A meta‐analysis of randomized controlled trials of laughter and humour interventions on depression, anxiety and sleep quality in adults

The Effect of Laughter Yoga on Vasomotor Symptoms and Sleep Quality in Menopausal Women: A Randomized Controlled Trial

This experimental study aimed to determine the effects of online laughter yoga on the sleep quality and vasomotor symptoms (VMS) of menopausal women through a prospective, randomized controlled trial. About 36 women who attend the Menopause School were randomized into either the laughter yoga (n = 18) or the control group (n = 18). The laughter yoga group participated in eight online laughter yoga sessions, with two sessions per week for four weeks, whereas the control group did not receive any intervention. Data were collected using the Descriptive Characteristics Form, Visual Analog Scale (VAS), and Pittsburgh Sleep Quality Index (PSQI). The laughter yoga group had significantly lower posttest VAS scores compared with the control group in all VMS (P < .05). Furthermore, the posttest PSQI score of the laughter yoga group was significantly lower than that of the control group (P < .05). Although there was no significant difference in the pretest and posttest scores obtained by the control group from the VAS and PSQI (P > .05), the intervention group exhibited a statistically significant difference in their pretest and posttest VAS and PSQI scores (P < .05; P < .001, respectively). The results indicate that laughter yoga is an effective method for reducing VMS and improving sleep quality.

Humor in professional coaching: a literature review and research agenda

Introduction

Extensive research has explored the incorporation of humor in therapy, revealing its potential positive effects on clients' mental well-being and personal growth. However, limited research exists on how coaching could benefit from humor as an intervention and how its utilization impacts the interaction processes and outcomes for both the coachee and coach. Therefore, our research focuses on the use and effects of spontaneous humor within professional dialogues. This paper aims to extract insights from academic literature on humor in adjacent fields and apply these insights to the context of coaching.

Methods

This paper offers implications for coaching theory and practice, alongside a proposed research agenda. The initial phase involves analyzing reviews on humor in professional contexts, and coaching. Secondly, following the PRISMA guidelines for review, we identified 13 empirical studies, which address the role of humor in counseling, psychotherapy, and mentoring.

Results and discussion

Our findings suggest that humor serves as a valuable tool for establishing and deepening the working alliance, fostering adaptive coping mechanisms in clients, and enhancing the cognitive and behavioral process. Moreover, humor is shown to be advantageous for professionals in navigating challenging client relationships. These findings hold significance for the realm of coaching practice as well. In light of these insights, we propose the integration of humor use in education toolkits for coaching professionals.

Humor Styles in Healthcare Professionals: A Correlational Study

Using humor as a caregiving strategy can help professionals perceive daily and work-related events from a more optimistic and light-hearted perspective. The main objective of this study was to analyze humor styles among health care professionals. A cross-sectional and correlational design was employed. Data were collected using the Humor Styles Questionnaire, which measures four humor styles: affiliative, self-enhancing, aggressive, and self-defeating humor. Health care professionals scored higher in positive humor than negative humor. Age exhibited a negative correlation with positive humor. Significant differences were observed between marital status and affiliative and self-enhancing humor, professional category and hospital unit with aggressive humor, shift work and self-enhancing humor, and type of contract and experience with affiliative humor. Health care professionals employ various humor styles based on their social and work contexts. It is crucial for health care professionals to receive training in the use of positive humor to consciously avoid humor styles that can hinder well-being.

Frequency of laughter and work engagement among Japanese employees: a cross-sectional study during COVID-19

Laughter is associated with better health and occurs most frequently during casual conversations. However, the COVID-19 pandemic has impaired social interactions, which may have reduced the frequency of laughter and led to poor well-being among workers. This study investigated the relationship between laughter frequency and work engagement among Japanese employees during the pandemic. We conducted a web-based survey among Japanese employees (20-59 yr) via an internet survey company in December 2021; 1,058 valid data were analysed. Of the respondents, 65.1% laughed at least once a week, but the frequency was much lower than that reported in previous studies conducted before the pandemic. Additionally, those who laughed at least once a week had significantly higher work engagement scores than those who laughed less than once a month. Although employees reduced their frequency of laughter during the pandemic, a certain frequency of laughter may be important for maintaining their work engagement.

Humor in autism spectrum disorders: A systematic review

OBJECTIVES

Humor is essential to social relationships. Its use and understanding appear to be impaired in people with Autism Spectrum Disorder (ASD). The main objective was to review the existing literature on the detection, understanding and use of humor in persons with ASD. The secondary objective involved exploring assessment scales and specific intervention tools.

METHODS

A systematic review of the literature was carried out on all available French and English scientific papers about humor - including irony - in persons with ASD up to November 2021. We extracted 552 references and included 43 articles from six databases.

RESULTS

Studies suggest that those with ASD can detect audiovisual and written humor. Understanding humor was impaired in writing and when using pure auditory stimuli and non-verbal cartoons. For irony, the results indicated a lower detection of quality and less understanding in speaking but not in writing. Regarding its use, in terms of expression, people with ASD use benevolent humor less often and do not consider humor as a key source of satisfaction with life, as opposed to the control group.

