Effective Logotherapy Improves Coping Ability in Low Self-Esteem Patients

Introduction: Low self-esteem is a self-concept disorder in which feelings of self are negative, feel inadequate and feel that they are inferior to others. Logotherapy can affect coping abilities in people with low self-esteem. Good coping skills can affect mental health in patients with low self-esteem. Objective : This study was to determine the effect of logotherapy on coping abilities in patients with low self-esteem. Methods: This study used a pre-experimental design with a pretest-posttest research design. The population of this study was patients with low self-esteem. The sample in this study was 15 patients. The research instrument used an observation


Introduction
Mental health is a healthy condition emotionally, psychologically and socially as seen from satisfying interpersonal relationships, effective behavior and coping, positive self-concept and emotionally stabilizing. 1 The World Health Organization defines mental health as a state of well-being in which individuals are aware of their abilities, can cope with stress in their lives, can work productively and make a contribution to society. 2 In addition to this understanding, the Ministry of Health has also defined mental health as a prosperous mental condition that allows individuals to live harmoniously and productively, as a person's quality of life by paying attention to all aspects of their life. Thus mental health is a part that exists in every individual to be able to adapt to the environment and be able to live productively in everyday life. 3 According to the American Psychiatric Association, a mental disorder is a clinically important psychological syndrome or pattern that occurs in an individual that is associated with distress (eg, painful symptoms) or disability (ie, impairment in an important area of functioning) or is accompanied by an increased risk of painful death. , pain, disability, or loss of independence. Low self-esteem is a negative self-assessment and is associated with feelings of weakness, helplessness, hopelessness, fear of danger, weakness, fragility, imperfection, worthlessness and inadequacy. 4 Mental disorders are still a world health problem, even in Indonesia until now the prevalence of severe mental disorders is still quite high. In 2016 an estimated 35 million people were diagnosed with depression, 60 million people were diagnosed with bipolar, 21 million were diagnosed with schizophrenia, and 47.5 million had dementia. 5 Riskesdas 2013 data shows that the prevalence of emotional mental disorders as indicated by symptoms of depression or anxiety for ages 15 years and over reaches around 14 million people or 6% of the total population of Indonesia. 6 Meanwhile, the prevalence of severe mental disorders, such as schizophrenia, reaches around 400,000 people, 1.7 per 1,000 population. 7 This figure means that for every 1000 Indonesian residents there are 4-5 people who experience mental disorders. The highest prevalence was in the province of the Special Capital City Region of Jakarta (20.3%), followed by Nangroe Aceh Darussalam (18.5%), West Sumatra (16.7‰), NTB (9.9%), and South Sumatra (9.2%).
Health problems of low self-esteem need intensive and comprehensive management to see the adverse effects that can occur on clients. The impact that can occur on clients with low self-esteem who do not receive proper and intensive treatment is the emergence of new problems, namely social isolation which can even lead to suicide attempts. This can happen because the client is too focused on negative feelings and thoughts about himself, so that the client feels that he is no longer meaningful either for himself or for others. 8 One of the treatments for dealing with the problem of low self-esteem is the logotherapy technique. Logotherapy is a group psychotherapy technique, but it can also be carried out individually. Logotherapy is a technique that focuses on finding the meaning of life so that individuals have positive strengths or thoughts to survive. Research results have proven that Logotherapy can increase self-esteem in the elderly in Pekanbaru nursing homes both from cognitive and behavioral aspects. 9 The main goal of logotherapy is to achieve a meaningful life and be able to overcome effectively the personal constraints and obstacles on the client. This is obtained by knowing the various potentials and spiritual resources that each person has that may still be hampered and neglected. 10 Based on a preliminary study conducted at the psychiatric hospital X on September 30 2019 by conducting interviews with hospital nurses and several patients. 5 nurses said they had never done logotherapy, 3 people said they only did TAKS, 2 people said they didn't know about logotherapy. Observation results on October 11 found that 12 patients with low selfesteem often felt alone and disappointed with themselves and patients with low self-esteem also said that they often vent their feelings of disappointment and anger by being alone. The purpose of this study was to determine the effect of logo therapy on coping abilities in patients with low self-esteem at the psychiatric hospital X.

