Comparing the Effects of Laughter Therapy and Cognitive Behavioral Therapy on Mental Health and Hopefulness in Pakistani Dialysis Patients

Abstract

Background: Chronic renal failure often requires dialysis as a life-sustaining treatment. However, dialysis is frequently associated with psychological complications, including stress, depression, and hopelessness. Objectives: This study aimed to compare the effects of laughter therapy and cognitive behavioral therapy on mental health and hopefulness in Pakistani patients undergoing dialysis. Methods: A total of 145 patients meeting the inclusion criteria were enrolled in a quasi-experimental study using convenience sampling at teaching hospitals in Lahore. Participants were allocated to three groups: laughter therapy (LT; n = 48), cognitive behavioral therapy (CBT; n = 48), and control (n = 49). The interventions comprised eight 1-hour sessions. Data were collected using a demographic questionnaire, the Symptom Checklist-90-Revised (SCL-90-R), and the Snyder Hope Scale (SHS) at baseline, immediately after the intervention, and at the 3-month follow-up. A total of 135 participants completed the post-intervention assessment, and 121 completed the 3-month follow-up and were included in the final complete-case analysis. Results: There were no statistically significant differences in baseline demographic characteristics among the three groups (P > 0.05). The mean ages in the LT, CBT, and control groups were 48.11 ± 13.56, 49.00 ± 13.14, and 48.30 ± 13.38 years, respectively. Significant time × group interactions were observed for psychological symptom severity (F = 12.714, P < 0.001, ηp2 = 0.300) and hopefulness (F = 8.563, P < 0.001, ηp2 = 0.224). Psychological symptom severity decreased from 1.82 ± 0.23 to 1.67 ± 0.49 in the LT group and from 1.84 ± 0.21 to 1.62 ± 0.48 in the CBT group, whereas hopefulness increased from 37.22 ± 2.53 to 42.82 ± 4.63 and from 39.84 ± 3.13 to 42.40 ± 5.36, respectively. The control group did not show comparable improvements. These effects were generally maintained at the 3-month follow-up. Conclusions: Laughter therapy and cognitive behavioral therapy may help reduce psychological symptom severity and improve hopefulness in patients undergoing dialysis. The favorable effects of both interventions were generally maintained at the 3-month follow-up, supporting their potential use as complementary psychological interventions in dialysis care.