International Journal of Social Science and Humanity, Vol. 3, No.

3, May 2013

Spiritual Emotional Freedom Technique (SEFT) to

Reduce Depression for Chronic Renal Failure Patients are
in Cilacap Hospital to Undergo Hemodialysis
Rias Pratiwi Safitri and Ria Safaria Sadif

social conditions perceived as stressful. Physical problems

Abstract—Hemodialysis is the process of separation and
retention of excess fluid metabolic waste substances from the DOI: 10.7763/IJSSH.2013.V3.249 300
blood into the dialysis fluid through a membrane that is semi experienced by patients with chronic renal failure in the form
permiabel the dialysis machine by diffusion, ultrafiltration and of changes in the body such as fluid overload, anemia, and
convection so that the composition of substances and fluids in
brittle bones easily and decreased muscle mass. Besides
the near normal blood. Giving SEFT aims to determine the
effectiveness SEFT to lower levels of depression in patients with other physical complaints such as tingling, yellowish black
chronic renal failure undergoing hemodialysis. Participants in color, pruritus, belly, malnutrition, in some patients
the study were 12 patients with chronic renal failure experience paralysis, nausea, no appetite and decreased
undergoing hemodialysis at hospitals Cilacap on Monday and sexual function [1].
Friday. SEFT includes three stages: the set-up (to neutralize the Data of Riskesdas 2010 showed 59% of deaths in
negative energy that is in your body), the tune-in (the mind on
Indonesia due to non-communicable diseases, which require
the place of pain), the tapping (lightly tapping with two fingers
at specific points on the human body). This is consistent with a very large medical expense such as stroke, cancer,
the techniques used in relaxation techniques in psychotherapy diabetes, kidney failure, heart disease, and AIDS
behavioristik. The research instrument was Beck Depression ([email protected]). Based on data obtained from Jogja
Inventory (BDI). The method used in this study is a Kidney Care Club in February to March 2013, recorded 952
quasi-experiment research. The design study is a patients with chronic renal failure who had undergone
nonrandomized pretest-posttest one group design. With the hemodialysis at 13 hospitals in Yogyakarta.
t-test performed on the data pretest and posttest can be
Psychological problems experienced by patients with
concluded that there are differences in the level of depression
experienced by hemodialysis patients before and after chronic renal failure demonstrated from the first time since
treatment the depression levels decreased after therapy. This is convicted of patients experiencing kidney failure. Some
demonstrated by the significant results, with paired samples patients feel frustrated, despair, anger and a sense of trust
correlations 0182 >0.05 (significant) and Sig F Change 0.000 will not diagnosis a doctor, even a patient who became angry
<0.01 (highly significant).The results of this study indicate that at the doctor and on a hunger strike when he was told that he
SEFT effective to reduce the level of depression in patients with had kidney failure and had to undergo hemodialysis. From
chronic renal failure undergoing hemodialysis.
the results of interviews conducted by researchers, obtained
after experiencing pain that they feel inferior that they be
Index Terms—Depression, SEFT, hemodialysis.
seldom meeting with others. A patient said that he now
rarely go out of the house and no longer active in the
I. INTRODUCTION neighborhood as it used to, for example, when invited to
attend an event in the village he just shut up and listen
Hemodialysis is the process of separation and retention of because he actually feels lazy to attend the event. This is
excess fluid metabolic waste substances from the blood into because he feels inferior in front of his friends and felt he
the dialysis fluid through a membrane that is semi permeable could not do anything else, although this time he was able to
the dialysis machine by diffusion, ultra filtration and accept the condition of the disease with the support of a
convection so that the composition of substances and fluids large family so she tried not to give up.
in the near-normal blood. The treatment process can help In research [2], about the anxiety experienced by patients
improve the body's homeostasis, but not to replace the with renal failure undergoing hemodialysis will, it was found
function of the other kidney, so as to maintain the life of that patients undergoing hemodialysis (HD) experience
hemodialysis patients should perform at least twice a week various problems arising from kidney malfunction. It pops up
throughout his life. Cause of kidney failure patients every time until the end of life. It is a physical stressor that
experience problems that are physical, psychological and affects the various dimensions of the patient's life which
includes bio, psycho, and socio, spiritual. Perceived physical
weakness such as nausea, vomiting, pain, muscle weakness,
edema is a clinical manifestation of the patients undergoing
Manuscript received March 15, 2013; revised May 25, 2013. This work HD. Powerlessness and lack of acceptance of the patient into
was supported in part by Master of Psychology, Islamic University of the psychological factors that can lead patients to the levels
Indonesia, SEFT to Reduce Depression for Chronic Renal Failure Patients.
of stress, anxiety and even depression. The phenomenon that
Rias Pratiwi Safitri, R. P. Safitri, and Ria Safaria Sadif, R. S. Sadif.
The authors are with the Islamic University of Indonesia (e-mail: occurs in patients with renal failure hemodialysis mejalani
[email protected], [email protected]). raises about life experiences of chronic renal failure patients
who do hemodialysis, there are six major themes emerged,
 International Journal of Social Science and Humanity, Vol. 3, No. 3, May 2013

