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SECTION: PSYCHOLOGY AND EDUCATION SCIENCES Arhipelag XXI Press, Tîrgu Mureș, 2015, ISBN: 978-606-8624-21-1


Lorena Antonovici
PhD Student, ”Al. Ioan Cuza” University of Iași

Abstract: BACKGROUND: When we experience humor, we focus mostly on positive affects, though,
apparently in a paradoxical manner, laugh and humor often occur in the presence of pain. Humor can
emerge where adversity is substantial, in most traumatic situations that sometimes help in the individual‟s
growth and in his development.
PURPOSE OF STUDY: The objective of this paper is to explore and analyze the relationship between
humor and pain, insisting on the importance of pain for understanding humor. We challenge different
approaches related to humor and pain with the aim to advance new directions of study.
SOURCES OF EVIDENCE: Although there are various studies to argue the relationship between humor
and pain, attempts to theorizing humor through pain are minimal to our knowledge (Veatch, 1998). The
main theories of humor (psychoanalytic, superiority, arousal, incongruity and reversal theories), but also
cultural and physiological factors underlying humor experimentation, add valuable explanations but
seem to be incomplete.
MAIN ARGUMENT: Of specific theories of humor, neither seems to fully explain the humor, which is why
pain needs to be reconsidered to a much greater extent and from here to reformulate the perspective
towards humor. The painful humor theory, the theory we propose indicates the fact that the relationship
between humor and pain, though being a paradoxical one, can contribute to a more in-depth exploration
of different facets of humor.
CONCLUSION: It can easily be noticed that there are correlations between humor and pain since the
two have common points in previous studies. A more in-depth exploration of the mechanisms of humor
and pain and a larger attention oriented towards the manner of studying both could be critical, from this
point of view. Therefore, the results could be relevant and the refinement of theories of humor could start
right here.
Keywords: humor, pain, theorizing, exploration, directions of study.

SECTION: PSYCHOLOGY AND EDUCATION SCIENCES Arhipelag XXI Press, Tîrgu Mureș, 2015, ISBN: 978-606-8624-21-1

When we experience humor, we often focus on the positive affects, although,
paradoxically, laughter and humor often occur in the presence of pain. Otherwise, humor is
closely linked to the concept of resilience, as a possibility to recover or to successfully cope with
situations though adversity is substantial (Rutter, 1985). The sense of humor has been seen as
one of the protective factors involved in shaping resilience (Werner & Smith, 1982) and the
connection between humor and resilience is captured in a wide range of studies and among all
age groups (Anthony, 1974; Bernard, 1991; Werner & Smith, 1992; Richardson, 2002). Some
authors consider humor a sign of emotional maturity (Haig, 1986) while laughing helps the
individual growth, being an act of gratitude and faith in the face of death and tragic events
(Bianchi, 2005).
This article focus on the relationship between humor and pain, highlighting the
importance of pain in understanding humor. The link between humor and pain, apparently a
paradoxical one, may contribute to further exploration of the different facets of humor. The
attempts of theorizing humor in relation to pain are, as to our knowledge, minimal (Veatch,
1998), although there are numerous studies that analyze the relationship between humor and
pain. In the current study, we explore different approaches to humor and we suggest for analyze
new directions of study.

Physiological mechanisms of humor and pain

Transforming pain into pleasure is a feature of great importance for the psychology of
our immune system (Lazarus & Folkman, 1984; Gross, 2008). The physiology of pain is close to
that of humor experimentation. When humor is perceived, the cognitive processes are stimulating
the emotional system, the response to humor being a pleasant emotional one, involving areas of
the pre-frontal cortex and the limbic system (Martin, 2007). It has been shown that laughter leads
to reduction of stress hormones such as cortisol or adrenaline (Fry, 1963). When we laugh, our
brain releases endorphins, which can diminish pain (Fry, 1963; Berk, 1994) and have an effect
similar to opiates such as morphine or heroin (Berk, 1994). On the other hand, other studies have

