The feigned annoyance and frustration test to activate the sympathoadrenal medullary system.

When perceived as threatening, social interactions have been shown to trigger the sympathoadrenal medullary system as well as the hypothalamic-pituitary-adrenal axis resulting in a physiologic stress response. The allostatic load placed on human health and physiology in the context of acute and chronic stress can have profound health consequences. The purpose of this study was to develop a protocol for a lab-based stress stimulus using social-evaluative threat. While several valid, stress-stimulating protocols exist, we sought to develop one that triggered a physiologic response, did not require significant lab resources, and could be completed in around 10 min. We included 53 participants (29 men and 24 women) and exposed them to a modified version of the Stroop Color-Word Interference Task during which the participants were made to feel they were performing the task poorly while the lead researcher feigned annoyance and frustration. After exposure to this Feigned Annoyance and Frustration (FAF) Test, both the men and women in this study demonstrated a statistically significant and clinically meaningful increase in subjective stress on the visual analog scale. Additionally, the men in this study demonstrated a statistically significant increase in heart rate and salivary α-amylase concentrations after exposure to the test. The women in this study did not demonstrate a statistically significant increase in the physiologic stress biomarkers. This protocol for the FAF Test shows promise to researchers with limited time and resources who are interested in experimentally activating the sympathoadrenal medullary system.

The Association between Affect and Biomarkers of Stress and Inflammation in Healthy Seventh-Day Adventists.

OBJECTIVE: To evaluate the association between positive and negative affective states with stress biomarkers, biomarkers of inflammation and blood pressure in a population of healthy Seventh-day Adventists. DESIGN: In a cross-sectional study, biomarkers were regressed on positive and negative affect and control variables among reportedly healthy 133 females and 100 males (35% Black and 65% White) who provided blood and urine samples following completion of a questionnaire and measurement of anthropometrics and vital signs. SETTING/LOCATION: Data were extracted from the Biological Manifestations of Religion Study, an NIA-funded study conducted in members of the entity who lived within driving distance of two clinic sites. OUTCOME MEASURES: The stress biomarkers, epinephrine, and norepinephrine, were measured in 12-hour overnight urine samples analyzed by high-performance liquid chromatography. Urinary cortisol was evaluated by enzyme-linked immunosorbent assay (ELISA) and normalized for urinary output (reported in µg/g creatinine). Serum DHEA-S (reported in µg/ml) was measured by ELISA. Inflammatory markers included CRP (ng/ml), IL-6, IL-10, and TNF-α, all analyzed in serum by ELISA, and the data expressed in pg/ml. RESULTS: Multiple linear regression analyses showed after controlling for age, gender, ethnicity, body mass index (BMI), education, socioeconomic status, exercise, and use of blood pressure medication, that negative affect was associated with higher levels of epinephrine (ß = .143; P = .030). Positive affect was not associated with the biomarkers. CONCLUSIONS: While negative affect was associated with a biomarker of sympathetic stimulation, positive affect was not protective against such stimulation.

Antioxidants and Autism: Teachers' Perceptions of Behavioral Changes.

BACKGROUND: Children with Autism Spectrum Disorder (ASD) demonstrate a physiological imbalance between free radicals, resultant from oxidative stress, and antioxidants. Oxidative stress is linked to the pathogenesis of this neurocognitive disorder. The aim of this pilot feasibility study was to examine the effect of consumption of high concentration antioxidant cacao on behavior of children with ASD. METHODS: This was a 4-week pre-test post-test experimental pilot study of high antioxidant cacao and children with ASD. Participants consumed 8 squares (or 16 grams) per day of the dark chocolate which had a concentration of 70% cacao and 30% organic cane sugar (total antioxidant concentration was 8,320). The two main behavioral measures were the Aberrant Behavior Checklist- 2nd Edition and the Autism Spectrum Rating Scale which were completed by the child's teacher at baseline and end of week four. RESULTS: Sixteen participants were recruited for this study. Follow up data was available on 12 participants (9 males, 3 females, mean age of 10.9 ±3.9 years). Significant improvements on the Autism Spectrum Rating Scale were noted in Social/Communication (P = .03, η2=0.79), Unusual Behaviors (P = .02, η2=0.70), and Self-Regulation (P = .04, η2=0.59). No significant changes were noted on any of the Aberrant Behavior Checklist-2 subscales (P >.05). CONCLUSION: Results from this study support the potential therapeutic benefit of antioxidants in improving social communication, unusual behaviors, and self-regulation behaviors of children with ASD. Further robust randomized controlled trials are now necessary to elaborate the validity of these findings.