namely: anger because his illness had made him suffer,

despair, hopelessness, feeling tired undergoing hemodialysis,
approximately family support and lack of surrender to the
Lord of the disease encountered.
According to Rodin and Karen [1], symptoms of
depression are often found in people with physical illness,
although it is often unrecognized and untreated as well as in
disease due to stroke, heart disease, kidney failure and
several other physical ailments or often called veiled by the
term depression. Patients who are undergoing treatment at
the hospital most of the symptoms of depression caused by
or in conjunction with a physical illness. This indicates that
the situation was experiencing kidney failure is a condition
that is very pressing and this causes the symptoms of
depression. This is confirmed by the results of pretest given
to several hospitals Cilacap hemodialysis patients using the
Beck Depression Inventory (BDI) to assess the extent to
which depressive symptoms appear. From the results of the
pretest showed that hemodialysis patients showing
symptoms of mild to moderate depression.
In detail Beck [1] describes the symptoms of depression
symptom-being: emotional symptoms that change the feeling
or behavior that is a direct result of the state of his feelings.
Cognitive symptoms are cognitive manifestations that appear
in the form of a self-assessment of low, negative
expectations, blame and self-criticism cannot decide and
body image distortion. Motivational symptoms are related to
desire and arousal and the people who tend to be
regressive-Vegetative symptoms physical symptoms that
appear in the form of fatigue, loss of appetite, less sleep, loss
of sexual interest, and several other symptoms.
The results of Guide Imagery (a psychosynthesis
approach) to a decrease in cancer patients suggest that this
therapy can reduce depression in patients with cancer [3].
Guide imagery is one technique used in psychotherapy
psychosynthesis [3]. Individuals directed to use their
imagination by listening to recordings or directly guided in
exploring problems and healing. Guide imagery allows
clients to experience the altered state of consciusness, an
unusual experience (unusual experiences) in perceiving the
world or themselves (self), changes in time, the world,
memory, sense of identity (sense of identity), cognitive
processes, perception of the world, the use of the body
(motor output), and interactions with the world [4]
Assessment of patients for the disease as well as his life
experiences will determine the acceptance of self to health. It
determines how people respond to the disease, so that will
underlie the behavior of the display. With the acceptance of
self to health will determine the extent of the patient
experiencing symptoms of depression.
Depression experienced by the patient conditions affecting
the physical condition that makes it weaker. Therefore takes
a very simple technique and has proven to be very effective
and efficient to overcome a range of emotions. Needed
therapy that uses spiritual elements to reduce the symptoms
of depression and physical pain experienced by the patient.
The book [5] SEFT used to heal physical problems caused
by emotional or psychosomatic. Therefore researchers using
SEFT to reduce the symptoms of depression so that
self-acceptance is enhanced.

