Keywords: Cognitive therapy, Low self-esteem, Mental disorders

INTRODUCTION

High self-esteem is described from the nature of the individual, who has a feeling of unconditional self-acceptance, even though wrong, defeated and failed, as a valuable and important trait for himself. Individuals who have feelings of worthlessness, insignificance, and prolonged low self-esteem due to negative evaluations of themselves and their own abilities are a picture of someone who has low self-esteem.

Low self-esteem is a pervasive psychological dysfunction - regardless of their specific problems, almost all patients state that they want to have better self-esteem. If we only reduce low self-esteem, many psychological problems will be substantially reduced or disappear completely [1]. According to [2] Self-esteem is an important component of psychological health. Much previous research indicates that lowered self-esteem frequently accompanies the psychiatric disorder. 

Lowered self-esteem has been consistently found to occur in several psychiatric disorders. Schizophrenia has positive symptoms and negative symptoms. Negative symptoms include low self-esteem. low self-esteem can be a consequence of mental health disorders (such as depression, anxiety, and panic) or it can be a vulnerability factor for the development of such problems [3]. According to [4] found 24% of the people with schizophrenia scored below the mid-score (reflecting low score and low self-esteem). Schizophrenia patients have significantly low self-esteem in comparison to other psychiatric conditions and they are expected to have a compromised quality of life and poor psychosocial functioning [5].

Low self-esteem causes feelings of emptiness and separation from others and sometimes causes depression, anxiety, or prolonged anxiety [6]. With low self-esteem disorders can cause an individual to have negative moods and memories so that the individual is more prone to face depression when faced with stress because the mindset he has towards himself is not good, the purpose of life is unclear, has a more future pessimistic, the lower the self-esteem, the more risky personality disorder. Low self-esteem that is not handled will cause disruption of social interaction: withdrawal, changes in appearance, hopelessness, and emergence of violent behavior that risks injuring oneself, others, and the environment [7]. Negative thoughts that exist in individuals who experience low self-esteem will be able to trigger mental stress on patients so that it can cause anxiety in patients, depression, or even trigger the desire to commit suicide in patients with mental disorders [8].

Some of the results of previous studies have examined the low self-esteem. Research results by [9]. Of the total of 87 participants who experience low self-esteem 20 (23.0%) had attempted suicide. Low self-esteem appears to represent a psychological dimension that is closely related to suicide risk. Therefore, clinical attention should be paid to the evaluation and enhancement of low self-esteem in schizophrenia patients with suicidality. A longitudinal prospective study is required to ascertain whether low self-esteem leads suicide attempts. Hasil penelitian [10]. Chronic low self-esteem is one of the nursing diagnosis that is often found in psychiatric hospitals and Percentages of patients with chronic low self-esteem at Arimbi room receached 90.4%. Hasil penelitian [11]. found 30 schizophrenic patients made respondents because of experiencing chronic low self-esteem problems.

Some researchers have previously obtained the percentage of patients who experience chronic low self-esteem problems. Patients who are respondents until there are depressed, suicidal and other problems caused by low self-esteem. So it is necessary to be treated with psychiatric nursing therapy so that chronic low self-esteem can be cured and not cause suicide.

Some researchers have previously examined the low self-esteem using several nursing therapies with the result that these therapies can reduce the symptoms of low self-esteem and improve the ability of patients. The results of research conducted by [12]. obtained results that Cognitive Behavior Therapy (CBT) can improve the cognitive ability of 29.31% and 22.4% of behavior capabilities on the client of schizophrenia with low self esteem. [13]. found a decrease in symptoms and an increased ability of clients low self-esteem who got CBT and Rational Emotive Behavior Therapy (REBT) is larger than not getting Cognitive Behavior Therapy and REBT (p < 0.05). The results of research conducted by [1]. Cognitive-Behavioral Treatment Of Low Self-Esteem. The results of research conducted by [13]. Acceptance and Commitment Therapy (ACT) and given medication compliance of 45.70 (39.05%), intervention 2 before the given ACT of 48.10 (41.02%) and group control of 44.37 (37.92%).

