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The Cognitive Neuroscience of Humor

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 8
The Effects of Humor
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on the Mind and Body

P revious chapters reviewed how humor is influenced by many different

factors. In contrast, this chapter examines how humor influences other
factors, including an individual’s health and well-being. A growing body of
research shows that experiencing humor and other forms of positive mood
influence the body and the mind for the better. The majority of these studies
reflect a subfield within psychology known as positive psychology. This
relatively young field of psychology is focused on investigating aspects of
normal and extraordinary functioning, which contrasts with the focus on
atypical functioning in mainstream psychology (Maslow, 1954; Seligman &
Csikszentmihalyi, 2000). Without the growing number of scientific studies on
the topic, we might mistakenly conclude that the idea that humor benefits
health is too good to be true. This chapter reviews studies showing links
between humor and health and discusses studies that detail humor’s multiple
effects on the body. Last, the chapter takes a look at studies that have attempted
to demonstrate that brief humor interventions produce measurable improve-
ments in health.

HUMOR AND HEALTH

Over the last several decades, a consensus has emerged that there are
links between humor and health (Allport, 1961; Carroll, 1990; Carroll &
Shmidt, 1992; Cousins, 1985; Dillon & Totten, 1989; Dyck & Holtzman, 2013;

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The Cognitive Neuroscience of Humor, by S. M. Kennison
Copyright © 2020 by the American Psychological Association. All rights reserved.
109
 110 The Cognitive Neuroscience of Humor

P. S. Fry, 1995; J. H. Goldstein, 1982; Pressman & Cohen, 2005; Ruch & Köhler,
1999; Stewart & Thompson, 2015; Walsh, 1928). Nevertheless, the research
on the topic has yielded conflicting results. In studies examining the relation-
ship between humor and measures of physical health, some studies have
failed to find that higher levels of sense of humor are related to better health
(A. Clark et al., 2001; Kerkkänen et al., 2004) or have found significant trends
in which humor explained only a small amount of the overall variance in
outcome variables (Svebak et al., 2004). L. R. Martin et al. (2002) found evidence
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that trait cheerfulness was significantly related to longevity. However, in a study

in which the biographies of professional comics were examined, Rotton (1992)
found no support for the possibility that they lived longer than others.
In the largest study of its kind, Svebak et al. (2004) investigated the
relationship between sense of humor and health. They surveyed over
65,000 Norwegians, asking them questions about their sense of humor, health
status, health satisfaction, health complaints, body mass index, and blood
pressure. Overall, higher health satisfaction was found among those who
rated their own sense of humor as high. Those with higher senses of humor
had lower blood pressure. In statistical analyses that controlled for age of the
respondents, Svebak et al. found that these significant correlations ultimately
explained a relatively small amount of the variance in blood pressure and
health satisfaction scores. They concluded that the results were fairly weak
in supporting a link between sense of humor and health.
More recent studies using similar methods produced stronger evidence for
the link between humor and health (Romundstad et al., 2016; Svebak et al.,
2006, 2010). Svebak et al. (2006) examined possible health benefits from
individual differences in sense of humor among a sample of patients diagnosed
with kidney failure who received regular dialysis. The study was carried out
over 2 years. After controlling for sex, age, education, and disease severity
measures, sense of humor was found to significantly predict quality of life
and likelihood of survival from the beginning of the study to the end of the
study. In a larger study, Svebak et al. (2010) investigated the relationship
between sense of humor and mortality among a sample of adults in Norway.
They included measures of sense of humor in a public health survey of over
50,000 respondents. The results showed that the likelihood of living to retire-
ment age increased with self-reported sense of humor even when self-reported
health status was controlled. The relationship was similar for men and women.
Romundstad et al. (2016) investigated the relationship between humor and
mortality in a large population-based study involving 53,556 individuals living
in Norway with a follow up after 15 years. Multiple facets of individuals’
sense of humor (i.e., affective, social, and cognitive) were assessed. The cogni-
tive facet of sense of humor predicted overall mortality, cardiovascular deaths,
and deaths caused by chronic obstructive pulmonary disease (COPD), cancer,
and infections.
The benefits of humor on well-being and/or mental health have been
demonstrated in a growing number of studies, many of them documenting
 The Effects of Humor on the Mind and Body 111