Metode
This type of research is quantitative using a pre-experimental design with a pretestposttest research design. 8 The population in this study were all patients with low self-esteem in the MR and ML rooms at psychiatric hospital X, totaling 45 people. The sampling technique in this study was purposive sampling. The sample in this study were 15 patients with low selfesteem at the X psychiatric hospital. This research was conducted on patients with low self-

Results
Univariate analysis Table 1. Frequency Distribution of Respondents Based on Low Self-Esteem Coping Ability Before and After Doing Logotherapy Based on table 1, the frequency distribution of respondents in low self-esteem coping abilities before logotherapy treatment found that some were not familiar with low self-esteem coping and had a lack of desire to do activities, namely 66.7%. The frequency distribution of respondents in low self-esteem coping abilities after logotherapy treatment found that most of them were incapacitated, namely as much as 20%. Based on table 2. The results of the Mc Nemar test above show that coping abilities in patients with low self-esteem before and after logotherapy are carried out with a p value of 0.016 with a significance level of 0.05. If the p value is greater than 0.05 then the null hypothesis is accepted and if the p value is less than 0.05 the hypothesis is rejected. The results of the Mc Nemar test show that the p value is less than 0.05 (0.016 <0.05). So it can be concluded that logotherapy has an effect on coping abilities in patients with low self-esteem at Mental Hospital X.

Coping Ability before Performing Logotherapy Actions in Low Self-Esteem Patients
Based on table 1, it was found that out of 15 respondents who had coping skills before logotherapy was carried out in patients with low self-esteem, most of them were unable as many as 10 respondents (66.7%) and those who were able to do coping were 5 respondents (33.3%).
The results of this study are in line with the research of Diani & Budi (2019) which states that the conclusion that logotherapy is effective for low self-esteem in drug addict teenagers at the Bidayatussalikin Islamic Boarding School, Yogyakarta. The quasiexperimental method uses a non-equivalent control group design. Based on the category of low self-esteem, a sample of 10 drug addicts was obtained which was divided into two groups, namely the control and experimental groups, each group consisting of 5 drug addicts who had low self-esteem. After forming into 2 groups, the experimental group was given treatment in the form of logotherapy for 9 meetings. The results of giving treatment with logotherapy are drug addict teenagers. By using statistical tests, it shows that the p-value <0.05 (0.016) means that there is a significant relationship between logotherapy and the success of low self-esteem in adolescent drug addicts. 9 Low self-esteem is a negative self-evaluation and is associated with feelings of weakness, helplessness, hopelessness, fear of danger, weakness, fragility, imperfection, worthlessness and inadequacy. 2 Low self-esteem is caused by many factors. Initially the individual is in a situation full of stressors (crisis), the individual tries to resolve the crisis but it is not complete so that thoughts arise that they are unable or feel they have failed to carry out their functions and roles. Individual self-assessment due to failure to carry out functions and roles is a condition of situational low self-esteem, if the environment does not provide positive support or instead blames the individual and occurs continuously it will result in the individual experiencing low self-esteem. 11 Low self-esteem needs intensive and comprehensive management considering the adverse effects it can have on clients. One of the appropriate management for mental disorders of low self-esteem is the logotherapy technique. Logotherapy is a form of group psychotherapy, but it can also be carried out individually. Logotherapy is a therapy that focuses on finding the meaning of life so that individuals have a positive power to survive. Logotherapy is aimed at individuals with depression, phobias, anxiety, substance dependence, alcoholism, obsessive compulsive disorder and other medical services. 12 According to research conducted in correctional institutions, it was stated that the group logotherapy intervention that was carried out was quite effective in reducing anxiety from previously experiencing high levels of anxiety to low. 13 In patients with low self-esteem before logotherapy, there are still many patients who behave maladaptively because there is still a lack of treatment and activities in the hospital. We can see this maladaptation from their daily lives in the hospital, for example patients who experience maladaptive low self-esteem are usually patients who are often angry because they have not been able to solve their problems, are still seen to often isolate themselves or be alone and patients are still seen to regress or experience periods of depression. past developmental period.

