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. 2024 Oct 16;17(1):e12610. doi: 10.1111/aphw.12610

The effect of laughter yoga on well‐being, perceived stress, and academic self‐efficacy in nursing students: A randomized controlled trial

Merve Altiner Yas 1,✉, Olga Incesu 2
PMCID: PMC11635907  PMID: 39415513

Abstract

Despite rigorous theoretical and clinical training, nursing students face emotional and academic challenges that can harm their well‐being. Nonetheless, there is a dearth of research investigating the impact of laughter yoga (LY) on nursing students' well‐being, perceived stress, and self‐efficacy. The aim of this single‐blinded, two‐armed randomized controlled trial is to evaluate the effect of LY on nursing students' well‐being, perceived stress, and academic self‐efficacy (ASE). A total of five sessions of LY were applied to the intervention group. The analysis included a total of 83 nursing students (intervention group n = 41 and control group n = 42). Repeated‐measures multivariate analysis of variance (MANOVA) and paired‐samples t‐test were used for data analysis. Results revealed that the intervention group showed a significant increase in well‐being (p < .001) and a decrease in perceived stress after LY (p < .01). However, statistically significant differences between the intervention and control groups were not found in well‐being, perceived stress, and ASE (p > .05). These results indicate the potential effects of LY on the students' well‐being and perceived stress. Community mental health nurses and educators can use LY to improve well‐being in universities.

Keywords: academic self‐efficacy, laughter yoga, nursing students, perceived stress, well‐being

INTRODUCTION

Young people have been experiencing mental health issues more frequently in recent years, and suicide has been identified as a major cause of death, especially at the ages of 15 and 29 (Centers for Disease Control and Prevention [CDC], 2023; World Health Organization [WHO], 2021). The United Nations aims to improve well‐being by 2030 in order to prevent or minimize mental health issues in line with the Sustainable Development Goals (United Nations, 2024). Specifically, university students encounter stressors unique to the developmental period, such as transitioning to independent living away from family, adapting to societal values and norms, maintaining social relationships, and dealing with academic and economic challenges (CDC, 2023; Sequeira et al., 2022). Additionally, nursing students may face difficulties related to intense and stressful clinical practice environments, as well as fears of experiencing traumatic events in clinical settings (Ngoc & Tuan, 2024; Xu et al., 2023). Therefore, prioritizing initiatives aimed at maintaining or enhancing well‐being during this stage of life is crucial (Chow et al., 2018; Kelly, 2017; United Nations, 2024; WHO, 2023).

The World Health Organization emphasizes well‐being in its definition that promotes a holistic view of health (Eser et al., 2019). Well‐being refers to a positive outcome for society, where individuals subjectively feel healthy and happy, perceiving that life is going well (Thanoi et al., 2023). Individuals with positive well‐being lay the foundation for a healthy society for current and future generations (WHO, 2023). Individual variables such as social support, high levels of resilience, low levels of stress, and self‐efficacy positively influence well‐being (Li & Hasson, 2020; Thanoi et al., 2023). Nursing students, who have a pioneering role in protecting and promoting public health, cope with emotional and academic challenges while translating theoretical knowledge into practice throughout their intensive education programs (Ngoc & Tuan, 2024; Thanoi et al., 2023; Xu et al., 2023). In this context, academic stress can lead to psychological problems and have negative effects on well‐being as maintaining health during challenges is associated with individuals' thoughts and actions to sustain their well‐being (WHO, 2023). Chow et al. (2018), who investigated the association between resilience and well‐being in nursing students, suggest imparting emotion regulation, psychosocial skills, and effective coping strategies to enhance nursing students' resilience.