the positive relationship between humor and measures of well-being (Doosje

et al., 2010, 2012; Lockwood & Yoshimura, 2014), life satisfaction (Lockwood
& Yoshimura, 2014; Peterson et al., 2007; Ruch et al., 2010), purpose in life
(Mak & Sörensen, 2018), zest for life (Celso et al., 2003), and greater morale
(Simon, 1990). There is a fairly large literature demonstrating that humor
may be useful to those coping with stress (Bizi et al., 1988; Kuiper et al., 1993,
1998; R. A. Martin et al., 1993; Marziali et al., 2008). Other studies have
shown that higher levels of humor predict lower levels of depression (C. A.
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Anderson & Arnoult, 1989; Nezu et al., 1988; Overholser, 1992; Porterfield,
1987; Safranek & Schill, 1982; Thorson & Powell, 1994; Thorson et al., 1997).
However, other studies have failed to find benefits of humor among patients
with serious physical illness (Merz et al., 2009) and psychiatric disorders
(Freiheit et al., 1998).
There have been studies exploring the relationship between the use of
positive and negative humor styles and depression in adults (Frewen et al.,
2008; Schneider et al., 2018) and adolescents (C. L. Fox et al., 2016). For
example, Frewen et al. (2008) found that individuals who reported greater
use of the self-defeating humor style and less use of the affiliative and self-
enhancing humor styles reported more depression than others. Dyck and
Holtzman (2013) showed that there were links between positive humor styles
and well-being related to perceived increases in social support. Similar results
have been observed by Sirigatti et al. (2016). In a meta-analysis that examined
37 studies in which humor styles were correlated with mental health variables
(e.g., depression, life satisfaction, optimism, self-esteem), Schneider et al.
(2018) found that the use of the self-defeating humor style predicted lower
levels of mental health. However, the strength of the relationship appeared
to vary by sex and by geographical region of the United States in which
participants were residing.
Research also shows that greater use of positive humor styles (i.e., affiliative
and self-enhancing) and less use of negative humor styles (i.e., aggressive
and self-defeating) may facilitate social relationships (Yip & Martin, 2006).
Supportive social relationships have been shown to be related to better health
(Holt-Lunstad & Uchino, 2015). Boyle and Joss-Reid (2004) examined the
relationships between humor and health in college students, adults from
the community with no health issues, and adults with a health issue. The
results indicated that individuals reporting higher levels of humor reported
better health.
Tucker, Judah, et al. (2013) investigated whether humor styles would
moderate the relationship between anxiety and depression, and found that
two of the humor styles (affiliative and self-defeating) confirmed this theory.
In a follow up study, Tucker, Wingate, et al. (2013) explored how humor styles
were related to factors known to predict suicidal ideation (e.g., perceived
burdensome and thwarted belongingness). Interestingly, they found that when
participants’ level of depression was considered, self-defeating and affiliative
humor styles moderated the relationship between these factors and suicidal
ideation.
 112 The Cognitive Neuroscience of Humor

PHYSIOLOGICAL EFFECTS OF HUMOR

Over the last 100 years, researchers have documented how experiencing
humor affects our bodies. This section reviews the evidence that experiencing
humor leads to increased arousal in the sympathetic nervous system (Ulrich-Lai
& Herman, 2009), activating the adrenal glands and processing in the brain-
stem. Second, the chapter reviews evidence that humor leads to activation of
the hypothalamic–pituitary–adrenocortical (HPA) axis, which is involved in
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our responses to stress. Last, the chapter covers the growing body of research
documenting humor’s effects on the immune system and the research on
humor’s effects on pain perception, which appear to be related to increases
in the release of endorphins in the brain during humorous experiences.

Activation of the Sympathetic Nervous System

The sympathetic nervous system (e.g., the “fight-or-flight” system; Sapolsky,

1994) is activated during episodes of anger or fear, as well as amusement, which
leads to changes in breathing, muscle tone, heart rate, and skin conductance
(e.g., increased physiological arousal; Mauss & Robinson, 2010) and changes
in the levels of some hormones (e.g., epinephrine, norepinephrine). Among
the earliest observations about the effects of humor on bodily function related
to the expansion of the lungs and increases in breathing that occurs during
laughter (W. F. Fry, 1992, 1994; W. F. Fry & Rader, 1977; W. F. Fry & Stoft,
1971; Lackner et al., 2013, 2014; Lloyd, 1938; Svebak, 1975). Lloyd (1938)
pointed out that during laughter, there is an initial strong exhalation that is
followed by smaller ones, often accompanied by a sequence of vocalizations
(e.g., ha ha). Because the exhalations during laughter empty a majority of the
air in the lungs, there is increased breathing immediately following the laughter.
The increase in breathing is estimated to be over twice the level of normal
breathing. The increased exhalation is brought about by muscle contractions
in the body’s trunk, which do not occur during normal breathing (Ruch &
Ekman, 2001). W. F. Fry and Stoft (1971) found that levels of oxygen in the
blood were higher following a humor experience. W. F. Fry (1994) compared
vigorous laughter with a brief session of aerobic exercise (see also Szabo, 2003;
Szabo et al., 2005).
Muscles are also acutely affected during experiences leading to mirth and
laughter. In some languages, a common descriptor of people having a good
time is that they were “weak with laughter” (Overeem et al., 1999). Research
suggests that the expression has a basis in fact. As early as the 1930s, there
was evidence supporting the link between mirth and muscle weakness during
laughter (Paskind, 1932; Prerost & Ruma, 1987; Wagner et al., 2014). Recent
studies have shown that there is reduced muscle tone during mirth and
laughing (Overeem et al., 1999, 2004), specifically the Hoffman’s reflex, which
was produced in participants by nerve stimulation using electromyography.
Participants experiencing humor or mirth showed a nearly 90% reduction in
 The Effects of Humor on the Mind and Body 113

