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Sense of humor and physical health:

Theoretical issues, recent findings,


and future directions

ROD A. MARTIN

Abstract

This article provides an introduction to this special issue on sense of humor


and physical health. It begins by discussing several di¤erent potential
mechanisms by which humor and laughter may benefit health. Each of these
mechanisms has di¤erent implications for the conceptualization and mea-
surement of humor or laughter, choice of research designs, and potential
therapeutic applications. A brief overview of the articles in this special issue
is provided, and their contributions are discussed in the context of past
research on humor and health. The results of these studies point to some
avenues of research that are not likely to be productive, as well as some
potentially fruitful directions for future research. Remaining questions are
discussed, and suggestions are given for future research in this area.

Keywords: Sense of humor; health; immunity; pain; well-being.

Introduction

Although some physicians and philosophers have been making claims


about health benefits of humor and laughter for centuries, these ideas
have become increasingly popular in recent decades. With the publication
of Norman Cousins’ (1979) account of his recovery from ankylosing
spondilitis following a self-prescribed treatment regimen involving daily
laughter and massive doses of vitamin C, and the subsequent populariza-
tion of alternative approaches to medicine, the therapeutic benefits of
humor and laughter have gained widespread acceptance. These popular
beliefs have been further bolstered by media reports of scientific research
purportedly showing evidence of beneficial e¤ects of laughter on immu-

Humor 17–1/2 (2004), 1–19 0933–1719/04/0017–0001


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2 R. A. Martin

nity, pain tolerance, blood pressure, and so forth. Stimulated by these


ideas, a number of enterprising health care practitioners have begun de-
veloping and promoting humor-based interventions, and therapeutic
clowns and comedy carts have become familiar sights in many hospitals.
Despite the popular belief in health benefits of humor and laughter,
and the proliferation of therapeutic interventions based on these ideas,
the empirical evidence for these claims to date is actually quite weak, in-
consistent, and inconclusive (for reviews of this research see Martin 2001;
2002). Due in large part to a lack of adequate funding for such research,
most of the studies have been small scale, with inadequate control groups
and other methodological weaknesses, making it di‰cult to draw firm
conclusions one way or the other. In general, although the research has
not provided convincing evidence that humor and laughter have bene-
ficial e¤ects on health, it also has not demonstrated that they do not.
Further research is clearly needed to determine potential health benefits
of humor and laughter and to examine the mechanisms, parameters, and
possible applications of such beneficial e¤ects, if indeed they are shown to
exist.
This special issue of Humor contains six articles presenting new empir-
ical research conducted by psychologists to investigate the humor-health
connection from various perspectives. Most of these articles focus on
sense of humor as a personality trait (rather than laughter) in relation to
aspects of health. If humor and/or laughter have positive e¤ects on health
variables, then one would expect that individuals who laugh and engage
in humor more frequently in their daily lives (i.e., those with greater
senses of humor) would show evidence of better general health, such as
enhanced immunity, fewer illnesses, and greater longevity.
In this introductory article, I will first discuss a number of issues rele-
vant to research on humor, laughter, and health, emphasizing the im-
portance of clarifying the hypothesized mechanisms and the need for
appropriate methodologies. Next, I will provide a brief overview of the
contributions of each of these articles to our knowledge about humor and
health. Finally, I will discuss some promising directions for further re-
search on this topic.

Hypothesized mechanisms

Humor is a very complex phenomenon, involving cognitive, emotional,


behavioral, physiological, and social aspects (Martin 2000). These di¤er-

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Sense of humor and physical health 3