A Pilot Study: Parent Perceptions of Behavior Change in Their Child With Autism Spectrum Disorder Following High Antioxidant Cacao Consumption.

BACKGROUND: Autism spectrum disorder (ASD) is a heterogeneous neurocognitive disorder with primary symptomology related to maladaptive behaviors and communication deficits. Children with ASD tend to have higher free radicals than antioxidants compared with their matched controls. This disequilibrium of oxidative stress has been associated with the pathogenesis of this neurocognitive disorder. The aim of this pilot feasibility study was to examine the effect of high antioxidant cacao consumption on behavior in children with ASD. METHODS: This was a 4-wk repeated measures experimental pilot study of high antioxidant cacao and children with ASD. Participants consumed 8 squares (or 16 g) per day of the dark chocolate that had a concentration of 70% cacao and 30% organic cane sugar (total antioxidant activity was 8320 µmoles TE/100 g). The 2 main behavioral measures, Aberrant Behavior Checklist, 2nd ed (ABC-2) and the Autism Spectrum Rating Scale (ASRS), were completed by the child's parent at baseline, end of week 2, and end of week 4. RESULTS: Seventeen participants were recruited for this study. Follow-up data were available for 16 participants (12 males, 4 females, aged 4 to 17 y). Significant improvements were noted on the ABC-2 subscales of irritability (P = .03, η2= 0.25), social withdrawal (P = .01, η2= 0.29), stereotypic behavior (P = .05, η2 = 0.13), hyperactivity/noncompliance (P = .04, η2 = 0.20), and inappropriate speech (P = .05, η2 = 0.16). Significant improvements were noted on the ASRS subscales of social/communication (P = .04, η2 = 0.25), unusual behaviors (P = .003, η2= 0.20), self-regulation (P = .02, η2= 0.32), and total scores (P < .001, η2= 0.54). CONCLUSION: Results from this study support previous literature on antioxidant intake as an adjunct therapy to improve behaviors of children with ASD. More robust randomized controlled trials are now necessary to validate and elaborate on these findings.

Effects of a meal replacement system alone or in combination with phentermine on weight loss and food cravings.

OBJECTIVE: To examine the effects of phentermine combined with a meal replacement program on weight loss and food cravings and to investigate the relationship between food cravings and weight loss. METHODS: In a 12-week randomized, double-blind, placebo-controlled clinical trial, 77 adults with obesity received either phentermine or placebo. All participants were provided Medifast® meal replacements, were instructed to follow the Take Shape for Life® Optimal Weight 5&1 Plan for weight loss, and received lifestyle coaching in the Habits of Health program. The Food Craving Inventory and the General Food Cravings State and Trait Questionnaires were used to measure food cravings. RESULTS: The phentermine group lost 12.1% of baseline body weight compared with 8.8% in the placebo group. Cravings for all food groups decreased in both groups; however, there was a greater reduction in cravings for fats and sweets in the phentermine group compared with the placebo group. Percent weight loss correlated significantly with reduced total food cravings (r = 0.332, P = 0.009), cravings for sweets (r = 0.412, P < 0.000), and state food cravings (r = 0.320, P = 0.007). CONCLUSIONS: Both phentermine combined with a meal replacement program and meal replacements alone significantly reduced body weight and food cravings; however, the addition of phentermine enhanced these effects.

Humors Effect on Short-term Memory in Healthy and Diabetic Older Adults.

