact.

Discussion

Further research should focus on qualitative exploration of the mechanisms by which comedy interventions may have impact on wellbeing and mental health recovery for specific populations and within different settings. It is concluded that there is a need for transdisciplinary collaboration in research on comedy interventions, which brings together the expertise of comedians delivering/developing interventions, those with lived experience of mental health issues and researchers from both health sciences and humanities disciplines.

Differential effects of stress-related and stress-unrelated humor in remitted depression

Enhancing emotion regulation among previously depressed people is crucial for improving their resilience and reducing relapse. Therefore, emphasis is placed on determining effective regulation strategies, particularly those that, besides down-regulating negative emotions, also up-regulate positive emotions. One promising strategy, with great potential in both these respects, is humor. It is unclear, however, what type of humor is most adaptive in remitted depression. This study compared two distinct humor-based strategies: stress-related humor and stress-unrelated humor. Outpatients with remitted depression (N = 94) participated in a randomized experiment evoking personal stress and the subsequent application of stress-related humor, stress-unrelated humor, or a non-humorous regulation. They repeatedly reported positive and negative emotions (at four time points) and experienced distress (at three time points). There were also assessments of selective attention, subsequent performance, effort, and intrusive thoughts. Unlike non-humorous regulation, humor-based strategies had adaptive consequences, both immediately and after a delay; however, stress-unrelated humor was most beneficial and was the only effective strategy when attention deficits were present. Humor, especially if unrelated to stressors, might broaden the repertoire of powerful emotion regulation strategies in remitted depression. Humorous focusing on distress can be detrimental for patients with attention impairment.

Clinical trial registration: The study was registered under the number ISRCTN86314628 (20/09/2021).

Humor interventions in psychotherapy and their effect on levels of depression and anxiety in adult clients, a systematic review

INTRODUCTION

Humor as a valuable construct in psychology has been the subject of much discussion for many years and has received increased attention more recently in the field of positive psychology. However, empirical research on the application of humor in a clinical setting with depressed or anxious clients has been difficult to discover. Because of the potential benefits and the low costs of providing humorous interventions, our goal was to give an overview of the studies conducted in psychotherapy and to show the effect of humor on the levels of depression and anxiety symptoms. Furthermore, we wanted to assess the empiric support of humor as a clinical intervention in psychotherapy according to the SIGN system.

METHODS

We used the PRISMA guidelines. Because of the differences in the design of the 10 included studies, it was not possible to perform a meta-analysis.

RESULTS

Results from studies performed in seven different countries show that humorous interventions can have significant positive effects on symptoms of depression and anxiety. The results also confirm the prior observation that empirical research in the field is based on different designs with different populations and different methods of translating the abstract concept of humor into measurable observations. The results need to be considered with caution because of the methodological limitations of the research to date.

DISCUSSION

Some authors advocate for an integrative approach to continue research on humor in psychotherapy. It is our recommendation to first focus on the separate aspects of humor and to conduct research based on sound methodology. To initiate wider research to the application of humor in psychotherapy, we propose an approach to humorous interventions based on surprise and confusion which can help clients to search for an alternative framework to resolve the confusion and therefore promote taking on new perspectives and distancing themselves from the actual problem.

Humour-based interventions for people with schizophrenia

BACKGROUND

Humour-based interventions are defined as any intervention that promotes health and wellness by stimulating a playful discovery, expression, or appreciation of the absurdity or incongruity of life's situations. Humour-based interventions can be implemented in different settings, including hospitals, nursing homes and day care centres. They have been posed as an adjunct to usual care for people with schizophrenia, but a summary of the evidence is lacking.

OBJECTIVES

To examine the effects of humour-based interventions as an add-on intervention to standard care for people with schizophrenia.

SEARCH METHODS

On 31 July 2019 and 10 February 2021 we searched the Cochrane Schizophrenia Group's study-based register of trials, which is based on CENTRAL, CINAHL, ClinicalTrials.Gov, Embase, ISRCTN, MEDLINE, PsycINFO, PubMed, and WHO ICTRP.

SELECTION CRITERIA

We included all randomised controlled trials comparing humour-based interventions with active controls, other psychological interventions, or standard care for people with schizophrenia. We excluded studies fulfilling our prespecified selection criteria but without useable data from further quantitative synthesis.

DATA COLLECTION AND ANALYSIS

Two review authors independently inspected citations, selected studies, extracted data and appraised study quality, following the guidance from the Cochrane Handbook for Systematic Reviews of Interventions. For binary outcomes we calculated risk ratios (RRs) and their 95% confidence intervals (CIs). For continuous outcomes we calculated the mean differences (MDs) and their 95% CIs. We assessed risks of bias for included studies and created summary of findings tables using the GRADE approach.

