EFFECT OF HYPNOTHERAPY IN REDUCING PHOBIA SYMPTOMS

A phobia from the perspective of psychoanalysis is a traumatic experience of the past which is repressed into the unconscious. Hypnotherapy is used to help someone easily, quickly, effectively, efficiently in reaching the subconscious mind, re-educating, reducing physiological and psychological symptoms caused by phobias and giving them more control in everyday situations. The purpose of this study was to determine the effectiveness of hypnotherapy in reducing phobia symptoms. This research is aresearch pre-experimental using one-group pre-post test design. Participants numbered 20 people. The sampling technique used sampling incidental. The questionnaire in this study used the Fear Questionnaire (FQ). The results showed a characteristic age of 22 years, the majority of phobias were found in 80% women and 20% men. Based on the paired sample t-test results obtained data indicate that thevalue Asymp. Sig. 0,000 <0.05, which means that there is a significant change in the decrease in phobia symptoms by 51.87% after hypnotherapy. This study concluded that hypnotherapy was effective in reducing phobia symptoms with 2 therapy sessions in 4 meetings.


INTRODUCTION
Phobias are irrational fears of certain objects, places and or situations (Salih, 1968). Excessive fears will be a symptom of phobias that adversely affect the quality of life (Theofilou, 2013;Jarymowicz & Bar-tal, 2006). Decreased quality of life certainly has an influence on stress and mental disorders which are considered as risk factors that correlate to the subsequent development of mental disorders and other illnesses with consequences such as anxiety disorders, panic, depression, mood affective disorders, insomnia, parkinsonism, heart disease, decreased appetite, gastric pains, migraines, infectious diseases, drug abuse, drug dependence, and worse, suicide attempts (Safren, 1996;Fahlen, 1996;Lichtenberg, 1991;Pitkanen et al., 2009;Perales et al., 2014).
Prevalence with the general population related to DSM III R is that most people have a type of phobia namely agoraphobia 87.6%, simple phobia 83.4%, social phobia 81.0%, and report at least once in a lifetime (Magee, 1996). Many as 59.2% of them reported phobia disrupting their daily lives (Wardenaar et al., 2017). In Indonesia, mental disorders such as phobias, anxiety and depression are on e-ISSN : 2686-2123 p-ISSN : 2686-0538 average around the age of 15 years or around 19 million inhabitants (Depkes, 2011). In East Java the highest mental disorders are reported to be in Malang, which is 29.6% (Riskesdas, 2008). During an interview with a hypnotherapy practitioner at Malang's medicare hypnotherapy clinic, he said that it was noted that the most clients were around 85% with phobia complaints with almost the same symptoms.
Phobias are physiological and psychological reactions with the aim of surviving dangerous situations (Jarymowicz & Bar-tal, 2006). These symptoms will appear when individuals meet or are in situations that trigger phobias and cause panic reactions (Purnama, 2016). Panic attacks are discrete periods with intense fear in which four or more of these symptoms such as palpitations, sweating, trembling , shortness of breath, chest pain, nausea, abdominal pain, gastrc pains, diarrhea, tingling, weakening, body aches, shivering, increasing blood pressure and heart rate, fear of losing control or going crazy, fainting (Shelton, 2004;Shri, 2010;Kraft, 2010;Crozier et al., 2011;Katzman et al., 2014;Soodan & Arya, 2015;Sharma & Parle, 2016). Phobic reactions occur automatically and unconsciously (Jarymowicz & Bar-tal, 2006 The examples of psychotherapy are cognitive behavioral therapy (CBT), relaxation, social support, and hypnotherapy (Barrios, 1970;Kraft, 2010). Meanwhile, pharmacology is such as the use of antidepressants and tranquillizers (benzodiazepines).
Hypnotherapy is one of easiest, fastest, the most effective, and efficient ways in reaching the subconscious mind by re-educating, and able to provide a faster and permanent solution (Horowitz, 1970;Gunawan, 2012). Kraft (2010) stated that hypnotherapy is very effective in helping a person: a) to explore feared situations in a safe environment, b) to reduce anxiety using desensitization, c) to gain control using achoring, d) to improve coping strategies by strengthening the ego using breathing techniques, e) to overcome inner conflict and traumatic events using age regression techniques. The results of research by Kumar and Jena (2013) stated that 95% of hypnotherapy can significantly reduce phobia symptoms and anxiety.
Based on the background, it can be inferred a research question whether hypnotherapy can reduce phobia symptoms in the hypnotherapy medicare clinic. The aim of the study was to analyze the differences in phobia signs and symptoms before and after hypnotherapy.

