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The Heart of the Matter: The Effects of Humor on WellBeing During Recovery From Cardiovascular Disease
a
Nicholas L. Lockwood & Stephen M. Yoshimura
a
a
Department of Communication Studies , University of Montana
Published online: 05 Jul 2013.
To cite this article: Nicholas L. Lockwood & Stephen M. Yoshimura (2014) The Heart of the Matter: The Effects of
Humor on Well-Being During Recovery From Cardiovascular Disease, Health Communication, 29:4, 410-420, DOI:
10.1080/10410236.2012.762748
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Health Communication, 29: 410–420, 2014
Copyright © Taylor & Francis Group, LLC
ISSN: 1041-0236 print / 1532-7027 online
DOI: 10.1080/10410236.2012.762748
The Heart of the Matter: The Effects of Humor on Well-Being During
Recovery From Cardiovascular Disease
Nicholas L. Lockwood and Stephen M. Yoshimura
Downloaded by [University of Montana] at 14:38 17 June 2014
Department of Communication Studies
University of Montana
This study examines the uses of humor among cardiovascular patients to test the associations
between humor use, satisfaction with companion relationships, and health during recovery.
Self-report data were collected from members of two national support groups for patients
recovering from cardiovascular disease. As expected, general humorousness associated with
social and psychological well-being. Several specific functions of humor in cardiovascular
recovery were identified and linked with health perceptions. Antidote humor increased social
and psychological health perceptions, whereas conversation regulation humor and distancing
humor were negatively related to perceived social and psychological health. Relationship satisfaction mediated most effects. The findings offer new insight into the variability of humor
effects, particularly following cardiovascular treatment.
Cardiovascular disease, a cardiac manifestation of arteriosclerosis, affects approximately 81,100,000 American
adults in the United States (American Heart Association,
2010). Medical indicators of arteriosclerosis include
increased cholesterol levels, arterial lesions, and congestive heart failure (Blake, 1958). Risk of mortality increases
without treatment, but recovery from cardiovascular treatment is a challenging, life-altering process for both patients
and their families, involving relationship stress, depression,
and difficulty in returning to normal activities (Arenhall,
Kristofferzon, Fridlund, & Nilsson, 2010).
Unfortunately, many cardiac physicians and nurses are
unable to assist patients with the interpersonal dimensions of
recovery after cardiac treatment (Lett et al., 2009). Patients
and their companions are consequently left without guidance on how to manage the relational and psychological
changes that follow. Although not a cure for cardiovascular
disease, humor is one of many communicative tools patients
can use to cope with recovery. As discussed in the following, humorous communication affects patient well-being
primarily by altering the quality of one’s relationship with
companions.
Correspondence should be addressed to Stephen M. Yoshimura,
Department of Communication Studies, University of Montana, Missoula,
MT 59812-1028. E-mail: [email protected]
THE FUNCTIONS OF HUMOR IN SOCIAL LIFE
From a communication perspective, humor is an intentional
or unintentional message interpreted as funny (Lynch, 2002).
Receivers can interpret either intentional or unintentional
messages as funny, and senders enact humor by engaging
in “intentional verbal and nonverbal messages which elicit
laughter, chuckling, and other forms of spontaneous behavior taken to mean pleasure, delight, and/or surprise in the
targeted receiver” (Booth-Butterfield & Booth-Butterfield,
1991, p. 206). Alternatively, humor is defined as perceptiveness toward humorous situations (e.g., sense of humor), conditions involving humorous activity (e.g., comedic shows),
or a physiological response (e.g., laughter) (Martin, 2001).
For the purposes of this study, we focus on humor senders.
This approach is consistent with a large majority of research
on the communication of humor, which reasonably assumes
that the laughter of another is a function of an intentional
message of another (for a larger discussion see BoothButterfield & Booth Butterfield, 1991). Indeed, humorous
communication is an essential mechanism with which a
sender fulfills his or her interpersonal social goals (Graham,
Papa, & Brooks, 1992). To the extent that such goals are relevant to health, we would expect humorous performances to
play a key role in the connection.
The inclination toward humorous communication has
been examined among many groups coping with adverse
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HUMOR AND WELL-BEING DURING RECOVERY
situations, including health care workers, older adults,
student workers, and women with breast cancer (BoothButterfield, Booth-Butterfield, & Wanzer, 2007; Carver
et al., 1993; Wanzer, Booth-Butterfield, & Booth-Butterfield,
2005; Wanzer, Sparks, & Frymier, 2009). This line of
research has shown that the predisposition toward humorousness is associated with various conditions of well-being,
such as optimism and satisfaction with jobs and life. Notably,
the effects of humor orientation appear to be at least partly
explained by its positive effects on one’s perceptions of one’s
coping efficacy (Booth-Butterfield et al., 2007; Wanzer et al.,
2005; Wanzer et al., 2009). In essence, an inclination toward
humor is primarily beneficial because it alters perceptions
about one’s personal or social conditions. This conclusion
is consistent with studies showing that humor functions to
increase positive affect, which is also implicated in increased
perceptions of well-being (Diener & Lucas, 2000; Graham
et al., 1992).
