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J Affect Disord. 2019 Jan 28;248:42-51. doi: 10.1016/j.jad.2019.01.030. [Epub ahead of print]

Feasibility of a group-based laughter yoga intervention as an adjunctive treatment for residual symptoms of depression, anxiety and stress in people with depression.

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School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hong Kong. Electronic address:
Castle Peak and Siu Lam Hospitals, Tuen Mun, Hong Kong.
School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hong Kong.
School of Nursing, Midwifery and Health, Coventry University, UK.
Nethersole School of Nursing, Chinese University of Hong Kong, Shatin, Hong Kong.



Laughter Yoga (LY) is a group-based intervention involving simulated laughter, gentle stretching, rhythmic breathing and meditation. There is some limited evidence that LY reduces depressive symptoms over the short term. However, the quality of previous LY studies is poor and none involved working-aged people with a clinical diagnosis of depression. Therefore, this study aimed to investigate the feasibility and potential efficacy of LY for improving residual mood, anxiety and stress symptoms in adults diagnosed with depression.


Fifty participants were randomised to the group LY intervention (n = 23) consisting of eight sessions over four weeks, or treatment-as-usual (n = 27). Participants completed the Depression Anxiety Stress Scale and the Short Form 12 item Health Survey at baseline (T0), post-intervention (T1) and at 3 months follow-up (T2). LY participants also completed a Client Satisfaction Questionnaire (CSQ8) at T1 and eleven participated in individual qualitative interviews at T2.


The LY group had statistically greater decreases in depression and improvements in mental health related quality of life compared to the control group from T0 to T1. The CSQ8 scores indicated a favourable level of satisfaction with the LY intervention. The qualitative interviews highlighted aspects of the intervention that were effective and those requiring modification.


Limitations include the small sample size and treatment-as-usual control group.


A full scale RCT of LY could be feasible if some modifications were made to the protocol/intervention. The intervention may be effective to improve depression and mental health related quality of life immediately post intervention.


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