SECTION: PSYCHOLOGY AND EDUCATION SCIENCES Arhipelag XXI Press, Tîrgu Mureș, 2015, ISBN: 978-606-8624-21-1

not shown the effect of humor on beta-endorphins (Berk & al. 1989; Itami & al., 1994).
However, these studies have a number of limitations.
Severe chronic pain does not occur only on a biological level, it is a lived experience
that integrates sensorial, motivational, emotional, and cognitive behaviors and takes into account
the social and cultural environment of the individual (Jackson, 1999; Winterowd et al., 2000).
When the painful signal is processed in the brain, inside the somatosensory cortex, this can
activate a number of thoughts and memories while a range of emotions could be activated in the
limbic system (Winterowd et al., 2000). Pain and suffering are not necessarily one and the same,
so that some people experience pain without suffering, so they are more tolerant to pain
mechanisms and do not necessarily need professional help in fighting pain (Winterowd et al.,
2000). Among the psychological theories of pain, the gate control theory (Melzack & Wall,
1965) focuses on two approaching perspectives: a biological one and a psychological one. Thus,
pain is considerate more than a simple sensory event that signals tissue damage. The
psychological perspective emphasizes the fact that pain is a dynamic, complex and
multidimensional experience with sensory, affective and evaluative components.

From humor to pain

Martin (2007) defines humor as having four main components: 1. the social context 2. a
cognitive-perceptual process 3. the emotional response 4. the behavioral-vocal expression of
1. Humor is a social phenomenon that is mostly conducted in relationship to other
people, but even when it occurs individually it has an important social component in relation to
the one who designed the humorous material – being a ―pseudo-social‖ phenomenon. Humor is
closely linked to the social situation, to the social context, having a character of a social game
without pursuing an important goal, mentally. Among the goals of humor, there are also included
the following: the need for social approval, the denial of serious intentions, the unmasked
hypocrisy, the intra-group control, the anxiety management or expressing antipathy and hostility
(Foot & McCreaddie, 2006).
2. The core of humor seems to be represented by the incongruity, the surprise, the
unexpected. Both humor and pain can surprise us. The theories of incongruity (Koestler, 1964

SECTION: PSYCHOLOGY AND EDUCATION SCIENCES Arhipelag XXI Press, Tîrgu Mureș, 2015, ISBN: 978-606-8624-21-1

Suls, 1977) suggest that the perception of incongruity is crucial in deciding whether or not
something is funny - funny things are incongruous, surprising, distinctive, unusual or different
from what we expect. This theory has its limits. Not every incongruity can cause humor: for
example, being violently attacked by a person while you quietly read your newspaper is
incongruent, but it is not funny. On the other hand, we do not negate the possibility that humor,
on a situation that causes pain, is activated later, when the event no longer affects us.
3. The response to humor is a pleasant emotional one, which activates the limbic
system in the brain. It is a good mood response which does not have a specific name like other
emotions, given the close association with laughter, but which can be described by the following
terms: fun, joy, laughter. McDougall (1903, 1922) considers humor a sort of "emotional
anesthesia", a protective response that protects us from the depressive influence of others. Thus,
when we make a joke about our problems or other people‘s problems, we separate at least
momentary from the emotional pain involved.
4. Laughter and smile are expressions of humor. Depending on the intensity, the
expression takes different forms and can be accompanied by behavioral movements such as
bringing the head backward, rocking, etc. Sometimes, laughter and smile can hide the pain. In
communicating pain, we can use both verbal and non-verbal channels (e.g.: Self-reporting, facial
expressions, tone, etc.).
To our knowledge, an attempt to theorize humor clearly showing the significant role of
pain, though discreetly, is that of Veatch (1998). The author considers humor as being an
emotional pain that does not hurt us. In other words, humor occurs when we feel bad about
something in a first phase, after which we manage to feel that this thing is actually okay. The
behavioral models of pain (Fordyce, 1976) challenge the maladaptive pain behaviors that may
arise repetitively, as a result of the powerful environmental contingencies and can be
extinguished and replaced with adaptive behaviors. Following the same ideas, Ramachandran
(1998) distinguishes a smile of 'false alarm' which refers to the presence of a situation where we
have certain expectations and which becomes tensed and that, by a sudden change, we are
determined to reinterpret the facts which now are non-threatening ones and thus causing
laughter. The cognitive behavioral models of pain (Turk et al., 1983; Turner & Clancy, 1988)

