The use of humor in serious mental illness: a review

Sanity through Insanity: The Use of Dark Humor among United States Veterans

Humor is generally known to effectively help individuals manage distress. Yet a variety of ways exist to engage in humor, and not all of them may be equally associated with desirable outcomes. The purpose of this study is to examine the extent to which dark humor is associated with the subjective well-being of United States military veterans. An online survey was announced on several social media pages populated by US veterans, to which 93 fully responded. Our findings indicate that the use of dark humor does not appear to be associated with a sense of connectedness, but the reported use of self-defeating types of dark humor was associated with lower levels of life satisfaction. Our hypothesis that increased feelings of connectedness to civilian and veteran/active-duty friends would predict increased reports of overall subjective well-being was supported. The implications of these findings for understanding the functions of dark humor are discussed.

Humor in professional coaching: a literature review and research agenda

Introduction

Extensive research has explored the incorporation of humor in therapy, revealing its potential positive effects on clients' mental well-being and personal growth. However, limited research exists on how coaching could benefit from humor as an intervention and how its utilization impacts the interaction processes and outcomes for both the coachee and coach. Therefore, our research focuses on the use and effects of spontaneous humor within professional dialogues. This paper aims to extract insights from academic literature on humor in adjacent fields and apply these insights to the context of coaching.

Methods

This paper offers implications for coaching theory and practice, alongside a proposed research agenda. The initial phase involves analyzing reviews on humor in professional contexts, and coaching. Secondly, following the PRISMA guidelines for review, we identified 13 empirical studies, which address the role of humor in counseling, psychotherapy, and mentoring.

Results and discussion

Our findings suggest that humor serves as a valuable tool for establishing and deepening the working alliance, fostering adaptive coping mechanisms in clients, and enhancing the cognitive and behavioral process. Moreover, humor is shown to be advantageous for professionals in navigating challenging client relationships. These findings hold significance for the realm of coaching practice as well. In light of these insights, we propose the integration of humor use in education toolkits for coaching professionals.

Young adults' views on the mechanisms underpinning the impact of pets on symptoms of anxiety and depression

Introduction

Emerging adulthood is considered a peak age for the onset of mental health difficulties with approximately 75% of mental health disorders being diagnosed during this developmental period. Companion animals confer both risk and benefits to mental health yet the potential underpinning mechanisms which explain such impacts are not fully understood. This study aimed to gather an in-depth understanding of young adults' lived experience of how their companion dogs and cats may impact their mental health symptoms and the perceived mechanisms which explain their effects.

Methods

Semi-structured interviews were carried out with 16 young adults aged 18-26 years, from the United Kingdom, who either had a companion dog, cat, or both. All participants had difficulties with anxiety and or depression, and 12 had received a formal diagnosis of an affective disorder.

Results

Five overarching themes and one subtheme were identified through reflexive thematic analysis using an inductive approach: Theme 1: Pet impact on generalized anxiety and panic, Subtheme 1A: Pet impact on social anxiety and loneliness; Theme 2: Pet impact on low mood, depression, and stress; Theme 3: Pet impact on severe mental health and suicide prevention; Theme 4: Staying well; Theme 5: Positive outlook and successful futures. Several perceived mechanisms underpinning the impacts of pets for mental health were also identified.

Discussion

These findings have relevance for the development and evaluation of mental health interventions and treatment protocols aimed at young adults with mental health difficulties, where companion animals may prove to be effective for symptom management and improvements in positive wellbeing.

A bite of dark chocolate? Black humour in mental health services

OBJECTIVE

Black humour permits expression of what may otherwise be unspeakable and is observed and used by staff working in mental health services. The aim of this study was to identify how humour, particularly black humour, was perceived by different health professionals in psychiatric practice.

METHODS

Participants were invited to complete a survey. Data was collated and statistically analysed by a biostatistician. Chi square and univariate tests were performed to identify associations between categories.

RESULTS

The sub-question relating to the benefits of black humour was analysed. Main findings were that the majority of staff perceived black humour to be beneficial in psychiatric practice (n = 564 of 710 total; 79.4%), particularly if they used general and black humour with patients, families and colleagues. Those who observed black humour being used collegially about patients and families were more likely to find black humour beneficial; and even those uncomfortable with black humour being used by colleagues were more likely to see the benefits of black humour.

