The Impact of Self-Induced Laughter on Psychological Stress

M. I. Evelina Rutdal
Christina M. Frederick*

Sierra Nevada College

Key Words: ESRQ, humor, laughter, reading, stress, therapy


American stress levels rose 39 percent in 2011 (APA, 2011). Research shows laughter produces endorphins that decrease health risks (e.g., MacDonald, 2008) but has primarily considered laughter produced by comic events (e.g., Ko & Youn, 2011). The current study examined the impact of self-induced laughter on psychological stress. Undergraduates (33 males and 27 females) were randomly paired and assigned to laugh or read aloud. Following, participants completed a stress inducing activity (adapted from Försvarsmakten, 2013). During this activity, participants listened to and recorded answers from a soundtrack, sorted cards, and paired information. After stress induction, participants completed the Emotional Stress Reaction Questionnaire (ESRQ; Larsson, 2010) followed by a relaxation exercise. ESRQs were sorted by laughter or reading group and scored. General linear modeling indicated no significant difference in psychological stress between laughter and reading conditions (p = .980). No significant difference in psychological stress was found between genders (p = .767). Generally, the findings indicate self-induced laughter prior to a stressful event does not decrease psychological stress.


Societal norms suggest people should be successful at work, be responsive parents, have a certain appearance, and somehow still have time to preserve their own mental health. The pressure to be accepted in society could increase stress for anyone. The American Psychological Association (APA; 2011) assessed American stress and found it increased 44 percent between 2006 and 2011 and increased, specifically, 39 percent between 2010 and 2011. The APA conducted a cross-country stress survey designed for American adults that revealed an average stress level of 5.2 on a 10-point Likert scale. Reasons behind indicated stress levels are concerns about personal finances (75%), employment (70%), national finances (67%), relationships (58%), as well as personal and family health (53%) (APA, 2011). College undergraduates are especially concerned about the bleak prospective for future employment and their personal finances (Guo, Wang, Johnson, & Diaz, 2011).

Stress impacts the human physiological state. Viamontes and Nemeroff (2009) state the brain reacts to external stressors by sending signals to the rest of the body to prepare the person for action. This activation for preparedness produces an increase in heart rate and dilates blood vessels, thus increasing blood flow (Viamontes & Nemeroff, 2009). These increases in blood flow can increase risk of endothelial dysfunction, the forerunner to cardiovascular disease, if left untreated (Toda & Nakanishi-Toda, 2011). Toda and Nakanishi-Toda (2011) also claimed that adolescents exposed to long-term stress are prone to developing cardiovascular disease. Martin and Dobbin (1988) examined participants' saliva and measured secretory immunoglobulin A levels as an indicator of immune system efficiency. The findings show involvement in frequent stressful situations decreased secretory immunoglobulin A levels and, hence, reduced the efficiency of the immune system (Martin & Dobbin, 1988). The research indicates stress can increase serious health risks. Thus, education regarding effective stress reduction techniques is needed.

In the APA (2011) stress survey, 74 percent of American adults indicated they were actively trying to reduce stress by consuming more nutritious foods, increasing physical activity, decreasing body mass, and getting enough sleep. Unfortunately, no momentous results in stress reduction were noted and the other 26 percent of American adults stated they did not have enough time to participate in stress relieving activities. Losing weight, cooking healthier foods, sleeping longer, and spending time with friends are all time commitments; although these activities are encouraged, it can be difficult for people to motivate themselves when they already feel stress due to other obligations.

When physical attempts to relieve stress are ineffective (APA, 2011), a method incorporating psychological change may offer improvement. In an interview with a humor professional, Godfrey probed Goodman who stated a highly cultivated sense of humor, applied in everyday life, could aid people in their effort to deal with potentially stressful situations (Godfrey, 2004). Laughter is the physiological response to a humorous event and is essential in the healing process of the psyche (Abraml, 2009).

