REDUCING THE LEVEL OF STRESS AMONG
ADOLESCENTS STUDYING IN SELECTED SCHOOLS AT TIRUNELVELI DISTRICT
BY
Ms.Priya S.George
DISSERTATION SUBMITTED TO
THE TAMIL NADU Dr.M.G.R. MEDICAL UNIVERSITY CHENNAI
IN PARTIAL FULFILLMENT FOR THE DEGREE OF MASTER OF SCIENCE IN NURSING
OCTOBER – 2019
REDUCING THE LEVEL OF STRESS AMONG
ADOLESCENTS STUDYING IN SELECTED SCHOOLS AT TIRUNELVELI DISTRICT
DISSERTATION SUBMITTED TO
THE TAMIL NADU Dr.M.G.R. MEDICAL UNIVERSITY CHENNAI
IN PARTIAL FULFILLMENT FOR THE DEGREE OF MASTER OF SCIENCE IN NURSING
OCTOBER – 2019
Affiliated To The Tamil Nadu Dr.M.G.R. Medical University, K. R. Naidu Nagar, Sankarankovil. Tirunelveli District - 627 753
Tamil Nadu.
CERTIFICATE
This is a bonafide work of Ms. Priya S.George M.Sc. NURSING II year (2017-2019 Batch) student of Sri K.Ramachandran Naidu College of Nursing, Sankarankovil - 627 753. Submitted in partial fulfillment for the Degree of Master of Science in Nursing, under the Tamil Nadu Dr.M.G. R. Medical University, Chennai.
SIGNATURE: _________________________
Dr.Prof.(Mrs).N.Saraswathi, M.Sc. (N)., Ph.D (N)., Principal & Head of the Department of Paediatric Nursing Sri K.Ramachandran Naidu College of Nursing
Sankarankovil (TK), Tirunelveli (Dist)
COLLEGE SEAL
OF STRESS AMONG ADOLESCENTS STUDYING IN SELECTED SCHOOLS AT TIRUNELVELI DISTRICT
APPROVED BY THE DISSERTATION COMMITTEE ON ______________
RESEARCH GUIDE
Dr.Prof.(Mrs).N.Saraswathi, M.Sc. (N)., Ph.D. (N)., ______________
Principal & Head of the Department of Paediatric Nursing Sri K.Ramachandran Naidu College of Nursing
Sankarankovil (TK), Tirunelveli - 627 753, Tamil Nadu.
CLINICAL GUIDE
Mr.C.SELGIN LEONS, M.Sc. (N)., ______________
Reader, Department of Mental Health (Psychiatric) Nursing, Sri K.Ramachandran Naidu College of Nursing,
Sankarankovil, Tirunclveli - 627 753, Tamil Nadu.
MEDICAL GUIDE
Dr.C.PANNEER SELVAN, M.B.B.S., M.D. (Psy) NIMHANS _____________
Consultant Psychiatrist, Sneka Mind Care Centre,
Sound Bye Pass Road, Tirunelveli - 627005 Tamil Nadu.
DISSERTATION SUBMITTED TO
THE TAMIL NADU Dr.M.G.R.MEDICAL UNIVERSITY CHENNAI
IN PARTIAL FULFILLMENT FOR THE DEGREE OF MASTER OF SCIENCE IN NURSING
OCTOBER 2019
See I will not forget you:
I have carved you on the palm of my hand
(Isaiah 49:15)
The journey had been long, had to pass through bright and dark days, calm, and storm. There were times when the path was rough and at times it was smooth.
There were many guiding and supporting hands in this journey, which made it easier.
I take this opportunity to look at the path that I have travelled in shaping this research endeavour and to thank all those who have accompanied me in this journey.
I thank God, the Almighty and my immense belief on him which helped me in each and every step for enabling me to undertake this programme and to complete my dissertation to my optimal satisfaction.
At the outset, I, the researcher of this study express my honest and sincere gratitude to Mr.R.Vivekanandan, Chairman and Mrs.G.Prem Santha, Managing Trustee of Sri K.Ramachandran Naidu College of Nursing for giving me the precious opportunity to be a part of this esteemed institution.
I, the researcher of this study consider myself to be privileged to express my honest and sincere gratitude to Dr.Prof.Mrs.N.Saraswathi, M.Sc (N)., Ph.D. (N)., Principal & Head of the Department of Pediatric Nursing, Sri K.Ramachandran Naidu College of Nursing who taught the concept of research and provided the constant support, encouragement and expert guidance throughout my research.
At this moment, I convey my profound gratitude to Mrs.A.Meena, MSc (N)., Reader and Mrs.G.Thangasubulakshmi, MSc (N), Reader, class coordinators, for
complete the study.
My hearty deepest gratitude and immense thanks to Mr.C.Selgin Leons, M.Sc (N)., Reader, Department of Mental Health (psychiatric) Nursing for his constant source of inspiration, guidance and encouragement, which was a key for the successful completion of the study.
I extend my sincere thanks to Dr.C.Paneer Selvan, M.B.B.S, M.D (Psychiatry) NIMHANS, Consultant Psychiatrist, Sneka mind care center for his encouragement, valuable suggestions and technical guidance throughout the study.
I extend my sincere thanks to all the Medical and Nursing Experts for giving their valuable guidance and suggestions towards modification of the tool for data collection.
I extend my sincere and honest gratitude to the authorities of A.Maruthappa Chettiyar Government Higher Secondary School, Karivalamvanthanallur and Government Higher Secondary School, Kalingapatti, Tirunelveli District for permitting me to conduct the study in their esteemed institutions.
I extend my sincere thanks to Dr.Anil Koshy,M.A.,M.Phil, Ph.D., Asst.Prof.
in English for his patience and expertise in editing the content in English.
I extend my sincere thanks to Dr.Kavitha, M.A, Ph.D. Asst.Prof. in Tamil for her patience and expertise in editing the content in Tamil.
I extend my deep sense of gratitude and thanks to the adolescents for their participation and cooperation in completion of the study.
I am very much grateful to Librarians of Sri K.Ramachandran Naidu College of nursing for their help in procuring books whenever required.
concepts of nursing and research.
I extend my sincere thanks to the teachers of Apollo college of Nursing and staffs of Apollo Multi specialty hospitals, Madurai
I extend my immense and heartfelt gratitude to my supporters Mr.Karthick and Mr.Sony for printout works throughout the study.
There was somebody all the time whole heartedly willing to help, sail through and to boost up in the ups and downs. It was none other than my family.
