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.

Effects of Laughter Yoga on Premenstrual Symptoms.

Context: Premenstrual syndrome (PMS) is associated with a group of emotional, behavioral, and somatic symptoms that occur during the menstrual cycle. Laughter yoga involves a combination of laughter exercises and breathing techniques derived from more traditional yoga practice. No previous studies have examined the effects of laughter yoga on the symptoms of PMS. Objective: The study intended to assess the effectiveness of laughter yoga in coping with the premenstrual symptoms of women. Design: The research team performed a pretest and posttest, quasi-experimental study. Setting: The study took place in the nursing and midwifery departments at Marmara University, a state university located in Istanbul, Turkey. Participants: Participants were 80 female students in those departments at the university between February 2019 and May 2020 who had PMS. Intervention: The research team divided participants into two groups based on their departments: (1) an intervention group, the laughter yoga group, with 32 participants who took part in a twice-weekly laughter yoga program that included a weekly 30-min group session consisting of laughter and deep breathing, and (2) a control group with 48 participants. Outcome Measures: The research team collected the data using the Demographic and Descriptive Information Form (DDIF), Premenstrual Syndrome Symptom Scale (PMSS), and Visual Analogue Scale (VAS). Results: Between baseline and postintervention, the laughter yoga group's mean scores for the PMSS subdimensions depressive affection (P = .00), anxiety (P = .04), fatigue (P = .00), irritability (P = .01), depressive thoughts (P = .03), pain (P = .002), changes in sleep (P = .004), and bloating (P = .001) significantly decreased. The laughter yoga group's scores for fatigue (P = .03) and pain (P = .001) were significantly lower than those of the control group postintervention. Conclusions: Laughter yoga is a noninvasive complementary therapy that clinicians can use to reduce the PMS symptoms.

Effects of Laughter Yoga on Patients Receiving Hemodialysis: A Systematic Review.

When it comes to end-stage renal disease patients, hemodialysing is one of the most critical treatments they can receive. Even if they received hemodialysis (HD) treatment regularly, patients would experience many complications such as cardiovascular disease, fatigue, anxiety, depression, sleep disturbances, and a declining quality of life. Laughter Yoga has been reported to have many positive effects on patients with chronic illnesses. By removing or reducing stress, Laughter Yoga (LY) helps to improve patients' quality of life, Thus, they have a longer chance of survival. However, the effect of Laughter Yoga on HD patients is generally inconclusive. Objective is to evaluate LY's impact on HD patients. We searched electronic databases that included Web of Science, Embase, PubMed, the Cochrane Library, Wanfang, China National Knowledge Infrastructure, and clinical trial registries. The search period was from their inception to January 29, 2023. The search keywords included laughter therapy, laughter yoga, laugh, hemodialysis, dialysis, and renal dialysis. The systematic review included both randomized controlled trials (RCTs) and quasi-experiments studies. Three RCTs and three non-RCTs met the inclusion criteria. Laughter Yoga showed patients having improvement in several outcomes such as life quality, pain severity, sleep quality, subjective well-being, mood, depression, blood pressure, and vital capacity. A well-designed RCT will be developed to further test the potential benefits of LY for HD patients.

The Effect of Laughter Yoga on the Psychological Resilience and Sleep Quality of Nurses During the Pandemic: A Randomized Controlled Trial.

Background: During the COVID-19 pandemic, nurses frequently experienced psychological health problems such as anxiety, depression, insomnia, and stress. These problems have reduced the psychological health of nurses. Primary Objective: This study aims to reveal the effect of laughter yoga on the psychological resilience and sleep quality of nurses during the COVID-19 pandemic. Design: This randomized controlled trial study was carried out using an experimental research design with pre- and post-tests, including a control group. Setting: This study was conducted on nurses working in a hospital in Erzurum, located in the northeastern part of Turkey. Participants: The study involved 90 nurses, including 46 in the experimental group and 44 in the control group, between October and December 2021. Intervention: As an intervention, laughter yoga sessions were held online on Zoom for nurses in the experimental group. The experimental group was divided into three groups of 17, 17, and 16 individuals. Eight sessions of laughter yoga (two days a week for four weeks) were offered to nurses in the experimental group. Primary Outcome Measures: The Introductory Question Form, Connor-Davidson Resilience Scale, and Pittsburgh Sleep Quality Index were used for data collection. Results: Laughter yoga significantly improved the resilience levels and sleep quality of the experimental group (P < .05). Conclusion: Laughter yoga can be used to improve the resilience and sleep quality of nurses.