301
II. METHODS
 Research design this study is a quasi-experiment research, technique performed in psychotherapy behavioristik,
the design study is a nonrandomized pretest-posttest one particularly relaxation, meditation, and visualization [8], [9],
group design [6]. Dependent variable: Depression, such techniques in accordance with the stages behavioristik
independent variable: Spiritual Emotional Freedom in doing SEFT. Behavioristik approach assumes that people
Technique (SEFT). Research participants involved in this are basically referred to and determined by the social and
study amounted to 12 people with chronic kidney failure cultural environment so that people can learn from
patients aged 26-58 years, which is a hospital patient environmental conditions that determine their behavior. In a
Cilacap. Participants were included in the study had relaxation technique to overcome the stress experienced in
undergone hemodialysis for 3 months to 5 years. everyday life, which is often manifested by psychosomatic
Participants are patients undergoing hemodialysis on symptoms, high blood pressure and heart disease, migraines,
Monday and Friday at 07:00 to 12:00 pm. asthma and insomnia [10].
Thus it can be seen clearly that the model adopted SEFT
therapy psychotherapy behavioristik as many similarities of
III. INTERVENTION technique or procedure execution [11]. In the implementation
of SEFT, consists of three series consisting of; the set-up (to
Earlier developed SEFT in Indonesia originated from EFT, neutralize the negative energy that is in your body), the
developed by Gary Craig in the U.S., this technique tune-in (the mind on the place of pain), the tapping (lightly
combines acupuncture science with behavioral techniques in tapping with two fingers certain points on the human body).
psychology. EFT uses finger to tap these energy points with a In the stages of implementation of the required three things,
certain number of beats and sequence, along with positive that must be taken seriously, namely humility, unwilling and
affirmations, some relaxation techniques and visualization [5] resigned. This is consistent with the techniques used in
Aziz said that SEFT is a method that can be used to relaxation techniques in psychotherapy behavioristik [12].
improve the SQ one, to unite him with the divine power that Before treatment carried out, participants were given a
enables people to be happier, more certainty in life, the result pretest using the Beck Depression Inventory (BDI). SEFT
is not easily stressed. In psychological, SEFT could be implementation requires meeting 3 times so that the time
interpreted as a method to manage the potential systematic required is 2 weeks. Each meeting takes time for ± 30
unconscious, so it can be used for multiple purposes in minutes-1 hour. Participants were given an evaluation sheet
improving the welfare of the soul [7]. after the training is completed and given SEFT posttest using
According to Zainuddin that SEFT behavioristik based on BDI. SEFT is guided by two researchers who act as
psychotherapy or behavior, this is evidenced by the model or
International Journal of Social Science and Humanity, Vol. 3, No. 3, May 2013
and resigned themselves to the authority so that they are
facilitators and co-facilitators. Research tools are: BDI sheet, more aware of the importance of the self-motivation that
attendance sheet, consent form, informed concent sheet, could be a cure for physical ailments experienced.
leaflet on depression, SEFT guidebooks, training books. Second Meeting: The therapist practicing again SEFT
movements to get participants to better remember the
movements are given so that the participants can practice it in
IV. RESULTS AND DISCUSSION their homes better. The therapist wrote in a book evaluation
results of the evaluation with the help of co-therapists so that
A. Implementation Research evaluation can be done on an individual basis. Then the
First meeting: Barriers were found in the therapeutic overall evaluation by the FGD so that they are more
process relating to the procedure of treatment is the client's motivated to carry out the healing process despite therapy
physical limitations to writing client concentration and easily had ended by sharing experiences for implementing SEFT.
distracted while giving the material provided by the therapist. Third Meeting: The therapist SEFT evaluated by asking
This makes the therapist decided to conduct FGD (Focus the participants how far they carry SEFT at home and what
Group Discussion). Results from the FGD process that most changes are felt. They felt no physical symptoms that
patients feel very insecure and demotivated because they can decrease their body condition is more stable. There's even
not live like normal activities while they are still healthy and one of the main participants who said that he did SEFT in
have to rely on dialysis equipment should be regularly they the morning and evening, followed by his wife and children,
do each week and activities that make them often feel bored participants felt her to be more qualified, not vomiting blood
and want to end their lives. and more emotionally stable condition. Other participants
They feel insecure because of physical changes in the did SEFT only a few times and did not understand the
body that is swollen, flaky skin with itching on the skin, the affirmations in SEFT so do not feel the changes in himself
color becomes darker skin, hair loss and the body is powered even when his physical condition declined the meeting
so as to make them limiting interaction with the surrounding because of lack of rest and too much to eat vegetables that
environment by preferring to remain at home. In addition, are not allowed to eat.
they lose the motivation to survive because they are limited Before ending the therapy process, participants were asked
by the space should not be too much activity, weak physical to complete the posttest. Posttest results showed that there
condition that does not allow them to work, if they do not do was reduction in the level of depression experienced by the
dialysis they will not move and unstable so dependent on
family members others, and can not perform sexual function
so felt it was useless.
The therapist demonstrates SEFT and attended by
participants who focus on affirmations that are used for
auto-suggestion own clients unwilling to accept the situation
 participants to perform healing therapies that participants
expect the process to be continued healing methods to help
patients hemodialysis increase motivation and confidence to
face the process of hemodialysis.
B. Result of T Test
With the t-test performed on the data pretest and posttest
of 12 patients using the BDI can be concluded that there are
differences in the level of depression experienced by
hemodialysis patients before and after treatment the
depression levels decreased after therapy. This is
demonstrated by the significant results, with paired samples
correlations 0182 > 0.05 (significant) and Sig F Change
0.000 < 0.01 (highly significant).