Humor also functions to communicate relational messages, particularly by constructing relational themes along
the dominance/submission and affiliation/disaffiliation continua (Dillard, Solomon, & Samp, 1996; Lynch, 2002).
For example, humor can help alter power differentials via
teasing, pranks, or jokes, raising sensitive social issues,
promoting or masking embarrassment, erecting facades of
competence and power, or differentiating views and opinions
(Meyer, 2000). Such actions are useful to both the powerful and powerless in the process of negotiating power, as
they help illuminate differences and weaknesses in others
(Meyer, 2000). Humor can also enhance social solidarity,
identification, and affiliation between people (Lynch, 2002;
Meyer, 2000). For example, humor helps communicators
share common perspectives (Obrdlik, 1942). It unites people by promoting a sense of closeness, liking, and a sense
of commonality (Mettee, Hrelec, & Wilkins, 1971). Humor
additionally allows the source to investigate or transmit
information in new, creative, strategic, and socially appropriate ways (Graham et al., 1992). In short, humor is a
nonthreatening way for a source to seek or disclose information, and provides greater connectedness and unity with
the receiver (Scholl & Ragan, 2003).
The idea that humor could function as a relational message raises the possibility that humor serves relationshiprelated functions in the process of cardiovascular recovery.
Relationships between cardiovascular patients and companions can change dramatically following medical treatment, and their relational experiences reflect their changing
environmental and physical contexts. Following a partner’s initial cardiac treatment, for example, women experience an increased sense of responsibility, loss of emotional and physical connection with their partner, more
uncertainty about life, and they struggle with new asymmetry in power and responsibility distributions (Arenhall
et al., 2010). Cardiovascular treatment also changes couples’ thoughts about their future life together (Eriksson,
411
Asplund, & Svedlund, 2010). In some cases those outlooks
become more positive, and relationships are enhanced following cardiovascular treatment. In other cases, however,
outlooks following cardiovascular treatment become more
tentative and pessimistic (Eriksson et al., 2012; Thompson,
Ersser, & Webster, 1995).
Yet little is known about the specific ways that humor
facilitates interactions between cardiovascular patients and
their companions. Identifying these functions would provide
insight into the ways in which cardiovascular patients use
humor to manage personal and relational changes. Thus, the
first research question aims to survey the functions of humor
in this context.
RQ1: For what functions do patients recovering from
cardiovascular treatment use humor?
THE BENEFITS OF HUMOR
Humor can have both direct and indirect effects on health.
The direct effects are traceable to laughter, which triggers the
release of beta-endorphins, increases immune-system functioning, reduces stress-related hormone levels, and reduces
muscle tension (Lefcourt, 2005). It can also enhance coping by distracting individuals from tension-filled situations
and perceived moments of instability (Scholl & Ragan,
2003). The indirect effects are traceable to enhanced coping resources. Humorous people tend to excel at approaching
and positively reframing challenging situations, and are less
likely to deny and avoid problems (Lefcourt, 2005).
The indirect effects model fits within the framework
of the buffering hypothesis, which asserts that social support helps protect against distress by providing perceived
resources needed to manage stressful situations (Cohen &
Wills, 1985). With these perceived resources, challenges can
be reappraised, if not prevented (Cohen & Wills, 1985).
Indeed, humor is one of many actions involved in communicating social support. For example, affiliative humor is vital
to sustaining a sense of resilience and buffering the effects
of stress (Ceung & Yung, 2012), and general use of humor
buffers against the negative effects of rumination and depression (Olson, Hugelshofer, Kwon, & Reff, 2005). In fact,
the buffering hypothesis is commonly invoked to explain
the benefits of humor orientation among distressed groups
(Booth-Butterfield et al., 2007; Wanzer et al., 2005; Wanzer
et al., 2009). The physical, psychological, and relational benefits discussed in the following have been explained from
both the direct effects model and the buffering perspective.
Physical benefits. Lefcourt (2005) describes evidence
of the physical benefits of humor, dating to the 13th century.
Modern research commonly shows connections between
self-reported use of humor and signs of immune-system
functioning (Bennett & Lengacher, 2009), increased pain
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412
LOCKWOOD AND YOSHIMURA
tolerance, and reduced need for pain medication following treatment (Martin, 2001, 2002). No known research has
directly examined the benefit of humor use during the process of cardiovascular recovery, although the evidence just
described suggests that it could be an important element.
On the other hand, some argue that the effects of humorousness on physical health are sometimes inconsistent, and
mostly affect people’s perceptions of health (Kuiper &
Nicholl, 2004; Martin, 2001). According to this view, humorous and nonhumorous individuals may not have objectively
different biological health states, but can be distinguished by
their levels of attentiveness to health states and behaviors.
