An investigation of the emotions elicited by hospital clowns in comparison to circus clowns and nursing staff
Tribute to Lorene M. Birden


Positive Psychology

How to Cite

Auerbach, S., Hofmann, J., Platt, T., & Ruch, W. F. (2014). An investigation of the emotions elicited by hospital clowns in comparison to circus clowns and nursing staff. The European Journal of Humour Research, 1(3), 26–53.


The present research aims at identifying emotional states induced in observers of hospital clown interventions utilizing a list of clown-specific ratings, the 29 Clown Emotion List (CLEM-29, Auerbach et al. 2012a). Study 1 investigated whether hospital clowns elicit emotional states other than those already covered by scales representing existing models of emotional states. One hundred and nineteen adults watched videos of hospital clowns and circus clowns and, after each video, completed a general mood scale, a humour-related mood scale, and the CLEM-29, and indicated the global intensity of positive and negative feelings towards each video. Results showed that emotional states elicited by hospital clowns go beyond states represented in general mood scales. Some elements of the CLEM-29 relating to humour and amusement overlapped with existing models of mood, but many other emotional qualities like “feeling connected to the clown” or feeling “appreciated” were not well represented. Some of the clown-specific ratings best predicted the positive experiences towards the videos. In Study 2, 183 adults watched 15 videos of hospital clown interventions, circus clown performances and nurse-patient interactions, and filled in the CLEM-29. Four factors emerged from a factor analysis of the ratings: amusement, transcendence, arousal, and uneasiness. Both circus and hospital clowns elicited amusement, but only the hospital clowns additionally elicited feelings of transcendence (i.e., feeling privileged and appreciated). Nurses also elicited transcendent experiences without being amusing. This research shows that prior studies underestimated emotional states elicited by hospital clowns, which go beyond a typical humour response.


Adams, P. (2002). Humour and love: The origination of clown therapy. Postgraduate Medicine Journal, 78, 447-448.

Auerbach, S., Hofmann, J., Platt, T., & Ruch, W. (2012a). The 29 Clown Emotion List (CLEM-29). Unpublished research instrument, University of Zurich, Switzerland.

Auerbach, S., Hofmann, J., Platt, T., & Ruch, W. (2012b). The Cheerfulness-Empathy Video Collection (CEVC). Unpublished research instrument, University of Zurich, Switzerland.

Bertini, M., Isola, E., Paolone, G., & Curcio, G. (2011). Clowns benefit children hospitalized for respiratory pathologies. Evidence-Based Complementary and Alternative Medicine, 2011, 1-9.

Brutsche, M. H., Gossmann, P., Müller, R. E., Wiegand, J., Pello, Baty, F., & Ruch, W. (2008). Impact of laughter on air trapping in severe chronic obstructive lung disease. International Journal of COPD, 3, 185-192.

Costa Fernandes, S., & Arriaga, P. (2010). The effects of clown intervention on worries and emotional responses in children undergoing surgery. Journal of Health Psychology, 15, 405-415.

Friedler, S., Glasser, S., Azani, L., Freedman, L. S., Raziel, A., Strassburger, D., et al. (2011). The effect of medical clowning on pregnancy rates after in vitro fertilization and embryo transfer. Fertility and Sterility, 95, 2127-2130.

Golan, G., Tighe, P., Dobija N., Perel, A., & Keidan, I. (2009). Clowns for the prevention of preoperative anxiety in children. A randomized control trial. Journal of Pediatric Anesthesia, 19, 262-266.

Higueras, A., Carretero-Dios, H., Muñoz, J. P., Idini, E., Ortiz, A., Rincon, F., & Prieto-Merino, D. (2006). Effects of a humor-centered activity on disruptive behavior in psychiatric patients in a general hospital psychiatric ward. International Journal of Clinical and Health Psychology, 6, 53-64.

Hirsch, R. D., Junglas, K., Konradt, B., & Jonitz, M. F. (2010). Humortherapie bei alten Menschen mit einer Depression. Ergebnisse einer empirischen Untersuchung [Humor therapy in the depressed elderly. Results of an empirical study]. Zeitschrift für Gerontologie und Geriatrie, 43, 42-52.