MAIN RESULTS

We included three studies in this review for qualitative synthesis, although one study did not report any relevant outcomes. We therefore include two studies (n = 96) in our quantitative synthesis. No data were available on the following prespecified primary outcomes: clinically-important change in general mental state, clinically-important change in negative symptoms, clinically-important change in overall quality of life, and adverse effects. As compared with active control, humour-based interventions may not improve the average endpoint score of a general mental state scale (Positive and Negative Syndrome Scale (PANSS) total score: MD -1.70, 95% CI -17.01 to 13.61; 1 study, 30 participants; very low certainty of evidence); positive symptoms (PANSS positive symptom score: MD 0.00, 95% CI -2.58 to 2.58; 1 study, 30 participants; low certainty of evidence), negative symptoms (PANSS negative symptom score: MD -0.70, 95% CI -4.22 to 2.82; 1 study, 30 participants; very low certainty of evidence) and anxiety (State-Trait Anxiety Inventory (STAI): MD -2.60, 95% CI -5.76 to 0.56; 1 study, 30 participants; low certainty of evidence). Due to the small sample size, we remain uncertain about the effect of humour-based interventions on leaving the study early as compared with active control (no event, 1 study, 30 participants; very low certainty of evidence). On the other hand, humour-based interventions may reduce depressive symptoms (Beck Depression Inventory (BDI): MD -6.20, 95% CI -12.08 to -0.32; 1 study, 30 participants; low certainty of evidence). Compared with standard care, humour-based interventions may not improve  depressive symptoms (BDI second edition: MD 0.80, 95% CI -2.64 to 4.24; 1 study, 59 participants; low certainty of evidence). We are uncertain about the effect of humour-based interventions on leaving the study early for any reason compared with standard care (risk ratio 0.38, 95% CI 0.08 to 1.80; 1 study, 66 participants; very low certainty of evidence).

AUTHORS' CONCLUSIONS

We are currently uncertain whether the evidence supports the use of humour-based interventions in people with schizophrenia. Future research with rigorous and transparent methodology investigating clinically important outcomes is warranted.

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.

Humor in Psychiatry: Lessons From Neuroscience, Psychopathology, and Treatment Research

Humor is a ubiquitous human characteristic that is socially motivated at its core and has a broad range of significant positive effects on emotional well-being and interpersonal relationships. Simultaneously, however, impairments in humor abilities have often been described in close association with the occurrence and course of neuropsychiatric disorders, such as schizophrenia, social anxiety, or depression. In the past decade, research in the neuroimaging and psychiatric domain has substantially progressed to (i) characterize impaired humor as an element of psychopathology, and (ii) shed light on the neurobiological mechanisms underlying the role of humor in neuropsychiatric diseases. However, (iii) targeted interventions using concepts of positive psychology have revealed first evidence that a systematic training and/or a potential reactivation of humor-related skills can improve rehabilitative outcome in neuropsychiatric patient groups. Here, we sought to integrate evidence from neuroscience, as well as from psychopathology and treatment research to shed more light on the role of humor in psychiatry. Based on these considerations, we provide directions for future research and application in mental health services, focusing on the question of how our scientific understanding of humor can provide the basis for psychological interventions that foster positive attitudes and well-being.

Eye tracking and attentional bias for depressive internet memes in depression

Previous research highlights the potential benefits of engaging with depressive internet memes for those experiencing symptoms of depression. This study aimed to determine whether: compared to non-depressed controls, individuals experiencing depressive symptoms were quicker to orient and maintain overall attention for internet memes depicting depressive content relative to neutral memes. N = 21 individuals were grouped based on the severity of reported depression symptoms using the PhQ-9. Specifically, a score of:  ≤ 4 denoted the control group; and  ≥ 15 the depressive symptoms group. Participants viewed a series of meme pairs depicting depressive and neutral memes for periods of 4000 ms. Data for the first fixation onset and duration, total fixation count and total fixation and gaze duration of eye-movements were recorded. A significant group x meme-type interaction indicated that participants with depressive symptoms displayed significantly more fixations on depressive rather than neutral memes. These outcomes provide suggestive evidence for the notion that depressive symptoms are associated with an attentional bias towards socio-emotionally salient stimuli.

Don't worry, be happy: Protective factors to buffer against distress associated with psychotic experiences

BACKGROUND

Around 6-7% of the general population report psychotic experiences (PEs). Positive PEs (e.g. hearing voices) may increase the risk of development of psychotic disorder. An important predictor of the transition to a psychotic disorder is secondary distress associated with PEs. We examined the moderating effect of potential protective factors on this secondary distress.

METHODS

Data come from 2870 individuals of the HowNutsAreTheDutch study. PEs were assessed with the Community Assessment of Psychic Experience (CAPE) questionnaire and were divided into three subdomains ("Bizarre experiences", "Delusional ideations", and "Perceptual anomalies"). Protective factors explored were having a partner, having a pet, benevolent types of humor, optimism and the high levels of personality traits emotional stability (reversed neuroticism), extraversion, openness to experience, conscientiousness, and agreeableness. We examined whether these protective factors moderated (lowered) the association between frequency of PEs and PE-associated distress.

RESULTS

Due to low prevalence of perceptual anomalies in the sample, this domain was excluded from analysis. No moderating effects were observed of protective factors on the association between bizarre experiences and distress. Having a partner and high levels of optimism, self-enhancing humor, openness, extraversion and emotional stability moderated the association between delusional ideations and secondary distress, leading to lower levels of distress.

