PENGARUH PSIKOTERAPI SPIRITUAL TERHADAP PENINGKATAN HITUNG SEL T-CD4+ PADA PENDERITA HIV/AIDS

SPIRITUAL PSYCHOTHERAPY EFFECT TO INCREASE CD4+ COUNT IN

HIV /AIDS PATIENTS.

M. Faisal Idrus,1 Jayalangkara T, 1 Syamsu, 2 Ilham,3

1Department of Psychiatry, Medical Faculty of Hasanuddin University 2Departement of Internal Medicine, Medical Faculty of Hasanuddin University

3Departement of Physiology, Medical Faculty of Hasanuddin University

Alamat Korespondensi :

M. Faisal Idrus Bagian Psikiatri Fakultas Kedokteran Universitas Hasanuddin Makassar, HP : 081524966494 Email : faisalidrus@yahoo.com

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Abstrak

HIV/AIDS adalah penyakit infeksi virus yang menyebabkan penurunan imunitas tubuh ditandai dengan penurunan hitung sel CD4+. Penurunan hitung sel T-CD4 ini disebabkan oleh karena proses penghancuran sel limfosit T oleh human immunodificiencies virus Sedangkan psikoterapi spiritual adalah bentuk pengobatan kejiwaan yang memberikan ketenteraman, kedamaian, dan kebahagiaan jiwa. Ketenangan jiwa diharapkan akan membangkitkan respons imunitas tubuh individu. Penelitian bertujuan untuk mengetahui pengaruh psikoterapi spiritual terhadap hitung sel T-CD4. Ini adalah penelitian quasi experimental pretest-post-test control group design dengan jumlah sampel 40 orang penderita HIV/AIDS yang dipilih secara purposive sampling. Penelitian ini dilaksanakan di Pokja HIV/AIDS dan bangsal rawat inap RS BLU. Dr. Wahidin Sudirohusodo. Makassar. Sampel dibagi menjadi dua kelompok, yaitu 10 orang kelompok rawat inap yang mendapat psikoterapi spiritual secara intensif, 10 orang dari Lapas Bolangi yang mendapat psikoterapi spiritual yang kurang intensif dan 20 orang kelompok kontrol yang tidak mendapat psikoterapi spiritual. Analisa statistik dengan menggunakan uji Wilcoxon test. Hasil analisis CD4+ serum berbeda secara bermakna (p < 0,05) antara kelompok perlakuan dan kelompok kontrol. Setelah perlakuan pada kelompok rawat inap hitung sel T-CD4 serum meningkat dari 15 menjadi 160, tetapi kelompok lainnya (kelompok bolangi dari 446,50 menjadi 365,50 dan kelompok kontrol dari 424,5 menjadi 201,0) mengalami penurunan, terutama pada kelompok kontrol (tabel 2 dan 3). Tabel 4 menunjukkan bahwa dari 10 orang kelompok rawat inap, semuanya mengalami peningkatan kadar CD4+ serum, sedangkan pada kelompok Bolangi hanya 3 orang (30%) diantara 10 orang kelompok kontrol, dari 20 orang hanya 1 orang (5%) mengalami peningkatan kadar CD4+ serum, 19 orang (95%) lainnya mengalami penurunan.

Kata kunci : Psikoterapi spiritual – relaksasi – hitung sel T- CD4

ABSTRACT HIV / AIDS is a viral infection that causes decrease of immunity system characterized by decrease CD4+ T lymphocyte counts. Low CD4 T-cell counts are considered due to destruction of lymphocytes T by human immunodeficiency virus. The spiritual psychotherapy is a form of psychiatric treatment that provides peace, and happiness of the soul. Peace of mind is expected to generate individual immune response. Objective to determine the effect of spiritual psychotherapy to CD4 T-cell count. This is a quasi experimental study pretest-posttest control group design of 40 sample with HIV / AIDS who were selected by purposive sampling. This research was conducted in the HIV / AIDS Working Group and hospital inpatient BLU. Dr. Wahidin Sudirohusodo. Makassar. The samples were divided into two groups, the treatment group of 10 inpatient who received intensive spiritual psychotherapy, 10 sample from Lapas Bolangi and 20 control group who did not receive supportive psychotherapy. Statistical analysis using the Wilcoxon test. The results of the analysis of CD4 + serum between the treatment and control groups was significantly different (p <0.05). After treatment, the CD4 T-cell count in the inpatient group increased serum from 15 to 160, but in the other groups (group bolangi from 446.50 to 365.50 and the control group from 424.5 to 201.0) was decreased, especially in the control group (Tables 2 and 3). Table 4 shows that of the 10 inpatient samples group, all had increased levels of CD4 + serum, whereas in the group Bolangi only 3 samples (30%) among the 10 sample of the control group , of 20 sample only 1 person (5%) had increase of CD4 + serum , and 19 sample (95%) had decrease

Keywords: Spiritual Psychotherapy – relaxation - CD4 count

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INTRODUCTION

HIV / AIDS is now a priority public health problem in the world and gets a very

serious attention. Disease caused by HIV (Human Immunodeficiency Virus) causes

decreased level of immunity. (Adler MW, 1996; Irwin M., (2001). Decreased immunity level

will facilitate the entry of other germs into the body whether pathogenic or non-pathogenic.

