Laughter Therapy on Self-Compassion and Hyperglycemia in the Elderly with Type 2 Diabetes

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.