The effect of humor on anxiety in patients receiving hemodialysis: An open-label, randomized trial

Authors

1 1 Clinical Research Center, Department of Operating Room, School of Paramedics, Sabzevar University of Medical Sciences, Sabzevar, Iran

2 Iranian Research Center on Healthy Aging, Department of Nursing, Nursing and Midwifery School, Sabzevar University of Medical Sciences, Sabzevar, Iran

3 Student Research Committee, Faculty Member of Paramedicine School, Sabzevar University of Medical Sciences, Sabzevar, Iran

4 Department of Paramedical School, Sabzevar University of Medical Sciences, Sabzevar, Iran

5 Student Research Committee, School of Nursing, Mashhad University of Medical Sciences, Mashhad, Iran

6 Department of Biostatistics, Student Research Committee, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran

7 School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada

Abstract

Background: Patients receiving hemodialysis experience high levels of anxiety and stress. Objectives: This study aimed to examine the effect of humor on anxiety in patients receiving hemodialysis. Methods: This open-label, randomized, controlled trial was conducted in 2018, on 63 patients receiving hemodialysis in Sabzevar, Iran. The participants were randomly assigned to an intervention and a control group using a permuted block randomization method. The intervention group participated in humor therapy sessions twice a week for 3 weeks. The control group received no intervention. Data were collected using Spielberger's State-Trait Anxiety Inventory (STAI) before and 3 weeks after the intervention. Data were analyzed using the independent samples and the paired t tests. Results: The mean age of the participants was 61.85 ± 7.93 and 54.61 ± 5.89 in the intervention and control groups, respectively (P = 0.217). The mean baseline and posttest trait anxiety (TA) scores were not significantly different between the two groups (P = 0.152 and 0.170, respectively). Also, the mean baseline scores of state anxiety (SA) in the intervention and the control groups were 48.45 ± 14.21 and 47.28 ± 15.12, respectively (P = 0.133). However, after the intervention, the mean score of SA decreased to 27.45 ± 16.65 in the intervention group (P < 0.001), but this score increased to 49.43 ± 15.42 in the control group (P = 0.227). Conclusion: Humor therapy was effective in reducing SA. Hence, nurses working in hemodialysis departments are advised to use humor therapy as an easy, low-cost, and effective complementary therapy to reduce patients' anxiety during a hemodialysis session.

