The Effect of Laughter Therapy on Physical and Mental Health: Systematic Review

Abstract

Objective: Laughter yoga/therapy is a non-humorous laughter inducing exercise consisting of breathing techniques and positively changes the mood. This systematic review was conducted to determine the effects of randomized controlled trials (RCTs) regarding laughter therapy on physical and mental health in individuals with different health conditions. Methods: The PICOS format was used in this systematic review. The PRISMA checklist was used for data summarization and result reporting. In this systematic review assessed randomized controlled trials (RCTs) published in Turkish and English in the EBSCO, Web of Science, Wiley Online Library, PubMed, National Thesis Center, National Academic Network and Ulakbim data sources from January 2005 to November 2020. Results: This study was completed with 16 RCTs meeting the research criteria. At the end of the study, the laughter therapy was found to be effective in reducing pain, depression, stress and anxiety in individuals and increasing sleep quality. There was limited evidence for the effect of therapy on somatization, blood glucose, blood pressure, endorphin and cortisol levels. Conclusion: It was determined that laughter therapy can be considered as an appropriate approach for public health nurses to improve the physical and mental health of individuals and its effectiveness can be tested. Laughter therapy can be recommended by healthcare professionals working in hospitals or community centers as a non-pharmacological, simple, inexpensive and therapeutic method that they can benefit from in care.

Keywords

• Laughter
• therapy
• Nurse
• Public Health
• Systematic Review

Kahkaha Terapisinin Fiziksel ve Ruhsal Sağlığa Etkisi: Sistematik Derleme

Abstract

Objective: This systematic review was conducted to determine the effects of laughter therapy on physical and mental health in individuals with different health conditions. Materials and Methods: The PICOS format was used to determine eligibility criteria in this systematic review. The PRISMA checklist was used for data summarization and result reporting. In this systematic review assessed randomized controlled trials published in Turkish and English in the EBSCO, Web of Science, Wiley Online Library, PubMed, National Thesis Center, National Academic Network and Ulakbim databases from January 2005 to November 2020. The keywords "laughter therapy OR laughter yoga" were used for the search. The quality assessment of the included studies was performed with the Critical Appraisal Checklist tool prepared by The Joanna Briggs Institute. This study was completed with 16 randomized controlled trials meeting the research criteria. Results: At the end of the study, the laughter therapy was found to be effective in reducing pain, depression, stress, and anxiety in individuals and increasing sleep quality. There was limited evidence for the effect of therapy on somatization, blood glucose, blood pressure, endorphin, and cortisol levels. Conclusion and recommendations: It was determined that laughter therapy can be considered as an appropriate approach for public health nurses to improve the physical and mental health of individuals and its effectiveness can be tested. Laughter therapy can be recommended by healthcare professionals working in hospitals or community centers as a non-pharmacological, simple, inexpensive and therapeutic method that they can benefit from in care.