ent components of humor are also reflected in di¤erent conceptualizations


of sense of humor, which refers to a set of relatively stable humor-related
personality traits or individual di¤erence variables (Ruch 1998). Indeed,
no single dimension can adequately capture the concept of sense of
humor. For example, sense of humor may be variously conceived as a
tendency to laugh frequently, to easily perceive humorous incongruities in
the environment, to tell jokes and amuse others, to be generally cheerful,
to maintain a humorous outlook in coping with stress, to deprecate one-
self in a humorous way, and so on. Some of these definitions of sense
of humor may be related to certain physical health variables, while
others may not. Researchers therefore need to ensure that their measures
accurately capture the definitions of humor that are relevant to their
hypotheses.
Moreover, the mechanisms by which they are related to health may be
di¤erent for di¤erent ‘‘senses’’ of humor. Systematic research is needed to
investigate carefully each of these potential mechanisms separately and to
determine which components and aspects of humor are important and
which are not. Only when we have gained such knowledge can we begin
to design e¤ective therapeutic interventions based on these findings. In
general, four potential mechanisms have been proposed, each involving a
di¤erent aspect of humor (and hence a di¤erent conceptualization of
sense of humor), each requiring di¤erent research approaches, and each
suggesting di¤erent implications for health care interventions (Martin
2001).
First, health benefits may result from some of the many physiological
changes in the body that accompany laughter, such as changes in muskulo-
skeletal, cardiovascular, endocrine, immunological, and neural systems.
Various authors have suggested, for example, that vigorous laughter ex-
ercises and relaxes muscles, improves respiration, stimulates circulation,
increases the production of pain-killing endorphins, decreases the produc-
tion of stress-related hormones, and enhances the immune system (e.g.,
Fry 1994). According to this theoretical model, hearty laughter is the
crucial component in the humor-health connection; humor and amuse-
ment without laughter would not be expected to provide any health bene-
fits. Indeed, laughter may be expected to have beneficial e¤ects even
without humor (e.g., feigned or forced laughter), as advocated by leaders
of the laughter club movement (e.g., Kataria 2002). From this perspec-
tive, the person with a ‘‘healthy’’ sense of humor is the one who laughs
uproariously as often as possible, rather than the one who enjoys dry hu-

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4 R. A. Martin

mor accompanied only by the occasional chuckle or smile. In this model,


humor interventions should be aimed particularly at encouraging people
to engage in frequent and intense laughter.
A second, alternative mechanism by which humor may potentially
influence health is through the positive emotional states accompanying
humor and laughter. Positive emotions, regardless of how they are gen-
erated, may have beneficial e¤ects on health, such as increasing pain tol-
erance (Bruehl et al. 1993), enhancing immunity (Stone et al. 1987),
or undoing the cardiovascular consequences of negative emotions (Fre-
drickson 1998). Compared with the first model, this one gives humor and
laughter a less unique role in health enhancement, as they are particular
means of increasing positive emotions, along with happiness, love, joy,
optimism, and so forth. In addition, according to this model, overt
laugher may not even be necessary for health benefits to occur because
humor and amusement may induce positive moods even without laugh-
ter. Here, a ‘‘healthy’’ sense of humor would involve a generally cheerful
temperament characterized by happiness, joy, optimism, and a playful
approach to life (cf. Ruch 1993). If this model is correct, therapeutic
interventions should aim at increasing people’s positive emotions by a
variety of means in addition to humor, and the promotion of laughter
would not be as important.
As a third potential mechanism, humor might benefit health indirectly
by moderating the adverse e¤ects of psychosocial stress on health. There
is a large body of research evidence that stressful life experiences can have
adverse e¤ects on various aspects of health, such as suppression of the
immune system (Adler and Hillhouse 1996) and increased risk of heart
disease (Esler 1998), through the chronic production of various stress-
related hormones, such as catecholamines and cortisol. There is also a
considerable amount of research indicating that certain personality vari-
ables and coping styles can serve to moderate the degree to which po-
tential stressors lead to such adverse health outcomes (e.g., Cohen and
Edwards 1989). Thus, a humorous outlook on life and ability to see the
funny side of one’s problems may enable individuals to cope more e¤ec-
tively with stress by allowing them to gain perspective and distance
themselves from stressful situations, enhancing their feelings of mastery
and well-being in the face of adversity (Lefcourt and Martin 1986;
Martin et al. 1993; Martin and Lefcourt 1983). As a consequence, these
individuals may experience fewer of the adverse e¤ects of stress on their
physical health.