CONCLUSIONS

It appears that it would be worthwhile to develop standardized humor detection and assessment tools specific to persons with ASD. Practical strategies that focus on humor ability could be worth developing, either individually or in groups.

Effectiveness of web-based interventions for women with urinary incontinence: protocol for a systematic review and meta-analysis of randomised controlled trials

INTRODUCTION

Urinary incontinence (UI) is one of the most common chronic diseases among women, which can endanger their physical and mental health and incur a heavy financial burden on both individuals and society. Web-based interventions (WBIs) have been applied to manage women's UI, but their effectiveness has remained inconclusive. This systematic review and meta-analysis aims to explore the effectiveness of WBIs on self-reported symptom severity, condition-specific quality of life, adherence to pelvic floor muscle training (primary outcomes) and other extensive secondary outcomes among women with UI. We also aimed to investigate whether intervention characteristics (format, interactivity and main technology) have impacts on the effectiveness of primary outcomes.

METHODS AND ANALYSIS

This systematic review protocol was developed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols guidelines. 10 electronic databases will be comprehensively searched from their inception to 1 May 2024, along with grey literature searches and manual reviews of relevant reference lists to identify eligible randomised controlled trials. The methodological quality of the included studies will be assessed by two reviewers based on the Cochrane Risk of Bias Tool. Meta-analyses will be conducted via Stata V.12.0. Leave-one-out sensitivity analyses will be performed, and publication bias will be evaluated using funnel plots and Egger's test. Subgroup analyses regarding intervention format, interactivity and main technology will be carried out.

ETHICS AND DISSEMINATION

No ethics approval is needed for this review since no primary data are to be collected. The results of this review will help develop an optimal WBI for women with UI, thereby providing them with maximum benefits. The findings will be disseminated via a peer-reviewed journal or conference presentation.

PROSPERO REGISTRATION NUMBER

CRD42023435047.

Psychological aspects of rehabilitation nutrition: A position paper by the Japanese Association of Rehabilitation Nutrition (secondary publication)

Psychological aspects of rehabilitation nutrition affect physical, cognitive, and social rehabilitation nutrition. When depression is recognized, not only pharmacotherapy and psychotherapy, but also non-pharmacological therapies such as exercise, nutrition, psychosocial, and other interventions can be expected to improve depression. Therefore, accurate diagnosis and intervention without overlooking depression is important. Psychological aspects of preventive rehabilitation nutrition is also important because depression can be partially prevented by appropriate exercise and nutritional management. Even in the absence of psychological negatives, increasing more psychological positives from a positive psychology perspective can be useful for both patients and healthcare professionals. Positive rehabilitation nutrition interventions can increase more psychological positives, such as well-being, through cognitive-behavioral therapy and mindfulness on their own, as well as through interventions on environmental factors. Consequently, physical, cognitive, and social positives are also expected to be enhanced.

Effects of Laughter Therapy on Improving Negative Emotions Associated with Cancer: A Systematic Review and Meta-Analysis

INTRODUCTION

With aging and growth of the population, the risk of cancer incidence and mortality is rapidly increasing. However, psychosocial treatment has been seriously neglected in many healthcare settings. Laughter therapy is a therapeutic program to improve emotional wellbeing and health which has been applied as a complementary treatment. We aim to explore effects of laughter therapy for patients with cancer on their negative emotions such as depression, anxiety, stress, pain, and fatigue.

METHODS

We searched the Cochrane Library, Embase, PubMed, Scopus, Web of Science, WANFANG data, Weipu (VIP), Chinese National Knowledge Infrastructure (CNKI) and independently rated the risk of bias in every article using the Cochrane Collaboration's Risk of Bias Assessment Tool. Review Manager and STATA software were used to pool the individually included studies.

RESULTS

Seven studies were found eligible to be included in the present review. Overall, study quality was relatively high. Our findings suggest that laughter therapy might have a positive effect on improving emotional response in cancer patients. Arguably, laughter therapy, whether humor or laughter, has a positive effect on anxiety, stress, pain feeling, fatigue, and depression in cancer patients.

CONCLUSIONS

Laughter therapy is a convenient, multi-modality, flexible-duration therapy to improve negative emotions in cancer patients, regardless of their gender, age, and type of cancer.

Evaluation of a Study Protocol of the Application of Humor Interventions in Palliative Care Through a First Pilot Study

Background

Humor and laughter might have an alleviating effect on pain threshold and enhance coping and building relationships. However, randomized controlled studies in palliative care have struggled with high percentages of attrition and missing values.

Objectives

We aimed to evaluate a study protocol through a pilot study for the evaluation of a multistage humor intervention with psychological and physiological outcome parameters that may be applied successfully in a palliative care environment.

Design

This pilot study utilized a pre-post design. The inclusion of a control group for the final study setting recruiting 120 patients is planned.

Setting/Subjects

The study was a monocenter study in a clinic for palliative care in Germany. All patients were eligible for recruitment. Seven patients were recruited for the pilot study.