SECTION: PSYCHOLOGY AND EDUCATION SCIENCES Arhipelag XXI Press, Tîrgu Mureș, 2015, ISBN: 978-606-8624-21-1

suggest that cognitive responses (e.g.: Thoughts, beliefs, expectations, etc.) play an important
role in pain perception and in accommodation with pain.
In psychoanalytic theories of Freud (1905, re-edited 2002), unlike repression, which
determine the unpleasant affects evade from our attention, humor is the highest manifestation of
the defensive mechanisms, being able to involve energy of the unpleasant affect about to trigger
and to transform that energy by ease it into pleasure - resembling itself in this manner with the
regressive processes or with the reactional ones that play an important role in psychopathology.
Some dynamic approaches explain pain with the help of innate drives related to aggression,
addiction, and sexuality, experiencing pain being thus a form of gratification or frustration as a
result of these drives (Pilowsky, 1986). When linked to aggression drives, pain can be directed
either against oneself or against others and thus form a ―cruel‖ super-ego '' that is associated with
chronic conditions of guilt and low self-esteem (Pilowsky, 1986).
The superiority theories of humor (Gruner, 1997) explain humor through aggressivity
and hostility. As some studies already suggest (Wicker et al., 1981; Deckers & Carr, 1986),
humor is experienced in higher rates when we perceive the pain in others. Thus, the pain could
be a starting point for aggression and hostility. The arousal theories of humor (Berlyne, 1960)
refer to humor as a potential for tension release, tension that can arise from many sources and
can also be a pain reliever. The reversal theories of humor (Apter, 1982) consider humor as a
form of mental play. Hence, the humor involving themes that would normally provoke pain
(such as horror parodies, macabre jokes, etc.) can be made enjoyable because of the way that
these negative emotions are a pleasant arousal when they are brought into -a playful mental
Although the main theories of humor evoke pain, the role of pain in experiencing
humor is not a primary one. Among the theories mentioned above, neither seems to fully explain
humor.We believe that what is lacking in humor theorizing, could be, paradoxically , precisely
the theory of painful humor, which is why humor theories should take into account at a greater
extent the pain topic and reformulate their views starting from here.

Previous studies

SECTION: PSYCHOLOGY AND EDUCATION SCIENCES Arhipelag XXI Press, Tîrgu Mureș, 2015, ISBN: 978-606-8624-21-1

In previous studies, Kunz et al. (2009) indicate a high rate of people who show facial
expressions of smile during painful stimulations such as stimulation through the use of high
temperature, electric current or pressure. Humour can act as a distractor which helps to increase
pain tolerance (Weisenberg & al., 1995; Astedt-Kurki & Isola, 2001; Zweyer & al., 2004),
although the results are not of the highest. In a study by Stuber et al. (2009) conducted on
children, the authors showed that the introduction of videos with humorous content as a
distractor in a pain task increased children pain tolerance, although, surprisingly, it was not
associated with changes in the assessment of pain intensity. The authors consider that laughter is
not so susceptible to asses humor, considering the emotional involvement and participants‘
expectations towards humor in the study, a fact supported by other authors who sustain the
importance that participants perceive the video content as really humorous (Nevo & al., 1993).
Goodenough & Ford (2005) reported that in children who used humor coping when confronting
with pain, it was more likely that during medical interventions, they would use an adaptive and
focused on problem coping style.
From the testimonies of people involved in all sorts of trauma (Ladegaard, 2013), such
as physical and sexual abuse, insufficient income and hunger, harassment and other forms of
abuse, in addition to lamentable reactions that were frequent, it proved that expressions of
laughter are also frequently used. Humor can help alleviate pain and discomfort (Cogan & al.,
1987; Hudak & al., 1991; Zillmann & al., 1993). Although, in some cases (ex. Zillmann & al.,
1993), analgesic effects have been proved with both positive and negative arousal, without being
able to test humor specificity. Major changes in life, such as the death of a loved one, which
occur sometimes, unexpectedly, are also accompanied by laughter and humor (Abel, 2002;
Matsumoto, 2009). Those who have gone through a loss situation or suffered after someone‘s
death, experienced many facets of humor: positive or negative humor, or both forms of humor at
the same time – hence, humor has an incredible impact on pain (Bonanno, 2004).
In the case of people under the communist regime, one can observe a wide range of
jokes that circulated at the time (Davies, 2007) - jokes constituted as a form of protest against the
regime and that were said at the risk of losing one‘s freedom. In such a regime in which people
are grieving, sense of humor is still present. Also in the case of Holocaust survivors, one used
jokes to cope with difficult conditions and torture (Lipman, 1991).

