Prescribing laughter to ameliorate mental health, sleep, and wellbeing in university students: A protocol for a feasibility study of a randomised controlled trial

Abstract

Objectives: This research is the first study to investigate the potential effects of a laughter prescription on both psychological health and objective sleep parameters in university students. The primary objective is to evaluate the feasibility of prescribing laughter to inform a larger randomised controlled trial. Secondary objectives are to assess if a two-week laughter prescription improves subjective and objective sleep outcomes, wellbeing, and/or psychological health outcomes.

Trial design: To assess the feasibility of a randomised controlled trial for laughter prescription in relation to sleep, psychological health, and wellbeing. Forty university students will be recruited and randomised to one of two conditions (control/experimental).

Methods: Wrist actigraphy and sleep diaries will be used to estimate sleep outcomes during a one-week baseline testing phase and across the two-week intervention. The experimental group will be shown how to record a Laughie (a 1-min recording of their joyful laughter on their smartphone) and prescribed to laugh with it three times daily for 14 days (the control group will only track sleep). All participants will complete the WHO (Five) Well-being Index, and Hospital Anxiety and Depression Scale pre- and post-intervention. The CONSORT checklist, and the Feasibility, Reach-out, Acceptability, Maintenance, Efficacy, Implementation, and Tailorabilty (FRAME-IT) framework will guide intervention planning and evaluation. Participant interviews will be analysed using Differential Qualitative Analysis (DQA).

Results: The feasibility of a two-week laughter prescription in university students and its impact on sleep, wellbeing, and/or psychological health outcomes will be assessed.

Conclusions: Zayed University Research Ethics Committee approved the study in July 2019. The research will be completed following protocol publication.

Trial registration: ClinicalTrials.gov. ID: NCT04171245. Date of registration: 18 October 2019.

Keywords: ANCOVA, Analysis of Covariance; BPSE-B, Biological; CBT, Cognitive Behavioural Therapy; DQA, Differential Qualitative Analysis; Environmental, and Behavioural; FRAME-IT, Feasibility; Feasibility study; HADS, Hospital Anxiety Depression Scale; IQR, Interquartile Range; ITT, Intention To Treat; Implementation, Tailorability; Laughter prescription; Maintenance, Efficacy; PI, Principal Investigator; PSG, Polysomnography; PSQI, Pittsburgh Sleep Quality Index; Psychological health; Psychological, Social and socio-economic; RCT, Randomised Controlled Trial; Randomised controlled trial; Reach-out, Acceptability; SE, Sleep Efficiency; SOL, Sleep Onset Latency; Sleep; TST, Total Sleep Time; UAE, United Arab Emirates; University students; WASO, Wake After Sleep Onset; WHO, World Health Organization; Wellbeing.

© 2020 Published by Elsevier Inc.

Figures

Fig. 1

Smart laughter techniques and instructions for recording and using the Laughie. Note. Instructions for the experimental group: 1. Your recording should sound like your natural joyful and playful laughter. If it doesn't, practice and record another Laughie! 2. Try to make the Laughie an enjoyable experience! You can add visual props (e.g. a mirror – laughing in front of a mirror), gestures (e.g. moving your arms, or legs, as well as sitting); mental aspects (e.g. thinking about joyful or amusing things, or using humour and jokes to help you to laugh); or social (e.g. laughing together with someone else while using your Laughie). 3. This is a new way of laughing and for some might be easier than others. Practice can help. 4. Because you will be laughing alone, for all or some of the time, it is good to find a reason to do it! Reason may include for health, happiness, joy, humour, exercise, relaxation, meditation, and energy. Based on and adapted [19].