muscle response. Overeem et al. (2004) examined whether the muscle effects
were due to mirth only or the breathing and movement occurring during
the mirth response. Their results confirmed that the cause was mirth alone.
Reductions in Hoffman’s reflex can also be observed when pressure is applied
to a muscle, as in manual massage (Goldberg et al., 1992).
Changes in blood pressure during and following humor have been examined
(W. F. Fry & Savin, 1988; Lefcourt et al., 1997; White & Camarena, 1989).
W. F. Fry and Savin (1988) observed increases in blood pressure following
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a bout of laughter accompanied by mirth, which were rapidly followed by

reductions in blood pressure that were lower than individuals’ baseline blood
pressure level. In contrast, White and Camarena (1989) found no evidence
for significant changes in blood pressure following a humor experiment. They
randomly assigned participants to one of three groups: a relaxation training
group, a laughter group, or a control group. Each group met weekly over
6 weeks for 90 minutes. Compared with the control group, the laughter group
showed lower levels of self-reported stress but did not differ in physiological
measures (i.e., heart rate and blood pressure).
Numerous studies have examined possible changes in heart rate as the
result of experiencing humor (Averill, 1969; Fiacconi & Owen, 2015; Foster
et al., 2002; Giuliani et al., 2008; Godkewitsch, 1974, 1976; J. H. Goldstein
et al., 1975; Herring et al., 2011; Hubert & de Jong-Meyer, 1990, 1991; J. M.
Jones & Harris, 1971; Lackner et al., 2013, 2014; Langevin & Day, 1972; Marci
et al., 2004). Averill (1969) showed that humor processing was associated
with increases in heart rate and skin conductance. The results suggest that
humor processing involves an increase in arousal within the sympathetic
nervous system. Langevin and Day (1972) demonstrated that the increases
in heart rate and skin conductance were greater when participants rated the
stimuli as more humorous. Godkewitsch (1974, 1976) measured heart rate
and skin conductance as participants comprehended simple jokes with
punchlines. He found that during the processing of the setup of the joke and
the punchline, skin conductance increased as rated humorousness increased.
There was an increase in heart rate related to the humorousness of jokes
during the processing of the punchlines.
Giuliani et al. (2008) investigated the effects of brief movie clips involving
amusement. Participants were randomly assigned to one of three groups.
The first group was asked to watch the clips with no further instruction. The
second group was instructed to try to increase the amusement that they
experienced by watching the film by using cognitive reappraisal. The third
group was instructed to try to decrease their amusement also using cognitive
reappraisal. Compared with the no-instructions group, participants’ physio-
logical responses to the film clips differed as a function of the instructions
that they were given. Physiological responses (i.e., heart rate, respiration,
sympathetic nervous system activation) were higher in the condition in which
participants were instructed to increase amusement and lower in the condition
in which participants were instructed to decrease amusement.
 114 The Cognitive Neuroscience of Humor

Foster et al. (2002) examined participants’ physiological responses while

experiencing humor, imagining a humorous scenario, or recalling a humorous
scenario. Interestingly, imagined and recalled humor resulted in greater physio-
logical changes (i.e., heart rate and galvanic skin response) than experiencing
humor in the moment. In addition, they found that the increased arousal
occurs even when an individual does not laugh in response to funny material,
rather experiences only the feeling of mirth. The greater the mirth experience,
the higher the level of arousal.
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More recently, Lackner and colleagues (2013, 2014) examined participants’