Laughter has been an essential part of human mental health for most of our existence. Within the tribes of Alaskan Natives, laughter is viewed both as medicine and food for the soul (Cueva, Kuhnley, Lanier, & Dignan, 2006). Laughter is said to purify the soul and fill the body with energy (Cueva et al., 2006). Humor is essential to human mental health (Paden-Levy, 2003) because laughter increases happiness through the discharge of endorphins that, in turn, increase immune system efficiency and decrease blood pressure (Abraml, 2009; Brassil, 2002; Cueva et al., 2006; Funk & Ferrell, 1995; Hoare, 2004; MacDonald, 2008). Cortisol, an active substance in the stress response, is found to be decreased through laughing (Sahakian & Frishman, 2007). Laughter, in turn, decreases blood pressure (Sahakian & Frishman, 2007). Together, these benefits help decrease both mental and physical symptoms of stress (Abraml, 2009) such as insomnia; weight gain; feelings of emptiness, misery, or resentment; and seclusion (APA, 2011).

In an interview with Abraml (2009), Sultanoff explained how humor and laughter are related by stating humor includes, "wit, mirth, and laughter" (p. 9) where laughter is the physiological component and, hence, an important part of humor. Humor, and the subsequent laughter, is often used to relieve stress (Abraml, 2009). The act of laughing creates a mental free space by allowing the person to release interpersonal, intrapersonal, and psychological worries otherwise overwhelming their cognitive abilities (Abraml, 2009). When a person's mental state is relaxed, more complex cognitions (e.g., problem solving) become possible (Dziegielewski, Jacinto, Laudadio, & Legg-Rodriguez, 2004). Research indicates the presence of laughter increases health and aids in managing stress. Sing-a-longs (Houston et al., 1998), humorous human interaction (Ko & Youn, 2011), and joke telling (Trice & Price-Greathouse, 1986) are used to induce laughter. Dziegielewski et al. (2004) stated that further research on humor and laughter would be beneficial to clinicians and society.

Experts in the field of laughter therapy, Smith and Segal (2012), stated that the optimal way to incorporate laughter in everyday life is to develop the ability to laugh in situations when one usually would not (Smith & Segal, 2012). Laughing together, with others and for no particular reason, helps people view the world from a child's perspective where issues are temporary and easily overcome (Smith & Segal, 2012). Certified laughter therapist, Junkins (1999), stated that laugh therapy's most important goal is to teach people how to laugh without restraint. Laughing helps us discharge suppressed tension and can open windows to other emotions (e.g., frustration and sadness) (Junkins, n.d.).

Humor producing laughter is also believed to be a positive component in therapeutic relationships due to the multiplied advantage produced when laughter is shared with another person (Abraml, 2009). Ko and Youn (2011) conducted a study that aligns with the view of positive affect derived from interactive laughter therapy. Adults over the age of 65 participated in four, one-hour group laughter therapy sessions for the duration of one month. The laughter therapy consisted of self- and interaction-induced laughter where participants clapped their hands while laughing, engaged in laughter meditation, and sang and danced while laughing. Staff at the convalescent home where the study took place assessed outcomes by observing behavior. The findings showed that laughter therapy can reduce symptoms of depression and insomnia and increase self-esteem. The study by Ko and Youn (2011) expanded on previous research by Houston, McKee, Carroll, and Marsh, (1998) who investigated laughter's effect on negative emotions such as anxiety and depression in the elderly population. Houston et al. (1998) concluded that participating in a sing-a-long could increase well-being in this population. Ko and Youn (2011) speculated whether the benefits of laughter could be an effect of the human interaction required in many laughter settings and also argued that laughter in therapeutic settings is practical because the procedure is affordable and convenient.

Through laughter therapy interventions (e.g., sing-a-longs, laughter meditation, etc.), several studies (Houston et al., 1998; Ko & Youn, 2011) indicated increases in laughter were correlated with decreases in depressive symptoms, decreases in sleep difficulties, and corresponding increases in sleep quality. Utilizing humor as a method for stress relief does not eliminate the stressful situation, but the laughter can alter perception and coping strategies through an increased awareness and acceptance of responsibility (Jacobs, 2009).