SECTION: PSYCHOLOGY AND EDUCATION SCIENCES Arhipelag XXI Press, Tîrgu Mureș, 2015, ISBN: 978-606-8624-21-1

In a longitudinal study (McGraw & al., 2014) which aims to observe the reactions of
the participants on Hurricane Sandy and given the psychological distance to the event, shortly
after the tragedy, the participants find it difficult to make jokes about it. For this reason, we
sometimes admit the impossibility to asses humor, given the short period after the painful event.
After a while, humor records high levels, but decreases for longer periods of time because the
event becomes benign, non-threatening (McGraw & al., 2014).
The humor can also be seen as a defense mechanism when we are ashamed of a
situation (Kaufman, 1989; Nathanson, 1992). If the child manages to overcome the shame, he
will become more competent and he will grow at an emotional level (Nathanson, 1992). Also,
while being tickled, one can observe facial expressions that indicate shame (Harris & Alvarado,
2015). Some authors have shown that we have very similar grimaces when we are tickled and
when we feel pain (Harris & Alvarado, 2005).
For some diseases (multiple sclerosis, Parkinson's disease, manic-depressive disorder,
etc.) the altered manifestations of humor lead to unpleasant conditions of the sufferer (Dumbre,
2012). For those who suffer from schizophrenia, they do not understand humor and do not
experience any pleasure from humor (Dumbre, 2012; Bell et al., 2010). Also, those who provide
health services, and patients as well, they use humor as a coping mechanism in embarrassing
situations, anxiety, among friends, in the face of pain and uncertainty (du Pre, 1998; Wanzer &
al. , 2005). Sometimes, however, and especially in therapy, humor is used as a form of denial and
distancing from the emotional pain (Marcus, 1990). On the other hand, the therapists who use
humor during therapy sessions, can help reducing patients‘ pain (Tse & al., 2010; Garrick, 2006).

Conclusions and Discussions

There is evidence in the literature that indicates a link between humor and pain. The
link between humor and pain has been proven by many studies, although the results do not
always indicate a strong association or do not capture very well the issue of humor and pain. This
can be due to low emotional involvement and expectations of study participants towards humor.
Starting from the idea that at the core of experiencing humor would stand the pain, one can note
in the above studies, the frequency of laughter and humor in critical or traumatic life events and
its resilient role. The theories of humor are considering pain in various occasions, which leads us

SECTION: PSYCHOLOGY AND EDUCATION SCIENCES Arhipelag XXI Press, Tîrgu Mureș, 2015, ISBN: 978-606-8624-21-1

to believe that pain should instead be more relevant in theorizing humor. Even when humor
arises in pleasant contexts of life, we sustain that at his very basis would actually stand a painful
situation that has not been healed yet and that it is possible to be repressed. From this point of
view, we should probably investigate in a proper manner jokes contents or humorous situations
that have a potential for us.
Although there is often a tendency to consider humor an enjoyable and common
experience, there are some goals of humor that came into our attention: the need for social
approval, the denial of serious intentions, the unmasked hypocrisy, the intragroup control, the
anxiety management or expressing antipathy and hostility (Foot & McCreaddie, 2006). Kunz et
al. (2009) note an issue that deserves further investigation, namely that the smiling during pain
may be considered inappropriate and it could either intensify empathy or diminishing it - the
smile is perceived as an invalidation of suffering, which allows social neglect. The self-
enhancing humor is the type of humor associated most with empathy (Martin & Dutrizac, 2004;
Hampes, 2010).
Another issue to be discussed is that we do not know for sure if making fun of an event
facilitates coping or if coping facilitates jokes on account of an event (McGraw & al., 2014). In
other words, humor could be either cause or outcome of coping. This relationship should be
investigated further. But we cannot refer to humor in the context of pain, as it would only be a
coping mechanism. Humor is more than that. Humor sometimes occurs at longer distances of
time from the painful event, which indicates that humor is in this case rather a way of growth and
maturation of the individual who has already managed to successfully cope with aversion.
Compared with quiet moments through which a nation passes, a large number of humorous
productions occurred during the communist regimes. Humor can be a form of communication of
pain in handy at such times and can be accessible to a whole nation. In major physical disorders
or mental illness, humor forms appear altered, which can cause an unpleasant condition of the
person concerned. Physically and mental pain alter the forms of humor, pain, and humor merging
in an altered form. One can add here the physiological processes of pain and humor that have
similar valences.

