REDUCING ANXIETY LEVELS THROUGH INTEGRATIVE INTERVENTION OF FIVE-FINGER HYPNOSIS AND AROMATHERAPY

Dudi Hartono1, Unang Arifin Hidayat1, Yanti Cahyati1*, Sandeep Poddar2

1Department of Nursinng Poltekkes Kemenkes Tasikmalaya, Indonesia

2Lincoln University College, Petaling Jaya, Selangor Darul Ehsan,Malaysia

*Corresponding Author’s Email: yantinaufal@gmail.com

ABSTRACT

Anxiety is the most common mental disorder, around 3.6% of the population. Effective care and treatment for anxiety disorders are needed. This is done so that individuals who experience these disorders can return to being productive in meeting their life needs and do not depend on other people. Currently, client management is not only given psychopharmaceutical treatment but also with a psychotherapy approach.

This study aims to determine the integrative effect of five-finger hypnosis and aromatherapy on the level of anxiety of patients at the Mental Polyclinic of dr. Soekardjo City of Tasikmalaya. The method used is research quantitative with research quasi- experimental design pre-test and post-test with control design. Bivariate analysis on the variables before and after the intervention using paired t-test, and independent t-test to see the comparison of anxiety scores after intervention in the control group and the intervention group.

The results showed 60 respondents, 30 control group respondents received Five Finger Hypnosis treatment for 4 times a week for 3 weeks, while 30 people in the intervention group received a combination of Five Finger Hypnosis and Aromatherapy for 4 times a week for 3 weeks. Before and after the intervention was carried out, the level of anxiety was measured using the Hamilton Anxiety Rating Scale (HARS). The analysis showed that there was a difference in the average score of anxiety before and after the intervention in the intervention group. Further analysis found that there was a significant difference in the average score of anxiety after the intervention between the control group and the intervention group. therapy Five finger hypnosis and aromatherapy should be used as an independent nursing intervention in dealing with anxiety problems.

Keywords: Five Finger Hypnosis; Aroma Therapy; Anxiety

INTRODUCTION

Mental health is an important part of creating productive Indonesian human resources as well as a valuable national asset. But mental health is still one of the significant health problems in the world, including in Indonesia. Mental health is one disease that has a tendency to become chronic and is often accompanied by a decrease in function(disability)in the field of employment, social relationships, and the ability to care for themselves so it tends to hang various aspects of life in the surrounding environment (Hasmira, Keliat & Hargiana, 2020).

Anxiety is a mental disorder that is most often found and is usually associated with a high burden of illness. Based on the study, there are 7.7%% cases of anxiety that occur in children aged 13-17 years and 6.6% cases at ages 18-64 years (Öztürk et al., 2015). According to the results of the Basic Health Research (Agency of Health Research and Development, 2013) in 2013, it showed that as many as 6% of the population aged 15 years and over around 14 million people in Indonesia experienced mental-emotional disorders which manifest as anxiety and depression disorders. Anxiety disorders develop from a complex set of risk factors, including genetics, brain chemistry, personality, and life events. It is not uncommon for someone with an anxiety disorder to suffer from depression or vice versa. Nearly half of those diagnosed with depression are also diagnosed with anxiety disorders (Udawiyah, Ariani & Lesmana, 2019).

Studi introduction in the General Hospital (RSU) dr. Soekardjo Tasikmalaya obtained data that the diagnosis of anxiety is the highest-ranking of patients who come for treatment at the mental polyclinic. Effective care and treatment for anxiety disorders are needed. This is done so that individuals who experience these disorders can return to being productive in meeting the needs of life, do not depend on other people, and can carry out daily activities. Currently, the management of clients with anxiety and depression is not only given psychopharmaceutical treatment but also with a psychotherapy approach (Zakiyah, 2014).

