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Effect of Humor Therapy on Blood Pressure of Patients Undergoing Hemodialysis

December 2017
Journal of Research in Medical and Dental Science 5(6)

DOI:10.24896/jrmds.20175615

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Shahid Beheshti University of Medical Sciences

One of the problems of the twenty-first century health community is the increasing prevalence of chronic diseases and the side effects of their treatment. Chronic renal failure undergoing hemodialysis is such a disease and controlling its complications through a low-risk approach is of utmost importance. Humor therapy is one of complementary treatment methods which can help these patients. The present study aimed to investigate the effects of humor therapy on blood pressure of patients undergoing hemodialysis in Bu-Ali Sina Hospital of Qazvin in 2010-2011. A total of 26 females and 14 males participated in this pre-and post-intervention clinical trial. The data were collected with a mercury manometer. Humor therapy was performed during hemodialysis using a CD for 30 minutes, 2 sessions per week for 8 weeks. The data were analyzed with SPSS-16. Findings: This study showed that humor therapy is effective on blood pressure of hemodialysis patients (p<0.001). Conclusion: Humor therapy can reduce blood pressure in hemodialysis patients.

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Journal of Research in Medical and Dental Science

Volume 5, Issue 6, Page No: 85-88

Available Online at: www.jrmds.in

eISSN No. 2347-2367: pISSN No. 2347-2545

Journal of Research in Medical and Dental Science | Vol. 5 | Issue 6 | December 2017

Effect of Humor Therapy on Blood Pressure of Patients Undergoing

Hemodialysis

Zahra Moshtag Eshg

, Jaleh Ezzati

, Navideh Nasiri

, Raziyeh Ghafouri

Assistant Professor, School of Nursing and Midwifery, Shahid beheshti University of Medical

Sciences, Tehran, Iran

PhD Student, Student Research committee, School of Nursing and Midwifery, Iran University of

Medical Sciences, Tehran, Iran

DOI: 10.24896/jrmds.20175615

ABSTRACT

One of the problems of the twenty-first century health community is the increasing prevalence of chronic

diseases and the side effects of their treatment. Chronic renal failure undergoing hemodialysis is such a

disease and controlling its complications through a low-risk approach is of utmost importance. Humor

therapy is one of complementary treatment methods which can help these patients. The present study aimed

to investigate the effects of humor therapy on blood pressure of patients undergoing hemodialysis in Bu-Ali

Sina Hospital of Qazvin in 2010-2011. A total of 26 females and 14 males participated in this pre- and post-

intervention clinical trial. The data were collected with a mercury manometer. Humor therapy was

performed during hemodialysis using a CD for 30 minutes, 2 sessions per week for 8 weeks. The data were

analyzed with SPSS-16. Findings: This study showed that humor therapy is effective on blood pressure of

hemodialysis patients (p<0.001). Conclusion: Humor therapy can reduce blood pressure in hemodialysis

patients.

Keywords: Humor Therapy, Hemodialysis, Blood Pressure

HOW TO CITE THIS ARTICLE:

hra Moshtag Eshg, Jaleh Ezzati

, Nav

ideh Nasiri, Raziyeh Ghafouri

Effect of Humor Therapy on

Blood Pressure of Patients Undergoing Hemodialysis, J Res Med Dent Sci, 2017, 5 (6):85-88, DOI: 10.24896/jrmds.20175615

Corresponding author: Raziyeh Ghafouri

e-mailghafouri.r@tak.iums.ac.ir

Received: 15/10/2016

Accepted: 20/03/2017

INTRODUCTION

The increasing prevalence of chronic diseases is

the most prominent problem in human societies

faced with health staff in the twenty-first

century [1]. Advances in the methods of

treatment and health care as well as increased

life expectancy are the causes of the increased

prevalence of chronic diseases [2]. Chronic renal

failure (CRF) is a chronic disease with a growing

prevalence [3]. CRF is referred to irreversible

renal dysfunction which often leads to the end

stage renal disease (ESRD) [4] and the patients

require hemodialysis (peritoneal dialysis) [5, 6].

