Hypnotherapy as an alternative approach in reducing anxiety in the elderly

Elderly is a natural process experienced by every human being who will reach the old age. Elderly is not a disease, but this is a normal process that will occur. In this stage, there are many problems faced by the elderly both the deceased physical and mental problems such as depression, anxiety, stress. The problems occurring in the elderly are important things that require attention and care. Hypnotherapy is a way to improve mental health such as anxiety. This method of therapy uses hypnosis in the form of verbal advice. This paper tries to explain the concept of hypnotherapy and aspects related to hypnotherapy, which it intend which reduce mental problems such as anxiety that occurs in the elderly.


Introduction
Elderly is the final stage of the human life cycle (Zulfitri, 2011).According to Annisa & Ifdil (2016) that elderly is the final stage of development in the human life cycle which is a natural process every individual can avoid that.Elderly is a continuation of adulthood.Elderly is a continuation of adulthood (Nugroho & 2012).According to WHO and Law Number 13 of 1998 concerning the welfare of the elderly in article 1 paragraph 2 which states that the age of 60 years is the age of beginning of elderly.Elderly is not a disease (Moniaga, 2013).Every individual who reaches the old age will experience that (Sutikno, 2011).
The growth of the elderly (elderly) is exploding in the 21st century (Khairani & Sumiera, 2005).According to Ambardini (2009) in Indonesia the number of the elderly reaches 18 million, making up 7.8% of the population.The large number of the elderly raises various problems (Urbayatun, 2006).Prawitasari (1994 revealed that this stage is not simple.According to Andria (2013) ) the elderly is an attack by diseases such as hypertension, and they are susceptible to occurrence of side effects from drugs.Another problem experienced by the elderly is sleep disorders or insomnia (Polytechnic, 2010).
According to Marchira & Wirasto (2007) elderly is also a prone stage of occurrence of problems such as stress.Marchira & Wirasto (2007) suggest there are five mental disorders that often found in the elderly: depression, insomnia, anxiety, and delirium.According to Ausrianti (2010) mental health problems are the most common problem in the elderly, such as anxiety.
Few studies have looked at a broad range of mental disorders in the elderly.Cognitive impairment and depression have surveyed, but there is much less information available about other disorders, anxiety states (Lindesay, Briggs & Murphy, 1989).
Supported by (Astuti, 2012;Irawan, 2013), expressing anxiety is a mood disorder that often occurs in the elderly and is one of the emotional disorders.Beware of anxiety that can occur in the elderly (Saputri & Indrawati, 2011).According to (Prasetya, Hamid, & Susanti, 2010) the elderly shows that anxiety behavior with a moody behavior.
Anxiety in the elderly is often unrecognized.Several factors complicate recognition and treatment, including concomitant medical illness, overlap with cognitive disorders (Small, 1997).There is a high rate of anxiety in elderly with major depressive disorders compared with younger depressive ( Gottfries,1998).It expects the elderly to adapt to mental decline and health.With presence of various diseases both physical and psychological that are prone to occur in the elderly, hypnotherapy in the elderly is a relaxation activity that can reduce tension and mental disorders in the elderly.According to DS, Kristiyawati, & Supriyadi (2014) the art of hypnotherapy is the mastery of client-centered techniques.The concept of hypnotherapy was first presented by Erickson, using an informal conversational approach, which uses a distinctive and complex language pattern while making a precise strategy in doing therapy (Hakim, 2010).Hypnotherapy is one of the mind therapy techniques (Afriani, 2015;Krouwel, Jolly, & Greenfield, 2019;Slomski, 2019).
Based on this phenomenon, the hypnotherapy method can use to reduce anxiety (Fathi, Janbabai, & Pourasghar, 2019;Gafner, 1997;Palsson, 2019;Shestopal & Bramness, 2019;Taylor & Genkov, 2019).Hypnotherapy is a combination of hypnosis and a therapeutic intervention.The therapist in this case guides the client to have a positive change to reduce anxiety when the client experiences deep relaxation where the condition has a high level of suggestion, it call the condition trance.During the trance condition, humans are in a subconscious condition.The subconscious condition can control the conscious mind without realizing it and can express ideas or actual thoughts far beyond the conscious mind.
Hypnotherapy is useful in addressing habit problems, acute and chronic anxiety, acute and chronic pain, biobehavioral disorders (Kohen & Olness, 1993).It expected to be effective because of the relaxation component, often associated with hypnosis (Melis, Rooimans, Spierings & Hoogduin, 1991).Hypnotherapy is most beneficial if we crea-tively combine our hypnotherapeutic skills (Gardner, 1976).