At last but not least, a bottomless and abundance of thanks to my beloved parents Mr.Shibu T.George B.A, B.Th., M.A., M.Th., B.L.I.S., M.L.I.S. and my
mother Mrs.Mariamma S.George and my sisters Miss.Preethi S.George, Miss. Praise S.George and Miss.Grace Sara Biju and my grandfather
Mr.M.Georgekutty (Retired Telegraphist) and my grandmother Mrs.Chinnamma George and my aunties Mrs.Shirley Thomas R.N (U.S.A), Mrs. Ligi Biju R.N and my uncles Mr.John Thomas and Mr.Biju Antony for their constant inspiration, psychological and financial support throughout this study.
A special bouquet of thanks to all my lovable friends, brothers, neighbours and church members who helped me a lot to complete the study.
I extend my grateful thanks to those who helped me directly and indirectly during my project work.
CHAPTER
NO CONTENT PAGE
NO
I INTRODUCTION
Background of the study 1-5
Need for the study 5-8
Statement of the problem 8
Objectives of the study 8
Hypotheses 9
Operational definitions 9-10
Assumption 10
Delimitation 11
Conceptual framework 12-16
II REVIEW OF LITERATURE
Review of related literature 17-28
III RESEARCH METHODOLOGY
Research approach 30
Research design 30
Variables 31
Setting of the study 31-32
Population 32
Sample 32
Sample size 33
Sampling technique 33
Development and description of the tool 34-35
Reliability 37
Content Validity 37
Pilot study 37-38
Data collection procedure 38-40
Plan for data analysis 40-41
Protection of human rights 41
IV DATA ANALYSIS AND INTERPRETATION
Organization of data 42-43
Presentation of data 44-79
V DISCUSSION 80-86
VI SUMMARY, CONCLUSION, LIMITATIONS, NURSING IMPLICATIONS AND
RECOMMENDATIONS
87-93
BIBLIOGRAPHY APPENDICES
TABLE
NO. TITLE PAGE
NO.
1.
Frequency and percentage distribution of demographic variables of adolescents with respect to age, gender, education, religion, area of living, dietary pattern, hobbies, type of family, birth order, number of siblings, number of friends, education of father, education of mother, occupation of father, occupation of mother, family monthly income and status of parents in experimental group and control group.
44-46
2.
Frequency and percentage distribution of the pre test level of stress among adolescents in experimental group and control group.
60
3.
Frequency and percentage distribution of the post test level of stress among adolescents in experimental group
and control group. 62
4.
Mean and standard deviation of the pre test level of stress among adolescents in experimental group and control
group. 64
5.
Mean and standard deviation of the post test level of stress among adolescents in experimental group and control group.
66
6. Mean and standard deviation of pre test and post test level
of stress among adolescents in experimental group. 68 7. Mean and standard deviation of pre test and level of stress
among adolescents in control group. 70
8.
adolescents in experimental group with their selected demographic variables such as age, gender, education, religion, area of living, dietary pattern, hobbies, type of family, number of siblings, number of friends education of father, education of mother, occupation of father, occupation of mother, family monthly income and status of parents.
72-74
9.
Association between the post test level of stress among adolescents in control group with their selected demographic variables such as age, gender, education, religion, area of living, dietary pattern, hobbies, type of family, number of siblings, number of friends education of father, education of mother, occupation of father, occupation of mother, family monthly income and status of parents.
76-78
FIGURE
NO. TITLE PAGE
NO 1. Conceptual framework based on Modified Roy’s
adaptation model (1999) 16
2. Schematic Representation of Research Methodology 29 3. Schematic Representation of Research design 30 4. Percentage distribution of age of adolescents in
experimental group and control group 51
5. Percentage distribution of gender of adolescents in
experimental group and control group 51
6. Percentage distribution of education in experimental
group and control group 52
7. Percentage distribution of religion of adolescents in
experimental group and control group 52
8. Percentage distribution of area of living of adolescents
in experimental group and control group 53 9. Percentage distribution of dietary pattern of
adolescents in experimental group and control group 53 10 Percentage distribution of hobbies of adolescents in
experimental group and control group 54
11 Percentage distribution of type of family of adolescents
in experimental group and control group 54 12. Percentage distribution of birth order of adolescents in
experimental group and control group 55
13. Percentage distribution of number of siblings of
adolescents in experimental group and control group 55 14. Percentage distribution of number of friends of
adolescents in experimental group and control group 56 15 Percentage distribution of education of father of
adolescents in experimental group and control group 56 16 Percentage distribution of education of mother of
adolescents in experimental group and control group 57 17 Percentage distribution of occupation of father
adolescents in experimental group and control group. 57
adolescents in experimental group and control group 19 Percentage distribution of family monthly income of
adolescents in experimental group and control group 58 20 Percentage distribution of status of parents of
adolescents in experimental group and control group 59 21
Percentage distribution of the pre test level of stress among adolescents in experimental group and control group
61
22
Percentage distribution of the post test level of stress among adolescents in experimental group and control group
63
23
Mean and standard deviation of the pre test level of stress among adolescents in experimental group and control group
65
24
Mean and standard deviation of the post test level of stress among adolescents in experimental group and control group.
67
25
Mean and standard deviation of the pre test and post test level of stress among adolescents in experimental group.
69
26 Mean and standard deviation of the pre test and post
test level of stress among adolescents in control group. 71
APPENDIX TITLE
A Letter seeking and granting permission for conducting the study
B Letter seeking expert’s opinion for content validity C Certificate for content validity
D List of experts for content validity E Certificate of English editing F Certificate of Tamil editing G Certificate of Informed consent
H Copy of the tool for data collection-English I Copy of the tool for data collection- Tamil J Certificate of Plagiarism
S.NO ABBREVIATIONS
1. SPSS – Statistical Package for the Social Sciences 2. HIV-Human Immuno deficiency Virus
3. AIDS – Acquired Immuno Deficiency Syndrome
“A Study to assess the effectiveness of laughter therapy on reducing the level of stress among adolescents studying in selected schools at Tirunelveli District” was done by Ms. Priya S.George as a partial fulfillment of the requirement for the Degree of Master of Science in Nursing at Sri K.Ramachandran Naidu college of nursing, Tirunelveli under the Tamil Nadu Dr.M.G.R Medical university, Chennai during the year of October 2019.
The Objectives of the study were:
To assess the pre test and post test level of stress among adolescents in experimental group and control group.
