It is generally accepted that cancer affects the concept of mental well-being by changing the physical, psychological, spiritual, and social dimensions of the patient’s life. Laughter yoga as one of the complementary therapies may promote mental well-being in patients undergoing chemotherapy.
The purpose of this study, conducted by research researchers from Mashhad, Iran, was to ascertain how laughter yoga affected the mental health of cancer patients receiving chemotherapy.
In 2018, Reza Medical Centre in Mashhad, Iran, conducted a randomised controlled trial on 69 cancer patients taking chemotherapy for this purpose. Before starting chemotherapy, the intervention group participated in four 20–30-minute laughter yoga sessions. The control group, however, had regular instruction in self-care.
The Warwick-Edinburgh Mental Well-being Scale (WEMWBS) was used to gauge participants’ mental health both before and after the laughter yoga sessions. Using the independent t-test, Mann-Whitney test, Wilcoxon test, and repeated measures ANOVA, data were analysed using SPSS software (version 20).
Cancer and its impact on mental health
Cancer patients’ and their families’ lives can be affected psychologically, emotionally, and physically. It can also result in changes to many facets of life, such as the mental, physical, spiritual, and social realms. Cancer patients frequently experience symptoms of depression, anxiety, hopelessness, social isolation, fear of a spouse’s or family member’s reaction, marital anxiety, fear of death, and fear of sterility, all of which are linked to the idea of mental health in this population.
What is mental well-being?
The self-evaluation of one’s life, both past and current, as well as an individual’s emotional reaction to events and assessments of their level of personal satisfaction, are all considered components of mental well-being. The idea of mental well-being includes a cognitive dimension (i.e., people’s contentment with life) as well as two emotional components (i.e., the maximum positive and minimum negative feelings).
When a person is diagnosed with cancer, having strong personal values and mental health can help them accept the diagnosis more easily and experience less anxiety. One of the key ideas in determining the quality of life for cancer patients is mental health.
Therefore, improving empowerment, enhancing life satisfaction, changing the quality of life, and eventually advancing mental health ought to be the main goals of the current treatments. Encouraging patients’ mental well-being not only enhances their physical and mental health but also raises their life expectancy, happiness, success in the workplace, and social engagement.
Thus, people with cancer may benefit from complementary and alternative medicine (CAM) either on its own or in conjunction with conventional therapies.
What is Laugher Yoga?
Laughing sports and laughter yoga are examples of complementary and alternative medicine (CAM). To make people laugh without jokes or satirical shows, this treatment combines unconditional laughing with yoga breathing and yoga stretching exercises. Some people think that the effects of false and real laughter are like each other’s bodies. Thus far, research has demonstrated the beneficial effects of laughing on several bodily systems, including immune system, hormone, and mental factors, as well as muscular relaxation. An Indian doctor originally popularised laughter yoga, which featured a variety of laughing exercises. To help patients laugh without making jokes or jokes, this treatment combines yoga breathing and yoga stretching exercises with unconditional laughing.
How is laugher yoga effective?
There are four basic components to laughter yoga: clapping, deep breathing, joyful playfulness, and laughter exercises. Laughing makes you feel “well-being” because it lowers stress hormones and releases endorphins. Laughter yoga benefits patients by lowering stress, pain, sadness, and psychosomatic ailments. It also boosts immunity, interpersonal relationships, self-esteem, and social presence. Moreover, it is a simple, accessible, and economical approach that can support and enhance patients’ mental health. Furthermore, patients have the option to instruct and engage in laughter yoga on their own, which promotes self-care—which is one of the main goals of nursing.
Three dimensions of mental well-being: feelings of optimism, positive relationships and having energy
Upon fulfilling the eligibility requirements, the qualified participants were divided into two groups—the intervention and the control group—using randomised sequences generated by SPSS software and sealed envelopes. The goals and methodology of the study were explained to every participant, and the chosen people in the intervention and control groups provided written informed consent.