For example, humor may not directly affect physiological
health, but it could increase perceptions of health by facilitating reappraisals and distancing from challenging situations,
reducing inclinations toward worrying about pain and illness,
and increasing enjoyment of daily activity. This approach
is largely consistent with the biopsychosocial approach to
health, which proposes that perceptions of health are as
important as biological health alone. Thus, even those who
are well can feel ill, and those who are ill can feel well
(Engel, 1992).
Psychological benefits. Humor can be an effective
coping strategy for many negative life events, particularly by
promoting sense-making and reappraisals about difficult situations (Martin, Kuiper, Olinger, & Dance, 1993, Wanzer
et al., 2005; Wanzer et al., 2009). For example, Martin
et al. (1993) report finding that college students who were
more inclined to use coping humor in the week before taking an exam showed little increase in their perceptions of
how important the exam was in the week after the exam,
regardless of their performance. In contrast, students who
reported being less inclined toward using coping humor were
more likely to assign greater importance to the exam in the
week following, especially when they performed worse than
they expected. In another study of how students’ use of
humor helps cope with the demands of student and work
life, Booth-Butterfield et al. (2007) found that one’s general inclination to use humor increased perceived coping
effectiveness, which also helped predict job satisfaction. The
increased perception of coping effectiveness suggests that
humor afforded participants sufficient perceived resources
to manage the demands of balancing academic and nonacademic work. Consistent with those findings, Wanzer et al.
(2005) found that nurses with higher humor orientation
scores tended to report higher job satisfaction as a function
of increased perceived coping effectiveness.
Such benefits appear to hold for patients as well. One
longitudinal study on humorousness among women in the
initial stages of breast cancer treatment showed that humor
mediated the relationship between optimism and posttreatment distress, with optimism relating to greater self-reported
use of humor, and use of humor negatively relating to
distress at both three and six months following treatment
(Carver et al., 1993). Aggregated, the preceding findings hint
that humor affects recovery by enhancing the efficacy of
currently existing resources.
Social benefits. Cardiovascular recovery is a social
experience involving patients, caregivers, and larger social
networks. Research suggests that some of the psychological challenges during recovery are inherently social. For
example, cardiovascular patients can experience negative
psychological impacts similar to impacts on those who are
widowed, including depression, guilt, anxiety, loneliness,
and anger (Lund, Utz, Caserta, & De Vries, 2009). However,
perceived social support, particularly the presence of close
companions and friends, has measurable effects on depression following myocardial infarctions (Lett et al., 2009).
To the extent that humor helps build those relationships and
promotes perceptions of social support, humor enactment
could help alleviate postevent distress.
Humor positively impacts social environments by reducing inclinations toward conflict, increasing attractiveness,
and facilitating social interaction (Bonanno & Keltner,
1997). For example, humor can be used to handle persistent marital problems, such as inflexibility (Alberts, 1990).
Humor can also benefit families and similar systems by
providing an outlet for entertainment and expressions of
warmth, and by helping members cope with difficult situations (Wuerffel, 1986).
The research just described suggests two propositions
about cardiovascular recovery. One is that the increased general use of humor will relate to an increased sense of wellbeing. The second is that the precise relationship between
humor and health could vary by the type of humor enacted.
Of course, not all humor is positive. Some humor can be used
for negative functions (Graham et al., 1992), and negative
humor could associate with different outcomes for cardiac
patients than positive humor. Given the state of research on
these possibilities, the first hypothesis and second research
question are proposed:
H1: Increased patient use of general humor will relate to
increased reports of physical, psychological, and social
well-being.
RQ2: In what ways do differing functions of humor relate to
cardiovascular patients’ well-being?
HUMOR AND RELATIONSHIP SATISFACTION
Feeling loved, supported, and respected is responsible for
more than half of all positive emotional experiences on a
daily basis (Tay & Diener, 2011), and satisfying relationships
have strong effects on psychological and physical well-being
(Myers & Deiner, 1995). Those with high-quality relationships tend to have fewer diagnosed chronic conditions, fewer
acute symptoms of illness, and higher ratings of subjective
health perceptions (Ryff & Singer, 1998).
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HUMOR AND WELL-BEING DURING RECOVERY
Relationship satisfaction is a positive affective state
resulting from the belief that a partner fulfills one’s needs
beyond expectations (Rusbult, Martz, & Agnew, 1998).
When used positively, humor can facilitate relationship satisfaction by easing the transition to difficult discussions,
minimizing distress among relational partners, and providing
opportunities for connection. Used negatively, it can increase
psychological distance and dissatisfaction between partners
(Butzer & Kuiper, 2008; Graham et al., 1992).
Humor repeatedly emerges in research as a way to enact
maintenance and sustain relationship quality (Canary &
Dainton, 2006). Maintaining relationship quality is particularly important during recovery from a cardiovascular event.
Companions of all kinds offer patients support and positive
interaction experiences, which helps minimize depression
during recovery and stimulates health-promoting behaviors
(Kawachi & Berkman, 2001; Lett et al., 2009). Yet studies
have not examined how humor affects relational satisfaction
among chronically ill patients. Thus, relationship satisfaction is a potential explanation for why humor would enhance
health perceptions. The following research question and
hypotheses are aimed at testing this idea.