Measurements

Interventions were developed using a humor training for psychiatric patients. Quantitative sensory testing for pain threshold testing and questionnaires on humor as a character trait, pain intensity, life satisfaction, and symptom burden were planned to be evaluated before and after three humor interventions.

Results

The feasibility of the original study design was re-evaluated after pilot testing. Only two out of the seven patients were able to complete two interventions, requiring modification. Fewer questionnaires, less complex physiological testing, and reduction from three to two interventions were then planned.

Conclusion

The initial planned research methodology must be adjusted for patients with high symptom burden. In the experimental group of the final study setting, the effects of one to two interventions will be evaluated measuring oxytocin levels in saliva and using standardized questionnaires to determine cheerfulness, life satisfaction and symptom burden, as well as assessing as-needed medication.

Trial registration

DRKS00028978 German Registry of Clinical Studies.

The effect of laughter yoga applied before simulation training on state anxiety, perceived stress levels, self-confidence and satisfaction in undergraduate nursing students: A pragmatic randomized controlled trial

AIM

This study aimed to examine the effect of laughter yoga applied before simulation training on state anxiety, perceived stress levels, self-confidence and satisfaction in undergraduate nursing students.

BACKGROUND

Clinical simulation-based teaching implied a revolution in nursing education. Along with the many opportunities that simulation offers, some disadvantages, such as anxiety and stress experienced during simulation scenarios, could affect students' satisfaction and self-confidence in learning. Therefore, laughter yoga could be an alternative method that reduces students' anxiety and stress levels and increases their self-confidence and satisfaction with simulation training.

DESIGN

The study was designed as a pragmatic randomized controlled trial.

SETTING

This study was conducted at a university in Turkey.

PARTICIPANTS

A total of 88 undergraduate nursing students were randomized to the intervention group (n = 44) or control group (n = 44).

METHODS

The intervention group participated in the laughter yoga sessions just before the clinical simulation scenario, while the control group only performed the simulation training. The researchers examined the effect of laughter yoga on state anxiety, perceived stress levels, self-confidence and satisfaction in learning before and after the intervention. Data were collected between January - February 2022.

RESULTS

This study showed that the mean scores of state anxiety, perceived stress, mean pulse rate and arterial pressure of the intervention group were significantly lower than those of the control group (p < 0.05). In addition, there was also a significant group*time interaction between the groups on state anxiety, perceived stress, pulse, respiratory and mean arterial pressure scores (p < 0.05). Moreover, the mean scores of student satisfaction and self-confidence in the learning of the intervention group were significantly higher than those of the control group (p < 0.05).

CONCLUSION

The findings showed that laughter yoga helped nursing students reduce their state anxiety and perceived stress levels related to simulation training and improved their self-confidence and satisfaction with learning. Additionally, it enhanced the students' vital signs (including mean pulse rate and mean arterial pressure). These positive results are promising for using LY as an easy, safe and effective method to reduce undergraduate nursing students' stress and anxiety levels and to improve their learning satisfaction and self-confidence levels in clinical skills training such as simulation training.

PROTOCOL: Treatment for depressive disorder among adults: An evidence and gap map of systematic reviews

This is the protocol for a Campbell evidence and gap map. The objective of the map is to map available systematic reviews on the effectiveness of treatments for depressive disorders among adults. Specifically, this EGM includes studies on the effectiveness of treatments across a range of outcome domains.

Determinants of natural adult sleep: An umbrella review

BACKGROUND

Sleep has a major impact on health, which makes it a relevant topic for research and health practitioners. Research on sleep determinants, i.e. factors that positively or negatively influence sleep, is fragmented.

OBJECTIVE

The purpose of this umbrella review is to provide an overview of the current evidence on determinants of natural adult sleep.

METHODS

A comprehensive literature search was performed on determinants of sleep. Reviews and meta-analyses on natural adult sleep were included. Six electronic databases (PubMed, WoS, Embase, CINAHL, PsycInfo and Cochrane) were used for the search, last accessed September 2021. The quality of the selected articles was assessed using the AMSTAR2 tool. Results were categorized in four main categories: biological, behavioral, environmental and personal/socio-economical determinants.

RESULTS

In total 93 reviews and meta-analyses resulted in a total of 30 identified determinants. The impact of each determinant differs per individual and per situation. Each determinant was found to affect different sleep parameters and the relationship with sleep is influenced by both generic and specific moderators.

DISCUSSION

A comprehensive overview on relevant sleep determinants provides a practical and scientifically based starting point to identify relevant intervention approaches to secure or improve individual sleep quality. The difference in aggregation level of the determinants and in measurement methods are the major limitations of this umbrella review. Extending existing generic sleep hygiene rules with an overview of all types of potential determinants will enhance the awareness of the complexity and can be used to improve the effect of sleep interventions in health promotion.

TRIAL REGISTRATION

The umbrella review was registered with PROSPERO (registration ID CRD42020149648) https://www.google.com/search?client=firefox-b-d&q=CRD42020149648.