Although hemodialysis can increase life

expectancy, it cannot alter the natural course of

the disease, is not a perfect substitute for full

function of kidneys, results in numerous

complications in patients, and leads to physical,

mental, and social problems for patients and

their families [7]. Hypertension is the first and

earliest sign of renal failure [8] and if left

untreated, results in cardiovascular disease as

the most common cause of death in renal failure

patients [9]. About 80 to 90 percent of patients

with renal failure are hypertensive and if left

untreated, it may result in myocardial disorders

in the form left ventricular hypertrophic

cardiomyopathy [10].

Regarding the use of humor in nurse

interactions, Riley stated that humor is a way of

communication between nurses and patients

and facilities training to patients [11]. humor

can be an important tool in coping with the

disease and reduces its stress. Several studies

have been conducted on negative emotions,

while positive emotions such as happiness and

satisfaction are less studied [12].

Hostler wrote that humor reduces anxiety,

relieves pain, and relaxes muscles [13].

Raziyeh Ghafouri et al J Res Med Dent Sci, 2017, 5 (6):85-88

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Journal of Research in Medical and Dental Science | Vol. 5 | Issue 6 | December 2017

Research has shown that humor can reduce

blood pressure [14], acute pain [15], chronic

pain [16], stress hormones, raise self-esteem,

decrease depression [17] increase enkephalin

and endorphin [18] and cardiac output [19], and

improve pulmonary ventilation [20]. Laughter is

effective in preventing hyperglycemia-induced

renal failure [21] and in reducing anxiety in the

first hemodialysis [22]. In this regard, the

present study aimed to determine the effect of

humor therapy on blood pressure of

hemodialysis patients in Bu-Ali Sina Hospital of

Qazvin in 2010-2011.

MATERIALS AND METHOD

A total of 41 patients referred to Bu-Ali Sina

Hospital in Qazvin for hemodialysis were

enrolled in the study based on inclusion criteria

which were chronic renal failure treated with

hemodialysis, willingness to participate in the

research, constant blood pressure (no greater

than 20% fluctuations in blood pressure a

month before starting the study), and using a

method such as venous fistula for dialysis a

month before starting the study. The data were

collected using a demographic questionnaire, a

mercury manometer, and two depression

assessment tools. Exclusion criteria were

fluctuations in blood pressure, changing dialysis

method, and unwillingness to continue the

research. A participant excluded from the study

during the study due to changing the dialysis

method.

The demographic questionnaire included 11

items about demographic information and 14

items about the disease. Mercury manometer

was calibrated and its reliability was assessed

through the intra-rater test giving rise to a

Pearson correlation coefficient of 0.93 after 10

repeats. Reliability of the researcher was

assessed through the inter-rater test and after

10 times measurement of blood pressure by the

researcher and another nurse, the Pearson

correlation coefficient was obtained 0.94.

In the first session of laughter therapy, the mean

blood pressure of participants was measured by

the researcher prior to initiation of dialysis

using the mercury manometer. The CD used in

the research was provided to the Security Office

of Qazvin University of Medical Sciences, the

Cultural Council of Qazvin University of Medical

Sciences, and the Public Relations of Qazvin

University of Medical Sciences and was

approved by the Deputy of Student and Cultural

Affairs. The participants in both groups were

undergone hemodialysis in two groups of 15-20

people and humor therapy was performed 30

minutes after initiation of dialysis therapy using

the approved CD for 30 minutes. Blood pressure

was measured at the end of the first session

after the end of hemodialysis. Humor therapy

and data collection was continued for 8 weeks, 2

sessions per week (totally 16 sessions). Blood

pressure was monitored at all sessions during

the study, and in case of sudden changes (more

than 20% to the previous blood pressure), the

subject was excluded from the study. During this

research, none of the participants had more

than 20% change in blood pressure compared

with the previous measurement. The maximum,

minimum, and mean arterial blood pressures of

the participants were measured at the beginning

and end of hemodialysis in the first and last

sessions of humor therapy and the obtained

data were analyzed with independent t-test and

paired t-test.

RESULTS

A total of 26 women and 14 men with a mean

age of 56 years were participated in this study.

