When humor is a matter of heart: effects on emotional state and Interbeat Interval

Previous studies demonstrated that exposure to humor has beneficial effects on psychological well-being. In the present work, we investigated the behavioral and psychophysiological effects of different types of humor on psychological well-being and on the performance during the execution of a stressful cognitive task. To this aim, we examined the behavioral and psychophysiological effects of ToM humorous and Slapstick humorous comic strips before and after executing a stressful cognitive task. We hypothesized that only slapstick humor could reduce the level of anxiety, increase positive affect and improve performance on the cognitive task. Our findings revealed that, at a specific point in time, exposure to ToM Humor and No Humor strips were associated with lower IBI (higher HR, increase in cardiac recruitment) than slapstick humor. This result suggests that humor involving ToM abilities and No Humor strips elicited a greater cognitive engagement level than slapstick humor. Moreover, in an exploratory analysis we found a positive correlation between cardiac deactivation during the exposure to slapstick Humor and individual empathy scores, suggesting that the empathy skills might influence cardiac recruitment and the level of cognitive engagement during the exposure to humorous material.

Laugh before You Study: Does Watching Funny Videos before Study Facilitate Learning?

Emotions exist widely in the entire process of learning and affect students' motivation as well as academic performance. In multimedia learning, academics usually focus on the impact of teachers' emotions or the emotional design of multimedia learning materials on students' emotions and learning results. Few studies have investigated how to enhance learning by regulating students' pre-learning emotions. This study focused on whether playing funny videos before learning could promote students' positive emotions to enhance their motivation, satisfaction, and learning outcomes. We randomly divided 81 elementary school students into two groups: experimental group and control group. While the experimental group watched funny video clips, the control group watched neutral video clips before starting the video learning. The experimental group had more positive pre-learning emotions than the control group. After the course, the emotion of the experimental group declined while that of the control group enhanced. However, positive pre-learning emotions still promoted students' understanding and transfer of learning materials. Moreover, no significant differences were observed between the two groups in learning motivation, satisfaction, and retention tests. Furthermore, this paper analyzed the causes of the experimental results and discussed the insights for teaching.

Development and Initial Validation of the Humor Climate in Sport Scale

In sport teams, humor is an essential element that influences communication processes, and plays an important role in group dynamics. Despite this, no current instrument is presented in the literature to measure humor climate in sport teams. Therefore, the current study presents the development and initial validation of the Humor Climate in Sport Scale (HCSS). The aim was to assess content, structural and concurrent validity of the developed instrument, and to examine differential item functioning (DIF) as a function of sex. Three different phases were completed in this study. The first phase involved focus groups (n = 5) that explored humor as communication in a team sport context. In phase 2, information from the focus groups was used to create a pool of potential items for the questionnaire. Two discussion groups with sport science students contributed to the development of 80 potential items, that two different expert groups then assessed for item quality. The final version of the instrument after this phase contained 14 items, representing three different humor dimensions. In phase 3, two independent samples with a total number of 776 participants were recruited for the psychometric evaluation of the instrument. EFA, ICM-CFA, and ESEM analysis were performed, supporting a three-factor structure with positive humor, negative humor in-group, and negative humor out-group. In addition, partial DIF as a function of sex on the negative humor dimensions was found, indicating differences in how male and female interpret the negative humor items. The findings in the current study expand our understanding of humor in sport teams and may be a starting point for further research on humor climate in sport teams and its role in group function.

A short humorous intervention protects against subsequent psychological stress and attenuates cortisol levels without affecting attention

Presentation of humor simultaneously with a stressful event has been shown to dampen the psychological and physiological responses of stress. However, whether a relatively short humorous intervention can be utilized to prevent the subsequent stress processing is still underinvestigated. Furthermore, it is unknown, whether such a humor intervention changes stress processing at a cost of cognitive functioning. According to the broaden-and-build theory inducing positive emotions may subsequently impact cognitive performance. Here, we investigated whether humor protects against subsequent stressors by attenuating both, psychological and physiological stress levels and whether this affects cognitive performance. Participants watched either a humorous or a neutral movie, underwent stress induction and performed in a visual search task. Compared to the control group, psychological stress levels and salivary cortisol levels were lower in the humor group, yet no differences were found in response times and accuracy rates for the visual search task. Our results demonstrate that a short humorous intervention shields against subsequent psychological stress leaving cognitive performance intact, thus making it highly applicable to improve mental and physical health in everyday life situations.