RQ3: Which functions of humor associate with relational
satisfaction?
H2: Increased patient use of humor will positively associate
with relational satisfaction.
H3: Relational satisfaction level will mediate the relationship
between humor functions and health.
METHOD
Participants
Participants were recruited from two national support and
advocacy groups for those impacted by cardiovascular disease in the United States. Eligible participants were required
to have cardiovascular disease and a companion who accompanied them through the medical process. Participants were
allowed to report on any companionate relationship, as long
as that person was the individual who provided them with the
most support during their recovery process. Indeed, research
suggests that many companionate relationship types (e.g.,
partners, friends, and relatives) are equally important sources
of support for cardiovascular patients during the recovery
process (Lett et al., 2009).
A total of 122 participants initially entered the Internet
portal for the electronic questionnaire. The data for 92 participants are reported here, as 30 (24.6%) participants chose
to complete no items or only a small number of them. Of the
participants who completed the study, most were female (n =
52, 56.5%) and Caucasian (n = 82; 94.6%), with an average
age of 58 years old (SD = 15.24, median = 59), ranging from
20 to 91 years old.
413
Measures
Humor functions. To determine the specific functions
of humor used, an index of 16 items was developed from
the Use of Humor Index (UHI, Graham et al., 1992), and
from research on humorous episodes during psychological
and medical distress (e.g., Bonanno & Keltner, 1997; Scholl
& Ragan, 2003; Wanzer et al., 2009). UHI items were reworded to fit the health context, and items were constructed
to reflect five functions of humor: positive affect (e.g., Using
humor made me happy), negative affect (e.g., Using humor
helped me forget my anxiety), expressiveness (e.g., Using
humor helped me express my feelings in a new way), affiliation (e.g., Using humor entertained my companion), and
dominance (e.g., Using humor showed that I am knowledgeable about my health). Responses were measured on
a 5-point Likert scale (1 = strongly disagree, 5 = strongly
agree).
Humor orientation. To assess the degree to which the
patients were likely to enact humor in daily life, the respondents were asked to complete the Humor Orientation Scale
(Booth-Butterfield & Booth-Butterfield, 1991). The Humor
Orientation Scale consists of 17 total Likert-scale items
designed to measure an individual’s predisposition to using
humor regularly in social interaction (1 = strongly disagree,
5 =strongly agree). Items included “People often ask me to
tell jokes or stories” and “I use humor to communicate in
a variety of situations.” Inter-item reliability analysis indicated high internal consistency among the items (α = .94).
Overall, participants reported moderate use of humor in their
relationship (M = 3.73, SD = .68).
Psychological and social health. Meza and
Fahoome’s (2008) Self-Integration Scale (v. 2.1) was
used to examine social and psychological health. The
instrument includes 18 total items (nine for each domain)
each measured on a 5-point Likert-scale (1 = very rarely,
5 = most of the time). Social health items include “I know
how to ask for help when I need it” and “I have someone
that I can tell my deepest darkest secrets and still feel safe.”
Ratings were scaled in a positive direction for this subscale
(i.e., higher scores denoted health). Inter-item reliability
analysis indicated acceptable internal consistency among the
items (α = .73). Overall, participants reported strong social
health (M = 4.03, SD = .66). The nine psychological health
questions included “When my future is uncertain, I have
a basic sense of trust that things will turn out OK” and “I
feel that others control my life” (reverse scored). Inter-item
reliability analysis indicated good internal consistency
among the items (α = .80). Overall, participants reported
strong psychological health (M = 4.13, SD = .60).
Physical health. The physical domain section of the
World Health Organization Quality of Life Scale-Brief
(WHOQOL-BREF; WHOQOL Group, 1998) supplemented
the Self-Integration Scale. Adding this measure allowed a
414
LOCKWOOD AND YOSHIMURA
TABLE 1
Variable Correlations
Variable
1. Antidote
2. Conversation regulation
3. Distancing
4. Relationship satisfaction
5. Psychological health
6. Social health
7. Physical health
8. Humor orientation
1
2
—
.64∗∗
.20
−.11
.01
.15
−.01
.28∗∗
—
.13
−.22∗
−.14
−.01
−.15
.24∗
3
—
−.44∗∗
−.33∗∗
.25∗
−.07
−.32∗∗
4
—
.56∗∗
.58∗∗
.33∗∗
.07
5
—
.67∗∗
.46∗∗
.12
6
—
.48∗∗
.29∗∗
7
—
−.14
8
M
SD
α
.72
.76
.90
.97
.60
.66
.75
.68
.90
.85
—
3.71
3.37
2.12
3.87
4.13
4.03
3.68
3.73
.95
.80
.73
.85
.94
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Note. Distancing measured with a single item.