CONCLUSION

Black humour was perceived to be beneficial in mental health settings when used mindfully, sensitively and in context. Further study with patients and relatives may shed light on how widely the perception of benefit is shared.

Evaluation of a Humor Training for Patients with Chronic Pain: A Randomized Clinical Trial

Background

Humor and laughter are positively associated with psychological as well as with physical well-being. As there is little research examining to what extent patients suffering from chronic pain could benefit from a humor intervention, the goal of this study was to develop a pain-specific humor training and to evaluate its feasibility and effectiveness as component of regular, multimodal pain therapy.

Patients and Methods

Patients from inpatient treatment groups for chronic pain in a German hospital were randomly assigned to the training group (final n = 62) and the control group (final n = 65). The training consisted of four sessions that were implemented in the usual therapy throughout two weeks. Outcomes were divided into primary (perceived current pain intensity and depression) and secondary ones (quality of life impairment by pain, cheerfulness, and self-enhancing humor) and were assessed prior to and after intervention.

Results

Results showed improvements in all outcomes for both groups. For primary outcomes, a trend for a greater reduction in current pain intensity was found for the training group compared to the control group (p = 0.060, η²_p = 0.02), as well as, for secondary outcomes, a trend for greater reduction of quality of life impairment by pain (p = 0.079, η²_p = 0.02) and a trend for greater increase in self-enhancing humor (p = 0.086, η²_p = 0.02). Depression and cheerfulness remained unaffected. Feedback indicated feasibility of the training within multimodal therapy, showing overall acceptance as well as providing specific suggestions for improvement.

Conclusion

As the first study evaluating a specific humor training for patients with chronic pain within a randomized controlled trial, its results are promising regarding an additional contribution that humor interventions can make towards multimodal pain therapy.

The experience and meaning of recovery-oriented practice for nurses working in acute mental health services

Since the 1990s, New Zealand mental health policy has shifted from a focus on the management of symptoms and risk to the recovery of psychological, social, cultural, and physical well-being. Despite a vision for recovery-oriented services being integrated within national and regional policies, there is growing concern that barriers to recovery-oriented service provision continue to exist. Such barriers include the attitudes, skills, and knowledge of front-line staff, as well as system issues. This study explored the experience and meaning of recovery-oriented practice for 10 nurses working in an acute inpatient mental health service. A phenomenological and hermeneutic lens was used to explore the nurses' experience of working in a recovery-focused manner alongside service users. Stories of practice were collected from participants through open-ended conversational interviews. Transcribed narratives were analysed to explore taken-for-granted aspects of working in acute mental health care and to uncover the meaning of being recovery-oriented in this setting. Findings revealed that although the experience and meaning of recovery-focused care varied among nurses, there were common elements in the practice accounts. The accounts highlighted the nurses' role in creating different therapeutic spaces to promote safety, relational commitment, and healing for service users. However, the nurses faced challenges to recovery-oriented care within the team hierarchical culture and the broader service systems. The nurses were, at times, fearless in advocating for service users and recognized that this was essential for developing recovery-focused services. The findings have implications for nursing practice, as well as training and service development.

Characterization and Comparison of the Utilization of Facebook Groups Between Public Medical Professionals and Technical Communities to Facilitate Idea Sharing and Crowdsourcing During the COVID-19 Pandemic: Cross-sectional Observational Study

BACKGROUND

Strict social distancing measures owing to the COVID-19 pandemic have led people to rely more heavily on social media, such as Facebook groups, as a means of communication and information sharing. Multiple Facebook groups have been formed by medical professionals, laypeople, and engineering or technical groups to discuss current issues and possible solutions to the current medical crisis.

OBJECTIVE

This study aimed to characterize Facebook groups formed by laypersons, medical professionals, and technical professionals, with specific focus on information dissemination and requests for crowdsourcing.

METHODS

Facebook was queried for user-created groups with the keywords "COVID," "Coronavirus," and "SARS-CoV-2" at a single time point on March 31, 2020. The characteristics of each group were recorded, including language, privacy settings, security requirements to attain membership, and membership type. For each membership type, the group with the greatest number of members was selected, and in each of these groups, the top 100 posts were identified using Facebook's algorithm. Each post was categorized and characterized (evidence-based, crowd-sourced, and whether the poster self-identified). STATA (version 13 SE, Stata Corp) was used for statistical analysis.

