Journal List > J Korean Acad Nurs > v.48(3) > 1108867

Lee and Hyun: The Effects of Laughter Therapy Program on Perceived Stress, and Psycho-Neuro-Endocrino-Immuno Responses in Obese Women

Abstract

Purpose

The purpose of this study was to examine the effects of the laughter therapy program on perceived stress and psycho-neuro-endocrine-immune responses in obese women.

Methods

A nonequivalent control group with a pretest-posttest design was used. The participants (n=60), whose age ranged from 30 to 50 years (pre-menopausal and body mass index of over 25 kg/m2), were assigned to the experimental group (n=24) or control group (n=26). The experimental group was provided with the laughter therapy program (12 sessions) for 6 weeks.

Results

There were significant differences in perceived stress, psychological stress response, fasting blood sugar, interleukin-6, and tumor necrosis factor alpha between the two groups after the program. However, there were no significant differences in normalized low frequency (norm LF), normalized high frequency (norm HF), LF/HF ratio, and cortisol between the two groups after the program.

Conclusion

It was found that the laughter therapy program had positive effects on some variables in terms of perceived stress and psycho-neuro-endocrine-immuno responses. It is suggested that the laughter therapy in this study can provide the direction for developing a program for obese women.

References

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Figure 1.
Conceptual framework
jkan-48-298f1.tif
Figure 2.
Research flow diagram.
jkan-48-298f2.tif
Table 1.
Laughter Therapy Program for Obese Women
Session Subjects Activities
1 Introduction of laughter therapy • Laugh greeting
• Explain the effect and types of laughter
2 Understanding the mind and body change by laughter • Reduce perceived stress by laughter
• Take off face clothes and wear laughter clothes
• Laugh with flying hope
3 Understanding the effects of intentional laughter • Maintaining laughing face: Facial muscle stretching, Laughter forming, and Smile training
4 Understanding the effects of laughter on emotion • Laugh with open mind
• Laughter in the morning: Stretching laughter and Hippo laughter
• Laughter at noon: Lion laughter and King Kong laughter
• Laughter in the evening: Foolish laughter, Knee-jerk laughter, Massage laughter, Following
laughter, Applause laughter, Mirror laughter, and Shower laughter
5 Bring out laughter with positive mind • Reverse the story, Speak positively, Flying planes for bad idea, Wish-fulfillment laughter, and
Applaud laughter
• Make a laughing zone at home
6 Laughter training for expressing one’s emotion • Express one’s emotion with the laughter
• Cocktail laughter, Miss Korea laughter, Newspaper laughter, Cell phone laughter, and Wonder
laughter
7 Laughing together • Emperor Penguin laughter: I belong to you, you belong to me laughter
8 Maintaining positive laughter • Laughter: Parasympathetic nervous system activation, laughter, and immune response
• Skating laughter, Heaven earth human laughter, Run-stop laughter, Shower laughter, Scarf
laughter, and Belly touching laughter
9 Making laughter confidence • Precious me: Praise and thankful for my body
• Individual laughter contest, Praise laughter, and Flipped laughter when praised
10 Laughter training for happiness • Nan-ta laughter blowing stress
• Balloon laughter, Frame laughter, Photo laughter, Cell phone laughter, Elevator laughter, and
Snow White laughter
11 Laughter training with family • Laughter with family
• Utilizing a laughing zone, Wish-fulfilling laughter, Surfing laughter, Recall laughter, Fan laughter,
and Brush teeth laughter
12 Maintaining laughing • I win You win laughter, Band laughter, Vacuum cleaner laughter, Applause laughter, Surfing
laughter, and Expressing laughter episode
• Closing
Table 2.
Homogeneity Tests of General Characteristics for the Two Groups (N=50)
Characteristics Categories Exp. (n=24) Cont. (n=26) χ2 or t p
n (%) or M±SD n (%) or M±SD
Age (yr) 41.21±5.25 43.54±5.35 1.55 .127
BMI (Kg/m2) 28.38±3.59 28.48±3.86 0.10 .924
Education level High shool 14 (58.4) 19 (73.1) .563
College graduate 8 (33.3) 6 (23.1)
≥ Graduate school 2 (8.3) 1 (3.8)
Religion Yes 12 (50.0) 15 (57.7) 0.30 .586
No 12 (50.0) 11 (42.3)
Occupation Yes 3 (12.5) 9 (34.6) .067
No 21 (87.5) 17 (65.4)
Monthly income (10,000 won) None 6 (25.0) 7 (27.0) .645
< 200 6 (25.0) 3 (11.5)
200∼400 8 (33.4) 13 (50.0)
> 400 4 (16.6) 3 (11.5)
Exercise Never 10 (41.7) 10 (38.5) 0.14 .931
Sometimes 8 (33.3) 10 (38.5)
Regularly 6 (25.0) 6 (23.0)
Meal (times per day) Two 10 (41.7) 7 (26.9) 1.21 .272
Three 14 (58.3) 19 (73.1)
Snack (times per day) One 11 (45.8) 12 (46.2) .645
Two 8 (33.3) 11 (42.3)
Three 5 (20.9) 3 (11.5)
Health status Bad 9 (37.5) 7 (26.9) .771
Average 14 (58.3) 16 (61.5)
Good 1 (4.2) 3 (11.6)
Health concern No 2 (8.4) 2 (7.7) .481
Average 8 (33.3) 14 (53.8)
Much 14 (58.3) 10 (38.5)
Weight control No 11 (45.8) 9 (34.6) 0.79 .674
Moderate 7 (29.2) 8 (30.8)
Severe 6 (25.0) 9 (34.6)

