Table 2.

Potential contributions of humor to group therapy for people with SMI.

Diagnostic: The way individuals use humor in group situations can, in certain cases, be an indicator of inadequate social coping means, or can be explored as a positive coping skill that can be generalized to other social situations. Analyzing the timing of laughter may also help understand certain dynamic group processes.

Emotional: Due to the social contagion effect of laughter, the potential of emotional catharsis in groups is great. Furthermore, using humor as an outlet for hostility and fear in a group situation may enhance the acceptance of these feelings and the pleasure of making people laugh may boost their expression.

The contagion effect of laughter in groups can lead to both loud and strong laughter and in some instances to “fou rire” or uncontrolled positive laughter, effecting both physical and emotional catharsis and relaxation.

As one major problem for patients with SMI is the deficit in the ability for emotional self-regulation, group humor may be a good setting in which to learn this, due to positive up-regulation of emotions within the group. Indeed, a recent study has shown that humor can serve as a potent cue for emotional up-regulation [59].

Therapist-related aspects: The therapist, as a model figure, displays behaviors, including humor, that the patient may imitate [60], and adopt as a coping mode.

Cognitive: As in individual therapy, humor within a group context may enable and facilitate the development of a sense of proportion, and may help overcome exaggerated seriousness that often serves as a defense against ambiguity. The presentation of one's life in a humoristic manner may often help patients accept certain difficult situations in a more existential way, accepting life's absurdities and quandaries.

Social: Patients' use of humor may strengthen interpersonal skills, social confidence and reduce social phobia very often present in SMI's. In gender- or ethnic-specific groups within psychiatric contexts, humor can be used to strengthen the gender or ethnic identity of the participants [58] and as such foster community integration.

Group-related aspects: The use of incongruity and surprise by means of humor may stimulate the group, evoke curiosity, overcome defenses and provide a cue for remembering and internalizing insights more readily than verbal interpretations. Humor in a group context can help the self-disclosure process, thereby contributing to emotional catharsis and strengthening group belonging. It can promote a sense of intimacy, attachment and friendliness in the group, improving cohesion and morale. This aspect is paramount in institutional settings and with patients with SMI, who are often socially alienated.

Institutional aspects: Group humor may be especially beneficial in that it sets aside institutional rules to facilitate dialogue between clients and professionals [61]. If humor is used in large groups or in regular ward meetings, its impact may generalize to the larger therapeutic setting of the ward or the clinic.