RESULTS

Our search yielded 257 COVID-19-related Facebook groups. Majority of the groups (n=229, 89%) were for laypersons, 26 (10%) were for medical professionals, and only 2 (1%) were for technical professionals. The number of members was significantly greater in medical groups (21,215, SD 35,040) than in layperson groups (7623, SD 19,480) (P<.01). Medical groups were significantly more likely to require security checks to attain membership (81% vs 43%; P<.001) and less likely to be public (3 vs 123; P<.001) than layperson groups. Medical groups had the highest user engagement, averaging 502 (SD 633) reactions (P<.01) and 224 (SD 311) comments (P<.01) per post. Medical professionals were more likely to use the Facebook groups for education and information sharing, including academic posts (P<.001), idea sharing (P=.003), resource sharing (P=.02) and professional opinions (P<.001), and requesting for crowdsourcing (P=.003). Layperson groups were more likely to share news (P<.001), humor and motivation (P<.001), and layperson opinions (P<.001). There was no significant difference in the number of evidence-based posts among the groups (P=.10).

CONCLUSIONS

Medical professionals utilize Facebook groups as a forum to facilitate collective intelligence (CI) and are more likely to use Facebook groups for education and information sharing, including academic posts, idea sharing, resource sharing, and professional opinions, which highlights the power of social media to facilitate CI across geographic distances. Layperson groups were more likely to share news, humor, and motivation, which suggests the utilization of Facebook groups to provide comedic relief as a coping mechanism. Further investigations are necessary to study Facebook groups' roles in facilitating CI, crowdsourcing, education, and community-building.

Adapting to People With Schizophrenia: A Phenomenological Study on a Rural Society in Indonesia

BACKGROUND

The growing prevalence of schizophrenia in Indonesia requires the consideration of the families, caregivers, health care professionals, and the entire society, to serve as a support and coping resource for the patients. The process of recovery is rather difficult, especially in the absence of a decent place to live. Hence, there is the need to provide a supportive environment that facilitates recuperation from psychotic symptoms, enhances interaction with others, promotes self-expression of thoughts and feelings, and helps deal with daily stress and challenges. There are currently no studies on the framework of societal adaptation for people with schizophrenia (PWS). The aim of this research, therefore, was to explore the experiences of rural society inhabitants in adapting to PWS in Indonesia.

METHODS

The study uses a qualitative research design and implements an interpretive phenomenological approach. A total of ten society members were recruited from the community by purposive sampling, and the in-depth interviews conducted were audio-recorded and transcribed. In addition, thematic analysis was carried out using the interpretive phenomenological analysis method.

RESULTS

The majority of the participants assumed that PWS prompt the feeling of alertness over fear. In addition, the participants revealed a feeling of indecisiveness in related situations and emphasized the value of keeping up traditional beliefs and practices and the effectiveness of a demonstration of indifference. They explained the need to combine traditional and modern health practices as recommended by the spiritual leaders.

CONCLUSION

Societal adaptation to PWS entails the understanding of how to deal with the disease's uncertainty and complexity. It is important to create a supportive environment to promote mental health and wellbeing.

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.

The impact of medical clowns exposure over postoperative pain and anxiety in children and caregivers: An Israeli experience

While postoperative pain management was shown to reduce unwanted physiological and emotional outcomes, pediatric postoperative pain management remains suboptimal. Medical-clowns were shown to be beneficial in many medical contexts including reduction of stress, anxiety and pain. This study was set to assess the effectiveness of medical-clowns on pediatric postoperative pain reduction. Children age 4 or above, planned for elective hernia repair surgery were recruited. Children were randomly divided to a control or medicalclown escorted groups. Demographical and clinical data were collected using questionnaires and electronic sheets. Children escorted by clowns reported lower levels of pain upon admittance, discharge and 12- hours post-surgery. Statistically significant reduction of parental distress and significantly higher serum cortisol levels were observed in the clown-therapy group. Although small, our study supports the possibility that preoperative medical-clown therapy might be a cheap, safe and yet beneficial method for postoperative pain reduction.

'We're not all dangerous and crazy'. Negotiating the voice hearing identity: A critical discursive approach

A critical discursive approach examined how the voice hearing identity is negotiated. Conflicting constructions identified voice hearing not only as distressing but also as a normal experience. The discursive strategies reveal that when individuals who hear voices construct their identity, they must either disavow their own distress to avoid stigma or accept the stigmatising accounts of their identity imposed on them if they are to have their distress recognised. The study points to the value and importance of discursive approaches in uncovering unspoken distress in individuals and society, and towards the need to address identity issues in clinical and social interventions.

