In the experimental group, 65 older persons were approached by the research team and invited to join the study. There were 41 who fit the inclusion criteria and had suffered from pain for more than three months, and 36 of them agreed to take part in our study. As for the control group, 61 older persons were approached, of whom 42 had suffered from pain for more than three months and fit all the inclusion criteria.
Of these, 34 agreed to join the study. This procedure is illustrated by the consort diagram in Figure 1. Humor therapy was carried out in the multifunction room of the nursing home. It was an 8-week program involving one hour per week. The overall atmosphere was relaxed and cheerful during all the humor therapy sessions. The research team would work with the participants to design and make entries in the portfolios, with funny books and photos, jokes, funny audio tapes and videos, comedy clips and cartoons, and funny and interesting news clips, articles, stories and reflections.
Their portfolios were reviewed every week, and any difficulties and happiness in making the portfolios were shared. In the following weeks, humor therapy was carried out by the research team. From week 2 to week 8, each session started with a joke of the day and the reading of funny jokes and stories; lectures on humor research were then given.
Participants in the therapy group were also shown how to give higher priority to humor in their everyday lives, laughing exercises and games, sharing of their own funny stories, magic shows, and hot tips to stimulate humor and joy. At the end of the 8th week, portfolios were shared among all participants. Post-test questionnaires were also collected, and participants in the experimental group were invited for an interview to share their experience of the humor therapy.
Demographic data including gender, age, previous health history, and time spent in nursing homes were collected for all participants. Also, perception of pain assessed using the Cantonese Verbal Rating Scales [ 36 — 38 ], and psychological parameters including happiness assessed using the Subjective Happiness Scale [ 39 ] , loneliness assessed using the Revised UCLA Loneliness Scale [ 40 ] , and life satisfaction assessed using the Revised Life Satisfaction Index-A scale [ 41 ] were examined before week 1 and after the 8-week humor therapy program for all participants.
Pain was measured by the Cantonese Verbal Rating Scales [ 36 — 38 ] and consisted of a series of words commonly used to describe pain. Participants were instructed to read the words and choose the option that best described the pain in their experience. The reliability and validity of the pain scale in the Cantonese VRS have been established previously [ 36 — 38 ].
Happiness was measured by The Subjective Happiness Scale [ 39 ], which consists of a 4-item measure of global subjective happiness. Items are rated on a 7-point Likert scale with different descriptors for each item. The Cronbach's alpha was 0. The test-retest reliability ranged from 0. Two items asked participants to characterize themselves using both absolute ratings and ratings relative to peers, while the other two items offered brief descriptions of happy and unhappy individuals and asked participants the extent to which each characterization described them.
The total range of the scores was 4—28, with higher scores reflecting greater happiness. The SHS used only 4 short, simple questions, and every effort was made to render the Chinese translation of the SHS easily understandable and applicable to the Chinese elderly in the present study. In version 3, there are 20 items, including 9 positively and 11 negatively worded items. Each of the 20 items is rated on a scale of 1 never , 2 rarely , 3 sometimes , and 4 often.
After reverse scoring appropriate items, loneliness scores were calculated by summing all items. The range of possible scores was 20 to 80, with higher scores signifying greater loneliness.
Scores from 30 to 40 are considered a normal experience of loneliness, while scores above 60 indicate that a person is experiencing severe loneliness. Reliability testing indicates that the internal consistency of this scale has a Cronbach's alpha ranging from 0.
The Life Satisfaction Index-A [ 43 ] form scale consists of 18 questions related to five different components: zest, resolution and fortitude, congruence between desired and achieved goals, positive self-concept and mood tone.
Items scored 1 point for agree and 0 for disagree. Reverse scoring appropriate items provided a range of scores from 0 to 18, with the highest scores indicating the greatest satisfaction.