SECTION: PSYCHOLOGY AND EDUCATION SCIENCES Arhipelag XXI Press, Tîrgu Mureș, 2015, ISBN: 978-606-8624-21-1

Concluding, it is necessary to explore further the mechanisms of pain and humor and
with considerable attention on both concepts, so that the results are relevant. The study of humor
and pain should be investigated in more depth and the humor theories should evolve from here.

1. Abel, M. H. (2002). Humor, stress, and coping strategies. Humor: International Journal
of Humor Research, 15(4): 365–381.
2. Anthony, E. J. (1974). The syndrome of the psychologically invulnerable child. In E. J.
Anthony & C. Koupernik (Eds.), The child in his family: Children at psychiatric risk (pp.
201-230). New York: Wiley.
3. Apter, M. J. (1982). The experience of motivation: The theory of psychological reversals.
London: Academic Press.
4. Astedt-Kurki, P., & Isola, A. (2001). Humour between nurse and patient, and among
staff: Analysis of nurses‘ diaries. Journal of Advanced Nursing, 35(3): 452–458.
5. Bell., D. & Col. (2010). Mentalizing, mental illness and mirth: linking the psychology of
theory of mind and humour in psychotic illness disorders, Acta Neuropsychiatrica, 22(1):
6. Berk, Lee S., Stanley A. Ta, William F. Fr, Barbara J. Napier, Jerry W. Lee, Richard W.
Hubbard, John E. Lewis, and William C. Eby (1989) Neuroendocrine and stress hormone
changes during mirthful laughter. American Journal of the Medical Sciences, 298(6):
7. Berk, L. S. (1994). New discoveries in psychoneuroimmunology. Humor and Health

SECTION: PSYCHOLOGY AND EDUCATION SCIENCES Arhipelag XXI Press, Tîrgu Mureș, 2015, ISBN: 978-606-8624-21-1

8. Letter, 3(6): 1-8.

9. Berlyne, D. E. (1960). Conflict, arousal, and curiosity. New York, NY: McGraw-Hill.
10. Bernard, B. (1991). Fostering resiliency in kids: Protective factors in the family, school
and community. Portland, OR: Northwest Regional Educational Laboratory.
11. Bianchi, E. (2005). Living with elder wisdom. Journal of Gerontological Social Work,
12. 45(3): 319–329.
13. Bonanno, G. A. (2004). Loss, trauma, & human resilience: have we underestimated the
human capacity to thrive after extremely aversive events? . American Psychologist,
59(1): 20–28.
14. Cogan, R., Cogan, D., Waltz, W., McCue, M. (1987). Effects of laughter and relaxation
on discomfort thresholds. Journal of Behavioral Medicine, 10(2): 139-144.
15. Davies, C. (2007). Humour and Protest: Jokes under Communism. International Review
of Social History, 52(15): 291-305.
16. Deckers, L., & Carr, D. E. (1986). Cartoons varying in low-level pain ratings, not
aggression ratings, correlate positively with funniness ratings. Motivation & Emotion,
10(3), 207–216.
17. Dumbre, S. P (2012). Laughter Therapy. Journal of Pharmaceutical and Scientific
Innovation, 1(2): 23-24.
18. du Pre, A. (1998). Humor and the healing arts: A multimethod analysis of humor use in
health care. Mahwah, NJ: Lawrence Erlbaum Associates.
19. Foot, H., McCreaddie, M. (2006). Humour and laughter. In O. Hargie (Ed.), The
handbook of communication skills (pp. 293-322). New York, NY: Routledge.
20. Fordyce, W.E. (1976) Behavioral methods for chronic pain and illness. C.V. Mosby, St
21. Freud, S. (2005). Comicul şi Umorul – Opere 8, ed. Trei, reeditat după volumul din 1905.
22. Fry, W. F. (1963). Sweet Madness: A Study of Humor. Palo Alto, CA: Pacific Books
23. Garrick (2006). The Humor of Trauma Survivors: Its application in a therapeutic milieu.
Journal of Aggression, Maltreatment and Trauma, 12(1-2): 169-182.

