Sport and Fitness Journal

Volume 9, No.3, September 2021: 146-154

E-ISSN: 2654-9182

YOGA PRANAYAMA LOWERS THE RISK OF VIOLENT BEHAVIOR IN SCHIZOPHRENIA PATIENTS

Desak Made Ari Dwi Jayanti1*, I Made Dwi Satwika Wiraputra 2, Ni Ketut Ayu Mirayanti3, 1,2,3 STIKes Wira Medika Bali, 80232, Denpasar, Indonesia

Email: [email protected]

ABSTRACT

The main problem that often occurs in schizophrenic patients is violent behavior. As a result of violent behavior can hurt or injure yourself or others. Handling violent behavior is done by a combination of psychopharmacology and psychotherapy intervention. One of management of violent behavior through individual psychotherapy is physical activity in the form of pranayama yoga exercises. The purpose of this study was to determine the effect of Pranayama yoga on the risk of violent behavior in schizophrenic clients. This type of pre-experimental research, using a one-group pre-posttest design. The number of samples is 20 people with simple random sampling. Data collection uses observation sheets. The mean symptom of the risk of violent behavior pre-test of 13.55 including the risk of moderate violent behavior. The average post-test of 5.50 included the risk of mild violent behavior. Paired t test statistic results obtained p value <0.05 means that there are significant differences in symptoms of risk of violent behavior in schizophrenic patients pre-test and post-test it shows there is an influence of pranayama yoga on symptoms of risk of violent behavior in schizophrenic patients. Physical exercise through pranayama yoga exercises in general can reduce physiological stimulation and tension so as to reduce patient anger. Based on these results it is recommended that setting a routine schedule for schizophrenics in the Mental Hospital.

Keywords: 3rdPranayama Yoga, Risk of Violent Behavior, Schizophrenia

INTRODUCTION

Mental disorder is one of the four main health problems in developed, modern and industrial countries. The four main health problems are degenerative diseases, cancer, mental disorders, and accidents. Mental disorders are not considered as disorders that cause direct death, but the severity of these disorders in terms of disability and invalidity, both individually and in groups, will hinder development because they are unproductive and inefficient 1. The main problem with mental disorders in the world is schizophrenia, approximately 85% of patients admitted to mental hospitals are schizophrenia clients and most schizophrenia clients require long treatment 2. Schizophrenia is a group of psychotic reactions that affect various areas of an individual's function, including thinking and communication functions, accept and interpret reality, feel and show emotions and behave that can be accepted rationally 3.

Statistical data of World Health Organization (WHO) in 2018 show that 540 million people in the world experience mental health problems, one third of them occur in developing countries. It is estimated that 35 million people have depression, 60 million people have bipolar disorder, 21 million people have schizophrenia and as many as 47.5 million have dementia. The results of the Basic Health Research in 2018 showed that the prevalence data of schizophrenia reached around 14 million people or as many as seven per 1,000 Indonesian population, while Bali province itself was ranked first with the highest prevalence in Indonesia which reached 11 per 1,000 population 4. Documentation data from the nursing field at the Mental Hospital of Bali Province states that the number of schizophrenia patients treated in 2017 was 7,002 people, while in 2018 the number of schizophrenic patients increased to 7,664, of which 1,236

people (17.65%) were treated with behavioral nursing diagnoses. violence in 2017 then increased to reach 1,153 people (15.04%) in 2018 5.

The main problem that often occurs in schizophrenic patients is violent behavior such as showing emotions and behavior that cannot be accepted rationally and catatonic behavior such as restless rowdy (Keliat, 2015). Patients with violent behavior often show signs and symptoms that are not friendly, among others. yelling, face tense and face tense, eyes bulging, high voice intonation, rampage, hitting objects around him 6.

The impact that can be caused by patients with violent behavior can endanger themselves, others and damage the environment, nurses (79%), insult to nurses (77%) and verbal abuse (70%). More than half of respondents (51%) reported experiencing physical violence resulting in minor injuries and a small proportion of respondents (20%) reported experiencing physical violence that resulted in serious injury 7. The treatment of schizophrenia clients with violent behavior by a combination of psychopharmacology and psychosocial interventions such as psychotherapy, family therapy, modality therapy and behavioral therapy shows better results8. According to Fausiah and Widury (2015) it is estimated that no more than 10% of schizophrenic clients with violent behavior experience symptom relief only with the antipsychotic therapy approach, while the remaining 90% require a variety of dynamic approaches including pharmacotherapy, individual psychotherapy, group psychotherapy, analytical psychotherapy, creative arts therapy. , occupational therapy and behavior therapy with relaxation techniques 9.

