PENGARUH COGNITIVE BEHAVIOUR THERAPY TERHADAP DERAJAT DEPRESI DAN AKTIVITAS PERAWATAN DIRI PADA PASIEN DIABETES MELLITUS (DM) TIPE 2
EFFECT OF COGNITIVE BEHAVIOUR THERAPY ON DEGREES OF DEPRESSION AND SELF- CARE ACTIVITIES OF TYPE 2 DIABETES PATIENT
Abstract
Pemberian psikoterapi telah terbukti berhasil untuk pasien depresi yang menderita penyakit medis kronik. Psikoterapi kognitif perilaku didasarkan atas konsep bahwa perubahan dalam struktur kognitif akan mengubah kondisi emosi serta perilaku pasien. Sehingga diharapkan dengan membaiknya depresi maka akan memperbaiki perilaku pasien dalam hal ini aktivitas perawatan diri diabetesnya. Penelitian ini untuk mengetahui keefektifan Cognitive Behaviour Therapy (CBT) dalam menurunkan derajat depresi dan meningkatkan aktivitas perawatan diri pada pasien Diabetes Mellitus tipe-2 di Rumah Sakit Dr. Moewardi Surakarta. Penelitian ini menggunakan metode eksperimental dengan rancangan randomized controlled trial pre and post design. Jumlah subjek 34 pasien, dibagi dua kelompok yaitu perlakuan dan kontrol. Subjek adalah pasien 34 pasien Diabetes Mellitus tipe-2 di Poli Penyakit Dalam Rumah Sakit Dr. Moewardi Surakarta dengan kadar GDP ≥ 100 mg/dL, GD2PP ≥ 140 mg/dL, umur 18 – 60 tahun, pendidikan minimal SMP, skor BDI ≥ 10, dan kriteria eksklusi apabila mengalami komplikasi dan atau menderita penyakit fisik medis yang berat, gangguan mental berat (psikotik), retardasi mental, atau demensia, gangguan berat dalam berkomunikasi (kesulitan bahasa, tuli), gangguan kognitif yang berat atau ketidakmampuan intelektual, yang ditunjukkan dari penilaian MMSE < 25, dan skor L-MMPI ≤ 1. Depresi dievaluasi menggunakan Beck Depression Inventory, aktivitas perawatan diri diabetes menggunakan The Summary of Diabetes Self-Care Activities. Uji statistik menggunakan uji t tidak berpasangan dan uji Mann Whitney, dipakai untuk signifikansi perbedaan variabel dengan tingkat kemaknaan 5%. Subjek yang mendapat CBT secara signifikan (p<0,05) didapatkan penurunan skor depresi (5,76 ± 3,58) dibandingkan kelompok yang tidak mendapat CBT (2,76 ± 1,56) sedangkan subjek yang mendapat CBT secara sangat signifikan (p<0,01) mengalami peningkatan aktivitas perawatan diri diabetes (15,35±7,78) dibandingkan kelompok yang tidak mendapat CBT (3,00±2,78), sehingga disimpulkan CBT efektif menurunkan derajat depresi dan meningkatkan aktivitas perawatan diri pada pasien diabetes mellitus tipe-2.
Cognitive behavior therapy had sucesfully referred as an effective method for reducing depression, particularly in individual with a chronic disease. Cognitive behavior psychotherapy is based on the concept that changes in cognitive structure will change patient's emotional state and behavior. The decreasing depression in patient with diabetes will improve diabetes self-care activities. The aim was to determine the effectiveness of Cognitive Behavior Therapy (CBT) adjuvant therapy in decreasing and improving the degree of diabetes self-care activities of patients with type-2 Diabetes Mellitus in Dr. Moewardi Hospital Surakarta. This study was an experimental design of randomized controlled trial with pre and post-test design. In total, 34 patients were enrolled in the mg/dl, Blood sugar level test post pandrial 140 mg/dL aged between 18-60 years old with junior high school as minimum education, BDI score > 10, the exclusion criteria is when experiencing complication with or suffering from physical illness, psychotic, mental retardation or dementia , severe interference in communication ( language difficulties and deafness), severe cognitive impairment, intellectual impairment, MMSE score < 25, L MMPI score < 1, The total 34 subjects devided into two groups, treatment and control. Statistical test using unpaired T-test and Mann Whitney, with level of 5%. Depression was evaluated by using the Beck Depression Inventory and diabetes self-care activities using the Summary of Diabetes Self-Care Activities. Subjects who received CBT significantly decrease (p <0,05) scores of depression compared with that of the group without CBT and increase in diabetes self-care activities (p<0,01). It is concluded that CBT is effective to decrease degree of depression and improve diabetes self-care activities of patients with type 2 diabetes mellitus.
References
Barclay, L. 2011. CBT for depressed diabetes patients improves overall health. Medical Care.(Abstr).
Blacker, D. 2009. Psychiatric rating scales. In: Sadock B. J., Sadock V.A., Ruiz P. (Editors). Kaplan & Sadock's Comprehensive Textbook of Psychiatry. 9th Edition.Volume I.Philadelphia. Lippincott Williams & Wilkins.
De Groot, M., Anderson R., Freedland K.E., Clouse R.E, and Lustman P.J. 2001. Association of depression and diabetes complications: a meta-analysis. Psychosom Med 63(4): 619-630.
Elliot. 2011. A systematic review and meta-analysis of the effects of cognitive behavioural therapy on blood glucose control in diabetes mellitus. Masters thesis. Queen Margaret University.