Laughter evoked by comic elements is the most prominent intervention examined in previous research, however, Kuiper and Martin (1998) argued that the source of laughter is unimportant when considering laughter's effect on stress. Given the results of pre-existing research and Kuiper and Martin's argument, the purpose of the current study was to examine the impact of self-induced laughter on psychological stress to determine whether or not self-induced laughter had a similar impact on stress as comically-induced laughter and to investigate whether or not self-induced laughter could act as a buffer and minimize stress when this laughter occurred immediately previous to the stressful event. In the current study, the presence or absence of self-induced laughter, prior to a stressful activity, was assessed with regard to self-reported stress with the hypothesis that the presence of self-induced laughter would reduce the amount of self-reported psychological stress.


The current study assessed the impact of the presence or absence of laughter on individual stress levels. After providing informed consent, participants completed either a self-induced laughter session or a neutral (i.e., non-emotion evoking) reading session. After this session, participants completed a stress inducing activity followed by a questionnaire designed to facilitate independent assessment of psychological stress.


A convenience sample of 60 undergraduate students (33 males and 27 females) completed the current study. Participants received course credit for their participation. Using an independent groups design, participants were assigned to one of two groups: the laughter group or the reading group. Participants in each group were paired with a randomly assigned person from the same group.


Randomly assigned pairs in the laughter group were instructed to sit, facing each other with their knees touching, looking into each other's eyes, while laughing, for the timed duration of 5 minutes. As a part of the instructional phase, the concept of self-induced laughter was defined for participants as simply laughing aloud for no particular reason.

Randomly assigned pairs in the reading group were instructed to take turns reading a factual text, The Birth of the Earth by Hugh Thomas (Thomas, 1996), aloud for a duration of 5 min. The text was deliberately selected due to the lack of emotional and physical arousal it would, likely, produce in participants. Reading group participants completed the activity in pairs to control for effects produced by interaction.

After the 5 minute laughter or reading session, participants were unpaired and each participant took part in a 15 minute individually executed, stress inducing activity. The stress audio recording played while participants were asked to simultaneously sort one deck of cards by suit, one deck of cards by number, match 74 countries with their corresponding capitals, and record instructions provided via the stress audio recording in the stress packet (see Appendix A).   Participants were informed the activity must be completed within a time constraint but were not informed how much time they were given. Participants were also informed they were competing against one another for the highest score. The 15 minute time limit was imposed to assure unattainable completion of activity components.

To evaluate participant stress levels after completion of the stress inducing activity, all participants completed the Emotional Stress Reaction Questionnaire (ESRQ; Larsson, 2010; see Appendix B). Larsson's (2010) ESRQ was designed to estimate stress in less than 60 seconds and does so by posing 14 questions, each requesting a rating on a 4-point Likert-scale. After ESRQ completion, participants took part in a 10 minute relaxation session including deep breathing meditation. The relaxation session was based on mindfulness-based stress reduction (Praissman, 2008) and was included to ensure participant well-being after completion of the study. During the first minute of relaxing music (Okanokumo, 2013), participants were instructed to focus on their breathing. The remaining time was dedicated to focusing their breathing on specific body parts for 1 minute each (in this order: feet, legs, back, shoulders, arms, hands, brain, and heart).


The stress audio recording, created for the purpose of this study, was played for the duration of the stress inducing activity. The recording included multiple, overlapping, background sounds (e.g., air horns, marching soldiers, alarms, etc.) retrieved from YouTube.com (see Appendix C for detailed summary). The background sounds were constantly interrupted with vocally recorded and task relevant instructions requiring participants to write specific information into their test packet. The stress audio recording was projected through JBL Creature 2.1 speakers and was set to play, once, from beginning to end via Windows Movie Maker on a Dell Studio 15 personal computer.

To take part in the study, each participant was provided

One Test Packet consisting of

  • One section of neighbor information: 12 segments of a fictional story concerning neighborhood life
  • One section of numbers: 5 sets of 5 single digit numbers
  • One section of phone book inventory: 10 names to locate using their phone numbers in a phone book
  • One world knowledge packet: 74 world countries and their respective capitals to pair

One standard Yellow Pages phone book (AT & T, 2013)

Two decks of Bee® Club Special brand playing cards. Each deck consisted of 52 cards, jokers removed, in the colors black and red.