Hypnotherapy
The term hypnotherapy comes from the English word, hypnosis or hypnotism (hypnotism) and therapy (Huda, 2016).True hypnotherapy is a scientific discipline which began in the late eighteenth century with Anton Mesmer (1785).The early history of hypnotherapy, it is true, was one of sensationalism and dramatic discoveries (Fromm, 1980).Hypnotherapy is healing of mental disorders by bringing the sufferer to a trance condition so that the individuals can tell their feelings (Wardani, 2016;Alizamar, etc., 2018).This is one branch of psychology that studies the benefits of suggestions to overcome problems of mind, feeling and behavior (Rakhmawati, Putra, & Perdana, 2015).
Hypnotherapy is conduct by a trained therapist, It is administered by a mental health clinician certified in hypnotherapy (Rowley, 1986).Hypnosis is an ability or a mental state, hypnotherapy is a treatment modality with specific therapeutic goals and specific techniques used when the patient is in the state of hypnosis (Huynh, Vandvik & Diseth, 2008).Hypnotherapy is applied hypnosis in curing one's mental problems.Define hypnosis according to Gunawan (2006) is: 1) hypnosis is a condition of a person where attention becomes very centralized, making the suggestibility levels high, 2) hypnosis is an art of communication to influence and change one's consciousness by lowering the brain waves.
Hypnosis can be interpreted as a condition of relaxation, focus, or concentration, which is a characteristic of the condition, in another term hypnosis is a condition or condition when humans are more suggestive and there is a trance phenomenon that occurs for the nerve sleep or the sleep of someone's unconscious mind (Gumelar & Erik, 2017).Hypnotherapy is one branch of psychology that studies the benefits of suggestions to overcome problems of mind, feeling and behavior (Rakhmawati et al., 2015).Hypnosis can also be interpreted as a state of mind in which the mind becomes reduced in logical analytical functions that enable a person to enter an unconscious (sub-conscious / unconscious) state, which is stored in various internal potentials that can be used further to improve one's life quality Erik, 2017).
Flammer and Bongartz from Konstanze University in Germany, conducted a meta-analysis of various researches on hypnotherapy in 2003.As a result, from the 57 studies analyzed, the success rate reached 64%.This success is hypnotherapy deal with psychosomatic disorders that are macro or micro (e.g.anxiety, stress, depression, emotional instability, conflict, etc.), anxiety tests, helping clients stop smoking, and controlling pain in some patients with chronic diseases (Prihantanto, 2009).Hypnotherapy is only using the power of suggestions which will relax the condition of the individual, so it can be more comfortable in a short amount of time (Nugroho & Asrin, 2012).
(Hypnotherapy as an alternative approach in reducing anxiety in the elderly)