Nursing education is a program that requires intense and complex knowledge acquisition, clinical practice, and close interaction with healthcare professionals and patients/patient relatives (Aloufi et al., 2021). Therefore, evidence suggests that students in health disciplines experience higher levels of stress and anxiety compared with other university students (Aloufi et al., 2021; Chow et al., 2018; Li & Hasson, 2020). Some studies show that stress in nursing students is a result of their workload, patient care, skill deficits (Chaabane et al., 2021), financial issues, and education (Ngoc & Tuan, 2024). Additionally, nursing students may experience different levels of stress based on their academic year (Ngoc & Tuan, 2024). Studies indicate that as stress increases, cognitive flexibility (Turan et al., 2019), emotional intelligence (Mousa et al., 2017), and well‐being (Berdida et al., 2023) decrease. Although low to moderate levels of stress enhance academic motivation for students, high levels of stress lead to negative effects on health and academic life (Onieva‐Zafra et al., 2020). Despite stress being inevitable, many studies suggest that stress levels may increase or decrease depending on coping strategies used during nursing education (Arthur et al., 2018; Kelly, 2017; Onieva‐Zafra et al., 2020).

Self‐efficacy is defined by psychologist Albert Bandura as an individual's subjective judgment regarding their performance (Bandura, 1993). As a subtype of self‐efficacy, academic self‐efficacy (ASE) describes a person's confidence and belief in their capacity to succeed in academic endeavors (Bulfone et al., 2020). The individual's physical and emotional state, as well as stress levels, influences self‐efficacy (Bandura, 1993; Bouih et al., 2021). Studies have shown a negative correlation between self‐efficacy and stress levels and a positive correlation between self‐efficacy and psychological well‐being (Berdida et al., 2023; Thanoi et al., 2023). Individuals with high self‐efficacy tend to have higher emotional resilience and greater emotional stability (İncesu, 2024). Initiatives aimed at enhancing ASE are crucial for students to successfully complete their intensive educational programs, achieve career goals, and maintain psychological well‐being (Berdida et al., 2023; Bouih et al., 2021; Xu et al., 2023). In particular, Xu et al. (2023) identified the mediation of mindfulness in the impact of psychological problems on ASE and recommended that nursing educators support mindfulness in students.

Laughter yoga (LY) is a complementary medicine practice that combines yoga breathing techniques with unconditional laughter (Hatchard & Worth, 2021). Based on the philosophy that the brain is unable to distinguish between genuine and fake laughter, it is assumed to have positive effects on the mind and body (Kataria, 2011). It has been applied in various groups in recent years, including elderly residents in nursing homes, women with depression, diabetes patients, cancer patients, and smartphone‐addicted students (Alici & Dönmez, 2020; Stiwi & Rosendahl, 2022). Many studies have demonstrated the effects of LY in reducing stress and depression symptoms, relaxing muscle tone, lowering blood pressure, increasing melatonin and growth hormone secretion, raising pain thresholds, and strengthening the immune system (Alici & Dönmez, 2020; Hatchard & Worth, 2021; Kramer & Leitao, 2023; Stiwi & Rosendahl, 2022). Ozturk and Tezel (2021) found that at least four sessions of LY are required to alleviate symptoms such as anxiety and depression and reduce cortisol levels.

When studies investigating the effect of LY on nursing students are examined, it is observed that stress, anxiety, life satisfaction, and depression are the main topics of investigation (Eraydin & Alpar, 2022; Ozturk & Tekkas‐Kerman, 2022; Ozturk & Tezel, 2021). A study conducted on nursing students found that LY reduced the level of depression but did not show significant changes in anxiety and stress levels (Ozturk & Tekkas‐Kerman, 2022). Another study reported that LY increased life satisfaction and well‐being and decreased anxiety levels in nursing students (Eraydin & Alpar, 2022). The literature includes limited studies demonstrating that LY promotes well‐being and decreases perceived stress in nursing students. To the best of our knowledge, there is no research in the existing literature evaluating the effect of LY on ASE levels in nursing students. Thus, this is the first study examining the effect of LY on well‐being, perceived stress, and ASE concurrently. The purpose of the study is to investigate the effect of LY on the well‐being, perceived stress, and ASE of nursing students.