METHODS
This research is a quasiexperimental research that is an experiment carried out in one group without a comparison group or a control group by using a one-group pretest-posttest design, that is a group of subjects observed before intervention, then observed again after the intervention (Nursalam, 2016).

Pre-test Intervention Post-test
One Group O OI I The sampling technique used is non-probability sampling, namely incidental sampling, which is a technique for determining samples based on chance meeting with researchers who can be used as samples, if viewed by people who happen to be found suitable as data sources (Sugiyono, 2016). Inclusion criteria are participants who are diagnosed with phobias using the Fear Questionnaire (FQ), participants who are willing to be respondents, participants who have the ability to focus, have psychological symptoms that are behavioral or autonomic which are the primary manifestations of phobias. Exclusion criteria are participants who have a terminal disease that allows not to follow the stages of hypnotherapy until the end, participants are not in a state of severe stress or loss of focus ability, for example due to drugs abuse.
The scale used is the fear questionnaire (FQ) adopted from Marks and Mathews (1979). This questionnaire aims at assessing and identifying the types of phobia as well as phobia symptoms. This questionnaire contains 24 questions with 1 answer choice on each question using a rating scale model scoring scale of 15 phobias consists of 3 separate types of phobias namely agoraphobia in item 5, 6, 8, 12, and 15 with reliability of 0.89, specific phobia or blood phobia and injury in item 2, 4, 10, 13, and 16 with reliability of 0.96, and social phobia in item 3, 7, 9, 11, and 14 with reliability of 0.82 17 items on other situations with reliability of 0.93. Then the score associated with phobic symptoms in items 18-24 with reliability of 0.86.
Research variables consisting of intervention variables are hypnotherapy performed on subjects who have phobias, while the dependent variables are phobia symptoms. Operational definitions of hypnotherapy intervention variables are therapeutic methods using hypnosis techniques by lowering brain waves to theta, as well as giving positive suggestions. Dependent variable of phobia symptoms is a form of human response when faced with threats from the environment that stimulates other physical and psychological reactions.
Data has been collected since 2018 in Malang's hypnotherapy medicare clinic, Malang city, East Java province. Data collection is directly collected by researchers. In the procedure of conducting hypnotherapy, researchers are assisted by hypnotherapy practitioners who have registered certificates at the professional hypnotherapy organization in Indonesia.
Ethics committee approval was obtained by universities and professional hypnotherapy organizations in Indonesia. Hypnotherapy procedures are used in accordance with the guidelines and code of ethics of the hypnotherapy organization body in Indonesia. The place used is a place that is comfortable, clean, not noisy, and has therapeutic support facilities such as sofas.
Data analysis in this research is univariate analysis in the form of frequency distribution and percentage of each variable. Statistical tests used in bivariate analysis used paired sample t-tests with a significance level of 95% (p<0.05) by using IBM SPSS Statistics version 21.

RESULTS
Descriptive test results based on age showed the study participants had an age range from 19 years to 25 years with an average age of 22 years with a standard deviation of 1,486. The number of participants is 20 people. Data obtained from male participants are 4 people (20%) and 16 female participants (80%). Total 20 100 Table 1 shows that the most common types of phobias occurred are social phobias, such as fear of crowds, fear of public speaking, fear of criticism, fear of talking to superiors, and fear of walking with others.  Table 2, the statistical test shows the phobia symptom score before the intervention is 95.5 and after the intervention is 20.6. It can be seen that there is a decrease in phobia symptoms before and after hypnotherapy. The results of the paired sample t-test calculation showed a value of p<0.05 which means that hypnotherapy could significantly reduce phobia symptoms, the hypothesis was accepted.