In overcoming the problems found in patients with mental disorders, especially patients with low self-esteem can be given one of the cognitive therapy. The results of the study [14]. Cognitive therapies can increase self-esteem in patients avoidant and obsessive-compulsive disorders. According to [15]. Cognitive therapy can also help individuals especially those who have problems dealing with others, cope with stress well, increase self-esteem, reduce fear, and be more confident. Cognitive therapy is a short-term therapy and is carried out regularly, which provides a basis for thinking of patients to express their negative feelings, understand the problem, be able to overcome negative feelings and be able to solve the problem. The results of the study [8]. using cognitive therapy in schizophrenia patients who experience low self-esteem become able to control negative thoughts well.

The results of the initial survey at Prof.Dr.M.Ildrem Mental Hospital Obtained data from Medical Records in 2018 patients with mental disorders amounted to 4,341 people, of which the number of patients experiencing disorders mental with low self-esteem problems as many as 155 people (3.5%), patients with social isolation as many as 248 people (5.7%), patients with hallucinations 3435 people (79.6%), patients with violent behavior as many as 155 people (3.5%), patients with delusions was 61 people (1.4%), patients with self-care deficits were 280 people (6.3%).

Some things that cause a person to experience low self-esteem include patients experiencing physical violence behavior, past trauma, rejection from the environment and those closest to them, and experiencing repeated failures. In February 2019 patients with low self-esteem were 47 people (13.6%), social isolation were 22 people (6.3%), hallucinations were 253 people (73.3%), violent behavior were 10 people (3% ), delusions for 3 people (1%), epilepsy for 1 person (0.2%), and self-care deficit for 9 people (2.6%). Low self-esteem is the second-highest diagnosis of nursing problems that arise after hallucinations. So that researchers are interested in examining the effect of cognitive therapy on changes in self-esteem in patients with low self-esteem at Prof. Dr. M. Ildrem Mental Hospital in Medan.

RESEARCH METHODOLOGY

The design of this study was Quasi-experimental one group pre-test-post test design, the population in this study were all patients with Low Self-Esteem totaling 47 people, the sampling technique in this study was purposive sampling as many as 22 patients with low self-esteem. The sampling criteria in this study are inclusion and exclusion criteria, inclusion criteria: the patient has been screened with a nursing diagnosis of low self-esteem, the patient is cooperative, can communicate well, age 18-55 years, the patient does not experience recurrence, and the exclusion criteria: the patient stop when an intervention is carried out. This study uses a questionnaire to measure self-esteem in respondents who have tested the validity of the Cronbach Alpa value of 0.82. The statistical test used in the study is the mc-Neymar test with a p-value of 0,000 (p <0.05) with a significant level of 95%.

RESULT

Table 1: Frequency and Percentage Distribution Based on Characteristics of Respondents.

Based on Table 1, it can be seen that the majority of respondents were male as many as 17 people (77.3%), the majority of the age of the respondents were 40-50 years as many as 10 people (45.5%), with the last educational background being the majority There were 9 respondents (40.9%) in elementary school, 12% of respondents (90.0%) were not working, and the majority of respondents were 11 respondents (50%) married, then the majority of respondents were treated> 1 time 12 respondents (54.5%)

Table 2: Respondents' Self-Esteem Before being given Cognitive Therapy.

Based on Table 2, it can be seen the self-esteem in respondents before cognitive therapy is given, overall respondents have low self-esteem of 22 respondents (100%).

Table 3: Respondents' Self-Esteem After Being Given Cognitive Therapy.

Based on Table 3, it can be seen that the majority of respondents' self-esteem after being given cognitive therapy is high self-esteem of 19 respondents (86.4%)

Table 4: Changes in Self-Esteem in Patients Low Self-Esteem Before and After Given Cognitive Therapy.