To find out the effectiveness of laughter therapy on the level of stress among adolescents in experimental group.
To compare the pre test and post test level of stress among adolescents in experimental group and control group.
To associate the post test level of stress among adolescents in experimental group and control group with their selected demographic variables like age, gender, education, religion, area of living, dietary pattern, hobbies, type of family, birth order, number of siblings, number of friends, education of father, education of mother, occupation of father, occupation of mother, family monthly income and status of parents.
All hypotheses were tested at 0.05 level
RH1-The mean post test level of stress among adolescents in experimental group will be significantly lower than the mean post test level of stress in the control group.
RH2-The mean post test level of stress among adolescents in experimental group will be significantly lower than their mean pre test level of stress.
RH3-The mean post test level of stress among adolescents in control group will be significantly higher than their mean pre test level of stress.
RH4-There will be a significantly association between the post test level of stress among adolescents in experimental group and control group with their selected demographic variables like age, gender, education, religion, area of living, dietary pattern, hobbies, type of family, birth order, number of siblings, number of friends, education of father, education of mother, occupation of father, occupation of mother, family monthly income and status of parents.
The study was based on modified Roy’s adaptation model. The quantitative approach was used for this study. The study was conducted in A.Maruthappa chettiyar Government Higher Secondary School, karivalamvanthanallur and Government Higher Secondary School, kalingapatti Tirunelveli District. The design adopted for this study was quasi experimental pre test post test control group design to evaluate the effectiveness of laughter therapy on level of stress among adolescents. Non probability purposive sampling technique was used to select 30 samples for control group from Government Higher Secondary School, kalingapatti and the same method
Government Higher Secondary School, Karivalamvanthanallur.
The data collection tool used for the study was modified perceived stress scale. The content validity of the tool was obtained from four nursing experts and one medical expert in the field of psychiatry. The reliability of the tool (r=0.9) was established by test retest method by using karl pearson’s correlation coefficient formula. The tool was accepted as reliable by clinical experts. Pilot study was conducted to find out the feasibility and done the data analysis.
Data collection was done by using the modified perceived stress scale and the data obtained were analyzed both in terms of descriptive and inferential statistics.
The major findings of the study were:
With regard to the pre test level of stress in experimental group, out of 30 samples, 20 (66.6%) of them were having mild stress, 10 (33.4%) of them were having moderate stress and none of them were having no stress and severe stress.
With regard to the pre test level of stress in control group, out of 30 samples 18 (60%) of them were having mild stress, 12 (40%) of them were having moderate stress and none of them were having no stress and severe stress.
The experimental group showed that the pre test mean value of stress was 60.3 with the standard deviation 6.35 and the post test mean value of stress was 52.3 with the standard deviation 5.54 . The mean difference was 43.3. The calculated ‘t’
value was 3.04.
The control group showed the pre test mean value of stress was 56.3 with the standard deviation 5.54. In control group the post-test mean value was 55.4 with the standard deviation of 1.18. The calculated‘t’ value was 0.233.
post test level of stress among adolescents in experimental group with the demographic variables such as age, gender, religion, dietary pattern, hobbies, type of family, number of siblings, occupation of father, occupation of the mother, family monthly income and there was no significant association between the post test level of stress among adolescents in experimental group with the demographic variables education, area of living, birth order, number of friends, education of father, education of mother and status of parents at p<0.05 level.
The findings showed that there was no significant association between the post test level of stress among adolescents in control group with their selected demographic variables like age, gender, education, religion, area of living, dietary pattern, hobbies, type of family, birth order, number of siblings, number of friends, education of father, education of mother, occupation of father, occupation of mother, family monthly income and status of parents.
On the basis of the findings of the study it is recommended that:
A comparative study can be conducted to assess the level of stress among male and female adolescents studying in colleges.
A study can be carried out to assess the relationship between the stress and coping among adolescents in orphanages.
A study can be conducted to assess the effectiveness of laughter therapy on level of communication among chronic mentally ill patients.
An experimental study can be done to assess the effectiveness of laughter therapy among orphan adolescents.
From the result of the study, it was concluded that providing laughter therapy to the adolescents was very effective in reducing the level of stress. Therefore the investigator felt that more importance should be given for laughter therapy to reduce the stress among adolescents.
CHAPTER – I INTRODUCTION
“Laughter is the mechanism everyone has; Laughter is part of universal human vocabulary. Laughter is universal medicine”
-Bertrand Russell
BACKGROUND OF THE STUDY
Stress is n’t always bad. In small doses, it can help to perform under pressure and motivate one to do the best. But when constantly running in emergency mode, mind and body pay the price. If frequently find feeling frazzled and overwhelmed, it’s time to take action to bring the nervous system back into balance. It can protect and improve how one think and feel by learning how to recognize the signs and symptoms of chronic stress and taking steps to reduce its harmful effects. (Jeanne Segal., 2018)
Stress is the body’s way of responding to any kind of demand or threat. When sense danger whether it’s real or imagined, the body's defenses kick into high gear in a rapid, automatic process known as the “fight-or-flight” reaction or the "stress response". The stress response is the body’s way of protecting the persons. When working properly, it helps to stay focused, energetic, and alert. In emergency situations, stress can save life giving extra strength to defend. (Segal., 2018)
Stress can also help rise to meet challenges. But beyond a certain point, stress stops being helpful and starts causing major damage to health, mood, productivity, relationships, and quality of life. (Melinda Smith., 2018)
When feel threatened, the nervous system responds by releasing a flood of stress hormones, including adrenaline and cortical, which arouse the body for emergency action. The heart pounds faster, muscles tighten, blood pressure rises,
breath quickens, and senses become sharper. These physical changes increase strength and stamina, speed reaction time, and enhance focus - preparing to either fight or flee from the danger at hand. (Robert Segal., 2018)
The nervous system is n’t very good at distinguishing between emotional and physical threats. If super stressed over an argument with a friend, a work deadline, or a mountain of bills, body can react just as strongly as if facing a true life-or-death situation. And the more emergency stress system is activated, the easier it becomes to trigger and the harder it becomes to shut off. (Lawrence., 2018)
If tend to get stressed out frequently - as many of us do in today’s demanding world. The body may be in a heightened state of stress most of the time. And that can lead to serious health problems. Chronic stress disrupts nearly every system in body.
