Effectiveness of Laughter Yoga and Mindfulness on Psychological Well-Being and Physiological Parameters among School-Going Adolescents at Risk for Smartphone Addiction: A Quasi-Experimental Study

INTRODUCTION

The rapid advancement of digital technology has significantly transformed the lifestyle of adolescents, with smartphones becoming an integral part of daily life. Globally, it is estimated that >90% of adolescents have access to a smartphone, and ∼50–60% report excessive or problematic use patterns.^[1,2] In India, recent studies indicate that ∼35–45% of adolescents are at risk for smartphone addiction, with higher prevalence reported in urban and semi-urban school populations.^[3,4] While smartphones offer numerous educational and social benefits, excessive and uncontrolled use has led to the emergence of smartphone addiction, now recognized as a growing public health concern worldwide.^[5,6]

Smartphone addiction, often conceptualized under behavioural addiction frameworks, is associated with compulsive usage, impaired control, withdrawal symptoms, and functional impairment in daily life.^[7] Adolescents are particularly vulnerable due to their developmental stage, characterized by increased curiosity, emotional sensitivity, peer influence, and susceptibility to behavioural dependence.^[8] The seriousness of this issue is reflected in its wide-ranging impact on mental, emotional, and physical health, as well as academic performance and social relationships.^[9]

Adolescents at risk for smartphone addiction frequently experience psychological problems such as stress, anxiety, depression, poor emotional regulation, and reduced concentration.^[10,11] In addition to psychological consequences, there is growing evidence of physiological alterations, including elevated blood pressure, increased resting heart rate, sleep disturbances, fatigue, and dysregulation of autonomic nervous system functioning.^[12,13] Studies suggest that excessive screen exposure, especially before bedtime, disrupts circadian rhythms and melatonin secretion, contributing to poor sleep quality and long-term health risks.^[14]

Prolonged sedentary behaviour, reduced physical activity, and chronic psychological stress further contribute to autonomic imbalance, characterized by increased sympathetic activity and reduced parasympathetic tone.^[15] These changes not only affect immediate well-being but may also predispose adolescents to future cardiovascular and metabolic disorders if left unaddressed.^[16]

In this context, body-mind interventions can be introduced, which are simple, cost-effective, and feasible strategies for promoting holistic health among adolescents, particularly within school settings.^[17] Among these, laughter yoga and mindfulness approaches are very useful in improving both psychological well-being and physiological functioning.

Laughter yoga, developed by Madan Kataria, combines voluntary laughter exercises with yogic breathing (pranayama), promoting relaxation, enhancing oxygenation, and reducing stress-related physiological responses.^[18] Evidence suggests that laughter yoga can significantly reduce cortisol levels, improve cardiovascular parameters, and enhance mood and overall well-being.^[19,20]

Mindfulness, defined as present-moment awareness with a non-judgmental attitude, is widely used to reduce stress and improve emotional regulation.^[21] Mindfulness practices have been shown to positively influence physiological parameters by decreasing sympathetic nervous system activity and enhancing parasympathetic responses.^[22] Regular mindfulness practice is associated with improvements in heart rate variability, blood pressure regulation, sleep quality, and psychological resilience.^[23,24]

Although both laughter yoga and mindfulness have demonstrated beneficial effects independently, there is limited comparative evidence regarding their effectiveness on psychological and physiological parameters among adolescents at risk for smartphone addiction.^[25] Furthermore, there is a growing need for structured, school-based interventions to promote healthy lifestyle behaviours and mitigate the adverse effects of excessive smartphone use.

Despite the known benefits of these interventions, insufficient comparative data create a challenge for educators, school health nurses, and healthcare professionals in selecting the most appropriate, feasible, and impactful approach. Therefore, the present study aims to evaluate and compare the effectiveness of laughter yoga and mindfulness on selected psychological and physiological parameters among adolescents at risk for smartphone addiction in selected schools.

MATERIAL AND METHODS

A quantitative quasi- experimental pre-test post-test control group design was employed for this study. The study was approved by the Athena Institutional Ethics Committee (Approval number: ACON/IEC 28/2022) of the college. A participant information sheet was given and explained to the participants and parents. Informed consent was obtained from the parents, and assent was obtained from adolescents. Confidentiality and anonymity were maintained throughout the study.