Results and Discussion

It was predicted participants who laughed for 5 minutes prior to a stress inducing activity would report lower levels of immediate stress than participants who did not laugh before the activity. As the stress inducing activity was an induction activity (i.e., not an outcome measure), the corresponding stress packet was not scored. The ESRQs, the outcome measure, were sorted by laughter or reading group and scored. The 14 ESRQ items were categorized into four groups (Larsson & Larsson-Wilde, 2012): irrelevant (indifferent), benign-positive (relaxed, pleased, glad), challenge (alert, focused, concentrated, energetic) and threat, harm, or loss (uncertain, concerned, disappointed, heated, mad, angry). The raw scores from the positive emotion categories (benign-positive and challenge) and the negative emotion categories (threat, harm, or loss and irrelevant) were added to each other, respectively. Then, the sum of the negative emotion categories was subtracted from the sum of the positive emotion categories to compute the ESRQ appraisal index. The ESRQ appraisal index ranged from -21 to +21 where a score of -21 indicated, "maximum dominance of negative emotions" and a score of +21 indicated, "maximum dominance of positive emotions" (p. 32).

Average participant stress levels in each group were compared through general linear modeling. No significant difference in immediate psychological stress was found between self-induced laughter or neutral reading conditions (p = .980). Figure 1 (see Appendix D) displays the pattern of results between conditions where the self-induced laughter group showed an average of a 3.65 ESRQ appraisal index and the neutral reading group showed an average 3.50 ESRQ appraisal index.

Although it was reasonable to predict the methods employed in the current study would produce lower stress levels in the laughter condition, based on the observed data, we failed to reject the null hypothesis. These findings indicate self-induced laughter immediately prior to a stressful event is not effective as a buffer for psychological stress. The results from the current study do not align with previous research where several studies (Houston et al., 1998; Ko & Youn, 2011) indicated laughter had a positive influence on physiological and mental health.

A post hoc analysis was conducted to explore differences in reported stress levels between males and females, but no significant difference was found between genders (p = .767). Figure 2 (see Appendix E) shows the relative similarity of ESRQ means where the average for males was a 4.29 ESRQ appraisal index and the average for females was a 2.78 ESRQ appraisal index. These findings indicate no statistical difference between male and female response to self-induced laughter occurring before a stressful event.

The current study investigated self-induced laughter's effect on psychological stress as a preventative measure. Because no significant difference was found, perhaps self-induced laughter is not useful as a buffer against stress but might be effective after a stressful event. It is recommended future research employ self-induced laughter after a stress-inducing activity, rather than before, to further investigate whether self-induced laughter could be effective as an intervention.

Experimental realism as related to the duration of each experimental phase should also be considered. Everyday stress is maintained over a longer period of time (Toda & Nakanishi-Toda, 2011) compared to the 15 minute duration of the intensely stress inducing activity. Fifteen consecutive minutes of intense challenge may not be the norm, hence, the relatively short period of self-induced laughter might not have been sufficient to act as a buffer against psychological stress. Self-induced laughter might be less powerful than laughter induced by comic events and, therefore, should be employed for a longer duration to have an impact.

Although the current study showed no benefit of self-induced laughter as related to psychological stress, laughter therapists (e.g., Junkins) claim self-induced laughter aids in psychological care. It is possible laughter, as a therapy, requires a therapeutic setting where the client, or therapist, has chosen this method. A clinical setting, or a modified experimental setting created to produce a genuine situation with experimental realism, would be more suitable to test laughter's impact on stress. In the current study, experimental sessions were conducted in classrooms with multiple (6-20) participants present at a time, while laughter therapy is, generally, conducted in pairs. Modifying the experimental methodology to be more sensitive for use in therapeutic practice may produce different results.

Laughter remains important, and prior research supports its utility for physiological and mental health. Accordingly, the results of this study should not discourage use of this method for relieving stress. Therapists who support laughter therapy should also not be dissuaded as research may reveal the hypothesized impact of self-induced laughter on psychological stress.   Further research is necessary to investigate the practical impact of self-induced laughter on psychological stress.