Hypotheses of the study

The hypotheses of the research are stated below:

The level of well‐being in the intervention group is higher than that in the control group after LY.

The level of perceived stress in the intervention group is lower than that in the control group after LY.

The level of ASE in the intervention group is higher than that in the control group after LY.

The level of well‐being increases in the intervention group after LY.

The level of perceived stress decreases in the intervention group after LY.

The level of ASE increases in the intervention group after LY.

METHODS

Design

The study is a single‐blinded, two‐armed randomized controlled trial.

Setting and participants

The research population consists of fourth‐year nursing students enrolled in a nursing faculty during the academic year 2023–2024 (N = 120). The G Power 3.1 software was utilized to conduct power analysis and calculate the sample size of the study. Based on the data from a randomized controlled study conducted by Eraydin and Alpar (2022) on psychological well‐being, the effect size was calculated as 0.67. With an effect size (d) of 0.67, a significance level (α) of .05, and a power of 90 per cent (1 − β), it was determined that the intervention group (IG) should consist of 40 students and the control group (CG) of 40 students, totaling 80 students. Following the explanation of the study, obtaining informed consent, and the application of a descriptive features form to the research population, 100 students were determined to be eligible for the inclusion criteria. In the study, 50 students were allocated to the IG and 50 students to the CG. Eight students from each group withdrew from the study following the intervention. During the analysis, one student who did not comply with the normal distribution was removed from the IG. Thus, the study was completed with a total of 83 students (Figure 1).

FIGURE 1.

FIGURE 1

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Consort diagram.

The study's inclusion criterion was voluntary participation as a fourth‐year nursing student. Exclusion criteria comprised enrollment in an internship program, concurrent participation in any complementary medicine method training, undergoing surgery within the last 3 months, and having a diagnosis of hernia, epilepsy, uncontrolled diabetes, or cardiovascular disease.

Randomization and blinding

A simple randomization method was used in the study. The 100 nursing students who met the inclusion criteria were listed in alphabetical order by an independent person who was not familiar with the research process. Then, the students in this list were given numbers. From the students on the list, 50 students selected through www.randomizer.org were assigned to the IG, and the remaining 50 students were assigned to the CG. The assignment of participants to the IG or CG was concealed, and a single‐blind method was applied, meaning that participants were unaware of whether they were part of the IG or CG (Sil et al., 2019). However, due to the nature of the intervention in the study, the researchers were not blinded after randomization.

Measurements

Descriptive features form

The researchers prepared a form consisting of a total of 12 closed‐ended questions, including the demographic and health characteristics of the participating students.

WHO‐5 Well‐Being Index (WBI)

The WHO‐5, created by the World Health Organization and validated in Turkish by Eser et al. (2019), is a generic scale used to assess the overall mental well‐being of individuals. The index consists of five questions that inquire about how the person has been feeling over the past 2 weeks. The total score on this index is multiplied by 4 and converted to a scale ranging from 0 to 100. Higher scores indicate higher levels of well‐being. The Cronbach's α coefficient of the scale is reported as .81 (Eser et al., 2019). In the current study, the Cronbach's α of the scale was calculated as .813.

Academic Self‐Efficacy Scale (ASES) for Undergraduate Nursing Students

The scale, developed by Bulfone et al. (2020) and adapted into Turkish by Uludag et al. (2022), is a 5‐point Likert scale (5: strongly agree; 1: strongly disagree). It consists of 14 items under four dimensions. In the study, the total score of the scale was utilized. The minimum and maximum values of the scale are 14 and 70, respectively. Higher scores from the scale indicate higher levels of ASE. The original scale has a Cronbach's α coefficient of .84, whereas the Turkish adaptation has a coefficient of .72. In the present study, the Cronbach's α of the scale was found to be .71.