BMI=Body mass index; Cont.=Control group; Exp.=Experimental group; M±SD=Mean standard deviation.

Fisher Exact Test.

Table 3.
Homogeneity Test of the Dependent Variables for the Two Groups (N=50)
Variable Exp. (n=24) Cont. (n=26) t p
M±SD M±SD
Perceived stress 28.58±5.59 28.58±7.00 -0.04 .997
Psychological stress response 51.13±27.56 44.65±28.82 -0.81 .442
norm LF (nu) 68.15±18.67 60.23±18.49 -1.51 .139
norm HF (nu) 31.85±18.67 39.77±18.49 1.51 .139
LF/HF ratio 3.18±2.30 2.16±1.62 -1.81 .078
Cortisol (μg/dl) 9.52±2.87 9.67±3.26 0.18 .862
Fasting blood sugar (mg/dl) 106.04±11.30 108.00±10.36 0.64 .526
IL-6 (pg/ml) 2.43±1.28 2.03±1.92 -0.86 .395
TNF-α (pg/ml) 1.73±0.50 1.33±0.41 -3.15 .003

Cont.=Control group; Exp.=Experimental group; IL-6=Interleukin-6; norm HF=Normalized high frequency; norm LF=Normalized low frequency; TNF-α=Tumor necrosis factor alpha.

Table 4.
Differences in Dependent Variables between the Two Groups (N=50)
Variables Groups Pretest Posttest Difference t or F p
M±SD M±SD M±SD
Perceived stress Exp. 28.58±5.59 19.50±6.14 -9.08±7.39 3.73 <.001
Cont. 28.58±7.00 26.88±8.17 -1.70±6.63
Psychological stress response Exp. 51.13±27.56 19.50±21.94 -31.63±21.75 2.94 .005
Cont. 44.65±28.82 41.42±30.44 -3.23±14.49
norm LF (nu) Exp. 68.15±0.19 65.49±0.15 -2.66±0.20 0.78 .438
Cont. 60.23±0.18 61.52±0.15 1.29±0.16
norm HF (nu) Exp. 31.85±0.19 34.51±0.15 2.66±0.20 -0.78 .438
Cont. 39.77±0.18 38.48±0.15 -1.29±0.16
LF/HF ratio Exp. 3.18±2.30 2.57±1.84 -0.61±3.00 0.85 .399
Cont. 2.16±1.62 2.15±1.72 -0.01±1.83
Cortisol (μg/dl) Exp. 9.52±2.87 9.84±3.08 0.32±3.74 0.27 .979
Cont. 9.67±3.27 10.02±4.22 0.35±4.01
Fasting blood sugar (mg/dl) Exp. 106.04±11.30 99.42±10.38 -6.62±13.43 2.10 .041
Cont. 108.00±10.36 110.35±15.18 2.35±16.50
IL-6 (pg/ml) Exp. 2.43±1.28 1.51±0.74 -0.92±1.27 2.17 .035
Cont. 2.03±1.92 1.92±1.63 -0.11±1.36
TNF-α (pg/ml) Exp. 1.73±0.50 1.08±0.38 -0.65±0.08 4.44 .041
Cont. 1.33±0.41 1.15±0.47 -0.18±0.08

Cont.=Control group (n=26); Exp.=Experimental group (n=24); IL-6=Interleukin-6; norm HF=Normalized high frequency; norm LF=Normalized low frequency; TNF-α=Tumor necrosis factor alpha.

Analysis of Covariance with pre-test score as covariate.

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