For individuals suffering from psychological distress the benefits associated with humour and laughter have displayed some promise. Research studies have yielded promising results in regard to the ability of humour and laughter to help increase resilience (Cann & Collette, 2014; Konradt, Hirsch, Jonitz, & Junglas., 2013), and improve levels of self-efficacy and optimism (Crawford & Caltabiano, 2011). Humour use has also been associated with improved coping strategies (Falkenberg, Buchkremer, Bartels, & Wild., 2011) and higher levels of global and social self-esteem (Kuiper, Kirsh, & Maiolino, 2016). Additionally, previous research has found that increasing some individuals use and enjoyment of humour can result in decreased levels of perceived stress, anxiety and depression (Crawford & Caltabiano, 2011). This study is the first of its kind to pilot an innovative educational and importantly ‘individualized program’ that combines the methodologies of humour therapy and laughter therapy into one educational model delivered to a patient in receipt of mental health treatment.
Aim: The overall aim of the pilot study is to determine whether an individually delivered educational program which combined the theories and principles of humour therapy and laughter therapy can reduce baseline levels of depression, anxiety and stress as measured by the Depression Anxiety Stress Scale (Lovibond & Lovibond, 1995) (DASS). A specific aim was to assess participant ability to increase their use of affiliative and self-enhancing humour styles after having been taught skills aimed at enabling and encouraging them to do so. Humour style use was identified and measured using the Humor Styles Questionnaire developed by (Martin, Patricia, Larsen, Gray, & Weir, 2003). A subsequent aim of this study was to investigate the procedures associated with the delivery of the program.
Participants: A total of seven individuals (4 male and 3 female) were purposively recruited from two private mental health clinics in the South East Queensland Service region. The age range of participants was 19 to 71 (average age 38.42) with diagnoses ranging from mild to moderate depression as assessed by participants’ treating clinicians. All participants were in treatment for not less than three months prior to engaging in the study and all volunteered to engage in the Humour and Laughter Education HALE program as an adjunct to their existing and ongoing treatment (either psychological or psychiatric).
Procedure: Participants attended five one-hour sessions that focused on enhancing knowledge and awareness of the four different styles of humour and how each style relates to either psychological well-being or negative well-being. A specific educational focus was on increasing the use of the adaptive humour styles of affiliative and self-enhancing humour. As part of the HALE intervention, participants were encouraged to complete specific homework tasks in-between sessions, which involved the sourcing of humour-based material and the implementation of self-initiated daily laughter therapy sessions.
Results: Results indicated positive outcomes for all participants. All constructs of depression, anxiety and stress exhibited a decrease over the five sessions as measured by the DASS, however the biggest decline was observed for depression which saw an approximate 10-point decline from weeks 1 to 5. DASS scores for anxiety and stress symptoms displayed drops in scores of approximately 3.5 and 7 respectively. Constructs of the four humour styles showed an increase in the use of both affiliative and self-enhancing humour, however the use of aggressive and self-defeating humour remained stable over the study period. The biggest increase was observed in the use of self-enhancing humour, with an average increase of 10-points between weeks 1 and 5. All study participants reported self-initiating laughter therapy sessions once they had established a personal ‘Laughter Library’. Of the 7 participants, one reported using multiple short 3-5-minute laughter therapy session throughout the day to increase their mood, with the remaining six participants choosing a single 20-30-minute laughter therapy session which usually took place late evening.
Discussion and limitations: The data collected from this research demonstrated various positive outcomes for participants. The increase in participants use of self-enhancing humour coupled with decreases in levels of depression across the study group is worthy of further investigation. The limitations of this pilot study include the very small number of participants, resulting in an inability to detect true power and undertake more appropriate statistical analysis in the obtained differences on measures post HALE. Another limitation of this study lies with the exclusive use of self-report questionnaires for the assessment of psychological well-being. Further to this, at the time of the study, all participants were under the clinical care of a psychologist, therefore, the author acknowledges the limitations associated with drawing conclusions as to the effectiveness of the program to improve psychological well-being, it is therefore proposed that future research should focus on using an experimental design. Despite these limitations, the strength of this study is that it has investigated previously untested methodologies relating to the individual delivery and tailoring of humour and laughter therapy, and its findings display a level of consistency associated with previous research. The results have also contributed to new knowledge around what is helpful for increasing individuals’ use of self-enhancing humour to reduce psychological distress. The future development and research directions of the Humour and Laughter Education HALE program are also discussed in this paper.