Janke, W., Hüppe, M., & Erdmann, G. (2003). Befindlichkeitsskalierung anhand von Kategorien und Eigenschaftswörtern [Mood checklist by categories and adjectives]. Würzburg: Department of Psychology, University of Würzburg.

Kingsnorth, S., Blain, S., & Keever, P. M. (2010). Physiological and emotional response of disabled children to therapeutic clowns: a pilot study. Evidence Based Complementary and Alternative Medicine, 1-10.

Linge, L. (2008). Hospital clowns working in pairs – in synchronized communication with ailing children. International Journal of Qualitative Studies on Health and Well-Being, 3(1), 27-38.

Linge, L. (2011). Joy without demands: Hospital clowns in the world of ailing children. International Journal of Qualitative Studies on Health and Well-being, 6, 5899.

Linge, L. (2012). Magical attachment: Children in magical relations with hospital clowns. International Journal of Qualitative Studies on Health and Well-being, 7, 11862.

Pinquart, M., Skolaude, D., Zaplinski, K., & Maier, R. F. (2011). Do clown visits improve psychological and sense of physical well-being of hospitalized pediatric patients? Klinische Pädiatrie, 223, 74-78.

Platt, T., Hofmann, J., Ruch, W., & Proyer, R. T. (2013). Duchenne display responses towards sixteen enjoyable emotions: Individual differences between no and fear of being laughed at. Motivation and Emotion. 10.1007/s11031-013-9342-9.

Ruch, W. (1993). Exhilaration and humor. In M. Lewis & J. M. Haviland (Eds.), The handbook of emotions (pp. 605-626). New York, NY: Guilford Publications.

Ruch, W., & Hehl, F.-J. (1998). A two-mode model of humor appreciation: Its relation to aesthetic appreciation and simplicity-complexity of personality. In W. Ruch (Ed.), The sense of humor: Explorations of a personality characteristic (pp. 109-142). Berlin, Germany: Mouton de Gruyter.

Ruch, W., & Hofmann, J. (2012). A temperament approach to humor. In P. Gremigni (Ed.), Humor and health promotion (pp. 79-113), Hauppauge, NY: Nova Science Publishers.

Ruch, W., & Rath, S. (1993). The nature of humor appreciation: Toward an integration of perception of stimulus properties and affective experience. Humor: International Journal of Humor Research, 6, 363-384.

Ruch, W., Köhler, G., & van Thriel, C. (1997). To be in good or bad humor: Construction of the state form of the State-Trait-Cheerfulness-Inventory – STCI. Personality and Individual Differences, 22, 477-491.

Ruch, W., Platt, T., Hofmann, J., Auerbach, S., & Dionigi, A. (2013). Hospital clown research: A positive psychology perspective. Manuscript submitted for publication.

Stuber, M., Hilber, S. D., Libman Mintzer, L., Castaneda, M., Glover, D., & Zeltzer, L. (2009). Laughter, humor and pain perception in children: A pilot study. Evidence-Based Complementary and Alternative Medicine 6, 271-276.

Tabachnick, B. G., & Fidell, L. S. (2013). Using multivariate statistics. Boston: Pearson.

Transcendence. (n.d.). In Merriam-Webster’s Online Dictionary. Retrieved from

Vagnoli, L., Caprilli, S., & Messeri, A. (2010). Parental presence, clowns or sedative premedication to treat preoperative anxiety in children: What could be the most promising option? Pediatric Anesthesia, 20, 937-943.

Vagnoli, L., Caprilli, S., Roblioglio, B. A., & Messeri, A. (2005). Clown doctors as a treatment for preoperative anxiety in children: A randomized, prospective study. Pediatrics, 116, 563-567.

Watson, D., & Tellegen, A. (1985). Toward a consensual structure of mood. Psychological Bulletin, 98, 219-235.

Wild, B., Wetzel, P., Gottwald, U., Buchkremer, G., & Wormstall, H. (2007). Clowns in der Psychiatrie. Ein Pilotprojekt [A pilot project with clowns in psychiatric clinics]. Nervenarzt, 78, 571-574.

Zweyer, K., Velker, B., & Ruch, W. (2004). Do cheerfulness, exhilaration, and humor production moderate pain tolerance? A FACS study. Humor: International Journal of Humor Research, 17, 85-119.

All authors agree to an Attribution Non-Commercial Non Derivative Creative Commons License on their work.


Download data is not yet available.