Psychological interventions to foster resilience in healthcare students

BACKGROUND

Resilience can be defined as maintaining or regaining mental health during or after significant adversities such as a potentially traumatising event, challenging life circumstances, a critical life transition or physical illness. Healthcare students, such as medical, nursing, psychology and social work students, are exposed to various study- and work-related stressors, the latter particularly during later phases of health professional education. They are at increased risk of developing symptoms of burnout or mental disorders. This population may benefit from resilience-promoting training programmes.

OBJECTIVES

To assess the effects of interventions to foster resilience in healthcare students, that is, students in training for health professions delivering direct medical care (e.g. medical, nursing, midwifery or paramedic students), and those in training for allied health professions, as distinct from medical care (e.g. psychology, physical therapy or social work students).

SEARCH METHODS

We searched CENTRAL, MEDLINE, Embase, 11 other databases and three trial registries from 1990 to June 2019. We checked reference lists and contacted researchers in the field. We updated this search in four key databases in June 2020, but we have not yet incorporated these results.

SELECTION CRITERIA

Randomised controlled trials (RCTs) comparing any form of psychological intervention to foster resilience, hardiness or post-traumatic growth versus no intervention, waiting list, usual care, and active or attention control, in adults (18 years and older), who are healthcare students. Primary outcomes were resilience, anxiety, depression, stress or stress perception, and well-being or quality of life. Secondary outcomes were resilience factors.

DATA COLLECTION AND ANALYSIS

Two review authors independently selected studies, extracted data, assessed risks of bias, and rated the certainty of the evidence using the GRADE approach (at post-test only).

MAIN RESULTS

We included 30 RCTs, of which 24 were set in high-income countries and six in (upper- to lower-) middle-income countries. Twenty-two studies focused solely on healthcare students (1315 participants; number randomised not specified for two studies), including both students in health professions delivering direct medical care and those in allied health professions, such as psychology and physical therapy. Half of the studies were conducted in a university or school setting, including nursing/midwifery students or medical students. Eight studies investigated mixed samples (1365 participants), with healthcare students and participants outside of a health professional study field. Participants mainly included women (63.3% to 67.3% in mixed samples) from young adulthood (mean age range, if reported: 19.5 to 26.83 years; 19.35 to 38.14 years in mixed samples). Seventeen of the studies investigated group interventions of high training intensity (11 studies; > 12 hours/sessions), that were delivered face-to-face (17 studies). Of the included studies, eight compared a resilience training based on mindfulness versus unspecific comparators (e.g. wait-list). The studies were funded by different sources (e.g. universities, foundations), or a combination of various sources (four studies). Seven studies did not specify a potential funder, and three studies received no funding support. Risk of bias was high or unclear, with main flaws in performance, detection, attrition and reporting bias domains. At post-intervention, very-low certainty evidence indicated that, compared to controls, healthcare students receiving resilience training may report higher levels of resilience (standardised mean difference (SMD) 0.43, 95% confidence interval (CI) 0.07 to 0.78; 9 studies, 561 participants), lower levels of anxiety (SMD -0.45, 95% CI -0.84 to -0.06; 7 studies, 362 participants), and lower levels of stress or stress perception (SMD -0.28, 95% CI -0.48 to -0.09; 7 studies, 420 participants). Effect sizes varied between small and moderate. There was little or no evidence of any effect of resilience training on depression (SMD -0.20, 95% CI -0.52 to 0.11; 6 studies, 332 participants; very-low certainty evidence) or well-being or quality of life (SMD 0.15, 95% CI -0.14 to 0.43; 4 studies, 251 participants; very-low certainty evidence). Adverse effects were measured in four studies, but data were only reported for three of them. None of the three studies reported any adverse events occurring during the study (very-low certainty of evidence).

AUTHORS' CONCLUSIONS

For healthcare students, there is very-low certainty evidence for the effect of resilience training on resilience, anxiety, and stress or stress perception at post-intervention. The heterogeneous interventions, the paucity of short-, medium- or long-term data, and the geographical distribution restricted to high-income countries limit the generalisability of results. Conclusions should therefore be drawn cautiously. Since the findings suggest positive effects of resilience training for healthcare students with very-low certainty evidence, high-quality replications and improved study designs (e.g. a consensus on the definition of resilience, the assessment of individual stressor exposure, more attention controls, and longer follow-up periods) are clearly needed.

Psychological interventions to foster resilience in healthcare professionals

BACKGROUND

Resilience can be defined as the maintenance or quick recovery of mental health during or after periods of stressor exposure, which may result from a potentially traumatising event, challenging life circumstances, a critical life transition phase, or physical illness. Healthcare professionals, such as nurses, physicians, psychologists and social workers, are exposed to various work-related stressors (e.g. patient care, time pressure, administration) and are at increased risk of developing mental disorders. This population may benefit from resilience-promoting training programmes.

