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

Humor in parenting: Does it have a role?

BACKGROUND

Despite the widespread use of humor in social interactions and the considerable literature on humor in multiple fields of study, the use of humor in parenting has received very little formal study. The purpose of this pilot study was to gather preliminary data on the use of humor in the raising of children.

MATERIALS AND METHODS

We developed and administered a 10-item survey to measure people's experiences being raised with humor and their views regarding humor as a parenting tool. Responses were aggregated into Disagree, Indeterminate, and Agree, and analyzed using standard statistical methods.

RESULTS

Respondents (n = 312) predominantly identified as male (63.6%) and white (76.6%) and were (by selection) between the ages of 18-45 years old. The majority of participants reported that they: were raised by people who used humor in their parenting (55.2%); believe humor can be an effective parenting tool (71.8%) and in that capacity has more potential benefit than harm (63.3%); either use (or plan to use) humor in parenting their own children (61.8%); and would value a course on how to utilize humor in parenting (69.7%). Significant correlations were found between the use of humor and both i) the quality of respondents' relationships with their parents and ii) assessments of how good a job their parents had done.

CONCLUSIONS

In this pilot study, respondents of childbearing/rearing age reported positive views about humor as a parenting tool.

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.

A Comprehensive Review on the Effects of Humor in Patients With Depression

Depression is a leading cause of disability worldwide and a major contributor to the overall global burden of disease. Although there are known, effective treatments for depression, people in low- and middle-income areas experience multiple barriers which limit their ability to receive adequate treatment. Some known barriers to effective care include a lack of resources, lack of trained healthcare providers, and social stigma associated with mental disorders and this creates gaps in mental health care and the need for more treatment modalities and adjuvant therapies to address these gaps. This review article was conducted using the scale for the assessment of non-systematic review articles (SANRA). We searched three databases; EMBASE, PubMed (MEDLINE), and Google Scholar using specified search terms. We had a total of nine articles with sample sizes ranging from 37 to 1551, and the age of participants ranged from 23 to 93 years. Articles were diverse in race and geographical locations. The articles were derived from cross-sectional studies, randomized studies, and experimental studies, and they focused on the relationship between humor and depression, and the reduced risk of depression in the study population. The articles identified different aspects of the relationship between humor and depression. The willingness of patients with depression to recognize or participate in humor could be defective resulting in abnormal social interactions such as withdrawal. However, there was some significant influence of humor or its styles on patients with depression either mitigating depressive symptoms or having no impact at all.

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.

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.

Mind-Body Interventions for Anxiety Disorders: A Review of the Evidence Base for Mental Health Practitioners

Mind-body interventions have gained increasing popularity for use with anxiety symptoms; however, it is unclear what role they play in the treatment of anxiety disorders, such as generalized anxiety disorder, panic disorder, and social anxiety disorder. Although psychopharmacology and psychotherapy treatment interventions are available, mind-body interventions may be low-stigma options that can serve as effective alternatives. The goal of this review is to provide clinicians with an overview of high-quality studies for the most well researched mind-body interventions. This review involved a search of the primary literature, including meta-analyses, systematic reviews, and randomized controlled trials (RCTs), that evaluated mind-body interventions for the treatment of anxiety disorders. When published evidence was limited, lower-quality studies were reviewed. Overall, data were limited on the efficacy of most mind-body modalities for anxiety disorders. The highest-quality data existed for yoga, mindfulness-based interventions, and applied relaxation for anxiety disorders. However, findings were sometimes inconsistent across studies, and some studies were limited by small sample sizes, poorly defined randomization and blinding procedures, and inadequate control groups. Although not enough data exist to recommend mind-body interventions as primary treatment options, they may be considered as part of a larger treatment plan given their relatively low levels of risk. Future steps for researchers include conducting additional RCTs with adequate control groups, comparing mind-body treatments with existing treatments, and examining long-term effects of mind-body interventions.

Therapeutic Interventions for Adjustment Disorder: A Systematic Review

BACKGROUND

Adjustment disorder requires therapeutic intervention because of its complications, which include a significant risk of suicide, but evidence-based therapeutic guidelines are not available.

AREAS OF UNCERTAINTY

The main problem is related to answer to the following question: What is the optimal therapeutic approach to adjustment disorder? In this respect we review all randomized controlled trials that aimed to investigate therapeutic interventions for adjustment disorder in adult populations.

DATA SOURCES

Comprehensive search of the electronic database PubMed (January 1980-June 2019). The review included clinical trials that aimed to investigate a psychological or pharmacological treatment for adjustment disorder in adult population and reported outcome data for therapeutic interventions.

RESULTS

The search identified 23 studies that fulfilled the inclusion criteria for this review. Pharmacotherapy interventions were the focus of 11 studies that used various medications and dosages including viloxazine, lormetazepam, S-adenosylmethionine, pivagabine, trazodone, clorazepate, etifoxine, lorazepam, diazepam, afobazole, and plant extracts (Kava-kava, Euphytose, and Ginkgo biloba) on a total number of 1020 patients. Psychotherapy interventions were identified in 12 studies that used mirror therapy, short-term dynamic psychotherapy, yoga meditation, body-mind-spirit technique, mindfulness, bibliotherapy (self-help manual), humor training, and cognitive behavioral therapy.

CONCLUSIONS

Psychotherapy seems indicated for mildly symptomatic adjustment disorder. Given the fact that adjustment disorder with severe symptoms is associated with a high risk of suicidal ideation and suicide attempts, clinicians must consider the potential benefit of using psychotropic agents such as benzodiazepines, antidepressants, or etifoxine.

Influence of humor expression on suicidal ideation among adolescents: mediating effects of depressive emotion and positive emotion

BACKGROUND

The occurrence and degree of suicidal ideation during the past month in adolescents should be regarded seriously. Several studies have noted that humor expression style and depressive emotion may influence adolescents' suicidal ideation. However, there is insufficient evidence concerning whether positive emotion reduces such suicidal ideation in adolescents. In addition, the relationships among humor expression, depressive emotion, positive emotion and suicidal ideation remain to be confirmed. Therefore, in this study, we aimed to test the mediating roles of depressive emotion and positive emotion in the relationship between humor expression and recent adolescent's suicidal ideation.

METHODS

A total of 1551 students in junior high school completed questionnaires. The collected data were analyzed using structural equation modeling (SEM) with LISREL 8.80 and Monte Carlo resampling with R.

RESULTS

The results indicate that suicidal ideation in adolescents during the past month was related not only to humor expression but also to depressive emotion and positive emotion. The stronger the depressive emotion felt, the stronger the suicidal ideation; in contrast, the stronger the positive emotion, the weaker the suicidal ideation. Moreover, depressive emotion and positive emotion were found to mediate the relationship between humor expression and suicidal ideation; additionally, positive emotion was found to mediate the relationship between depressive emotion and suicidal ideation.

CONCLUSION

These results highlight that depressive emotion and positive emotion may mediate the influence of humor expression on suicidal ideation among adolescents, and positive emotion may mediate the influence of depressive emotion on suicidal ideation. More attention should be paid to decreasing adolescents' self-deprecating humor expression and depressive emotion, whereas more witty response humor expression and positive emotion should be encouraged to prevent their suicidal ideation.