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

Do Young Lee; Myung Sun Hyun

doi:10.4040/jkan.2018.48.3.298

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

Original Article

J Korean Acad Nurs 2018;48(3):298-310.

Published online: 15 January 2018

DOI: https://doi.org/10.4040/jkan.2018.48.3.298

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

Do Young Lee¹, Myung Sun Hyun^2,

¹Department of Nursing, Changshin University, Changwon

²College of Nursing · Institute of Nursing Science, Ajou University, Suwon, Korea

Address reprint requests to : Hyun, Myung Sun College of Nursing · Institute of Nursing Science, Ajou University, 164 Worldcup-ro, Yeongtong-gu, Suwon 16499, Korea Tel: +82-31-219-7014 Fax: +82-31-219-7020 E-mail: mhyun@ajou.ac.kr

Received 4 July 2017 Revised 16 April 2018 Accepted 3 May 2018

This is an Open Access article distributed under the terms of the Creative Commons Attribution NoDerivs License. (http://creativecommons.org/licenses/by-nd/4.0) If the original work is properly cited and retained without any modification or reproduction, it can be used and re-distributed in any format and medium.

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.

Keywords: Laughter Therapy, Psychological Stress, Obesity, Physiological Stress Response

References

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Figure 1.

Conceptual framework

Figure 2.

Research flow diagram.

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
Characteristics	Categories	n (%) or M±SD	n (%) or M±SD	χ² or t	p
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
Variable	M±SD	M±SD	t	p
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
Variables	Groups	M±SD	M±SD	M±SD	t or F	p
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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