∗ p < .05; ∗∗ p < .01.
more complete biopsychosocial operationalization of health,
which includes social, psychological, and physical dimensions (Engel, 1992). Responses to seven items were measured on a 5-point Likert-scale (1 = not at all, 5 = an
extreme amount). Items included “To what extent do you
feel that physical pain prevents you from doing what you
need to do?” and “How much do you need any medical treatment to function in your daily life?” (reverse
scored). Inter-item reliability analysis indicated high internal consistency among the items (α = .85). Ratings were
scaled in a positive direction, and participants reported
being moderately physically healthy (M = 3.68, SD = .75).
Relationship satisfaction. The participants’ perceived
level of relationship satisfaction was measured with the
Rusbult et al. (1998) global relationship satisfaction scale.
This well-validated measure reliably predicts relationship outcomes, commitment, and interdependence (Rusbult
et al.,1998). Participants indicated their current relationship
satisfaction with five items on a 5-point Likert scale (5 =
agree completely; 1 = do not agree at all). Inter-item reliability analysis indicated high internal consistency among the
items (α = .95), and participants reported having moderate
relational satisfaction with their companion (M = 3.87, SD =
.97).
Procedure
Volunteers were recruited for participation through network
sampling procedures. Local participants were recruited in
person, and participants in nonlocal regions were recruited
via email messages. E-mail messages were sent to group
members containing a link to the online questionnaire asking
for their participation in the study. One group posted a survey link on its website and another group member posted the
survey link on the support group’s discussion board. All participants were asked to think of their interactions with their
primary companion, defined as the person “who you believe
has offered you the most support in your recovery process.”
RESULTS
The first research question inquired into the ways in which
cardiovascular patients used humor with their primary companion. Using the constructed 16-item index of specific
humor functions, the answer to the question was analyzed
using principal components analysis (PCA) with varimax
rotation. Following the guidelines of Tabachnick and Fidell
(2001) and Kim and Mueller (1978), the criteria for variable selection were (a) an eigenvalue greater than 1.0; (b)
a primary factor loading of at least .50; and (c) a minimum difference of .20 on secondary loadings. The solution
yielded three components measured by 14 items, together
accounting for 67% of the total variance. Table 1 displays
the descriptive statistics and bivariate correlations of all
variables.
The first component accounted for 48.1% of the total variance and was named antidote humor (eigenvalue = 7.86).
It was defined by eight items depicting humor as a cure
to negative affective states. This component reflects a need
to alleviate and control the negative affects associated with
chronic illness (e.g., I often use humor to redirect my concerns, and I often use humor to cope with cardiovascular
disease).
The second component accounted for 10.7% of the total
variance and was named conversation regulation humor
(eigenvalue = 1.71). This component was defined by five
items reflecting prosocial behaviors of humor. This component depicted humor as a tool for accomplishing social or
conversational goals (e.g., I often use humor to start a difficult conversation, and I often use humor to entertain my
companion).
The third component, labeled distancing humor (eigenvalue = 1.61), accounted for 7.26% of the total variance.
It was defined by one item reflecting antisocial behaviors.
This component reflected humor as a way of distancing
the patient from their companion (i.e., I often use humor
to distance myself from my companion). The components
were then assembled for use in examining the subsequent
hypotheses and research questions.
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HUMOR AND WELL-BEING DURING RECOVERY
satisfaction (conversation regulation: β = −.32, t = −2.69,
p < .01; distancing: β = −.48, t = −5.24, p < .01). Table 2
displays these results.
Hypothesis 3, that relationship satisfaction would mediate the relationship between humor functions and health,
was tested using bootstrap analysis to assess indirect effects
(Hayes, 2008; Preacher & Hayes, 2008). The results are
presented in Table 3. Both distancing and conversation regulation humor had significant, negative indirect effects on psychological, social, and physical health, indicating that the use
of those humor functions had negative effects on well-being,
to the extent that they had negative effects on relational satisfaction. No significant indirect effects emerged, however, for
the connection between antidote humor and any health state.
Thus, hypothesis three was partially supported, with satisfaction mediating the connection between distancing and
conversation regulation humor and well-being.
Hypothesis 1, that increased reports of general humorousness would result in greater reports of health, was partially
supported. The hypothesis was tested using a set of simple
linear regression models. Table 2 summarizes the results.
The first model examined the effect of general humor use
on physical health. The results indicated no significant effect
(β = −.14, t = −1.37 p = ns). However, tests for the association between general use of humor and psychological
and social health showed significant effects (psychological
health: β = .20 t = 1.91, p < .05; social health: β = .29, t =
2.90, p < .01).
Research question 2 investigated how the specific types
of humor associated with greater health. Multiple regression analysis indicated significant multivariate effects for the
effects of humor types on psychological health (R = .40, F
[3, 88] = 5.61, p < .05, R2 = .16) and social health (R = .36,
F [3, 88] = 4.24, p < .01, R2 = .13). Antidote humor positively related to increased reports of psychological (β = .26,
t = 1.98, p < .05) and social health (β = .34, t = 2.55, p <
.05). However, distancing humor negatively associated with
psychological (β = −.35, t = −3.51, p < .01) and social
health (β = −.30, t = −2.94, p < .05). Conversation regulation humor also negatively related to psychological health (β
= −.28, t = −2.17, p < .05). These results are displayed in
Table 2.