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.

Effect of Laughter Yoga on Sleep and Quality of Life in Individuals With Fecal Ostomies: A Randomized Controlled Trial.

PURPOSE: The aim of this study was to evaluate the effect of laughter yoga on the quality of life and sleep quality in individuals with fecal ostomies. DESIGN: This was randomized controlled trial. SUBJECTS AND SETTING: The sample comprised 55 individuals with an ostomy who received care at Ankara University's I˙bni Sina Hospital Stoma Therapy Unit in Ankara, Turkey. Data were collected over a 2-month period (January and February 2020). METHODS: Participants were allocated into an intervention group (n = 27) who received a yoga therapy intervention and a control group (n = 28) who received no intervention via simple randomization. Demographic and pertinent clinical variables were obtained during a baseline visit in both groups, along with the Pittsburgh Sleep Quality Index (PSQI) and Stoma-Quality of Life (Stoma-QOL) instruments. The intervention group received laughter yoga weekly over a period of 8 weeks. RESULTS: Mean scores on the PSQI and the Stoma-QOL at baseline were compared. Participants in the intervention had a significant decline in mean PSQI scores (6.85 vs 5.48, P = .044) indicating improvement in sleep quality following the intervention. Analysis revealed no significant difference in mean Stoma-QOL scores (P = .077). Control group participants had no significant difference in either mean PSQI or Stoma-QOL scores following data collection at the end of 8 weeks. CONCLUSIONS: Laughter yoga had a positive effect on the sleep quality in individuals with fecal ostomies. Further research is recommended to evaluate the effect of the number of laughter yoga sessions on the sleep quality and quality of life in individuals with ostomies.

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.

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 effect of medical/therapeutic clowns on the playfulness of children with intellectual disabilities.

BACKGROUND: Play is an essential component of children's development. Children with intellectual disability tend to have poor socioemotional abilities and impaired play. This study examined the effects of a medical/therapeutic clowning play intervention on the playfulness of children with intellectual disability. METHOD: Two medical clowns facilitated a play intervention in a preschool classroom setting with a total of 52 children with intellectual disability. We compared before and after two groups that received the intervention: group 1 met the medical clowns once a week for 6 months (long-intervention group) and group 2 for 3 months (short intervention group). Children's functioning was assessed using the Vineland Adaptive Behaviour Scales. Children's playfulness was scored using the Test of Playfulness observational assessment. A teachers' focus- group was used to gather additional information on the clowns' work. RESULTS: Children's playfulness increased significantly at the end of the intervention, whereas the improvement in the playfulness scores of group 1 was significantly larger than those of group 2 (t50  = -4.82, p < .001). The teachers' focus group revealed additional benefits of the medical clowns' work. CONCLUSION: The results shed light on the play and playfulness of children with intellectual disability and the possible contribution of a clowning play intervention to their development.

The Effect of Medical Clowns on Blood Pressure Measurement in Children Presenting to the Emergency Department.

BACKGROUND: Blood pressure (BP) is routinely measured while triaging children presenting to the pediatric emergency department (PED). OBJECTIVES: To determine whether a medical clown shortens the time to acquire a BP measurement among children undergoing triage in the PED. METHODS: The study comprised 133 children. Patients were assigned to one of two groups: with a medical clown or without a medical clown. RESULTS: The presence of a medical clown led to a significantly shorter time to acquire a blood pressure measurement (60 ± 23 seconds vs. 81 ± 43.5 seconds, P < 0.001. Clowns had a significant effect on shortening total triage length among children of Jewish ethnicity compared to Arab ethnicity (113 ± 353.6 seconds vs. 154 ± 418 seconds, P = 0.012). CONCLUSIONS: Using medical clowns while measuring BP during triage when used in a culturally appropriate manner shortens time.

