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Effects of laughter therapy on depression and anxiety: A dose-response meta-analysis with trial sequential analysis.

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Τίτλος: Effects of laughter therapy on depression and anxiety: A dose-response meta-analysis with trial sequential analysis.
Συγγραφείς: Liu CY; Department of Audiology and Speech-Language Pathology, Asia University, Taichung, Taiwan., Liu TH; Department of Psychiatry, Chi Mei Medical Center, Tainan, Taiwan., Huang CW; Department of Psychiatry, Chi Mei Medical Center, Tainan, Taiwan., Lai CC; Division of Hospital Medicine, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan; School of Medicine, College of Medicine, National Sun Yat-sen University, Kaohsiung, Taiwan., Lin CH; Department of Psychiatry, Chi Mei Medical Center, Tainan, Taiwan. Electronic address: alholin@gmail.com., Su KP; Office of Research and Development, Asia University, Taichung, Taiwan; Mind-Body Interface Research Center (MBI Lab & Care), China Medical University Hospital, Taichung, Taiwan; College of Medicine, China Medical University, Taichung, Taiwan; An-Nan Hospital, China Medical University, Tainan, Taiwan. Electronic address: cobol@cmu.edu.tw.
Πηγή: Journal of psychiatric research [J Psychiatr Res] 2026 Aug; Vol. 199, pp. 50-61. Date of Electronic Publication: 2026 Apr 16.
Τύπος έκδοσης: Journal Article; Meta-Analysis; Systematic Review; Review
Γλώσσα: English
Στοιχεία περιοδικού: Publisher: Pergamon Press Country of Publication: England NLM ID: 0376331 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1879-1379 (Electronic) Linking ISSN: 00223956 NLM ISO Abbreviation: J Psychiatr Res Subsets: MEDLINE
Imprint Name(s): Original Publication: Oxford : Pergamon Press
Ιατρικοί όροι (MeSH): Laughter Therapy*/methods , Depression*/therapy , Anxiety*/therapy , Outcome Assessment, Health Care*/statistics & numerical data , Stress, Psychological*/therapy, Humans
Περίληψη: Objective: Laughter therapy serves as a practical and efficient complementary alternative therapy for psychological distress. This meta-analysis aimed to further investigate the efficacy of laughter therapy by integrating trial sequential analysis (TSA) and exploring the optimal treatment duration using a dose-response meta-analysis.
Data Sources: This systematic review conducted randomized controlled trials across major databases (PubMed, EMBASE, PsycINFO, and the Cochrane Library), from their inception to November 12, 2023. Included articles using laughter therapy for depression, anxiety, stress, pain, or quality of life. We employed TSA to assess evidence conclusiveness and the dose-response meta-analysis to explore optimal treatment length.
Study Selection and Data Extraction: Thirty-three studies were included in the analysis. The following information was extracted: information on publication, patients' characteristics, intervention type, intervention duration. Information on outcomes (e.g., type of outcome, measurement tool) and statistical data needed for effect size estimation were extracted independently by two authors (THL & CYL).
Results: Laughter therapy significantly reduced depression (standardized mean differences [SMD] = -0.9; 95% CI: -1.29 to -0.52), anxiety (SMD = -0.83; 95% CI: -1.16 to -0.50), and stress (SMD = -0.68; 95% CI: -1.02 to -0.33) (all p < .001). The dose-response meta-analysis revealed that longer cumulative treatment durations up to 400 min for depression and 600 min for anxiety yielded greater improvements, with benefits plateauing thereafter. Our subgroup analyses showed that laughter-inducing therapies significantly alleviate depression, anxiety and stress across various ages, patient conditions, and care settings.
Conclusions: Laughter therapy effectively alleviates depression, anxiety, and stress, with optimal durations identified for these benefits. The study strengthens the evidence base for laughter therapy and provide supportive evidence for conducting more future RCTs to clinical implication.
(Copyright © 2026 Elsevier Ltd. All rights reserved.)
Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Kuan-Pin Su reports research grant support provided by Ministry of Science and Technology (NSTC), Taiwan, and by An-Nan Hospital, China Medical University, Tainan, Taiwan. The other authors declare no competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
Contributed Indexing: Keywords: Anxiety; Depression; Dose-response; Laughter therapy; Meta-analysis; Stress
Entry Date(s): Date Created: 20260422 Date Completed: 20260715 Latest Revision: 20260715
Update Code: 20260716
DOI: 10.1016/j.jpsychires.2026.04.006
PMID: 42019364
Βάση Δεδομένων: MEDLINE
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  Data: Effects of laughter therapy on depression and anxiety: A dose-response meta-analysis with trial sequential analysis.