cardiovascular responses as they watched humorous and emotionally neutral
film clips. Lackner et al. (2013) asked participants to press a button as soon as
they understood a humorous film’s meaning. The results indicated that cardiac
changes (i.e., cardiac output and heart rate) occurred approximately 500 ms
before participants pressed the button to confirm their comprehension of the
humorous clip. The researchers suggested that the changes in heart functioning
were temporally linked to the participants’ “moment of insight” involved
in understanding the humor of each clip (see also Fiacconi & Owen, 2015).
Lackner et al. (2014) also had participants watch comedy films and emotionally
neutral films while their cardiovascular responses were recorded. They found
evidence for increased arousal of the sympathetic nervous system when
amusement levels were high. They were able to rule out the possibility that
the observed changes were due to changes in breathing during the humor
experience. Experiencing humor was not found to lead to changes of the
parasympathetic nervous system.

Activation of the Hypothalamic–Pituitary–Adrenocorticol Axis

The processing of humor also activates the human stress responses (e.g., HPA
axis; Acevedo-Rodriguez et al., 2018), resulting in the release of the stress
hormone cortisol. Following the experience of a stressor, the hypothalamus
releases hormones that act on the pituitary gland (see Figure 1.7, Chapter 1,
this volume) and the adrenal glands, which are located near the kidneys. The
pituitary gland and adrenal glands also produce hormones. The most studied
stress-related hormone is cortisol (Heim et al., 2000). Long-term stress leading
to elevated levels of cortisol over a long period has been associated with
negative health outcomes. There have been cases in which individuals report
using humor to cope with extreme circumstances involving long-term stress
(C. V. Ford & Spaulding, 1973). The term “black humor” or “gallows humor”
refers to humor that arises in adverse situations (Obrdlik, 1942). Some studies
have measured the levels of cortisol, which can be measured in saliva and
in blood, and found increased levels of cortisol after watching comedy films
(Hubert & de Jong-Meyer, 1990, 1991; Hubert et al., 1993; Lai et al., 2010).
Hubert and de Jong-Meyer (1990) found that watching 90 minutes of a comedy
film resulted in significant increases in salivary cortisol levels in participants,
whereas watching a shorter film lasting 9 minutes did not. Hubert et al. (1993)
 The Effects of Humor on the Mind and Body 115

observed increased cortisol in about half of the participants tested when mea-
surements were taken 1 hour after participants began viewing a comedy film.
Interestingly, their results showed that higher levels of humorousness resulted
in higher levels of cortisol.
Other research has shown that experiencing humor is associated with
lower levels of cortisol (Berk, Tan, Fry, et al., 1989; Lai et al., 2010). Lai et al.
(2010) found evidence that higher levels of humor in daily life was related to
lower cortisol levels in a sample of older men between the ages of 64 years
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old and 86 years old. Still another study observed a more complex relation-
ship between positive emotions and cortisol. Human et al. (2015) investi-
gated the relationship between individual differences in positive emotions
across days (Study 1) or weeks (Study 2) and cortisol levels. The results of
both studies revealed that those reporting the lowest and the highest levels of
positive emotions had higher cortisol levels.

Effects on the Immune System

The immune system functions to defend the body from foreign substances
(e.g., parasites, viruses, bacteria; Kusnecov & Anisman, 2014). The immune
system can be weakened through malnutrition, prolonged exposure to illness,
long-term stress, and the normal aging process. In studies investigating the
effect of humor and immune system function, researchers have measured
salivary secretory-IgA (also called S-IgA), which has been shown to reflect
the body’s immune system response to minor infections (e.g., colds, flu) and
has been shown to increase during short-term stress and decrease in response
to long-term stress (Neale & Stone, 1989).
Dillon et al. (1986) compared salivary S-IgA collected from participants who
had watched a comedy video or a video with neutral context. They found that
levels of S-IgA were significantly higher for those who had viewed comedy.
Similar results have been observed in several other studies (Dillon & Totten,
1989; Harrison et al., 2000; Hucklebridge et al., 2000; Lambert & Lambert,
1995; Lefcourt et al., 1990; McClelland & Cheriff, 1997; Perera et al., 1998).
Inconsistent findings have been reported in at least three studies (Harrison et al.,
2000; Labott et al., 1990; Njus et al., 1996).
R. A. Martin and Dobbin (1989) investigated the effect of humor on immune
system function. Participants provided information about their daily hassles
and their sense of humor, and a saliva sample from which levels of S-IgA was
obtained. The results showed that those who reported more hassles had lower
levels of S-IgA in their saliva. For three of the four aspects of sense of humor,
there were significant moderations of this relationship with sense of humor
functioning as a buffer against the negative effects of hassles on the immune
system. In contrast, Hucklebridge et al. (2000) found that S-IgA was increased
in individuals following negative moods states as well as positive mood states.
Others have examined blood samples in search of support for the view
that experiencing humor has positive effects on the immune system (Bennett
 116 The Cognitive Neuroscience of Humor