The effect of online laughter therapy on depression, anxiety, stress, and loneliness among nursing students during the Covid-19 pandemic.

BACKGROUND: Nursing students experienced mental symptoms when they switched to distance education due to the pandemic. AIMS: This study was conducted to evaluate the effects of online laughter therapy sessions on depression, anxiety, stress, and loneliness levels in first-year nursing students. METHODS: In this randomized controlled trial, 61 healthy nursing students were randomly assigned to intervention (n = 32) and control groups (n = 29). The intervention group received online laughter therapy twice weekly for four weeks. The control group received no intervention. The data were collected using a demographic questionnaire, the Depression Anxiety Stress Scale, and the De Jong Gierveld Loneliness Scale at the study initiation and week four in both groups. RESULTS: There was no difference between the mean scores of the groups in the pre-test (p > 0.05). There was a statistically significant difference between groups in terms of depression after online laughter therapy sessions (p < 0.05), but there was no significant difference between anxiety, stress, and loneliness levels (p > 0.05). CONCLUSIONS: Online laughter therapy sessions significantly reduced depression but had no effect on anxiety, stress, and loneliness. During the COVID-19 pandemic, online laughter therapy can be organized to reduce depression levels.

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.

The impact of laughter yoga on depression and anxiety among retired women: a randomized controlled clinical trial.

Recently, laughter yoga (LY) has been introduced for managing depression and anxiety. This study aimed to investigate the impact of LY on depression and anxiety among retired women in city of Bojnurd, Iran, 2018. Sixty-six retired women were randomly assigned to intervention and control groups. Intervention group received LY twice weekly for 8 weeks; control group had their routine daily activities. Depression and anxiety levels were measured at study initiation, week 4, and week 8 in both groups. Results showed significant difference in the pattern of depression (p <.001) and anxiety (p <.001) scores within and between groups. LY could be an effective intervention in reducing depression and anxiety among retired women.

Laughter yoga reduces the cortisol response to acute stress in healthy individuals.

Stress is one of the foremost contributors to the development of psychiatric diseases. Since the prevalence of stress-related complaints is increasing, we are in need for affordable and effective treatment alternatives. Laughter yoga (LY), a popular method encouraging participants to simulate laughter and participate in yogic breathing exercises, is hypothesized to buffer negative effects of stress. Although widely practiced, empirical evidence for beneficial effects of LY is scarce. We investigated the acute effects of a single 30-min LY session on the autonomic, endocrine and psychological response to a standardized psychosocial stressor. Thirty-five healthy subjects (51% female) were randomly assigned to experience either a LY (n = 11), a relaxation breathing (n = 12) or a (non-intervention) control (n = 12) session prior to their exposure to the Trier Social Stress Test for Groups (TSST-G). Salivary cortisol, salivary alpha amylase, and subjective stress were assessed repeatedly throughout the experiment. We expected that LY and relaxation breathing group each show a downregulation of stress response indices compared to the control group. Further, we expected that LY has beneficial effects compared to relaxation breathing. The groups did not differ in salivary cortisol, alpha amylase or subjective stress reactivity during the 30-min intervention. However, in response to the TSST-G, the LY, but neither the relaxation breathing, nor the control condition, showed an attenuated cortisol stress response. These findings highlight the potential of LY to buffer the endocrine stress response. Therefore, LY could be used as a cheap and easily-to-implement add-on to more traditional stress interventions. LAY SUMMARY In recent years, more and more people have reported to feel stressed. Although our body is well equipped to deal with acute stress, chronic stress can tire our system and contribute to illness in the long run. Therefore, we need affordable and effective measures to reduce stress. In this study we have investigated whether a single laughter yoga session can help us to deal with acute stress. Although laughter yoga did not change how stressful a situation was perceived, it reduced the amount of stress hormones that were released in response to the situation. As such, laughter yoga might be a cheap and easily-to-implement add-on to more traditional stress reduction interventions.