Based on Table 4, it can be seen that there are significant changes between respondents' self-esteem before and after cognitive therapy, which of all respondents with low self-esteem before being given cognitive therapy there are 86.4% of respondents experiencing changes in self-esteem after therapy and 13, 6% of respondents did not experience changes in self-esteem after being given therapy.

Bivariate Analysis Results The Effect of Cognitive Therapy on Changes in Self-Esteem in Patients with Low Self-Esteem using the Mc Neymar Test obtained p value of 0,000 (p <0.05). This shows that there are significant differences from cognitive therapy to changes in self-esteem.

DISCUSSION

Respondents' Self-Esteem Before being given Cognitive Therapy

The results obtained as many as 22 people (100%) with low self-esteem, which means the value of the respondent's self-esteem before given overall cognitive therapy in the low category. This can be seen from the results of the questionnaire that was filled out by respondents before therapy, as many as 82% of respondents said they preferred to be alone, then 86% of respondents said they rarely interacted with the surrounding environment, and 77% of respondents said that they were useless and difficult to concentrate.

This happens because low self-esteem is synonymous with rejection of one's own abilities, pessimistic views. The results of this study are also in line with the theory put forward by [16]. which says a person who experiences low self-esteem often experiences social interaction disorders, such as preferring to be alone and dislike meeting other people, in line with the results of this study [8]. which before doing cognitive therapy from 14 respondents there were 13 respondents (92.9%) included in the bad category in controlling negative thoughts while 1 respondent (7.1%) had the ability to control negative thoughts.

Harga Diri Responden Setelah Diberikan Terapi Kognitif

Hasil penelitian didapatkan bahwa harga diri responden setelah dilakukan terapi kognitif mayoritas mengalami peningkatan yang mana sebanyak 19 orang reponden (86,4%) dengan harga diri yang tinggi dan 3 orang responden (13,6%) tidak mengalami perubahan harga diri.

Based on the research results obtained indicate that there is a change in the respondent's self-esteem after cognitive therapy can be seen from each response value of the respondent. This value is obtained from the results of a questionnaire that researchers distributed to respondents after cognitive therapy. Most respondents said they would try to get other people to talk, not be alone anymore, and said that they were sure they could be relied on by others in a job, they were able to overcome the problem and would recover soon and help the family again. From these statements, it can be concluded that respondents can overcome the negative thoughts that arise in him independently after cognitive therapy.

The same research results that support this study do not yet exist, but research conducted by [17]. that examines the effect of cognitive therapy on the ability to interact with schizophrenia patients with social isolation with the results, from 20 respondents 3 people (15%) on high level, 10 people (50%) at the moderate level and 7 people (35%) who are at the low level. The results obtained are different levels of ability to interact after this cognitive therapy.

Effect of Cognitive Therapy on Changes in Self-Esteem in Patients with Low Self-Esteem

The results of this study obtained respondents' self-esteem before being given Cognitive Therapy is 100% in which all respondents have low self-esteem. Then after being given Cognitive Therapy, the respondent's self-esteem experienced an increase and some did not increase. Mc Nemar's statistical test results showed an increase of 19 respondents (86.4%) and those who did not experience changes were 3 respondents (13.6%). So that the obtained p-value = 0,000 (p <0.05). The results of this study indicate that cognitive therapy has a difference in changes in respondent's self-esteem before cognitive therapy and after cognitive therapy is carried out.

This research proves that cognitive therapy is effective for overcoming the problems of patients with low self-esteem. Cognitive therapy is able to change the mindset of an individual towards more positive directions. The thought process is very important because it is related to a person's behavior and the success of his life in the future.

CONCLUSION

The Effect of Cognitive Therapy on Changes in Self-Esteem in Patients with Low Self-Esteem using the Mc Neymar Test obtained p value of 0,000 (p <0.05). This shows that there are significant differences from cognitive therapy to changes in self-esteem.

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