Psychotherapy is a form of treatment or treatment of problems that are emotional with the aim of eliminating, changing, slowing down symptoms to promote positive personal development. Interventions are carried out to help patients recognize anxiety, teach relaxation techniques to improve control and confidence in the form of distraction and self-hypnosis. Distraction is diverting the patient's attention to something else so that it can reduce awareness of pain or anxiety, and even increase tolerance to pain or anxiety. Distraction works for a good effect for a short period, a pleasant sensory stimulus will stimulate the secretion of endorphins so that the stimulus of pain or anxiety will be reduced.

Forms of relaxation distraction include deep breathing techniques and 5 finger hypnosis techniques. The 5-finger hypnosis technique is one of the distraction techniques using self-hypnosis using 5 fingers which aims to distract the patient from things that make him anxious (Pardede, Sitepu & Saragih, 2018). Also, the 5 finger hypnosis technique is a powerful weapon in relieving stress associated with a disease, this is one of the fastest, easiest methods of producing relaxation (Hakim, 2010).

The results of the study (Loriana, 2017) were about "The effectiveness of self-hypnotic relaxation techniques with five-finger exercises on reducing the anxiety level of pre- operative appendectomy clients in the Cempaka Room AW Sjahranie Hospital Samarinda". The result was that after 1 time the 5 finger hypnosis technique was carried out, there was a change in the level of anxiety, namely the level of anxiety during pre was mild anxiety by 5 people, moderate anxiety by 5 people. Meanwhile, the level of post anxiety was mild anxiety by 7 people, moderate anxiety was 1 person, and there was no anxiety by 2 people.

According to (Noorkasiani, 2014) in his article entitled "The Effectiveness of Five Finger Hypnosis Therapy to Reduce Anxiety Levels in Hypertensive Patients, shows a decrease in anxiety levels with a p-value α 0.019 between the intervention group and the control group. The decrease in the level of anxiety in the intervention group was 5.16 points and the control group was 2.13 points. Research shows that five-finger hypnosis can reduce anxiety in hypertensive patients.

Another complementary therapy that is relatively safer and almost without complications for anxiety is aromatherapy. Aromatherapy is a nursing therapy method that uses volatile plant liquid ingredients known as essential oils which aim to influence a person's mood or health (Cahyati et al., 2020). Research conducted by (Karadag et al.,2017) on the effects of aromatherapy on sleep quality and anxiety in 60 coronary heart disease patients who were treated in the ICU of a hospital located in the Southeastern Turkish province. The aromatherapy type used is Lavender. The intervention group was given Lavender oil inhalation for 15 days, then the anxiety level and sleep quality were measured, while the control group was not given inhalation and the anxiety level was measured after 15 days. The results showed that Lavender oil improved sleep quality and decreased the anxiety of coronary heart disease patients who were admitted to the ICU. Five-finger hypnosis and aromatherapy in the concept of previous research can be effective complementary therapies in overcoming anxiety problems. If the two complementary therapies are combined, it is hoped that they can further increase their effectiveness in reducing the anxiety level of depressed patients. This study aims to determine the effect of the five- finger hypnosis integrative action and aromatherapy on the anxiety level of patients in the Polyclinic of Dr. Soekardjo City of Tasikmalaya.

METHODOLOGY

The design used was a research quasi-experimental design. The design used is a pre-test and post-test with control design. This research was conducted at the Polyclinic RSUD Dr. Soekardjo Tasikmalaya. The sample size was 60 respondents who were selected using purposive sampling. The inclusion criteria in this study were the respondents were diagnosed with anxiety, the patient's condition was stable, the patient was adult, accompanied by a family who lived in the same house, and was cooperative. The exclusion criteria in this study were that patients were not willing to be respondents, were outside the city of Tasikmalaya, were intolerant of Lavender aromatherapy (Surya, Zuriati & Poddar, 2020).