It can suppress immune system; upset digestive and reproductive systems increase the risk of heart attack and stroke, and speed up the aging process. It can even rewire the brain, leaving more vulnerable to anxiety, depression, and other mental health problems. (Robinson., 2018)
Health problems caused or exacerbated by stress include depression and anxiety, Pain of any kind, sleep problems, autoimmune diseases, digestive problems, skin conditions, such as eczema, heart disease, weight problems, reproductive issues, thinking and memory problems. (Herbert I., 2016)
Cognitive symptoms are memory problems, inability to concentrate, poor judgment, seeing only the negative, anxious or racing thoughts and constant worrying, emotional symptoms like depression or general unhappiness, anxiety and agitation, moodiness, irritability, or anger, feeling overwhelmed, loneliness and isolation.
Physical symptoms like aches and pains, diarrhea or constipation, nausea, dizziness,
chest pain, rapid heart rate, loss of sex drive, frequent colds or flu, behavioral symptoms like eating more or less, sleeping too much or too little, withdrawing from others, procrastinating or neglecting responsibilities, using alcohol, cigarettes, or drugs to relax, nervous habits (e.g. nail biting, pacing) and also other mental or emotional health problems. (Paul., 2018)
The situations and pressures that cause stress are known as stressors, usually stressors as being negative, such as an exhausting work schedule or a rocky relationship. However, anything that puts high demands on any persons can be stressful. This includes positive events such as getting married, buying a house, going to college, or receiving a promotion. Of course, not all stress is caused by external factors. Stress can also be internal or self-generated, when worry excessively about something that may or may not happen, or have irrational, pessimistic thoughts about life. (Kabeer., 2016)
Common external causes of stress are major life changes, work or school, relationship difficulties, financial problems, being too busy, pessimism, inability to accept uncertainty, rigid thinking, lack of flexibility, negative self-talk, unrealistic expectations, perfectionism, all-or-nothing attitude. According to the widely validated Holmes and Rah Stress Scale, these are the top ten stressful life events for adolescents and adults that can contribute to illness i.e. death of a spouse, divorce, marriage, separation, imprisonment, death of a close family member, injury or illness, job loss.
Marriage, reconciliation, retirement etc. (Holmes., 2018)
Relaxation Techniques are accessing the relaxation response. Completely eliminate stress from life, but can control how much it affects all. Relaxation techniques such as yoga, meditation, and deep breathing activate the body’s relaxation
response, a state of restfulness that is the polar opposite of the stress response. When practiced regularly, these activities can reduce everyday stress levels and boost feelings of joy and serenity. They also increase the ability to stay calm and collected under pressure. The food can improve or worsen mood and affect the ability to cope with life’s stressors. Eating a diet full of processed and convenience food, refined carbohydrates, and sugary snacks can worsen symptoms of stress while eating a diet rich in fresh fruits and vegetables, high-quality protein and omega-3 fatty acids, can help better cope with life’s ups and downs. (Sreevani., 2018)
Adolescence is a period of good physical health. The most common problems during adolescence relate to growth and development, school, childhood illnesses that continue into adolescence, mental health disorders, injury, pregnancy, interpersonal violence, mood disorders, anxiety disorders and thought disorders. Suicide is a major cause of death for this age group. (Kabeer., 2016)
Laughter has a direct relationship with the well being of an individual. That is both physical and physiological wellbeing. A Chinese proverb that says ‘Laugh and live, rather than to loose and die’. Laughter exercise is done to improve health, to increase wellbeing and to promote peace in the world through personal transformation. It is non-religious, nonsectarian and non political. It is an universal language. (Lee Tzuang., 2016)
Researches proved that children laugh about 40 times a day, has amazing positive effects and some of them are almost immediate. Unlike other exercise forms such as weight lift, aerobics and jogging, the effects of laughter exercise become apparent immediately after the first couple of sessions. This applies even if we laugh
without reason or for pleasure as it is a therapy that keeps the body and mind as fit.
(Paul ., 2018)
Laughing is the antidote for stress and disease, it is the international language and world-wide communication. Spontaneous and splitting laughter is contagious. It dispels gloominess, monotony, moodiness, and darkness from human life and brings mirth, joy, excitement and elation. It has physiological and psychological effects. It has been proved scientifically that humor and laughter have positive impact on health, especially in the battle against stress. Laughter increases oxygen in the body and breathing capacity through the work of the diaphragm. It reduces muscle tension and improves the functions of the heart and blood vessels. Laughter has analgesic effect by releasing endorphins in the body. It enhances the immune system. Studies prove that laughing enhances the work productivity in industries and factories (Dr.Provine., 2012)
NEED FOR THE STUDY
Stress is the most important problem among worldwide and appears to be quite severe in Asian countries. Asian adolescents usually have high academic burden, low satisfaction regarding their academic performance and high expectations and may suffer more academic stress than other stress. Stress is a significant contributor to a variety of mental and behavioural disorders, such as depression, anxiety and suicidal behavior. (Anghuan., 2015)
The living conditions of the adolescents in both developed and developing countries differ widely. The annual increase in the proportion of the adolescents between 1990 and 2010 in Europe and North American countries is much lesser than in China, India and Mexico. Late life stress affects about six million Americans in
adolescence, but only ten percent receive treatment for stress and depression.
(John., 2015)
India is a vast country in terms of area as well as population. India is a subcontinent that causes fifteen percent of world population with a decline in fertility and mortality rates accompanied by an improvement in child survival and increased life expectancy. There is an increase in the number of adolescent’s people. In 1951 sixty plus population was around adolescence. Three decades later in 1981 it was above 43 million a further decade later in 1991 it had increased to 54.7 millions. The increase in the adolescent’s people between 1951 and 1991 was greater than for the general population. (National Family Health Survey., 2011)
In India the total number of population above 13 years of age group is 79 million. In Tamil Nadu, the total population above the age group of 13 years is 58,07,400 among them 32,22,748 of adolescents are living in rural areas and 22,84652 in city. (Census Report of Tamil Nadu., 2013)
Stress is little more prevalent among men (23%) compared to women (20%).
Stress indicators, with the exception of anxiety, were slightly more prevalent among men. (European Report., 2017)
Fifteen minutes of laughter a day keeps one fresh throughout the day and it keeps the doctor away. Nobody can escape that which is contagious. Laughter leads to the development of confidence and leadership qualities as well as communication skills. Humor contributes greatly to a feeling of wellbeing. Stress and strain of modern life is taking a heavy toll on the humans, mind and body. Laughter therapy provides better sleep and reduces pain tolerance, reduces blood pressure, it increase the levels of endorphins (happiness hormones) and it enables to overcome any
negative emotion. The bodies healing system responds favorably to positive antidepression and prevents peoples from suicidal tendencies. It helps to improve mental health. It leads people to live with more hope, more confidence and more optimism. (Dr.Kataria., 2016)
Laughter contributes to the stress relief, tides, thoughts, humor and laughter.