Perceived Stress Scale (PSS)

PSS, developed by Cohen et al. (1983), has been adapted into Turkish by Eskin et al. (2013). The scale, designed to measure the extent to which various situations in an individual's life are perceived as stressful, comprises a total of 14 items. Participants evaluate each item on a 5‐point Likert scale ranging from “never” (0) to “very often” (4). Seven items with positive expressions (4, 5, 6, 7, 9, 10, and 13) are reverse‐scored. The maximum score that can be obtained from the scale is 56. Scores on the scale range from 0 to 14 indicating minimum stress, 15–28 indicating low stress, 29–42 indicating moderate stress, and 43–56 indicating high stress levels (Kaur & Bajwa, 2018). A high score indicates a higher perception of stress. The Cronbach's α of the scale is reported as .86 (Eskin et al., 2013). In the present study, the Cronbach's α of the scale was calculated as .73.

Intervention: LY

LY comprises four components: (1) clapping and warm‐up exercises, (2) deep breathing exercises, (3) playful games, and (4) laughter exercises. These stages are designed to eliminate inhibitions for laughter, foster emotions for playful activities, and prepare the lungs for laughter exercises (Hatchard & Worth, 2021; Kataria, 2011). The IG in this study had five sessions of LY, each lasting 40 min, once a week. (Figure 2). The contagious nature of laughter suggests that inducing laughter becomes easier with a larger number of participants (Kataria, 2011). Hence, participants were not segregated into groups for LY. LY sessions were held in a suitable classroom on a predetermined day and time agreed upon with the students. These sessions were facilitated by the researcher, who is certified as an International LY Leader. Following the intervention, participants received electronic participation certificates.

FIGURE 2.

FIGURE 2

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Parts of a laughter yoga session in the study.

Procedure

This study is registered with ClinicalTrials.gov under number NCT06175936. The study was reported using CONSORT 2010 guidelines. Data collection took place between October and December 2023.

Pretest

After obtaining consent, the participants completed the descriptive features form, the WBI, the PSS, and the ASES for Undergraduate Nursing Students. Students who met the criteria for inclusion were determined by the researchers (n = 100). An independent person listed students alphabetically, assigned numbers to them on the list, and randomized groups using www.randomizer.org.

Intervention

Participants in the IG attended LY sessions, which lasted for 40 min once a week, totaling five sessions. The day and time for the LY sessions were determined in consultation with the participants. Participants were informed that they could get in touch with the researcher at any time if they experienced any adverse effects following the intervention, and they were provided with contact information for this purpose.

Posttest

Fifteen days following the end of the LY sessions, all the participants in both groups filled out the WBI, PSS, and ASES for Undergraduate Nursing Students again. The participants in the CG who expressed interest in participating were also provided with five sessions of LY. After the LY was over, the students received a digital certificate of attendance.

Ethics

The Ethics Committee approved the research, dated September 12, 2023, and numbered 2023/315. The Faculty of Nursing, where the study was carried out, granted institutional permission (dated October 16, 2023, and numbered 2023‐10) for the research. The nursing students who agreed to participate in the study provided informed consent. Written permissions were obtained via email from the authors who developed the ASES for Undergraduate Nursing Students, the PSS, and the WBI.

Data analysis

The IBM SPSS 25.0 software was used to analyze the data. The normality assumption was tested using the Shapiro–Wilk test, skewness and kurtosis values (<+1.5), histograms, and normal Q–Q plots. Mean, standard deviation, frequency, and percentage were used to analyze descriptive findings. The reliability of the scales was assessed using Cronbach's α internal consistency coefficient. Descriptive analyses, chi‐squared test, and independent‐samples t‐test were used to compare the homogeneity of the IG and CG. A repeated‐measures multivariate analysis of variance (MANOVA) was conducted to determine whether there were any differences in the dependent variables of WBI, PSS, and ASES between the IG and CG. This allowed for an investigation of whether LY had an effect on participants' WBI, PSS, and ASES without increasing the risk of type I error (O'Brien & Kaiser, 1985). During the MANOVA, Pillai's trace was used as the test statistic. In the evaluation of partial eta‐squared (η 2), a value of .01 is interpreted as a small effect, .06 as a medium effect, and .14 or higher as a large effect (Cohen, 1988). Within‐group comparisons were evaluated using paired‐samples t‐test. Effect sizes were determined with Cohen's d (Lenhard & Lenhard, 2022). Effect sizes of 0.21–0.80 were regarded as moderate, effect sizes of 0.81 and above as strong, and effect sizes of 0.20 and below as weak (Cohen, 2008). The data were considered statistically significant at the 95 per cent confidence interval (p < .05).