In this study, a control group of 30 people received five-finger hypnosis 4 times per week for 3 weeks, while the intervention group received a combination of five-finger hypnosis and Aromatherapy for 4 times/week for 3 weeks, by dropping 2-3 drops of Lavender aromatherapy. on the pillow at least 30 minutes before bed. Anxiety level measurements were carried out before and after the intervention was carried out using a standardized anxiety measuring questionnaire, namely the Hamilton Anxiety Rating Scale (HARS). This study involved respondents who consciously and without coercion were willing to be involved in the research. Before the research was carried out, the researcher explained the objectives, benefits, and procedures of the study to the respondents. Furthermore, the researcher will ask for the respondent's consent to be involved in the research. After the respondent agrees, the respondent is asked to sign a letter of approval to become the respondent. Researchers apply ethical principles in conducting this research. Data processing is usually done by editing, coding, data entry, and cleaning. Data that has been processed will then be analyzed.

RESULTS

The results of the univariate analysis were carried out to describe the anxiety scores of respondents in the control group and the intervention group, the results of the univariate analysis can be seen in Table 1 below:

Table 1: Distribution of Respondents Based on Anxiety Score

Based on Table 1 above it can be seen that the average score of group respondents' anxiety control before the intervention was 21.70 and after intervention 13.77. Whereas in the intervention group the average score of anxiety was 23.15 and after the intervention was 12.03.

Researchers conducted a bivariate analysis to see the effect of the intervention carried out in the control and intervention groups on the average score of respondents' anxiety. The results of the analysis can be seen in the following table:

Table 2: Distribution of Average Anxiety Values Before and After Intervention in the Control & Intervention

Based on Table 2 above, the average score of anxiety in the control group before intervention is 21.70 while the anxiety value after the intervention is 13.77. The statistical test results obtained a p-value of 0.371, it can be concluded that there is no significant difference in the anxiety score between before and after the intervention in the control group. In the intervention group, it can be seen that the mean score of anxiety before training is 23.15 and the average anxiety score after the intervention is 12.03. The statistical test results obtained a p-value of 0.036, it can be concluded that there is a significant difference in the level of anxiety between before and after the intervention in the intervention group.

Furthermore, the researcher analyzed to see the difference in the average score of anxiety after exercising in the control group and the intervention group. The results can be seen in Table 3 below:

Table 3: Distribution of Average Difference of Anxiety Levels After Intervention between Control Group & Intervention

Table 3 above shows the mean the average value of anxiety level after intervention in the control group was 13.77, while the average anxiety level after intervention in the intervention group was 12.03. The statistical test results obtained a p-value of 0.036 means that at 5% neglect there is a significant difference in the average level of anxiety after the intervention in the two groups of respondents.

To further clarify the comparison of the average level of anxiety before and after intervention in the intervention group and the control group is described in table 4 below:

Table 4: Comparison of Changes in the Average Level of Anxiety Before and after Intervention in the Control & Intervention Group at dr. Soekardjo Kota Tasikmalaya August - November 2018 (n = 60)

Table 4 above shows clearly that the average level of anxiety in the group control before the five-finger hypnosis was 21.70 and after the intervention changed to 13.77, meaning that there was a change in the value of 7.93, it can be concluded that the level of anxiety decreased after the five-finger hypnosis intervention was carried out. When compared with the intervention group, before the Five Finger Hypnosis and Aromatherapy the average anxiety level was 23.15 and after the Five Finger Hypnosis was done, it was 12.03, decreased by 11.12, greater than the control group.

DISCUSSION

The results of this study indicate that statistically, there is no significant difference in the mean score of anxiety in the control group, but there is a significant difference in the average score of anxiety in the intervention group after intervention. Although statistically there is no difference in the control group, if seen from the mean reduction in anxiety levels, there is a decrease of 7.93 points. The results of further research indicate that there is a significant difference in the mean score of anxiety after the intervention in the control group and the intervention group.

The results of this study generally indicate that five-finger hypnosis can reduce anxiety scores, although these results are not statistically significant in the control group. The results of research conducted (Astuti, 2017), on the effect of Five Finger Hypnosis on the level of anxiety in the elderly with hypertension in the work area of Puskesmas Sempor 1 Kabumen Regency with the result that there is a significant relationship between five finger hypnosis and anxiety level p-value 0.000 with a decrease in the level of anxiety from severe to moderate as much as 3.3%, and from moderate to low anxiety as much as 96.7%. This is in line with research conducted by (Marbun, Pardede & Perkasa, 2019); (Pratiwi, 2020) and (Saswati, Sutinah & Dasuki, 2020), these three studies show the effect of five finger hypnosis on anxiety levels.