The most common cause of morbidity was

hypertension followed by hyperglycemia. There

was no significant difference between men and

women in the blood pressure (p>0.05). No

significant difference was found between the

cause of renal failure and hypertension

(p>0.05).

According to paired t-test, a significant

difference existed between blood pressure in

the first and last sessions of humor therapyat all

times of investigation (beginning of

hemodialysis, an hour after the initiation of

dialysis, and at the end of humor), which shows

that humor therapy is effective on blood

pressure in patients undergoing hemodialysis

(p>0.001). Unilateral evaluation of the effect of

humor therapy also showed that humor therapy

can decrease blood pressure of patients

undergoing hemodialysis (p>0.001).

Raziyeh Ghafouri et al J Res Med Dent Sci, 2017, 5 (6):85-88

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Journal of Research in Medical and Dental Science | Vol. 5 | Issue 6 | December 2017

Table 1: Result of blood pressure comparison in first and last sessions of hemodialysis

DISCUSSION

In this study, 65% of the participants were

female and 35% were male. The most common

cause of renal failure in the present study was

hypertension followed by hyperglycemia.

According to Andreoli et al., the most common

cause of renal failure was hyperglycemia and

then hypertension [23]. Their finding was same

as this study.

This study showed that humor can reduce blood

patient undergoing heamodialysis. Jalali et al.

demonstrated that humor therapy is effective in

reducing blood pressure [14]. Humor reduces

blood pressure by influencing vessel wall

performance through two ways:

1. Activation of nitric oxide secretion [20].

2. Effect on the activity of vasoconstrictors

receptors and reducing their activity and

number [24].

Further research is needed regarding the

therapeutic effect of laughter on blood pressure

to explicitly claim that downregulation of blood

pressure with humor therapy is whether

through activating the secretion of nitric oxide

in blood vessels and reduction of

catecholamines (stress hormones) or through

regulation of vessel wall receptors and affecting

neurotransmitters receptors of the endocrine

system in two directions and regulation of blood

pressure within normal limits [24]. In a study by

Wolter et al., no significant difference existed

between drug therapy and drug therapy plus

humor therapy; the reason of which was

attributed to the existence of drug therapy in

both groups of intervention and control [25].

On the other hand, Martin confirmed the

therapeutic effect of humor on the psychologic

and refused its physical effects [26]. Cutdif and

McKenna did not confirm the physiological

effects of laughter therapy; this was attributed

to the lack of research on positive emotions and

their performance in small statistical societies.

They suggested more research in this field in

order to demonstrate the physical effects of

humor [12].

CONCLUSION

According to the findings of this research,

humor therapy is effective in reducing blood

pressure in patients undergoing hemodialysis.

Acknowledgement

The author would like to thank the nurses and

staffs of the dialysis ward of Bu-Ali Sina

Educational Hospital of Qazvin University of

Medical Sciences that helped us in conducting

this study.

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Raziyeh Ghafouri et al J Res Med Dent Sci, 2017, 5 (6):85-88

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Journal of Research in Medical and Dental Science | Vol. 5 | Issue 6 | December 2017

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Benefits of laughter-inducing and humor nursing interventions in people undergoing hemodialysis

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Objective: To know the health and welfare benefits of Laughter-inducing and humor nursing interventions in people with CKD undergoing haemodialysis. Methods: Systematic Review of Literature (RSL). The research was conducted between November 2018 and May 2019. Articles were selected through the Biblioteca Virtual em Saúde (BVS) and EBSCOhost databases, whose research was complemented by Google Scholar. Articles published between 2014 and 2019 were searched and articles published with the Portuguese, English and Spanish language were used as criteria for inclusion, articles available with full text, referring to elderly / elderly people undergoing haemodialysis, which included primary experimental studies and quasi-experimental and that use as intervention humor, laughter-inducing therapy. Results: Five articles were selected, with quasi-experimental studies showing the control and reduction of blood pressure, the quality of life, the promotion of well-being (happiness and satisfaction with life in general), the reduction of depression, stress and anxiety and increased sense of humor are the main benefits of laughter-inducing and humor nursing interventions. Conclusion: Laughter-inducing and humor nursing interventions have benefits in the health and well-being of people undergoing haemodialysis and help them cope with disease and treatment.

