Assignment One, Part 3
Literature Search and Article Critique
Jessica Poitras – OT (Used with permission)
Topic Sentence: The effects of Laughter on pain and discomfort thresholds.
Article Reference: Cogan R., Cogan D., Waltz W., McCue M. Effects of laughter and relaxation
on discomfort thresholds. Journal of Behavioral Medicine. 10(2):139-44, 1987 April.
Research Question: The research question addressed by the study was: Can the effects of laughter
reduce pain and discomfort and be used as a therapy intervention strategy.
Variables: The independent variable, was an active categorical variable with four nominal
categories: laughter, relaxation, dull narrative, and No treatment. The dependent variable was a
continuous variable using an interval scale measuring pain/discomfort thresholds by inducing
pressure from a sphygmomanometer. The control variables were sex: male or female and the
effects of distraction. The extraneous variables consisted of type of laughter, strength of
participant, and different sense of humors. The experiment’s goal was to examine the effect of
laughter making it the primary independent variable. It is being compared to relaxation because
relaxation has been proven in past research to increase pain tolerance. The use of dull narrative is to
control for distraction.
Hypotheses: There was one directional hypotheses: Laughter, and not simply distraction, reduces
discomfort sensitivity.
First Research Design: There were 2 experiments that took place in this study. The first was a 4
group experimental design.
EVENT
Group 1
Group 2
Group 3
Group 4
1
X
X
X
X
2
O1
O1
O1
O1
The data on the dependent variable was probably reliable because a standardized blood
pressure cuff was used and pressure was increased in the same increment for each individual. They
also did three trials and took the average so that any mishaps did not sway the outcome. The
reliability is questionable in that only the participants heard laughing in an adjacent room were
recorded as having laughed. They could have laughed quietly or silently and not been recorded.
The validity of the test is questionable because there was no pre-test observation to form a base
line. Therefore, each person has their own normal discomfort threshold and this fact was not taken
into consideration. The validity was supported in that there was no discrepancy in examples not
completing the experiment, so the averages did represent the whole sample. The internal validity
is in question due to the extraneous variables as the baseline not being controlled, the discomfort
only to pressure and the degree of laughter. Also questionable is the small population size and the
duration of the experiment being short lived. The participation, equal treatment and precise
measurement are acceptable.
Population: 20 male and 20 female undergraduate student volunteers were randomly assigned to
one of the four groups: (1) laughter (2) relaxation (3) informative narrative (4) no treatment. The
subjects were introduced individually to the experiment and then were assigned to listen to a 20
minute audio tape corresponding to appropriate group assignments. This experiment will have little
external validity because the sample was not a random sample form the population that was trying
to be portrayed. However the experiment did have an effect on pain thresholds in their group of
subjects.
Data Gathered: After listening to the tape subjects threshold for discomfort was measured by
inducing pressure with a Narco-Biosystems Electro-Sphyonomanometer placed on the nondominant arm. Pressure was increased in 15mm Hg /sec until subject indicated discomfort or to the
max of 300mmHg/sec. After 2 preliminary measures to familiarize individuals with procedure 3
test trials were carried out. The average threshold values were then computed. The threshold for
woman was lower but did not reach statistical reliability. Duncan’s multiple range test was used to
determine that subjects in laughter and relaxation groups were reliably higher than those of
narrative and control groups.
To help support the reliability of the study a second experiment took place to determine whether
laughter itself or the distraction associated with attending to humorous material leads to reduced
sensitivity to discomfort.
Second Research Design: In the second experiment there were 5 groups. The study was a
difference, pre-post, simple experimental design.
Events
Group1
Group2
Group3
Group4
Group5
1
O1
O1
O1
O1
O2
2
X
X
X
X
3
O2
O2
O2
O2
O2
The validity of the dependent variable is increasingly acceptable in the second experiment due to
the pretest baseline. The reliability is acceptable because again a standardized, precise
measurement was preformed on all subjects. Again, however, only laughter heard, and pain in the
form of pressure is used to determine the threshold. A person’s sense of humor is again not
considered. These extraneous variables weaken the reliability. The small population size and
female population makes the internal validity questionable. A strength to the internal validity is that
there was no problem with subjects dropping out or being treated equally. The experiment was
done only once yet it was enough to show a significant difference increasing the validity.
Population: The discomfort thresholds of 40 undergraduate women who did not participate in the
first experiment were randomly assigned to 1 of the 5 groups (1) laughter (2)interesting narrative
(3) uninteresting narrative (4) Multiplication (5) No treatment. They then listened to the designated
tape or did the exercise and laughter was recorded if heard. The sample was a nonrandom sample
and will therefore have little external validity portraying on to a larger population.
Data Gathered: After recording thresholds the same way as in experiment 1, both before and after
treatment an analysis of variance of the difference in scores indicated a reliable difference between
group comparisons. Duncan’s Multiple range test indicated that discomfort thresholds increased
after subjects had listened to the laughter inducing tape as compared to No treatment. The laughter
group threshold scores were different than all groups except the uninteresting narrative condition.