Plausibility of a Neural Network Classifier-Based Neuroprosthesis for Depression Detection via Laughter Records

The present work explores the diagnostic performance for depression of neural network classifiers analyzing the sound structures of laughter as registered from clinical patients and healthy controls. The main methodological novelty of this work is that simple sound variables of laughter are used as inputs, instead of electrophysiological signals or local field potentials (LFPs) or spoken language utterances, which are the usual protocols up-to-date. In the present study, involving 934 laughs from 30 patients and 20 controls, four different neural networks models were tested for sensitivity analysis, and were additionally trained for depression detection. Some elementary sound variables were extracted from the records: timing, fundamental frequency mean, first three formants, average power, and the Shannon-Wiener entropy. In the results obtained, two of the neural networks show a diagnostic discrimination capability of 93.02 and 91.15% respectively, while the third and fourth ones have an 87.96 and 82.40% percentage of success. Remarkably, entropy turns out to be a fundamental variable to distinguish between patients and controls, and this is a significant factor which becomes essential to understand the deep neurocognitive relationships between laughter and depression. In biomedical terms, our neural network classifier-based neuroprosthesis opens up the possibility of applying the same methodology to other mental-health and neuropsychiatric pathologies. Indeed, exploring the application of laughter in the early detection and prognosis of Alzheimer and Parkinson would represent an enticing possibility, both from the biomedical and the computational points of view.

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.

Cross-sectional analysis of veterinary student coping strategies and stigma in seeking psychological help

Veterinary education can result in high levels of academic stressors for students. Students are also susceptible to non-academic stressors, including relationship issues and financial concerns. These can all result in mental ill health, which may impair the student's ability to complete their studies and go on to a successful professional career. Finding and using strategies early on to help alleviate mental health problems is critical to successful management of these problems, but seeking help may be impeded by the stigma associated with mental health problems. Using a cross-sectional online survey of a sample of Australian veterinary students, the aim of the current study was to investigate the type and frequency of their coping strategies as well as to explore relationships between self-stigma and coping strategies. Female veterinary students reported more use of instrumental and emotional support as coping strategies, while male veterinary students demonstrated more use of humour. Self-stigma was related to less instrumental support, greater self-blame and gender, while males who employed more humour as a coping strategy reported more self-stigma. Improving the coping strategies of veterinary students and reducing the self-stigma surrounding mental ill health is important to improve the wellbeing and resilience of the veterinary profession.

Uncommon and/or bizarre features of dementia: Part III

Clinical neurologists have long recognized that dementia can present as atypical or variant syndromes/symptoms. This study aimed at describing uncommon or bizarre symptoms/syndromes observed in patients suffering from dementia. Medline and Google scholar searches were conducted for relevant articles, chapters, and books published before 2018. Search terms used included compulsion, dementia, extracampine hallucination, disordered gambling, humour, and obsession. Publications found through this indexed search were reviewed for further relevant references. The uncommon/bizarre feature of dementia was described as case reports and there were no systematic investigations.

Laughter is the best medicine: The Second City® improvisation as an intervention for Parkinson's disease

BACKGROUND

Expressive therapies are increasingly incorporated into the management of Parkinson's disease (PD), although there are little objective data assessing their benefits.

OBJECTIVE

Develop and study a novel community Improvisation Theater (IT) program for PD in order to improve quality of life.

METHODS

A prospective, rater-blinded, modified cross-over design study of IT for PD. 22 subjects were randomized 1:1 to active-start (AS) or control-start (CS) groups, controlling for age and Hoehn and Yahr stage. Participants were recruited from the Northwestern PD and Movement Disorders Center. 60 min IT sessions were led by The Second City^® faculty weekly for 12 weeks. The primary aim was to assess feasibility, determined as 70% of participants attending at least 75% of the classes. Exploratory data were obtained comparing pre- and post-intervention outcomes using Wilcoxon signed rank test for UPDRS parts I-IV, PDQ-39, and 5 neuro-QoL measures (communication, anxiety, stigma, depression, and wellbeing).

RESULTS

All 22 participants completed the study. 21/22 (95%) participants attended at least 80% of the classes. All participants indicated that they would recommend the class to others with PD. 21/22 participants enjoyed the class and felt it was beneficial for their symptoms. A significant improvement pre-to-post intervention was seen with the UPDRS part II ADL measure (mean -1.5, p = 0.019).