CONTEXT: With aging, the detrimental effects of stress can impair a person's ability to learn and sustain memory. Humor and its associated mirthful laughter can reduce stress by decreasing the hormone cortisol. Chronic release of cortisol can damage hippocampal neurons, leading to impairment of learning and memory. Objectives • The study intended to examine the effect of watching a humor video on short-term memory in older adults. Design • The research team designed a randomized, controlled trial. SETTING: The study took place at Loma Linda University in Loma Linda, CA, USA. PARTICIPANTS: The study included 30 participants: 20 normal, healthy, older adults-11 males and 9 females-and 10 older adults with type 2 diabetes mellitus (T2DM)-6 males and 4 females. INTERVENTION: The study included 2 intervention groups of older adults who viewed humorous videos, a healthy group (humor group), aged 69.9 ± 3.7 y, and the diabetic group, aged 67.1 ± 3.8 y. Each participant selected 1 of 2 humorous videos that were 20 min in length, either a Red Skeleton comedy or a montage of America's Funniest Home Videos. The control group, aged 68.7 ± 5.5 y, did not watch a humor video and sat in quiescence. OUTCOME MEASURES: A standardized, neuropsychological, memory-assessment tool, the Rey Auditory Verbal Learning Test (RAVLT), was used to assess the following abilities: (1) learning, (2) recall, and (3) visual recognition. The testing occurred twice, once before (RAVLT1) and once after (RAVLT2) the humorous video for the humor and diabetic groups, and once before (RAVLT1) and once after (RAVLT2) the period of quiescence for the control group. At 5 time points, measurements of salivary cortisol were also obtained. The Kruskal-Wallis test was used to measure significance of the data based on the 3 groups. RESULTS: In the humor, diabetic, and control groups, (1) learning ability improved by 38.5%, 33.4%, and 24.0%, respectively (P = .025); (2) delayed recall improved by 43.6%, 48.1%, and 20.3%, respectively (P = .064); and (3) visual recognition increased by 12.6%, 16.7%, and 8.3%, respectively (P = .321). For levels of salivary cortisol, the research team found significant and borderline decreases for the humor group between baseline and (1) post-RAVLT1 (P = .047), (2) postvideo (P = .046), and (3) post-RAVLT2 (P = .062). The diabetic group showed significant decreases between baseline and (1) post-RAVLT1 (P = .047), (2) postvideo (P = .025), and (3) post-RAVLT2 (P = .034). The study found no significant changes for the control group. CONCLUSION: The research findings supported potential clinical and rehabilitative benefits for humor that can be applied to whole-person wellness programs for older adults. The cognitive components-learning ability and delayed recall-become more challenging as individuals age and are essential to older adults for providing a high quality of life: mind, body, and spirit. Because older adults can experience age-related memory deficits, complementary, enjoyable, and beneficial humor therapies should be implemented for them.

Religious vs. conventional cognitive behavioral therapy for major depression in persons with chronic medical illness: a pilot randomized trial.

We examine the efficacy of conventional cognitive behavioral therapy (CCBT) versus religiously integrated CBT (RCBT) in persons with major depression and chronic medical illness. Participants were randomized to either CCBT (n = 67) or RCBT (n = 65). The intervention in both groups consisted of ten 50-minute sessions delivered remotely during 12 weeks (94% by telephone). Adherence to treatment was similar, except in more religious participants in whom adherence to RCBT was slightly greater (85.7% vs. 65.9%, p = 0.10). The intention-to-treat analysis at 12 weeks indicated no significant difference in outcome between the two groups (B = 0.33; SE, 1.80; p = 0.86). Response rates and remission rates were also similar. Overall religiosity interacted with treatment group (B = -0.10; SE, 0.05; p = 0.048), suggesting that RCBT was slightly more efficacious in the more religious participants. These preliminary findings suggest that CCBT and RCBT are equivalent treatments of major depression in persons with chronic medical illness. Efficacy, as well as adherence, may be affected by client religiosity.

Cortical activation associated with muscle synergies of the human male pelvic floor.

Human pelvic floor muscles have been shown to operate synergistically with a wide variety of muscles, which has been suggested to be an important contributor to continence and pelvic stability during functional tasks. However, the neural mechanism of pelvic floor muscle synergies remains unknown. Here, we test the hypothesis that activation in motor cortical regions associated with pelvic floor activation are part of the neural substrate for such synergies. We first use electromyographic recordings to extend previous findings and demonstrate that pelvic floor muscles activate synergistically during voluntary activation of gluteal muscles, but not during voluntary activation of finger muscles. We then show, using functional magnetic resonance imaging (fMRI), that a region of the medial wall of the precentral gyrus consistently activates during both voluntary pelvic floor muscle activation and voluntary gluteal activation, but not during voluntary finger activation. We finally confirm, using transcranial magnetic stimulation, that the fMRI-identified medial wall region is likely to generate pelvic floor muscle activation. Thus, muscle synergies of the human male pelvic floor appear to involve activation of motor cortical areas associated with pelvic floor control.

Religious involvement is associated with greater purpose, optimism, generosity and gratitude in persons with major depression and chronic medical illness.