et al., 2003; Berk et al., 1984, 1988, 2001; Berk, Tan, Napier, & Eby, 1989; Itami
et al., 1994; Kamei et al., 1997; Locke et al., 1984; Mittwoch-Jaffe et al., 1995;
Yoshino et al., 1996; cf. Kamei et al., 1997). For example, Berk et al. (2001) had
52 men who reported being in good health watch a comedy film for an hour.
Blood was sampled before the film, after the film had been played 30 minutes,
and 12 hours after the film ended. Blood was analyzed for numerous immune
system markers. Significant increases were observed for many of these markers,
including natural killer cell activity, immunoglobulins, and activated T-cells,
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as well as others. Several markers were significantly higher 12 hours following

the film. In a similar study with 33 women, Bennett et al. (2003) found that
participants who watched a comedy film were later found to have lower levels
of stress and higher levels of natural killer cells than those in the control group.
Participants who scored higher on a humor appreciation measure showed the
largest reduction in stress and largest increases in natural killer cells.
In multiple studies, Kimata (2001, 2004a, 2004b) showed that experiencing
humor reduced allergic responses to an allergen. In the earliest study, Kimata
(2001) investigated how individuals with dermatitis responded to skin prick
test in which they were exposed to multiple allergens. Exposure to the allergens
occurred after participants either watched a humorous film or nonhumorous
documentary film. The results showed that allergic reactions were less severe
when performed after the humorous film. In follow up studies, Kimata
(2004a, 2004b) demonstrated similar reductions in allergic reactions following
humor experiences in participants with allergic conjunctivitis and bronchial
asthma. The results suggest that experiencing humor reduces the likelihood
of an overreaction by the immune system. In other research by Atsumi et al.
(2004), blood samples of participants had higher levels of antioxidant-
like substances that served to reduce free radicals after they had watched
humorous videos as compared with blood samples taken before they had
watched the videos.

Increased Pain Tolerance

Numerous studies have shown that humor experiences (including play states)
can increase pain tolerance (Cogan et al., 1987; Dunbar et al., 2012; H. L. Fritz
et al., 2017; Mitchell et al., 2006; Nevo et al., 1993; Panksepp, 1993, 1998;
Weaver & Zillmann, 1994; Weisenberg et al., 1995; Zillmann et al., 1993,
1996; Zweyer et al., 2004). Cogan et al. (1987) measured pain thresholds for
participants who listened to audiotapes containing humorous, relaxing, or dull
content. Pain thresholds were measured using pressure-induced discomfort
in which participants who could tolerate higher levels of pressure on an arm
were viewed as having higher pain threshold. The results showed that pain
thresholds were higher when participants listened to humorous or relaxing
content than when they listened to dull content. A second experiment showed
that pain thresholds were higher when participants experienced humor versus
doing a short math activity.
 The Effects of Humor on the Mind and Body 117

A number of studies have induced pain in participants using a cold pressor

task, in which participants are asked to keep a hand or arm submerged in ice
water (Nevo et al., 1993; Zweyer et al., 2004). Participants who can keep their
hand in cold water the longest are viewed as having a higher pain tolerance
(MacLachlan et al., 2016; Patanwala et al., 2019). Nevo et al. (1993) investi-
gated to what extent experiencing humor reduced pain in college students.
Participants were instructed to hold their hands in cold water while watching
either a humorous film or a nonhumorous documentary film. Participants
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in both groups spent more time in the cold water than participants in a
“no film” control group. In the humor group, individual differences in
participants’ sense of humor and ability to produce humor were related to
task performance with higher levels of humor ability related to more pain
tolerance. In a later study Zweyer et al. (2004) showed that experiencing
humor increased participants’ pain tolerance in a laboratory task. Partici-
pants (all women) watched a humorous film and carried out the cold pressor
task before the film, immediately following the film, and 20 min after the
film ended.
In a study of different types of laughter, Dunbar et al. (2012) investigated
pain reduction following unforced laughter using two methods for inducing
pain: exposing participants to intense cold using a frozen wine cooler sleeve
that was −16 degrees Celsius or exposing participants to a maximally inflated
cuff used to measure blood pressure. Dunbar et al. claimed that unforced
laughter is spontaneously produced in response to a stimulus and is associ-
ated with positive emotion. In their study, they examined the pain-reducing
effects of unforced laughter in naturalistic and laboratory experiments. Par-
ticipants either viewed humorous or emotionally neutral videos or stage per-
formance and then carried out a pain tolerance task. The results showed that
there was increased pain tolerance in the humorous condition. They con-
cluded that the reduction of pain following laughter stems from the effects of
endorphins, which are released during social laughter.
In at least one study, the effect of humor on pain was suggested to be
related to endorphin levels in the brain. Manninen et al. (2017) used posi-
tron emission tomography to measure the activation of opioid release following
laughter. Participants sat alone in a room for 30 minutes after which a
baseline scan was obtained. Then, they had participants watch a 30-minute
comedy film with others, after which a second scan was obtained. The scan
taken after the comedy film revealed that there was release of endogenous
opioid in multiple brain areas (i.e., anterior insula, caudate nucleus, and
thalamus). The results suggest that humor may be a useful therapeutic
intervention for individuals who have health conditions causing debilita­ting
pain. H. L. Fritz et al. (2017) surveyed individuals with fibromyalgia, a condi-
tion that can cause widespread body pain. They found that participants
reporting higher levels of humor appreciation reported lower levels of pain in
daily life. The next section reviews numerous studies investigating the use of
humor-based therapies to improve a variety of medical conditions.
 118 The Cognitive Neuroscience of Humor

