Effect of Laughter Therapy on Depression and Quality of Life of the Elderly Living in Nursing Homes

The effect of laughter therapy on self-efficacy and psychological well-being in nursing students

BACKGROUND

Academic self-efficacy and psychological well-being play a crucial role in the mental health of nursing students and influence whether they decide to remain in the nursing profession.

AIMS

This study aimed to determine the effect of laughter therapy on self-efficacy and psychological well-being in nursing students.

METHODS

In this randomized controlled study, 208 nursing students were randomly assigned to an experimental (n = 102) and a control (n = 106) group. The experimental group received laughter therapy face-to-face once a week for eight weeks. No intervention was applied to the control group. In both groups, data were collected at the beginning of the study and the end of the eighth week using a Sociodemographic Questionnaire Form, the Academic Self-Efficacy Scale, and the Psychological Well-Being Scale.

RESULTS

In the post-study group comparisons, there was a statistically significant difference in the scores for the total Academic Self-Efficacy Scale, the external emotion management and collegiality subscales, and the total Psychological Well-Being Scale (p > 0.05). With regard to all the scale scores, no statistically significant difference was found in the groups in the pre- and post-comparisons (p > 0.05).

CONCLUSIONS

It was determined that laughter therapy increased the mean psychological well-being score in the experimental group. It was also found that after the laughter therapy, distraction and loss of interest in lectures decreased, stress and anxiety levels decreased, eating and sleeping habits were regulated, and social media use decreased. Laughter therapy can be used to increase self-efficacy and psychological well-being.

Effect of laughter exercise versus 0.1% sodium hyaluronic acid on ocular surface discomfort in dry eye disease: non-inferiority randomised controlled trial

OBJECTIVE

To assess efficacy and safety of laughter exercise in patients with symptomatic dry eye disease.

DESIGN

Non-inferiority randomised controlled trial.

SETTING

Recruitment was from clinics and community and the trial took place at Zhongshan Ophthalmic Center, Sun Yat-sen University, the largest ophthalmic centre in China, between 18 June 2020 to 8 January 2021.

PARTICIPANTS

People with symptomatic dry eye disease aged 18-45 years with ocular surface disease index scores ranging from 18 to 80 and tear film break-up time of eight seconds or less.

INTERVENTIONS

Participants were randomised 1:1 to receive laughter exercise or artificial tears (0.1% sodium hyaluronic acid eyedrop, control group) four times daily for eight weeks. The laughter exercise group viewed an instructional video and participants were requested to vocalise the phrases "Hee hee hee, hah hah hah, cheese cheese cheese, cheek cheek cheek, hah hah hah hah hah hah" 30 times per five minute session. Investigators assessing study outcomes were masked to group assignment but participants were unmasked for practical reasons.

MAIN OUTCOME MEASURES

The primary outcome was the mean change in the ocular surface disease index (0-100, higher scores indicating worse ocular surface discomfort) from baseline to eight weeks in the per protocol population. The non-inferiority margin was 6 points of this index score. Main secondary outcomes included the proportion of patients with a decrease from baseline in ocular surface disease index score of at least 10 points and changes in dry eye disease signs, for example, non-invasive tear break up time at eight weeks.

RESULTS

299 participants (mean age 28.9 years; 74% female) were randomly assigned to receive laughter exercise (n=149) or 0.1% sodium hyaluronic acid (n=150). 283 (95%) completed the trial. The mean change in ocular surface disease index score at eight weeks was -10.5 points (95% confidence interval (CI) -13.1 to -7.82) in the laughter exercise group and -8.83 (-11.7 to -6.02) in the control group. The upper boundary of the CI for difference in change between groups was lower than the non-inferiority margin (mean difference -1.45 points (95% CI -5.08 to 2.19); P=0.43), supporting non-inferiority. Among secondary outcomes, the laughter exercise was better in improving non-invasive tear break up time (mean difference 2.30 seconds (95% CI 1.30 to 3.30), P<0.001); other secondary outcomes showed no significant difference. No adverse events were noted in either study group.

CONCLUSIONS

The laughter exercise was non-inferior to 0.1% sodium hyaluronic acid in relieving subjective symptoms in patients with dry eye disease with limited corneal staining over eight weeks intervention.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04421300.