One of the management of violent behavior through individual psychotherapy is physical activity. Physical activity can increase the vascularity of the brain, increase the neuroprotective role of neutropic factors and increase the levels of dopamine and serotonin. The release of serotonin will cause a feeling of pleasure, a sense of satisfaction and a good mood for people who are doing physical activity, and the body will be more energized, and the number of red blood cells will also increase so that the oxygen transport system throughout the body becomes more effective10. One of the activities that can be given to schizophrenia patients to reduce violent behavior is through physical activity in the form of yoga pranayama. Yoga Pranayama is a breathing practice in yoga, by doing breathing exercises or pranayama regularly, a person cleans himself from the inside so that his mind becomes calm11. When breathing is out of control, emotions become churned, thoughts become chaotic, body muscles will tighten, heart beats fast and skin sweats. Conversely, by breathing gently and regularly, the mind will become calmer, the emotions will be filled with peace and the body will become more relaxed12.

Physical exercise through yoga pranayama in general can reduce physiological stimulation and tension so that it can reduce patient anger. Pranayama practice can relieve tension slowly through gentle stretching combined with correct breathing, yoga movements can also improve blood circulation, increase lung capacitation so that a lot of oxygen gets into the blood. All yoga pranayama movements make the heart beat faster and produce more sweat out of the body. Yoga movements can also teach the art of relaxation that can reduce muscle tension due to being attacked by stress. Yoga practice teaches how to direct energy into the body to create a feeling of peace, increase concentration and stabilize the mind and calmness13. Research by Indirawaty et al., (2018) on the effect of complementary yoga therapy on the ability to control auditory hallucinations at the Special Hospital for South Sulawesi Province, found that there was a significant effect of complementary yoga therapy on the ability to control auditory hallucinations (p = 0.001)14. Research conducted by Dewinda (2016), regarding the effect of yoga Pranayama on the anxiety level of mental disorders patients at the Mental Hospital of Bali Province, found that there was a significant effect of the implementation of yoga ‘Pranayama” on anxiety levels (p = 0,000)15. Research by Fhadilah et al., (2017) show there is a decrease in the symptoms of angry behavior in schizophrenia patients16. Research by Jayanti and Antari (2019) on the effect of energy channeling group activity therapy: poco-poco exercise on the risk of violent behavior in schizophrenic clients at the Mental Hospital of Bali Province, found that there was a significant effect of

group activity therapy for energy distribution: poco-poco exercise on risk. violent behavior in schizophrenia (p = 0.000)17.

Based on data of the Nursing Division at Mental Hospital of Bali Province, 923 patients with a diagnosis of violent behavior were obtained in 2016, then in 2017 it increased to 1120 people and in 2018 there were 1236 patients treated with a history of violent behavior. The average number of patients treated with a risk of violent behavior in the last three months, namely April-June 2019 was 112 people, while the average number of patients treated with a risk problem of violent behavior in April-June 2019 were: Bratasena Room (Intensive) : 20 people, Drupadi Room: 12 people, Kunti Room: 11 people, Rsi Bisma Room: 13 people, Abhimanyu Room: 15 people, Arimbi Room: 16 people, Darmawangsa Room: 2 people, Nakula Room: 13 people and Sahadewa Room: 10 people5.

Management of clients with a risk of violent behavior in the inpatient room of the Bali Provincial Hospital is carried out with antipsychotic therapy, individual therapy through implementing strategies for implementation violent behavior such as deep breathing relaxation, hitting pillows / mattresses, verbal and spiritual methods, perceptual stimulation group activity therapy and music therapy. Based on the data obtained about changes in the symptoms of clients who are at risk of violent behavior after being given treatment, it is obtained data from 112 clients with the risk of violent behavior as many as 60 people (53, 57%) have not experienced changes in symptoms of violent behavior after being given antipsychotic therapy in the form of giving psychopharmaceutical drugs, individual therapy , perceptual stimulation group activity therapy and music therapy such as traditional music and songs. Giving yoga exercises to patients who are treated at the mental hospital of Bali Province, has been carried out in several rooms where nurses serve as yoga instructors, but it is not specifically done for schizophrenic patients with violent behavior and there has been no evaluation of the effectiveness of yoga exercises given to the patient's violent behavior.

Based on the description, the authors are very interested in knowing more deeply about the influence of Pranayama yoga on the risk of violent behavior in schizophrenia clients at the Mental Hospital of Bali Province.

