زری احمدی

Diabetes is an incurable disease among the elderly. Itis estimated that it affects the quality of life, and non-pharmacological and psychological therapies can help reduce the problems of the elderly with diabetes. The objective of this study was to compare the effectiveness of laughter therapy and solution-based therapy on hopefulness, meaningfulness, self-compassion, and hemoglobin A1C elderly patients with type 2 diabetes.

The present study was quasi-experimental with pretest-posttest, follow-up, and control group. The statistical population of the study included elderly patients 60-75 years old with type 2 diabetes referred to the Iranian Diabetes Association in Tehran. Among them, 54 were randomly selected and replaced in three groups: laughter therapy, solution therapy, and controlgroup. Data were obtained by self-compassion questionnaire, hopefulness scale, meaningfulness questionnaire, and glycated hemoglobin test. Before the beginning of the sessions, the pretest was administered for all three groups. After two months, the posttest was administered. In the first experimental group, laughter therapy, in the second experimental solution-centered intervention, and in the control group, no intervention was done. Glycated hemoglobin test was completed again two months after the end of the training in order to follow up and evaluate the sustainability of treatment effects. Data were analyzed by repeated measure ANOVA and SPSS software.

The mean (SD) of self-compassion in the laughter group increased from 67.5 (5.2) at pretest to 85.8 (6.2) at posttest and 86.2 (6.1) at the end of the follow-up period (P<0.001) and increased in solution-based therapy group from 69.2 (4.7) in pretest to 81.3 (8.3) in posttest and 81.7 (8.4) at the end of the follow-up period (P<0.001). The mean (SD) of meaningfulness in the laughter group increased from 43.9 (6.2) at pretest to 50.3 (6.8) at posttest and 50.7 (6.5) at the end of the follow-up period (P<0.001). It increased in the solution-based therapy group, from 44.8 (6.7) at pretest to 49.5 (7.9) at posttest and 49.8 (7.7) at the end of the follow-up period (P <0.001). The mean (SD) of hopefulness in the laughter group increased from 40.3 (8.1) at pretest to 45.6 (8.1) at posttest and 46.1 (7.7) at the end of the follow-up period (P<0.001) and increased in solution-based therapy from 40.2 (7.9) at pretest to 43.7 (8.1) at posttest and 43.7 (7.7) at the end of the follow-up period (P<0.001). The mean (SD) of hemoglobin A1C in the laughter group decreased from 7.3 (1.6) at pretest to 6.4 (1.1) at posttest and 6.3 (0.9) at the end of the follow-up period. (P<0.001). Moreover, it decreased in the solution-based therapy, from 7.2 (1.1) at pretest to 6.6 (1.1) at posttest and 6.6 (1.1) at the end of the follow-up period (P<0.001). In the control group,there was no significant difference in mean (SD) self-compassion, hopefulness, meaningfulness, and A1C hemoglobin levels in pretest, posttest, and follow up. A comparison of two treatments showed that laughter therapy was more effective in self-compassionand meaningfulness in the posttest period than solution-based therapy (P<0.001).

The study showed that both laughter therapy and solution-based therapy led to increased hopefulness, self-compassion, and reduced hyperglycemia. Laughter therapy was more effective than solution-based therapy in enhancing self-compassion and meaningfulness in patients with diabetes. However, there was no difference between hope and hyperglycemia in two therapy methods.

The elderly population is increasing due to important reasons, like decreased mortality rate resulting from advances in medical sciences, health, and education, and subsequently increased life expectancy globally. Aging is associated with various biopsychosocial aspects. The prevalence of no communicable diseases, like diabetes, increases with age and reaches its maximum in the elderly. Diabetes is among the most prevalent metabolic disorders, especially in the elderly. Diabetes has debilitating and dangerous effects on the vital organs of the body. Moreover, due to deficiency in insulin secretion, blood glucose levels of the patient is significantly increased; the most frequent symptom of diabetes is glucose intolerance or hyperglycemia. Accordingly, the patient encounters short– and long–term complications of diabetes. One of such problems in the elderly is the odds of the occurrence of another concomitant disease that complicates blood glucose level control. The current study aimed to evaluate the effectiveness of laughter therapy on self–compassion and hypoglycemia in the elderly with type 2 diabetes.

This was a quasi–experimental research with a pretest–posttest, follow–up, and a control group design. The statistical population of the study consisted of 60– to 75–year–old patients with type 2 diabetes, referring to the Iranian Diabetes Association treatment centers in Tehran City, Iran, in 2019. The study participants were voluntarily selected, 36 of whom were randomly divided into two groups (laughter therapy=18; control group=18). The criterion for the selection of sample size was an effect size of 0.25, alpha of 0.05, and power of 0.80 in both study groups. The minimum sample size was 18 per group. The study participants were selected from three treatment centers, and 15 were chosen from each center. The required data were obtained by the Self–Compassion Scale (SCS, Neff, 2003) and glycated hemoglobin test (HbA1c). The experimental group received 8 sessions of laughter therapy, and no intervention was provided to the control group. The follow–up test was performed two months after the end of the training period. The inclusion criteria were ≥1 year of type 2 diabetes according to a physician’s approval, hemoglobin A1c level of ≥6%, minimum high–school diploma education, moderate socioeconomic status, receiving no concurrent psychological treatment, no acute or chronic medical illnesses, such as epilepsy, skeletal diseases, cardiovascular failure, etc. which could cause problems in blood sampling and attending meetings, no severe mental illnesses, such as psychotic disorders and sensory impairment, no current use of psychotropic drugs or substance abuse, as well as no severe diabetes complications (e.g., nausea, & undergoing kidney dialysis, etc.) that could lead to hospitalization. Absence from >2 therapeutic sessions and the occurrence of major stress due to unpredicted events were also considered as the exclusion criteria. The acquired data were analyzed by repeated–measures Analysis of Variance (ANOVA) at the significance level of p<0.05 in SPSS.

The obtained results revealed that laughter therapy increased self–compassion (p<0.001) and reduced blood glucose level (p<0.001) in the posttest phase; the treatment effects retained after two months (p<0.001). The posttest scores of the self–compassion components in the experimental group were relatively higher than those of the pretest stage. In other words, the intervention significantly improved compassion variables in the experimental group. The relevant findings also indicated that the self–compassion scores of the follow–up phase significantly increased in the experimental group, and blood glucose levels significantly decreased in the experimental group.

The present study evaluated the effectiveness of laughter therapy on self–compassion and hypoglycemia in elderly patients with type 2 diabetes. The collected results demonstrated that laughter therapy could improve the study subjects’ compassion and blood glucose level. Thus, laughter therapy is effective on self–compassion and hypoglycemia in elderly patients with type 2 diabetes and could be used by clinicians to improve the health status of patients with diabetes.