OBJECTIVE: Religious involvement may help individuals with chronic medical illness cope better with physical disability and other life changes. We examine the relationships between religiosity, depressive symptoms, and positive emotions in persons with major depression and chronic illness. METHODS: 129 persons who were at least somewhat religious/spiritual were recruited into a clinical trial to evaluate the effectiveness of religious vs. secular cognitive behavioral therapy. Reported here are the relationships at baseline between religious involvement and depressive symptoms, purpose in life, optimism, generosity, and gratefulness using standard measures. RESULTS: Although religiosity was unrelated to depressive symptoms (F=0.96, p=0.43) and did not buffer the disability-depression relationship (B=-1.56, SE 2.90, p=0.59), strong relationships were found between religious indicators and greater purpose, optimism, generosity, and gratefulness (F=7.08, p<0.0001). CONCLUSIONS: Although unrelated to depressive symptoms in the setting of major depression and chronic medical illness, higher religious involvement is associated with positive emotions, a finding which may influence the course of depression over time.

The effect of humor on short-term memory in older adults: a new component for whole-person wellness.

CONTEXT: For older adults, the damaging effects of aging and stress can impair the ability to learn and sustain memory. Humor, with its associated mirthful laughter, can reduce stress and cortisol, a stress hormone. Chronic release of cortisol can damage hippocampus neurons, leading to impairment of learning and memory. OBJECTIVES: The primary goal of this study was to determine whether watching a humorous video had an effect on short-term memory in an older population. DESIGN: The research team designed a randomized, controlled trial. SETTING: The study took place at Loma Linda University in Loma Linda, California. PARTICIPANTS: The research team recruited 20 normal, healthy, older adults, 11 males and 9 females. INTERVENTION: The humor group (n = 10, mean = 69.3 ± 3.7 y) self-selected 1 of 2 humorous videos--a Red Skelton comedy or a montage of America's Funniest Home Videos--and watched it for 20 min. A control group (n = 10, mean = 68.7 ± 5.5 y) sat calmly for 20 min and were not allowed to read, sleep, or talk on a cell phone. OUTCOME MEASURES: The Rey Auditory Verbal Learning Test was used to assess short-term memory--learning ability, delayed recall, and visual recognition. Salivary cortisol levels were measured at predetermined times. RESULTS: Learning ability improved by 38.5% and 24.0% in the humor and control groups, respectively (P = .014). Delayed recall improved by 43.6% and 20.3% in the humor and control groups, respectively (P =.029). Within the humor group, delayed recall (43.6%) was significant compared with learning ability (38.5%) (P = .002). At 3 predetermined time points, significant decreases in salivary cortisol were observed in the humor group (P = .047, P = .046, and P = .062, respectively). CONCLUSION: The study's findings suggest that humor can have clinical benefits and rehabilitative implications and can be implemented in programs that support whole-person wellness for older adults. Learning ability and delayed recall are important to these individuals for a better quality of life--considering mind, body, spirit, social, and economic aspects. Older adults may have age-associated memory deficiencies. However, medical practitioners now can offer positive, enjoyable, and beneficial humor therapies to improve these deficiencies.

The effects of simultaneous exercise and psychotherapy on depressive symptoms in inpatient, psychiatric older adults.

CONTEXT: Depression is the leading cause of early death, affecting 15% of Americans older than 65 y and costing $43 billion each year. The current mental health service system for seniors, particularly for the population hospitalized in acute inpatient psychiatric units, is fragmented because of poor funding and a shift to a transitory health care paradigm, leading to inadequate treatment modalities, questionable quality of care, and lack of research demonstrating the superiority of a particular treatment. These issues are likely to lead to a public health crisis in the coming years. OBJECTIVE: To investigate the effectiveness of combining exercise and psychotherapy in improving acute depressive symptoms among older adults who were receiving treatment in an inpatient psychiatric unit. DESIGN: Based on rolling admissions, inpatients were randomly assigned to 1 of 3 treatment groups. The study was blinded and controlled. SETTING: This study took place in inpatient psychiatric units at the Loma Linda University's Behavioral Medicine Center (LLUBMC) in Redlands, California. PARTICIPANTS: Participants were 78 inpatients, aged 50-89 y. INTERVENTION: Participants in the simultaneous exercise and psychotherapy (STEP) group (n = 26) took part in exercise and received psychotherapy for 30 min per session, whereas those in the TALK group (n = 26) received individual psychotherapy for 30 min per session. Participants in the control group (n = 26) served as a comparison group, receiving standard therapy. OUTCOME MEASURES: The effects of the interventions were determined by assessing differences from baseline to postintervention in the symptomatology of all 3 groups. The research team also administered the Behavioral and Symptom Identification Scale (BASIS-32) and the Geriatric Depression Scale (GDS) pre- and postintervention. RESULTS: At posttest, the STEP group (M = 4.24, SE = 0.62) had a better response than the TALK group (M = 11.34, SE = 0.62, P < .001), which in turn showed greater improvement than the control group (M = 14.84, SE = 0.62, P < .001). Overall, these results indicate that patients' posttreatment depression scores were significantly lower in those receiving the STEP treatment compared with those receiving individual psychotherapy only or standard care. CONCLUSION: A short-term exercise program consisting of 30 min of walking in conjunction with individual psychotherapy was an effective intervention for depression among older adults in inpatient psychiatric units.