CONCLUSIONS

Several protective factors were found to moderate the association between frequency and secondary distress of delusional ideations, with high levels of the protective factors being associated with lower levels of distress. A focus on protective factors could be relevant for interventions and prevention strategies regarding psychotic phenomena.

Development and Linguistic Cue Analysis of the State-Trait Cheerfulness Inventory-Short Form

The present study derived a short form of the State-Trait Cheerfulness Inventory-Trait Version (STCI-T30) using an item response theory framework. Latent trait test-retest correlations and reliability across the latent continuum in the STCI-T30 remained high. Moreover, the STCI-T30 showed external validity with criterion variables (e.g., playfulness) and a short writing task completed by these participants was rated by unacquainted judges to infer the author's cheerfulness, seriousness, and bad-mood. Results suggested significant self-other and inter-judge agreement of cheerfulness, seriousness, and bad-mood and linguistic cues analysis suggested cheerfulness and bad-mood manifested through writing in tone, social processes, and affect.

Covid-19 Outbreak In Italy: Are We Ready for the Psychosocial and the Economic Crisis? Baseline Findings From the PsyCovid Study

The Covid-19 pandemic is burning all over the world. National healthcare systems are facing the contagion with incredible strength, but concern regarding the psychosocial and economic effects is growing quickly. The PsyCovid Study assessed the influence of psychosocial variables on individual differences from the perceived impact of the Covid-19 outbreak on the issues of health and economy in the Italian population. Italian volunteers from different regions completed an online anonymous survey. The main outcomes were the perceived impact of the Covid-19 outbreak on health and the economy. A two-way MANOVA evaluated differences in the main outcomes, with geographical area (northern, central, and southern regions) and professional status (healthcare workers or not) as factors. We then tested the relationship linking psychosocial variables (i.e. perceived distress and social isolation, empathy, and coping style) to the main outcomes through two different mediation models. 1163 responders completed the survey (835 females; mean age: 42 ± 13.5 y.o.; age range: 18-81 y.o.) between March 14 and 21, 2020. Healthcare workers and people living in northern Italy reported a significantly worse outbreak impact on health, but not on the economy. In the whole sample, distress and loneliness were key variables influencing the perceived impact of the Covid-19 outbreak on health, while empathy and coping style affected the perceived impact on the economy. The Covid-19 pandemic is a worldwide emergency in terms of psychological, social, and economic consequences. Our data suggests that in the Italian population, actual differences in individual perception of the Covid-19 outbreak severity for health are dramatically modulated by psychosocial frailty (i.e., distress and loneliness). At the same time, problem-oriented coping strategies and enhanced empathic abilities increase people's awareness of the severity of the impact of the Covid-19 emergency on economics. There is an immediate need for consensus guidelines and healthcare policies to support interventions aimed to manage psychosocial distress and increase population resilience towards the imminent crisis.

Diabetes and Humor: A Preliminary Investigation

Diabetes can take a tremendous toll on physical and psychological health. Given the growing evidence of the benefits of humor, this study examined the association between diabetes and humor. The sample consisted of 249 participants: 72.3% with type 1 diabetes, 70.3% female, 89.5% Caucasian, and 70.9% college educated. Participants completed the Humor Styles Questionnaire (HSQ) and were compared with HSQ norms. On the affiliative humor scale, the diabetes group did not differ from the norm (P >0.05), nor did those with type 1 diabetes (P >0.05). Scores of those with type 2 diabetes were lower than the norm (P <0.05). On the self-enhancing humor scale, the diabetes group did not differ from the norm (P >0.05), nor did the subgroups with type 1 diabetes (P >0.05) or type 2 diabetes (P >0.05). The diabetes group was lower than the norm on aggressive humor (P <0.01), as were the subgroups with type 1 diabetes (P <0.01) and type 2 diabetes (P <0.05). The diabetes group was higher than the norm on self-defeating humor (P <0.01), as were the subgroups with type 1 diabetes (P <0.01) and type 2 diabetes (P <0.01). Results suggest that people with either type of diabetes are more inclined toward self-enhancing humor, are less inclined toward aggressive humor, and score higher on self-defeating humor, and those with type 1 diabetes are also inclined toward affiliative humor. Results are discussed relative to the sample being comprised of individuals with good glycemic control (mean A1C 7.06 ± 1.39%). This study offers a preliminary comparison of humor among people with diabetes versus those in a healthy norm group without diabetes.

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.

[Effect of humor training on stress, cheerfulness and depression in patients with coronary artery disease and refractory angina pectoris]

BACKGROUND

Angina pectoris refractory to conventional medical treatment is a common phenomenon in patients with stable coronary artery disease (CAD). Many of these patients suffer from depression and generate substantial costs in the healthcare system. Therefore, the development of new therapeutic concepts is of particular importance. This study investigated whether professional, structured humor training has a positive effect on the symptoms of patients with treatment refractory angina pectoris.