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Sense of humor and physical health 5

According to this stress-moderator view, the cognitive-perceptual


aspects of humor are more important than mere laughter, and the ability
to maintain a humorous outlook during times of stress and adversity is
particularly important: humor and laughter during non-stressful times
would be less relevant to health. This view also introduces the possibility
that certain styles of humor (e.g., perspective-taking humor) may be
more adaptive and health-enhancing than others (e.g., excessively self-
disparaging humor). If this view is correct, therapeutic humor inter-
ventions should be viewed as a component of stress management training,
focusing on teaching individuals ways of using humor to cope with stress
in their daily lives.
Finally, humor may indirectly benefit health by increasing one’s level
of social support. Individuals who are able to use humor e¤ectively to
reduce interpersonal conflicts and tensions and to enhance positive feel-
ings in others may consequently enjoy more numerous and satisfying so-
cial relationships. In turn, the greater levels of social support resulting
from these relationships may confer stress-bu¤ering and health-enhancing
e¤ects (Cohen and Wills 1985). In this model the focus is on interpersonal
aspects of humor and the social competence with which individuals ex-
press humor in relationships, rather than the frequency with which they
engage in laughter. Here, a ‘‘healthy’’ sense of humor would involve the
use of humor to enhance relationships with others in an a‰liative and
non-hostile manner. If this mechanism is correct, therapeutic humor in-
terventions may be seen as an adjunct to social skills training, teaching
individuals to develop a socially facilitative sense of humor.

Approaches to research on humor, laughter, and health

Researchers need to be clear about which of these potential mechanisms


they are investigating, as this will have an important bearing on their re-
search design, including the types of questions they seek to answer; the
ways in which they manipulate or measure humor and/or laughter; addi-
tional variables that they manipulate, measure, or control; and the types
of health-related outcome variables that they assess. In general, past re-
search has made use of two broad approaches to investigate the e¤ects
of humor and laughter on physical health variables: the experimental
approach and the correlational approach. In the experimental approach,
participants are exposed to humorous stimuli (typically a comedy video-

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6 R. A. Martin

tape), either alone or in groups, and various physiological measures such


as components of the immune system or pain tolerance are assessed be-
fore and after this humor intervention. Of course, this type of research
requires control groups to control for potential non-humor-related influ-
ences on the variables under investigation, such as diurnal variations,
passage of time, presence of other people, and factors associated with
watching an interesting videotape such as absorption and distraction.
In addition, to determine whether laughter is necessary for any observed
e¤ects, researchers should monitor the frequency, duration, and intensity
of laughter that occurs during the exposure to comedy, distinguishing
between genuine felt (Duchenne) laughter and feigned or forced laughter
(Ekman et al. 1990), and examine correlations of each of these types of
laughter with any observed changes in the physiological variables under
investigation. It would also be beneficial to include conditions in which
some participants are instructed to laugh aloud and others are instructed
to inhibit overt laughter to determine whether laughter is essential.
Furthermore, researchers should also include non-humor-related posi-
tive and negative emotion conditions (e.g., exposure to videotapes that
have been demonstrated to evoke specific positive and negative emotions)
to determine whether any changes in dependent variables are specific to
humor or are also found with other positive, or even negative, emotions.
Additionally, it is important to include manipulation checks, having par-
ticipants rate the various stimuli for funniness, interest, boredom, enjoy-
ableness, etc., to ensure that the conditions di¤er as intended on funniness
and in the specific emotions elicited but do not di¤er on other dimensions.
Unfortunately, most of the experimental studies conducted to date have
not directly monitored laughter in the participants, and most have not
included positive and negative emotion control groups (Martin 2001).
However, several of the studies on humor and pain tolerance have in-
cluded control conditions inducing negative emotions such as fear, sad-
ness, or disgust. Interestingly, these studies have shown similar increases
in pain tolerance in the negative emotion groups as well as the humor
groups (e.g., Weisenberg et al. 1995).
Besides examining the hypothesized benefits of laughter and humor-
induced positive emotions, the experimental approach can also be used to
test the stress-moderator model of the humor-health connection. For ex-
ample, individuals can be exposed to a stressful laboratory procedure
(e.g., anticipation of painful electric shock or exposure to a distressing
videotape), and humor can be manipulated, either by providing partic-