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A Systematic Review of the Effects of Laughter on Blood Pressure and Heart Rate Variability

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In this systematic review, we sought to understand the effects of laughter-inducing interventions on blood pressure and heart rate variability. For this purpose, we identified 32 relevant records through database searching. The results suggest that laughter is associated with a decrease in blood pressure in pre-post measurements. However, this association varies according to the type of intervention delivered and the characteristics of participants. In controlled between-groups comparisons, the effect of laughter-inducing interventions on blood pressure was found to be non-significant, which can be due to the small number of studies available and its high level of heterogeneity. In studies involving heart rate variability, the most consistent findings point to an association between laughter and decreases in both frequency (LF/HF) and time-domain (SDNN) indicators. Longitudinal studies suggest that laughter frequency is associated with improved cardiovascular health. Several studies presented sub-optimal levels of quality, and more research is necessary to examine the impact of individual and intervention-related factors in the effectiveness of laughter-inducing interventions in cardiovascular health.

Laughter and humour for personal development: A systematic scoping review of the evidence

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Introduction The accessibility of laughter and humour make them attractive choices for self-care, and integrative medicine. There is a growing body of literature, but both fields are fragmented and the overall evidence has not been systematically reviewed. The relationship between health and personal development is increasingly recognized. This review scopes the evidence for laughter and humour interventions from the perspective of their potential benefits on personal development. Methods A systematic scoping review used Joanna Briggs guidelines and the Preferred Reporting Items for Systematic Reviews Scoping Review extension (PRISMA-ScR). All-population laughter and humour interventions described in primary and secondary research from 1970, and in English, were searched in Web of Science and PubMed/Medline. Results Analysis of 240 primary research articles (k), and 11 systematic reviews (K), identified k = 564 discrete articles with studies involving 574,611 participants (n). Twelve large studies (n >15,000) contributed 77% of participants. Classification analysis found more research relating to humour (k = 445, n = 334,996) than laughter (k = 119, n = 239,615) and identified diverse personal development outcomes associated with Biological, Psychological, Social, Environmental, and Behavioural (BPSE-B) factors. Conclusion This review presents growing evidence for the diverse applications and benefits of laughter and humour. Multiple opportunities for self-care and interventional applications are described. The consideration of personal development outcomes may support tailored applications according to specific needs and objectives. An umbrella Personal Development Theory of laughter and humour, inclusive humour and laughter definitions, and a humour-laughter-affect model are proposed to unify the fields.

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Diabetes can take a tremendous toll on physical and psychological health. Given the growing evidence of the benefits of humor, this study examined the association between diabetes and humor. The sample consisted of 249 participants: 72.3% with type 1 diabetes, 70.3% female, 89.5% Caucasian, and 70.9% college educated. Participants completed the Humor Styles Questionnaire (HSQ) and were compared with HSQ norms. On the affiliative humor scale, the diabetes group did not differ from the norm (P >0.05), nor did those with type 1 diabetes (P >0.05). Scores of those with type 2 diabetes were lower than the norm (P <0.05). On the self-enhancing humor scale, the diabetes group did not differ from the norm (P >0.05), nor did the subgroups with type 1 diabetes (P >0.05) or type 2 diabetes (P >0.05). The diabetes group was lower than the norm on aggressive humor (P <0.01), as were the subgroups with type 1 diabetes (P <0.01) and type 2 diabetes (P <0.05). The diabetes group was higher than the norm on self-defeating humor (P <0.01), as were the subgroups with type 1 diabetes (P <0.01) and type 2 diabetes (P <0.01). Results suggest that people with either type of diabetes are more inclined toward self-enhancing humor, are less inclined toward aggressive humor, and score higher on self-defeating humor, and those with type 1 diabetes are also inclined toward affiliative humor. Results are discussed relative to the sample being comprised of individuals with good glycemic control (mean A1C 7.06 ± 1.39%). This study offers a preliminary comparison of humor among people with diabetes versus those in a healthy norm group without diabetes.

