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

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.

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.

Effectiveness of stress management interventions for nursing students: A systematic review and meta-analysis

Elevated stress levels are related to diminished mental health, potentially leading to decreased well-being and performance of nursing students. While researchers have focused on developing stress management interventions, there is a need to synthesize the evidence. A systematic review with meta-analysis was conducted to assess the evidence for the effectiveness of stress management interventions in nursing students. A systematic literature search identified controlled stress management interventions employing a validated psychological or physiological stress measure. Forty-one studies were included, with 36 forming a pool of 2715 participants in the meta-analysis. The overall effect on psychological stress was positive. Intervention type, delivery modality, intervention duration in weeks, and number of sessions were moderators of intervention effectiveness, with more significant effects for mind-body programs, on-site delivery methods, durations of 9-12 weeks, and 15-30 sessions. For physiological stress, the biomarkers of blood pressure, heart rate, and cortisol levels decreased significantly. Future research is necessary for promising outcomes related to currently underrepresented indicators and to investigate the long-term effects of interventions.

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.

Why Laughing Heals? A Review on the Use of Humor in Therapy

Humor is an important tool for expressing many emotions such as happiness, sadness, anger and surprise. In recent years, the use of humor has started to gain the quality of a therapy approach. The use of humor in therapy helps clients to express meaningless situations or inconsistencies in their lives in a humorous way by making them entertaining. At this point, it is very important for the counselor to be able to understand the purpose of the clients' arrival and their sense of humor depending on this purpose and to make interventions accordingly. Since the concepts of humor therapy and Laughter Therapy / Laughter Yoga are often used interchangeably in the literature, this study synthesizes both therapy approaches and tries to reveal their elements and importance. In this review, it is aimed to examine all aspects of the emergence of the use of humor in therapy, basic concepts, sub-dimensions of humor, counselor-client relationship using humor in therapy, humor therapy process, laughter therapy / laughter yoga process, laughter therapy / laughter yoga techniques, studies on the use of humor in therapy, why humor should or should not be used in therapy. In these respects, this study is expected to contribute to the literature and help fill the existing gaps. In addition, it is predicted that the widespread use of humor therapy and the use of humor therapy in different studies will benefit many clients and experts working in this field.

Laughter as medicine: A systematic review and meta-analysis of interventional studies evaluating the impact of spontaneous laughter on cortisol levels

OBJECTIVES

Laughter as an expression of humor has been recognized as good medicine for centuries. The health benefits of humor-induced well-being remain unclear and thus we conducted a systematic review and meta-analysis of interventional studies to evaluate the impact of spontaneous laughter on stress response as measured by cortisol levels.

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

MEDLINE/PubMed, EMBASE, PsycINFO, Scopus, and Clinicaltrials.gov.

ELIGIBILITY CRITERIA

Interventional studies, which could be either randomized placebo-controlled trials (RCTs) or quasi-experimental studies, conducted in adults that compared any spontaneous laughter intervention to a controlled setting and reported changes in cortisol levels were selected.

DATA EXTRACTION AND SYNTHESIS

We examined the impact of laughter on percentage change in cortisol levels by calculating pooled estimates of the absolute differences between arithmetic means before and after interventions as compared to control using random-effects model.

RESULTS

Eight studies (315 participants; mean age 38.6) met our inclusion criteria; four were RCTs and four were quasi-experiment studies. Five studies evaluated the impact of watching a humor/comedy video, two studies evaluating laughter sessions administered by a trained laughter therapist, and one study evaluating a self-administered laughter program. Pooling these data showed a significant reduction in cortisol levels by 31.9% (95%CI -47.7% to -16.3%) induced by laughter intervention compared to control group with no evidence of publication bias (P = 0.66). Sensitivity analyses demonstrated that even a single laughter session induced a significant reduction of 36.7% in cortisol (95%CI -52.5% to -20.8%). In addition, analyses including the four RCTs reinforced these results by demonstrating a significant reduction in cortisol levels promoted by laughter as compared to the placebo arm [-37.2% (95%CI -56.3% to -18.1%)].

CONCLUSIONS

Current evidence demonstrates that spontaneous laughter is associated with greater reduction in cortisol levels as compared with usual activities, suggesting laughter as a potential adjunctive medical therapy to improve well-being.

TRIAL REGISTRATION

Registration number: CRD42021267972.

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.

The influence of laughter yoga on pregnancy symptoms, mental well-being, and prenatal attachment: A randomized controlled study

The researchers' aim was to evaluate the impact of laughter yoga on pregnancy symptoms, mental well-being, and prenatal attachment. They carried out this study on 85 pregnant women randomized in a maternity hospital in the Eastern Anatolia Region of Turkey. The researchers collected data using the Pregnant Introduction Form, Pregnancy Symptom Inventory (PSI), Warwick-Edinburgh Mental Well-being Scale (WEMWBS), and Prenatal Attachment Inventory (PAI). After applying the laughter yoga practice, they found that mental well-being and prenatal attachment levels were higher in pregnant women in the experimental group and the difference was statistically significant. Thus, they concluded that laughter yoga was an effective practice in reducing the frequency of pregnancy symptoms and limiting daily activities by pregnancy symptoms and increasing mental well-being and prenatal attachment levels.

Psychological stress factors and salivary cortisol in nursing students throughout their training

OBJECTIVE

to analyze psychological stress factors and salivary cortisol concentration in nursing undergraduates throughout their training.

METHOD

a cross-sectional, analytical, and comparative study carried out in an evening course using a sociodemographic questionnaire, an Instrument to Assess Stress in Nursing Students, and salivary cortisol analysis. The study included descriptive and comparative analyses and a multiple linear regression model.