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Sense of humor and physical health 7

ipants with a humorous narrative, or by instructing them to produce


humor. Again, non-humorous control conditions are needed. E¤ects on
various physiological variables can be examined, such as heart-rate,
blood pressure, and various components of immunity (e.g., Newman and
Stone 1996).
In addition, the experimental approach can be taken out of the labo-
ratory, where it is likely to produce only short-term e¤ects with unknown
clinical significance, and used in field studies involving experimental in-
terventions. Here, for example, humor could be included as a therapeutic
intervention repeated over a series of sessions, with either healthy partic-
ipants or medical patients, and more long-term health outcomes may be
assessed (e.g., Rotton and Shats 1996; White and Camarena 1989).
Again, appropriate control groups and manipulation checks are needed in
such approaches to identify the active components of the interventions,
determine the mechanisms involved, and explore parameters such as
dose-response curves.
The second general research approach is the correlational approach,
which typically involves measuring individual di¤erences in sense of
humor (usually with self-report scales) and examining their relationship
to health-related variables. Although the correlational approach does not
demonstrate causal relationships, it does allow for a more naturalistic
examination of longer-term health outcomes than the short-term phy-
siological changes studied in the laboratory experimental approach. If
humor-related physiological changes shown in the laboratory are robust
and clinically significant, then it should be possible to demonstrate that
people who habitually engage in more humor and/or laughter in their
daily lives have, on average, better health outcomes over the course of
time.
In addition to examining simple correlations between sense of humor
and various health variables, the correlational approach also allows for
investigation of more indirect mechanisms, such as the stress-moderation
and social support mediation hypotheses, using multivariate statistical
techniques, such as multiple regression analysis or structural equation
modeling. In the correlational approach, it is also important for re-
searchers to carefully select reliable and valid measurement instruments
that assess the components or aspects of sense of humor that are relevant
to their hypotheses. For example, a test of appreciation of di¤erent types
of jokes and cartoons may not be an appropriate way to assess sense of
humor when researchers are wishing to investigate potential long-term

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8 R. A. Martin

benefits of humor used as a coping strategy. Each research approach has


its strengths and weaknesses, and the combination of a variety of meth-
odologies will allow for a convergence of evidence and accumulation of
knowledge.

Overview of research

Most of the articles in this special issue take the correlational approach,
focusing particularly on ‘‘sense of humor’’ as a personality trait. As such,
they make use of a variety of self-report measures of sense of humor, ex-
amining their relationships with various aspects of physical (and psycho-
logical) health. One exception to this is the article by Zweyer et al., which
presents an experimental laboratory study examining the e¤ects of humor
and laughter on pain tolerance and threshold. Even in this study, though,
the authors were also interested in the role of humor-related personality
traits (trait cheerfulness and seriousness) in moderating the observed ex-
perimental e¤ects of a humorous stimulus on pain perception.
Since I have provided a detailed review of the research on humor,
laughter, and physical health elsewhere (Martin 2001; see also Martin
2002), I will only briefly summarize some of the past findings here.
Instead, I will focus on the contributions made by the articles in this issue
to the research literature.

Experimental research

Past researchers have used experimental methods to examine e¤ects of


exposure to comedy on a variety of immunological and endocrinologic
variables assayed in saliva and blood samples, including the levels, ratios,
and activity of various immunoglobulins, natural killer, helper, and sup-
pressor cells, tumor necrosis factor, and interleukins, as well as cortisol,
catecholamines, growth hormone, beta-endorphin, and so on. Although
these studies have reported some humor-related changes in some of these
variables, the results have often been inconsistent across studies, with
some studies showing an increase in a particular immunity-related vari-
able, others finding a decrease in the same variable, and still others find-
ing no change. In addition, it is often di‰cult to draw firm conclusions
from these studies due to a number of methodological weaknesses, in-