Clowning during COVID-19 - A survey of European Healthcare Clowning Organisations highlights the role of humour and art in the healthcare system.

OBJECTIVES: This paper presents the findings of a Europe-wide survey that investigates the impact of COVID-19 on Healthcare Clowning Organisations and encourages the healthcare community to reflect on the role of medical clowning within the healthcare system. STUDY DESIGN: Online survey. METHODS: The survey was conducted in June 2020. Forty organisations from 21 countries across Europe responded through a mix of closed and open-ended answers. RESULTS: During the pandemic, 36 out of 39 of the surveyed organisations (with one non-response) had to postpone or cancel their artistic activities. As the crisis continued, 34 out of 40 of them managed to adapt their in-person activities, but the impact of virtual and distanced interactions with the beneficiaries was generally perceived as lower than that of in-person activities. In open responses, many Healthcare Clowning Organisations criticised the exclusion of medical clowns from healthcare institutions in times when the need for psychosocial support was particularly acute. CONCLUSIONS: The healthcare sector should reconsider the important role the medical clowns play within healthcare settings, and allow for more inclusive and flexible safety regulations that take into consideration the holistic well-being of vulnerable groups, especially children, the elderly, and medical staff.

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.

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.

Laughter therapy in diabetes.

Gelotology, or the science of laughter, is developing as a complementary field of medicine. Laughter therapy has been shown to have multifaceted physiological and endocrine benefits, and is being used to help manage various chronic diseases. This communication describes some aspects of laughter therapy, and reviews evidence related to its therapeutic potential in diabetes care.

A digital media attention diversion improves mood and fear in patients receiving chemotherapy for recurrent gynecologic malignancies: results of a randomized trial.

BACKGROUND: Recurrent gynecologic cancer patients experience symptoms that affect psychologic, emotional, social, and physical well-being. Chemotherapy can further exacerbate these symptoms. Poor mood, pain, and fatigue are linked and are detrimental to quality of life. Interventions targeting these symptoms may improve patient-reported outcomes and performance status. OBJECTIVES: To determine the ability of a humorous digital media attention diversion to improve symptom domains of positive and negative mood during chemotherapy for patients with recurrent gynecologic cancers. STUDY DESIGN: This randomized, crossover clinical trial enrolled women with recurrent gynecologic cancers. Subjects participated over three cycles of chemotherapy. The primary outcome was the change in mood on the validated Positive and Negative Affect Scale-Extended (PANAS-X) instrument, which measures positive and negative affect domains. All subjects completed the PANAS-X after receiving chemotherapy during cycle 1 on study. In atudy arm 1, subjects watched their choice of humorous movies on a digital media device while receiving chemotherapy during cycle 2 on study. They selected from non-humorous movies during cycle 3 on study. In arm 2, the order of movies was reversed. After each cycle, mood, fatigue, and other patient-reported outcomes were assessed for comparison with baseline measurements. RESULTS: The target enrollment of 66 subjects was achieved. Subjects watched humorous content for an average of 96.0 min and non-humorous content for an average of 62.5 min. Negative mood improved after exposure to humorous (p=0.017) and non-humorous content (p=0.001). Patient-reported fear also improved after exposure to both humorous (p=0.038) and non-humorous content (p=0.002). Subjects reported higher use of affiliating and self-effacing humor types. CONCLUSIONS: Offering patients a choice of digital media during chemotherapy significantly improved negative mood and fear. This was seen with both humorous and non-humorous content. This low-cost and low-risk intervention should be implemented as an attention diversion to improve negative mood and fear for patients receiving chemotherapy.