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End stage renal disease (ESRD) is a growing problem. The effect of patient counseling is to be defined on health-related quality of life. Objective: The purpose of this study was to find out the impact of patient counseling in health related quality of life (QoL). Methods: In this prospective interventional study, the Karnofsky Performance Status (KPS) for QoL questionnaire was used in test and control groups for data collection. The same data collection method was used during six months to study the effect of patient counseling. Results: Health related quality of life in test group showed a consistent improvement of 2% in six months. Improvement of awareness by patient counseling was also improved. Conclusion: As part of medication therapy management (MTM), patient counseling focusing on dialysis compliance, diet and medications are an effective way to improve health-related QoL and awareness in ESRD. Such services should be made mandatory by law in India to improve outcomes in chronic illness.

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It has become increasingly recognized and more widely acknowledged during the past several decades, that a complex relationship exists between behavior associated with emotion and the human cardiovascular (CV) system. Early studies focused on the interplay between negative emotions and elevated CV risk, an effect that has in large part been attributed to increased adrenergic activity. Thus, a variety of adverse CV effects ranging from sudden cardiac death triggered by natural disasters such as earthquakes to transient myocardial stunning resulting from heightened sympathetic overload have been identified in response to acute emotional distress. In fact, the biologic interplay between emotion and CV health has been greatly enhanced through studies of the vascular endothelium. As the largest organ in humans, the inner blood vessel lining serves as a conduit for the transfer of blood cells, lipids and various nutrients across the lumen to neighboring tissues. Healthy endothelial cells secrete vasoactive chemicals, most notably endothelial-derived relaxing factor or nitric oxide (NO), that effects smooth muscle relaxation and vessel dilation via a cyclic guanosine monophosphate (cGMP) dependent protein kinase signaling pathway. In addition, endothelial derived NO may reduce vascular inflammation by attenuating or inhibiting leukocyte adhesion and subendothelial transmigration as well as decreasing platelet activation via cGMP mediated pathways. Taken together, studying the endothelium provides an exceptional opportunity to advance our understanding of the potentially important interrelationship between emotions and the vasculature. Premised on the identification of physiological and biochemical correlates, the former was demonstrated after intracoronary administration of acetylcholine yielded paradoxical endothelial vasoconstriction in response to mental stress exercises. More recently, the brachial artery reactivity test (BART) has permitted endothelial function to be assessed in a non-invasive manner. In addition to traditional CV risk factors, exposure to negative emotions including mental stress and depression have been associated with reduced endothelial vasoreactivity as measured by BART. Whether mirthful laughter has the opposite effect garnered consideration following the discovery that mu3 opiate receptors were expressed in the vascular endothelium. Because mirthful laughter induces the release of beta-endorphins which in turn have high affinity for mu3 opiate receptors, we hypothesize that such positive emotions lead to the direct release of NO and associated biological consequences. Indeed, our studies have demonstrated opposing effects on endothelial vasoreactivity between those previously established (e.g., mental stress induced by negative visual and/or auditory stimuli) and those induced after mirthful laughter, thereby providing a potential mechanistic link between positive emotions and beneficial effects on the vasculature. This article reviews the relevant physiology and comments on the potentially wider clinical implications in the integration of this process to improve vascular health.

Impact of cinematic viewing on endothelial function

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Mar 2006
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Chronic life stressors such as depression, anxiety, hostility, and anger may contribute to increased risk of coronary heart disease,1 in part by impairing endothelial function.2,3 Although coronary heart disease may also be associated with attenuated positive emotions as shown by reduced situational humour,4 little if any information is available regarding the potential impact of positive emotions on vascular reactivity. Because cinematic viewing evokes a range of negative and positive emotions, the present study was designed to compare the effect of mental stress versus laughter on endothelial function. Twenty non-smoking, healthy men and women, mean (SD) age 33 (7) years, with normal blood pressure, cholesterol, and blood glucose provided written informed consent to participate in this randomised and counterbalanced, crossover study approved by the institutional review board. After an overnight fast that included abstinence from alcohol, vitamins, herbs, and aerobic activity, volunteers had a baseline brachial artery reactivity test and were then randomly assigned to view a 15–30 minute segment of a movie designed …