The Effect of Laughter Yoga Applied to Intensive Care Nurses on Their Perceived Stress, Job Motivation, and Mental Well-being: Randomized Controlled Study

AIM

The aim of this study was to examine the effect of laughter yoga applied to intensive care nurses on perceived stress, job motivation, and mental well-being.

DESIGN

This study was a randomized controlled trial.

METHODS

The study was conducted with nurses working at the university hospital's surgical intensive care and anesthesia intensive care units of the third-level intensive care unit in Turkey. Data obtained from 30 participants in the intervention group and 33 participants in the control group were analyzed. The Nurse Introduction Form, Nurse Job Motivation Scale, Perceived Stress Scale, and Warwick-Edinburgh Mental Well-being Scale were used to collect data. Data obtained from the study were evaluated using the SPSS 22.0 package.

RESULTS

It was determined that there was no statistically significant difference in the average scores of the pretest/posttest 1/posttest 2 of the Perceived Stress Scale (13.70 ± 3.33 to 14.57 ± 4.57, P > .05; 13.50 ± 3.15 to 13.48 ± 4.59, P > .05; and 13.56 ± 3.15 to 13.15 ± 3.49, P > .05, respectively) and Work Motivation Scale (59.70 ± 7.58 to 59.69 ± 7.98, P > .05; 60.30 ± 8.07 to 58.48 ± 8.94, P > .05; and 60.56 ± 7.86 to 57.93 ± 9.54, P > .05, respectively) for both the intervention and control groups of nurses. A statistically significant difference was found in the average scores of the Warwick-Edinburgh Mental Well-Being Scale pretest/posttest 1/posttest 2 for the intervention group of nurses (50.90 ± 7.60, 51.50 ± 7.80, and 53.70 ± 7.08, respectively; F = 3.330, P = .043). However, the difference was found to be insignificant in pairwise comparisons in the further analysis (a = b = c). It was determined that there was no statistically significant difference in the average scores of the Warwick-Edinburgh Mental Well-Being Scale pretest/posttest 1/posttest 2 for the control group of nurses (52.21 ± 9.89, 51.93 ± 10.45, and 51.03 ± 9.63, respectively; P > .05).

CONCLUSIONS

The application of laughter yoga on intensive care nurses did not result in a significant change in perceived stress levels and work motivation. However, statistically significant differences were observed in the average mental well-being scores among the intervention group.

Impact of Laughter Yoga on Test Anxiety and Education Stress of 8th Grade Students: An Experimental Study

Objective: In an exam-based education system, it is of utmost importance to identify levels of test anxiety and educational stress that directly affect success, and to reduce anxiety. A study was conducted to examine the effects of laughter yoga on test anxiety and educational stress in 8th grade students in Turkey. Methods: A cluster sampling, parallel-group randomized controlled trial with pre-test/post-test design studied 64 students (32 in the intervention group and 32 in the control group). The intervention group received laughter yoga sessions twice a week for 6 weeks. The control group received no intervention. Data were collected by a demographic questionnaire, the Westside Test Anxiety Scale, and the Educational Stress Scale. Results: After laughter yoga, the intervention group showed a significant decrease in test anxiety (d = 0.859; p < 0.005) and educational stress scores (d = 0.52875; p < 0.001) compared to the control group. Conclusion: Laughter yoga was associated with decreased test anxiety and educational stress. Laughter yoga activities in schools are recommended to decrease educational stress and test anxiety of students.

The Effect of Laughter Therapy on Perceived Stress and Quality of Life in Persons with Schizophrenia: A Mixed Method Pilot Study

This study was planned to examine the effects of laughter therapy on the perceived stress and quality of life level of persons with schizophrenia and their views on laughter therapy. This study is a mixed-methods pilot study conducted using a quasi-experimental design based on the pretest-posttest model. Of the participants 68% (n = 17) were male, 92% (n = 23) were single, 56% (14) were high school graduates, 60% (n = 15) were unemployed, 60% (n = 15) lived with their parents, 88% (22) had been receiving treatment for schizophrenia for more than 10 years. The difference between the pretest and post-test means was not found to be significant in participants' perceived stress (p > 0.05), and the difference between the pretest and post-test means of the Schizophrenia Quality of Life Scale's Interpersonal Relations, Instrumental Role, and Intrapsychicv (mental findings) subscales was found to be statistically significant (p < 0.05). The main themes of laughter therapy among persons with schizophrenia in the focus group interviews were found to be optimism, coping, health, sociability, motivation, awareness, and functionality. Laughter therapy was found to increase the quality of life of persons with schizophrenia, not affect perceived stress, and positively affect optimism, coping, health, sociability, motivation, awareness, and functionality levels. The researchers recommend using laughter therapy to improve the quality of life of people with schizophrenia during their rehabilitation.

