Effectiveness of Humor Skills Training on Psychological Hardiness and Psychological Distress of Mothers with Children with Autism Spectrum Disorder

Introduction

Autism spectrum disorder (ASD) as a neurodevelopmental disorder is a disorder whose diagnostic criteria have occurred based on the fifth diagnostic and statistical manual of mental disorders (DSM-5) as a continuous impairment of communication and social interactions in different situations and patterns of interests, behavior and repetitive activities limited in the present or past and at the beginning of development [1].

Autism Spectrum Disorders Information Center considers the symptoms of this spectrum to be defects in verbal and nonverbal communication, eye contact abnormalities, inability to participate in imaginative games, sensory processing problems, intense and unusual attachment to objects, repetitive games, repetitive and stereotypical movements, and inflexible adherence to everyday habits, destruction of emotional and social bilateral relationships and self-harm [2].

Behavioral problems are not the main feature of autism spectrum disorders, but these problems are significantly seen in these children and create problems for these individuals and their families [1]. Therefore, paying attention to the mental health of parents of autistic children, especially their mothers as primary caregivers, is one of the most important issues in this group of children. In other words, spending time with a child with pervasive developmental disorders causes anxiety and stress in family members, challenges the family system, damages the health and balance of the family [2].

Psychological hardiness was first considered by Kobasa and was considered as a formed set of personality traits that acts as a source of resistance in contrast to life’s pressing events, such as protective shields, and its qualified individuals can efficiently deal with life’s problems and pressures [3].

Kobasa and his colleagues have defined hardiness as a combination of beliefs about themselves and the world, composed of three components of commitment, containment and struggle [4]. Humor skills training is a positive and inclusive activity experienced by people from social and cultural contexts around the world. Zahed and partners (2011) in a study entitled “The Mediating Role of Psychological Hardiness in the Relationship between Forgiveness and Humor with Hope” showed that firstly, forgiveness and humor have a poor prediction of hope. Secondly, forgiveness is a predictor of tenacity. Thirdly, tenacity plays a mediating role between forgiveness and hope in people.

Based on the findings of this study, it can be concluded that the constructs of hardiness and forgiveness (directly and indirectly) can predict changes related to hope in people. According to the above, the aim of this study was to find out the effectiveness of humor skills training on psychological hardiness and psychological helplessness of mothers with children with autism spectrum disorder.

Research Methodology and type of Research plan:

Materials and methods: According to the objectives and hypotheses, the present study method is a semi-experimental type (pre-test and post-test design with control group).

Table 1:

Statistical population: The statistical population of this study included all mothers of children with autism spectrum disorder who referred to pediatric clinics referred to autism clinics in the first half of 2020 in Ardabil.

Sampling Method and Sample size

Among mothers of children with autism, 40 mothers were selected by available method and randomly assigned to two groups of 20 patients, and in experimental research, at least 15 samples were suggested [2].

Data Collection Method

Data collection in this study was that after obtaining the necessary permissions and coordination, the treatment clinics of autistic children in Ardabil were referred. Then, by inviting mothers of these children and explaining the research objectives to them, through implementing psychological hardiness questionnaires, learned helplessness, 40 of them were selected and replaced in experimental and control groups.

Then, the experimental group received humor skills training (for 8 sessions, each session for 90 minutes) and the control group remained without any intervention and finally both groups completed the questionnaire again and the questionnaires were collected and the information was analyzed by SPSS software.

Due to the coronavirus outbreak and observance of health protocols in the executive of the study, we encountered problems that individual interventions were performed and finally the cooperation of parents of these children solved these problems.

Data Analysis Method

Data analysis was performed in descriptive and inferential sections. Descriptive indices such as mean, standard deviation and frequency and percentage tables were used in the descriptive section. Then, multivariate analysis of variance (MANOVA) was used to test the research hypotheses. Data analysis was performed using SPSS statistical software, 18th edition [Table 1].