Three characteristics comprised the WEMWBS: optimism, positive relationships, and energy. The first dimension has to do with utility, ease of relaxation, energy, vigour, assurance, and optimism. The second dimension is intelligence, interpersonal empathy, and critical thinking. High vitality, the capacity to conquer obstacles, getting the right kind of attention, and receiving affection from others are all associated with the third dimension.
The patients answered the surveys either through interviews conducted in a quiet room of the chemotherapy ward or before and after their laughter yoga sessions. Four laughter yoga sessions lasting 20 to 30 minutes each were given to the intervention group. Each session included 30 to 45 seconds of laughter.
The exercises consisted of fifteen basic standing steps including:
Step 1: Clapping in a rhythm of 1-2-3, 1-2-3, with chanting of ho-ho-ho,ha-ha-ha.
Step 2: Deep breathing with inhalation through the nose and exhalation through the mouth (five times).
Step 3: Warming up and stretching the neck and shoulders (five times each).
Step 4: Hearty laugh technique in which both arms are opened over the head tilted slightly backward laughing simultaneously.
Step 5: Greeting laughter technique in which palms facing each other and laughing at other people in the group.
Step 6: Appreciation laughter technique in which the pointing finger is joined with the thumb to make a circle while making gestures as if one is appreciating the group members and laughing simultaneously.
Step 7: One-meter laughter technique in which one hand is moved over the stretched arm of the other and shoulder is extended in three moves by chanting Ae…., Ae….., Aeee….., and then the participants burst into laughter by stretching both arms and throwing their heads a little backward laughing from the belly (four times).
Step 8: Silent laughter technique in which the mouth is opened as far as possible without sound and then looking into other’s eyes making some funny gestures.
Step 9: Humming laughter technique with a closed mouth in which the mouth is closed with laughing and a humming sound while humming keeps on moving in the group and shaking hands with other members of the group.
Step 10: Swinging laughter technique in which a large circle is formed while running and laughing towards the centre of the circle by chanting Aee….Ooo….Eee…Uuu.
Step 11: Lion laughter technique in which the tongue is extended fully with eyes wide open, and hands stretched out like the claws of a lion laughing from the tummy.
Step 12: Cell phone laughter technique in which an imaginary mobile phone is held next to ear while making different gestures moving around in the group to meet different people.
Step 13: Argument laughter technique in which a finger is pointed at different members of the group with laughing.
Step 14: Gradient laughter technique which starts with the appearance of a smile on the face, and the smile gradually getting bigger and bigger. Subsequently, the members gradually burst into hearty laughter and bring the laughter down slowly and gradually and stop.
Step 15: Heart to heart laughter technique in which the members come together and hold hands or hug each other and laugh.
Positive affirmations like “I am the happiest person in the world” and “I am the healthiest person in the world” were loudly repeated by the participants at the conclusion of the session. Group laughter yoga sessions were conducted. The treatment programme, which specified the day of attendance at the chemotherapy centre, was followed to group the patients. There were three groups consisting of eight, fourteen, and twelve participants. Chemotherapy was administered as prescribed by the centre following each laughter yoga class.
In the centre’s auditorium, which is adjacent to the chemotherapy ward, the researcher gave the control group educational brochures in addition to the standard self-care instruction, which included in-person instruction.
Implementation of laughter yoga significantly improved mental well-being of patients
The results shown that the application of the laughter yoga programme might raise the WEMWBS score of chemotherapy patients by around 6%.
The observed difference in the two groups’ mental well-being scores could be attributed to the intervention’s effect, as the two groups in this study were identical with respect to all underlying and confounding characteristics except for the use of laughter yoga.
As a result, the research hypothesis is supported by the higher mental well-being scores obtained from laughing yoga for chemotherapy patients. It can be concluded, then, that laughter yoga improves mental health in cancer patients receiving chemotherapy.
The benefits of laughter yoga are likely linked to bettering one’s quality of life, elevating one’s mood, increasing life satisfaction, and improving mental health by lowering stress and depression.
It will need further research to determine the precise mechanism underlying laughter yoga’s beneficial effects on mental health. Therefore, to obtain more precise results, it is advised that future studies examine the impact of a laughter yoga programme by increasing the program’s duration.
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