THE EFFECT OF SPIRITUAL EMOTIONAL FREEDOM TECHNIQUE TO INCREASE SELF ESTEEM OF SCHIZOPHRENIA IN MENTAL HOSPITAL SURAKARTA Endang Caturini Sulistyowati, Ros Endah Happy Patriyani, Insiyah Health Polytechnic of Surakarta Email : c.endang@yahoo.com ABSTRACT Introduction: Schizophrenia is a chronic psychotic with the prevalence of schizophrenia in Indonesia is 70%. The schizhophrenia often accompanied by negative feelings self-perception, and self-efficacy, helplessness, anxiety, behavioral changes. The number of schizhopheria in Mental Hospital in Surakarta was 93% in 2008. Physical treatment of schizophrenia patients were included drug delivery and Convultion Electro Therapy (ECT). These treatments were considered unsufficient so that psychological approach such as psychotherapy can be taken into account. One provision of psychotherapy patients with schizophrenia is Spiritual Emotional Freedom Technique (SEFT) which can help individuals to develop skills in improving the coping mechanisms, reducing anxiety and increasing self-esteem. This study is aimed to determine the effect of SEFT to change coping mechanisms, anxiety, self-esteem in patients schizophrenia in Mental Hospital, Surakarta. Method: The research method was quasi experimental with pre-post test with control group. The data was gathered before and after giving the SEFT interventions in intervention and control group of schizophrenia patients.the amount of samples were 64 respondents which were 32 respondents of intervention group and 32 respondents of control group. The research instrument was adapted from Coopersmith Self Esteem Inventory (CSEI) that consist of 58 items regarding self esteem. Data were analyzed using paired t-tests., Independent t-test multiple linear regression. Result: The results of this study showed that there was a significant difference of self esteem before and after SEFT (p value <0.05). Conclusion: This proves that the existence of a significant change in the patients in the intervention group SEFT than the control group. The conclusion is that the level of self esteem could be increased by SEFT with the probability score is 31.3% and could increase point 4.312 point for self esteem degree. Keyword: Schizophrenia, Self Esteem, Spiritual Emotional Freedom Technique (SEFT) INTRODUCTION Schizophrenia is a group of psychotic reactions that affect many areas of individual functions, including functions of thinking communicating, receiving and interpreting reality, feeling and showing emotions and behaving in an acceptable rational. Schizophrenia is a severe mental disorder exhibiting behaviors such as: inability to care for themselves, unwilling to socialize, feelings of worthlessness, and / or showing the affected of unnatural habits, causing them unable to have social function in their daily life. Conflict happens to schizophrenia may be due to a negative assessment in themselves. A negative self assessment or low self esteem is a chronic low self-esteem (Stuart & Laraia, 2006). Various models of treatment of schizophrenic patients have been performed by practitioners in order to help patients to solve the problems. The models applied vary among healthcare professionals such as nurses, psychiatrists, psychologists, social workers who often work to help patients with mental disorders. Some applied models include: psychoanalytic models, interpersonal, social, existential, supportive and the medical model (Stuart & Laraia, 2006). Other model are cognitive therapy (CT), behavioral therapy (BT), logotherapy, therapeutic reality and 241
psychoeducation family (Videbeck, 2008). Cognitive behavioral therapy (CBT), educational therapy, thought stopping, bibliotherapy and music therapy were also utilized in order to help mental ill patient as well as (Boyd & Nihart 1998), therapy assertive, time outs, and token economy (Stuart & Laraia, 2006), and therapy Milieu (Townsend 2005). Therapeutic nursing progresses with the presence of a therapeutic technique is complementary therapy, which is part of the complementary modalities. In the western, complementary modalities are already widely used by professional nursing personnels. Complementary therapies refer to the fulfillment of human needs as a holistic being. SEFT is one form of complementary therapy. SEFT helps patients with various current difficulties experienced by a person in different phase of life. SEFT that is developed from EFT was introduced in 1995 by Gary Craig. EFT is a simple method that emphasizes focus on problems within the individual accompanied by gentle tapping on acupuncture points (tapping) on the face, upper body and arms. EFT can help a variety of emotional and physical problems. SEFT method is to unite ourselves with divine power that allows people to become happier, more certainty in life, the results are not easily stressed so that it can improve mental health (Zainuddin, 2009). SEFT is a method that manages the potential for systematic consciousness, so it can be used for multiple purposes in improving the welfare of the soul. SEFT is behavioristic method based on psychotherapy or behavior, it is applied by the model or technique performed in behavioristik psychotherapy, relaxation, meditation, visualization, logotherapy, and cognitive behavioral therapy (CBT). The technique used in conducting SEFT is with behavioristik stages (Zainuddin, 2009). Mental Hospital of Surakarta is a reference to cases of mental illnesses with the coverage of service in