RESULTS

The data were analysed using statistical package for social sciences (SPSS-23 version). The data were analysed in terms of the objectives and hypotheses of the study using both descriptive and inferential statistics.

The majority of adolescents in all three groups were aged 13–14 years, with 48.3% in intervention Group 1, 51.7% in intervention Group II, and 48.3% in the control group. Most participants were female across all the groups (71.7%, 80.0%, and 75.0%). The majority of them resided in urban areas (86.7%, 80.0%, and 95.0%), and almost all stayed at home (93.3–100%). Class distribution was identical, with equal numbers studying in the 8th and 9th standards (50% each).

Regarding parental education, most of the fathers were educated up to high school or graduation (56.7–65%), and most mothers were similarly educated (43.3–51.7%), with high school education in all the groups. Regarding occupation, the majority of the mothers were homemakers (46.7–61.7%), while fathers were mainly self-employed or privately employed. With regard to the number of siblings majority had one sibling (36.7%–60%). Overall, the groups were homogeneous at baseline, with no significant differences across any baseline variables.

Regarding the duration of the mobile use intervention, Group 1 and Group II had the highest proportion using mobiles for 3–6 h per day (46.7 and 36.7%), while the control group had more students using mobiles for >6 h (36.7%). Most participants had been using mobiles for >3 years (43.3, 51.7, 53.3%). Bedtime habits were similar, with 41.7% of Group 1, 53.3% of Group II, and 55% of the control group going to bed between 10–11 pm (p = 0.651). Most of the adolescents did not keep phones beside them during sleep (91.7, 83.3, 81.7%) and did not wake up at night to check them (93.3, 93.3, 83.3%). Participation in physical or recreational activity was 95% of Group 1 and 98.3% of the control group, being active compared to only 66.7% of Group II. Parental mobile-use patterns also varied significantly: for fathers, 48.3% in Group 1 used mobiles for 2–4 h compared to 45% in Group II and 41.7% in the control using <2 h for mothers, Group II (41.7%) and the control (36.7%) reported lower usage (<2 h), whereas Group 1 showed higher usage with none in the <2 or 2–4 h categories.

Table 1 revealed the baseline comparison of psychological well-being and physiological parameters among adolescents across Group I (Laughter Yoga), Group II (Mindfulness), and the Control group. The results indicate that there were no statistically significant differences among the groups in most variables (p >0.05), except for diastolic blood pressure (p = 0.045), which showed a marginal difference. Overall, the findings suggest that the groups were largely homogeneous at baseline, supporting the internal validity of the study and indicating that post-intervention changes can be attributed to the interventions rather than pre-existing differences.

Table 2 demonstrates a progressive and significant improvement in psychological well-being scores across time points in both intervention groups compared to the control group. Group I (Laughter Yoga) improved from 69.58 ± 10.69 (pre-test) to 82.15 ± 8.35 (post-test 3), while Group II (Mindfulness) improved from 68.35 ± 10.22 to 83.52 ± 7.32. In contrast, the control group showed only minimal changes. The repeated measures ANOVA revealed a highly significant difference (p ≤ 0.001) with a large effect size (η² = 0.604). This indicates that both interventions were highly effective in enhancing psychological well-being, with mindfulness showing slightly greater improvement than laughter yoga.

Table 3 indicates that both interventions produced significant improvements in physiological parameters over time. Systolic BP showed a significant reduction in both groups (p ≤0.001), indicating improved cardiovascular regulation. Diastolic BP showed significant improvement in the mindfulness group (p = 0.005), while changes in the laughter yoga group were not statistically significant. Heart rate significantly decreased in both groups (p ≤0.001), reflecting reduced physiological stress. Sleep score improved significantly in both groups (p ≤0.001), indicating better sleep quality. These findings suggest that both laughter yoga and mindfulness interventions are effective in improving autonomic stability and sleep patterns, with mindfulness demonstrating slightly stronger effects in certain parameters.

Table 4 reveals a direct comparison between intervention and control groups. Both Group I and Group II showed statistically significant improvements compared to the control group across most parameters. For systolic BP and sleep score, both interventions were highly significant (p ≤0.001). Heart rate reduction was more pronounced in the mindfulness group (p = 0.002) compared to laughter yoga (p = 0.047). The findings indicate that while both interventions are effective, mindfulness is statistically superior in improving cardiovascular parameters (systolic and diastolic blood pressure), whereas laughter yoga demonstrates significantly greater effectiveness in enhancing sleep quality. Both interventions show comparable efficacy in reducing heart rate, reflecting similar impacts on autonomic regulation. The study concluded that both laughter yoga and Mindfulness interventions were effective in improving psychological well-being and physiological parameters among school-going adolescents with smartphone addiction.

