This study was conducted to determine the effect of Laughter Yoga-Based Mental Health Enhancement Training, applied to mothers of children with special needs, on the burden of care, positive mental health, perceived stress, and salivary cortisol levels.

Individuals with special needs are those with physical, developmental, or behavioral differences and require more intensive and specialized care in areas such as education, healthcare, and social life. Mothers, as the primary caregivers of children, play a significant role in meeting the needs of children with special needs. However, the extraordinary effort exerted by these mothers can become challenging due to various circumstances, leading to increased caregiving burden and difficulties in the physical, emotional, social, or economic areas. During this process, mothers may become vulnerable to mental health problems and may need support to cope with these challenges. Therefore, providing empowerment training to protect and improve the mental health of mothers of children with special needs is essential in the future.

This study was a randomized controlled trial designed with a pre-test post-test experimental design. The study group consisted of mothers of children with special needs who were receiving special education at a Rehabilitation Center in Konya, Turkey. A total of 40 participants were included in the study: 20 in the intervention group and 20 in the control group.

Data collection tools included the Personal Information Form, the Zarit Caregiver Burden Scale, the Positive Mental Health Scale, and the Perceived Stress Scale. Saliva samples were also collected to measure the cortisol levels of the participants. The intervention group received an 8-week Laughter Yoga-Based Mental Health Empowerment Training, administered by the researcher. No intervention was provided to the control group (CG).

Before the study began, ethical approval was obtained from the Non-Invasive Clinical Research Ethics Committee of a university's Faculty of Nursing, institutional permission was received from the Provincial Directorate of National Education, and written informed consent was obtained from all participants.

For data analysis:

• Independent Sample t-tests were used to compare numerical descriptive variables between groups,
• Pearson's chi-square and Fisher's exact tests were used for categorical variables.
• Pearson's correlation coefficients were used to examine the relationships between numerical variables.
• Mixed-design ANOVA was used to compare changes over time within the groups.
• Logistic regression analysis was conducted to determine the significant predictors in the intervention group.
• The strength of the relationship between the dependent and independent variables in the logistic regression was evaluated using Cox-Snell R² and Nagelkerke R².
• A p-value of <0.05 was considered statistically significant.

Inclusion Criteria:

• Being the primary caregiver of the child
• Having a score of 21 or higher on the Zarit Caregiver Burden Scale
• Understanding and speaking Turkish at a level sufficient to complete data collection forms and participate in sessions

Exclusion Criteria:

• Having participated in a similar program within the last 6 months

Women were chosen as biological mothers