The impact of humor therapy on people suffering from depression or anxiety: An integrative literature review

OBJECTIVES

To identify and synthesize existing research on the effectiveness and feasibility of multiform humor therapy on people suffering from depression or anxiety, with the hope of benefiting future research.

METHODS

An integrative literature review of quantitative, qualitative, and mixed studies was performed. The PubMed, Cochrane Library, Web of Science, Embase, and CINAHL databases were searched up to March 2022. Two independent reviewers conducted each stage of the review process, by assessing eligibility using preferred reporting items for systematic review and meta-analyses (PRISMA) and quality appraisal using the Mixed Methods Appraisal Tool, and data extraction.

RESULTS

In this integrative review, 29 papers were included, containing 2964 participants across a diverse range of studies, including quantitative, qualitative, and mixed methods. The articles were from the United States, Australia, Italy, Turkey, South Korea, Iran, Israel, China, and Germany. The findings indicated that most of the subjects thought humor therapy was effective in improving depression and anxiety while a few participants considered the effect insignificant. However, more high-quality studies will be needed to confirm these conclusions.

DISCUSSION

This review collated and summarized findings from studies examining the impact of humor therapy (medical clowns, laughter therapy/yoga) on people with depression or anxiety, including children undergoing surgery or anesthesia, older people in nursing homes, patients with Parkinson's disease, cancer, mental illness, and undergoing dialysis, retired women, and college students. The results from this review may help inform future research, policy, and practice in humor therapy to improve people's symptoms of depression and anxiety.

IMPACT

This systematic review objectively evaluated the effect of humor therapy on depression and anxiety. As a simple and feasible complementary alternative therapy, humor therapy may provide a favorable alternative for clinicians, nurses, and patients in the future.

Intervention and application of clown care in nursing homes: a scoping review

BACKGROUND

The purpose of this scoping review was to organize and describe the literature on the application of clown care to the elderly population in nursing homes, including intervention time, intervention methods and intervention effects, so as to provide reference ideas for other scholars to explore clown care programs suitable for the elderly population in nursing homes.

METHODS

Employing Arksey and O'Malley's methodology, we searched for PubMed, Web of Science, Embase, Cochrane, CNKI, WanFang, VIP, and CBM systematically and thoroughly, and the search period was from the establishment of each database to December 12, 2022. Two researchers with evidence-based learning experience independently conducted literature retrieval, information extraction, and cross-checking in strict accordance with the inclusion and exclusion criteria. The review process is reported according to PRISMA.

RESULTS

148 literature were initially obtained after searching, of which 18 were finally included. Among them, 17 were in English and 1 was in Chinese. There are 16 quantitative studies and 2 qualitative studies published from 2010 to 2022. It is found that the current clown care intervention program has not established a unified intervention standard and effective evaluation program.

CONCLUSIONS

The results of this scoping review conclude that clown care played a significant role in the nursing home. At first, it can reduce negative emotions, cognitive impairments and physical pain among older adults. In addition, it can improve their quality of life, life satisfaction, etc. It is suggested to learn from the advanced experience of clown care in foreign countries and carry out more clown care among the elderly population in nursing homes in China.

The effect of laughter yoga on loneliness, psychological resilience, and quality of life in older adults: A pilot randomized controlled trial

This study aims to examine how laughter yoga affects the loneliness, psychological resilience, and quality of life of older adults living in a nursing home. The sample of this intervention study, made using a control group with a pretest/posttest design, consists of 65 older adults living in Turkey. The data were collected in September 2022 using the Personal Information Form, the Loneliness Scale for the Elderly, the Brief Psychological Resilience Scale, and the Quality of Life Scale for the Elderly. The intervention group (n=32) took part in laughter yoga twice a week for four weeks. No intervention was made with the control group (n=33). A statistically significant difference was found between the groups' mean post-test scores for loneliness, psychological resilience, and quality of life (p < 0.05) after the laughter yoga sessions. The eight-session laughter yoga program was found to reduce loneliness and increase resilience and quality of life in older adults.