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  Data: &lt;searchLink fieldCode=&quot;AU&quot; term=&quot;%22Liu+CY%22&quot;&gt;Liu CY&lt;/searchLink&gt;; Department of Audiology and Speech-Language Pathology, Asia University, Taichung, Taiwan.&lt;br /&gt;&lt;searchLink fieldCode=&quot;AU&quot; term=&quot;%22Liu+TH%22&quot;&gt;Liu TH&lt;/searchLink&gt;; Department of Psychiatry, Chi Mei Medical Center, Tainan, Taiwan.&lt;br /&gt;&lt;searchLink fieldCode=&quot;AU&quot; term=&quot;%22Huang+CW%22&quot;&gt;Huang CW&lt;/searchLink&gt;; Department of Psychiatry, Chi Mei Medical Center, Tainan, Taiwan.&lt;br /&gt;&lt;searchLink fieldCode=&quot;AU&quot; term=&quot;%22Lai+CC%22&quot;&gt;Lai CC&lt;/searchLink&gt;; Division of Hospital Medicine, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan; School of Medicine, College of Medicine, National Sun Yat-sen University, Kaohsiung, Taiwan.&lt;br /&gt;&lt;searchLink fieldCode=&quot;AU&quot; term=&quot;%22Lin+CH%22&quot;&gt;Lin CH&lt;/searchLink&gt;; Department of Psychiatry, Chi Mei Medical Center, Tainan, Taiwan. Electronic address: alholin@gmail.com.&lt;br /&gt;&lt;searchLink fieldCode=&quot;AU&quot; term=&quot;%22Su+KP%22&quot;&gt;Su KP&lt;/searchLink&gt;; Office of Research and Development, Asia University, Taichung, Taiwan; Mind-Body Interface Research Center (MBI Lab &amp; Care), China Medical University Hospital, Taichung, Taiwan; College of Medicine, China Medical University, Taichung, Taiwan; An-Nan Hospital, China Medical University, Tainan, Taiwan. Electronic address: cobol@cmu.edu.tw.
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  Data: Objective: Laughter therapy serves as a practical and efficient complementary alternative therapy for psychological distress. This meta-analysis aimed to further investigate the efficacy of laughter therapy by integrating trial sequential analysis (TSA) and exploring the optimal treatment duration using a dose-response meta-analysis.&lt;br /&gt;Data Sources: This systematic review conducted randomized controlled trials across major databases (PubMed, EMBASE, PsycINFO, and the Cochrane Library), from their inception to November 12, 2023. Included articles using laughter therapy for depression, anxiety, stress, pain, or quality of life. We employed TSA to assess evidence conclusiveness and the dose-response meta-analysis to explore optimal treatment length.&lt;br /&gt;Study Selection and Data Extraction: Thirty-three studies were included in the analysis. The following information was extracted: information on publication, patients&#39; characteristics, intervention type, intervention duration. Information on outcomes (e.g., type of outcome, measurement tool) and statistical data needed for effect size estimation were extracted independently by two authors (THL &amp; CYL).&lt;br /&gt;Results: Laughter therapy significantly reduced depression (standardized mean differences [SMD]&#160;=&#160;-0.9; 95% CI: -1.29 to -0.52), anxiety (SMD&#160;=&#160;-0.83; 95% CI: -1.16 to -0.50), and stress (SMD&#160;=&#160;-0.68; 95% CI: -1.02 to -0.33) (all p&#160;&amp;lt;&#160;.001). The dose-response meta-analysis revealed that longer cumulative treatment durations up to 400&#160;min for depression and 600&#160;min for anxiety yielded greater improvements, with benefits plateauing thereafter. Our subgroup analyses showed that laughter-inducing therapies significantly alleviate depression, anxiety and stress across various ages, patient conditions, and care settings.&lt;br /&gt;Conclusions: Laughter therapy effectively alleviates depression, anxiety, and stress, with optimal durations identified for these benefits. The study strengthens the evidence base for laughter therapy and provide supportive evidence for conducting more future RCTs to clinical implication.&lt;br /&gt; (Copyright &#169; 2026 Elsevier Ltd. All rights reserved.)
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  Data: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Kuan-Pin Su reports research grant support provided by Ministry of Science and Technology (NSTC), Taiwan, and by An-Nan Hospital, China Medical University, Tainan, Taiwan. The other authors declare no competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
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