Guyton and Hall Textbook of Medical Physiology

Article

Jan 2011

J.E. Hall

Braunwald's Heart Disease

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Dec 2011

New Medical Dictionary

Book

Jan 1890

George M. Gould

Humor as a cognitive technique for increasing pain tolerance

Article

Nov 1995
PAIN

Substantial research has demonstrated that cognitive psychological techniques including distraction can increase pain tolerance. In recent years, there also have been claims that humor and laughter possess unique characteristics for coping with pain and stress. Theoretically, explanations include the release of endorphins, the lowering of tension, as well as the distraction that results from humor. The question is whether humor is more effective than simple distraction. For this purpose humor was contrasted with a repulsive stimulus and a neutral stimulus controlled for interest level, that would also have distraction capabilities but not the unique aspects of humor. Pain tolerance was tested using cold pressor stimulation. Four groups (20 subjects in each) were tested. Three groups were shown a film: (1) a humorous film, (2) a repulsive film, (3) a neutral film. Group 4 was not shown any film. Results indicated that both the humor and repulsive groups showed a significant increase in pain tolerance as compared to the other groups. The repulsive group yielded the largest increase in pain tolerance although not different from the humor group. Except for sex differences, pain ratings did not show any group effects. Discussion focused on the type of distraction that would be meaningful for increasing pain tolerance and on the place of humor in pain control.

Humour and dialysis

Article

Oct 1998

Z Leibovitz

There are many articles on the connection between the spirit and the body and the influence of a good mood on the way people deal with physical problems. This paper will demonstrate that the use of humour is a way of influencing our patients' spirit in order to help them deal with problems relating to their illness. In our every day experience with renal patients, we have noticed that humour helps us reduce patients' anxiety, before the first dialysis, before using the dialysis needles, or before performing painful procedures. Humour also helps us to offset the anger patients often express during treatment. Humour brings about a better atmosphere and the possibility of creating positive communication with the patients in a more relaxed environment and in a much more effective way. Our findings are similar to those in the literature and conclude that humour is an aid for dealing with patients' problems.

Humour and love: The origination of clown therapy

Article

Sep 2002

Patch Adams

Compassion, joy, love, and humour are essential to build healthy and peaceful societies The events of terror in the United States on 11 September 2001 have provoked many reactions and the traditional revenge/fear action. The casual, quick acceptance of this response globally, instead of outrage over more senseless carnage, is symptomatic, in medical jargon, of a massive malignant cancer in human society. Also symptomatic is that, on the same day, over 30 000 children died of starvation and there was no noise heard. As I explore the health of the human society, with the same tender, thoughtful compassion I have explored individual patients, I find the “patient” in critical condition, needing global universal attention. Why do we revere our diversions, and neglect our collective health? We live in a country where athletes and actresses are multimillionaires. Though school teachers are second only to mothers in supporting a healthy human society, in the US, 60% have to hold second jobs to support a family. Mechanisms need to be found to help midwife a human society that never needs war again; where all are cared for (and all of nature too), and life is a celebration. At this point in human history these goals can no longer be considered idealistic or naive. They are thoughtful imperatives if we want to get humans off the endangered species list. I know, after September 11th, everywhere I travelled I heard the nation echoing our president's immediate call to war. I started to ask my audiences if any of them had wondered what “love strategy” could effectively respond to terror? I've never heard any nation or people discuss a love strategy in the face of violence. We have to be the pioneers. First, we declare the intention to be peaceful and loving and, being present in …

Humor in Medicine

Article

Jan 2004

Howard J Bennett

Humor and laughter have been a focus of attention in the popular media and in the medical literature. Despite statements about the health benefits of humor, current research is insufficient to validate such claims. There is support in the literature for the role of humor and laughter in other areas, including patient-physician communication, psychological aspects of patient care, medical education, and as a means of reducing stress in medical professionals.

Effect of Humor Therapy on Blood Pressure of Patients Undergoing Hemodialysis

Abstract

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