SECTION: PSYCHOLOGY AND EDUCATION SCIENCES Arhipelag XXI Press, Tîrgu Mureș, 2015, ISBN: 978-606-8624-21-1

24. Goodenough, B., & Ford, J. (2005). Self-reported use of humor by hospitalized
preadolescent children to cope with pain-related distress from a medical intervention.
Humor, 18(3): 279–298.
25. Gross, J. J. (2008). Emotion regulation. In M. Lewis, J. M. Haviland-Jones, & L. F.
Barrett (Eds.), Handbook of emotions (3rd ed.) (pp. 497–512). New York, London: The
Guilford Press.
26. Gruner, C. R. (1997). The game of humor: A comprehensive theory of why we laugh.
New Brunswick, NJ: Transaction Publishers.
27. Haig, R. A. (1986). Therapeutic Uses of Humor. American Journal of Psychotherapy,
40(4): 543-553.
28. Hampes, W. P. (2010). The relation between humor styles and empathy. Europe‟s
Journal of Psychology, 6(3): 34-45.
29. Harris, C. R. & Alvarado, N. (2005). Facial expressions, smile types and self-report
during humour, tickle, and pain. Cognition and emotion, 19(5): 655-669.
30. Hudak, D. A., Dale, J. A., Hudak, M., DeGood, D. E. (1991). Effect of humorous stimuli
and sense of humor on discomfort. Psychological Reports, 69(3 Pt. 1): 779-786.
31. Itami, J., M. Nobori, H. Teshima (1994) Laughter and immunity. Shinshin-Igaku 34,
32. Jackson, J. (1999). Talking with cronic pain patients. Philadelphia, PA, USA, University
of Pennsylvania Press.
33. Kaufman, G. (1989). The Psychology of Shame. Theory and Treatment of Shame-Based
Syndromes. New York: Springer Publishing Company.
34. Koestler, A. (1964). The act of creation. London: Hutchinson.
35. Kunz, M., Prkachin, K., Lautenbacher, S. (2009). The smile of pain. Pain, 145(3): 273-
36. Ladegaard, H. J. (2013). Laughing at adversity: Laughter as communication in domestic
helper narratives. Journal of language and social psychology, 32(40): 390-411.
37. Lazarus, R. S., & Folkman, S. (1984). Stress, appraisal, and coping . New York, NY:

SECTION: PSYCHOLOGY AND EDUCATION SCIENCES Arhipelag XXI Press, Tîrgu Mureș, 2015, ISBN: 978-606-8624-21-1

38. Lipman (1991). Laughter in Hell: The Use of Humor During the Holocaust. Jason
Aronson, Inc.
39. Marcus, N. N. (1990). Treating those who fail to take themselves seriously: Pathological
40. aspects of humor. American Journal of Psychotherapy, 44(3): 423-332.
41. Martin, R.A. & Dutrizac, G. (2004) Humor styles, social skills, and quality of
interactions with close others: a prospective daily diary study. Paper presented at the
annual conference of the International Society for Humor Studies, Dijon, France.
42. Martin, R. A. (2007). The Psychology of Humor: an integrative approach. Burlington,
MA : Elsevier Academic Press.
43. Matsumoto, Y. (2009). Dealing with life changes: humour in painful selfdisclosures
44. by elderly Japanese women. Ageing and Society, 29(6): 929-952.
45. McDougall, W. (1903). The theory of laughter. Nature, 67, 318–319.
46. McDougall, W. (1922). Why do we laugh? Scribners, 71, 359–363.
47. McGraw, A. P., Williams, L. E., Warren, C. (2014). The rise and fall of humor:
psychological distance modulates humorous responses to tragedy. Social Psychological
and Personality Science, 5(5): 566-572.
48. Melzack, R., & Wall, P. D. (1965). Pain mechanisms: A new theory. Science, 150: 971–
49. Nathanson, D. (1992). Shame and Pride. Affect, Sex, and the Birth of the Self. New
York: Norton & Company.
50. Nevo, Ofra, Giora Keinan, and Mina Teshimovsky-Arditi (1993). Humor and pain
tolerance. Humor: International Journal of Humor Research, 6(1): 71–88.
51. Olsson, H., Backe, H., Sorensen, S. & Kock, M. (2002). The essence of humour and its
effects and functions: a qualitative study. Journal of Nursing Management, 10(1): 21-26.
52. Pilowsky, I. (1986). Psychodynamic aspects of the pain experience. In R. A. Sternbach
(Ed.), The psychology of pain (pp. 181–195). New York: Raven Press.
53. Ramachandran, V. S. (1998). The neurology and evolution of humor, laughter, and
smiling: the false alarm theory. Medical Hypotheses, 51(4): 351-354.
54. Richardson, G. E. (2002). The metatheory of resilience and resiliency. Journal of Clinical
Psychology, 58(3): 307-321.