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Sense of humor and physical health 9

cluding inadequate control groups, small sample sizes, and inflated alpha
levels (Martin 2001). In sum, more well-controlled research is needed
before we can have any confidence about potential beneficial e¤ects of
humor or laughter on immunity.
In contrast, the experimental studies that have investigated the e¤ects
of exposure to comedy on pain tolerance or threshold have generally been
more carefully controlled and methodologically rigorous. Most of these
studies have included several control groups, controlling for such factors
as distraction, relaxation, and negative emotion. Overall, these studies
have provided fairly consistent evidence that exposure to comedy results
in increases in pain threshold and tolerance that do not appear to be
simply due to distraction. There is also some indirect evidence that these
e¤ects are due to physiological changes a¤ecting the sensory components
of pain, rather than simply altering the cognitive-a¤ective-motivational
components of pain, although the exact mechanisms are still not known
(Weisenberg et al. 1998). Because none of the previous studies have ex-
amined the actual occurrence of laughter in relation to changes in pain
tolerance, it has been unclear whether laughter is necessary for the e¤ects
to occur.
In the present issue, the study described by Zweyer et al. was designed
to address such questions regarding the mechanisms involved in humor-
related pain-reduction e¤ects, as well as exploring various parameters of
the e¤ects, such as duration and interaction with trait cheerfulness and
seriousness. Accordingly, they randomly assigned participants to three
conditions while watching a funny film to compare the e¤ects of (1) a
cheerful mood without smiling or laughing, (2) extensive smiling and
laughing, and (3) production of humorous commentary. Pain tolerance
was measured before, immediately after, and twenty minutes after the
film. The researchers also videotaped the participants during the proce-
dure and subsequently coded their facial expressions for genuine and
faked smiling and laughter, using the Facial Action Coding System (Ek-
man and Friesen 1978).
This study provides a number of interesting findings concerning poten-
tial analgesic e¤ects of humor. Overall, the three conditions yielded simi-
lar increases in pain threshold and tolerance, which were evident imme-
diately after the film and continued twenty minutes later. These findings
indicate that neither laughter nor humor production are necessary, be-
yond amusement, for the e¤ect to occur. Moreover, the observed in-
creases in pain tolerance were positively associated with genuine enjoy-

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10 R. A. Martin

ment smiles (Duchenne display), but not with the frequency or intensity
of laughter. In fact, voluntary e¤orts to show or amplify laughter-related
positive emotions were actually negatively associated with pain tolerance.
Thus, contrary to the hypothesis of laughter-induced physiological
changes, these results suggest that the mechanisms have to do with
amusement-related positive emotional states. These findings will, of
course, need to be replicated before we can draw firm conclusions. How-
ever, with regard to humor interventions, they suggest that, for pain-
reducing e¤ects of humor, individuals should be encouraged to enjoy
themselves in an unrestrained manner, whereas forcing themselves to
laugh artificially may actually be counter-therapeutic. Overall, this article
provides an excellent model for future experimental research exploring
the mechanisms and parameters of e¤ects of humor and laughter on
health-related variables, such as aspects of the immune system as well as
pain tolerance.

Correlational research

A number of previous researchers have taken a correlational approach to


investigate the relationship between various measures of sense of humor
and aspects of physical health. Overall, the results of these studies have
been weak and inconsistent. For example, there is little consistent evi-
dence of simple correlations between scores on self-report measures
of sense of humor and such health-related variables as immunoglobulin
levels, pain tolerance, blood pressure, or self-reported illness symptoms
(Martin 2001). One well-known longitudinal study, involving nearly
1,200 participants who were followed over many decades, has actually
shown that individuals who were rated as more cheerful in childhood
(combining ratings of sense of humor and optimism) had a greater risk of
mortality from all causes of death throughout the lifespan (Friedman et
al. 1993; Martin et al. 2002). These researchers concluded that, rather
than enhancing health and longevity, a more cheerful outlook on life may
lead to a greater propensity for taking risks and ignoring potential health
problems, leading to a risk of earlier death. Critics of this study, however,
have noted that the measurement of humor may not adequately reflect
other potentially important dimensions (e.g., Svebak et al. this issue).
Studies examining potential stress-moderating e¤ects of sense of humor
on physical health variables have also yielded mixed results, with some