Keywords

• Kahkaha
• Terapi
• Hemşire
• Halk Sağlığı
• Sistematik Derleme

References

1. Ahmadi, Z., Bazzazian, S., Tajeri, B. & Rajab, A. (2020). Laughter therapy on self-compassion and hyperglycemia in the elderly with type 2 diabetes. Middle East Journal of Digestive Diseases, 10, 20-20.
2. ennett, P.N., Husseın, W.F., Reterman, M., Yu, J. & Schıller, B. (2020). The effects of laughter therapy on depression symptoms in patients undergoing center hemodialysis: A pragmatic randomized controlled trial. Hemodialysis International, 24, 541-549. doi: https://doi.org/10.1111/hdi.12870.
3. Bressingtona, D., Muib, J., Yua, C. et al. (2019). Feasibility of a group-based laughter yoga intervention as an adjunctive treatment for residual symptoms of depression, anxiety and stress in people with depression. Journal of Affective Disorders, 248, 42-51. doi: https://doi.org/10.1016/j.jad.2019.01.030.
4. Butcher, H.K., Bulechek, G.M., Dochterman, J.M.M. & Wagner, C.M. (2018). Nursing ınterventions classification (NIC)-E-Book. Elsevier Health Sciences.
5. Carlos, M.C., Carrasco, B.C., Castillo, V.F. et al. (2014). Effectiveness of laughter yoga as an adjunct to naproxen treatment in relieving symptoms of knee or hip osteoarthritis in geriatric patients: A randomized controlled trial. UERM Health Sciences Journal, 3(2), 79-83.
6. Cha, MY., Hong, H.K. (2015). Effect and path analysis of laughter therapy on serotonin, depression and quality of life in middle aged women. Journal of Korean Academy of Fundamentals of Nursing, 45(2):221-230. doi: 10.4040/jkan.2015.45.2.221.
7. Choi, W., Park, J., Jung, H. et al. (2016). The effects of laughter therapy ınterventions for smartphone addicts. International Journal of Bio-Science and Bio-Technology, 8(4), 189-198. doi: http://dx.doi.org/10.14257/ijbsbt.2016.8.4.21.
8. Cohen, J. (1988). Statistical power analysis for the behavioral sciences. 2nd Ed. Hillsdale: Erlbaum Associates.