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American Psychological Association. (2011). Stress in America: Our health at risk. Retrieved from http://www.apa.org/news/press/releases/stress/2011/final-2011.pdf

AT & T.  (2013).  yp: The real yellow pages. Reno, Nevada: AT & T.

Brassil, D. F. (2002). Using humor in our daily lives. Urologic Nursing, 22(3), 144-148.

CMIUC100. (2012, November 6). Home phone ringing sound effect [Web log post]. Retrieved from http://www.youtube.com/watch?v=ShPgEY1UjOk

CMIUC100.   (2012), November 6. Soldiers marching sound effect [Web log post]. Retrieved from http://www.youtube.com/watch?v=U9xSFHo8RvI

Cueva, M., Kuhnley, R., Lanier, A., & Dignan, M. (2006). Healing hearts: Laughter and learning.   Journal of Cancer Education, 21(2), 104-107.

Dziegielewski, S. F., Jacinto, G. A., Laudadio, A., & Legg-Rodriguez, L. (2004). Humor: An essential communication tool in therapy. International Journal of Mental Health, 32(3), 74-90.

Edvin25. (2012, November 6). Lightning strike and thunder sound effect [Web log post]. Retrieved from http://www.youtube.com/watch?v=6_39wbGIJ_I

EffectsLibrary. (2012, November 6). Explosion sound effect [Web log post]. Retrieved from http://www.youtube.com/watch?v=ANe5AeOIFm4

Funk, B., & Ferrell, B. R. (1995). Using cognitive methods to relieve pain. Nursing, 25(3), 30.

Försvarsmakten. (2013, April 8). Officerstestet [Web application]. Retrieved from http://forsvar.fileflat.com/

Godfrey, J. R. (2004). Toward optimal health: The experts discuss therapeutic humor. Journal of Women's Health, 13(5), 474-479. doi:10.1089/1540999041280972

Guo, Y-J., Wang, S-C., Johnson, V., & Diaz, M. (2011). College students' stress under current economic downturn. College Student Journal, 45(3), 536-543.

Hoare, J. (2004). The best medicine. (Cover story). Nursing Standard, 19(14-16), 18-19.

Houston, D. M., McKee, K. J., Carroll, L. L., & Marsh H. H. (1998). Using humour to promote psychological wellbeing in residential homes for older people. Aging & Mental Health, 2(4), 328-332. doi:10.1080/13607869856588

Jacobs, S. (2009). Humour in gestalt therapy – Curative force and catalyst for change: A case study. South African Journal of Psychology, 39(4), 498-506.

Joeyboy680.   (2012), November 6.   Sound effects – Alarm siren (police-ambulance siren) Good HD quality   [Web log post].   Retrieved from http://www.youtube.com/watch?v=8hXQMjjuNe0

Jojikiba. (2012, November 6). Air horn sound effect (long) [Web log post]. Retrieved from http://www.youtube.com/watch?v=XDvuAYySJj0

Jojikiba. (2012, November 6). Clock ticking sound effect (1) [Web log post]. Retrieved from http://www.youtube.com/watch?v=i72Dgsuy3yc

Jojikiba. (2012, November 6). Clock ticking sound effect (2) [Web log post]. Retrieved from http://www.youtube.com/watch?v=cokwoi5GPyQ

Junkins, E. (n.d). The power of laughter in therapy [Article]. Retrieved from http://www.laughtertherapy.com/Articlebestbetforblues.htm#Article:%20Power%20of%20Laughter

Junkins, E. (1999). We need to laugh more [Article]. Retrieved from http://www.laughtertherapy.com/articlesonlaughter.htm

Ko, H-J., & Youn, C-H. (2011). Effects of laughter therapy on depression, cognition and sleep among the community-dwelling elderly. Geriatrics Gerontology, 11, 267-274.   doi: 10.1111/j.1447-0594.2010.00680.x

Kuiper, N. A., & Martin, R. A. (1998). Laughter and stress in daily life: Relation to positive and negative affect. Motivation and Emotion, 22(2), 133-153. doi:10.1023/A:1021392305352

Larsson, G. (2010). The Emotional Stress Reaction Questionnaire (ESRQ): Measurement of stress reaction level in field conditions in 60 seconds. Karlstad, Sweden: North Atlantic Treaty Organization.