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Sense of humor and physical health 11

studies showing the expected interaction (e.g., Martin and Dobbin 1988),
others showing no e¤ect (e.g., Porterfield 1987), and still others showing
significant e¤ects opposite to prediction (e.g., Anderson and Arnoult 1989).
Most of the articles in this special issue report on correlational research
that has explored a variety of di¤erent avenues in attempting to clarify
potential relations between sense of humor and health. The study by
Svebak et al. represented a unique opportunity to include a measure of
sense of humor in a large population health study that involved the en-
tire adult population of a county in Norway. Besides completing a brief,
three-item sense of humor measure derived from Svebak’s (1996) Sense of
Humor Questionnaire (SHQ), more than 65,000 participants completed a
survey about their illness symptoms in a variety of areas (e.g., nausea,
diarrhea, pounding heart, dyspnea, musculuskeletal pain) and their over-
all health satisfaction and were also assessed for blood pressure, height,
and weight (allowing for computation of body mass index, a measure of
obesity). As such, this is the largest correlational study of sense of humor
and health ever conducted.
However, the results provide very little evidence for a simple relation-
ship between sense of humor and health. After controlling for age, no
meaningful relationships were found between sense of humor and either
illness symptoms or objective health indicators although the study did
find a weak relationship between sense of humor and satisfaction with
health ðr ¼ :12Þ. These results suggest that, although high humor in-
dividuals do not seem to have objectively better health, they are more
subjectively satisfied with their health. In view of the very large sample
size of this study, the broad age range of participants, and the unselected
nature of the sample, these data provide quite convincing evidence that
people with a greater sense of humor (at least as defined by high scores on
such self-report tests as the SHQ) are not healthier overall than their low
humor counterparts. If a sense of humor does confer any health benefits,
it would appear that either they are too subtle to be captured by such a
cross-sectional design, or the type of humor involved is not adequately
captured by the SHQ. For example, this study did not include a measure
of life stress, so the authors were unable to examine the possibility of a
stress-moderating e¤ect of sense of humor on health. In addition, the
possibility remains that e¤ects of humor on health might emerge over
time in a longitudinal design.
The study reported by Svebak et al. provides further data concerning
potential stress-moderating e¤ects of sense of humor. In this study, more

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12 R. A. Martin

than 1,000 high school students completed measures of sense of humor


(the SHQ-6; Svebak 1996), life stress, bodily complaints (e.g., muscle
pain, cardiovascular symptoms, headache, respiratory problems, colds,
influenza, gastrointestinal symptoms), meaning in life, and sense of im-
portance of life activities. Although there was a highly significant rela-
tionship between life stress and bodily complaints (those who reported
experiencing more stress also reported more symptoms), there was again
no simple direct relationship between sense of humor and symptoms.
Moreover, multiple regression analyses did not reveal any evidence of a
stress-moderating e¤ect of sense of humor in predicting bodily symptoms.
However, the study did find a significant interaction between sense of
humor and importance of life activities in predicting symptoms. Among
individuals with a high sense that their life activities had importance,
higher sense of humor was related to lower bodily complaints, whereas
there was a positive relationship between sense of humor and bodily
complaints among those with a low sense of life importance. Although
these unexpected findings require replication, they point toward a need
for greater distinctions between di¤erent styles or functions of humor that
may be associated with other personality traits. A sense of humor in itself
may be neither healthy nor unhealthy, but humor associated with certain
other traits or characteristics, such as a sense that one’s life pursuits have
meaning or importance, may be more conducive to health.
The article by Kerkkänen et al. addresses the question of potential
longitudinal relationships between sense of humor and physical health
over several years. In this study, data were obtained from 34 Finnish
police chiefs on two occasions three years apart. Sense of humor was
measured using the Multidimensional Sense of Humor Scale (MSHS;
Thorson and Powell 1993), as well as peer ratings of sense of humor.
Health-related measures included assessments of blood pressure, choles-
terol levels, alcohol consumption, body mass index, and smoking. Once
again, the results did not support the humor-health hypothesis, as sense of
humor scores obtained at Time 1 did not predict any of the Time 2 levels
of physical health. In fact, further analyses, including data on an addi-
tional sample of 53 Finnish police constables, revealed some associations
that were contrary to the humor-health hypothesis (e.g., higher scores on
some aspects of sense of humor were associated with greater obesity, in-
creased smoking, and greater risk of cardiovascular disease), suggesting
that individuals with a greater sense of humor may actually engage in less
healthy lifestyle behaviors, such as smoking and overeating. Although the