Characteristics of participants based on age, gender, and types of phobia
Based on data of the participants' characteristics regarding age, it is obtained from the results of the study aged 19 to 25 years with an average age of 22 years. This research is in line with Ibrahim (2011) saying phobias appear from a young age and continue until adulthood. The cause of the emergence of phobias in the average age of 22 years is a traumatic factor since childhood and influenced by negative information such as bullying, often underestimated, often watching horror films that can trigger phobias. Gunawan (2005) said that information can be obtained through the media, teachers, parents, friends, and the environment that can influence individual behavior which can trigger trauma. The intended traumatic experience is a frightening event and leaves psychological trauma. The other events that trigger phobias are other traumatic experiences such as embarrassing or guilty experiences. When an individual returns to face or experiences a situation similar to his traumatic, then symptoms of fear will occur. This condition also marks the emergence of phobias in these individuals and will continue to persist throughout their age if there is no attempt to cure the phobia experienced.
Based on the gender of participants, the majority of people with phobias are women, with data showing that women who have phobias are 16 people (80%) while men only 4 (20%). This research is in line with Bener, Ghuloum and Dafeeah (2011) stating that women have 62.4% phobia rate higher than men which is 37.6%. Rehatta et al. (2014) stated that women are more anxious about their disabilities compared to men, where men are more active and explorative while women are more sensitive as well as showing that men are calmer than women. Women are also more easily influenced by environmental pressures than men. Fear arises due to threatening purposes, uncertain outcomes, loss avoidance in the future, and less optimistic about the future (Lench & Levine, 2005).
Based on the characteristics of the types of phobias, it can be found that individuals can experience one to three types of phobias that are avoided with data prevalence of 15% of participants in agoraphobia, 50% in social phobia, and 35% in specific phobias. The highest phobia is found in social phobia by 50%. The results of this study are in line with Chartier, Walker and Stein (2003) saying that all mental health disorders are significantly more common among participants who have social phobia. Social phobia is also known as social anxiety disorder. Social phobia is the fear of being observed and humiliated in public (Maramis & Maramis, 2009). This study is in line with Bener, Ghuloum and Dafeeah (2011) which found agoraphobia (8.6%), social phobia (14.9%), and specific phobia (9.6%).

Decreasing phobia symptoms before and after hypnotherapy
As showed in the results of the study, it has been proven that there is a significant influence of hypnotherapy on the reduction of phobia symptoms with two sessions of hypnotherapy sessions. These results are different from previous studies such as research by Kraft (2010) that required four therapy sessions. The results of this study form the basis of new knowledge about the concept of hypnotherapy that contributes to the scope of alternative complementary therapies that have been described in the Indonesian Ministry of Health's Law regarding mind body interventions as a support to improve health services and quality.
Hypnotherapy can reduce phobias because basically the concept of hypnotherapy makes a person relaxed and able to reach their subconscious mind. In a relaxed state, the brain waves will go down to alpha wave even to theta so that in this condition, it is very easy to access the subconscious mind that functions as a longterm storage of human memory including traumatic experiences that cause phobias.
Hypnosis techniques used are age regression then proceeded by providing positive suggestions for re-educating traumatic experiences using desensitization techniques, namely reducing the sensitivity of phobias and providing new understanding and learning or new meanings so that participants are able to adapt to the object or situation they fear. In order to get longer effects of this therapy, anchoring will be given to participants such as visual, auditory, and kinesthetic symbols with the aim of controlling themselves and strengthening the therapeutic effect on daily activities. This method is supported by a psychoanalytic view which is an effort to cure phobias according to Freud by reopening past memories related to traumatic events that are repressed into the subconscious mind by hypnosis methods (Furnham, 1995;Purnama, 2016).
The reason for decreasing phobia symptoms is because of the effects of hypnotherapy intervention, which are mood swings such as being happy, comfortable, and more relaxed. The results of this study are in line with studies by McGuinness (1984) stated that a person will feel happy, happy, relaxed, and peaceful after being hypnotized. The reason someone feels happy, happy is when the hypnosis condition decreases brain waves to theta will produce a stimulus that is sent from the axons of ascending fibers to the neuros from the reticular activating system (RAS). RAS has a reciprocal relationship with the limbic system that functions as an emotional response that leads to the behavior of individuals. Then in a relaxed state, the body will experience a resting phase. At that moment, the body will activate the parasympathetic nervous system. Parasympathetic nerve workings cause a decrease in heart rate, respiratory rate and blood pressure and produce