RESULTS

Students in the IG were on average 21.9 years old (SD = 0.82), with a weighted grade point average (weighted GPA) of 3.2 (SD = 0.34). Most of the students were female (85.7%), had a nuclear family (85.4%), and had an average perceived income (75.6%). In the CG, the students were on average 22.1 (SD = 0.75), with a weighted GPA of 3.1 (SD = 0.28). Most of the students were female (83.3%), had a nuclear family (83.3%), and had an average perceived income (66.7%). The descriptive characteristics of the IG and CG did not show any statistically significant differences (p > .05) (Table 1).

TABLE 1.

Descriptive features of the nursing students in the intervention and control groups.

Variables Intervention (n = 41) Control (n = 42) Test value p
M (SD) M (SD)
Age 21.9 (0.82) 22.1 (0.75) −0.84 a .402
Weighted GPA 3.2 (0.34) 3.1 (0.28) 1.04 a .302
n (%) n (%)
Gender Female 36 (85.7) 35 (83.3) 0.39 b .533
Male 5 (14.3) 7 (16.7)
Family structure Nuclear family 35 (85.4) 35 (83.3) 0.07 b .799
Extended family 6 (14.6) 7 (16.7)
Income perception Good 4 (9.8) 6 (14.3) 0.83 b .662
Average 31 (75.6) 28 (66.7)
Bad 6 (14.6) 8 (19.0)
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Abbreviation: GPA, grade point average.

a

Independent‐samples t‐test.

b

Chi‐squared test.

Table 2 presents the repeated‐measures MANOVA examining changes in WBI, PSS, and ASES by time and across groups. The results showed that there were no statistically significant differences between the groups in the scores of WBI, PSS, and ASES (p > .05). Thus, H1, H2, and H3 were rejected. However, a statistically significant difference was found in time (F = 5.55, p = .002, η 2 = .17) and group × time interaction (F = 10.69, p < .001, η 2 = .29) with a large effect.

TABLE 2.

Results of the repeated‐measures multivariate analysis of variance (MANOVA) assessing changes in the variables by time and across groups.

Effect Pillai's trace F p η 2
Time .17 5.55 .002* .17
Group .07 2.08 .109 ‐
Group × time .29 10.69 <.001** .29
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*

p < .01, and

**

p < .001.

The within‐group changes in the WBI scores were significant in the IG (t = −6.11, p < .001, d = 0.95). The IG showed a significant increase after LY (M = 52.20, SD = 15.72 to M = 66.93, SD = 12.07) over time, whereas the CG showed no increase (M = 53.43, SD = 16.87 to M = 50.57, SD = 18.29). A strong effect size of the LY on increasing WBI was observed in the IG (Table 3). Thus, H4 was accepted.

TABLE 3.

Intragroup evaluations of the intervention and control groups.

Groups Variables Pretest Posttest t a p Cohen's d
M (SD) M (SD)
Intervention (n = 41) WBI 52.20 (15.72) 66.93 (12.07) −6.11 <.001** 0.95
PSS 42.24 (3.65) 39.93 (4.09) 2.93 .006* 0.46
ASES 50.61 (4.68) 51.78 (3.67) −1.54 .131 ‐
Control (n = 42) WBI 53.43 (16.87) 50.57 (18.29) 1.44 .158 ‐
PSS 41.55 (5.41) 41.69 (5.03) −0.24 .815 ‐
ASES 51.90 (6.27) 50.55 (7.94) 1.38 .175 ‐
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Abbreviations: ASES, Academic Self‐Efficacy Scale; PSS, Perceived Stress Scale; WBI, WHO‐5 Well‐Being Index.

a

Paired‐samples t‐test.