Keywords


1. El-Monshed A, El-Etreby R, Mahgoub N, El-Boraie O. Effect
of cognitive behavioral nursing intervention on depression and
anxiety among patients on maintenance hemodialysis. J Nurs
Health Sci 2019;8:58-67.
2. Nematollahi  M, Bazeli J, Moghaddam  M, Aalami  H. Effect
of aromatherapy on anxiety in patients with acute coronary
syndrome hospitalized in cardiac care unit. Bali Med J
2017;6:331-6.
3. Hmwe NT, Subramanian P, Tan LP, Chong WK. The effects of
acupressure on depression, anxiety and stress in patients with
hemodialysis: A randomized controlled trial. Int J Nurs Stud
2015;52:509-18.
4. Goh  ZS, Griva  K. Anxiety and depression in patients with
end-stage renal disease: Impact and management challenges:
A narrative review. Int J Nephrol Renovasc Dis 2018;11:93-102.
5. Gerogianni  G, Babatsikou  F, Polikandrioti  M, Grapsa  E.
Management of anxiety and depression in haemodialysis
patients: The role of non-pharmacological methods. Int Urol
Nephrol 2019;51:113-8.
6. Gonot-Schoupinsky  FN, Garip  G. Laughter and humour
interventions for well-being in older adults: A  systematic
review and intervention classification. Complement Ther Med
2018;38:85-91.
7. Zhao  J, Yin  H, Zhang  G, Li  G, Shang  B, Wang  C, et  al. A
meta-analysis of randomized controlled trials of laughter and
humour interventions on depression, anxiety and sleep quality
in adults. J Adv Nurs 2019;75:2435-48.
8. Pérez-Aranda  A, Hofmann  J, Feliu-Soler  A, RamírezMaestre C, Andrés-Rodríguez L, Ruch W, et al. Laughing away
the pain: A narrative review of humour, sense of humour and
pain. European j pain (London, England) 2019;23:220-33.
9. De  Francisco  S, Torres  C, De  Andrés  S, Millet  A, Ricart  MT,
Hernández-Martínez-Esparza  E. Effectiveness of integrative
laughter therapy to reduce anxiety, improve self-esteem and
increase happiness: A  naturalistic study at a day hospital for
addictive disorders. Int J Environ Res Public Health. 2019;16:4194.
10. Macaron  G, Fahed  M, Matar  D, Bou-Khalil  R, Kazour  F,
Nehme-Chlela  D, et  al. Anxiety, depression and suicidal
ideation in Lebanese patients undergoing hemodialysis.
Community Ment Health J 2014;50:235-8.
11. Yoshikawa Y, Ohmaki E, Kawahata H, Maekawa Y, Ogihara T,
Morishita  R, et  al. Beneficial effect of laughter therapy on
physiological and psychological function in elders. Nurs Open
2019;6:93-9.
12. Kalaivani  S, Rajkumar  K. Laughter is the best medicine for
stress relief. Int J Adv Nurs Manage 2017;5:262-4.
13. Nelson  AM. Effects of Laughter on Self-Reported and
Psychophysiological Measures of Stress. The University ofWisconsin-Milwaukee; 2017. Available from: https://dc.uwm.
edu/cgi/viewcontent.cgi?article=2522&context=etd. [Last
accessed on 2021 Jun 20].
14. Bennett PN, Parsons T, Ben-Moshe R, Weinberg M, Neal M,
Gilbert K, et al. Laughter and humor therapy in dialysis. Semin
Dial 2014;27:488-93.
15. Spielberger Ch, Gorsuch R, Lushene R, Vagg PR. Jacobs G.
Manual for the State-Trait Anxiety Inventory (Form Y1 – Y2).
Palo Alto, CA: Consulting Psychologists Press; 1983.
16. Tulgar S, Boga I, Piroglu MD, Ates NG, Bombaci E, Can T,
et  al. Preoperative anxiety before spinal anesthesia: Does
internet-based visual information/multimedia research decrease
anxiety and information desire? A  prospective multicentered
study. Anesth Essays Res 2017;11:390-6.
17. Stojanović NM, Ranđelović PJ, Nikolić G, Stojiljković N, Ilic S,
Stoiljković B. Reliability and validity of the Spielberger’s StateTrait Anxiety Inventory (STAI) in Serbian university student
and psychiatric non-psychotic outpatient populations. Acta
Facult Med Nais 2020;37:149-59.
18. Delgado AM, Freire AD, Wanderley EL, Lemos A. Analysis of the
construct validity and internal consistency of the state-trait anxiety
inventory (STAI) state-anxiety (S-anxiety) scale for pregnant
women during labor. Rev Bras Ginecol Obstet 2016;38:531-7.
19. Sousa  L, Antunes  V, Marques-Vieira  C, Silva  P, Severino  S,
Helena  J. Effect of humor intervention on well-being,
depression, and sense of humor in hemodialysis patients.
Enferm Nefrológ 2019;22:256-65.
20. Bennett PN, Hussein WF, Reiterman M, Yu J, Schiller B. The
effects of laughter therapy on depression symptoms in patients
undergoing center hemodialysis: A  pragmatic randomized
controlled trial. Hemodial Int 2020;24:541-9.
21. Demir  Doğan  M. The effect of laughter therapy on anxiety:
A meta-analysis. Holist Nurs Pract 2020;34:35-9.
22. Bennett  PN, Parsons  T, Ben-Moshe  R, Neal  M,
Weinberg  MK, Gilbert  K, et  al. Intradialytic laughter yoga
therapy for haemodialysis patients: A  pre-post intervention
feasibility study. BMC Complement Altern Med 2015;
15:176.
23. Genç H, Saritas S. The effects of watching comedy videos on
anxiety and vital signs in surgical oncology patients. Explore
(Ny) 2020;16:401-6.
24. Sarıtaş S, Genç H, Okutan Ş, İnci R, Özdemir A, Kizilkaya G.
The effect of comedy films on postoperative pain and
anxiety in surgical oncology patients. Complement Med Res
2019;26:231-9.
25. Grases  G, Sánchez-Curto  C, Rigo  EA, Adrover-Roig  D.
Relationship between positive humor and state and trait
anxiety. Ansiedad Estres 2012;18:79-90.
26. Shelton G. How and When Can Humor Be Therapeutic? Creating
Heathy Work Environments 2019. Available from: https://
sigma.nursingrepository.org/bitstream/handle/10755/16660/
Shelton_93863_A05.pdf?sequence=1&isAllowed=y. [Last
accessed on 2020 Jun 12].