The meta-inner humor therapy: Insights from a three-arm randomized controlled trial for comorbid emotional disorders

Meta-Inner Humor Therapy (MIHT) was developed to cultivate active mindfulness by integrating humor-based metacognition with mindful awareness. We evaluated this treatment protocol in a feasibility pilot (Study 1) and a three-arm randomized controlled trial (RCT; Study 2).

In Study 1, 27 adults with comorbid emotional disorders completed ten weekly 90-minute group sessions of MIHT. In Study 2, 93 adults (59% female; mean age=32.6; SD= 9.9), each with at least one primary DSM-5 anxiety, depressive, or obsessive-compulsive disorder (mean comorbidity diagnosis = 2.4), were randomized to MIHT, a Health-Enhancement Program (HEP), or waitlist. Outcomes were measured at baseline, post-treatment, and 9-month follow-up.

Study 1 showed high feasibility (92.5% retention) and strong therapist fidelity (91%), with preliminary within-group symptom reductions. In Study 2, MIHT produced significantly greater improvements than HEP and waitlist across all primary and secondary outcomes. Primary outcomes were emotional symptoms, including anxiety, depression, stress, and obsessive-compulsive symptoms. Secondary outcomes included repetitive negative thinking, mindfulness, and adaptive/maladaptive meta-inner humor beliefs. Changes in adaptive and maladaptive meta-inner humor beliefs (MIHBs) uniquely predicted reductions in emotional symptoms after accounting for mindfulness-related improvements. Mediation analyses indicated that MIHB change was associated with reductions in repetitive negative thinking and psychological inflexibility which, in turn, contributed to reductions in anxious, depressive, and obsessive-compulsive symptoms. Treatment effects remained significant following multiplicity correction and were robust across all clustering sensitivity checks, confirming the stability and reliability of MIHT advantages.

Across a pilot and an RCT, MIHT demonstrated strong feasibility, acceptability, and clinical efficacy. By transforming passive observation into engaged, compassionate inner playfulness, MIHT may represent a scalable transdiagnostic intervention for targeting cognitive-emotional rigidity.