Hypothesis 2, that increased reports of general humorousness would predict greater relational satisfaction, was not
supported. This hypothesis was tested using a simple linear
regression model with general humor use as the independent variable and relationship satisfaction as the dependent
variable. The results showed no connection between overall
humor use and relationship satisfaction.
However, specific humor types did associate with relationship satisfaction (RQ3). A multiple regression analysis
with the humor functions as the independent variables and
satisfaction as the dependent variable showed an overall multivariate effect (R = .54, F(3, 88) = 11.89, p < .01, R2 =
.29). Univariate analyses showed that antidotal humor had
no significant relationship with relationship satisfaction (β
= .16, t = 1.31, p = ns), but that conversation regulation
and distancing humor both had negative relationships with
DISCUSSION
Although recovery from cardiovascular treatment involves a
complex, multifaceted set of factors, this study shows that
humorous messages can play a role in the process of recovery, partly because of their connection to one’s satisfaction
with a companionate relationship. The associations can be
positive or negative, however, depending on the ways in
which humor is used.
The Role of Humor in Cardiovascular Recovery
We uncovered three humor functions among the participating cardiovascular patients: antidote, conversation regulation, and distancing. Antidote humor invokes the intent to
reframe one’s affective or cognitive states and increase feelings of control. Our findings support other research showing
that humor can function to reduce tension (Scholl & Ragan,
2003), alleviate general anxiety (Graham et al., 1992), cope
with illness, and demonstrate control over health (Rossell,
1981). As the items in the measure reflect, antidote humor
TABLE 2
Standardized Beta Coefficients for Humor Types on Health and Relationship Satisfaction
Health
Physical
Type
Antidote
Conversation regulation
Distancing
∗p
< .05; ∗∗ p < .01.
415
Psychological
Relationship
Satisfaction
Social
β
t
β
t
β
t
β
t
.17
−.25
−.08
1.20
−1.79
−.70
.26∗
−.28∗
−.35∗∗
1.98
−2.17
−3.51
.34∗
−.19
−.30∗∗
2.55
−1.47
−2.94
.16
−.32∗
−.48∗∗
1.31
−2.69
−5.24
416
LOCKWOOD AND YOSHIMURA
TABLE 3
Indirect Effects of Humor Types on Well-Being
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Independent
Variable (X)
Mediating
Variable (M)
Dependent
Variable (Y)
Effect of X on Effect of M on
M (a)
Y (b)
Direct Effect
(c’)
Indirect Effect 95% CI (BCA)
(ab)
Lower, Upper Total Effect (c)
Distancing
Relational
satisfaction
Psychological health
Social health
Physical health
−.48
−.48
−.48
.32
.40
.28
−.07
.01
.08
−.15
−.19
−.14
−.28, −.06
−.32, −.09
−.26, −.06
−.22
−.19
−.06
Conversation
regulation
Relational
satisfaction
Psychological health
Social health
Physical health
−.29
−.29
−.29
.34
.42
.24
−.02
.11
−.08
−.10
−.12
−.07
−.23, −.01
−.25, −.01
−.17, −.01
−.12
.11
−.14
Antidote
Relational
satisfaction
Psychological health
Social health
Physical health
−.14
−.14
−.14
.35
.42
.26
.05
.20
.03
−.05
−.06
−.04
−.16, .04
−.18, .06
−.12, .03
.00
.14
−.01
primarily functions to help patients alleviate negative affective and cognitive states by distracting patients from their
major challenges. From a buffering approach, the enhanced
perceptions of control would reduce the perceived threat
of many challenges, and would allow for reappraisals of
additional coping resources (Morreall, 1983; Wanzer et al.,
2009).
Conversation regulation humor reflects the attempt to
manage interaction by initiating or enhancing an existing
conversation. The emergence of this function is consistent with previous findings showing that humor can function as a conversational catalyst, facilitating expressiveness,
decreasing social distance, and promoting closeness via
self-expansion (Graham et al., 1992). In the context of
cardiovascular recovery, however, conversation regulation
humor is further distinguished as a mechanism for managing difficult conversations. Graham et al. (1992) explain
that humor is commonly used to communicate difficult
information, because some information is perceivably inappropriate or threatening to disclose. Thus, using conversation
regulation humor appears to be a way of discussing difficult situations (e.g., cardiovascular disease) in a direct but
approachable way.