Larsson, G., & Wilde-Larsson, B. (2012). Stress measurement in less than one minute. Retrieved from bookboon.com

LightItUp Studios. (2012, November 6). Nails on chalkboard [Web log post]. Retrieved from http://www.youtube.com/watch?v=YbTsebLs7yU

MacDonald, P. (2008). Laughter -- the best medicine? Practice Nurse, 36(2), 38-39.  

Martin, R. A., & Dobbin, J. P. (1988). Sense of humor, hassles, and immunoglobulin A: Evidence for a stress-moderating effect of humor. International Journal of Psychiatry in Medicine, 18(2), 93-105.

Okanokumo. (2013, January 30). 10 minute ambient music "deep relaxing" [Web log post].   Retrieved from http://www.youtube.com/watch?v=UdoqN4FTx-s&list=PLW7qWuSwNFyLq4BgR9c0ziajOE5Jux5ao&index=8

Praissman, S. (2008). Mindfulness-based stress reduction: A literature review and clinician's guide. Journal of the American Academy of Nurse Practitioners, 20(4), 212-216.   doi:10.1111/j.1745-7599.2008.00306.x

Sahakian, A., & Frishman, W. H. (2007). Humor and the cardiovascular system. Alternative Therapies, 13(4), 56-58.  

Smith, M., & Segal, J. (2013). Laughter is the best medicine [Web page]. Retrieved from http://www.helpguide.org/life/humor_laughter_health.htm

Thesoundfxguru.   (2012), November 6.   Alarm clock digital buzzer sound effect   [Web log post].   Retrieved from http://www.youtube.com/watch?v=NHg8jTH7Bqk

Thomas, H. (1996). The birth of the world. World history: The story of mankind from prehistory to the present. (pp. 3-10).   New York, NY: HarperCollins Publishers.

Toda, N., & Nakanishi-Toda, M. (2011). How mental stress affects endothelial function. European Journal of Physiology, 462, 779-784. doi: 10.1007/s00424-011-1022-6                                                      

Trice, A. D., & Price-Greathouse, J. (1986). Joking under the drill: A validity study of the coping humor scale. Journal of Social Behavior and Personality, 1(2), 265-266.

Viamontes, G. I., & Nemeroff, C. B. (2009). Brain-body interactions: The physiological impact of mental processes—The neurobiology of the stress response. Psychiatric Annals, 39(12), 975-984. doi:10.3928/00485718-20091124-03


A special acknowledgement to Steve Ellsworth for statistical consultation concerning appropriate statistical measures.


Appendix A

Test Packet

Instructions: Please answer the questions with information presented in the Stress Audio Recording. Your score will be recorded and used to evaluate your ability to multitask.

Neighborhood information

  • How many students are there in Mary's class?
  • Where did Harold go for vacation?
  • What was the date of Daniels' deadline?
  • How many cows were there at the farm?
  • What pattern was banner above the window in the farmhouse?
  • Where did Susan go camping?
  • What is the color of the house across from Greg's?
  • How many cats does Greg have?
  • What color is Lisa's car?
  • Where did Bob forget his daughter?
  • Who, except for her husband, loves Susan?
  • What color is the farmer's tractor?


  • _____    _____    _____    _____    _____
  • _____    _____    _____    _____    _____
  • _____    _____    _____    _____    _____
  • _____    _____    _____    _____    _____
  • _____    _____    _____    _____    _____

Phonebook Inventory

  • Name: ________________________________________
    Phone Number: _________________________________
  • Name: ________________________________________
    Phone Number: _________________________________
  • Name: ________________________________________
    Phone Number: ________________________________
  • Name: ________________________________________
    Phone Number: ________________________________
  • Name: ________________________________________
    Phone Number: ________________________________
  • Name: ________________________________________
    Phone Number: ________________________________
  • Name: ________________________________________
    Phone Number: ________________________________

  • Name: _______________________________________
    Phone Number: _______________________________

  • Name: _______________________________________
    Phone Number: _______________________________
  • Name: _______________________________________
    Phone Number: _______________________________

World Knowledge Packet

Instructions: Pair the countries with the correct capital by writing the number of the country in the provided space in front of the capital.