Coping Ability after Logotherapy Actions in Low Self-Esteem Patients
Based on table 1, the results of the study of coping abilities in patients with low selfesteem after logotherapy were carried out, most of them were able to overcome low self-esteem as many as 12 (80.0%). This shows that after logotherapy, patients with low self-esteem can overcome their illness.
The results of this study are in line with Claudia, et al (2017) entitled "The effect of logotherapy on the self-esteem of leprosy sufferers who experience low self-esteem at the Kediri leprosy hospital." The research method used was an experimental method, namely quasy experiment design with a pre-test approach -post test with control group. The treatment given is logotherapy. Respondents totaled 32 people who were divided into 2 groups, namely the treatment group and the control group obtained by quota sampling technique. The research was conducted in July 2017, it was found that almost all respondents in this study experienced an increase in self-esteem scores which were shown to be significantly using statistical tests obtained p <0.05, so it can be concluded that giving logotherapy to leprosy sufferers has a positive effect on increasing their self-esteem. 14 The main goal of logotherapy is to achieve a meaningful life and be able to overcome effectively various personal obstacles and obstacles. This is obtained by realizing and Agustina and Isriyanto Vol: 02(02) 156 understanding as well as realizing the various spiritual potentials and resources that each person has that has so far been hampered and neglected. If someone does not understand their potentials, then the main task of that person is to find them.
Taking the appropriate attitude or the attitude given by the individual towards conditions that cannot be changed or tragic events that have occurred and cannot be avoided. In this case, what can be changed is the attitude, not the tragic event. By taking the right attitude, the burden of the tragic experience is reduced, it can even lead to a more meaningful meaning. 13 According to researchers Hardianti & Nida (2016) logotherapy will help clients to deal with frightening difficulties or be in conditions that do not allow them to be active and creative, assisted to find the meaning of life by how individuals deal with these conditions and how individuals overcome suffering. In this way, the client is helped to use his daily aggravation and suffering as a tool for discovering his purpose in life. 13 After the logotherapy procedure was carried out in patients with low self-esteem, the patient already looked better than before, initially the patient was still maladaptive and after the logotherapy procedure the patient was seen to be adaptive. The behavior seen in patients with adaptive low self-esteem is that the patient is willing to do activities that have been taught, namely dereflection to divert the patient's unfavorable behavior to activities that are more positive and beneficial to him, for example cleaning activities, conversing with other people , worship and so on.

The Effect of Logotherapy on Coping Ability in Low Self-Esteem Patients at X Psychiatric Hospital
Based on table 2, Mc Nemar's results obtained 15 respondents. The p value sig (2 tailed) is 0.016 where the value is less than the research critical limit of 0.05, so the hypothesis decision is that Ha is accepted and H0 is rejected. The value of p <0.05, it can be concluded that there is a significant influence on the ability to cope with low self-esteem pre-test and post-test at psychiatric hospital X.
Related research that is in line is research conducted by Widianti, Efri (2011) in his research entitled "The Influence of Logo Therapy and Group Supportive Therapy on Adolescent Anxiety in Detention Centers and Correctional Institutions in West Java Province". The design used in this study was a quasi-experimental pre-post test with control group with 78 respondents who were the result of screening based on inclusion criteria, consisting of 39 respondents for the intervention group and 39 respondents for the control group. This therapy was given in 8 sessions consisting of 4 sessions of logo therapy and 4 sessions of supportive therapy. This research was conducted for 5 weeks. The results showed that there was a significant effect of logo therapy and supportive therapy on reducing the level of adolescent anxiety in the intervention group. 15 Coping mechanisms are efforts directed at implementing stress, including efforts to solve immediate problems and defense mechanisms used to protect oneself. 13 Coping mechanisms can also assist in the treatment of patients with mental disorders because the function of coping mechanisms is to maintain or restore a balance between demands and available resources. According to the researchers, that there is an effect of logotherapy on coping abilities in patients with low self-esteem because it can be seen in the comparison before and after logotherapy has been carried out, initially the patient is still lacking in activity or activity and after being given the action the patient already seems willing to do several activities or activities such as sweeping, talk to other people and there are some patients who want to do worship. In addition to the attachment above, the data obtained from the results of the study before logotherapy was carried out, 10 out of 15 people had poor coping abilities in low self-

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Vol: 02(02) 157 esteem and after logotherapy 12 out of 15 people were able to improve their low self-esteem coping abilities. Thus one of the treatments for low self-esteem is to perform logotherapy. So nurses should be able to routinely apply logotherapy to patients with low self-esteem at the hospital at least once a week so that patients can solve their problems and can be more calm and relaxed.

Conclusion
Based on the results of research that has been done on the effect of logotherapy on coping abilities in patients with low self-esteem at psychiatric hospital X it can be concluded that: Coping skills before logotherapy is performed on patients with low self-esteem at psychiatric hospital X almost all respondents cannot cope with price low self. Coping skills after logotherapy was carried out in patients with low self-esteem at psychiatric hospital X, almost all respondents were able to overcome low self-esteem. So it can be concluded that Logotherapy is effective in improving coping abilities in patients with low self-esteem. This can be a recommendation that the importance of Logotherapy to improve coping in patients with low self-esteem.