It is important to remember that there are other studies that have not shown
that humor affects pain (Bruehl et al., 1993; Dixey et al., 2008; Rotton &
Shats, 1996). Research with children investigated whether humor could reduce
pain during injections (Dixey et al., 2008; B. Goodenough & Ford, 2005).
B. Goodenough and Ford (2005) found that children who described them-
selves as appreciating humor were better able to cope with the unpleasantness
of pain. No relationship was found between humor and the intensity of the
pain. In a compelling application of these results, Dixey et al. (2008) investi-
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gated whether children between the ages of 3 years old and 5 years old who
received an injection would experience less discomfort when the injection
was preceded by a humorous cartoon sticker (versus no sticker). Unfortu-
nately, the results failed to show a decrease in reported pain in the humorous
sticker condition.

THE EFFECTIVENESS OF HUMOR INTERVENTIONS

Given the impressive number of research studies documenting the positive

effects of humor on physical and mental health, it is not surprising that some
researchers have begun developing and testing the extent to which short-term
humor interventions improve mental and physical health outcomes. Calls for
this type of research are decades old (McGhee, 1999; Salameh & Fry, 2001).
Before discussing the studies that have yielded encouraging results, it should
be noted that there are studies in which interventions involving humor have
not produced significant outcomes (Adams & McGuire, 1986; Gelkopf et al.,
1993; Ko & Youn, 2011; Lapierre et al., 2019; Low et al., 2013; Walter et al.,
2007; White & Camarena, 1989).
Among the studies that have demonstrated significant outcomes, the
targeted populations include middle-age women (Cha & Hong, 2015), older
adults living in care facilities (Boyd & McGuire, 1996; B. Goodenough et al.,
2012; Houston et al., 1998; Hsieh et al., 2015; Kuru & Kublay, 2017), older
adults living independently (Ghodsbin et al., 2015; Ko & Youn, 2011; Mathieu,
2008; Morse et al., 2018; Prerost, 1993; Proyer et al., 2013; Tse et al., 2010;
Yoshikawa et al., 2019), older adults with depression (Konradt et al., 2013),
patients with dementia (Brodaty et al., 2014; Kontos et al., 2016; Takeda
et al., 2010; Walter et al., 2007), individuals with Parkinson’s disease (Bega
et al., 2017), adults with schizophrenia (Cai et al., 2014; Rosenheim et al., 1989;
Witztum et al., 1999), adults with Type 2 diabetes (Hirosaki et al., 2013),
adults with mental illness (Rosenheim & Golan, 1986; Rudnick et al., 2014),
women following childbirth (Ryu et al., 2015), patients with cancer (S. H. Kim
et al., 2015), individuals with COPD (Lebowitz et al., 2011), hospitalized
children (Sánchez et al., 2017), and college undergraduates (Foley et al., 2002;
Neuhoff & Schaefer, 2002).
McGhee (1999, 2010) developed a humor regime for the purposes of
promoting health in daily life. He referred to it as the Seven Humor Habits
 The Effects of Humor on the Mind and Body 119

Program, which was later expanded to include eight habits (McGhee, 1999;
see Figure 8.1). The effectiveness of training people to use the eight habits for
the purposes of well-being has been examined in two studies (S. A. Crawford
& Caltabiano, 2011; Falkenberg et al., 2011). Falkenberg et al. (2011) reported
a pilot study involving six adults hospitalized with a diagnosis of major
depression. There was no control group. At weekly sessions, participants were
introduced to one of the habits. Measures of mood and general functioning
were administered before and after the introduction of the humor program.
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Significant improvement was observed in the majority of measures.