*

p < .01, and

**

p < .001.

The within‐group changes in PSS scores were significant in the IG (t = 2.93, p = .006, d = 0.46) but not in the CG (t = −0.24, p = .815). The LY group had a significantly lower level of PSS at the posttest (M = 39.93, SD = 4.09) than at the pretest (M = 42.24, SD = 3.65). The LY showed a moderate effect size in reducing PSS in IG (Table 3). Thus, H5 was accepted.

The baseline mean total scores of the ASES in the IG and the CG were 50.61 (SD = 4.68) and 51.90 (SD = 6.27), respectively. After LY, the mean total score of the ASES in the IG was found to be 51.78 (SD = 3.67), whereas it was 50.55 (SD = 7.94) in the CG. The within‐group changes in ASES scores were not significant in both the IG and CG (t = −1.54, p = .131 and t = 1.38, p = .175, respectively) (Table 3). Thus, H6 was rejected.

DISCUSSION

The study contributes to the literature as the first known research examining the effects of LY on nursing students' well‐being, perceived stress, and ASE.

The study found that students' well‐being in the IG was at a moderate level before the five sessions of LY. There was a significant increase in the well‐being score of the IG compared with that in the pre‐test, with a strong effect size, whereas there was no significant change in the well‐being scores between the groups. Eraydin and Alpar (2022) found an increase in nursing students' well‐being following 10 sessions of LY during the coronavirus pandemic. Several studies have also concluded that LY is effective in maintaining well‐being in cancer patients undergoing chemotherapy (Nia et al., 2019) and the elderly (Gonot‐Schoupinsky & Garip, 2018). Students in their final year of education often face many of the stressors associated with the transition from university life to working life, such as the search for a job, expectations, and new responsibilities, which can have a negative impact on their well‐being. Aiming to improve students' well‐being enables individuals to utilize their internal and external life resources against stressors, work efficiently, contribute to society, and support sustainability (WHO, 2021). Therefore, LY as a non‐invasive and non‐pharmacological intervention can be suggested to protect, improve, and maintain the well‐being of university students in their daily lives.

Studies conducted with nursing students indicate that nursing students experience stress at different levels (low, moderate, and high) (Berdida et al., 2023; Ngoc & Tuan, 2024; Onieva‐Zafra et al., 2020). The study found that students' stress levels were moderate in all groups. A significant decrease in stress levels was observed in the IG after LY; however, no significant difference was detected compared with that in the CG. In contrast to our findings, in the experimental study conducted by Dönmez et al. (2023), it was detected that although nursing students perceived high levels of stress, their stress levels decreased to a moderate level after LY. Meta‐analyses examining the effects of LY on stress levels in various populations have determined that LY reduces stress levels (Gonot‐Schoupinsky & Garip, 2018; Stiwi & Rosendahl, 2022; Van der Wal & Kok, 2019). A systematic review of nursing students also indicates that an eight‐session LY program conducted over a month has the effect of reducing stress levels among nursing students (Nazari et al., 2024). In the study, the students' stress scores are very close to the high‐stress range, which may be related to students being in their final year, experiencing career‐ and future‐related concerns. According to research by Hamurcu and Terzioglu (2022), fourth‐year nursing students experienced more stress than first‐year ones. Additionally, the fact that students live in a metropolitan city in their study may have contributed to this situation. In future randomized controlled studies, it is recommended to design an LY program involving more than five sessions for decreasing the perceived stress of university students.