Scientist view that laughter is a form of internal jogging that stimulates the body to release beneficial brain neurotransmitters and hormones. (Geal Crystal and Patrick., 2010)
In the modern society, the meaning of the word “FAMILY” has gone down and there is no place for parents, grandparents, uncles, aunties, brother, sisters, cousins, and nephews, as nuclear families increasing day by day, life is becoming so busy. Most of the people are feeling that they do not have enough time to spend time with families and children. (Derick., 2017)
In the changing society, India is slowly grasping the western culture where the parents limit their children and even children will have full freedom to live according to their needs. (Mary., 2011)
Laughter is one of the simplest and easiest form of relaxation. Without humor, life is dry and drab. Humor oils the wheels of life and helps to keep it running smoothly. The investigator realized that laughter is a gift to human kind and with the help of laughter therapy, the adolescents and other people can maintain their emotion in equilibrium. (Dennis., 2015)
Laughter therapy was conducted for reducing stress among physically challenged adolescents. The program ran for 10 hours a week for 10 weeks. The participants of the program were between the ages of 12 to 21years. The laughter
therapy sessions were conducted for 8 sessions in 8 weeks. The study demonstrated reduced stress for the participants. (Heenan., 2017
Since the laughter therapy keeps everyone fresh and keep the doctor away, also reducing stress, the investigator was motivated to select laughter therapy as an intervention to reduce the level of stress among adolescents.
STATEMENT OF THE PROBLEM
A Study to assess the effectiveness of laughter therapy on reducing the level of stress among adolescents studying in selected schools at Tirunelveli District.
OBJECTIVES
1. To assess the pre test and post test level of stress among adolescents in experimental group and control group.
2. To find out the effectiveness of laughter therapy on the level of stress among adolescents in experimental group.
3. To compare the pre test and post test level of stress among adolescents in experimental group and control group.
4. To associate the post test level of stress among adolescents in experimental group and control group with their selected demographic variables like age, gender, education, religion, area of living, dietary pattern, hobbies, type of family, birth order, number of siblings, number of friends, education of father, education of mother, occupation of father, occupation of mother, family monthly income and status of parents.
HYPOTHESES
RH1-The mean post test level of stress among adolescents in experimental group will be significantly lower than the mean post test level of stress in the control group.
RH2-The mean post test level of stress among adolescents in experimental group will be significantly lower than their mean pretest level of stress.
RH3-The mean post test level of stress among adolescents in control group will be significantly higher than their mean pretest level of stress.
RH4 -There will be a significant association between the post test level of stress among adolescents in experimental group and control group with their selected demographic variables. age, gender, education, religion, area of living, dietary pattern, hobbies, type of family, birth order, number of siblings, number of friends, education of father, education of mother, occupation of father, occupation of mother, family monthly income and status of parents.
OPERATIONAL DEFINITIONS ASSESS
It refers to systematically collecting, validating and interpreting data that includes the assessment of the level of stress among adolescents by using modified perceived stress scale.
EFFECTIVENESS
It is the process of determining the outcome of laughter therapy among adolescents and is measured in terms of the difference between the pre test and post test scores using modified perceived stress scale.
LAUGHTER THERAPY
It refers to a therapy that includes greeting laughter, milk shake laughter, one meter laughter, lion laughter, cell phone laughter, argument laughter and electric shock laughter and it was administered 25 minutes a day for 25 days during morning except Sundays
ADOLESCENTS
In this study, adolescent is an individual person who is between the age group of 13-14 years of both sexes studying 8th and 9th standard in selected schools.
STRESS
In this study stress refers to an uncomfortable subjective feeling felt by the adolescents and it is interpreted in mild and moderate level with modified perceived stress scale consist of five sections such as behavioral, emotional, physical, psychological and academic.
SCHOOL
It is an administrative unit dedicated and designed to impart skills and knowledge to students. The researcher selected A. Maruthappa Chettiyar Government Higher Secondary School, Karivalamvanthanallur and Government Higher Secondary School, Kalingapatti.
ASSUMPTION
Adolescents may have more stress.
Laughter therapy may be beneficial to reduce the level of stress.
DELIMITATIONS
The study was limited to selected schools in Tirunelveli district.
The study was limited to the adolescents within the age group of 13 to 14 years.
The study was limited to sample of 60.
The study period was limited to one month.
PROJECTED OUTCOME
The findings of the study will help the school health nurses to provide laughter therapy for students who have stress.
The findings of the study will help the school teachers to provide laughter therapy to the students in order to reduce stress.
CONCEPTUAL FRAMEWORK
MODIFIED ROY'S ADAPTATION MODEL
Roy (1914) stated that the recipient of nursing care may be the person, a family, group, community, or a society. Each is considered by the nurse as a holistic adaptive system. According to Roy “person is bio-psycho-social being, in constant interaction with a changing environment”. The person as living system is whole made up of parts or subsystems that function as unity for some purpose”.
The idea of an adaptive system combines the concepts of system and adaptation as follows:-
SYSTEM
In her model, Roy conceptualizes the person as a holistic perspective.
Individual aspects of parts act together to form a unified being. Additionally, on living systems, persons are in constant interaction with their environment. Between the system and the environment occurs an exchange of information matter and energy.
Characteristics of a system include input, control process and feedback.
In this study, the system is adolescents and the environment is their school.
Both will have constant interaction with each other.
INPUT
The adaptive system has input of stimuli and adaptation level, output as behavioural responses that serve as feedback, control process known as coping mechanisms.
Demographic variables of adolescents such as age, gender, birth order (internal factors) education, type of family, religion, education of father, education of mother, occupation of father, occupation of mother, family monthly income, area of living, dietary pattern, hobbies, type of family, number of siblings, number of friends, and status of parents (external factors) precipitates the coping mechanism of the adolescents reflected either as adaptive or maladaptive responses. Because of internal and external factors interaction, most of adolescents will have stress and reduced coping abilities. Stress levels were assessed by modified perceived stress scale.
CONTROL PROCESS/ COPING MECHANISMS
Roy had used the term coping mechanism to describe control processes of the person as adaptive system which are called the “Regulator” and “Cognator”.