Five-finger hypnosis is a technique of distracting someone's thoughts by touching the fingers while imagining things that are fun or like (Saswati, Sutinah & Dasuki, 2020). This technique is known to treat psychological disorders. During the five-finger hypnosis process, information is transmitted to the brain stem, then to the limbic cortex, and then to the hippocampus. Finally, the information will reach the hypothalamus. This will cause the endocrine to increase so that the two autonomic nerves are balanced and there is a process of relaxation and calmness (Smeltzer, Bare & Hinkle,2010).

This five-finger hypnosis can have a relaxing and calming effect, this is done by exploring and recalling pleasant experiences that have been experienced by individuals (Agustin Sumarsih & Nugroho, 2019). Individuals who are in a hypnotic state will experience changes that occur in the brain's condition in the dorsal anterior cingulate cortex (ACC), such as becoming more focused and better able to control several physical and emotional symptoms. When entering a hypnotic situation, the patient is asked to focus on his physical sensations while thinking about triggers for anxiety. Once the patient recognizes these sensations, the hypnotherapist will speak soothing words and offer the best advice. Also, a hypnotic condition will stimulate the reticular activation system in the brain which causes a response to the autonomic nervous system, in the form of a decrease in pulse frequency, blood pressure, and respiratory rate as well as control of feelings, emotions, and stress (Subandiyo, 2014; Fitriani et al., 2020).

Research results that combine five finger hypnosis and aromatherapy do not exist. Previous research on the effect of Lavender Aromatherapy on reducing the degree of anxiety in the elderly at the Wredha St. Yoseph Kediri conducted by (Kristanti, 2010) showed that 90% of respondents experienced a decrease in anxiety levels after Lavender aromatherapy. The statistical test shows a p-value <0.05 which indicates that there is a significant relationship between Lavender Aromatherapy and the anxiety level of elderly patients at the Wredha St. Yoseph Kediri.

Aromatherapy is a therapy that uses essential oils that are considered to help reduce and even overcome psychological disorders and comfort disorders such as anxiety, stress, depression, and so on. According to scientific research, smells affect the brain, like alcohol, for example, lavender aromatherapy can increase the frequency of alpha waves in the back of the head, and this condition is associated with relaxation (Chien, Cheng & Liu, 2012). Lavender therapy is a therapy that uses essential oils that are considered to help reduce and even overcome psychological disorders and comfort disorders such as anxiety, stress, depression, and so on. Therefore, giving lavender aromatherapy relaxation techniques can reduce anxiety levels (Cahyati et al., 2020).

Five-finger hypnosis is a form of self-hypnosis that can cause a high relaxing effect, thereby reducing tension and stress from one's mind. Five-finger hypnosis affects a person's limbic system so that it affects the secretion of hormones that can spur stress. Patients who are given five-finger hypnosis will experience relaxation so that it affects the body's systems and creates a sense of comfort and a feeling of calm (Hartono, Somantri & Februanti, 2019).

In addition to providing calm, five-finger hypnosis therapy can also provide comfort. Comfort is the experience that a person receives from an intervention. It is a direct and comprehensive experience when physical, psychospiritual, social, and environmental needs are met. The relaxing effect produced by the five-finger hypnosis action is strengthened with aromatherapy which both provides a relaxing effect, of course, this will have a more beneficial effect in reducing patient anxiety.

CONCLUSION

There is a significant difference in the score of anxiety levels in the intervention group before and after the five-finger hypnosis exercise and aromatherapy. In the next analysis, it can be seen that there is a significant difference in the mean score of anxiety in the intervention group and the control group. So it can be concluded that the five-finger hypnosis exercise combined with aromatherapy can reduce anxiety scores.

Conflict of Interests

The authors declare that they have no conflict of interest.

ACKNOWLEDGEMENT

The authors are thankful to the institutional authority for completion of the work.

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