Results: The data from these studies indicate that laughter increases thresholds of discomfort as
effectively as relaxation. The data also indicates that the effect is due to the humorous nature of the
material rather than the interesting character of the material alone. Therefore, the authors’ suggest
that the use of laughter may be worthwhile as an intervention therapy for reduction of pain. To
increase the validity of this study a larger sample, randomly selected with different pain inducers,
would be needed.
<1>
Unique Identifier
95107584
Authors
Parse RR.
Title
Laughing and health: a study using Parse's research method.
Source
Nursing Science Quarterly. 7(2):55-64, 1994 Summer.
Abstract
The purpose of this research was to uncover a structure of the lived
experience of laughing and health using Parse's research method. Twenty men
and women over 65 years of age volunteered to participate in the study. The
structure of the lived experience of laughing and health was found to be a
potent buoyant vitality sparked through mirthful engagements, prompting an
unburdening delight deflecting disheartenments while emerging with blissful
contentment. Recommendations for further research and practice are suggested.
<2>
Authors
Adams P.
Institution
Gesundheit Institute, Arlington, VA 22213.
Title
The best medicine [interview by Jim Montague].
Source
Hospitals & Health Networks. 68(14):6-7, 1994 Jul 20.
Abstract
Laughter can be crucial to patient care, but physician and
clown Patch Adams, M.D., sees nothing funny about the greed he finds in the
nation's health care system and in current reform plans. Adams has spent
almost 25 years infusing practitioners with a sense of humor. This philosophy
extends into his work as founder of the not-for-profit Gesundheit Institute,
which is trying to build an "ultimate fantasy" hospital on 310 acres in rural
West Virginia. So far, he's raised $1.1 million, built one of three main
buildings, and broken ground on a second. However, millions of dollars still
need to be raised. Adams sees the very notion of his dream hospital as a
necessary pie in the face of the traditional health care system. Besides
speaking and performing, Adams takes groups of clowns to Russia, where they
perform in hospitals, orphanages, prisons and on the street. Adams has
co-authored a book about his philosophies, Gesundheit, and sold the rights to
a Hollywood studio. He spoke recently with staff editor Jim Montague.
<3>
Authors
Parse RR.
Title
The experience of laughter: a phenomenological study.
Source
Nursing Science Quarterly. 6(1):39-43, 1993 Spring.
Abstract
The purpose of this research was to uncover a structural definition of
laughing in persons over 65. The structural definition that arises from this
study is: laughing is a buoyant immersion in the presence of unanticipated
glimpsings prompting harmonious integrity which surfaces anew through
contemplative visioning. This definition is congruent with some of the
current literature and practices related to laughter and
health. It corresponds to the principles of Parse's human becoming theory and
thus expands understanding of human experiences related to structuring
meaning, living in relation to others, and viewing the familiar in a new
light.
<4>
Authors
Tennant KF.
Title
Laugh it off. The effect of humor on the well-being of the older adult.
Source
Journal of Gerontological Nursing. 16(12):11-7, 1990 Dec.
Abstract
1. Laughter releases excessive physical and psychological
energy, and it reduces stress, anxiety, worry, and frustration. Humor as a
skillful nursing intervention can enhance the overall well-being of older
adults. 2. If the timing is inappropriate, humor can be a destructive rather
than constructive intervention, especially in nursing situations where
embarrassing, sensitive, or emotion-laden issues are at hand. 3. This study
found that as one ages, one's self-perception of health seems to decrease.
Therefore, nurses need to promote a positive outlook toward the aging process
and one's own health status while interacting with the elderly in a variety
of settings. 4. Nurses should be encouraged to explore the use of humor, not
only with patients of all ages, but also with their nurse colleagues to help
reduce burn out; to cope with the everyday stress and pressures inherent in
the profession; and to enhance learning in the classroom.
<5>
Authors
Cogan R. Cogan D. Waltz W. McCue M.
Title
Effects of laughter and relaxation on discomfort thresholds.
Source
Journal of Behavioral Medicine. 10(2):139-44, 1987 Apr.
Abstract
Two experiments were conducted to test the proposal that
laughter is a pain antagonist. In Experiment I, thresholds
for pressure-induced discomfort of 20 male and 20 female subjects were
measured after each subject listened to a 20-min-long
laughter-inducing, relaxation-inducing, or dull-narrative
audio tape or no tape. Discomfort thresholds were higher for subjects in the
laughter- and the relaxation-inducing conditions. In
Experiment II, 40 female subjects were matched for pressure-induced
discomfort thresholds. Their discomfort thresholds were measured after they
listened to a laughter-inducing, interesting narrative, or
uninteresting narrative audio tape, completed a multiplication task, or
experienced no intervention. Discomfort thresholds increased for subjects in
the laughter-inducing condition. Laughter,
and not simply distraction, reduces discomfort sensitivity, suggesting that
laughter has potential as an intervention strategy for the
reduction of clinical discomfort.