METHODS

The research design used in this study was pre experimental design. The design in this study used one group pretest posttest design. In this study the data collected were primary data, namely data on the results of examining violent behavior in schizophrenic patients, which was carried out twice, namely before treatment (pretest) and after treatment (posttest). The intervention was given 3 times a week lasting 6 weeks. The population in this study were 20 patients at the Bangli Mental Hospital. The sample in this study was 20 people. Sampling using probability sampling technique type simple random sampling. The research used Yoga in the form of Standard Operating Procedures (SOP) and predefined violent behavior observation sheets. The data analysis technique used to test for normality is using the Shapiro-Wilk test, and after obtaining a normally distributed value, it is continued by Paried t Test.

RESULTS

Table 1. Frequency Distribution of Research Subjects Based on Age and Educational

No

Variable

Result

f

%

1

Age

26-35 years (early adulthood)

1

5.0

2

36-45 years (late adulthood)

4

20.0

3

46-55 years (early age)

15

75.0

1

Education

No Educated

4

20.0

2

Primary School

11

55.0

3

Junior Hight School

3

15.0

4

Senior Hight School

2

10.0

Total

20

100.0

Table 2. Results of Analysis of the Effect of Yoga Pranayama on the Risk of Violent Behavior in Schizophrenia Clients at the Mental Hospital of Bali Province in 2019

Variabel

n

Mean

SD

p value

t hitung

Symtoms of risk of violent behaviour- Pre Test

20

13.55

2.089

0.000

25.815

Symtoms of risk of violent

20

5.50

1.732

behaviour -Post Test

DISCUSSION

  • a.    Identify the risk of violent behavior in schizophrenic patients before being given Pranayama yoga

The results showed that the mean risk of violent behavior in schizophrenic patients before being given Pranayama yoga was 13.55, including the risk of moderate violent behavior. This is in accordance with the results of the observation that the physical signs of all respondents have a sharp view, the emotional signs of most of the voices are loud. Coercive belonging to other patients, from the cognitive signs that most of them like to threaten verbally and like to argue. The social signs of all patients like to snarl and from the overall behavior. often pacing the room. These symptoms are in accordance with the theory of Videbeck (2015) which states that moderate violent behavior is a response to moderate category violent behavior which is expressed physically, verbally, but is still controlled, encourages others with threats and has not taken actions that injure or injure themselves or other people other2. According to Yosep (2016), the risk of violent behavior is the possibility of someone taking action in a destructive form and is still under control18.

The results of this study are supported by Keliat (2015) that violent behavior is a response to stressors faced by someone who can be identified by the symptoms shown such as pacing, anxiety, facial expressions and tense body language, giving threats that can be caused because frustration, fear, manipulation or intimidation. The risk of violent behavior is the result of unsolved emotional conflict. Violent behavior also describes a sense of insecurity, the need for attention and dependence on others8. The results of the research obtained are in accordance with Yosep's (2016)

theory of violent behavior is actually a maladaptive response to anger. Feelings of anger are common to every individual and are a normal response when you get stressors or unfulfilled needs. Anger is a normal emotion in humans, namely a strong and unpleasant emotional response to a provocation, both real and perceived by the individual. Anger is a normal response, but if expressed inappropriately it can lead to hostility and aggression. Anger that cannot be expressed assertively can extend to the most maladaptive response, namely violent behavior18.

The results research conducted by Fhadilah et all (2017), with the title of research on the effect of relaxation techniques on changes in violent behavior of schizophrenia patients at the Surakarta Mental Hospital is medium category16. The results obtained are supported by research conducted by Sodikin et al (2015) on the effect of assertive training in shortening the intensive phase and reducing symptoms of violent behavior in the RSJ Intensive Psychiatric Care Unit (IPCU). Dr. Radjiman Wediodiningrat Lawang. The results of this research indicate that the symptom score of violent behavior was 58, this indicates that all respondents both from the treatment group and the control group were in an acute / intensive condition (score of Modified Global Assessment of Function-Revised (GAF-R) <3019.