Table 2:summarizes the implementation of a treatment program based on teaching specific skills of humor, practicing jokes, benefits and different types of humor, harmful humor, cognitive restructuring, facing resistances, encouraging the advancement of humor, and direct guidance on how to use it, how to use humor in the environment and times of crisis and stresses of life.

Results

Demographic Characteristics

As can be seen Table 2, the mean age of mothers in the experimental group is 33.65 and in the control, group is 37.11. As can be seen Table 3, in the experimental group, 0.50 respondents with most of the diploma education and in the control group 37.5 also have a diploma.

Table 3:Mean and standard deviation of age of mothers of children with autism spectrum disorder in the studied groups.

Table 4:Education status of mothers with children with autism spectrum disorder in the studied groups.

Descriptive Finding

As can be seen Table 4, the mean and standard deviation of psychological hardiness dimensions (commitment, control and Struggle) are expressed in the control and experimental groups in the post-test phase of the control group and the post-test of the experimental group. As can be seen in Table 5, the mean and standard deviation of helplessness learned in mothers of children with autism spectrum disorder are expressed in the post-test stage of the control group and the post-test of the experimental group.

Table 5:Descriptive statistics of psychological hardiness dimensions in mothers of children with autism spectrum disorder in the studied groups.

Table 6:Descriptive statistics of helplessness learned in mothers of children with autism spectrum disorder in the studied groups.

Inferential Finding

Main hypothesis: Teaching humor skills affects the hardness and helplessness of mothers of children with autism spectrum. According to the results of Table 6, the significant level of error of variance parity test (p>0.05) shows that the variances are equal.

As shown [Table 7], the results of the box test are given to investigate the homogeneity of the matrix of variances. According to the results, the significance level (sig=0.239) is greater than 0.05. Therefore, the assumption of homogeneity of the variance matrix is established. According to [Tables 6 & 7] since the assumption of homogeneity of error variances and homogeneity of the covariance matrix were established. Multivariate variance analysis was used to compare the scores (hardiness and helplessness of mothers of children with autism spectrum) in the studied groups.

Table 7:Levine test results to determine the parity of variances.

Table 8:Box test to investigate homogeneity assumptions of variance matrix.

As Table 8 shows, the significant levels of all tests allow the ability to use multivariate analysis of variance. These results show that there is a significant difference in at least one of the dependent variables in the studied groups. (0.01 p<, f= 612/139, 0.11 = Wilks’s lambda) Eta square shows.

Table 9:The results of a significant multivariate variance analysis (hardiness and helplessness of mothers of children with autism spectrum).

The difference between the groups with regard to the dependent variables is significant and the rate of this difference based on Wilks’s lambda test is 0.11, i.e., 88% of the variance is related to the difference between the groups due to the interaction of dependent variables.

As [Table 9] shows There is a significant difference between psychological hardiness and learned helplessness in pre-test and post-test of humor skills training group and there is a significant difference in pre-test and post-test of humor skills training group (p<0.01) and also from the results of descriptive statistics of variables, it can be concluded that psychological hardiness of mothers of children with autism spectrum disorder who received humor skills training, more of mothers.

Table 10:Multivariate Variance Analysis Test (Manova) On (Hardiness and Helplessness of Mothers of Children with Autism Spectrum).

The training, and the helplessness learned in mothers of children with autism spectrum disorder who received humor skills training is less than mothers who did not receive this training.

Sub hypothesis 1: Teaching humor skills affects the psychological hardiness of mothers with children with autism spectrum disorder. According to the results of [Table 10], the significant level of error of variances parity test (p>0.05) shows that the variances are equal.

Table 11:Levine test results to determine the parity of variances.

As [Table 11] shows that the significant levels of all tests allow the ability to use multivariate analysis of variance. These results show that there is a significant difference in at least one of the dependent variables in the studied groups. (0.01 p<, 38.53 F=, 0.39 = Lambda Wilkes). Eta square shows that the difference between groups according to the dependent variables is significant and the rate of this difference based on Wilks’s lambda test is 0.16. That is, 83% of the variance related to the difference between groups is due to the interaction of dependent variables.