OBJECTIVES

To assess the effects of interventions to foster resilience in healthcare professionals, that is, healthcare staff delivering direct medical care (e.g. nurses, physicians, hospital personnel) and allied healthcare staff (e.g. social workers, psychologists).

SEARCH METHODS

We searched CENTRAL, MEDLINE, Embase, 11 other databases and three trial registries from 1990 to June 2019. We checked reference lists and contacted researchers in the field. We updated this search in four key databases in June 2020, but we have not yet incorporated these results.

SELECTION CRITERIA

Randomised controlled trials (RCTs) in adults aged 18 years and older who are employed as healthcare professionals, comparing any form of psychological intervention to foster resilience, hardiness or post-traumatic growth versus no intervention, wait-list, usual care, active or attention control. Primary outcomes were resilience, anxiety, depression, stress or stress perception and well-being or quality of life. Secondary outcomes were resilience factors.

DATA COLLECTION AND ANALYSIS

Two review authors independently selected studies, extracted data, assessed risks of bias, and rated the certainty of the evidence using the GRADE approach (at post-test only).

MAIN RESULTS

We included 44 RCTs (high-income countries: 36). Thirty-nine studies solely focused on healthcare professionals (6892 participants), including both healthcare staff delivering direct medical care and allied healthcare staff. Four studies investigated mixed samples (1000 participants) with healthcare professionals and participants working outside of the healthcare sector, and one study evaluated training for emergency personnel in general population volunteers (82 participants). The included studies were mainly conducted in a hospital setting and included physicians, nurses and different hospital personnel (37/44 studies). Participants mainly included women (68%) from young to middle adulthood (mean age range: 27 to 52.4 years). Most studies investigated group interventions (30 studies) of high training intensity (18 studies; > 12 hours/sessions), that were delivered face-to-face (29 studies). Of the included studies, 19 compared a resilience training based on combined theoretical foundation (e.g. mindfulness and cognitive-behavioural therapy) versus unspecific comparators (e.g. wait-list). The studies were funded by different sources (e.g. hospitals, universities), or a combination of different sources. Fifteen studies did not specify the source of their funding, and one study received no funding support. Risk of bias was high or unclear for most studies in performance, detection, and attrition bias domains. At post-intervention, very-low certainty evidence indicated that, compared to controls, healthcare professionals receiving resilience training may report higher levels of resilience (standardised mean difference (SMD) 0.45, 95% confidence interval (CI) 0.25 to 0.65; 12 studies, 690 participants), lower levels of depression (SMD -0.29, 95% CI -0.50 to -0.09; 14 studies, 788 participants), and lower levels of stress or stress perception (SMD -0.61, 95% CI -1.07 to -0.15; 17 studies, 997 participants). There was little or no evidence of any effect of resilience training on anxiety (SMD -0.06, 95% CI -0.35 to 0.23; 5 studies, 231 participants; very-low certainty evidence) or well-being or quality of life (SMD 0.14, 95% CI -0.01 to 0.30; 13 studies, 1494 participants; very-low certainty evidence). Effect sizes were small except for resilience and stress reduction (moderate). Data on adverse effects were available for three studies, with none reporting any adverse effects occurring during the study (very-low certainty evidence).

AUTHORS' CONCLUSIONS

For healthcare professionals, there is very-low certainty evidence that, compared to control, resilience training may result in higher levels of resilience, lower levels of depression, stress or stress perception, and higher levels of certain resilience factors at post-intervention. The paucity of medium- or long-term data, heterogeneous interventions and restricted geographical distribution limit the generalisability of our results. Conclusions should therefore be drawn cautiously. The findings suggest positive effects of resilience training for healthcare professionals, but the evidence is very uncertain. There is a clear need for high-quality replications and improved study designs.

Humor as a protective factor against anxiety and depression

Background/Objectives

Even though humor its part of everyday life, only in the last 40 years has Psychology begun to discern its impact on mental health. The aim of this paper is to explore the role that humor styles may have as protectors against anxiety and depression and their relationship with optimism.

Method

A sample of 804 participants (M = 39.28; SD = 14.71) was used to analyze the uses of humor, optimism and clinical symptoms of anxiety and depression. In addition, the influence of sociodemographic variables such as sex, geographic location, age and educational level on different uses of humor was studied. Through an analysis of structural equations, the variables that had a protective or facilitating role in depression and anxiety were analyzed.

Results

Men and women differ in the use of a more aggressive humor style, and the use of affiliative humor styles decreases with age. The structural equation model indicated a good fit to the proposed theoretical model.