The ASE level of students across all groups was noted to be high. However, there was no significant rise in ASE level observed in the IG following LY. Nevertheless, it is encouraging to observe the high ASE levels among students. The existing literature highlights the diverse levels of ASE among nursing students, ranging from low (Uzdil & Gunaydın, 2022) to moderate (Turan et al., 2019) and high (Zhou et al., 2022). Stress is indicated as one of the variables influencing ASE, as it can either enhance or diminish it (Bandura, 1993; Bouih et al., 2021). The lack of increase in ASE levels among students in the IG, despite the notable reduction in stress levels following LY, could be attributed to the already elevated ASE levels among these students. Furthermore, there is a paucity of research investigating the impact of LY or complementary therapeutic approaches on ASE levels in nursing students. Studies pertaining to ASE typically adopt a cross‐sectional approach (İncesu, 2024). Therefore, experimental studies where LY is applied, especially in student groups with high levels of stress and low ASE, could be beneficial for evaluating the relationship between LY and ASE and for observing the effectiveness of LY. In a randomized controlled study, it was found that LY applied before clinical simulation increased the self‐confidence level of nursing students (Dönmez et al., 2023). In a different intervention aimed at increasing self‐efficacy, the results of a quasi‐experimental study involving eight sessions of yoga for middle school students and another study involving 58 sessions of yoga for high school students showed an increase in self‐efficacy (Hagins & Rundle, 2016; Kwasky & Serowoky, 2018).

Limitations and strengths

The strengths of the study include the random selection and allocation of final‐year nursing students into the IG and CG, which reduces the likelihood of making type II errors as students complete the sessions without dropping out. Additionally, the LY sessions were conducted by a researcher with an international certification, ensuring consistency and quality of the intervention. However, there are limitations in the study, such as the reliance on self‐reported data for pretest and posttest measurements, conducting of only a single measurement, and implementing single‐blinding.

CONCLUSION

It was found that pre‐intervention findings indicated that nursing students had moderate levels of stress and well‐being, whereas their ASE was high. LY was applied to nursing students once a week, totaling five sessions. The IG showed a significant increase in well‐being after LY with a strong effect size, whereas there was no significant change between the IG and the CG. Perceived stress levels decreased in the IG; however, no significant difference was found between the IG and CG. LY did not affect the ASE levels of nursing students.

RELEVANCE FOR CLINICAL PRACTICE

The WHO's Comprehensive Mental Health Action Plan prioritizes prevention initiatives for maintaining mental health and well‐being until 2030 (WHO, 2021). According to the study's findings, LY can be utilized to support mental well‐being in senior nursing students as a beneficial, non‐pharmacological, and cost‐effective approach. Moreover, community mental health nurses and educators can plan regular LY programs for promoting mental health and well‐being in universities. Future randomized controlled studies are recommended to investigate whether more than five LY sessions significantly affect university students' well‐being, perceived stress, and ASE.

CONFLICT OF INTEREST STATEMENT

The authors declare no conflict of interests.

ETHICS APPROVAL STATEMENT

The study was approved by the Istanbul University‐Cerrahpaşa Social and Human Sciences Ethics Committee (date: September 12, 2023; no.: 2023/315). Institutional permission (date: October 16, 2023; no.: 2023‐10) was obtained from the faculty. Informed consent was obtained from nursing students who agreed to participate in the study.

CLINICAL TRIAL REGISTRATION

The study was registered with ClinicalTrials.gov under number NCT06175936.

ACKNOWLEDGMENTS

The authors would like to thank all the students who participated in this research.

Yas, M. A. , & Incesu, O. (2025). The effect of laughter yoga on well‐being, perceived stress, and academic self‐efficacy in nursing students: A randomized controlled trial. Applied Psychology: Health and Well‐Being, 17(1), e12610. 10.1111/aphw.12610

DATA AVAILABILITY STATEMENT

The data that support the results of this study are available from the corresponding author upon reasonable request. The data are not publicly available due to privacy or ethical restrictions.

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Associated Data

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Data Availability Statement

The data that support the results of this study are available from the corresponding author upon reasonable request. The data are not publicly available due to privacy or ethical restrictions.

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