[Humor therapy in the depressed elderly: results of an empirical study]

A lighthearted approach to mindfulness: development and evaluation of a humor-enriched mindfulness-based program in a randomized trial

Objectives

Recently, research on mindfulness and humor has begun to spark interest, both being essential contributors to well-being. This article proposes that forms of humor that share intention and attitudinal foundations with mindfulness, constitute the foundation of a mindful-humorous perspective and mindful humor. Once intention and attitude are in alignment, shared mechanisms underlying a mindful-humorous perspective may lead to synergetic effects (e.g., reinforcing a shift in perspective and attitudinal foundations) as summarized in the proposed mindful humor filter model (MHFM). Based on this theoretical framework, the humor-enriched mindfulness-based program (HEMBP) was developed and evaluated for validity and efficacy in a randomized controlled trial as a first step to test the newly introduced model.

Methods

A total of 60 participants were randomly allocated to either the HEMBP or a wait-list control group. Participants' mindfulness, comic styles (e.g., benevolent humor, sarcasm, and cynicism), psychological well-being, life satisfaction, stress, and gelotophobia (fear of being laughed at) were assessed 1 week before and after training, and at a 1-month follow-up. Linear mixed-effects models were fitted to model changes in outcome variables over time.

Results

The HEMBP was effective in increasing mindfulness, benevolent humor, and psychological well-being, and in reducing sarcasm, cynicism, stress, and gelotophobia, compared to the control group.

Conclusion

Results support the validity and efficacy of the HEMBP as a promising approach for improving well-being and reducing stress. The HEMBP broadens the scope of existing mindfulness-based programs by cultivating a mindful-humorous outlook on life, facilitating mindfulness practice and insights, and fostering positive emotions and relationships with others through mindful humor. Results are also suggestive of the validity of the mindful humor filter model.

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.

The Association between Laughter and Functional Dyspepsia in a Young Japanese Population

The potential health benefits of laughter are recognized in relation to several chronic diseases. However, no study has yet investigated the association between laughter and functional dyspepsia (FD). The purpose of this study was to investigate this issue in a young Japanese population.

METHODS

This study was conducted on 8923 Japanese university students. Information on the frequency of laughter and types of laughter-inducing situations, digestive symptoms (Rome III criteria) were obtained through a self-administered, web-based questionnaire.

RESULTS

The percentage of respondents who laughed out loud almost every day was 64.3%. On the other hand, 1.8% of the subjects reported that they rarely laughed. No association was found between the total frequency of laughter and FD. Laughing while talking with family and friends almost every day was significantly inversely associated with FD (adjusted odds ratio (OR): 0.47 (95% confidence interval (CI): 0.28-0.81); p for trend was 0.003). On the other hand, laughing while watching TV or videos and laughing while looking at comics or magazines independently showed a positive correlation with FD (TV or videos: adjusted OR, 1-5 times a week: 1.74 (95% CI: 1.16-2.60); comics or magazines: adjusted OR, 1-5 times a week: 1.78 (95% CI: 1.08-2.81)).

CONCLUSION

In this young Japanese population, no association between laughter frequency and FD was observed although laughing while talking with friends and family was independently and inversely associated with FD.

Autobiographical Memory, Gratitude, Forgiveness and Sense of Humor: An Intervention in Older Adults

Research has shown that happiness and well-being play a fundamental role in the health of older adults. For this reason, programs based on Positive Psychology seek to improve quality of life, preventing and reducing the appearance of emotional disorders. The objective of this study was to verify whether an intervention based on Autobiographical Memory, Forgiveness, Gratitude, and Sense of humor would increase quality of life in institutionalized older adults. We used a quasi-experimental design with pre- and post-intervention measures and follow-on measures at 3, 6, and 12 months. A total of 111 institutionalized older adults participated in the study and were randomly assigned to one of three groups: experimental (n = 36), placebo (n = 39), and control (n = 36). Measurements were taken of depression, subjective happiness, satisfaction with life, psychological well-being, and specific memories. Program duration was 11 weeks, followed by refresher sessions of the activities that had been conducted. The results showed that the intervention was effective, producing lasting increase in the participating adults' well-being, maintained for the following 12 months, in contrast to the other two groups. In conclusion, the proposed intervention proved to be a novel tool that was effective, easily applied, and able to improve quality of life and emotional disorders in older adults.

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.