A regulator subsystem is a coping mechanism which responds through complex perception and information processing through learning, judgement and emotion. The maladaptive pattern of stress response alters both regulator and cognator subsystem can be noted as inadequate sleep and rest. The changes in cognator subsystem can be noted as reduced concentration, poor problem solving, maladaptive coping mechanism, decreased academic performance, increased self esteem, increased feeling of inadequacy and social disintegrity.
There is an imbalance of regulator and cognator subsystem because of maladaptive stress response. It is balanced by practising laughter therapy technique.
Laughter therapy technique was given to the adolescents of experimental group 25 minutes a day (morning) for 25 days except Sundays. Laughter therapy is the coping mechanisms which help to reduce the level of stress among adolescents
EFFECTORS / ADAPTIVE MODES
Although cognator and regulator processes are essential to the adaptive responses of the person, these processes are not directly observable. The adaptive modes are the physiological self concept, role function and interdependence modes.
Observing the person's behavior in relation to the adaptive modes, the nurse can identify adaptive or ineffective responses in relation to health and illness.
The four adaptive modes for assessment are as follows:
Physiological Mode
The physiological mode represents physical response to environmental stimuli and properly involves the regulator subsystem. The basic need of this mode is physiologic integrity comprised of the needs associated with oxygenation, nutrition, elimination, activity, rest and protection. The complex processes of this mode are associated with all senses, fluids and electrolytes, neurological function and endocrine functions. The adaptive responses in physiological mode is adequate sleep.
Role function Mode
It involves behaviour based on a person's position in society. It is dependent on how a person interacts with others in a given situation. The adaptive responses in role function mode is increased concentration, adaptive coping mechanism and increased academic performance.
Self Concept Mode
The self concept mode relates to their basic need of psychic integrity. It is focused on the psychological and spiritual aspects of the person. The adaptive
response in concept mode is increased self esteem, and decreased feeling of inadequacy.
Interdependent Mode
Interdependent mode is where affectional needs are met. The adaptive response in interdependent mode is to maintain social integrity.
OUTPUT AND FEEDBACK
Adaptive responses are those which promote the integrity of the person.
Practicing laughter therapy may increase the coping mechanisms which reflect in reduction of stress that is assessed through modified perceived stress scale
Adolescents with moderate level of stress will gain knowledge and able to practice laughter therapy to reduce the level of stress under the guidance of researcher and it is followed regularly by the adolescents. Those who are exhibiting low level of stress are also encouraged and motivated to practice laughter therapy technique at regular timings continuously.
INTERVENTION Administration of laughter therapy 25
minutes a day for 25 days during morning except
Sundays.
No Improvement Assessment of the Pre test
level of stress by Modified Perceived Stress Scale
Assessment of the post test level of stress
by Modified Perceived Stress Scale
INPUT THROUGH PUT OUTPUT
DEMOGRAPHIC VARIABLES
Adolescents
Age
Gender
Education
Religion
Area of living
Dietary pattern
Hobbies
Type of family
Birth order
Number of siblings
Number of friends
Education of father
Education of mother
Occupation of father
Occupation of mother
Family monthly income
Status of parents.
EXPERIMENTAL GROUP (n=30)
Mild and moderate level of stress.
CONTROL GROUP (n=30).
Mild and moderate level of stress.
NO INTERVENTION
FEED BACK
No stress.
Mild stress.
Moderate stress.
NOT INCLUDED IN THE STUDY
Fig:1 CONCEPTUAL FRAMEWORK BASED ON MODIFIED ROY’S ADAPTATION
MODEL (1999) 16
CHAPTER II
REVIEW OF LIERATURE
Review of literature refers to an extensive and systematic examination of publications relevant to the research project. One of the most satisfying aspects of the literature review is the contribution it makes to the new knowledge of the research.
(Basavanthappa B.T., 1997)
Researcher almost never conducts a study in an intellectual vacuum. Their studies are under taken within the context of an existing knowledge base. Researcher generally undertakes the literature review to familiarize himself\ herself with the knowledge base. (Polit and Hungler., 1991).
The review of literature in the research report is a summary of current knowledge about a particular practice problem and includes what is known and not known about the problem. The literature is reviewed to summarize knowledge for use in practice or to provide a basis for conducting a study. (Burns., 1997)
The literature reviewed for the present study has been organized and presented under the following sections.
Section-A: Studies related to the incidence and prevalence of stress among adolescents.
Section-B: Studies related to the effectiveness of laughter therapy on other conditions.
Section-C: Studies related to the effectiveness of laughter therapy on stress among adolescents.
SECTION-A: STUDIES RELATED TO THE INCIDENCE AND PREVALENCE OF STRESS AMONG ADOLESCENTS.
Shi Kan., (2015) conducted a study to associate the social anxiety with stress and mental health of school students in Kolkata. In this study 1450 school students were tested by stress questionnaire and social anxiety scale. Purposive sampling technique was adopted to collect data. The study results and analysis suggest that the school student’s stressors were related to social anxiety and mental health. There were demographic difference between stressors, social anxiety and mental health. The research report concluded that most stressors of students included stress of punishment, stress of external expectation, learning, stress of examination and stress of loosing relatives.
Rathinabapathy., (2014) conducted a study to assess the stress of fifty college students at Puducherry. The tool used in the study was stress assessment tool.
The results of the study suggested that among the college students 10 (20%) possess high level of stress and 2 (4%) possess very low stress, Girl possess higher level of stress compared with that of boys.
Mussen., (2013) conducted a cross sectional descriptive study on the prevalence of stress among adolescents in Canada (11-19 year). This study reported approximately boys have higher stress (6.5%) than girls, (1.8%). Overall prevalence of stress among adolescents was 5.5%. The same study was conducted in Newyork among adolescents (9-12 years). Boys have higher stress (8.0%) than girls (0.8%).
Mohsen Rezazadeh., (2013) conducted a descriptive analytical study to investigate the relationship between gender, academic achievement, years of study and levels of test stress among 110 higher secondary students in New Delhi. The
Suinn Test stress questionnaire with 48 questions was used to gather the data and convenient sampling technique was adopted. The findings revealed that female students have a higher level of test stress in contrast to male students. The average of test stress score among female students was higher. Also a statistically significant negative correlation was observed between test stress and academic achievement.
Ponnusamy.A., (2012) conducted a quantitative study on examination stress among 50 students of a recognized school in Coimbatore. Stress level was assessed by examination stress inventory and purposive sampling technique was used. The result showed that 40% of the students were with moderate levels of examination stress, 36% of the students were with low levels of examination stress and 24% with severe levels of examination stress.