9. Čokolič, M., Herodež, S., Sternad, S. & Krebs, S. (2013). The ınhıbıtory effect of laughter yoga on the ıncrease ın postprandıal blood glucose ın type 2 dıabetıc patıents. Diabetologia Croatica, 42(2), 54-58.
10. Coutiño-Escamilla, L., Piña-Pozas, M., Tobías Garces, A., Gamboa-Loira, B. & López-Carrillo, L. (2019). Non-pharmacological therapies for depressive symptoms in breast cancer patients: Systematic review and meta-analysis of randomized clinical trials. The Breast, 44, 135-143. doi: https://doi.org/10.1016/j.breast.2019.01.006.
11. Decaro, D.S. & Brown, J.L.C. (2016). Laughter yoga, adults living with Parkinson’s disease, and caregivers: a pilot study. Explore: The Journal of Science and Healing, 12(3),196-199. doi: https://doi.org/10.1016/j.explore.2016.02.005.
12. Demir Dogan, M. (2020). The effect of laughter therapy on anxiety a meta-analysis. Holistic Nursing Practice, 34(1), 35-39. doi: 10.1097/HNP.0000000000000363.
13. Ellis, J.M., Ben‐Moshe, R. & Teshuva, K. (2017). Laughter yoga activities for older people living in residential aged care homes: a feasibility study. Australasian Journal On Ageing, 36(3), 28-31. doi: https://doi.org/10.1111/ajag.12447.
14. Fujisawa, A., Ota, A., Matsunaga, M. et al. (2018). Effect of laughter yoga on salivary cortisol and dehydroepiandrosterone among healthy university students: a randomized controlled trial. Complementary Therapies İn Clinical Practice, 32, 6-11. doi: https://doi.org/10.1016/j.ctcp.2018.04.005.
15. Ghodsbin, F., Ahmadi, Z.S., Jahanbin, I. & Sharıf, F. (2015). The effects of laughter therapy on general health of elderly people referring to jahandidegan community center in shiraz, iran: a randomized controlled trial. International Journal of Community Based Nursing and Midwifery, 3(1), 31-38.
16. Gonot-Schoupinsky, F.N. & Garip, G. (2018). Laughter and humour interventions for well-being in older adults: a systematic review and intervention classification. Complementary Therapies in Medicine, 38, 85-91. doi: https://doi.org/10.1016/j.ctim.2018.04.009.
17. Heo, E.H., Kım, S., Park, H.J. & Kıl, S.Y. (2016). The effects of a simulated laughter program on mood, cortisol levels, and health-related quality of life among hemodialysis patients. Complementary Therapies İn Clinical Practice, 25, 1-7. doi: 10.1016/j.ctcp.2016.07.001.
18. Hui, C.E., Ja, K.M. & Nam, L.E. (2020). A meta-analysis on the effects of mind-body therapy on patients with irritable bowel syndrome. Journal of Korean Academy of Nursing, 50(3), 385-391. doi: https://doi.org/10.4040/jkan.19224.
19. Kanji, N., White, A. & Ernst, E. (2006). Autogenic training to reduce anxiety in nursing students: randomized controlled trial. Journal of Advanced nursing, 53(6), 729-735. doi: https://doi.org/10.1111/j.1365-2648.2006.03779.x.
20. Karacam, Z. (2013). Systematic review methodology: A guide to preparing a systematic review. Dokuz Eylul University School of Nursing Electronic Journal, 6(1), 26-33.
21. Kataria, M. (2018). Certified laughter yoga teacher training manual. (Guide) Bangalore: Laughter Yoga International University.
22. Kim, S.H., Kim, Y.H. & Kim, H.J. (2015). Laughter and stress relief in cancer patients: a pilot study. Evidence-Based Complementary and Alternative Medicine 1-6. doi: http://dx.doi.org/10.1155/2015/864739.
23. Ko, H.J. & Youn, C.H. (2011). Effects of laughter therapy on depression, cognition and sleep among the community-dwelling elderly. Geriatrics Gerontology Internatıonal, 11, 267-274. doi: https://doi.org/10.1111/j.1447-0594.2010.00680.x.
24. Kuru Alıcı, N., Zorba Bahceli, P. & Emiroglu, ON. (2018). The preliminary effects of laughter therapy on loneliness and death anxiety among older adults living in nursing homes: a nonrandomised pilot study. International Journal of Older People Nursing, 13(4), 1-9. https://doi.org/10.1111/opn.12206.
25. Kuru, N., & Kublay, G. (2017). The effect of laughter therapy on the quality of life of nursing home residents. Journal of Clinical Nursing, 26(21-22), 3354-3362. doi: 10.1111/jocn.13687.
26. Lee, Y.J., Kim, M.A. & Park, H.J. (2020). Effects of a laughter programme with entrainment music on stress, depression, and health-related quality of life among gynaecological cancer patients, Complementary Therapies in Clinical Practice. 39, 101118. https://doi.org/10.1016/j.ctcp.2020.101118.
27. Macedo, M. et al. (2019). Benefits of laughter-inducing and humor nursing interventions in people undergoing hemodialysis. Journal of Aging & Innovation, 8(3), 4-20.
28. Moher, D., Liberati, A., Tetzlaff, J. & Altman, DG. (2009). Prisma group, reprint-preferred reporting ıtems for systematic reviews and meta-analyses: The Prisma statement. Physical Therapy, 89, 873-880.