Surakarta and the surrounding areas, Yogyakarta, East Java and West Java. The bed capacity in Mental Hospital of Surakarta. According to the report of the Hospital, in 2008 the average Bed Occupancy Rate (BOR) was 61.56% and the average value Average Length of Stay (AvLOS) in 2008 was 29 days (Surakarta RSJD Medical Records, 2009). Based on the recapitulation of ten cases for medical diagnosis in the year 2013 on patient cases, the highest number of cases of schizophrenia was about 93%. The results of the interview with the head of the room and the nurse room, standard procedure in patients with schizophrenia is psikofarmaka, ECT and psychotherapy therapy / education, no SEFT applied. Based on the data above, researchers who applied SEFT and researches with the title of spiritual influence of emotional freedom technique (SEFT) increases self esteem in patients with schizophrenia in the Mental Hospital of Surakarta METHOD This study uses a "quasi experimental pre-post test with control group" (Sugiyono, 2010). Grouping members of the sample in the experimental group and the control group was not done at random or random so that the draft is often called the Non-Randomized Control Group Pretest Posttest Design (Notoatmojo, 2010). The research was conducted at the Mental Hospital of Surakarta from April to June 2014. The samples in this study were patients with schizophrenia. The number of patient sample was 32 respondents for each intervention group and the control group. The Independent variable was Spiritual Emotional Freedom Technique (SEFT), while the dependent variable was patients Self Esteem. The instruments used in measuring the Coopersmith Self Esteem Inventory (CSEI), consists of 58 items, thus obtained scores range between 0-58 (Bolton, 2003). The bivariat analysis two mean test namely comparing the means of the two 242
group (Hastono, 2007) with t test Freedom Technique (SEFT). Multivariate independent, while the t analist bivariat was used to proof the hypothesis that the patient analysis was also used to proof that there are patient characteristics as factors that with schizophrenia who get Spiritual contribute to the patient s self-esteem using Emotional Freedom Technique (SEFT) double linear regression. have higher self-esteem compare with patient who did not get Spiritual Emotional RESULT Tabel.1 Independent t test of Self Esteem of Patients Before And After Intervention For Intervention And Control Group Kelp N Man SD SE T P Kontrol Intervensi 32 32 1.75 6.06 5.37 5.11 0.949 0.902-3.292 0.002 Using t test, the results reveals that there is a statistically significant difference (p = 0.002), on the self-esteem of patients between the intervention and control groups. Average patients self-esteem in the intervention group (mean = 6.06) is higher than in the control group (mean = 1.75), with p <0.05. Table 2. multiple linier regression analisis for SEFT Intervention without controling respondent characteristics. Variabel Model I Model II Koef Regresi B CI 95 % Batas Batas Koef Regresi CI 95 % Batas Batas bawah atas P Bawah atas p Konstanta 1.75-0.101 3.601 0.064 10.53 2.406 18.658 0.012 IntervSEFT 4.312 1.694 6.931 0.002 4.14 2.501 6.247 0.000 Kelamin -1.923-4.368 0.522 0.121 Umur 0.018-0.013 0.162 0.807 Status kawin 1.911-0.436 4.258 0.108 Pendidikan 0.628-0.583 2.839 0.303 Pekerjaan 0.971-1.240 3.183 0.382 Frek dirawat 0.03-0.541 0.082 0.146 Lama sakit -0.229-0.254 0.314 0.833 Self esteem respon sblm intervensi -0.374-0.501-0.247 0.000 n responden 32 32 Adjusted R² 13.5% 49% P 0.002 0.000 243
The analysis results of multiple linear regressions on the model I concludes that SEFT interventions effectively improves the patients self esteem. Patients who got SEFT interventions, provide patients self esteem 4,312 points higher than in patients who did not get SEFT interventions. The difference is statistically significant (b = 4,312; 95% CI 1.694-6931; p value = 0.002). The analysis shows that there are no differences in the regression coefficient b for SEFT interventions between models I and II models in the amount (4312-4.14) / 4312 = 4% <(10% - 20%). The confounding variables were entered into the model II did not confuse the estimated effect of SEFT interventions, so that the estimated effect of SEFT intervention used the result of the calculation model of I Adjusted R² 13.5% in model I. This shows that SEFT intervention can improve self-esteem of respondents up to 13.5%. A variety of confounding variables that do not cause confusion, because no body has the effect of increasing or decreasing the patients selfesteem, which number closes to 0, so it almost does not change the results of the estimated regression coefficients b SEFT intervention. DISCUSSION Traumatic events for patients with mental disorders especially schiziphrenic patient cause patients to experience low self-esteem problems. This will have an impact in the energy balance of the body so that the thoughts, emotions and behaviors will tend toward negative. While selfesteem is a positive or negative attitude of individuals towards a particular object called themselves (Rosenberg in Mruk, 2006). Self-esteem refers to the premise that an individual evaluation against him (either positive or negative) associated with a sense of preciousness, an individual's belief in the ability itself. Emotional condition such as anger, sadness, disappointment stress, panic and fear runs on the same system with the energy. When the energy flow is