METHODS

Between 2013 and 2014 a total of 35 patients with stable CAD were included. Enrolment was possible if patients suffered from treatment refractory angina pectoris (Canadian Cardiovascular Society, CCS grades II-IV) despite optimal antianginal medication and exhaustion of options for myocardial revascularization. Previously, 25.8% of the patients had had a myocardial infarction. In this study, a professional humor coaching was conducted with a duration of 7 weeks. In order to evaluate the effects of the coaching, the following examinations were performed before and after the intervention: exercise stress test (treadmill), hair segment cortisol analysis, Beck Depression Inventory (BDI), the Trier Inventory for the Assessment of Chronic Stress (TICS) and the State-Trait-Cheerfulness Inventory (STCI).

RESULTS

Out of the 35 initially recruited patients 31 completed the study. The mean age was 65.5 years and 94.5% were female. There was a significant improvement in cheerfulness (STCI, pre 23.3 ± 5.4, post 27.5 ± 5, p = 0,03). This effect was even stronger in a subgroup analysis in which only female patients were included (pre 23.6 ± 5.5, post 27.7 ± 4.6, p = 0.003). The results of the BDI showed a remarkable improvement in the pre-post analysis (pre 14.6 ± 8.1, post 11.0 ± 6.5, p = 0.064). Analyzing only the female patients, this difference became significant (pre 13.1 ± 6.4, post 9.9 ± 4.6 p = 0,037). The hair segment investigations showed that patients who had a higher cortisol level in the beginning (>25. percentile, n = 22) showed a significant reduction of the cortisol concentration (pre 6.54 pg/mg, 3.78-12.12 pg/mg, post 3.65 pg/mg, 2.82-7.68 pg/mg, p = 0.029).

CONCLUSION

Patients with refractory angina pectoris and stable CAD benefit from a professional humor coaching. This effect was shown in a) a significant decrease in cortisol concentrations in the hair segment analysis, b) an improvement in cheerfulness in the STCI and c) a significant difference in the BDI between pre-post values.

The effect of exposure to parodies of thin-ideal images on young women's body image and mood

Although social networking services typically promote the thin beauty ideal for women, they also provide an opportunity for users to challenge this dominant ideal in unique and novel ways. This study aimed to experimentally investigate the influence of exposure to humorous, parody images of thin-ideal celebrity Instagram posts on women's body satisfaction and mood compared to exposure to thin-ideal celebrity posts alone. Participants were 102 women aged 18-30 years who were randomly allocated to view either a set of Instagram images of thin-ideal celebrity posts or humorous parody images of the same celebrity posts. Results indicated that acute exposure to parody images led to increased body satisfaction and positive mood (happiness) compared to exposure to the thin-ideal celebrity images alone. No group differences were found on levels of trait appearance comparison or social media literacy, and the findings were not moderated by trait levels of thin-ideal internalisation. The findings provide preliminary support for the use of humorous, parody images for improving body satisfaction and positive mood in young women and add to the small but growing body of research highlighting potentially positive effects of social media.

Humor creation during efforts to find humorous cognitive reappraisals of threatening situations

This interdisciplinary study examined the structure of humor creation in the specific context of efforts to positively reappraise stressful situations for effective coping. In a sample of n = 101 participants, a performance test was used to assess the quantity (fluency, number of generated ideas that qualified as humor) and quality (rated funniness) of humor creation in cognitive reappraisal. Linguistic mechanisms were identified and quantified using cognitive-linguistic methods of corpus analysis, and their employment was correlated with humor production performance on the level of the individual. Almost all individuals were able to come up with reappraisal ideas that qualified as humorous. Depressive symptoms, a negative mood state, and high perceptions of threat did not compromise the participants' capability to create humor. Individuals who were more serious-minded as a trait produced ideas that were rated as less funny, but their basic ability to create humor was unaffected. Metonymy (a contiguity-based principle of meaning extension) emerged as by far the most prominent semantic mechanism in the creation of humorous re-interpretations. Furthermore, its use was related to good humor creation performance in terms of quantity and quality, which is in line with its assumed importance in the extension of meaning in general and the creation of humor in particular. Further effective linguistic mechanisms and conceptual phenomena were identified. The empirical data may be valuable for the development of interventions involving the creation of humorous ideas for cognitive reappraisal.

Efficacy and feasibility of a humor training for people suffering from depression, anxiety, and adjustment disorder: a randomized controlled trial

BACKGROUND

Humor trainings have positive effects on mental health and well-being. However, studies investigating the effects of humor trainings in clinical samples are still rare. This study investigated the efficacy and feasibility of a humor training for people suffering from depression, anxiety and adjustment disorders.

METHODS

Based on a diagnostic interview (SCID I and II), 37 people were randomized into a training (n = 19) or wait list control group (n = 18) and completed questionnaires at pre, post, and 1 month follow-up. After the training group had completed its training and evaluation measures, the wait list control group received the training and the outcomes of the group were additionally evaluated (post2 and follow-up2).

RESULTS

After training, improvements in humor-related outcomes were observed for the training group, but these were relativized when compared to the wait list control group. Secondary outcomes remained unaffected by the training. In addition, the training group reported interpersonal difficulties. Within-group analyses of the wait list control group after completion of their training showed effects on almost all primary and secondary outcomes and feedback indicated a better atmosphere.