Our analyses further revealed that humor helps distance
patients from their companions. At first glance, the use
of humor for distancing purposes may seem counterintuitive. After all, individuals recovering from cardiovascular
treatment should be inclined to move closer to their
companions—not become more distant. However, distancing
humor might help patients cope with unpleasant aspects of
the recovery process. For example, other research indicates
that approximately 40% of cardiovascular patients suffer
from depression (Taylor et al., 2005), and distancing humor
may be way to help patients satisfy inclinations toward social
withdrawal. Unfortunately, this type of behavior could also
negatively relate to the quality of one’s relationship with
companions. We found support for this possibility in our
examination of RQ3, which shows that distancing humor
was negatively associated with relationship satisfaction.
Overall, the humor functions uncovered here reflect
patient priorities in the process of recovery from
cardiovascular events. Unlike other stressful contexts,
cardiovascular patients do not appear to use humor to
distract themselves. Rather, they appear to work toward
curing negative emotional states and fostering conversation.
By using antidotal humor, patients attempt to minimize
recovery-related distress, whereas distancing and conversation regulation humors are more directly oriented toward
the relational challenges of recovery. In short, recovering
cardiovascular patients use humor to help accomplish a variety of emotional and relational goals salient to their recovery.
Connections Between Humor and Health
The results indicate that general humor orientation is associated with perceived social and psychological health, but
not physical health (H1). Indeed, the relationship between
tendencies toward humor and physical health is a tentative
one, and not entirely consistent in replication (e.g., Kuiper
& Nicholl, 2004; Martin, 2001). However, two reasons exist
for why humor orientation positively related to social and
psychological health states. One is that humor orientation
primarily measures the inclination toward socially positive
humor, such as telling of funny stories or jokes (Miczo &
Welter, 2006). Such inclinations appear to help people manage stress more effectively (Booth-Butterfield et al., 2007;
Wanzer et al., 2005). Another possibility is that these health
states are more easily changeable than physical health, and
are thus more responsive to humor. Patients can promptly
change their use of humor, their attitude, and their social support, but changes in physical health are much more gradual
in comparison.
Some nuanced associations emerged between specific
humor functions and health (RQ2). For example, antidote humor positively related to social and psychological health, which is consistent with research showing that
humor (a) enhances well-being (e.g. feeling of relief and
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HUMOR AND WELL-BEING DURING RECOVERY
life-satisfaction) (Lund et al., 2009; Wanzer et al., 2009), and
(b) helps manage the negative affects associated with distress
(McCarthy & Addington-Hall, 1997; Wanzer et al., 2009).
The buffering hypothesis supports this finding. Antidote
humor redirects concerns about one’s health situation, thus
facilitating reappraisals about the challenge.
In contrast, distancing humor related to lower levels of
reported psychological and social health. These results are
consistent with research showing that negative humor styles
associate with depression, loneliness, and somatic symptoms (cf. Ceung & Yue, 2012), and that negative humor
links to dyadic experiences of embarrassment (Hall, 2010).
The explanation for the finding might exist in our discovery
that satisfaction mediates the association between distancing humor and health. Distancing humor appears to relate
to lower levels of psychological well-being when it lowers
relationship satisfaction.
A negative association also emerged between conversation regulation humor and psychological health. This finding
is more challenging to explain, because conversation regulation humor could normally be expected to be positive for
conversations and relationships. We encourage further investigation into this finding, but propose a possible explanation.
Noting that this type of humor involves patients’ acknowledgment or management of the physical, relational, or
psychological challenges of recovering from cardiovascular
events (such as by raising difficult topics), the buffering
approach would suggest that conversation regulation humor
promotes perceptions about one’s insufficient ability to cope
with the demands of recovery. That is, acknowledging one’s
challenges through the use of humor could be a potential
contributor to patient distress, insofar as it either reflects
or creates rumination about challenges of recovery. This
hypothesis would be useful to test in future studies, as
it holds potential to help explain the tentative connection
humor use can share with well-being.
Humor and Relational Satisfaction
Although we did not find a statistical relationship between
general humorousness and satisfaction, (H2), specific uses
of humor (RQ3) did associate with health. Notably, the
results show a negative relationship between distancing and
conversation regulation humor and relationship satisfaction.
The negative relationship between distancing humor and
relational satisfaction is understandable, considering the
documented distress that both patients and their partners
experience following a cardiovascular event (e.g., Arenhall
et al., 2003). Increased psychological distance from companions would likely compound preexisting relational distress.
However, the negative relationship between conversation
regulation humor and relationship satisfaction contrasts with
other research showing that prosocial humor increases attraction (Kane et al., 1977 as cited in Graham et al., 1992),
417
increases likability (Mettee et al., 1971), and facilitates
relational development (Alberts, 1990).
Although conversation regulation humor could help
patients raise difficult topics in an approachable way, some
research suggests that such strategies can add uncertainty
to cardiovascular patients’ state of recovery, and even promote feelings of frustration and resentment among one or
both partners (Goldsmith, Bute, & Lindholm, 2012). The
explanation for such counterintuitive outcomes lies in how
conversation regulation humor is performed and interpreted.