These other infections is known as. "Opportunistic - infection ". Virus is transmitted through

infected body fluids, especially blood and semen. (Barlett JG, 2007). Standardized tests

assessing prognosis of AIDS progression was determined by measuring the increase in viral

load or" viral load "and a decrease in CD4 cell count. Disadvantaged areas with limited

examination of CD4 + cell count can be replaced by a count of total lymphocytes or total

lymphocyte count (TLC) (Barlett JG, 2007; Irwin, 2001).

At the end of 2010, it is estimated that there are about 34 million people living with

HIV, 30.8 million are adults, 3.4 million are children. New infections in adults are 2.7

million, 390,000 are children and 1.8 million deaths from AIDS.

(Http://www.avert.org/worldstats.htm. UNAIDS (2010). Statistics data of the HIV / AIDS

cases in Indonesia were reported cumulatively from April 1, 1987 s / d December 31, 2011

are derived from Direktorat Jenderal PP & PL Departemen Kesehatan RI (2003). Cumulative

cases of HIV was 76,879 people and AIDS was 29 879 people and the number who died

(mortality rate) was 5430 people . Sulawesi Selatan number of HIV / AIDS was ranked 8th of

33 provinces in Indonesia, that is 2448 HIV cases and 874 AIDS cases. (Direktorat Jenderal

PP & PL RI Departemen Kesehatan RI February 29, 2012).

One of the interventions that needed to be considered to cope with the rate of

progression of the disease is through religious activities (meditation, devotions and prayer)

that triggers the relaxation response and helps the body to relax and to calm the mind (Ayad

A, (2008). Relaxation response, spearheaded by Herbert Benson. Dr. Benson explained as a

response to the body's relaxation response, which produces physiological changes, while

individuals involved in mental activity repeatedly and consciously ignore negative thoughts

intrude. Dr. Benson has shown scientific evidence of the physiological changes that occur

during the relaxation response, such as a decrease in heart rate, blood lactate and rapid

decline associated with low levels of anxiety and lower blood pressure in people with

hypertension. Relaxation response gives individuals the ability to control the activity of

physiological, self-control and peace (Pasiak T, 2012. Benson H, 2000).

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According Hawari, D (2005) psikoreligius therapy or psikospiritual will raise the

confidence (self-confident) and a sense of optimism. Two of these (self-confidence and a

sense of optimism) is important for the healing of a disease in addition to drug therapy and

other medical treatment (Hawari, D., 2002). From the results of research in this area that was

done by Snyderman (1996), produced a conclusion, states that "medical therapy alone

without prayer and dhikir is incomplete; otherwise prayer and dhikr without medical therapy

is not effective". Similarly opinions of Christy (1998) which states that "prayer and

remembrance as well as a drug (prayer as medicine)" (Hawari, D. 2010).

Woods (1999) from the University of Miami found that HIV-positive patients who

were actively running religious services showed that the number of CD4 + and percentage

CD4 + (T-helper inducer cells) was increase, which means that the function of the immune

system were running well. Ironson (2000) conducted a study on the influence of religion /

spirituality in the immune system of HIV / AIDS concluded that religion plays an important

role in extending the age of a person suffering from HIV / AIDS. (D Hawari, 2002). Harold

G. Koenig on the first study of 87 patients with depressive state who were -religious recover

faster than those without religion (Koenig, HG, et al, 1992). In the second study of 1700

elderly showed immunity factor of the pious people who were significantly better (Koenig,

HG 1996) ..

This issue is an interesting thing for me. So I decide to pay attention and to see

whether the spiritual psychotherapy by religion activity (dzikir, praying, meditation, etc) can

affect the increasing of health recovering in patients with HIV/AIDS. This study is aimed to

determine the effect of spiritual psychotherapy for CD4 + cell count

MATERIALS AND METHODS

Location and design

This study was conducted at the hospital of Dr. Wahidin Sudirohusodo with quasi

experimental design with pretest-posttest control group design to examine the influence of

spiritual psychotherapy to CD4 + T-cells

Population and Sample.

