Conceptual Framework

GERIATRICS

Laughter Yoga

Laughter

Gate-Control Theory and Endorphin Release Theory

Pain

Depression

Figure 1. Schematic Diagram of the Relationship Between Laughter Yoga and Depression on Geriatrics Through the Gate-Control Theory and Endorphin Release Theory Figure 1 illustrates that the study was conducted to geriatrics. The physical pain brought about by depression was considered in the study. The physical pain and depression have a great impact to the development of the elderly. The first box represents the target population of the study which are the geriatrics. The selected geriatrics would be administered Laughter Yoga which used unconditional laughter and eventually developed into conditional laughter. These laughter stimulate the pituitary gland and other parts of the brain which releases

neurotransmitters called Endorphins. Increased level of endorphins relieves pain which is one of the major components of depression. Thus, the decreased level of pain also decreases the level of depression. In this study, the method used in decreasing the level of depression was by the administration of Laughter Yoga. Theoretical Framework The study is anchored on two theories: Gate-Control Theory and Endorphin Release Theory. Melzack and Wall (1965) proposed the gate-control theory to account for the ability of cognitive and emotional factors to block pain. They theorized that signals descending from the brain can activate neural gating circuits in the spinal cord to block incoming pain signal (Pinel, 2008). The Gate Control Theory suggests that by electrically stimulating sensory nerve receptors, a gate mechanism is closed in a segment of the spinal cord, preventing paincarrying messages from reaching the brain and blocking the perception of pain. We can stimulate sensor neurons with the specific type of stimulus and measure the responses in various nerves, in some cases, in individual neurons either in the peripheral or central nervous system measurement (Ortiz, et. al., 2004). According to Melzack (n.d.), the brain is not a passive receiver of pain information but can influence the information received, deciding whether it is important enough to be registered. The Endorphin Release Theory suggests that electrical impulses stimulate the production of endorphins and enkaphalins in the body. These natural morphine-like

substances block pain messages from reaching the brain, in a similar fashion to conventional drug therapy, but without the danger of dependence of other side effects (Ortiz, et. al., 2004). Endorphins are among the brain chemicals known as neurotransmitters, which function to transmit electrical signals within the nervous system. At least 20 types of endorphins have been demonstrated in humans. Endorphins can be found in the pituitary gland, in other parts of the brain, or distributed throughout the nervous system. Stress and pain are the two most common factors leading to the release of endorphins. Endorphins interact with the opiate receptors in the brain to reduce our perception of pain and act similarly to drugs such as morphine and codeine. In contrast to the opiate drugs, however, activation of the opiate receptors by the body's endorphins does not lead to addiction or dependence. In addition to decreased feelings of pain, secretion of endorphins leads to feelings of euphoria, modulation of appetite, release of sex hormones, and enhancement of the immune response. With high endorphin levels, we feel less pain and fewer negative effects of stress (Stoppler, 2007). Endorphins are released during exercise, pain, consumption of spicy food and sexual intercourse. Other triggers include laughter, alternative therapies like acupuncture and tai chi, and even moderate alcohol consumption (Foster, 2011).