Development and Validation of the Short Version of the Sense of Humor Scale (SHS-S)

Abstract. Humor training has become increasingly popular to enhance the “sense of humor” and well-being and to decrease depressive symptoms. Despite the wide applications of these training programs, the assessment of training efficacy has attracted less attention. The Sense of Humor Scale (SHS; McGhee, 1996 , 1999 ) recently was expanded to a long version (SHS-L) to enhance its internal consistency ( Ruch & Heintz, 2018 ). At the same time, there is also the need for a brief version of this scale. The purpose of the present study is to develop a short version (SHS-S) in both German- and English-speaking countries, test its psychometric properties (internal consistency, factorial, construct, and criterion validity), and assess measurement invariance across gender and the two languages. Using three samples (Sample 1: 570 English-speakers, Sample 2: 353 German-speakers, Sample 3: 94 other-reports), the 29-item SHS-S was developed and yielded promising internal consistency and validity scores for the six humor skill factors of enjoyment of humor, laughter, verbal humor, finding humor in everyday life, laughing at yourself, and humor under stress. Overall, the SHS-S is an internally consistent, valid, and economic tool for future research and group-based applications, while the SHS-L seems especially useful in individual applications.

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.

Does Laughter Predict Onset of Functional Disability and Mortality Among Older Japanese Adults? The JAGES Prospective Cohort Study

Background

While laughter is broadly recognized as a good medicine, a potential preventive effect of laughter on disability and death is still being debated. Accordingly, we investigated the association between the frequency of laughter and onset of functional disability and all-cause mortality among the older adults in Japan.

Methods

The data for a 3-year follow-up cohort including 14,233 individuals (50.3% men) aged ≥65 years who could independently perform the activities of daily living and participated in the Japan Gerontological Evaluation Study were analyzed. The participants were classified into four categories according to their frequency of laughter (almost every day, 1–5 days/week, 1–3 days/month, and never or almost never). We estimated the risks of functional disability and all-cause mortality in each category using a Cox proportional hazards model.

Results

During follow-up, 605 (4.3%) individuals developed functional disability, identified by new certification for the requirement of Long-Term Care Insurance, and 659 (4.6%) deaths were noted. After adjusting for the potential confounders, the multivariate-adjusted hazard ratio of functional disability increased with a decrease in the frequency of laughter (P for trend = 0.04). The risk of functional disability was 1.42 times higher for individuals who laughed never or almost never than for those who laughed almost every day. No such association was observed with the risk of all-cause mortality (P for trend = 0.39).

Conclusions

Low frequency of laughter is associated with increased risks of functional disability. Laughter may be an early predictor of functional disability later on in life.

Effect of Positive Psychotherapy on Psychological Well-Being, Happiness, Life Expectancy and Depression Among Retired Teachers with Depression: A Randomized Controlled Trial

Despite conducting numerous positive psychotherapy (PPT) tests, the effects of such activities in participants aged 50 and above have been dealt with by few studies. Therefore, the effects of PPT on psychological well-being (PWB), happiness, expectancy life (LX) and depression of retired teachers with depression, was investigated using a randomized controlled trial. In this study, 60 female teachers aged 55-80 years, who obtained the lowest scores in the Beck Depression Inventory-II (BDI-II), were randomly divided into the two PPT (n = 30) and untreated groups (n = 30) at the time of entering the study and 2 months later following their assessments through the Psychological Well-Being Scales-Short (PWBS-S), Oxford Happiness Inventory (OHI), Adult Hope Scale (AHS) and BDI-II. The PPT and untreated groups took part in 10 group sessions and underwent no interventions, respectively. The study was completed with a total number of 52 female teachers (n = 26 per group). The PPT group showed some effectiveness on the variables of PWBS-S, OHI, AHS and BDI-II in a way that the involved retired teachers with depression increased their PWB, happiness and LE after PPT training and teachers reduced their BDI-II after intervention (p < 0.05). PPT can be used in order to increase the level of PWB, happiness, and LX, along with depression symptoms decreasing amongst retired teachers with the age of 55, and also more than that.

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.

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.

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.

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.

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.

"A joke a day keeps the doctor away?" Meta-analytical evidence of differential associations of habitual humor styles with mental health

Humor and mental health are interconnected as is evidenced by a large number of studies. However, associations are only small and inconsistent as the operationalization of humor poses a methodological challenge. The Humor Styles Questionnaire (HSQ) differentiates four humor styles that might be beneficial or harmful to mental health. The aim of the present study was to meta-analytically aggregate studies using the HSQ to assess the associations of different humor styles with four areas of mental health (self-esteem, life satisfaction, optimism, depression). An extensive electronic database literature search identified 37 studies that reported correlations between the HSQ scales and the four areas of mental health in 45 independent samples (total N = 12,734). In total, 16 meta-analyses were conducted. Moderating effects of participant age, sex, and geographic region were examined via subgroup analyses and meta-regression. Humor styles differed in terms of their associations with mental health. Health-promoting humor styles were overall positively correlated with mental health (small-to-medium effect sizes). Self-defeating humor was overall negatively correlated with mental health. Aggressive humor was overall unrelated with mental health. Moderator analyses suggested geographic differences (Eastern vs. Western samples) and sex differences for some of these associations. Fostering specific humor styles may be beneficial for mental health. In addition, observing the habitual use of humor styles might help therapists to develop a better understanding of their clients. Differences in the utilization and the correlates of humor styles in Eastern and Western societies, and sex differences, need to be addressed in future research.

