PART II: HUMOR AND MENTAL HEALTH:
USING HUMOR TO COPE WITH STRESS
In the midst of the rapid changes that have occurred in the healthcare system in recent years, one constant has emerged. Nurses are experiencing more and more stress in their efforts to provide patient care. (But you already knew that, right?) It has long been argued that virtually all nursing is stressful to some extent.37 Similarly, job-related stress has long been known to be the greatest source of job dissatisfaction among nurses.38 This has recently led to calls for nurses to be provided specific training and skills to help manage this stress more effectively.39
Humor is a coping tool that is increasingly being recognized as a skill that is essential to effective nursing - in both the short and long run. Among nurses who are able to find humor in situations during their work, burnout is lower and job satisfaction is higher.40 Most nurses are quite aware of how important humor for them. One study showed that 92% of the nurses surveyed indicated that humor helped them cope with stress on the job. And 83% said they laugh and joke with coworkers about a difficult patient, unusual code, or death on the unit. In one study, the second most common situation in which nurses used humor was in some kind of stressful situation - typically when they are most busy or "a push is on." 41 (The most common situation was in the midst of routine care.)
Of course, humor is just as important for doctors as it is for nurses. In this time of increasing threat of malpractice lawsuits, it is worth noting that the Journal of the American Medical Association reported in the late 1990s that physicians who used humor and laughter more were less likely to have malpractice claims filed against them.42
Freud pointed out a century ago that humor offers us a healthy means of coping with life stress. George Vaillant, in his book, Adaptation to Life, reported that in-depth interviews revealed that humor was a very effective coping mechanism used by many professional men under stress. Gail Sheehy reported the same thing for both men and women in her book, Pathfinders.
A key idea emerging in both of these books is that you need to actively use your sense of humor in dealing with the hassles and stresses in your life to get the coping benefits offered by humor. You can have a good sense of humor in a general sense, but still have your sense of humor abandon you when things begin to go wrong. On your good mood days, you can have quick and easy access to a playful attitude, be the one who comes up with clever quips or finds a funny side to things that happen, and be able to poke fun at yourself. But this won't help you manage the stress in your life unless you can do the same thing on the tough days.
___________________________________________________________ "If it weren't for the brief respite we give the world with our foolishness, the world would see mass suicide in numbers that compare favorably with the death rate of lemmings." Groucho Marx
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This view was supported by a Canadian study that found that even if you're someone who finds a lot of humor in everyday life, it doesn't help you cope with stress unless you also make an effort to actively use humor to deal with that stress.43 So even though you have a great sense of humor when all is well, you'll be just as stressed out as the next person on your bad days.
People who have access to their sense of humor in the midst of stress are much more resilient than the rest of us. They are emotionally more flexible and can bend without breaking in the midst of the most difficult circumstances. If you're lucky, and have parents who generally showed a good sense of humor in the midst of stress, chances are you've already got some of those qualities within yourself. You just need to refine and strengthen them. One study showed that even a five-session humor workshop was enough to improve adults' use of humor to cope with life stress.44
It's important to know that it's never too late to improve your humor skills - even if you're past retirement age. One recent study showed that going through my "8-Step Humor Skills Program" (this is discussed below) had a significant positive impact on seniors' ability to cope with the stress in their lives.45 One group of seniors spent a week actively working on improving their sense of humor using this skill-development program, while the other simply got together once a week and watched old comedy programs (programs that they enjoyed watching 40 or 50 years earlier) together. Although the "passive" humor group enjoyed the old comedy programs and laughed a lot during them, only the group that made an active effort to improve their own humor skills got better at using humor to cope with their daily stressors.
The first section of part II discusses the basic research documenting humor's power as a tool for coping with life stress. Subsequent sections discuss the use of humor in coping with stress in real-life situations. The final section considers key factors that help explain the coping power of humor.
Experimental Research
Experimental studies of the coping power of humor have used various techniques to generate stress in a laboratory setting. The stress-inducing procedures used are tested in advance to assure that they are, in fact, generating stress. The goal is to arouse feelings of anger, anxiety, sadness, depression, etc., and then measure humor's power to alleviate those feelings and reduce the perception of stress. Funny cartoons or videos are then presented to these angry, anxious or depressed subjects, and the impact of humor on these feelings (or the level of stress experienced) is compared to the effect of non-humorous materials. People are randomly assigned to humor or non-humor groups, so the effect of humor on stress or negative emotion can be precisely determined.
Using this approach, humor has been shown in many studies to reduce feelings of anger or aggression,46 anxiety,47 and depression.48 In the case of anxiety, progressive relaxation (in which you focus attention on specific muscle systems, going from head to toe, or vice versa, relaxing one set of muscles after another) is one technique often used to help anxiety-prone individuals manage their anxiety. When watching a comedy video was compared to this standard progressive relaxation procedure, humor was just as effective as the 20-minute relaxation procedure in reducing anxiety.49 The great advantage of shared humor and a good belly laugh, of course, is that it's quicker and a lot more fun. 
And, let's face it, in the middle of most nurses' typical bad day, it's not possible to sit down and meditate or do a period of progressive relaxation. Although humor and laughter are obviously inappropriate in many healthcare settings, it's certainly much easier to find an appropriate place to share a funny anecdote and laugh yourself loose than to do a progressive relaxation exercise.
Sometimes any form of distraction can take your mind off whatever is making you anxious and give you a little bit of relief from the constant tension that goes along with anxiety. So it not surprising that some research has shown non-humorous videos to be just as effective as humorous ones in reducing anxiety. In one example of this kind of outcome, subjects first watched a movie segment known to cause stress and then viewed either a humorous or non-humorous videotape. Several stress-related measures were taken both before and after each of the two video segments. Both the humorous and non-humorous videos were effective in reducing anxiety generated by the film, presumably because of their shared ability to distract subjects from the previously-seen stressful content. However, only the humorous video also increased positive emotion.50 This increase in positive emotion occurred even though no attempt was made to match the funny video seen to participants' own humor preferences. When exposed to one's favorite comedians or forms of humor, this effect should be all the stronger.
Considering the research as a whole, it is this combination of increased positive emotion and reduced stress-related negative emotion that makes humor such a powerful and desirable stress management tool. And just as important, this emotional shift leaves the previously distressed person in a much better position to take steps to eliminate the source of stress - if s/he is inclined to do so.
One of the difficulties with these studies done in laboratory settings, of course, is that even though evidence is obtained that participating subjects really do feel more angry, anxious or depressed as a result of their stress-inducing intervention, this is quite different from the kinds of stress experienced in everyday life in the real world. So although it is crucial to establish in good experimental studies that humor is capable of reducing the main negative emotions typically resulting from stress, the argument for humor's stress-reducing power becomes much stronger if it can be shown that people who regularly use humor to cope in everyday life experience this same stress-reduction effect. Following the discussion of stress hormones, we will discuss that research.