Several statistical methods were used in data analysis. The Chi-square and Mann-Whitney U tests were used to determine any differences between the experimental and control groups, while the Wilcoxon Signed Ranks Test was used to examine differences within groups over two occasions. The Friedman test was used to detect changes in the happiness and pain scores throughout the 8-week humor therapy in the experimental group.
Of the 70 older people who participated in the study, 36 were in the experimental group and 34 in the control group. There were 38 females and 32 males, and their ages ranged from 65 to 95 years, with the median age ranging from 80 to The mean age was Table 1 shows the demographic data and Figure 2 shows the locations of pain for participants in both groups. Most of the participants had been in a nursing home for 1—3 years. In terms of past health history, it was found that more participants in the control group had DM than in the experimental group.
In spite of this, these participants' DM condition had been stable and controlled by dietary interventions and or medication, thus the presence of DM was not considered to affect their performance and enjoyment of the humor therapy.
Other than their past health history, participants in the experimental and control groups were similar in terms of their demographic characteristics. Pain scores of 5. Because participants had experienced pain over the previous three months, it was regarded as chronic pain.
As such, there was a significant reduction in pain scores from 5. However, there was no such significant reduction in pain or increase in happiness and life satisfaction for participants in the control group. The Friedman test was used to test the changes in the happiness and pain scores across the 8-week humor therapy program. Pain and happiness scores over the 8-week humor therapy program.
The Friedman Test was used. The present study demonstrated the therapeutic effects of humor therapy in reducing pain and loneliness and enhancing happiness and life satisfaction among older people with chronic pain living in nursing homes.
The prevalence and impact of chronic pain continue to increase; as such, the day-to-day management of chronic pain presents a major challenge. The pain intensity was found to be high, with a mean pain intensity of more than five on a point numeric pain scale. These findings were consistent with the literature, suggesting that older residents in nursing homes were in pain [ 5 , 6 , 10 ]. These findings illustrate the impact of chronic pain on the quality of life of older people.
One of the primary causes of a sedentary lifestyle is chronic pain, and this is more common among the elderly [ 44 ]. As a result of pain, it is difficult for older people to perform regular exercise and engage in social events. Indeed, chronic pain limits physical and functional mobility and ambulation, leading to muscle atrophy and causing falls and injury [ 45 ].
Unfortunately, the use of medications and nonpharmacological methods as pain relief has been woefully inadequate. These findings are consistent with the literature regarding older people's actions to seek medications [ 14 , 15 ]. It may be difficult to encourage patients to demand more complete relief of pain. To this end, nonpharmacological interventions can be very effective for all types and intensity of pain, and are thus recommended when used concurrently with pharmacological interventions in the treatment of pain [ 46 ].
It is also worrying to find that participants in both the experimental and control groups had low happiness and life satisfaction scores, and also moderately high scores in loneliness at the baseline. The maximum score for happiness was 28, with higher scores reflecting greater happiness; as such, the happiness scores of around 16 for both experimental and control groups indicate a relatively low level of happiness. Likewise, the maximum score for life satisfaction was 18, and scores of around 10 for participants in both groups indicated relatively low satisfaction in life.
It is also worrying to find that the loneliness scores were around 42 for older people in both groups, indicating experiences of loneliness. These findings were consistent with the literature suggesting that residents in nursing homes experienced relational losses including loss of spouse, relatives and friends, and that these losses may lead to social isolation and loneliness [ 47 ].
As such, nursing home residents are found to be socially isolated and feeling very lonely [ 48 , 49 ]. The cognitive therapy for managing pain emphasizes the role of cognitive, affective and behavioral factors in the development and maintenance of chronic pain Castro-Lopes, Cognitive therapy reduces feelings of helplessness and lack of control, and establishes a sense of control over pain.
As such, older persons with chronic pain learn to use various techniques to effectively deal with episodes of pain. In this regard, the use of humor therapy appears to be an effective cognitive, nonpharmacological intervention in chronic pain management, enhancing happiness and life satisfaction and reducing loneliness for older people.