CONCLUSIONS

In summary, the different outcomes of the two groups are surprising and can show potential moderators of efficacy, such as interpersonal and group-specific climate variables. Since moderators of humor trainings in clinical samples have not been investigated at all, future studies should consider integrating them into their design.

TRIAL REGISTRATION

The study was retrospectively registered in the German Clinical Trials Register ( DRKS00012443 ) on May 16, 2017.

[Psychometric evidence of a brief version of the Coping Humor Scale in elderly peruvians]

INTRODUCTION

Humour plays an important role in promoting successful and healthy aging. However, its scientific study is still limited, partly due to the absence of validated tools for use in Latin America. The objective of this study was to translate the 5-item Coping with Humor Scale (CHS-5) from English to Spanish and examine the evidence of reliability and validity based on the internal, convergent, and discriminant structure of the Peruvian version of the scale.

MATERIALS AND METHOD

The participants were 236 elderly Peruvian adults (78.4% A confirmatory factor analysis, analysis of correlation (r), and reliability (α, Cronbach's alpha and ω, omega) was performed.

RESULTS

The one-dimensional model presented an adequate fit of the data (χ² = 7.72, df =5, P=.17, χ² / df = 1.54, GFI = 0.988, CFI = 0.996, NFI = 0.988, RMSEA =0. 048 [95% CI; 0.000-0.111]; and SRMR = 0.016). The reliability indexes were adequate (α= 0.86 [95% CI: 0.82-0.89] and ω = 0.89 [95% CI: 0.87-0.91]). A positive correlation was observed between the mean score of CHS-5 and satisfaction with life, and was negative with depression.

CONCLUSIONS

The CHS-5 has excellent psychometric properties, being a measure that provides valid and reliable interpretations to be used in elderly Peruvians with depression.

Is it worth turning a trigger into a joke? Humor as an emotion regulation strategy in remitted depression

AIM

Humor has long been considered as an effective emotion regulation strategy for people vulnerable to depression, but empirical evidence in this area is scarce. To address this issue, we investigated the emotional consequences of humor in remitted depressed patients and compared them with the effects of positive reappraisal and spontaneous emotion regulation.

METHODS

Fifty-five patients with remitted major depression took part in a laboratory computer experiment in which they were shown negative pictures twice. First, the patients simply viewed the pictures and rated their reactions. Second, they viewed each of the pictures according to instructions, which are to (a) use humor, (b) use positive reappraisal, or (c) simply view the pictures, and then, they again rated their reactions.

RESULTS

Humor was found to decrease negative emotions, increase positive emotions, and enhance the distance from adversity; it was more effective than spontaneous emotion regulation and similarly as effective as positive reappraisal. Humor was the most effortful form of emotion regulation. Patients were able to successfully produce humorous comments, and their failure to do so did not lead to worse emotional outcomes than regulating emotions spontaneously. The analyses also indicated that distancing mediates between using humor and the intensity of positive and negative emotions.

CONCLUSIONS

Our findings provide preliminary empirical support for the idea that for individuals vulnerable to depression, humor can be an adaptive tool in dealing with negative responses to aversive events, and, thus, it may impair their potential of these events to trigger depressive episodes. Further studies in this area are warranted to determine the most adaptive forms of humor and analyze their effects in various depressogenic contexts.

Frontal hypoactivation and alterations in the reward-system during humor processing in patients with schizophrenia spectrum disorders

Humor is a ubiquitous human ability with important implications for both social and emotional functioning. Patients with neuropsychiatric disorders, such as schizophrenia, experience difficulties in the comprehension and appreciation of humor. However, the specific neural mechanisms underlying these deficits are unknown. In the current study, we sought to elucidate the neural correlates of humor processing in patients with schizophrenia spectrum disorders (SSD). Functional Magnetic Resonance Imaging (fMRI) was used in thirty-one patients with SSD and a control group, performing a humor processing paradigm. Both regional brain activation and parametric modulation of brain responses via subjective funniness ratings were collected during the scanning procedure. On a neural level, large overlaps in fronto-temporal brain activation was found in both groups. However, patients compared to healthy control subjects showed attenuated responses in frontal brain regions, including the anterior cingulate cortex, medial prefrontal cortex (mPFC), superior frontal gyrus and middle frontal gyrus, as well as in the striatum (i.e. caudate nucleus, putamen). Furthermore, parametric modulation of subjective funniness ratings resulted in attenuated responses in the mPFC, bilateral insula, and left hippocampus. Analysis of functional connectivity revealed alterations in mPFC-caudate nucleus coupling in patients with SSD, which might reflect impairments in reward-related processing. Notably, alterations in mPFC-caudate nucleus coupling in patients were significantly associated to subjective funniness ratings. Our results extend previous findings demonstrating the relevance of frontal hypoactivation for humor processing impairments in patients with SSD and first point towards alterations in humor appreciation processes.

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.