The effect of laughter yoga on perceived stress, burnout, and life satisfaction in nurses during the pandemic: A randomized controlled trial

BACKGROUND

A randomized controlled study was conducted on the effects of laughter yoga in reducing the perceived stress and burnout levels in nurses during the pandemic and in increasing their life satisfaction.

MATERIALS AND METHODS

The study was conducted with 101 (51 in the experimental group, and 50 in the control group) nurses providing care for patients with COVID-19. A total of eight sessions of laughter yoga were applied to the nurses in the experimental group for four weeks, twice a week. The Introductory Information Form, Perceived Stress Scale, Maslach Burnout Inventory, and Life Satisfaction Scale were used during data collection.

RESULTS

The difference between the pre- and posttest Perceived Stress Scale, Maslach Burnout Inventory, and Life Satisfaction Scale score averages of the nurses in the experimental group were found to be statistically significant (p < 0.05), whereas the difference between the pre- and posttest score averages of the nurses in the control group was not significant (p > 0.05).

CONCLUSION

Laughter yoga is an effective method to reduce perceived stress and burnout while also increasing life satisfaction.

CLINICALTRIALS

GOV ID

NCT05317091.

A Comprehensive Review on the Effects of Humor in Patients With Depression

Depression is a leading cause of disability worldwide and a major contributor to the overall global burden of disease. Although there are known, effective treatments for depression, people in low- and middle-income areas experience multiple barriers which limit their ability to receive adequate treatment. Some known barriers to effective care include a lack of resources, lack of trained healthcare providers, and social stigma associated with mental disorders and this creates gaps in mental health care and the need for more treatment modalities and adjuvant therapies to address these gaps. This review article was conducted using the scale for the assessment of non-systematic review articles (SANRA). We searched three databases; EMBASE, PubMed (MEDLINE), and Google Scholar using specified search terms. We had a total of nine articles with sample sizes ranging from 37 to 1551, and the age of participants ranged from 23 to 93 years. Articles were diverse in race and geographical locations. The articles were derived from cross-sectional studies, randomized studies, and experimental studies, and they focused on the relationship between humor and depression, and the reduced risk of depression in the study population. The articles identified different aspects of the relationship between humor and depression. The willingness of patients with depression to recognize or participate in humor could be defective resulting in abnormal social interactions such as withdrawal. However, there was some significant influence of humor or its styles on patients with depression either mitigating depressive symptoms or having no impact at all.

The Association between Laughter and Functional Dyspepsia in a Young Japanese Population

The potential health benefits of laughter are recognized in relation to several chronic diseases. However, no study has yet investigated the association between laughter and functional dyspepsia (FD). The purpose of this study was to investigate this issue in a young Japanese population.

METHODS

This study was conducted on 8923 Japanese university students. Information on the frequency of laughter and types of laughter-inducing situations, digestive symptoms (Rome III criteria) were obtained through a self-administered, web-based questionnaire.

RESULTS

The percentage of respondents who laughed out loud almost every day was 64.3%. On the other hand, 1.8% of the subjects reported that they rarely laughed. No association was found between the total frequency of laughter and FD. Laughing while talking with family and friends almost every day was significantly inversely associated with FD (adjusted odds ratio (OR): 0.47 (95% confidence interval (CI): 0.28-0.81); p for trend was 0.003). On the other hand, laughing while watching TV or videos and laughing while looking at comics or magazines independently showed a positive correlation with FD (TV or videos: adjusted OR, 1-5 times a week: 1.74 (95% CI: 1.16-2.60); comics or magazines: adjusted OR, 1-5 times a week: 1.78 (95% CI: 1.08-2.81)).

CONCLUSION

In this young Japanese population, no association between laughter frequency and FD was observed although laughing while talking with friends and family was independently and inversely associated with FD.

Sex-Specific Brain Transcriptional Signatures in Human MDD and Their Correlates in Mouse Models of Depression

Major depressive disorder (MDD) is amongst the most devastating psychiatric conditions affecting several millions of people worldwide every year. Despite the importance of this disease and its impact on modern societies, still very little is known about the etiological mechanisms. Treatment strategies have stagnated over the last decades and very little progress has been made to improve the efficiency of current therapeutic approaches. In order to better understand the disease, it is necessary for researchers to use appropriate animal models that reproduce specific aspects of the complex clinical manifestations at the behavioral and molecular levels. Here, we review the current literature describing the use of mouse models to reproduce specific aspects of MDD and anxiety in males and females. We first describe some of the most commonly used mouse models and their capacity to display unique but also shared features relevant to MDD. We then transition toward an integral description, combined with genome-wide transcriptional strategies. The use of these models reveals crucial insights into the molecular programs underlying the expression of stress susceptibility and resilience in a sex-specific fashion. These studies performed on human and mouse tissues establish correlates into the mechanisms mediating the impact of stress and the extent to which different mouse models of chronic stress recapitulate the molecular changes observed in depressed humans. The focus of this review is specifically to highlight the sex differences revealed from different stress paradigms and transcriptional analyses both in human and animal models.