29. Morishima, T., Miyashirol, I., Inoue, N. et al. (2019). Effects of laughter therapy on quality of life in patients with cancer: an open-label, randomized controlled trial. Plos One, 14(6), 1-15. doi: https://doi.org/10.1371/journal.pone.0219065.
30. Namazi Nia, M., Mohajer, S., Ghahramanzadeh, M. & Mazlom, S.R. (2019). Effect of laughter yoga on mental well-being of cancer patients undergoing chemotherapy. Evidence Based Care Journal, 9(3), 7-14. doi: 10.22038/ebcj.2019.39928.2050.
31. Ozer, Z. (2019). The effect of laughter yoga on plasma beta endorphin levels, pain intensity and sleep quality in patients undergoing hemodialysis. (Unpublished Doctorate Thesis). Uskudar University Institute of Health Sciences Department of Nursing, İstanbul.
32. Ozturk, F.O. (2018). Evaluation of the effect of laughter yoga on mental symptom frequency and salivary cortisol level in first grade students of nursing department. (Unpublished Doctorate Thesis). Ankara University Institute of Health Sciences Department of Nursing, Ankara.
33. Patra, S. & Kumar, A. (2019). Laughter therapy decreases depression among in senior citizens residing in old age homes. Medical & Clinical Research, 4(1), 1-2. doi:10.32474/IGWHC.2018.02.000143.
34. Ryan, R. (2013). Cochrane consumers and communication review group. cochrane consumers and communication review group: data synthesis and analysis. Cochrane Consumers and Communication Review Group, 1-5.
35. Salunke, S. & Shah, M. (2019). Effectiveness of laughter therapy in smartphone addicts on insomnia, lung functions and flexibility. International Journal of Health Sciences & Research, 76(9), 76-83.
36. Shahidi, M., Mojtahed, A., Modabbernia, A. et al. (2011). Laughter yoga versus group exercise program in elderly depressed women: a randomized controlled trial. International Journal of Geriatric psychiatry, 26(3), 322-327. doi: https://doi.org/10.1002/gps.2545.
37. Smith, V., Devane, D., Begley, CM. & Clarke, M. (2011). Methodology in conducting a systematic review of systematic reviews of healthcare interventions. BMC Medical Research Methodology, 11(1), 15. doi:10.1186/1471-2288-11-15.
38. Smitha, P.M. (2017). A study to assess the effectiveness of laughter therapy on quality of life among elderly at old age home, Chennai. International Journal of Applied Research, 3(9), 437-442.
39. Snilstveit, B., Oliver, S. & Vojtkova, M. (2012). Narrative approaches to systematic review and synthesis of evidence for international development policy and practice. Journal of Development Effectiveness, 4(3), 409-429. doi: https://doi.org/10.1080/19439342.2012.710641.
40. Sousa, L.M.M., Marques-Vieira, C.M.A., Antunes, A.V., Frade, M.F..G., Severino, SP.S. & Valentim, O.S. (2019). Humor intervention in the nurse patient interaction. Revista Brasileira de Enfermagem, 72(4), 1078-85. doi: http://dx.doi.org/10.1590/0034-7167-2018-0609.
41. Sung-Ho, H., Hyeon-Cheol, J. & Ji-Won, H.(2019). Effect of laughter therapy on healthy life: a meta-analysis. Journal of the Korea Convergence Society, 10(9), 291-299. doi: 10.24171/j.phrp.2020.11.1.07.
42. Tavakoli, T., Davoodi, N., Jafar Tabatabaee, T.S. et al. (2019). Comparison of laughter yoga and anti-anxiety medication on anxiety and gastrointestinal symptoms of patients with ırritable bowel syndrome. Middle East Journal Digestive Diseases, 11(4), 211-217. doi: 10.15171/mejdd.2019.151.
43. Tsai, S.H., Wang, M.Y., Miao, N.F., Chian, P.C., Chen, T.H. & Tsai, P.S. (2015). The efficacy of a nurse-led breathing training program in reducing depressive symptoms in patients on hemodialysis: a randomized controlled trial. The American Journal of Nursing, 115(4), 24-32. doi: 10.1097/01.NAJ.0000463023.48226.16.
44. Tufanaru, C., Munn, Z., Aromataris, E., Campbell, J. & Hopp, L. (2017) Chapter 3: Systematic reviews of effectiveness. In: Aromataris E, Munn Z (Editors). Joanna Briggs Institute Reviewer's Manual. The Joanna Briggs Institute, Available from https://reviewersmanual.joannabriggs.org/.
45. Varghese, S.M. (2017). A study to assess the effectiveness of laughter therapy on physical problems among ınstitutionalized elderly at ernakulam district ın Kerala. International Journal of Innovative Research and Advanced Studies (IJIRAS), 4(8), 1-3. doi: https://doi.org/10.52403/ijhsr.20210434.
46. Wal, N.V. & Kok, R.N. (2019). Laughter-inducing therapies: Systematic review and meta-analysis. Social Science & Medicine, 232, 473-488. doi: 10.1016/j.socscimed.2019.02.018.
47. Yim, J. (2016). Therapeutic benefits of laughter in mental health: a theoretical review. The Tohoku Journal of Experimental Medicine, 239(1), 243-249. doi: https://doi.org/10.1620/tjem.239.243.
48. Zhao, J., Yin, H., Zhang, G. et al. (2019). A meta-analysis of randomized controlled trials of laughter and humor interventions on depression, anxiety and sleep quality in adults. Journal of Advanced Nursing, 75(11), 2435-2448. doi: https://doi.org/10.1111/jan.14000.