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Sense of humor and physical health 13

sample size was quite small, these longitudinal data are consistent with
the cross-sectional findings of Svebak et al., casting further doubt on the
idea that people with a greater sense of humor (at least as defined by self-
report measures, such as the MSHS) have better overall physical health.
In view of the negative findings of the previous correlational studies,
the study by Kuiper and Nicholl represents a somewhat di¤erent
approach to investigating the relationship between sense of humor and
physical health. These researchers sought to explore potential reasons
why belief in physical health benefits of humor is so popular, despite a
lack of strong evidence for such a relationship. They suggested that it
may be important to distinguish between actual and perceived physical
health and proposed that a greater sense of humor may contribute to
more positive perceptions of physical health than may actually be war-
ranted. To test these ideas, they had undergraduate students complete a
questionnaire assessing four components of sense of humor, as well as a
broad range of health-related variables, including fear of death and dis-
ease, bodily focus, worry and concern about illness, frequency of seeking
medical treatment, decisions to seek treatment, health-related lifestyle
habits (e.g., smoking, overeating), and illness symptoms experienced.
The results provided some support for their proposal. Whereas in-
dividuals with higher scores on the sense of humor measures did not
report more healthy lifestyle habits, they did report more positive health-
related perceptions, such as less fear of death or serious disease, less neg-
ative bodily preoccupation, and less concern about pain. These results are
consistent with the finding of Svebak, Martin, and Holmen that higher
sense of humor is related to greater subjective satisfaction with health but
not with more objective indicators of health status. These findings may
help to explain the immense popularity of the idea that humor is benefi-
cial for one’s health. People with a greater sense of humor may perceive
themselves to be more healthy, showing less concern about symptoms of
illness, even though they are not objectively healthier. Again, these find-
ings require replication with larger samples of subjects representing a
broader age range.
Finally, the article by Kuiper et al., although focusing on psychological
rather than physical health in relation to sense of humor, is included in
this special issue because it explores a promising avenue that has impor-
tant implications for physical health research as well. In particular, they
examined the hypothesis that di¤erent components or styles of humor
may be related in quite di¤erent ways with psychological well-being, with

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14 R. A. Martin

only some being facilitative and others actually being detrimental. Par-
ticipants in this study completed measures of eight di¤erent components
of sense of humor (four derived from a previous study by Kirsh and
Kuiper 2003, and four from the Humor Styles Questionnaire, Martin et
al. 2003), as well as several indices of psychological well-being. The anal-
yses indicated strong support for a multidimensional approach to sense of
humor, distinguishing between aspects of humor that are potentially ben-
eficial to well-being and those that are potentially detrimental. Moreover,
the correlations between the sense of humor components and the psy-
chological well-being measures provided evidence for clear distinctions
between these di¤erent styles of humor, with correlations in opposite
directions being found for di¤erent components of humor and various
well-being measures. Although further research is needed to determine
whether these patterns of findings can be extended to physical health
variables as well, they do underscore the need for researchers, as well as
practitioners, to distinguish between potentially beneficial and detrimen-
tal forms of humor.

Future research directions

Overall, the research reported in this issue casts additional doubt on sim-
plistic notions of relations between sense of humor and physical health. In
particular, the studies by Svebak et al. and by Kerkkänen et al. suggest
that there is no simple relationship between sense of humor (at least as
measured by traditional scales) and various health parameters, either
cross-sectionally or prospectively. Indeed, the study by Kuiper and
Nicholl raises the possibility that the humor-health connection may actu-
ally be illusory. Due to a generally humorous outlook, cheerfulness, and
optimism, high humor people may believe they are healthier even though
they are not.
Does this mean that researchers should abandon the idea of health
benefits of humor and laughter? On the contrary, given the long-standing
popularity of this idea and the importance of such a finding if it does ex-
ist, I would argue that the current state of the research calls for greater
research e¤orts, employing more careful theoretical formulations and
more sophisticated and rigorous methodological approaches. The present
studies present some promising leads that future researchers might do
well to pursue.