Violent behavior is associated with age where in this study most of them were 15 people (75%) aged 46-55 years, this can be due to changes in physical conditions along with increasing age and the inability to face stressors in facing competition in life will cause someone prone to mental disorders. The results of this study are supported by research by Jayanti and Antari (2019) which examines the effect of energy channeling group activity therapy: poco-poco exercise on the risk of violent behavior in schizophrenic clients at the Mental Hospital of Bali Province where most of the respondents studied were 15 people (68, 2%) 46-55 years old. The characteristics based on education are mostly as many as 11 people (55%) of primary school education17. According to researchers, education affects personal development, that generally education enhances the level of intelligence, was able to adapt to the environment and had better coping skills to deal with stressors than people with low education. The level of education of a person will affect one's mindset, personality and behavior. The higher the formal education, the individual's behavior is expected to be easier in adopting new knowledge and having a good personality and behavior. The results of this study are supported by Agustina (2016) where the respondents studied were mostly 14 people (70%) with basic education (Primary School and Junior High School)20.

The results of this study indicated that violent behavior in schizophrenia patients was categorized as moderate violent behavior. According to the researcher's opinion, it can be caused by the patient's inability to face threats and the lack of ability to recognize and prevent violent behavior. Stress conditions, anxiety, anger are part of everyday life that must be faced by every individual. Stress can cause anxiety which causes unpleasant feelings and threats, anxiety can lead to anger, respondents in this study expressed their anger poorly by running away or challenging it would create hostility. And if this method is used continuously, then anger can be expressed in yourself or the environment.

  • b.    Identify the risks of violent behavior in patients with schizophrenia after being given Pranayama yoga

The results showed that the mean symptom of violent behavior in schizophrenia patients after being given Pranayama yoga was 5.50 including the risk of mild violent behavior. The results of this study showed that a decrease in symptoms of violent behavior could be caused by providing physical activity in the form of Pranayama yoga as a form of energy distribution for the patient. The results obtained are supported by Heryati (2015) that physical activity can increase brain

vascularization, increase neutropic factors that act as neuroprotective and increase dopamine and serotonin levels. The release of serotonin will lead to feelings of pleasure, satisfaction and a better mood for people doing physical activity, and the body will be more energized, and the number of red blood cells will also increase so that the oxygen transport system throughout the body becomes more effective One of the activities that can be given to schizophrenia patients to reduce violent behavior is through physical activity in the form of yoga pranayama exercises10.

The results of this study are in accordance with the theory of Sindhu (2016) which states that the a yoga movement can relieve tension slowly through light stretching combined with correct breathing, yoga movements can also accelerate blood circulation, increase lung capacitation so that more oxygen enters. blood. All yoga movements make the heart beat faster and produce more sweat out of the body, yoga movements can also teach the art of relaxation that can reduce muscle tension due to being attacked by various stressors. Yoga practice teaches how to direct energy to the body to create a sense of peace, increase concentration and stabilize the mind and great calm12.

The results of this study were in accordance with the results of research by Afriani (2015) concerning the effect of yoga in reducing the level of depression in rehabilitation drug addicts at Wisma Sirih Mental Hospital in Sungai Bangkong Region, West Kalimantan Province, the results of the study showed the level of depression before hatha yoga was on average at this level mild depression (55.5%) and after doing hatha yoga experienced a decrease in the level of depression to not depression (66.7%) 21 Andini (2017) said the effect of children's yoga therapy to changes emotional disorders in students at Primary School 1 Sukodadi, Wagir District, Malang Regency. The results of this study showed that the average total emotional score before doing yoga exercises was obtained an average score of 15.43, while after doing yoga exercises the score decreased to an average of 8.7322.

According to researchers, giving patients yoga practice aims to direct patients to focus their entire mind to control their five senses in order to be able to control their emotions. In addition, there is a decrease in the risk of violent behavior symptoms after being given yoga pranayama, according to the opinion of the researchers because there are some patients who are able to do activities well during the implementation of yoga pranayama so that it affects other patients to be able to follow their group friends in doing the yoga pranayama given which causes all patients to focus. and enjoy the activities provided in the implementation of yoga pranayama so that symptoms of the risk of violent behavior can be diverted. This is in accordance with what Keliat (2015) states that one of the roles of the group is as an encourager which functions as a positive influence on other group members7.