The use of thermal infra-red imaging to detect delayed onset muscle soreness.

Delayed onset muscle soreness (DOMS), also known as exercise induced muscle damage (EIMD), is commonly experienced in individuals who have been physically inactive for prolonged periods of time, and begin with an unexpected bout of exercise, but can also occur in athletes who exercise beyond their normal limits of training. The symptoms associated with this painful phenomenon can range from slight muscle tenderness, to severe debilitating pain. The intensity of these symptoms and the related discomfort increases within the first 24 hours following the termination of the exercise, and peaks between 24 to 72 hours post exercise. For this reason, DOMS is one of the most common recurrent forms of sports injury that can affect an individual's performance, and become intimidating for many. For the last 3 decades, the DOMS phenomenon has gained a considerable amount of interest amongst researchers and specialists in exercise physiology, sports, and rehabilitation fields. There has been a variety of published studies investigating this painful occurrence in regards to its underlying mechanisms, treatment interventions, and preventive strategies. However, it is evident from the literature that DOMS is not an easy pathology to quantify, as there is a wide amount of variability between the measurement tools and methods used to quantify this condition. It is obvious that no agreement has been made on one best evaluation measure for DOMS, which makes it difficult to verify whether a specific intervention really helps in decreasing the symptoms associated with this type of soreness or not. Thus, DOMS can be seen as somewhat ambiguous, because many studies depend on measuring soreness using a visual analog scale (VAS), which is a subjective rather than an objective measure. Even though needle biopsies of the muscle, and blood levels of myofibre proteins might be considered a gold standard to some, large variations in some of these blood proteins have been documented, in addition to the high risks sometimes associated with invasive techniques. Therefore, in the current investigation, we tested a thermal infra-red (IR) imaging technique of the skin above the exercised muscle to detect the associated muscle soreness. Infra-red thermography has been used, and found to be successful in detecting different types of diseases and infections since the 1950's. But surprisingly, near to nothing has been done on DOMS and changes in skin temperature. The main purpose of this investigation was to examine changes in DOMS using this safe and non-invasive technique.

The use of thermal infrared imaging to assess the efficacy of a therapeutic exercise program in individuals with diabetes.

BACKGROUND: Exercise is of great value for individuals with diabetes in helping to control their hemoglobin A1c levels and in increasing their insulin sensitivity. Delayed-onset muscle soreness (DOMS) is a common problem in healthy individuals and in people who have diabetes. People with diabetes are also faced with metabolic and endothelial impairments, which could make DOMS even worse. But because they usually have neuropathies, they may not feel this soreness appropriately, leading to premature return to exercise and causing further injuries. RESEARCH DESIGN: One hundred eighteen subjects participated in this study and were divided into four groups. Two groups (healthy and diabetes) performed a series of abdominal exercises, and the other two groups (healthy and diabetes) performed a series of arm exercises to induce DOMS. Skin temperature above the muscle was assessed using a thermal infrared camera, and perceived soreness of the exercised muscle was assessed using a 100-mm visual analog scale. Serum myoglobin concentrations were also measured. RESULTS: There was a significant increase in skin temperature 24 h post-exercise for all four exercise groups (P<0.05), where the combined average increase in skin temperature for all four groups was approximately 0.65°C from baseline. Also, 24 h post-exercise, all four groups were significantly sorer than they were at baseline (P<0.05). Serum myoglobin levels were also significantly higher on day 3 compared with day 1 (P<0.05). CONCLUSION: Infrared thermal imaging may be a valuable technique of seeing which muscles are sore hours or even days after the exercise is over. Thus, thermal imaging would be an efficient and painless way of looking at DOMS in both healthy individuals and individuals who have diabetes, even if they are facing neurological problems.