Elderly
Elderly is someone who has reached the age of 60 years and over (Saputri & Indrawati, 2011).This is the last term for the aging process.Elderly is a period or stage of human life ranging from babyhood, childhood, adolescence, adulthood, middle age to the old age (elderly).Ministry of Health (Urbayatun, 2006) limits the elderly as the advanced stage or the final stage of the journey of living things.Some other terms are often used and have the same meaning: 1) Old Age (in the Basic Health Act No. 9 of 1960), 2) Elderly / Elderly (in Law No. 4 of 1965), 3) MANULA (Old Man), 4) Wredawan, 5) Adi Yuswo.Hurlock (1980) explains that elderly is a closing period in a person's life span, e.g. a period someone has moved away from the previous period which is more pleasant, or moving from a time full of benefits.
According to Prayitno (2006) there are several characteristics of physical changes that occur in the elderly period 1) physical changes are no longer experiencing growth but there is a change or improvement of body cells, 2) in the elderly there is a decline reproduce existing cells in the body.With the decline of cell reproduction, there is a lot of replacement failure from damaged cells, when the elderly get sick, the healing process in the elderly lasts a long time, 3) changes in sexual drive.A research conducted by Master and Johnson (Prayitno, 2006) "justifying there is no reason that the elderly can no longer enjoy sex with their partners, even women experience renewed interest and pleasure in sex".According to (Padila, 2013) becoming old is characterized by biological deterioration that is seen as symptoms of physical deterioration such as the skin relaxes and the face wrinkles and permanent lines, the hair of the head turns gray or gray, the teeth fade (toothless), vision and hearing are reduced, fatigued and fall off, movements become sluggish and less agile.
Vision loss among the elderly is a major health care problem.One person in three has a vision-reducing eye disease by the age of 65 (Quillen, 1999).Hearing loss has been linked with several emotional factors like depression, neurotic symptoms, anxiety, paranoia, social (Andersson & Green, 1995).Furthermore, the elderly's personality type according to Kuntjoro (Azizah, 2011) is as follows: 1) constructive personality type (construction personality), this person has good integrity, enjoys life, high tolerance and flexibility.this type does not experience a lot of turmoil, calm until it's ancient.the elderly can accept the reality of the aging process and face retirement, and face death with full physical and mental readiness; 2) independent personality type (independent personality), in this type there is a tendency to experience post power syndrome, if it does not fill the elderly with activities that can provide autonomy; 3) dependent personality type (dependent personality), this type is very much influenced by a family life, if the family life is always harmonious then the elderly is not turbulent, but if his partner of life died, he will be sad.this type is happy to get retirement, has no initiative, is passive but still knows himself and is still acceptable to the community; 4) hostile personality type (hostile personality), the elderly in this type after entering the stage, he still feels dissatisfied with his life; many activities that are not taken into account, causing their economic conditions to decline. he considers other people who cause failure, always complain and suspect.being old is not considered good, afraid of death and envy with the young; 5) defensive personality type, this type always gives a refusal to the help offered, emotions are uncontrolled, active compulsive.he is afraid to grow old, and he does not not like retirement; 6) type of personality self-criticism (self hate personality), the elderly of this type looks miserable, which is caused by his own behavior, difficult for others to help or make himself difficult.he always blames himself, does not have ambition and feels as the victim of the situation.

Anxiety
Anxiety is an individual feeling related to unpleasant feelings characterized by physical, behavioral and cognitive symptoms.Anxiety is the subjective feeling of tension, apprehension, nervousness, and worry associated with an arousal of the autonomic nervous system (Horwitz, Horwitz & Cope 1986).
According to psychoanalytic theory, the main determinants of anxiety disorders are internal conflicts and unconscious motives (Santoso & Dewi, 2014).Freud (Suryabrata, 2011) distinguishes between aim anxiety which is a reasonable response to a situation and neurotic anxiety that is not proportional to the actual danger.Yusuf (2009) suggests anxiety is a neurotic helplessness, insecurity, immaturity, and inability to deal with the demands of reality (environment), difficulties and stresses of everyday life.Strengthened by (Kartono, 1989) that anxiety is a lack of courage plus concern about things that are not clear.
Anxiety is found as a central explanatory concept in almost all contemporary theories of personality, and it is regarded as a principal causative agent for such diverse behavioral consequences as insomnia, immoral acts, instances of creative self-expression (Spielberger, 1966).
In line with that, (Sarwono, 2012) explains that anxiety is a fear that is a vague object and also unclear reason.Thus, it can be concluded that anxiety is emerged a sense of discomfort in a person caused by something that is not clear.
Another variable that may be important in designing policies to reduce anxiety about aging is contact with elderly people (Allan & Johnson, 2008).He results of this study show that fostering a sense has a supportive social and familial network is important in decreasing death and dying anxiety among elderly people (Azaiza, Ron, Shoham & Gigini, 2010).

Conclusion
Elderly is not a disease, but it is a period of physical and psychological decline.Many changes and problems that occur in this stage, such as decreased vision and hearing power, memory and often forget and the more sensitive feelings that always want to be noticed, cared and loved by the environment and by the family.In this stage, anxiety, stress, and depression always occur.To minimize these problems, hypnotherapy is a way that can be done to deal with the causes or roots of a problem, and which makes people enter the anxious, stressful and depressed conditions.