  • c.    Analyzing the effect of yoga pranayama on the symptoms of risk of violent behavior in schizophrenic patients

The results showed that there was a decrease in the mean symptom of violent behavior between the pre-test and the post-test by 8.050. The results of the test with the Paired t Test obtained p value <0.05, which means that there is a significant difference in the risk symptoms of violent behavior in the pre-test and post-test schizophrenia clients.This shows that there was an effect of yoga pranayama on the symptoms of risk of violent behavior in schizophrenia patients at the Mental Hospital of Bali Province . According to Somvir (2015), one of the activities that can be given to schizophrenia patients to reduce violent behavior is through physical activity in the form of yoga pranayama exercises. Yoga Pranayama is a breathing practice in yoga, by doing

breathing exercises or pranayama regularly, a person cleans himself from the inside so that his mind becomes calm 11. The above statement is reinforced by Sindhu (2016) when breathing is uncontrollable, emotions become turbulent, thoughts become chaotic, body muscles will tense up, the heart beats fast and the skin sweats. Conversely, by breathing gently and regularly, the mind becomes calmer, the emotions will be filled with peace and the body becomes more relaxed12.

The results of this study are in accordance with Worby's (2016) theory of yoga pranayama breathing techniques to control breathing and thoughts. The breathing practice mechanism of yoga pranayama against the physical changes that occur in the body begins with the creation of an atmosphere of conscious relaxation which systematically leads to a deep relaxed state. Creating an atmosphere of relaxation will eliminate voices in your mind so that your body will be able to release muscle tension. When the body begins to relax, breathing slows down and has a positive influence on the entire circulatory system and the heart to rest and experience the process of rejuvenation. The sympathetic nervous system, which is always ready for action, receives safe messages for relaxation, while the parasympathetic nervous system will respond to relaxation. Apart from the sympathetic nerves, messages for relaxation are also received by the endocrine glands which are responsible for most emotional and physical states23.

According to Yogamurti (2014) physical exercise through yoga pranayama exercises in general can reduce physiological stimulation and tension so as to reduce patient anger. Yoga practice teaches how to direct energy into the body to create a feeling of peace, increase concentration and stabilize the mind and calmness through breathing because breathing is closely related to the mind. Feelings or emotions are products of thoughts. This will appear to someone who is angry, because his mind is not calm, does not go harmoniously, so his breathing becomes chaotic. People who are sad, anxious, afraid, or in panic may not breathe regularly13.

The results of this study were in accordance with the results of research by Indirawaty (2016) regarding the effect of complementary yoga therapy on the ability to control auditory hallucinations at the Special Hospital for South Sulawesi Province, it was found that there was a significant effect of complementary yoga therapy on the ability to control auditory hallucinations (p = 0.001)14. Research conducted by Dewi (2016), regarding the effect of yoga Pranayama on the level of anxiety of mental disorders patients at the Mental Hospital of Bali Province, found that there was a significant effect of the implementation of yoga ‘Pranayama” on anxiety levels (p = 0,000)15. Research by Fhadilah et al., (2017) on the effect of relaxation techniques on changes in violent behavior of schizophrenic clients at the Surakarta Mental Hospital, found that there was a significant effect of relaxation techniques on changes in violent behavior of schizophrenia clients (p = 0.001)16.

Yoga pranayama affects the risk of violent behavior in schizophrenia patients. According to researchers, giving yoga pranayama can reduce tension because breathing is closely related to thoughts and emotions. This will appear to someone who is angry, because his mind is not calm, does not go harmoniously, so his breathing becomes chaotic. People who are sad, anxious, afraid, or in panic may not breathe regularly. Yoga pranayama can be an alternative for patients at risk of violent behavior because yoga practice can be done by patients anywhere and can be done while in bed and while sitting by practicing the patient's breathing regularly. The implementation of yoga pranayama for schizophrenic patients at the Bali Provincial Mental Hospital has not been carried out. Yoga pranayama can be an alternative choice for patients who have undergone rehabilitation,

apart from providing the benefits of maintaining stable self-control, reducing and eliminating violent, stressful or tension behaviors.

CONCLUSION

Violent behavior in schizophrenic patients before being given yoga pranayama the score was 13.55 including the risk of moderate violent behavior and the average after being given yoga pranayama the score was 5.50 including the risk of mild violent behavior. The results of the Paired t Test statistical test obtained p value <0.05, which means that there is a significant difference in risk symptoms of violent behavior in pre-test and post-test schizophrenia patients, this shows that there is an effect of yoga pranayama on the symptoms of risk of violent behavior in schizophrenic patients in the hospital. The soul of the province of Bali. Suggestions: For the Mental Hospital of Bali Province, it is hoped that yoga pranayama can be continued by the Head of the Nursing Division by using the results of this study as a reference in the preparation of Standard Operating Procedures for yoga pranayama in schizophrenia patients in general and patients with violent behavior at the Bali Province Mental Hospital so that it can be applied in all spaces. inpatient.

CONFLICTS OF INTEREST

The author states that there is no conflict of interest.

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