DISCUSSION

The present study evaluated the effectiveness of laughter yoga and mindfulness interventions on psychological well-being and physiological parameters among adolescents at risk for smartphone addiction. The baseline characteristics confirmed that all three groups were homogeneous with respect to demographic and study variables, ensuring comparability among groups. Similar baseline homogeneity has been reported in adolescent intervention studies conducted in India and elsewhere. The pattern of smartphone usage observed in the present study indicated prolonged exposure among adolescents, which is consistent with recent Indian and global findings showing increased smartphone dependency and its association with psychological distress.^[27]

The findings demonstrated a statistically significant improvement in psychological well-being among both intervention groups compared to the control group. Repeated measures ANOVA revealed a highly significant difference (p = 0.001) with a large effect size (partial η² = 0.604), indicating the strong effectiveness of both interventions. Participants in the laughter yoga group showed steady improvement in psychological well-being scores. These findings are supported by previous literature reporting that laughter yoga reduces anxiety, loneliness, and psychological distress while enhancing emotional well-being among children and adolescents.^[19,28]

The mindfulness group demonstrated greater and more consistent improvement in psychological well-being compared with the laughter yoga group. Similar findings have been reported in recent Indian school-based studies, where mindful yoga and meditation interventions significantly improved emotional regulation, well-being, and reduced psychological distress among adolescents.^[29] Another Indian study on mindfulness-based interventions among school students also reported positive psychological outcomes and improved well-being following structured mindfulness practices.^[30] Furthermore, a pilot study among Indian adolescents demonstrated that mindfulness-based stress reduction significantly decreased stress and improved emotional competence and overall well-being.^[31] In contrast, the control group showed minimal change, indicating that routine activities alone were insufficient to enhance psychological well-being.

Significant improvements were also observed in physiological parameters among the intervention groups. In the laughter yoga group, there was a notable reduction in systolic blood pressure and heart rate, along with improvement in sleep scores. These findings are consistent with systematic reviews indicating that laughter yoga reduces stress hormones and promotes physiological relaxation responses.^[17]

The mindfulness intervention produced comparatively greater improvements in physiological outcomes, including significant reductions in systolic and diastolic blood pressure, heart rate, and enhanced sleep quality. Recent Indian research supports these findings. A randomized controlled trial conducted among Indian adolescents demonstrated that yoga and meditation significantly reduced stress, improved cognitive function, and enhanced physiological parameters such as cortisol levels.^[32] Additionally, a recent clinical trial among adolescents with behavioural addiction (internet gaming disorder) reported that structured yoga interventions significantly improved psychological distress, emotional regulation, and overall well-being.^[33]

When comparing both interventions, mindfulness appeared more effective in improving systolic blood pressure, diastolic blood pressure, and sleep quality. This may be attributed to its deeper neuro-physiological mechanisms, including improved autonomic balance and reduced sympathetic nervous system activation.^[16] Nevertheless, laughter yoga also proved beneficial, particularly in improving psychological well-being, heart rate, and sleep scores, although its effect on diastolic blood pressure was not statistically significant. These findings suggest that both interventions are effective, with mindfulness demonstrating relatively greater benefits across both psychological and physiological outcomes.

CONCLUSION

The present study concludes that both mindfulness and laughter yoga are effective mind–body interventions for improving psychological well-being and stabilizing physiological parameters among adolescents at risk for smartphone addiction. While both interventions significantly enhanced psychological well-being and improved selected physiological measures, mindfulness demonstrated comparatively superior and more sustained benefits, particularly in reducing systolic and diastolic blood pressure, heart rate, and improving sleep quality. Laughter yoga also produced meaningful improvements, especially in psychological well-being, heart rate, and sleep scores. These findings highlight the feasibility and effectiveness of implementing structured mindfulness and laughter yoga programs in school settings to address the growing problem of smartphone addiction and promote holistic adolescent health. Integrating these evidence-based interventions into school health programs may contribute to enhancing both the mental and physiological well-being of adolescents.