1. Afghanistan

___ Nairobi

2. Algeria

___ Lisbon

3. Andorra

___ Washington D.C.

4. Argentina

___ Athens

5. Australia

___ Nassau

6. Austria

___ Canberra

7. The Bahamas

___ Brasilia

8. Barbados

___ Manila

9. Belarus

___ Kuwait City

10. Belgium

___ Luxembourg

11. Botswana

___ Baghdad

12. Brazil

___ London

13. Bulgaria

___ Gaborone

14. Canada

___ Vienna

15. Chile

___ Vatican City

16. China

___ Riyadh

17. Colombia

___ Brussels

18. Costa Rica  

___ Budapest

19. Croatia

___ Kuala Lumpur

20. Czech Republic

___ Santiago

21. Denmark

___ Tunis

22. Dominican Republic

___ San Jose

23. Ecuador

___ Buenos Aires

24. Egypt

___ Cairo

25. Ethiopia

___ Bratislava

26. Germany

___ Tokyo

27. Ghana

___ Abuja

28. Greece

___ Panama City

29. Guatemala

___ Kingston

30. Guinea-Bissau

___ Minsk

31. Hungary

___ Reykjavik

32. Iceland

___ Quito

33. India

___ Pyongyang

34. Iran

___ Kampala

35. Iraq

___ Bogota

36. Ireland

___ Kabul

37. Italy

___ Monaco

38. Jamaica

___ Ottawa

39. Japan

___ Bridgetown

40. Kenya

___ Hanoi

41. North Korea  

___ Santo Domingo

42. South Korea

___ Moscow

43. Kuwait

___ Andorra la Vella

44. Latvia

___ Madrid

45. Libya

___ Algiers

46. Luxembourg

___ Tripoli

47. Malaysia

___ Bissau

48. Malta

___ Rabat

49. Mexico

___ Copenhagen

50. Monaco

___ Valletta

51. Morocco

___ Wellington

52. Namibia  

___ Singapore

53. New Zealand

___ Zagreb

54. Nigeria

___ Bangkok

55. Panama

___ Prague

56. Peru

___ Seoul

57. Philippines  

___ Windhoek

58. Poland

___ Rome

59. Portugal

___ Accra

60. Russia

___ Tehran

61. Saudi Arabia

___ Mexico City

62. Singapore

___ Addis Ababa

63. Slovakia

___ Beijing

64. Spain

___ New Delhi

65. Sudan

___ Lima

66. Taiwan

___ Guatemala City

67. Thailand

___ Sofia

68. Tunisia

___ Taipei

69. Uganda

___ Caracas

70. United Kingdom

___ Dublin

71. United States of America

___ Berlin

72. Vatican City

___ Riga

73. Venezuela

___ Khartoum

74. Vietnam

___ Warsaw



Appendix B

Emotional Stress Reaction Questionnaire

Instructions: Below is a list of words describing different emotions. Beside each word are four response choices. Circle the choice which best describes how you feel right now.

Respond as follows:

  • The word does not correspond to how I feel right now
  • The word partly corresponds to how I feel right now
  • The word fairly well corresponds to how I feel right now
  • The word completely corresponds to how I feel right now

Respond with the ranking that first comes to your mind.










































































































Note: Adapted from Emotional Stress Reaction Questionnaire (Larsson, 2010)

Appendix C

Table 1.

Stress Audio Recording Stimuli

Sound Title


Retrieved from

Air horns



Thunder and lightning



Marching soldiers



Ticking clock - slow



Ticking clock - fast



Beeping alarm clocks






Ringing home phones



Nails on a chalkboard

LightItUp Studios


Emergency vehicle sirens



Note.   A 15 min compilation of these audio stimuli was created for use with the stress audio recording.   Background sounds were interrupted by vocal recordings providing instructions to participants.

Appendix D


Appendix E





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