The effects of group-based Laughter Yoga interventions on mental health in adults: A systematic review

WHAT IS KNOWN ON THE SUBJECT?: Laughter yoga is claimed to promote mental health and has become increasingly popular worldwide. There has been no systematic review of laughter yoga intervention studies and thus evidence of its effects on mental health is unclear. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: Laughter Yoga interventions improved depressive symptoms in two studies over the short term. There is a lack of good quality evidence to show that laughter yoga is more effective than other group-based interventions in improving mental health. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Well-conducted and clearly reported trials of laughter yoga are needed before the intervention can be considered as an evidence-based intervention to improve mental health.

ABSTRACT

Introduction Laughter Yoga is claimed to promote mental health and is increasingly popular worldwide. Despite its popularity, there has been no systematic review of Laughter Yoga intervention studies and thus evidence of its effects on mental health is unclear. Aim This review aimed to critically evaluate the effects of group-based Laughter Yoga on improving mental health in adults. Method We conducted a systematic review of experimental studies (published from 1995 to 2017). Study quality was assessed, the effect sizes for individual mental health outcomes were calculated and all reviewed studies were narratively synthesized. Results Six experimental studies with inconsistent results were included in this review. The most promising effect of Laughter Yoga is the improvement of depressive symptoms, indicating significant medium-large effect sizes in two studies over the short term. The overall level of evidence was weak due to poor study quality and risks of bias. Discussion Laughter Yoga shows potential, but currently there is insufficient evidence to support its effectiveness in improving mental health when compared to other group-based interventions. Implications for practice This review highlights the need to conduct rigorous trials of laughter yoga before the intervention can be considered as an evidence-based intervention to improve mental health.

Who Benefits From Humor-Based Positive Psychology Interventions? The Moderating Effects of Personality Traits and Sense of Humor

The evidence for the effectiveness of humor-based positive psychology interventions (PPIs; i.e., interventions aimed at enhancing happiness and lowering depressive symptoms) is steadily increasing. However, little is known about who benefits most from them. We aim at narrowing this gap by examining whether personality traits and sense of humor moderate the long-term effects of humor-based interventions on happiness and depressive symptoms. We conducted two placebo-controlled online-intervention studies testing for moderation effects. In Study 1 (N = 104) we tested for moderation effects of basic personality traits (i.e., psychoticism, extraversion, and neuroticism) in the three funny things intervention, a humor-based PPI. In Study 2 (N = 632) we tested for moderation effects of the sense of humor in five different humor-based interventions. Happiness and depressive symptoms were assessed before and after the intervention, as well as after 1, 3, and 6 months. In Study 2, we assessed sense of humor before and 1 month after the intervention to investigate if changes in sense of humor go along with changes in happiness and depressive symptoms. We found moderating effects only for extraversion. Extraverts benefitted more from the three funny things intervention than introverts. For neuroticism and psychoticism no moderation effects were found. For sense of humor, no moderating effects were found for the effectiveness of the five humor-based interventions tested in Study 2. However, changes in sense of humor from pretest to the 1-month follow-up predicted changes in happiness and depressive symptoms. Taking a closer look, the playful attitude- and sense of humor-subscales predicted changes in happiness and depression for up to 6 months. Overall, moderating effects for personality (i.e., extraversion) were found, but none for sense of humor at baseline. However, increases in sense of humor during and after the intervention were associated with the interventions' effectiveness. Thus, we found humor-based interventions to be equally suited for humorous and non-humorous people, but increases in the sense of humor during the intervention phase could serve as an indicator whether it is worth continuing the intervention in the long-term.

Training the sense of humor with the 7 Humor Habits Program and satisfaction with life

The current study tested the 7 Humor Habits Program after McGhee (1996, Health, healing, and the amuse system (2. edition): Humor as survival training. Dubuque, IA: Kendall/Hunt Publishing; 2010, Humor as survival training for a stressed-out world: The 7 Humor Habits Program. Bloomington, IN: Author House) in two groups receiving the eight-week training (group sessions; one group additionally completing “Home Play” exercises and one group without Home Play) compared to two control groups (a placebo humor group and a waiting control group). The total sample of 110 adults completed measures on the sense of humor, the temperamental basis of the sense of humor, and life satisfaction at three time points: directly before and after the training time, as well as at a two-month follow up. Additionally, peer-ratings on the sense of humor were collected. At each session, the humor-related mood (state cheerfulness, seriousness, and bad mood) was assessed before and after the session. Results show that the sense of humor is malleable, noticeable to the trained individuals as well as to peers (but not in the placebo humor group). The sessions increased cheerful mood and decreased seriousness. Life satisfaction generally increased from the pre-training phase to the post-training phase. To conclude, humor can be trained but more work on consolidation strategies are needed in future studies and intervention designs.