In a larger study involving participants recruited from a community, S. A.
Crawford and Caltabiano (2011), compared three groups of individuals over
a period of 8 weeks. The humor group learned how to use the eight humor
habits. A second social group met weekly and engaged in conversation but
did not receive any humor training. A third group served as the control group,
completing the same measures as the other two groups after 8 weeks and also
3 months following the completion of the study, but did not receive any
additional training or contact. A variety of measures were used to assess well-
being, emotions, and self-efficacy. The same questions were asked at the end
of the program as well as 3 months after participants completed the program.
Participants in the humor group experienced decreased stress, anxiety, and
depression and increased optimism, positive affect, perceptions of control,
and self-efficacy. Outcomes for the social and control groups were similar
and did not show the patterns of the humor group.
Recently, the Second City Comedy Troup based in Chicago, which is well
known for producing many professional comedians, has developed partner-
ships with researchers to develop interventions for populations who might
benefit in terms of mental and/or physical functioning (Bega et al., 2017;
Morse et al., 2018). In a qualitative study, Morse et al. (2018) investigated the
effectiveness of a humor intervention associated with Second City for adults
over age 55 years. Among the benefits of the program described by participants
were increase levels of comfort, positivity, self-awareness, and feelings of
acceptance by others in the group. Participants also indicated that following the
intervention, they experienced improvements in social functioning and ability
to solve problems. In a similar study, Bega et al. (2017) tested 22 individuals

FIGURE 8.1. The Eight Humor Habits

Humor Habit Expected Level of Difficulty

1. Adopting a playful attitude Easiest
2. Laughing more often
3. Laughing more heartily
4. Cultivating joke-telling skills
5. Creating verbal humor
6. Looking for humor in everyday life
7. Laughing at yourself
8. Finding humor in the midst of stress Hardest

Note. Data from McGhee (1999)

 120 The Cognitive Neuroscience of Humor

with Parkinson’s disease who met once a week for 12 weeks with a member
of the Second City faculty. The results indicated that participants enjoyed the
intervention, all participants completed it, and most participants attended at
least 80% of the meetings. Measures of daily functioning in terms of Parkinson’s
symptoms were taken before and after the program. On average, participants’
scores reflected significance improvement.
Wellenzohn and colleagues (2016a, 2016b) tested the effectiveness of a
brief online humor intervention. Wellenzohn et al. (2016b) tested the benefits
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five humor activities: focusing on three funny things; counting funny things
from the day; collecting funny things, which involved selecting the funniest
experience in their life and writing it down in as much detail as possible;
applying humor during the day; and considering how humor could have
reduced stress during a prior event. For each activity, there was a placebo
control group in which participants were asked to reflect on early child-
hood memories. The results showed that participants reported lower levels of
depression and higher levels of happiness. Three of the interventions led to
higher happiness 6 months later. Further, Wellenzohn et al. found that some
individuals liked the intervention more than others and that the benefits of the
intervention may have been higher for those who liked the program more.
Wellenzohn et al. (2016a) tested the effectiveness of the three funny things
humor-based intervention. Participants were randomly assigned to one of three
intervention conditions or to a condition that served as a placebo control. For
1 week, participants were instructed to write about three funny things with
either a past, present, or future focus. In the control condition, participants
wrote about memories from early childhood. Participants completed pretest
and posttest measures of depression and happiness. Increased happiness and
decreased levels of depression were observed in all three humor conditions.
Using a similar approach, Maiolino and Kuiper (2016) investigated whether
participants writing briefly (for 5 minutes) about their own positive experiences
after a couple weeks would increase well-being. Participants in another group
were asked to write about things that made them feel grateful or examples
of positive life experiences that they savored. Participants in a control group
wrote about daily life experiences. Participants in all groups reported their
well-being in a variety of measures before and after the writing exercise.
Writing about humor, experiences leading to gratitude, and savored positive
life experiences lead to increased well-being, but writing about daily life experi-
ences did not. Overall, individuals reported using affiliative and self-enhancing
humor types more often in daily life had higher levels of well-being. In
addition, those who reported using self-defeating and aggressive humor styles
more often had lower levels of well-being.
Researchers have begun to demonstrate that humor-related interventions
can produce benefits for individuals with a range of health statuses. Relatively
few of these studies have used the most rigorous of methods, which involves
randomly assigning participants to an intervention or a control condition.
Randomized clinical trials of humor-based interventions are rare, as there are
 The Effects of Humor on the Mind and Body 121