Conclusions

Humor is a tool of everyday life and it can act for or against an individual’s mental health.

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.

Humor Styles and the Intolerance of Uncertainty Model of Generalized Anxiety

Past research suggests that sense of humor may play a role in anxiety. The present study builds upon this work by exploring how individual differences in various humor styles, such as affiliative, self-enhancing, and self-defeating humor, may fit within a contemporary research model of anxiety. In this model, intolerance of uncertainty is a fundamental personality characteristic that heightens excessive worry, thus increasing anxiety. We further propose that greater intolerance of uncertainty may also suppress the use of adaptive humor (affiliate and self-enhancing), and foster the increased use of maladaptive self-defeating humor. Initial correlational analyses provide empirical support for these proposals. In addition, we found that excessive worry and affiliative humor both served as significant mediators. In particular, heightened intolerance of uncertainty lead to both excessive worry and a reduction in affiliative humor use, which, in turn, increased anxiety. We also explored potential humor mediating effects for each of the individual worry content domains in this model. These analyses confirmed the importance of affiliative humor as a mediator for worry pertaining to a wide range of content domains (e.g., relationships, lack of confidence, the future and work). These findings were then discussed in terms of a combined model that considers how humor styles may impact the social sharing of positive and negative emotions.

Hedonic Hotspots Regulate Cingulate-driven Adaptation to Cognitive Demands

Positive hedonic states are known to attenuate the impact of demanding events on our body and brain, supporting adaptive behavior in response to changes in the environment. We used functional magnetic resonance imaging to examine the neural mechanism of this hedonic regulation. The effect of hedonic state (as induced by funny vs. neutral cartoons) on flexible behavioral and neural adaptation to cognitive demands was assessed in a flanker task in female volunteers. Behavioral results showed that humor reduced the compensatory adjustments to cognitive demands, as observed in sequential adaptations. This modulation was also reflected in midcingulate cortex (MCC; also known as the dorsal anterior cingulate cortex, ACC) activation. Furthermore, hedonic context increased activation in ventral striatum (VS) and ventral pallidum (VP). These hedonic hotspots attenuated the medial prefrontal cortex response to the cognitive demands in the ACC (also known as the rostral ACC). Activity in the ACC proved predictive of subsequent behavioral adaptation. Moreover, psychophysiological interaction analyses revealed that the MCC and the ACC were functionally connected with VS and VP, respectively. These observations reveal how MCC-VS and VP-ACC interactions are involved in the detection and hedonic modulation of behavioral adaptations to cognitive demands, which supports behavioral flexibility.

The purpose and function of humour in health, health care and nursing: a narrative review

AIM

This paper is a report of a review conducted to identify, critically analyse and synthesize the humour literature across a number of fields related to health, health care and nursing.

BACKGROUND

The humour-health hypothesis suggests that there is a positive link between humour and health. Humour has been a focus of much contention and deliberation for centuries, with three theories dominating the field: the superiority or tendentious theory, the incongruity theory and the relief theory.

DATA SOURCES

A comprehensive literature search was carried out in January 2007 using a number of databases, keywords, manual recursive searching and journal alerts (January 1980-2007) cross-referenced with the bibliographic databases of the International Society of Humor Studies. An inclusion and exclusion criterion was identified.

REVIEW METHODS

A narrative review of evidence- and non-evidence-based papers was conducted, using a relevant methodological framework with additional scrutiny of secondary data sources in the latter. Humour theories, incorporating definition, process and impact constituted a significant part of the appraisal process.

RESULTS

A total of 1630 papers were identified, with 220 fully sourced and 88 included in the final review. There is a dearth of humour research within nursing yet, ironically, an abundance of non-evidence-based opinion citing prerequisites and exclusion zones. Examination of physician-patient interaction and the humour-health hypothesis demonstrates that use of humour by patients is both challenging and revealing, particularly with regard to self-deprecating humour.

CONCLUSION

Nurses and nursing should adopt a circumspect and evidenced-based approach to humour use in their work.

Relations of humor with perceptions of stress

Humor has cognitive, emotional, and behavioral components but may be conceptualized as a multidimensional personality trait, comprised of both negative and positive dimensions and styles. Sense of humor may influence other evaluations of life, including perception of stress. Analysis of responses from 51 community adults and 131 undergraduates in psychology, nonrepresentative, random samples, indicated that styles of humor were correlated with self-perception of perceived stress; the largest correlations account for less than 50% of the common variance. Results are discussed in terms of their theoretical links to coping literature, potential for therapeutic interventions, and areas for research.