Feasibility of a Humor Training to Promote Humor and Decrease Stress in a Subclinical Sample: A Single-Arm Pilot Study

The present study investigates the feasibility of a humor training for a subclinical sample suffering from increased stress, depressiveness, or anxiety. Based on diagnostic interviews, 35 people were invited to participate in a 7-week humor training. Evaluation measures were filled in prior training, after training, and at a 1-month follow-up including humor related outcomes (coping humor and cheerfulness) and mental health-related outcomes (perceived stress, depressiveness, anxiety, and well-being). Outcomes were analyzed using repeated-measures ANOVAs. Within-group comparisons of intention-to-treat analysis showed main effects of time with large effect sizes on all outcomes. Post hoc tests showed medium to large effect sizes on all outcomes from pre to post and results remained stable until follow-up. Satisfaction with the training was high, attrition rate low (17.1%), and participants would highly recommend the training. Summarizing the results, the pilot study showed promising effects for people suffering from subclinical symptoms. All outcomes were positively influenced and showed stability over time. Humor trainings could be integrated more into mental health care as an innovative program to reduce stress whilst promoting also positive emotions. However, as this study was a single-arm pilot study, further research (including also randomized controlled trials) is still needed to evaluate the effects more profoundly.

Laughter therapy as an intervention to promote psychological well-being of volunteer community care workers working with HIV-affected families

The study explores the experiences of volunteer community care workers working with HIV-affected families, participating in laughter therapy. Laughter therapy is being used as an intervention to positively influence individuals experiencing various forms of emotional distress. Community care workers play a vital role in the support of the HIV/AIDS-infected and -affected members in communities. The nature of this type of work and their limited training contributes to high levels of secondary trauma and emotional exhaustion. The purpose of the study was firstly, to explore the effects of working with orphans and vulnerable children (OVC) on the community care workers and secondly, to establish the impact that laughter therapy has to positively combat stresses of working within the care workers' environment. All the community care workers from a community-based organisation that provides care for HIV/AIDS-infected and -affected OVC and their families in the greater region of Soweto, South Africa, took part in daily laughter therapy sessions for one month. To assess the experiences of participants of laughter therapy, seven community care workers agreed to participate in a mixed method assessment. Interviews were conducted before and after the intervention using the Interpretative Phenomenological Analysis as framework. As supportive data, a stress and anxiety and depression scale were added in the interview. Participants reported more positive emotions, positive coping, improved interpersonal relationships and improvement in their care work after exposure to laughter therapy. Quantitative results on stress, anxiety and depression for each participant confirmed observed changes. Laughter therapy as a self-care technique has potential as a low-cost intervention strategy to reduce stress and counteract negative emotions among people working in highly emotional environments.

Effectiveness of humor training among adolescents with autism

Humor training has been applied to educational and clinical cases and has been found to be effective, but humor training for individuals with autism is relatively rare. The present study proposed a humor-knowledge and humor-skill training workshop to enhance the humor comprehension and appreciation of individuals with autism and examined the effects of the training. Participants were 20 adolescents with autism and average intelligence (above 70 in WAIS-III). They were randomly divided into experimental and control groups. Both questionnaire of joke comprehension and appreciation and a humor style questionnaire were used as instruments. The results supported the effectiveness of the 15-h training. The comprehension and appreciation of nonsense humor were significantly increased in the experimental group in comparison with the control group, although the incongruity-resolution jokes remained difficult to comprehend. The tendency to use affiliative humor was greater among individuals with autism in the experimental group, suggesting that the appreciation of humor can be learned.

Three Decades Investigating Humor and Laughter: An Interview With Professor Rod Martin

Since the start of the 21st century, the investigation of various psychological aspects of humor and laughter has become an increasingly prominent topic of research. This growth can be attributed, in no small part, to the pioneering and creative work on humor and laughter conducted by Professor Rod Martin. Dr. Martin’s research interests in humor and laughter began in the early 1980s and continued throughout his 32 year long career as a professor of clinical psychology at the University of Western Ontario. During this time, Dr. Martin published numerous scholarly articles, chapters, and books on psychological aspects of humor and laughter. Professor Martin has just retired in July 2016, and in the present interview he recounts a number of research highlights of his illustrious career. Dr. Martin’s earliest influential work, conducted while he was still in graduate school, stemmed from an individual difference perspective that focused on the beneficial effects of sense of humor on psychological well-being. This research focus remained evident in many of Professor Martin’s subsequent investigations, but became increasingly refined as he developed several measures of different components of sense of humor, including both adaptive and maladaptive humor styles. In this interview, Dr. Martin describes the conceptualization, development and use of the Humor Styles Questionnaire, along with suggestions for future research and development. In doing so, he also discusses the three main components of humor (i.e., cognitive, emotional and interpersonal), as well as the distinctions and similarities between humor and laughter. Further highlights of this interview include Professor Martin’s comments on such diverse issues as the genetic versus environmental loadings for sense of humor, the multifaceted nature of the construct of humor, and the possible limitations of teaching individuals to use humor in a beneficial manner to cope with stress and enhance their social and interpersonal relationships.

Effectiveness of humor intervention for patients with schizophrenia: a randomized controlled trial

OBJECTIVE

The primary aim of this pilot study was to evaluate the possible therapeutic effects of a 10-session humor intervention program in improving rehabilitative outcomes and the effects of the intervention on patients' sense of humor among patients with schizophrenia.

METHOD

Thirty subjects were randomly assigned into either the intervention (humor skill training) group (n = 15) or the control (doing handwork) group (n = 15). The results were analyzed using descriptive statistics, t-tests and ANOVA.