multiple obstacles in conducting them, including cost, availability of capable

staff, and research volunteers (Djurisic et al., 2017). In one of the few studies
using a randomized clinical trial design, S. H. Kim et al. (2015) investigated
the effect of a laughter intervention for a group of patients treated for breast
cancer. There were four sessions in the intervention, which were completed
by 31 participants. Twenty-nine additional participants were included in
the control group. Both groups completed assessments of stress, anxiety, and
depression at the start of the study and after each session. Participants in
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the intervention group showed significant reductions in all three measures

following the intervention, with significant reductions observed as soon as after
the first session. Those in the control group showed no significant change.
Among the most compelling research on the benefits of humor interventions
on health are those involving individuals with Type 2 diabetes. (Hayashi et al.,
2006; Hirosaki et al., 2013). Hirosaki et al. (2013) found that laughing after
eating resulted in lower glucose levels in a group of healthy older adults. Two
groups, which assigned randomly, were given an exercise program involving
laughter. Hayashi et al. (2006) investigated whether positive emotion expressed
through laughter affected changes in individuals’ gene expression. They
collected blood samples of individuals with Type 2 diabetes. One group had
heard a humorous story, and the control group had listened to a nonhumorous
lecture. They analyzed the expression of over 18,000 genes from blood
leukocytes, which are cells that participate in the human immune response.
The results showed that the expression of 23 genes differed in the humor
intervention group. Hayashi et al. urged caution in interpreting the results,
suggesting that the study merely showed that there may be a link between
positive emotion and gene expression.
Among the most impressive studies is the Sydney Multisite Intervention of
LaughterBosses and ElderClowns study (Brodaty et al., 2014; B. Goodenough
et al., 2012; Low et al., 2013), which was conducted across multiple healthcare
settings in Australia. Low et al. (2013) reported results from 418 participants
from 35 nursing homes regarding the effectiveness of a humor intervention
in reducing depression, quality of life, or social engagement. The results
showed that there was a greater reduction in participants’ levels of agitation
for those receiving the humor intervention as compared with participants
who did not receive the humor intervention. Brodaty et al. (2014) analyzed
the data for those individuals who received the humor interventions (i.e.,
189 participants from 17 nursing homes) as well as responses from staff at
the facilities, finding the higher commitment by the staff predicted higher
engagement on the part of the participants. Further, when participants’ engage-
ment was high, there were lower levels of depression, agitation, and neuro-
psychiatric symptoms.
Not every study has found benefits to humor-based interventions. In some
cases, humor-related interventions may not be ideal, as in cases where it
may lead to adverse side effects. At least one study has demonstrated that
humor therapy inducing laughter may not be ideal for some patient groups.
 122 The Cognitive Neuroscience of Humor

For example, Lebowitz et al. (2011) investigated the effects of a humor inter-
vention on a group of patients diagnosed with COPD. They found that when
patients laughed, they experienced hyperinflation of their lungs, which
severely reduces breathing ability. For other populations, which have been
shown to have deficits in comprehending humor, there may be little or no
benefits of therapeutic uses of humor, such as with individuals with schizo-
phrenia (Gelkopf et al., 1993; Gelkopf & Sigal, 1995).
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SUMMARY

This chapter reviewed the large and growing literature on the topic of the
effects of humor on the body and mind. Correlational studies have found some
evidence that higher levels of sense of humor are related to better physical
and mental health. Large studies from Norway provide some of the strongest
evidence for the link between humor and better physical health. Greater use
of the positive humor styles (i.e., self-enhancing and affiliative) has been
found to be related to lower levels of depression and higher levels of well-
being. The health benefits of humor may stem from the effects of humor
experiences on the body, including activation of the sympathetic nervous
system affecting breathing, heart rate, the release of hormones (e.g., epineph-
rine, norepinephrine, cortisol), and the production of endorphins in the brain.
Studies have also found that experiencing humor leads to increases in immune
functioning, as indicated by increases in immune markers in saliva and blood.
A growing number of clinicians have tested the feasibility and effectiveness of
humor interventions for a variety of target populations. Many of these studies
show that humor interventions can produce positive outcomes in healthy
individuals and those dealing with illness. One study showed that laughter
therapy may produce adverse outcomes for individuals with COPD. The
benefit of humor-related interventions in populations that have been found to
have deficits in comprehending humor (e.g., individuals with schizophrenia)
may be smaller than with other populations.

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