CONCLUSION

A novel improvisation program can be well-attended, enjoyable, and improve ADL measures among patients with PD of varying ages and disease severity.

Humor

Humor has not been taken as seriously as it should be. Humor has many positive effects in the daily lives of patients and clinicians need to take advantage of these. Many indices of stress are attenuated and this serves to improve the therapeutic alliance. Freudian, rational emotive therapy, and kleinian views are presented, as well as examples of how to use playful therapy. In addition, advice on how to develop humor is given.

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.

Irony and proverb comprehension in schizophrenia: do female patients "dislike" ironic remarks?

Difficulties in understanding irony and sarcasm are part of the social cognition deficits in patients with schizophrenia. A number of studies have reported higher error rates during comprehension in patients with schizophrenia. However, the relationships of these impairments to schizotypal personality traits and other language deficits, such as the comprehension of proverbs, are unclear. We investigated irony and proverb comprehension in an all-female sample of 20 schizophrenia patients and 27 matched controls. Subjects indicated if a statement was intended to be ironic, literal, or meaningless and furthermore rated the meanness and funniness of the stimuli and certainty of their decision. Patients made significantly more errors than controls did. Globally, there were no overall differences in the ratings. However, patients rated the subgroup of stimuli with answers given incorrectly as having significantly less meanness and in case of an error indicated a significantly higher certainty than controls. Across all of the study participants, performances in irony (r = -0.51) and proverb (r = 0.56) comprehension were significantly correlated with schizotypal personality traits, suggesting a continuum of nonliteral language understanding. Because irony is so frequent in everyday conversations, this makes irony an especially promising candidate for social cognition training in schizophrenia.

Validation of laughter for diagnosis and evaluation of depression

BACKGROUND

In the medical field, laughter has been studied for its beneficial effects on health and as a therapeutic method to prevent and treat major medical diseases. However, very few works, if any, have explored the predictive potential of laughter and its potential use as a diagnostic tool.

METHOD

We registered laughs of depressed patients (n=30) and healthy controls (n=20), in total 934 laughs (517 from patients and 417 from controls). All patients were tested by the Hamilton Depression Rating Scale (HDRS). The processing was made in Matlab, with calculation of 8 variables per laugh plosive. General and discriminant analysis distinguished patients, controls, gender, and the association between laughter and HDRS test.

RESULTS

Depressed patients and healthy controls differed significantly on the type of laughter, with 88% efficacy. According to the Hamilton scale, 85.47% of the samples were correctly classified in males, and 66.17% in women, suggesting a tight relationship between laughter and the depressed condition.

LIMITATIONS

(i) The compilation of humorous videos created to evoke laughter implied quite variable chances of laughter production. (ii) Some laughing subjects might not feel comfortable when recording. (iii) Evaluation of laughter episodes depended on personal inspection of the records. (iv) Sample size was relatively small and may not be representative of the general population afflicted by depression.

CONCLUSIONS

Laughter may be applied as a diagnostic tool in the onset and evolution of depression and, potentially, of neuropsychiatric pathologies. The sound structures of laughter reveal the underlying emotional and mood states in interpersonal relationships.

Empirical study of the influence of a Laughing Qigong Program on long-term care residents

AIM

To determine the psychological and physiological effects of a Laughing Qigong Program on an elderly population in an institutionalized setting.

METHODS

Participants were recruited from a long-term care institution in northern Taiwan. A total of 99 residents were interviewed and 66 enrolled, there were 33 control participants and 33 experimental participants. The participants were matched according to their abilities as measured by the Barthel Index of Activities for Daily Living. Experimental participants attended the Laughing Qigong Program, twice a week for 4 weeks. Comparisons were made on the Mini-Mental State Examination, Faces Scale, Geriatric Depression Scale and cortisol levels.

RESULTS

Psychometric measures for participants in the experimental group improved, whereas those in the control group decreased. The experimental group showed the following changes: improved Mini-Mental State Examination scores (Z=-2.28; P<0.05), improved mood states (Z=-4.47; P<0.001) and decreased Geriatric Depression Scale scores (Z=3.79; P<0.001). There were no significant changes for the experimental group in cortisol levels. By comparison, the control group showed: decreased mood states (Z=2.53; P<0.011), increased Geriatric Depression Scale scores (Z=4.34; P<0.001) and significant increases in cortisol levels (Z=2.62; P<0.009).