Honglin chen., (2012) conducted a quantitative approach study to evaluate academic stress of 342 students at six schools in shanghai. Differences in school stress and coping strategy with reference to gender, subject etc. The study proved that academic stress has positive relationship with school stress and positive coping strategies have significant effects on psychological health problems. Male students reported higher level of academic stress, worse psychological well-being and having less inclination towards using positive coping strategies.
Hussan tunio., (2011) conducted a comparative study to assess the level of stress among school students. Students are both athletes and non athletes. The participants in this study were 35 females and 127 males and their stress level was assessed by questionnaire method. The regression analysis report concludes that 95%
of male athletes and 80% of female athletes were stressed by many factors than non athlete.
Hussain., (2011) conducted a study to know the causes of stress among school students. The design of this study was descriptive and causal. The stress assessment questionnaire was used to obtain data from students. Totally 30 samples were selected and random sampling technique was applied for this research. Data analysis done through SPSS in order to know the level of stress of students. This analysis helps the investigator to make decisions and to know the most important causes of stress among students and concluded that most important causes were worry over family, pressure
on study from family and how to take time out for rest and relaxation.
Aziz., (2010) conducted a cross sectional survey to screen for symptoms of stress and depression among students aged 14-18 years during school mental health programmes at Sri Lanka. All the students were assessed with self administered questionnaires. The results revealed that among 445 students (male - 54.4%, female 45.6%), thirty six percentage screened positive for depression (mild depression 17%, severe depression-19%) and 28% screened positive for severe stress. Females screened positive for depression and stress significantly more than the males. Students in classes facing barrier examinations at the end of the year had the highest positivity rates.
SECTION-B: STUDIES RELATED TO THE EFFECTIVENESS OF LAUGHTER THERAPY ON OTHER CONDITIONS
Joanne., (2014) conducted a study on evaluation of a community based laughter therapy intervention on self efficacy and self esteem among orphan adolescents affected with HIV and AIDS. A quasi experimental cross sectional post intervention survey of 297 children aged 8-18 years. Participants completed an inventory comprising standardized self esteem and self efficacy and key socio
demographic variables potentially relevant as risk and protective factors. Attending the intervention was predictive of significantly higher self efficacy and self esteem of orphan adolescents affected by HIV to protect their psychological health. The association remained in the analysis, controlling for potential confounders. Double parental death exerted a powerful effect on child psychosocial health, eliminating the association between intervention attendance and higher self efficacy and self esteem of orphan adolescents affected by HIV to protect their psychological health.
Ramirez., (2014) conducted a study to assess the effectiveness of laughter therapy on the management of stress in college students through a pragmatic two arm randomized controlled trail. The findings that the college students receiving laughter therapy described greater improvement in stress reduction and reduced depression at both 6 and 10 weeks post randomization.
David., (2014) conducted a study on the effects of the life force laughter therapy program on mood among school children. He measured the mood change before and after an intervention of a 5 day retreat in Tucson and two day retreats, at Kripalu. The participants in the five day retreat showed a 62% increase in happiness, 61% decrease in sadness, 76% decrease in anger and 53% decrease in anxiety, whereas participants in two day retreats showed a 39% increase in happiness, 34%
decrease in sadness, 54% decrease in anger and 62% decrease anxiety, which represents that the more number of practice of laughter therapy reduces the stress levels among school children respectively.
Elsevier., (2014) conducted an experimental study with higher secondary school students with severe exam stress in Kolkata. They were given laughter therapy training program for a period of four weeks once a day. This technique significantly
reduced stress. The findings of the study showed that laughter therapy significantly reduces stress in higher secondary school students.
SECTION - C: STUDIES RELATED TO THE EFFECTIVENESS OF LAUGHTER THERAPY ON STRESS AMONG ADOLESCENTS
Heenan., (2016) conducted a study to assess the effectiveness of laughter therapy as a method of reducing stress among physically challenged adolescents. The program run for 10 hours a week for 10 weeks. The participants of the program were between the ages of 12 to 21year. The laughter as therapy sessions were conducted for 8 sessions in 8 weeks. The study demonstrated in reduction in stress. Thus the laughter therapy increasing the self esteem, empowerment and reducing the stress.
Liz Hartz., (2016) conducted a study on laughter therapy strategies to reduce stress in juvenile offenders in Washinton. The exploratory, quasi experimental study compared the impact of laughter therapy approaches on the stress of 27 female juvenile offenders. Participants took part in the laughter therapy. Stress was measured with a questionnaire designed by the authors and the Harter adolescent self perception profile. There were no significant differences on the questionnaire post intervention, with both increased feelings of mastery, connection and stress released mind. The laughter therapy showed a significant increase in domains of close friendship and behavioral conduct whereas the laughter therapy did so in the domain of social acceptance.
Sasikala.G., (2015) conducted an experimental study to investigate the effect of laughter therapy versus group therapy with hypnosis (and psycho education) among 46 school students with stress. The laughter therapy program for four week
group sessions of half an hour each day and one booster session in 5th week
(23 participants). The hypnosis intervention for 4 week group sessions of half an hour each day and one booster session in 5th week (23 participants). The result showed that laughter therapy was significantly reduce stress than hypnosis.
Jones., (2014) conducted a randomized study at Australia to compare the effectiveness of laughter therapy to reduce stress . One thirty one subjects with mild to moderate levels of stress were selected from the school in South Australia state Trait personality inventory sub-scale stress and anxiety, was used for the data collection. Following the 10 week intervention, stress level was decreased over time.
Laughter therapy was found to be as effective as relaxation in reducing stress.
Laughter therapy appear to provide a comparable improvement in stress and health status compared to relaxation.
Gijo Thomas., (2014) conducted a quasi experimental study to find out the effectiveness of laughter therapy on stress among the students in tuition centre assessed by stress scale. The pre experimental design was used. Total number of the sample was 35 students. The study revealed that during the pre test period, the students had stress, but following laughter therapy administration 20 minutes for one month daily two times a day, the post test scores showed that most of them had only mild stress, so the intervention was effective in reducing stress among students at New Delhi.