Elevated levels of stress, depression, anxiety, and relational
distress are well documented among cardiovascular patients
and their close relatives (Arenhall et al., 2010), and these
experiences are known to relate with lower communication skills (Segrin, 2001). Yet communication skills under
stressful conditions are known to predict relationship success
(Gottman, 1994). The negative association between conversation regulation humor and relational satisfaction suggests
that patients are distressed by their use of conversation regulation humor. Although we currently lack data to fully test
these possibilities, we suspect that conversation regulation
humor is associated with patients’ relational distress because
patients either (a) feel obligated to make light of a difficult
situation, (b) feel incompetent in their attempts, or (c) feel
that their partners respond to them as if they were incompetent in their attempts. This question is a fruitful area for
future inquiry.
The Indirect Effects of Humor on Health
Past theoretical work on humor explains the connection
between humor and health in general ways, for example, as
a function of laughter, positive emotion, reduced stress, or
increased social support (Martin, 2002). Our findings complicate those general connections and suggest that research
should consider the specific conditions under which humor
is communicated.
In this study, relationship satisfaction mediated the effects
between distancing and conversation regulation humor, and
all relevant health dimensions. However, these types of
humor had overall negative indirect effects on health, in conjunction with their negative effects on relational satisfaction.
Essentially, using humor to address difficult topics or to psychologically distance patients from their companions weighs
negatively on well-being insofar as it weighs negatively on
relationship satisfaction.
Relationship quality is widely known to associate with
various states of well-being (Holt-Lunstad, Smith, & Layton,
2010; Ryff & Singer, 2000). By definition, relationship satisfaction is a positive affective state (Rusbult et al., 1998), and
many researchers believe that relationship quality facilitates
well-being by promoting less-threatening appraisals of challenging situations, and broadening one’s perceptions of
coping resources (cf. Cohen, 2004). In other words, relationship satisfaction is a buffer against stressful conditions.
418
LOCKWOOD AND YOSHIMURA
However, our study showed that only antidote humor had the
predicted positive effects on both relationship satisfaction
and well-being. Relationship satisfaction still mediated the
relationship between conversation regulation and distancing
humor and health, but the indirect effects were negative. This
finding suggests that not all types of humor have the same
potential to promote buffering, as some types associate with
reduced levels of relational satisfaction.
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Limitations
The current findings are situated among some methodological limitations that constrain our interpretations. Most
readers will be aware of the general limitations associated
with self-reported recollections and cross-sectional designs,
and we acknowledge those here. We attempted to control for
social desirability by allowing participants to respond to the
survey in comfortable settings where they felt privacy was
adequate, and attempted to control for recollection biases by
asking participants to report on general tendencies toward
humor rather than specific instances.
We also wish to note some uniqueness among the selfselected sample of cardiovascular patients participating in
recovery support groups. The very fact that these patients
participated in a support group, reported having a supportive companion, and volunteered for a study on humor during
recovery suggests that they are comfortable with social interaction in a variety of forums, and are skilled enough to
develop and maintain a variety of relationships. It is quite
possible that this group has additional characteristics that
could help explain our results.
A less obvious potential constraint surrounds the instructions given to the participants. As previously mentioned, we
asked our participants to report on the person who offered
them the most support during their recovery. On one hand,
this instruction allowed us to gather data on the use of humor
in a meaningful companionate relationship, while simultaneously allowing a degree of diversity in the relationships that
patients can develop and rely upon. However, focusing our
participants on the most supportive person they relied upon
during recovery could arguably have promoted inclinations
toward increased use of humor and relational satisfaction
versus what they might have reported if we either focused
them on a specific person or allowed them to consider any
companion, not only the most supportive one.
Finally, some caution is necessary around the results
involving distancing humor. Other than the reliability concerns surrounding the use of single-item measures, we suspect that the measure of this construct lacks scope. Although
the item directly reflects the desired separation between
patient and companion, distancing humor could have additional, nuanced characteristics, and such qualities might
facilitate further understanding of why distancing humor
negatively predicts relationship satisfaction and health.
Conclusion
Our results show that cardiovascular recovery is not only a
medical and psychological process; it also includes a social
component, of which humor and relationship satisfaction are
parts. Although we only studied the use of humor among
cardiovascular patients, many studies have shown that humor
plays an important role in coping with many challenges
(see, e.g., Booth-Butterfield et al., 2007; Lett et al., 2009;
Wanzer et al., 2005; & Wanzer et al., 2009). It is reasonable to believe that our results could apply to other types
of medical recovery, and exploring the possible associations
between humor and health for patients recovering from other
life-threatening illnesses seems theoretically and practically
useful. Nonetheless, our results show that humor is not a
panacea. The expression of humor in one’s supportive relationships appears helpful only to the extent that it enhances
one’s satisfaction with that relationship.
ACKNOWLEDGMENTS
This research was completed as part of the first author’s
MA thesis, completed under the supervision of the second
author. An earlier version of the work was presented at the
2012 International Communication Association conference,
Phoenix, AZ. The authors made equal contributions to this
article, and the order of authorship is alphabetical.
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