Effects of a laughter program on body weight and mental health among Japanese people with metabolic syndrome risk factors: a randomized controlled trial

Background

While there have been several intervention studies on the psychological effects of laughter, few have examined both the psychological and physical effects. This study investigates the effects of a laughter program on body weight, body mass index (BMI), subjective stress, depression, and health-related quality of life (HRQOL) among Japanese community-dwelling individuals using a randomized controlled trial with a waitlist.

Methods

Overall, 235 participants (37 men and 198 women) aged 43–79 years (mean 66.9, median 67.0) were randomized into laughter intervention and control groups (n = 117 and n = 118, respectively) to participate in a 12-week laughter program. Body weight, subjective stress, subjective well-being, and HRQOL were measured at the baseline, with a 12-week follow-up. The laughter program intervention’s effects on these factors were analyzed using an analysis of covariance adjusted by age, sex, risk factors, medication, and area. Furthermore, Pearson’s correlation and a general linear model analyzed the relationship between participants’ BMI and psychological index changes.

Results

The comprehensive laughter program significantly improved the mean body weight (p = 0.008), BMI (p = 0.006), subjective stress (p = 0.004), subjective well-being (p = 0.002), optimism (p = 0.03), and physical component summary (PCS) scores of HRQOL (p = 0.04). A similar tendency occurred for the mean changes in BMI and subjective stress score by area, sex, and age. Moreover, there was a significant and negative correlation between the change in BMI and PCS change (p = 0.04).

Conclusion

The comprehensive 12-week laughter intervention program, mainly comprising laughter yoga, significantly improved physical and psychological functions such as body weight, BMI, subjective stress, subjective well-being, and HRQOL among predominantly elderly Japanese community-dwelling individuals with metabolic syndrome risk factors. Moreover, PCS improved among participants who reduced BMI after the intervention. These results suggest that the laughter program may help reduce body weight in participants with metabolic syndrome risk factors by reducing stress and improving HRQOL and mental health factors, such as subjective well-being and optimism.

Trial registration

Registered with the University Hospital Medical Information Network Clinical Trials Registry UMIN-CTR000027145 on 27/04/2017.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-022-03038-y.

Humor interventions in psychotherapy and their effect on levels of depression and anxiety in adult clients, a systematic review

INTRODUCTION

Humor as a valuable construct in psychology has been the subject of much discussion for many years and has received increased attention more recently in the field of positive psychology. However, empirical research on the application of humor in a clinical setting with depressed or anxious clients has been difficult to discover. Because of the potential benefits and the low costs of providing humorous interventions, our goal was to give an overview of the studies conducted in psychotherapy and to show the effect of humor on the levels of depression and anxiety symptoms. Furthermore, we wanted to assess the empiric support of humor as a clinical intervention in psychotherapy according to the SIGN system.

METHODS

We used the PRISMA guidelines. Because of the differences in the design of the 10 included studies, it was not possible to perform a meta-analysis.

RESULTS

Results from studies performed in seven different countries show that humorous interventions can have significant positive effects on symptoms of depression and anxiety. The results also confirm the prior observation that empirical research in the field is based on different designs with different populations and different methods of translating the abstract concept of humor into measurable observations. The results need to be considered with caution because of the methodological limitations of the research to date.

DISCUSSION

Some authors advocate for an integrative approach to continue research on humor in psychotherapy. It is our recommendation to first focus on the separate aspects of humor and to conduct research based on sound methodology. To initiate wider research to the application of humor in psychotherapy, we propose an approach to humorous interventions based on surprise and confusion which can help clients to search for an alternative framework to resolve the confusion and therefore promote taking on new perspectives and distancing themselves from the actual problem.

Autobiographical Memory, Gratitude, Forgiveness and Sense of Humor: An Intervention in Older Adults

Research has shown that happiness and well-being play a fundamental role in the health of older adults. For this reason, programs based on Positive Psychology seek to improve quality of life, preventing and reducing the appearance of emotional disorders. The objective of this study was to verify whether an intervention based on Autobiographical Memory, Forgiveness, Gratitude, and Sense of humor would increase quality of life in institutionalized older adults. We used a quasi-experimental design with pre- and post-intervention measures and follow-on measures at 3, 6, and 12 months. A total of 111 institutionalized older adults participated in the study and were randomly assigned to one of three groups: experimental (n = 36), placebo (n = 39), and control (n = 36). Measurements were taken of depression, subjective happiness, satisfaction with life, psychological well-being, and specific memories. Program duration was 11 weeks, followed by refresher sessions of the activities that had been conducted. The results showed that the intervention was effective, producing lasting increase in the participating adults' well-being, maintained for the following 12 months, in contrast to the other two groups. In conclusion, the proposed intervention proved to be a novel tool that was effective, easily applied, and able to improve quality of life and emotional disorders in older adults.