RESULTS

187 participants answered the questionnaires, and 129 had their cortisol quantified. The domains Practical Activities Execution, Professional Communication, and Professional Training represented the stress factors with the highest mean values for 3rd, 4th, and 5th-year students compared to 1st and 2nd year. For the 5th year, it was the domains Professional Communication and Professional Training compared to the 3rd year and Environment compared to the 1st and 3rd year. A significant result was obtained between the times of cortisol collections for males (p < 0.0001), females (p < 0.0001), and for 1st (p = 0.0319) 2nd (p = 0.0245), and 5th (p < 0.0001) years.

CONCLUSION

Students in years 3 through 5 had higher exposure to stressors, and there were adjustments in cortisol production rhythmicity for students in years 1, 2, and 5.

The impact of national music activities on improving long-term care for happiness of elderly people

This paper aims to analyze the influence of national music activities on the long-term care for and happiness of elderly people in the current aging society. Under the popular square dance movement of the whole society, a questionnaire survey was conducted to investigate the differences in the silver-haired body self-esteem and the happiness of the silver-haired exercisers with different exercise methods. Forty first-time square dance participants were selected as experimental objects, and they were divided into an experimental group (ethnic music square dance) and a control group (ordinary music square dance), with 20 people in each group. The results showed that the effective recovery rate of the questionnaire was 95.10% (136/150). There were 47, 45, and 44 people in the square dance, other sports, and non-sport groups, respectively. The total scores of physical self-esteem, physical self-worth, physical quality, health worry, satisfaction and interest in life, control of emotion and behavior, and happiness of silver-haired people who participated in square dance activities were higher than those of other sports players (p < 0.05). The total scores of physical self-esteem, exercise ability, physical condition, and physical quality scores were significantly higher than those of non-sports people (p < 0.01), and each factor and total score on the happiness were higher than those of non-sports people (p < 0.05). The body weight, waist circumference, hip circumference, and thigh circumference of the experimental group after exercise were significantly different from those before exercise (p < 0.01), and the factors of the body self-esteem scale and well-being scale were higher than those before the experiment (p < 0.05). This shows that music has a positive effect on the long-term care for and happiness improvement of the silver-haired family, which can improve the physical and mental health of the silver-haired family and further improve the quality of life of the silver-haired family in their later years. This offers a theoretical basis for the development of the elderly folk music square dance movement in the future and provides a reference for the formulation of silver-haired patriarchal photos and happiness intervention programs.

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.

Fatores de estresse psicológico e cortisol salivar em alunos de enfermagem ao longo da formação

RESUMO Objetivo: analisar os fatores de estresse psicológico e a concentração de cortisol salivar de graduandos de Enfermagem ao longo da formação. Método: estudo transversal, analítico e comparativo realizado em curso noturno por meio de questionário sociodemográfico, Instrumento para Avaliação de Estresse em Estudantes de Enfermagem e análise do cortisol salivar. Foram feitas análises descritivas, comparativas e modelo de regressão linear múltipla. Resultados: um total de 187 responderam aos questionários, e 129 tiveram o cortisol quantificado. Os domínios Realização das Atividades Práticas, Comunicação Profissional e Formação Profissional representaram os fatores de estresse com os maiores valores médios para alunos do 3º, 4º e 5º anos em comparação ao 1º e 2º anos. Para o 5º ano, foram os domínios Comunicação Profissional e Formação Profissional em relação ao 3º ano e Ambiente em comparação ao 1º e 3º anos. Obteve-se resultado significativo entre os horários das coletas de cortisol para homens (p < 0,0001), mulheres (p < 0,0001) e para o 1º (p = 0,0319) 2º (p = 0,0245) e 5º (p < 0,0001) anos. Conclusão alunos do 3º ao 5º ano tiveram maior exposição aos fatores de estresse, e houve ajustes na ritmicidade de produção do cortisol para alunos do 1º, 2º e 5º anos.

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.

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.

Physical relaxation for occupational stress in healthcare workers: A systematic review and network meta-analysis of randomized controlled trials

OBJECTIVES

Work related stress is a major occupational health problem that is associated with adverse effects on physical and mental health. Healthcare workers are particularly vulnerable in the era of COVID-19. Physical methods of stress relief such as yoga and massage therapy may reduce occupational stress. The objective of this systematic review and network meta-analysis is to determine the effects of yoga, massage therapy, progressive muscle relaxation, and stretching on alleviating stress and improving physical and mental health in healthcare workers.

METHODS

Databases were searched for randomized controlled trials on the use of physical relaxation methods for occupational stress in healthcare workers with any duration of follow-up. Meta-analysis was performed for standard mean differences in stress measures from baseline between subjects undergoing relaxation vs non-intervention controls. Network meta-analysis was conducted to determine the best relaxation method.

RESULTS

Fifteen trials representing 688 healthcare workers were identified. Random-effects meta-analysis shows that physical relaxation methods overall reduced measures of occupational stress at the longest duration of follow-up vs baseline compared to non-intervention controls (SMD -0.53; 95% CI [-0.74 to -0.33]; p < .00001). On network meta-analysis, only yoga alone (SMD -0.71; 95% CI [-1.01 to -0.41]) and massage therapy alone (SMD -0.43; 95% CI [-0.72 to -0.14]) were more effective than control, with yoga identified as the best method (p-score = .89).

CONCLUSION

Physical relaxation may help reduce occupational stress in healthcare workers. Yoga is particularly effective and offers the convenience of online delivery. Employers should consider implementing these methods into workplace wellness programs.