The Effect of Laughter Therapy on Depression, Anxiety, and Stress in Patients with Breast Cancer Undergoing Radiotherapy

웃음요법이 방사선요법을 받는 유방암 여성의 우울, 불안, 스트레스에 미치는 효과

  • Published : 2009.08.31


Purpose: The purpose of this study was to investigate the of laughter therapy on depression, anxiety, and stress among patients underwent radiotherapy. Methods: Participants in the study were comprised of 60 breast cancer outpatients who received radiotherapy. Thirty-one of the patients were assigned in the experimental group and the other 29 patients made up the control group. Laughter therapy was consisted of the delivery of information and active motion resulting in laughter. We provided laughter therapy 4 times for 2 weeks. Each session lasted 60 min. The experimental group received laughter therapy intervention as a group. An average attendance frequency per person was 2.7. To evaluate the effect of laughter therapy, the degrees of depression and anxiety were measured by Hospital Anxiety and Depression (HAD) and stress was measured by the Brief Encounter Psychosocial Instrument (BEPSI). Data analysis included a 2-test, t-test, and Fisher's exact test using SPSS 12.0 and SAS 8.0. Results: There was significant decrease in the degrees of depression, anxiety, and stress in the experimental group compared to those in the control group (p<.01, p=.04, and p<.01, respectively). Conclusion: This study provides evidence that laughter therapy is an effective intervention in improving depression, anxiety, and stress in breast cancer patients.


  1. National Cancer Center. Annual report of national cancer registration. Seoul:Korean Ministry of Health and Welfare;2007.
  2. Gong GY, Kim MJ, Shim YH, Kang GH, Anh SH, Ro JY. Nationwide Korean breast cancer data of 2004 using breast cancer registration. J Breast Cancer 2006;9:151-61.
  3. Carpenter JS, Elam JL, Ridener SH, Carney PH, Cherry GJ, Cucullu HL. Sleep, fatigue and depressive symptom in breast cancer survivors and matched healthy women experiencing hot flashes. Oncol Nurs Forum 2004;31:591-8.
  4. Burgess C, Cornelius V, Love S, Grahamn J, Richard M, Ramirez A. Depression and anxiety in women with elderly breast cancer. BMJ 2005;330:702-5.
  5. Massie MJ. Prevalence of depression in patients with cancer. J Natl Cancer Inst Monogr 2004;32:57-71.
  6. Winnie KW, Gene M, Ling WM, Leung EY, Joe CK, Maggie Y, et al. The symptom cluster of fatigue, pain, anxiety and depression and the effect on the quality of life of women receiving treatment for breast cancer: a multicenter study. Oncol Nurs Forum 2009;36:205-14.
  7. Oberst MT, Hughes SH, Chang AS, McCubbin MA. Self-care burden, stress appraisal and mood among persons receiving radiotherapy. Cancer Nurs 1991;14(2):71-8.
  8. Park JH. Patterns and related factors of fatigue during radiotherapy in patients with breast cancer. J Korean Acad Adult Nurs 2003;15:33-44.
  9. Beck AT. The development of depression. A cognitive model: the psychology of depression. New York: John Wiely Sons;1974.
  10. Kim HC. Depression and anxiety in the cancer patients. J Pusan Psychiat 1998;7:81-9.
  11. Berk LS, Felten DL, Tan SA, Bittman BB, Westengard J. Modulation of neuroimmune parameters during the eustress of humor-associated mirthful laughter. Altern Ther Health Med 2001;7(2):62-76.
  12. Yang MS. The effects of laughter therapy on pain and state anxiety of spinal surgery patients [dissertation]. Jeonju:Chonbuk National Univ.;2008.
  13. Suh MJ, Kim KS. Effect of humor nursing intervention on the stress response for the cancer patient undergoing chemotherapy. Korean J Stress Res 1993;2:193-206.
  14. Kim HJ, Suh MJ. Effect of humor video tape on an anxiety, depression and coping of the impaired mobility patient. Seoul J Nurs 1996;10:203-17.
  15. Bennett HJ. Humor in medicine. South Med J 2003;96:1257-61.
  16. Kim KH, Lee MH. Effects of humor intervention program on anxiety, depression and coping of humor in hemodialysis patients. J Korean Acad Rehabil Nurs 1999;2:95-108.
  17. Lee JS, Kim KS, Kim MY, Oh SM, Oh SH, Lee HS. Effect of laughter therapy on sleep disturbance and depression in hemodialysis patient. Korean Clin Nurs Res 2006;9:107-50.
  18. Kim YS. Influence of laughter on stress response in the elderly [dissertation]. Busan:Busan Univ.;2006.
  19. Battle J. Relationship between self-esteem and depression. Psychosoc Rep 1978;4(3 Pt 1):745-6.
  20. Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand 1983;67:361-70.
  21. Oh SM, Min KJ, Park DB. A study on the standardization of the hospital anxiety and depressed scale for Koreans. J Korean Neuropsychiat Assoc 1999;38:289-96.
  22. Spielberger CD. Anxiety as an emotional state. In:Spielberger CD editor. Anxiety: current trends theory and research. New York:Academic Press;1972.
  23. Selye H. Stress of life. New York:McGraw-Hill;1974.
  24. Frank SH, Zyzanski SJ. Stress in the clinical setting: the brief encounter psychosocial instrument. J Fam Pract 1988;26:533-9.
  25. Lim JH, Bae JM, Choi SS, Hwang HS, Huh BY. The validity of modified Korean-translated BEPSI (brief encounter psychosocial instrument) as instrument of stress measurement in outpatient clinic. Korean Acad Famil Med 1996;17:42-53.
  26. Lee MH. Laughter therapy. Korean Nurs 2006;45(4):36-9.
  27. Yu SJ, Lee JE, Lee KR. The effect of laughter therapy on vital sign and emotional state in homes for the aged. J Korean Acad Psychiatr Ment Health Nurs 2005;14:55-63.