TABLE I: PAIRED SAMPLES STATISTIC

Pair 1 Mean N Std.Deviation Std.Error mean

Pretest 19.92 12 9.000 2.598 postest 7.25 12 2.768 0.799

With the results of t-test( see Table I) is significant over all

BDI then conducted t tests on the BDI items associated with
the physical and psychic to see the difference in the change
of physical and psychological symptoms experienced before
and after therapy. It can be concluded that there are
differences in physical symptoms experienced by patients
before and after therapy, with a decline in physical
symptoms significantly after therapy. This is indicated by the
results of 0,570 paired samples correlations > 0.05 (very
significant) and Sig F Change 0002 <0.01 (significant). In
addition, there were no significant changes in psychiatric
symptoms before and after therapy.
This is indicated by the results of 0042 paired samples
correlations> 0.05 (not significant) and Sig F Change 0002
<0.01 (significant). Overall it can be concluded that the
difference in the level of depression in hemodialysis patients
after therapy is given, with lower depression levels after
therapy is given. In the BDI are items that measure changes
in physical and psychological, of the t test results indicate
that the physical changes more visible than psychological
changes after therapy.
C. Other Recommendations
In this research need other recomendation intervention for
depression reduce to hemodialysis patient. Preminently
concerned mental healing, that is islamic relaxation, family
gathering for group support maintaining mental and physical
health.

V. CONCLUSION
The results of this study indicate that SEFT effective to
reduce the level of depression in patients with chronic renal
failure undergoing hemodialysis. Based on the assessment by
spreading the BDI measure that has been done, it is known
that the presence of psychological problems experienced by
the patients, indicating that the situation was experiencing
kidney failure is a condition that is very pressing and this

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International Journal of Social Science and Humanity, Vol. 3, No. 3, May 2013
causes the symptoms of depression that do Pretest by using
the Beck depression Inventory (BDI) to assess the extent to
which symptoms of depression that appears.
From the results of the pretest showed that hemodialysis
patients showed symptoms of mild depression, moderate and
severe. Of the 12 clients who were given gauge Beck
Depression Inventory (BDI) 8.33% no symptoms of
depression, 36% mild, 33.33% and severe symptoms. Based
on the pre-test and post-test given by the participants note
that there is a change towards a decrease symptoms of
depression, in which test scores 91.67% and 8.33% decline
experienced raising test scores.

ACKNOWLEDGMENT
This study is one case that was obtained at the time during
his professional practice the profession of psychology at the
master's level Islamic University of Indonesia.

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Pratiwi Safitri was born in Selong City (Indonesia), Juny

02, 1987. In 2005 to 2009, she was studied in psychology
department at Islamic University of Indonesia; 2009-Now
Master of Psychology at Islamic University of Indonesia.
The author major field of study clinical pshycology. She
interned for three months in a psychiatric hospital and
worked as a therapist at children with special needs
education institution for eight months in 2009 to 2010.
She interned for three months in a psychiatric hospital at Soeroyo Hospital
in 2009; interns in public hospitals Cilacap, in poly psychology for 2
months, 2009 to 2010.

Ria Safaria Sadif was born Kendari (Indonesia),

October 02, 1987. In 2005-2009, she studies at the
psychology department at Islamic University of
Indonesia; 2009-Now Master of Psychology at Islamic
University of Indonesia. The author major field of study
clinical pshycology. She interned for three months in a
psychiatric hospital at Soeroyo Hospital in 2009; interns
in public hospitals Cilacap, in poly psychology for 2
months, 2009 to 2010.