The needs of older people include pride, maintaining dignity, social contacts, and activity [ 50 ]. Upon completion of the humor therapy, participants in the experimental group had a significant reduction in pain sensation and felt less loneliness, and they were happier and more satisfied with their lives. Participants did express happiness and laughter. They shared and laughed at their own funny stories, and were able to appreciate life situations from a humorous perspective.
They also felt like members of a team when engaged in the laughing and humor activities. There was no significant change in the pain score, happiness and life satisfaction among older persons in the control group. It may not be safe to forgo your conventional medical treatment and rely only on an alternative therapy.
Maldonado PhD - Behavioral Health. Author: Healthwise Staff. This information does not replace the advice of a doctor. Healthwise, Incorporated, disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use. Learn how we develop our content. To learn more about Healthwise, visit Healthwise. Healthwise, Healthwise for every health decision, and the Healthwise logo are trademarks of Healthwise, Incorporated.
Updated visitor guidelines. Furthermore, endorphins secreted by laughter can help when people are uncomfortable or in a depressed mood. Laughter therapy is a noninvasive and non-pharmacological alternative treatment for stress and depression, representative cases that have a negative influence on mental health. In conclusion, laughter therapy is effective and scientifically supported as a single or adjuvant therapy. Put up a funny poster in your office. Choose a computer screensaver that makes you laugh.
Frame photos of you and your family or friends having fun. Remember funny things that happen. If something amusing happens or you hear a joke or funny story you really like, write it down or tell it to someone to help you remember it. Many things in life are beyond your control—particularly the behavior of other people. Find your inner child. Pay attention to children and try to emulate them—after all, they are the experts on playing, taking life lightly, and laughing at ordinary things.
Deal with stress. One great technique to relieve stress in the moment is to draw upon a favorite memory that always makes you smile—something your kids did, for example, or something funny a friend told you. Think of it like exercise or breakfast and make a conscious effort to find something each day that makes you laugh. Set aside 10 to 15 minutes and do something that amuses you.
The ability to laugh, play, and have fun not only makes life more enjoyable but also helps you solve problems, connect with others, and think more creatively. People who incorporate humor and play into their daily lives find that it renews them and all of their relationships. Life brings challenges that can either get the best of you or become playthings for your imagination.
But when you play with the problem, you can often transform it into an opportunity for creative learning. Playing with problems seems to come naturally to children. When they are confused or afraid, they make their problems into a game, giving them a sense of control and an opportunity to experiment with new solutions. Interacting with others in playful ways helps you retain this creative ability. Here are two examples of people who took everyday problems and turned them around through laughter and play:.
Roy , a semi-retired businessman, was excited to finally have time to devote to golf, his favorite sport. But the more he played, the less he enjoyed himself. Although his game had improved dramatically, he got angry with himself over every mistake. Roy wisely realized that his golfing buddies affected his attitude, so he stopped playing with people who took the game too seriously. When he played with friends who focused more on having fun than on their scores, he was less critical of himself.
Now golfing was as enjoyable as Roy had envisioned. He scored better without working harder. And the brighter outlook he was gaining from his companions and the game spread to other parts of his life. Jane worked at home designing greeting cards, a job she used to love but now felt had become routine.
Two little girls who loved to draw and paint lived next door. Eventually, Jane invited the girls over to play with all of her art supplies. At first, she just watched, but in time she joined in. Not only did it end her loneliness and boredom, but it sparked her imagination and helped her artwork flourish.
As laughter, humor, and play become integrated into your life, your creativity will flourish and new opportunities for laughing with friends, coworkers, acquaintances, and loved ones will occur to you daily.
Laughter takes you to a higher place where you can view the world from a more relaxed, positive, and joyful perspective. This holiday season alone, millions of people will turn to HelpGuide for free mental health guidance and support. So many people rely on us in their most difficult moments.
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