Effect of Fordyce’s Happiness Program on Stress, Anxiety, and Depression among the Patients Undergoing Hemodialysis

Younes Mehrabi, Zahra Ghazavi, Nahid Shahgholian


Background: Patients with end‑stage renal disease on hemodialysis are affected by psychological stressors, which contribute to poor quality of life and negative clinical outcomes. Stress, anxiety, and depression are highly prevalent in this population. Fordyce’s happiness program has been believed to be one of the complementary therapies that could promote psychological wellbeing. The goal of this study was to evaluate the effects of Fordyce’s happiness program on the stress, anxiety, and depression in patients with hemodialysis.

 Materials and Methods: This is a clinical trial. A total of 50 patients undergoing hemodialysis were randomly recruited into the study group (n = 25) and the control group (n = 25). Intervention of Fordyce’s happiness program was administrated for 20 minutes during hemodialysis sessions once a week for 6 sessions. For the control group, 3 sessions were held by the researcher’s colleague through communication, dialogue, and listening to the patients’ problems individually. The data was collected by the Stress, Anxiety and Depression (DASS‑21) questionnaire.

Results: There was a significant difference in the mean scores of stress, anxiety, and depression in the intervention group before immediately after and one month after intervention (P < 0.05), whereas there was no significant difference in the mean scores of stress, anxiety, and depression before, immediately after, and 1 month after intervention in control group.

Conclusions: The obtained results showed that Fordyce Happiness Training Program can reduce the stress, anxiety, and depression in patients treated with hemodialysis.


Anxiety; depression; Fordyce’s happiness program; hemodialysis patients; Iran

Full Text:



Asgari M, Soleimani M. Book of Critical Care Nursing, Bushra. 1387. p. 404. [In Persian].

Wang LJ, Chen CK. The Psychological impact of hemodialysis on patients with chronic renal failure. In: Polenakovic M, editor. Renal Failure. 2012

Chen CK, Tsai YC, Hsu HJ, Wu IW, Sun CY, et al. Depression and suicide risk in hemodialysis patients with chronic renal failure. Psychosomatics 2010;51:528.

Feroze U1, Martin D, Kalantar Zadeh K, Kim JC, Reina Patton A, Kopple JD. Anxiety and depression in maintenance dialysis patients: Preliminary data of a cross sectional study and brief literature review. J Ren Nutr 2012;22:207 10.

Murtagh FE, Addington Hall J, Higginson IJ. The prevalence of symptoms in end stage renal disease: A systematic review. Adv Chronic Kidney Dis 2007;14:82 99.

Gerogianni GK, Babatsikou FP. Identification of stress in chronic haemodialysis. Health Sci J 2013;7:169 76.

Johnson S, Dwyer A. Patient perceived barriers to treatment of depression and anxiety in hemodialysis patients. Clin Nephrol 2008;6:201 6.

Mollahadi M, Tayyebi A, Ebadi A, Daneshmandi M. Comparison of anxiety, depression and stress among hemodialysis and kidney transplantation patients. Iran J Critical Care Nursing 2010;2:153 6.

Tamdondar M, Aghayani K, Tabkhei N. Nursing and dialysis. Saha 1388. p. 16.

Imanishi J, Kuriyama H, Shigemori I, Watanabe S, Aihara Y, Kita M, et al. Anxiolytic effect of aromatherapy massage in patients with breast cancer. Evid Based Complement Alternat Med 2009;6:123 8.

Fordyce MW. Development of Program to increase personal happiness. J Couns Psychol 1977;24:511 21.

Farzadfar M, Molavi H, Atashpor H. The Effect of Fordyce Happiness Training on Depression of Sponsorless Women in Isfahan 3. 2006;30:39 50.

Sari Nasirlu M, Shahbaz Zadegan B, Abbasi M. Fordayce happiness model effectiveness on quality of life in patients undergo dialysis and patients who suffering from cancer. Procedia Social and Behavioral Sci 2013:644 9.

Brenner BM, Maarten W, Taal GM, Philip A, Marsden KS, Alan SL. The kidney. Vol. 1. 9th ed. Elsevier; 2012. p. 2294 6.

Jamshidi N, Abaszade A, Najafi Kaliani M. Stress, anxiety and depression of patients before coronary angiography. Zahedan J Res Med Sci (ZJRMS) 2012;13(Suppl 1):29.

Sahebi A, Asghari MJ, Salari RS. Validation of depression, anxiety and stress (DASS 21) for Iranian population. Iran Psychol 2005;1:50 60.

Rabiei L, Mazaheri MA, Masoudi R, Hasheminia SA. Fordyce happiness program was effectiveness training in reducing of postpartum depression. J Res Med Sci 2014;19:251 6.

Shirdel M, Abbasi F, Sharif S, Jahangir A, Dehnavi Z, Heidari P. Evaluating the Happiness Training Efficacy of Fordyce Method on the Psychological Capital of the patients Taking Methadone in Bojnoord. J Soc Issues Humanities 2015;3:217 20.

Kashani Nassab Z, Allahvirdiyani Kh. The effects of Fordyce happiness traning on decreasing depression among elderly women. Procedia Social and Behavioral Sci 2013:501-3


  • There are currently no refbacks.