disturbed or blocked, it can result in interruption of the tranquility of the center of thought and emotion. This leads to negative thoughts and emotions to emerge (Zainuddin, 2009). SEFT is one of spiritual therapy and energy psychology offers a more secure manner (without the use of needles), using only beat lightly with a fingertip (tapping) on certain body areas of mind, emotions and negative behaviors will be resolved. When someone is in a state of calm and relaxed, the flow of energy in the body's meridians flows smoothly. Psychological Reserval is want to be appreciated, in appropriate security, motivation and desire to release the problem. PR can be cured with SEFT by rubbing the palms on the 'afternoon point' or a knock on the point at hand (karate choppoint) (Zainuddin, 2009). With 12 energy pathways called meridians energy. If the energy flow is blocked or garbled, this arises emotional disorders or physical illness (Zainuddin, 2009). Likewise EFT provides evidence that we are overwhelmed by the energy flowing in our body, and we can feel it. By tapping some parts of the meridian points of the body, we can feel the emotional and physical changes in us. That change will not happen if there is no energy in our body system. This is consistent with the nursing actions that had been done to create a sense of security and comfort to the client that the massage technique and touch (touch). Massage is stimulating the skin and tissues in the body to facilitate the circulation and provide a relaxing effect (Frisch & Frisch, 2006). The influence of Spiritual Emotional Freedom Technique (SEFT) in patients with schizophrenia on self esteem of patients showed a statistically significant (p <0.05), that there is a difference on the self-esteem patiens between in the intervention and control groups. The results of this study are supported by Bradshaw (1998) that SEFT significant effect on the reduction on the symptomatology, rehospitalisations and 244
improved psychosocial functioning and achievement of treatment goals SEFT therapy combines the energy system of the body and spiritual therapies are used as a therapeutic technique to cope with emotional and physical problems, by performing a light knock (tapping) on nerve points (meridians of the body). Influence on the spiritual aspects of healing, disease management, anxiety, and acceptance of death has been a concern of nurses. Spiritual characteristics in nursing indicates recognition that natural factors are not visible and intangible affects the mind and behavior. These include the introduction of religious and supernatural beliefs. When people feel the power and influence of the outside of the physical existence and time, they are said to have suffered a metaphysical aspect of spiritual character. Supports and allow patients to talk about their confidence in bringing them closer to the source of spiritual encouragement. This helps giving strength and healing (Hudak & Gallo, 2012). SEFT intervention Award for 3 consecutive meetings of the respondents to change negative thoughts and feelings into the positive thoughts and rationale feelings to change their negative behavior into positive behavior. Smetzer (2004) states that the relaxation response can lower the yield stress. Hypothalamic activity will be inhibited and will decrease the activity of the sympathetic and parasympathetic. The sequence of physiological effects and symptoms and sign will be disconnected and psychological stress will be reduced. Respondents feel valueable when the current award can behave accordingly. It is able to increase the self-esteem of respondents. Real experience gained can be directly felt by respondents, so as to trigger the ability of respondents to develop their ability to enhance self-esteem. CONCLUSION AND RECOMENDATION It comes to the conclusion that Spiritual Emotional Freedom Technique (SEFT) is effective for patiens intervention group especially for their self-esteem. Development of SEFT for schizophrenia patients. Delopment of SEFT for schizophrenia patients applied to the curiculum of nursing education on the psychiatric nursing could be applied in various areas with different spiritual. Hospital as the health care services was a good place to establish SEFT care as one of program nursing education in impoving patient self-esteem. REFERENCES Bradshaw, W., 1998, Cognitive-Behavioral Treatment of Schizophrenia, A Case Study, Journal of Cognitive Psychotherapy: An International Journal, 12, (1) 13-25, 1998 (12 Agustus 2014) Bolton, B. 2003, Coopersmit Self Esteem Inventory : Test Review, Palo Alto : Proquest. Boyd, M.A., & Nihart, M.A. 1998, Psychiatric nursing contemporary practice, Lippincott, Philadelphia. Frisch,N.C. & Frisch,L.2006, Psychiatric mental health nursing, (3rd edition), Thompson Delmar Learning, USA. Hastono, S.P. 2007, Analisis data kesehatan. Tidak dipublikasikan, Depok. Hudak & Gallo, 2012, keperawatan Kritis. Pendekatan Holistik, EGC, Jakarta. Mruk, C.J., 200, Self Esteem, Researh, Theory, and Practice (3rd Edition). New Notoatmojo, S., 2010, Pendidikan dan perilaku kesehatan, Rinekacipta, Jakarta. RSJD Surakarta, 2008, Profil Rumah Sakit Jiwa Daerah Surakart, RSJD Surakarta. Smeltzer,S.C.(2004). Buku Ajar Keperawatan Bedah Brunner dan Suddart. Ed.8. vol. 2, EGC, Jakarta. Stuart, G. W., and Laraia, 2006, Principles and practice of psyhiatric nursing, (7"' ed.), Mosby Year B, St. Louis. 245
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