The study population was HIV inpatient and outpatient in the working group of HIV /

AIDS (Infection Center) at BLU RS. Dr. Wahidin Sudirohusodo and in Lapas Narkoba

Bolangi. Samples were patients with HIV (+) as evidenced by the results of a reactive rapid

test methadone treatment clinic and inpatients in RS.Dr. Wahidin Sudirohusodo and Drug

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Bolangi prison. Sampling was done by purposive sampling, ie sampling conducted on the

basis that the subject can provide sufficient information to answer the research question

(Sastroasmoro & Ismael, 2002).

Data Collection and Analysis

Data from subjects were collected from outpatient status in the clinic and inpatient

HIV / AIDS patients who were treated dibangsal and of Prison Drug Bolangi. to assess the

patient's level of immunity by the measurement of CD4 T-cell count. The statistical analysis

used in this study is the analysis of the Wilcoxon test for small sample amounts. Presentation

of the results in tables and described descriptively linearly with the percentage.

RESULTS.

The study collected 40 people with HIV who meet the criteria of the sample. Group

consisted of 10 inpatients, 10 people were treated at Bolangi and 20 ambulatory care

(control). The distribution of age groups, gender, education, occupation and marital status in

all three groups can be seen in table 1.Table 1 shows that all three groups can be considered

homogeneous by gender, age group, education level, occupation, marital status (p> 0.05).

After treatment, in the inpatient group, the CD4 T-cell serum count was increased

from 15 to 160, but in the other groups (group bolangi from 446.50 to 365.50 and the control

group from 424.5 to 201.0) was decreased, especially in the controls (Tables 2 and 3). Table

4 shows that of the 10 sample group hospitalization, all had increased levels of CD4 + serum,

whereas in the group Bolangi only 3 sample (30%) among the 10 sample and in the control

group of 20 sample only 1 person (5%) had elevated levels of CD4 + serum , 19 sample

CD4’s (95%) was declined.

Graphic 1 shows the changes in CD4 T-cell count in the group received spiritual

psychotherapy (inpatient group) and the group that did not receive spiritual psychotherapy

(Bolangi group and the control group) after three months. In the group receiving intensive

treatment (inpatient) , the number of CD4 T-cells increased. Whereas the other two groups

had decreased CD4 T-cell count, especially in the control group.

DISCUSSION

In the last two decades a number of studies have demonstrated the success of spiritual

care. The study comes from a wide number of areas and is associated with religious and

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spiritual practices. (Fenwick P, (2003) Most studies on spiritual care is associated with

meditation. (Mohandas E. 2008. Newberg AB, Iversen J., 2003). Meditation will evoke the

relaxation response which will work through psychoneuroimmunology.

Psychoneuroimmunology is a science system that connects medical psycho (emotions,

thoughts), neuro (reflexes, neuroendocrine), Immunology (cellular immune system and

humoral immune system) (http://www.drpaulose.com/spirituality/psycho-neuro-immunology-

pni. (Madeline M., Lorentz RN, 2006. Pasiak T, 2012). The relationship between these three

systems is aime to maintain body homeostasis. This relationship through the two subsystems,

namely, hypothalamic-pituitary-adrenal (HPA axis) and the autonomic nervous system

(SSO). ( Pasiak T, 2012. Madeline M., Lorentz RN, 2006)

The results of this study indicate that the group who received spiritual psychotherapy

adjuvant had increased CD4 T-cell count, especially those with CD4 T-cell count was

initially low, while at the group did not getting the adjuvant spiritual psychotherapy had

decreased CD4 T-cell count despite of the high initial CD4 T-cell count . This suggests that

the increased levels of CD4 in spiritual psychotherapy adjuvant group is believed to be the

effects of adjuvant spiritual psychotherapy.

According Pasiak (2012) psychotherapy works to increase the development of

cognition, emotion, and behavior skills. Psychotherapy is also enhance the development of

neurons and neuronal networks integration. Changes that occur at the brain is in line with the

changes in glucose metabolism, neurotransmitter concentrations and blood flow, which in

turn will boost the immune system (CD4 +). Behavior spiritual (meditation, prayer and

dhikr). freeing our minds from the superstitions, doubts and thoughts that lead to sin, and

filled with love, affection, and reflect on God's creation gives us a feeling of tranquility and

peace. (Ayad A, 2008). This spiritual healing mechanism psychotherapy through two

pathways, namely the hypothalamic-pituitary-adrenal (HPA axis) and the autonomic nervous

system (SSO). (Pasiak T, 2012. Madeline M., RN Lorentz, 2006). HPA axis is the stress

management system which aims to maintain a homeostatic state of the body through the

control of the hormone cortisol, HPA axis and cytokines that affect each other. (Pasiak T,

2012)

The results are consistent with the results of research carried out by "Natural

Pharmacist" to 40 first-stage cancer patients. They were divided into two groups, then they

are asked to implement the religious teachings, especially prayers and prayer. Six days in a

week for ten weeks. The patients undergoing therapy and treatment for six months. And the