Effects of Integrative Cognitive Function Improvement Program on Cognitive Function, Oral Health, and Mental Health in Older People: A Randomized Clinical Trial

We aimed to investigate the effects of an integrative cognitive function improvement program that combined existing cognitive, emotional, and physical therapies on cognitive function, oral health, and mental health in elder participants. Participants were classified into one of the following groups: cognitively normal (CN; n = 18), mild cognitive impairment (MCI; n = 17), and control (n = 17). An integrative cognitive function improvement program was administered to the CN and MCI groups for six weeks. To measure cognitive function, electroencephalogram (EEG) and cerebral blood flow (CBF) were evaluated, and to measure oral health, the O'Leary index, Löe & Silness index, tongue coating, unstimulated saliva flow rate, and oral muscle strength were measured. To measure mental health status, mental health, happiness and social support were measured. The CN and MCI groups showed a significant change in EEG-based indices for awareness level and physical stress. Regarding oral health, the O'Leary and the Löe & Silness index score decreased significantly in the CN and MCI groups. Saliva flow rate increased significantly in the CN and MCI groups. In regards to mental health, the happiness score increased post-intervention in the CN and MCI groups. In conclusion, the integrative cognitive function improvement program was effective in improving cognitive function, oral health, and mental health of elder people.

The effect of laughter therapy on nursing students' anxiety, satisfaction with life, and psychological well-being during the COVID-19 pandemic: Randomized controlled study

Background

Changes in routine due to the pandemic have increased nursing students' anxiety about clinical learning. The inadequacy experienced before graduation caused them to experience high levels of anxiety characterized by feelings of insecurity and unhappiness and negatively affected their life satisfaction. Methodological studies are needed to confirm the efficacy of laughter therapy, which is effective in reducing anxiety and stress, on the online platform. The current study protocol was designed to evaluate the effect of online laughter therapy on anxiety, life satisfaction, and psychological well-being.

Methods

Forty students were selected for the intervention group and forty students for the control group by assigning 1:1 with a real random number selector among 140 senior nursing students who made up the universe. The intervention group received ten sessions of online laughter therapy two days a week for five weeks. Participants in the control group did not receive any intervention during the study. Data were obtained at the beginning of the study and after five weeks with the 'State-Trait Anxiety Inventory', 'Satisfaction with Life Scale' and 'Psychological Well-Being Scale'.

Results

After laughter therapy, the intervention result showed a significant increase in life satisfaction and psychological well-being scores (p < 0.001) and a significant decrease in anxiety scores (p < 0.001) in the intervention group compared to the control group.

Conclusion

The study reveals that online laughter therapy significantly positively affects nursing students' anxiety, life satisfaction, and psychological well-being.

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.

Effectiveness of progressive muscle relaxation and laughter therapy on mental health and treatment outcomes in women undergoing in vitro fertilization: A randomized controlled trial

A majority of infertile women experience emotional problems, such as anxiety and depression. Nurses need nonpharmacological methods rather than drugs to address women's emotional distress during the in vitro fertilization (IVF) process. The purpose of this study was to examine the effect of progressive muscle relaxation exercises and laughter therapy on the mental health and treatment outcomes of women receiving IVF treatment. This parallel-group, randomized controlled trial was conducted in a private IVF center. Participants were randomly assigned to the intervention group (IG; n = 71) and control group (CG; n = 70). The IG received progressive muscle relaxation and laughter therapy for 40 min in each session for 3-4 sessions, whereas the CG received routine care. Data were obtained from the patient information form, State-Trait Anxiety Inventory, Beck Depression Inventory, and medical records. The questionnaire was completed at recruitment (T1) and oocyte pick-up day (T2). In the evaluation performed on the day of the oocyte pick-up, depression and trait anxiety scores of the IG were found to be lower than those in the CG, and the effect size was small. Group × time interaction was significant for depression (large effect size) and trait anxiety (small effect size). The estradiol levels, the number of oocytes, transfer status, and pregnancy rates (according to a blood test) were similar between groups. Women receiving IVF treatment who received progressive muscle relaxation and laughter therapy demonstrated psychological changes; however, the treatment did not affect medical outcomes.