The effects of a psychoneuroimmunology (PNI) based lifestyle intervention in modifying the progression of depression in clinically depressed adults.

OBJECTIVE: Uncontrolled stress can lead to poorly controlled upsurges of cortisol and deregulation of the hypothalamus pituitary-adrenal axis (HPA), thereby leading to major depression. Psychoneuroimmunology (PNI) is the area of medicine dealing with the bidirectional pathways connecting the influences of brain, neuroendocrine, and immune system. Individual PNI-based lifestyle interventions such as humor and guided imagery have been shown to modulate the stress response. However, researchers have not examined the composite effect of a PNI-based lifestyle intervention among clinically depressed adults. METHOD: This randomized interventional study examined the composite effect(s) of a PNI-based lifestyle intervention: progressive muscle relaxation, spiritual guided imagery, and humor as an adjunct therapy to modifying the progression of depression. Forty-one participants recruited from doctors' offices in San Bernardino and Riverside counties in Southern California, were randomized into two groups: treatment (N = 20) and control (N = 21). For a period of three weeks, participants in the treatment group listened to a 12-minute progressive muscle relaxation and spiritual guided imagery CD daily and watched 10 minutes of humorous DVDs. Participants in both groups were also receiving cognitive behavioral therapy and pharmacotherapy. RESULTS: Depression, spirituality, humor, and stress were assessed at baseline and week 3. Depression significantly decreased from severe to mild from baseline to week 3 in the treatment group. Spirituality significantly increased in the treatment group but remained unchanged in the controls. CONCLUSIONS: These findings offer depressed patients alternative approaches to preventing complications and managing their illness in the context of whole-person lifestyle optimization and integration of mind-body-spirit.

Studying the biology of hope: An interview with Lee S. Berk, DrPH, MPH. Interview by Sheldon Lewis.

Dr Lee S. Berk is a pioneering medical researcher studying the neuroendocrine and immune effects of positive emotions. He is an associate professor of Health Promotion and Education, School of Public Health, and associate research professor of Pathology and Human Anatomy, School of Medicine, both at Loma Linda University in Loma Linda, California. Dr Berk is a fellow of the American College of Sports Medicine and the American Association for Integrative Medicine. He is also nationally board certified as a health education specialist and has served as a member of the board of directors for the American College of Lifestyle Medicine in Loma Linda, California. Dr Berk is a member of the editorial board of Advances in Mind Body Medicine. During the Society for Neurosciences' annual 2001 meeting Dr Berk presented and received major media coverage of a landmark paper entitled, "The Anticipation of a Laughter Eustress Event Modulates Mood States Prior to the Actual Humor Experience." More recently Dr Berk presented at the FASEB (Federation of American Societies for Experimental Biology) annual 2006 meeting in the American Physiological Society section another landmark paper entitled, "Beta-Endorphin and HGH Increase are Associated With Both the Anticipation and Experience of Mirthful Laughter," with further major media coverage. Recently, Dr Berk spoke about his work with Sheldon Lewis, editor in chief of Advances.

Humor, as an adjunct therapy in cardiac rehabilitation, attenuates catecholamines and myocardial infarction recurrence.

BACKGROUND: Catecholamines, especially epinephrine, are implicated in causing arrhythmias, hypertension, and recurrence of myocardial infarction (MI). Diminishing or blocking the effect of catecholamines is useful in cardiac rehabilitation. We have shown previously that a single 1-hour viewing of a humorous video attenuates epinephrine production. DESIGN: We hypothesized that daily participation in viewing humor would diminish catecholamine production and improve cardiac rehabilitation. METHODS: Forty-eight diabetic patients who had recently experienced an MI were divided into 2 matched groups and followed for 1 year in their cardiac rehabilitation programs. The experimental humor group was asked to view self-selected humor for 30 minutes daily as an adjunct to the standard cardiac therapy. Blood pressure, urinary and plasma epinephrine and norepinephrine levels, and 24-hour Holter recording were monitored monthly in both experimental humor and control groups. RESULTS: The patients in the humor group had fewer episodes of arrhythmias, lower blood pressure, lower urinary and plasma epinephrine and norepinephrine levels, less use of nitroglycerin for angina, and a markedly lower incidence of recurrent MI (2/24) than did the control group (10/24). CONCLUSION: Humor appears to attenuate catecholamines and MI recurrence and thus may be an effective adjunct in post-MI care.