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changes are clearly visible in the group of patients who were devout prayer. The researchers

believe that sample are obedient worship such as prayer and prayer less likely to develop the

disease, either mental illness or physical diseases. They also have greater strength to bear the

pain and endure the pain. They also have a stronger and more stable soul that they can avoid

the stress, anxiety, and despair. Not only that, they also have a healthier body and if they get

pain, the recovery process goes faster. (Elzaky J, 2011)

This is also in line with what was reported by the Magazine "Psychosomatic

Medicine" , conducted a study involving two groups of respondents, namely 78 patients were

black and 77 white men, whose ages varied between 25 and 45 years. The two groups were

separated in the study because African Americans tend to be more religious and more

obedient to run prayer groups and prayer than whites. The patients were then asked to carry

out the commands of religion more obedient and reverent, especially prayer and prayer. The

results showed that a lot of prayer and prayer they do can reduce high blood pressure,

especially in black patients. Disease that affects the white patients did not experience any

significant change because they are more lazy followers pray and prayer. (Elzaky J, 2011)

Snyder states that "medical therapy alone without prayer and dhikr is incomplete; otherwise

prayer and dhikr without medical therapy is not effective". (Hawari D, 2002). While Einsein

stated that "Science without religion is blind, while science without religion is lame (D

Hawari, 2002). In a hadith the Prophet said:" "Every disease is curable. If proper medication

is given, by Allah's disease cured ". (Narrated by Ahmad and Hakim Bukhari Saheeh

Muslim).

So in treating a patient , we should not just focus on medical therapy alone, but we should

also pay attention to the spiritual aspect of the patient.

CONCLUSIONS AND RECOMMENDATIONS

This study gives us an understanding of the linkages between health and religion /

spiritual . From this study can be concluded that spiritual psychotherapy can influence the

increasing of the CD4 cell count through HPA axis activity and Autonomic Nervous System

(SSO). This spiritual power is the power that is not limited because it comes from God the

Creator that can be used to help the healing process. Therefore, in providing treatment to

patients, we need to pay attention to the spiritual aspects of the patient to help achieve a cure

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Bartlett JG, Gallant JE, (2007). Medical Management of HIV Infection. John Hopkins University Medicine: Johns Hopkins Medicine Health Publishing Business Group, Baltimore.

Benson H, Proctor W, (2000). “Keimanan Yang Menyembuhkan dasar-dasar respon relaksasi” Alih bahasa : dr. Nurhasan. Penyunting : Ary Nilandari. Cetakan 1. Penerbit Kaifa.. Bandung. Januari. hal. 34.

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Indonesia. Jakarta

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Koenig HG, (1996). Depressive disorder in hospitalised medically ill elders, Funded by National Institutes of Mental Health, grant # MH01138.

Madeline M, Lorentz RN, (2006). Stress and Psychoneuroimmunology. Alternative Journal of Nursing. Issue 11.p1-11

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LAMPIRAN

Tabel 1. The Three Groups Demography

Charateristic

Group

In patient (n=10)

Bolangi (n=10)

control (n=10)

Age (year) 20 – 29 4 6 10 p=0,469

30 – 30 5 4 10

40 – 49 1 0 0

Gender Male 7 10 15 p=0,179

Female 3 0 5

School SD 0 0 2 p=0,201

SMP 4 0 3

SMA 6 8 11

D3 0 0 1

S1 0 2 3

Job No 4 6 15 p=0,172

Yes 6 4 5

Marital status Not yet 5 5 6 p=0,589

Marriage 4 5 13

Widow 0 0 1

Widower 1 0 0

Tabel 2. Difference CD4 serum before perlakuan three groups

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Variable

Group

Kruskal

Wallis Test In patient

(n=10)

Bolangi

(n=10)

Control

(n=20)

CD4 before 87,10 (148,14)a 531,30 (286,82)b 438,80 (325,41)b p=0,001

CD4 after 253,70 (250,91) 484,70 (341,40) 275,30 (234,98) p=0,120

Tabel 3. The changes of CD4 after spiritual psychotherapy on three groups

Variable

roup g

Before

After

Changes

Min-Maks Median Min-Maks Median Median

CD4+ In Patient 2 – 399 15,0 7 – 720 160,0 73,0

Bolangi 198 -1033 446,50 229 -1280 365,50 - 66,5

Control 6 – 1240 424,5 3 – 751 201,0 -126,0

Tabel 4. The difference of CD4 on three groups

Variable

Group

Changes

P value Increase Decrease/stabil

CD4 Count

In patient 10 0

p=0,000 Bolangi 3 7

Control 1 19

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Graphic 1. The Amount of CD4+ count Before and after the therapy.