Laughter Therapy for Controlling Violent Behavior in Mental Health Institutions
In psychiatric hospital environments often filled with tension and unpredictable emotions, a simple yet powerful non-pharmacological intervention is beginning to show promising results. Laughter therapy, an approach that might initially be considered trivial, is now receiving serious attention from mental health professionals at RSJD Dr. Amino Gondohutomo in Central Java Province.
Central Java faces significant mental health challenges with 25% of its population experiencing mild mental disorders and approximately 1.7 per thousand suffering from severe mental disorders 4 .
Laughter therapy offers a humanistic approach with minimal side effects, providing a promising complementary approach in psychiatric nursing care.
This article examines the scientific mechanisms behind laughter therapy and presents empirical evidence of its effectiveness in reducing violent behavior risk.
Laughter is not merely a response to humor but a complex physiological process involving various body systems. When a person laughs, the body experiences increased nervous system activity followed by relaxation. This process stimulates the production of endorphin hormones - natural brain chemicals that act as natural tranquilizers and mood enhancers 6 .
According to research, laughter can increase oxygen levels in the blood, stimulate blood circulation, and help relax tense muscles 2 . Muscle tension is one physical manifestation of rage and aggressiveness that often accompanies violent behavior risk. By reducing physical tension, laughter therapy can break the cycle of violence at the earliest stage.
At the psychological level, laughter functions as an effective distraction tool from negative thoughts that often dominate patients with violent behavior risk. When laughing, individuals temporarily exit the cycle of angry or frustrated thoughts that can trigger violent behavior 1 .
Laughter also facilitates social connection between patients and therapists or among patients. In psychiatric hospital contexts where social isolation is often a problem, laughter's ability to bridge interpersonal distances represents a significant additional benefit. Positive interactions through laughter can build trust and create a more supportive therapeutic environment 5 .
A descriptive case study was conducted on two patients who met inclusion criteria at a mental health facility. Researchers used an observation sheet for signs and symptoms of violent behavior risk covering nine indicators of behavior, both verbal and physical 1 .
Laughter therapy was provided in three sessions over three consecutive days. Each therapy session was designed to stimulate spontaneous laughter through various exercises and fun games. Before intervention, both respondents showed several signs and symptoms of violent behavior risk - Respondent I showed three signs and symptoms, while Respondent II showed four symptoms 1 .
Two patients meeting inclusion criteria selected for study
Observation of 9 behavioral indicators before intervention
Three laughter therapy sessions over consecutive days
Re-evaluation of behavioral indicators after intervention
After the laughter therapy intervention, both respondents experienced a reduction in the number of signs and symptoms to just two symptoms each. The most consistent decrease occurred in verbal symptoms such as high-pitched tone and loud speech 1 .
| Respondent | Symptoms Before Therapy | Symptoms After Therapy | Change |
|---|---|---|---|
| Respondent I | 3 symptoms | 2 symptoms | Decrease 1 symptom |
| Respondent II | 4 symptoms | 2 symptoms | Decrease 2 symptoms |
| Symptom Type | Description | Improvement Level |
|---|---|---|
| Verbal Symptoms | High-pitched tone, loud speech | Most consistent decrease |
| Physical Symptoms | Restlessness, challenging posture | Showed improvement |
| Condition | Setting | Result | Intervention Duration |
|---|---|---|---|
| Violent Behavior Risk | Psychiatric Hospital | Reduction in verbal and physical symptoms | 3 sessions over 3 days |
| Anxiety in Elderly | Nursing Home | Significant decrease in anxiety levels (p=0.000) | Single intervention with pre-post measurement |
| Depression in Hypertensive Elderly | Community | Reduction from moderate to mild depression levels | Multiple sessions |
These findings are consistent with previous research showing the effectiveness of laughter therapy in reducing anxiety levels in the elderly, where statistical analysis showed p = 0.000 (p<0.05) indicating significant intervention influence 6 . In patients with violent behavior risk, this symptom reduction indicates that laughter therapy can be a valuable adjunctive intervention in the management of violent behavior.
At RSJD Dr. Amino Gondohutomo, laughter therapy is implemented through various structured approaches:
Laughter therapy at RSJD Dr. Amino Gondohutomo does not stand alone but is integrated with other therapeutic approaches such as the Tidal Model which focuses on patient recovery and self-awareness 5 . This integration creates a holistic approach where laughter therapy helps build a stronger therapeutic relationship between nurses and patients.
In the context of the Tidal model, laughter functions as one of the "small waves" that can help patients recognize their own abilities to change their emotional states. When patients experience that they can transition from anger to laughter, they develop self-confidence in their ability to control their emotions 5 .
Focus on recovery and self-awareness
Emotional state transformation
Evaluate patient's suitability and violent behavior risk
Choose appropriate laughter therapy techniques
Schedule appropriate frequency and duration
Monitor progress and adjust approach as needed
Laughter therapy proves that simple and non-invasive interventions can have a significant impact on managing violent behavior risk in psychiatric patients. With clear neurochemical mechanisms and supporting empirical evidence, this approach deserves consideration as part of standard care protocols in mental health facilities like RSJD Dr. Amino Gondohutomo.
The advantages of laughter therapy are not limited to its effectiveness alone, but also include its accessibility and low cost, as well as minimal side effects. In the context of Central Java with its high prevalence of mental disorders and limited health resources, laughter therapy offers a practical solution that can be widely implemented 4 .
Innovation in mental health services continues to be encouraged by local governments, as expressed by Central Java Governor Ganjar Pranowo 4 . Laughter therapy aligns with this spirit of innovation, offering a humanistic approach that focuses not only on symptom reduction, but also on improving overall quality of life.
As a closing thought, we might reflect on the words of a nurse at RSJD Dr. Amino Gondohutomo: "Laughter does not heal all wounds of the mind, but it provides the necessary pause - a breath of relief amid the turmoil of symptoms, a reminder that even in the most difficult struggles, there is still room for joy." It is in this context that laughter therapy finds its most valuable place.
Implementation in more mental health facilities
Integration with standard treatment protocols
Training for mental health professionals