As shown [Table 12], the results of the box test are used to investigate the homogeneity of the variance matrix. According to the results, the significance level (sig= 0.086) is greater than 0.05. Therefore, the assumption of homogeneity of the matrix of variances is established. According to [Tables 11 & 12], since the assumption of error variances and homogeneity of covariance matrix was established, multivariate variance analysis was used to compare scores (commitment, control and Struggle) in the studied groups.

Table 12:The results of a significant test of multivariate variance analysis of the variance of humor skills training on the dimensions of psychological hardiness of mothers of children with autism spectrum disorder.

Table 13:Box test to investigate homogeneity assumptions of variance matrix.

As [Table 13] shows that the dimensions of psychological hardiness variable (commitment, control and struggle) of mothers with children with autism spectrum disorder have a significant difference between control and experimental groups at alpha level of 0.01. Therefore, the first sub hypothesis is confirmed and there is a difference between teaching humor skills on the psychological hardiness dimensions of mothers of children with autism spectrum disorder between the control and experimental groups. Also, from the results of descriptive statistics of variables, it can be concluded that the dimensions of psychological hardiness (commitment, control and struggle) of mothers who received humor skills training are more than mothers who did not receive this training.

Table 14:The results of multivariate variance analysis test on teaching humor skills on the psychological hardiness dimensions of mothers with children with autism spectrum disorder.

Sub hypothesis 2: Humor skills training affects the learned helplessness of mothers with children with autism spectrum disorder. According to [Table14] results, the significant level of error of variances parity test (p>0.05) shows that the variances are equal.

According to the results of [Table 15] (p<0.01 F=34.01) for the learned helplessness variable of mothers of children with autism spectrum disorder, the difference between the control and test groups at the alpha level of 0.01 is significant, so the second sub hypothesis is confirmed and there is a difference between the learned helplessness of mothers of children with autism spectrum disorder between the control and experimental groups. Also, the results of descriptive statistics of variables can be concluded that the learned helplessness of mothers who received humor skills is less than mothers who did not receive this training.

Table 15:Levine test results to determine the parity of variances.

Table 16:Univariate Variance Analysis to Compare Mean Scores of Humor Skills Training on Learned Helplessness in Mothers of Children with Autism Spectrum Disorder.

Discussion & Conclusion

Main hypothesis

Teaching humor skills affected psychological hardiness and learned helplessness of mothers with children with autism spectrum disorder.

In this regard, the results showed that there is a significant difference between psychological hardiness and helplessness learned in pre-test and post-test of humor skills training group and there is a significant difference in pre-test and post-test of humor skills training group (p<0.01) and also from the results of descriptive statistics of variables can be concluded that psychological hardiness of mothers with children with children can be concluded. Autism spectrum disorder that received humor skills training is higher than mothers who did not receive this training.

And the helplessness learned in mothers with children with autism spectrum disorder who received humor skills training is less than mothers who did not receive this training. The results were also in line with the results of research by James C [5], Ching et al [6] and Fry [7]. In this regard, James C in a study entitled Sense of Humor when coping with the stress of life showed that humor and humor alone are associated with less depression and higher self-esteem.

However, these relationships vary according to the gender of the subject and the frequency of people’s use of humor to cope. The results confirm the notion that feelings of humor play an important role in the psychological regulation of some people.

In explaining this assumption, it can be said that psychological hardiness is a construct that as a personality trait and with its effective role in adjusting the consequences of stress, has been extensive studies so far. Philosophers and social scientists observed many people over the years who were better adapted to unpleasant life situations due to certain personality traits. In popular culture, there are also people who are known by traits such as “resistant” and “patient”, these people apparently tolerate problems better than others and come out later, and according to the results of this hypothesis, humor skills can positively affect the level of psychological hardiness of individuals.