Makinen., (2013) conducted a study to examine the effects of a short term laughter therapy course in high stressed school students. The design used for the study was a true experimental design. School students pre-screened for high stress were randomly assigned to intervention group and also a control group. The setting used for the study was school campus centre. There were 28 volunteer participants between the
age group of14 to 18. Subjects in the yoga group attended one hour each day for 5 consecutive weeks. The tool used for the study was Beck stression inventory and
state trait anxiety inventory. The result showed that subjects who participated in the laughter course demonstrated significant decrease in stress and trait anxiety. These findings provide suggestive evidence of the utility of laughter therapy in improving mood, reduce the stress and support the need for future studies with larger samples.
Elsevier., (2013) conducted an experimental study with higher secondary school students with severe exam stress in Kolkata. They were given laughter therapy training program for a period of four weeks once a day. This technique significantly reduced stress. The findings of the study showed that laughter therapy significantly reduces stress in higher secondary school students.
Laura., (2012) conducted a study to assess the effectiveness of laughter therapy on reducing stress. Higher secondary students were randomly assigned to an experimental and control group. Forty one experimental subjects were selected and provided laughter therapy during one hour session daily for 3 weeks, 41 control subjects were selected. Stress level was assessed by perceived stress scale.
Experimental subjects have significantly lower levels of post intervention stress level than control subjects.
Ciramitaro., (2011) conducted an experimental study to identify the benefits of laughter therapy on reduction of stress among school students. In this study samples were selected by using randomization. The stress level was assessed by stress assessment scale. Laughter therapy practiced by experimental group for one month 30 minutes a day. The study results showed that the stress level was reduced and
behavior improved by implementing laughter therapy in experimental group than control group.
N.K.Subbalakshmi., (2011) conducted a study to assess the effectiveness of laughter therapy to reduce stress among the physiotherapy students in Manipal institute of medical science in Gontok. Fifty students were selected and divided into two groups aged between 17-20 years. The stress was assessed by stress scale. The
experimental group was performed laughter therapy once a day 30 minutes for 3 weeks and control group did not practice laughter therapy. The study report suggests
that the laughter therapy improves perfection of body and reduces stress of students in experimental group and there is no change in the level of stress in control group. The results showed that 80% of students have decreased the level of stress and 30% of students have increased the level of concentration.
Quintino., (2011) conducted a study to assess the effectiveness of laughter therapy on reduction of stress among college students in Allahabad. In this study one group pre test and post test design was selected. Twenty five samples were selected.
A group of subjects who are volunteered to practice laughter therapy for 40 days applied Likert’s five point psychometric stress scale. Investigator applied t-test for statistical investigation. The study concluded that 80% of students have experienced better state of memory power and 75% students has been decreased academic as well as other types of stress after laughter therapy.
Dr.Rajesh., (2011) conducted a study to assess the effectiveness of laughter therapy to reduce the stress among school children in Agra. The subjects selected for this study divided randomly into 2 groups. The total number of subjects was 100.
Each group had 50 subjects. The experimental group was chosen to perform laughter therapy for the period of 2 weeks, daily one session and 45 minutes duration. The
control group was not given any sort of training. They did their daily routine work.
The obtained data from pre and post test were analyzed by one way analysis of variance, the positive effects and changes were found as reduced academic stress and tension after doing the laughter therapy and changes were found in the behavior of students. The results of the study have indicated that the laughter therapy have proved to be the best for removal of academic and other stress and tension of school children.
Fershteh MoradhiPanah., (2011) conducted a study to investigate the effects of laughter therapy to reduce stress of 20 Iranian orphan adolescent boys (13-18years
of age). Participants were randomly assigned to an experimental or a control group.
A 10 week laughter therapy was performed. Outcome measures included the stress inventory results of an analysis of covariance revealed that laughter therapy has led to significant decrease in the stress of participants.
Mussen., (2011) conducted a cross sectional descriptive study on the prevalence of stress among adolescents in Canada 11-19 year. This study reported approximately boys have higher stress (6.5%) than girls, (1.8%). Overall prevalence of stress among adolescents was 5.5%.The same study was conducted in Newyork among adolescents (9-12 years). Boys have higher stress (8.0%) than girls (0.8%).
Heenan., (2011) conducted a study to assess the effectiveness of laughter therapy as a method for increasing self esteem, self confidence and empowerment among physically challenged adolescents. The program for 10 hours a week for 10 weeks. The participants of the program were between the ages of 12 to 21. The laughter therapy sessions were conducted for 8 sessions in 8 weeks. The study demonstrated increase in self esteem and self confidence. Thus the laughter therapy increasing the self esteem, self confidence and empowerment.
Deshkar., (2010) conducted longitudinal study to assess the effectiveness of laughter therapy to reduce stress among higher secondary school students of Chhattisgarh school, Bilaspur. The study was carried out among 40 pre examination students after getting informed consent. The subjects were categorized into two groups. Group 1 who performed laughter therapy for seven days daily. Group II does not get any intervention. After training, they were assessed on the basis of the questionnaire. Investigator suggests that students stress level was reduced and attention span was increased during training in group I as compared to group II.
Verlynn., (2010) used laughter therapy and assessed the level of stress in children of age group 10-15 years. Questions were asked to determine the number of stressful events. The questions and stress allowed the child to indicate the amount of stress and how much stress was associated with exams. The children who had emotional problems and remained at the school entered laughter therapy. The children had expressed a sincere desire to participate in the laughter therapy 45 minutes once a day. The program included inhaling and exhaling process for the count of breath in 2 weeks. The findings of the study showed that the laughter therapy was effective in reducing stress among the children.
Lohas., (2010) utilized laughter therapy in an effort to reduce stress in 160 fourth and sixth grade students assessed by questionnaire. They found that laughter therapy can have more significant calming effect in children over the short term (5 sessions) as compared to additional training sessions (10 sessions).These results suggested that children are capable of learning laughter therapy over a relatively short period of time. It was concluded that laughter therapy decreases stress level in students.
Farkhondch., (2010) conducted a study to assess the effectiveness of laughter therapy to reduce the stress among twelfth students at shiraz school . In this study 90 samples were selected randomly. Pre assessment was done by questionnaire and laughter therapy practiced for 2 months daily half an hour two times a day. Study results showed that stress level was reduced for twelfth students after practicing laughter therapy.
Kim eh., (2010) verified the effect of laughter therapy on reduction of stress among adolescents living in rural areas of Kerala. The experimental group received laughter therapy. The stress scale used to evaluate the reduction of stress. Data was analyzed using the SPSS program. The score of the experimental group was significantly lower than that of the control group. The study showed that laughter therapy helps to reduce the stress in the adolescents.