Effectiveness of a Humor-Based Training for Reducing Employees' Distress

An increasing number of studies have demonstrated that humor can impact interpersonal relationships in organizations and employee well-being. However, there is little evidence coming from intervention studies in organizational settings. In response, we developed a training following the principles of positive psychology that aims at improving employees’ adaptive use of humor as a successful mechanism to deal with stress. In this study, we assess the effectiveness of such training and its impact on employee well-being. Results from this one-group intervention study in an emergency ambulance service (N = 58) revealed that the participants reported higher levels of cheerfulness (Z = −3.93; p < 0.001) and lower levels of seriousness (Z = −3.32; p < 0.001) after being exposed to the training. Indeed, the participants reported lower scores on psychological distress after the training (Z = −3.35; p < 0.001). The effect size of the training was medium (r = 0.31 to 0.36), suggesting that interventions to improve adaptive humor at work can be a useful resource to deal with workplace stress and foster employee well-being. These results may have interesting implications for designing and implementing positive interventions as well as for developing healthy organizations.

Laughter therapy: A humor-induced hormonal intervention to reduce stress and anxiety

Prolonged pharmacological interventions have detrimental health consequences by developing drug tolerance or drug resistance, in addition to adverse drug events. The ongoing COVID-19 pandemic-related stress has adversely affected the emotional and mental health aspects around the globe. Consequently, depression is growing during the COVID-19 pandemic. Besides specific pharmacological interventions, which if prolonged have detrimental health consequences, non-pharmacological interventions are needed to minimize the emotional burden related to the COVID-19 pandemic. Laughter therapy is a universal non-pharmacologic approach to reduce stress and anxiety. Therapeutic laughter is a non-invasive, cost-effective, and easily implementable intervention that can be used during this pandemic as a useful supplementary therapy to reduce the mental health burden. Laughter therapy can physiologically lessen the pro-stress factors and increase the mood-elevating anti-stress factors to reduce anxiety and depression. In this ongoing stressful period of the COVID-19 pandemic, keeping necessary social distancing, it is important to create a cheerful environment that will facilitate laughter among the family, neighbor, and community to cope with the stresses of the COVID-19 pandemic.

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Prolonged pharmacological interventions have detrimental health consequences.

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Laughter therapy is a universal non-pharmacologic approach to reduce stress and anxiety.

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Therapeutic laughter is a non-invasive, cost-effective, and easily implementable intervention.

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Laughter therapy can be used during COVID-19 pandemic as a useful supplementary therapy to reduce the mental health burden.

Humour-based interventions for people with schizophrenia

BACKGROUND

Humour-based interventions are defined as any intervention that promotes health and wellness by stimulating a playful discovery, expression, or appreciation of the absurdity or incongruity of life's situations. Humour-based interventions can be implemented in different settings, including hospitals, nursing homes and day care centres. They have been posed as an adjunct to usual care for people with schizophrenia, but a summary of the evidence is lacking.

OBJECTIVES

To examine the effects of humour-based interventions as an add-on intervention to standard care for people with schizophrenia.

SEARCH METHODS

On 31 July 2019 and 10 February 2021 we searched the Cochrane Schizophrenia Group's study-based register of trials, which is based on CENTRAL, CINAHL, ClinicalTrials.Gov, Embase, ISRCTN, MEDLINE, PsycINFO, PubMed, and WHO ICTRP.

SELECTION CRITERIA

We included all randomised controlled trials comparing humour-based interventions with active controls, other psychological interventions, or standard care for people with schizophrenia. We excluded studies fulfilling our prespecified selection criteria but without useable data from further quantitative synthesis.

DATA COLLECTION AND ANALYSIS

Two review authors independently inspected citations, selected studies, extracted data and appraised study quality, following the guidance from the Cochrane Handbook for Systematic Reviews of Interventions. For binary outcomes we calculated risk ratios (RRs) and their 95% confidence intervals (CIs). For continuous outcomes we calculated the mean differences (MDs) and their 95% CIs. We assessed risks of bias for included studies and created summary of findings tables using the GRADE approach.

MAIN RESULTS

We included three studies in this review for qualitative synthesis, although one study did not report any relevant outcomes. We therefore include two studies (n = 96) in our quantitative synthesis. No data were available on the following prespecified primary outcomes: clinically-important change in general mental state, clinically-important change in negative symptoms, clinically-important change in overall quality of life, and adverse effects. As compared with active control, humour-based interventions may not improve the average endpoint score of a general mental state scale (Positive and Negative Syndrome Scale (PANSS) total score: MD -1.70, 95% CI -17.01 to 13.61; 1 study, 30 participants; very low certainty of evidence); positive symptoms (PANSS positive symptom score: MD 0.00, 95% CI -2.58 to 2.58; 1 study, 30 participants; low certainty of evidence), negative symptoms (PANSS negative symptom score: MD -0.70, 95% CI -4.22 to 2.82; 1 study, 30 participants; very low certainty of evidence) and anxiety (State-Trait Anxiety Inventory (STAI): MD -2.60, 95% CI -5.76 to 0.56; 1 study, 30 participants; low certainty of evidence). Due to the small sample size, we remain uncertain about the effect of humour-based interventions on leaving the study early as compared with active control (no event, 1 study, 30 participants; very low certainty of evidence). On the other hand, humour-based interventions may reduce depressive symptoms (Beck Depression Inventory (BDI): MD -6.20, 95% CI -12.08 to -0.32; 1 study, 30 participants; low certainty of evidence). Compared with standard care, humour-based interventions may not improve  depressive symptoms (BDI second edition: MD 0.80, 95% CI -2.64 to 4.24; 1 study, 59 participants; low certainty of evidence). We are uncertain about the effect of humour-based interventions on leaving the study early for any reason compared with standard care (risk ratio 0.38, 95% CI 0.08 to 1.80; 1 study, 66 participants; very low certainty of evidence).