SECTION: PSYCHOLOGY AND EDUCATION SCIENCES Arhipelag XXI Press, Tîrgu Mureș, 2015, ISBN: 978-606-8624-21-1

55. Rutter, M. (1985). Resilience in the face of adversity: Protective factors and resistance to
psychiatric disorder. British Journal of Psychiatry, 147: 598-611.
56. Stuber, M., Hilber, S. D., Mintzer, L. L., Castenda, M., Glover, D., Zeltzer, L. (2009).
Laughter, humor and pain perception in children: a pilot study. Evidence-based
complementary and alternative medicine, 6(2): 271-276.
57. Suls, J. M. (1977). Cognitive and disparagement theories of humour: A theoretical and
empirical synthesis. In A. J. Chapman & H. C. Foot (Eds.), It‟s a funny thing, humour
(pp. 41–45). Oxford: Pergamon Press.
58. Tse, M. M. Y., Lo, A. P. K., Cheng, T. L. Y., Chan, E. K. K., Chan, A. H. Y., Chung, H.
S. W. (2010). Humor therapy: relieving chronic pain and enhancing happiness for older
adults. Journal of Aging Research, 1-9.
59. Turk, D. C., Meichenbaum, D., & Genest, M. (1983). Pain and behavioral medicine: A
cognitive-behavioral perspective. New York, NY: Guilford Press.
60. Turner, J. A., & Clancy, S. (1988). Comparison of operant behavioral and cognitive-
behavioral group treatment for chronic low back pain. Journal of Consulting and Clinical
Psychology, 56(2), 261–266.
61. Veatch, T. C. (1998). A theory of Humor. Humor, 11(2): 161-215.
62. Wanzer, M., Booth-Butterfield, M., Booth-Butterfield, S. (2005) ―If We Didn't Use
Humor, We'd Cry‖: Humorous Coping Communication in Health Care Settings. Journal
of Health Communication: International Perspectives, 10(2): 105-125.
63. Weisenberg, M., Tepper, I., Schwarzwald, J. (1995). Humor as a cognitive technique for
increasing pain tolerance. Pain, 63(2): 207-212.
64. Werner, E. E., Smith, R. S. (1982). Vulnerable but invincible: A longitudinal study of
resilient children and youth. New York: McGraw-Hill.
65. Werner, E., and R. Smith. (1992). Overcoming the Odds: High-Risk Children from Birth
to Adulthood. New York: Cornell University Press.
66. Wicker, F. W., Thorelli, I. M., Barron, W. L., & Ponder, M. R. (1981). Relationships
among affective and cognitive factors in humor. Journal of Research in Personality,
15(3), 359–370.

SECTION: PSYCHOLOGY AND EDUCATION SCIENCES Arhipelag XXI Press, Tîrgu Mureș, 2015, ISBN: 978-606-8624-21-1

67. Winterowd, C., Beck, A. T., Gruener, D. (2000). Cognitive therapy with chronic pain
patients, NY, USA, Springer.
68. Zillmann, D. Rockwell, S., Schweitzer, K., Sundar, S. S. (1993). Does humor facilitate
coping with physical discomfort? Motivation and Emotion, 17(1): 1-21.
69. Zweyer, K., Velker, B., Ruch, W. (2004). Do cheerfulness, exhilaration, and humor
production moderate pain toleration? A facs study. Humor, 17(1/2): 85-119.