Lehman and partners believe that the use of humor is an adaptive characteristic of personality that can act as a shield against the effects of life stress. In Torrance’s opinion, humorous people have some characteristics: fulfilling the role of funny comedy and fun, creating cartoons that are humorous and innovative, Making jokes or stories ridiculous in discussions, making others laugh (not mocking people), joking with others, adapting cleverly or superiorly when winning or succeeding, attaching incongruous factors to each other, appending incongruous factors that are suddenly communicated, considering something that doesn’t matter and considering or embodying what matters. And finally, it can be said that teaching humor skills due to raising the level of positivity and hope for the future of these mothers increases the level of hardiness and reduces helplessness in people.

Sub hypothesis 1: Teaching humor skills affects the psychological hardiness of mothers with children with autism spectrum disorder. In this regard, the results showed that there is a difference between teaching humor skills on the psychological hardiness dimensions of mothers of children with autism spectrum disorder between control and experimental groups. Also, from the results of descriptive statistics of variables, it can be concluded that the dimensions of psychological hardiness (commitment, control and struggle) of mothers who received humor skills training were more than mothers who did not receive this training (< P The results were also in line with the results of research by James C, ching and partners and Fry [5-7].

In this regard, Qing had a study entitled The Effectiveness of Humor Education in Adolescents with Autism, which, given that humor education has been used and proven in educational and clinical cases, is relatively rare for people with autism. The present study presented a workshop on humor and knowledge skills in order to strengthen the understanding and admiration of humor from people with autism and investigated the effects of this training.

In explaining this hypothesis, it can be said that playing the role of funny and recreational comedy, creating caricatures that are witty and innovative, making jokes or stories in discussions make others laugh. (not mocking people), joking with others, adapting cleverly or superiorly when winning or succeeding, attaching incongruous factors to each other, appending incongruous factors that are suddenly connected.

Considering something that is not important and considering or manifesting what is important and by learning these skills, the dimensions of psychological hardiness (commitment, control and struggle) in people who have many problems also improve the situation in psychological hardiness.

Sub hypothesis 2: Teaching humor skills affects the learned helplessness of mothers of children with autism spectrum disorder. In this regard, the results showed that there is a difference between the learned helplessness of mothers of children with autism spectrum disorder between the control and experimental groups. Also, the results of descriptive statistics of variables can be concluded that the learned helplessness of mothers who received humor skills was lower than mothers who did not receive this education (P<0.01).

The results were in line with the results of Khanjani and Rezaie’s, Karimi Vakil and partners, Fallahzadeh and partners [2], Hamidi and Jafari [8], Mikaeili and partners [9], Lan Lee, James C [7]. In this regard, Mikaeili and partners in a study entitled Comparing compassion for themselves, showed humor and emotional impermanence among mothers of autistic children with normality in Ahvaz.

There was a significant difference between self-compassion and emotional impurity of mothers of children with autism and mothers of normal children, but there was no difference between the two groups regarding humor. The findings of this study can be an important achievement for psychological interventions to mothers of autistic children, and Fry [8], showed that humor, physical illnesses and emotional disturbances, such as grief, can be used as a joke effect on daily disturbances and physical illnesses.

In explaining this assumption, it can be said that from the viewpoint of philosophers and ancient thinkers, humor is influenced by the four disturbances that cause physical and mental health. They believed that blood was red, flowing, warm and humid, and if it prevailed over other disturbances, the person would be healthy, hopeful, jolly and in a good mood. Psychology considers humor as one of the characteristics of human personality and has examined it from different perspectives.

In the 1960s, psychologists became interested in criticizing humor and laughter for human existence. Some psychologists believe that humor and laughter are of great importance to human beings and their lives, and according to the results of this hypothesis, teaching humor skills can reduce the amount of helplessness learned by mothers of children with autism spectrum disorder.

Acknowledgement

None.

Conflicts of Interest

No conflict of interest.

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