CONCLUSIONS

The Laughing Qigong Program has shown to be an effective, cost-effective non-pharmacological therapy for cognitive impairment, mood states and elderly depression.

Laughter and MIRTH (Methodical Investigation of Risibility, Therapeutic and Harmful): narrative synthesis

OBJECTIVE

To review the beneficial and harmful effects of laughter.

DESIGN

Narrative synthesis.

DATA SOURCES AND REVIEW METHODS

We searched Medline (1946 to June 2013) and Embase (1974 to June 2013) for reports of benefits or harms from laughter in humans, and counted the number of papers in each category.

RESULTS

Benefits of laughter include reduced anger, anxiety, depression, and stress; reduced tension (psychological and cardiovascular); increased pain threshold; reduced risk of myocardial infarction (presumably requiring hearty laughter); improved lung function; increased energy expenditure; and reduced blood glucose concentration. However, laughter is no joke-dangers include syncope, cardiac and oesophageal rupture, and protrusion of abdominal hernias (from side splitting laughter or laughing fit to burst), asthma attacks, interlobular emphysema, cataplexy, headaches, jaw dislocation, and stress incontinence (from laughing like a drain). Infectious laughter can disseminate real infection, which is potentially preventable by laughing up your sleeve. As a side effect of our search for side effects, we also list pathological causes of laughter, among them epilepsy (gelastic seizures), cerebral tumours, Angelman's syndrome, strokes, multiple sclerosis, and amyotrophic lateral sclerosis or motor neuron disease.

CONCLUSIONS

Laughter is not purely beneficial. The harms it can cause are immediate and dose related, the risks being highest for Homeric (uncontrollable) laughter. The benefit-harm balance is probably favourable. It remains to be seen whether sick jokes make you ill or jokes in bad taste cause dysgeusia, and whether our views on comedians stand up to further scrutiny.

Attitude toward humor in patients experiencing depressive symptoms

OBJECTIVE

This study measures the correlation between disposition to humor and level of depression to investigate openness to humorous interventions for the treatment of depression.Design, Participants, and Measurement: Individuals (n=200) with depression received questionnaires to assess their sense of humor and attitude toward humor using the Svebak's Humor Questionnaire and a disposition toward humor questionnaire. The correlation between Svebak's Humor Questionnaire scores and Quick Inventory of Depressive Symptomatology-Self Report scores was then measured. RESULTS were further analyzed by race, age, and gender to assess any emerging trends within those groups.

RESULTS

Svebak's Humor Questionnaire mean scores remained high across gender, race, and age. However, there was not a statistically significant correlation between the level of depression and sense of humor (r=-0.22). The only significant relationship noted was between disposition toward humor and depression was for subjects aged 70 and older (r=-0.83).

CONCLUSION

Though with certain limitations, these data provide preliminary support for the possibility that an appreciation of humor would persist despite symptoms of major depressive disorder. Clinicians could consider humor as part of an intervention in the treatment of depressive symptoms. The determination of the type of humor and manner of integrating it into therapy would require further study.

Clowns benefit children hospitalized for respiratory pathologies

The study aims at evaluating health-generating function of humor therapy in a hospital ward hosting children suffering from respiratory pathologies. The main scope of this study is to investigate possible positive effects of the presence of a clown on both the clinical evolution of the on-going disease, and on some physiological and pain parameters. Forty-three children with respiratory pathologies participated in the study: 21 of them belonged to the experimental group (EG) and 22 children to the control group (CG). During their hospitalization, the children of the EG interacted with two clowns who were experienced in the field of pediatric intervention. All participants were evaluated with respect to clinical progress and to a series of physiological and pain measures both before and after the clown interaction. When compared with the CG, EG children showed an earlier disappearance of the pathological symptoms. Moreover, the interaction of the clown with the children led to a statistically significant lowering of diastolic blood pressure, respiratory frequency and temperature in the EG as compared with the control group. The other two parameters of systolic pressure and heart frequency yielded results in the same direction, without reaching statistical significance. A similar health-inducing effect of clown presence was observed on pain parameters, both by self evaluation and assessment by nurses. Taken together, our data indicate that the presence of clowns in the ward has a possible health-inducing effect. Thus, humor can be seen as an easy-to-use, inexpensive and natural therapeutic modality to be used within different therapeutic settings.