AUTHORS' CONCLUSIONS

We are currently uncertain whether the evidence supports the use of humour-based interventions in people with schizophrenia. Future research with rigorous and transparent methodology investigating clinically important outcomes is warranted.

Effects of laughter therapy on the stress response of married immigrant women in South Korea: A randomized controlled trial

The authors aimed to investigate the effects of a laughter therapy (LT) program on the acculturative stress, anxiety, depression, salivary cortisol, and salivary IgA of married immigrant women in South Korea. A randomized waiting-list control design was utilized. The 19 experimental group participants were given LT twice a week for 2 weeks, whereas the 22 participants in the waiting-list control group received no treatment during the same period but received it afterward. Outcomes were measured right after the completion of the intervention and 2 weeks later. The experimental group showed significantly decreased levels of acculturative stress, anxiety, depression, and salivary cortisol compared to the control group. As for salivary IgA, however, the experimental group showed no statistically significant decrease compared to the control group. An LT program can be a good option for married immigrant women undergoing acculturation experiences in consideration of its effectiveness.

Mind-Body Interventions for Anxiety Disorders: A Review of the Evidence Base for Mental Health Practitioners

Mind-body interventions have gained increasing popularity for use with anxiety symptoms; however, it is unclear what role they play in the treatment of anxiety disorders, such as generalized anxiety disorder, panic disorder, and social anxiety disorder. Although psychopharmacology and psychotherapy treatment interventions are available, mind-body interventions may be low-stigma options that can serve as effective alternatives. The goal of this review is to provide clinicians with an overview of high-quality studies for the most well researched mind-body interventions. This review involved a search of the primary literature, including meta-analyses, systematic reviews, and randomized controlled trials (RCTs), that evaluated mind-body interventions for the treatment of anxiety disorders. When published evidence was limited, lower-quality studies were reviewed. Overall, data were limited on the efficacy of most mind-body modalities for anxiety disorders. The highest-quality data existed for yoga, mindfulness-based interventions, and applied relaxation for anxiety disorders. However, findings were sometimes inconsistent across studies, and some studies were limited by small sample sizes, poorly defined randomization and blinding procedures, and inadequate control groups. Although not enough data exist to recommend mind-body interventions as primary treatment options, they may be considered as part of a larger treatment plan given their relatively low levels of risk. Future steps for researchers include conducting additional RCTs with adequate control groups, comparing mind-body treatments with existing treatments, and examining long-term effects of mind-body interventions.

Effect of laughter yoga on mental symptoms and salivary cortisol levels in first-year nursing students: A randomized controlled trial

BACKGROUND

University students are faced with several stress factors affecting their mental health. Therefore, the first year at university is a period that calls for careful attention and research.

AIM

The aim of this study is to evaluate the effect of laughter yoga on mental symptoms and cortisol levels in nursing students.

METHODS

This study is a randomized controlled study employing a pre-/post-test design with a control group. A total of 75 healthy university students were assigned to the intervention group and control group. The Brief Symptom Inventory was applied to both groups before Session 1 and after Session 8. Saliva samples were taken from the students to measure their cortisol levels before and after each session.

RESULTS

Evaluation of the mean scores obtained from the Brief Symptom Inventory before and after the intervention showed a significant decrease in the scores between groups (P < 0.05). In three out of the eight sessions, there was a significant decrease in the intervention group compared with the control group regarding the mean values of pre-test and post-test salivary cortisol levels (P < 0.05).

CONCLUSION

Laughter yoga can provide an effective means to help first-year nursing students cope with stress and reduce mental symptoms.

Prescribing laughter to ameliorate mental health, sleep, and wellbeing in university students: A protocol for a feasibility study of a randomised controlled trial

Objectives

This research is the first study to investigate the potential effects of a laughter prescription on both psychological health and objective sleep parameters in university students. The primary objective is to evaluate the feasibility of prescribing laughter to inform a larger randomised controlled trial. Secondary objectives are to assess if a two-week laughter prescription improves subjective and objective sleep outcomes, wellbeing, and/or psychological health outcomes.

Trial design

To assess the feasibility of a randomised controlled trial for laughter prescription in relation to sleep, psychological health, and wellbeing. Forty university students will be recruited and randomised to one of two conditions (control/experimental).

Methods

Wrist actigraphy and sleep diaries will be used to estimate sleep outcomes during a one-week baseline testing phase and across the two-week intervention. The experimental group will be shown how to record a Laughie (a 1-min recording of their joyful laughter on their smartphone) and prescribed to laugh with it three times daily for 14 days (the control group will only track sleep). All participants will complete the WHO (Five) Well-being Index, and Hospital Anxiety and Depression Scale pre- and post-intervention. The CONSORT checklist, and the Feasibility, Reach-out, Acceptability, Maintenance, Efficacy, Implementation, and Tailorabilty (FRAME-IT) framework will guide intervention planning and evaluation. Participant interviews will be analysed using Differential Qualitative Analysis (DQA).