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Sense of humor and physical health 15

With regard to experimental approaches, the study by Zweyer et al.


provides a model for future research, underscoring the need for more
careful methodology, testing specific hypotheses, assessing a limited
number of variables, and exploring the potential mechanisms involved.
Coding of facial expressions of both genuine and forced laughter and
smiling, using the Facial Action Coding System, allowed for some im-
portant discoveries that would not have been possible otherwise, particu-
larly that laughter is not crucial to the pain-reducing e¤ects found pre-
viously. Thus, this methodological refinement furthers our understanding
of the phenomenon, casting doubt on the laughter mechanism hypothesis.
Such methodologies need to be applied to experimental research look-
ing at other health-related outcomes as well, such as immunity, stress-re-
lated hormones, etc. Indeed, our understanding of the physiological
bodily changes associated with laugher and amusement is still very in-
complete. We still have surprisingly little understanding of the basic neu-
ral (e.g., sympathetic and parasympathetic), cardiovascular, hormonal,
and other biochemical processes associated with laughter (Harrison et al.
2000).
With regard to ‘‘sense of humor’’ research, the studies by Kuiper et al.
and by Svebak et al. point to a need for new conceptualizations of humor,
distinguishing potentially healthy and unhealthy forms. Most of the tra-
ditional trait measures of sense of humor were developed on the assump-
tion that all humor is healthy, and they consequently ignore aspects or
forms of humor that may be detrimental to psychological and physical
health, such as aggressive or excessively self-disparaging humor. In the
relationship between humor and health, it may be at least as important
for individuals to show a lack of certain deleterious forms of humor as to
show a high level of more beneficial types of humor. Newer measures that
distinguish between di¤erent styles of humor, such as the Humor Styles
Questionnaire (Martin et al. 2003), may be useful tools for examining
these hypotheses. These measures may be particularly useful in examining
the hypothesized stress-moderation and social support mechanisms in the
humor-health link.
Besides using new measures that distinguish potentially beneficial and
detrimental uses of humor, researchers also need to make use of more
sophisticated methodologies. For example, research investigating poten-
tial stress-moderating e¤ects of humor has relied on cross-sectional
methods with retrospective assessments of stress and trait measures of
sense of humor, which may not have been sensitive enough to capture

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16 R. A. Martin

specific ways in which humor is used on a day-to-day basis in coping


with specific stressors. A more promising methodology involves more
intensive study of individuals over time, using daily diary or on-line
reporting methods with hand-held computers to examine actual expres-
sions of di¤erent types of humor in the context of particular types of
stressful experiences. Such approaches allow for a more intensive,
process-oriented study of interactions between expressions of humor or
laughter, life events, social relationships, and health variables over time.
Such rich and complex data require more sophisticated analysis methods,
such as hierarchical linear modeling approaches (Bryk and Raudenbush
1992).
In addition, researchers should explore other hypothesized mechanisms
for the humor-health link. For example, the hypothesis that health bene-
fits of humor are mediated by social support has received almost no re-
search attention to date. Very little research has examined the e¤ects of
sense of humor on social support or other aspects of interpersonal rela-
tionships such as attraction, intimacy, or marital satisfaction. Here again,
researchers should distinguish between styles of humor that are conducive
to greater relationship satisfaction, reduction of interpersonal conflict,
empathy, and intimacy, and forms of humor that may interfere with
e¤ective social relationships. For example, the tendency to engage in
humor that is hostile, sarcastic, or disparaging of others may lead to less
intimate social relationships and hence less social support, which might in
turn result in poorer health outcomes. Investigators should also be alert
to the possibility that certain forms of humor may be beneficial in some
ways and detrimental in others. For example, aggressive and sarcastic
styles of humor may be useful to the individual in relieving tension and
coping with daily stress but may be detrimental to one’s relationships and
potential social support.
In conclusion, despite widespread popular beliefs in health benefits of
humor and laughter, the research evidence for these e¤ects is still quite
weak, inconsistent, and inconclusive. The strongest evidence so far is for
humor-related increases in pain tolerance, although the mechanisms and
parameters are still not well understood. The articles in the present special
issue provide some new evidence, indicating paths that are not likely to be
productive, as well as pointing to potentially promising new directions for
future research.

University of Western Ontario

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Sense of humor and physical health 17

Note

Correspondence address: Rod A. Martin, Department of Psychology, University of Western


Ontario, London, Ontario, Canada, N6A 5C2; ramartin@uwo.ca

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