FINDINGS

Repeated measures analysis of variance (ANOVA) tests were conducted to examine the differences across conditions and time. A group by time interaction effect was observed on all of the outcomes, except positive symptoms of PANSS. The time main effect was also significant on the total score (p < 0.005) and the negative symptoms score (p < 0.001) of the PANSS.

CONCLUSIONS

The implementation of humor skill training in a mental health service can improve rehabilitative outcomes and sense of humor for schizophrenia patients who were in the rehabilitation stage.

The Humor Styles Questionnaire in Italy: Psychometric Properties and Relationships With Psychological Well-Being

This study investigated the psychometric properties of the Humor Styles Questionnaire (HSQ) and the relation between humor and psychological well-being within the context of Italy. A total of 293 (178 females, 115 males) Italian high school and undergraduate university students – whose ages ranged from 14 to 25 years – completed the Italian versions of the HSQ and the Ryff’s Psychological Well-Being scales (RPWB). The HSQ scale reliabilities were generally acceptable, and intercorrelations among the scales were rather low; the confirmatory factor analysis supported the four-factor structure. Males reported significantly more use of Aggressive humor than did females; no differences were found between adolescents and young adults in the use of humor styles. Affiliative and Self-enhancing humor styles were positively associated with the six dimensions of the RPWB, whereas Self-defeating humor was negatively correlated with the RPWB scales. SEM analysis showed a significant and positive relationship between humor as measured by the HSQ and psychological well-being as assessed by the RPWB. Overall, the findings supported the theoretical structure and usefulness of the HSQ in an Italian context and the differential role of humor components in the various dimensions of psychological well-being.

Sense of Humor, Stable Affect, and Psychological Well-Being

A good sense of humor has been implicated as a quality that could contribute to psychological well-being. The mechanisms through which sense of humor might operate include helping to reappraise threats, serving as a character strength, or facilitating happiness. The current research attempts to integrate these possibilities by examining whether a good sense of humor might operate globally by helping to maintain a more stable positive affect. Stable positive affect has been shown to facilitate more effective problem solving and to build resilience. However, not all humor is adaptive humor, so we also examine the roles that different styles of humor use might play. Individual differences in humor styles were used to predict stable levels of affect. Then, in a longitudinal design, humor styles and stable affect were used to predict subsequent resilience and psychological health. The results indicated that stable affect was related to resilience and psychological well-being, and that a sense of humor that involves self-enhancing humor, humor based on maintaining a humorous perspective about one’s experiences, was positively related to stable positive affect, negatively related to stable negative affect, and was mediated through stable affect in influencing resilience, well-being and distress. Thus, while a good sense of humor can lead to greater resilience and better psychological health, the current results, focusing on stable affect, find only self-enhancing humor provides reliable benefits.

Humour-related interventions for people with mental illness: a randomized controlled pilot study

This study explored the feasibility and effects of humour-related interventions for mentally ill adults. Twelve, randomly assigned, participated in each of 3 arms--stand up comedy training (the experimental arm), discussing comedy videos (the active control arm), and no humour-related intervention (the passive control arm). Quantitative and qualitative data were collected at baseline, end of interventions (3 months) and follow up (after another 3 months). Scale comparisons were largely negative, although self-esteem marginally increased in the experimental arm. Interview responses indicated benefits for the interventions, including improved self-esteem in the experimental arm. These results, though mixed, justify further study.

Laugh Away the Fat? Therapeutic Humor in the Control of Stress-induced Emotional Eating

This review explores the potential overlap between the fields of nutrition and therapeutic humor, together with the role of humor as a possible tool for aiding those in whom emotions, particularly negative ones, trigger eating as a means to improve mood. We review emotional eating, obesity, and the hypothesized mechanisms of emotional eating. We then review the field of therapeutic humor and its ability to de-stress individuals, possibly through endorphin and opioid systems, both of which are also involved in eating behavior. Finally, we present a novel hypothesis that people may be trained to use humor as a "food substitute" at best, or to blunt hunger stimuli, to achieve similar advantages, without the side effect of weight gain.

Humor and laughter in persons with cognitive impairment and their caregivers

PURPOSE

The purpose of this study was to describe humor and laughter in persons with cognitive impairment (PWCI) and caregivers who were recalling a shared experience in a focus group.

DESIGN

Twenty participants attended an Art Engagement Activity at the Andy Warhol Art Museum, which included a guided tour and an art project. All PWCI had medically diagnosed cognitive disorders and all caregiver participants did not. Four focus groups were conducted and transcripts of audio-recorded sessions were transferred to a qualitative software program.

METHOD

Words, phrases, and episodes of humor and laughter were used to construct codes, which were refined during group analysis using constant comparison.

FINDINGS

Humor and laughter were present in all four focus groups. Emerging themes of humor included silliness, sarcasm, and commenting about hardships of dementia. Laughter was identified in segments with and without humor. Some PWCI were unable to follow social cues.

CONCLUSIONS

Humor and laughter played a role in creating a safe social environment. PWCI were able to engage in humor during social interactions, yet some had difficulty recognizing social cues. Further study may reveal roles of humor and laughter in adaptation to cognitive decline and holistic interventions for improved quality of life.