The effect of laughter therapy on the quality of life of nursing home residents

AIMS AND OBJECTIVES

To evaluate the effect of Laughter therapy on the quality of life of nursing home residents.

BACKGROUND

By improving the quality of life of residents living in nursing homes and allowing them to have a healthier existence, their lives can be extended. Therefore, interventions impacting the quality of life of older adults are of critical importance.

DESIGN

Quasi-experimental design.

METHOD

The study was conducted between 2 March - 25 May 2015. The experimental group was composed of 32 nursing home residents from one nursing home, while the control group consisted of 33 nursing home residents from another nursing home in the capital city of Turkey. Laughter therapy was applied with nursing home residents of the experimental group two days per week (21 sessions in total). A socio-demographic form and the Short-Form Health Survey (SF-36) were used for data collection.

RESULTS

After the laughter therapy intervention, general and subscales (physical functioning, role-physical, bodily pain, general health, vitality, social functioning, role-emotional and spiritual health) quality-of-life scores of residents in the experimental group significantly increased in comparison with the pretest.

CONCLUSION

Laughter therapy improved the quality of life of nursing home residents. Therefore, nursing home management should integrate laughter therapy into health care and laughter therapy should be provided as a routine nursing intervention.

RELEVANCE TO CLINICAL PRACTICE

The results indicated that the laughter therapy programme had a positive effect on the quality of life of nursing home residents. Nurses can use laughter therapy as an intervention to improve quality of life of nursing home residents.

Laughter and Subjective Health Among Community-Dwelling Older People in Japan: Cross-Sectional Analysis of the Japan Gerontological Evaluation Study Cohort Data

The aim of this study was to evaluate the association of laughter with subjective health independent of socioeconomic status and social participation among older people in Japan. We used the data of 26,368 individuals (men, 12,174; women, 14,194) 65 years or older who participated in the Japan Gerontological Evaluation Study (JAGES) in 2013. Participants provided information on laughter and self-rated health, depression, socioeconomic, and psychosocial factors. We evaluated laughter from three perspectives: frequency, opportunities, and interpersonal interactions. Even after adjustment for depression, sociodemographic factors, and social participation, the prevalence ratio for poor subjective health among women who never or almost never laugh was 1.78 (95% confidence interval, 1.48-2.15) compared with those who reported laughing every day. Similar associations were observed among men. Laughter may be an important factor for the promotion of general and mental health of older adults. The mechanisms linking laughter and health warrant further study.

Positive psychology interventions in people aged 50-79 years: long-term effects of placebo-controlled online interventions on well-being and depression

OBJECTIVES

Various positive psychology interventions have been experimentally tested, but only few studies addressed the effects of such activities in participants aged 50 and above.

METHOD

We tested the impact of four self-administered positive psychology interventions in an online setting (i.e., gratitude visit, three good things, three funny things, and using signature strengths in a new way) on happiness and depressive symptoms in comparison with a placebo control exercise (i.e., early memories). A total of 163 females aged 50-79 tried the assigned interventions or the placebo control exercise for one week and completed measures on happiness and depressive symptoms at five times (pre- and post-test, 1, 3, and 6 months).

RESULTS

Three out of the four interventions (i.e., gratitude visit, three good things, and using signature strengths in a new way) increased happiness, whereas two interventions (three funny things and using signature strengths in a new way) led to a reduction of depressive symptoms on at one post-measure.

CONCLUSION

Positive psychology interventions yield similar results for people aged 50 and above as for younger people. The dissemination of such interventions via the Internet offers a valuable opportunity for older age groups as well.

Evaluation of a standardized humor group in a clinical setting: a feasibility study for older patients with depression

BACKGROUND

Positive effects of humor on older patients with depressive symptoms have been repeatedly reported. Empirical evidence however is rare. We investigated the efficacy of a standardized humor therapy group in a clinical context especially for older depressed patients.

PATIENTS AND METHODS

An experimental group with treatment (49 patients) was compared with a control group with no treatment (50 patients) in a semi-randomized design. Included were patients with major depression according to ICD-10. A set of questionnaires (Geriatric Depression Scale, Short Form Health Survey, State-Trait-Cheerfulness Inventory, and Satisfaction with Life Scale) was administered pretreatment and posttreatment.

RESULTS

Both groups showed improvement for depression, suicidal tendency, state cheerfulness, and state bad mood. Only participants of the humor group showed changes of state seriousness and satisfaction with life (p < 0.05). Further trends could be demonstrated for higher changes in state cheerfulness and resilience for the humor group.

CONCLUSION

Our results indicate an additional benefit of this specific therapeutic intervention for older depressed patients.