Gonzalez, J.S., McCarl L.A., Wexler D.J., Cagliero E., Delahanty L., Soper, Tiffany D., Goldman V., Knauz R., and Safren S.A. 2010. Cognitive-behavioral therapy for adherence and depression (CBT-AD) in type 2 diabetes. Journal of Cognitive Psychotherapy 24(4): 329-343.
Katon, W. and Ciechanowski P. 2009. Diabetes: Psychosocial issues and psychiatric disorders. In: Sadock B. J., Sadock V.A., Ruiz P., (Editors). Kaplan & Sadock's Comprehensive textbook of psychiatry. 9th Edition. Volume II. Lippincott Williams & Wilkins.
Kresnowati, L. 2008. Faktor-faktor internal eksternal yang mempengaruhi ketidakberhasilan pengendalian status glikemik pada DM tipe II (studi kasus di tpk yakes telkom area jateng dan DIY). Thesis. Fak.Kesehatan Masyarakat. UNDIP. Semarang.
Lin, E.H., Katon, W., Von Korff, M., Rutter C., Simon, G.E., Oliver, M., et al. 2004. Relationship of depression and diabetes self-care, medication adherence, and preventive care. Diabetes Care 27(9): 2154-2160.
Lustman, P.J., Clous, R.E., Griffith, L.S., Carney, R.M., Freedland, K.E. 1997. Screening for depression in diabetes using the beck depression inventory. Psychosomatic Medicine 59: 24-31.
Lustman, P.J., Griffith, L.S., Freedland, K.E., Kissel, S.S., Clouse, R.E. 1998. Cognitive behavior therapy for depression in type 2 diabetes mellitus: a randomized, controlled trial. Ann Intern Med 129:613-621.
Lustman, P.J., Anderson, R.J., Freedland, K.E., De Groot, M., Carney, R.M., Clouse, R.E. 2000. Depression and poor glycemic control: a meta-analytic review of the literature. Diabetes Care 23(7): 934-942.
Lustman, P.J. and Clouse, R.E. 2005. Depression in diabetic patients: the relationship between mood and glycemic control. J Diabetes Complications 19(2): 113-122.
Murti, B. 2010. Desain dan ukuran sampel untuk penelitian kuantitatif dan kualitatif di bidang kesehatan. Gadjah mada university press. Yogyakarta.
Newman, C.F. and Beck A.T. 2009. Cognitive therapy. in: Sadock, B.J., Sadock, V.A., Ruiz P. (Editors). Kaplan & Sadock's comprehensive textbook of psychiatry. 9th Edition. Volume II. Lippincott Williams & Wilkins.
Raval, A., Dhanaraj, E., Bhansali, A., Grover, S., Tiwari, P. 2010. Prevalence & determinants of depression in type 2 diabetes patients in a tertiary care centre. Indian J Med Res 132: 195-200.
Rosselló, J.M. and Chafey, M.I.J. 2006. Cognitive-behavioral group therapy for depression in adolescents with diabetes: a pilot study. Revista Interamericana de Psicología/Interamerican Journal of Psychology 40 (2): 219-226.
Roy, T. and Liyold, C. 2012. Epidemiology of depression and diabetes: a systematic review. Journal of Affective Disorders 142 Suppl(Suppl): S8-S21.
Rubin, R., Walen, S.R. and Ellis, A. 1990. Living with diabetes. J Rational-Emotive Cognitive Behav Ther 1: 21-39.
Sastroasmoro, S. and Ismael, S. 2008. Dasar-dasar metodologi penelitian klinis. Edisi 3. Sagung Seto. Jakarta.
Snoek, F.J., Van der V Nicole, C.W. and Lubach Caroline. 1999. Cognitive behavioral group training for poorly controlled type 1 diabetes patients: a psychoeducational approach. Diabetes Spectrum 12 (3): 147.
Sudiyanto, A. 2003. Pengalaman klinik penatalaksanaan nonfarmakologik gangguan ansietas. Dalam pertemuan ilmiah dua tahunan perhimpunan dokter spesialis kedokteran jiwa Indonesia. Jakarta 5-8 Juli 2003. .,
Sudiyanto, A. 2008. Pendekatan cognitive behavior therapy. Dalam workshop bimbingan teknis psikoterapi dan konseling bidang kesehatan. Surakarta. 18-19 Oktober 2008.
Supriyana, S. 2007. Keefektifan terapi realitas untuk menurunkan derajat depresi dan kadar gula darah pasien DM tipe 2. Tesis. FK UNS. Surakarta.
Suyono, S., Tjokorda Gde, P., Waspadji, S., Nugroho, H., Soegondo, S., H.A.H, Asdie, et al. 2011. Konsensus pengelolaan dan pencegahan diabetes melitus tipe 2 di Indonesia. Perkumpulan endokrinologi Indonesia.
Van der Ven, N., Weinger, K. and Snoek, F. 2002. Cognitive behaviour therapy: how to improve
diabetes self-management. Diabetes Voice 47(3).
Budi, W.A. dan Tjokroprawiro, A. 2011. Konsensus pengelolaan dan pencegahan diabetes melitus
tipe 2 di Indonesia. Perkumpulan endokrinologi Indonesia.
Toobert, D.J., Hampson, E.H. and Glasgow, R.E. 2000. The summary of diabetes self-care activities measure. Diabetes Care 27(7).
Van Tilburg, M.A.L., Georgiades A. and Surwit, R.S. 2008. Depression in type 2 diabetes. In: Feinglos, M.N., Bethel, M.A., (Editors). Type 2 diabetes mellitus: an evidence-based approach to practical management. Duke University Medical Center. Humana Press. Durham. USA.