Results

The feasibility of a two-week laughter prescription in university students and its impact on sleep, wellbeing, and/or psychological health outcomes will be assessed.

Conclusions

Zayed University Research Ethics Committee approved the study in July 2019. The research will be completed following protocol publication.

Trial registration

ClinicalTrials.gov. ID: NCT04171245. Date of registration: 18 October 2019.

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First study to explore the feasibility of a laughter only prescription for university students.

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First assessment of the impact of laughter on psychological health and objective sleep outcomes.

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A combination of wrist actigraphy and the Laughie enables clear measurements of sleep and laughter.

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Provision of a detailed description of the Laughie and how to use it and prescribe it.

Effect of humour intervention programme on depression, anxiety, subjective well-being, cognitive function and sleep quality in Chinese nursing home residents

AIM

To evaluate the effect of an 8-week humour intervention programme on reducing depression and anxiety and improving subjective well-being, cognitive function and sleep quality in nursing home residents.

DESIGN

A single-blinded and quasi-experimental design with repeated measures.

METHODS

Seventy-four older adults were recruited from May 2018-September 2018, with 37 older adults in the humour group received humour intervention and 37 in the control group received no intervention. The intervention was an 8-week humour intervention programme for older adults to learn to use humour and release their emotions. Primary outcomes include depression, anxiety and subjective well-being and secondary outcomes were cognitive function and sleep quality. Two-way repeated measures ANOVA was used to compare the differences of outcome measures between the two groups. Outcomes were measured at baseline, 8 and 16 weeks.

RESULTS

There was no significant difference between the two groups at baseline. The adherence to the sessions of humour intervention over the 8-weeks was 97.6%. Two-way repeated measures ANOVA revealed significant improvement in depression, anxiety, subjective well-being and sleep quality during the postintervention (8 weeks) and follow-up (16 weeks) periods in the humour group versus the control group. However, a significant time × group interaction for cognitive function was only found during postintervention.

CONCLUSION

The humour intervention programme was effective in reducing depression and anxiety symptoms and increasing subjective well-being, cognitive function and sleep quality in older adults.

IMPACT

Physical and mental health problems are common among older adults in nursing homes. The study demonstrated that humour intervention has feasibility and potential to be used as an effective non-pharmacological intervention in improving well-beings of Chinese nursing home residents.

TRIAL REGISTRATION

ChiCTR1800016148.

The Effects of Laughter Therapy for the Relief of Employment-Stress in Korean Student Nurses by Assessing Psychological Stress Salivary Cortisol and Subjective Happiness

Objectives

Korean student nurses may be exposed to stress caused by their future employment (employment stress). The aim of this study was to investigate the effects of a Laughter Program on psychological stress, by assessing salivary cortisol and the subjective happiness of student nurses in order to relieve employment stress.

Methods

A quasi-experimental, non-equivalent, control-group, and pre-test/post-test was conducted in 4^th year student nurses (n = 48) from 2 universities in Korea at a time when participants’ final exams and job searches were simultaneously occurring. Physiological stress (salivary cortisol), and psychological stress measured using modified Cornell Medical Index questionnaire and the Subjective Happiness Scale were used to determine the effects of the program.

Results

The results of the study showed that the Laughter Program was effective in relieving employment stress and increasing the subjective well-being of student nurses. Psychological stress (p < 0.001), salivary cortisol levels (p < 0.001), and subjective happiness (p < 0.001) were statistically significantly improved after the intervention compared with before the Laughter Program.

Conclusion

This study is an effective evidence-based intervention to reduce student nurses employment stress and improve subjective happiness.

Effectiveness of Integrative Laughter Therapy to Reduce Anxiety, Improve Self-Esteem and Increase Happiness: A Naturalistic Study at a Day Hospital for Addictive Disorders

Little is known about the effectiveness of laughter therapy as an adjunctive treatment for patients with addictive disorders. This study aims to evaluate the benefits of integrative laughter therapy (ILT) on levels of self-esteem, anxiety, and happiness in patients treated for addiction at a day hospital (DH). A prospective, naturalistic study with a pre-post design was conducted. All 185 participants received the standard, multicomponent treatment at the DH (treatment as usual; TAU). The participants were also invited to attend weekly ILT sessions. Upon completion of the 2-month DH treatment program, patients were classified according to their attendance at the ILT sessions: patients who attended ≥80% constituted the experimental group (TAU + ILT group) while those who attended <80% were considered controls. Although both groups achieved statistically significant increases in self-esteem and happiness with a decrease in trait anxiety, the improvement on these variables was significantly greater in the TAU + ILT group. Subject to the limitations inherent to quasi-experimental research, the findings of the present study suggest that the addition of an ILT module to the standard treatment in a DH for addictive disorders may yield greater improvement in self-esteem, anxiety, and happiness compared to TAU.