Mental disorder is a health problem with psychological or behavioural manifestations associated with real suffering and poor performance and is caused by biological, social, psychological, genetic, physical or chemical disorders. Mental disorders represent a problem which is a deviation from a normative concept. Worldwide, the prevalence of schizophrenia is estimated at 0.2% to 1.5%, equivalent for men and women of all age levels. The prevalence of schizophrenia is quite high not only in the world but in Indonesia which experiences the same thing because the schizophrenia group which occupies 90% of patients in Magelang mental hospital [1,2]. Schizophrenia is a chronic, severe and disabling disease, a brain disorder characterized by chaotic thoughts, delusions, hallucinations and strange or catatonic behaviour, so it needs special attention in prevention, treatment and ongoing care [3,4].

Average prevalence of severe and chronic mental disorders or schizophrenia in Indonesians regardless of the age limit indicates that people with severe mental disorders in Indonesia are 1.7 per 1,000 people. The same study noted that of the total population at risk of 1,093,150 people, only 3.5% or 38,260 people were served with adequate care in various health facilities [5]. According to Pardede and Siregar [6], Hallucinations are also false or false perceptions but there are no stimuli that cause them (no objects). Hallucinations are one of the symptoms of sensory perception disorders experienced by mental patients. Patients feel sensations of sound, sight, taste, touch or smell without real stimulation [7].

The appropriate modality therapy for hallucination patients is perception stimulation group activity therapy which aims to improve sensory abilities, efforts to focus attention, physical fitness and express feelings. This therapy uses activities as stimuli and related experiences in life to be discussed in groups [8]. The survey results obtained by the author from the Medical Record at RSJ Prof. Dr. Muhammad Ildrem, Medan Province, found that 2,070 patients had mental disorders and 13,065 people had schizophrenia.

Based on interviews with nurses in the room, of the 12 patients who had participated in the Group Activity Therapy stimulation of the perception of hallucinations from session 1 to session 5, 5 of them were unable to rebuke hallucinations, did activities, had conversations with other people and obeyed taking medication. 4 people were able to rebuke hallucinations, were able to converse but were not able to carry out scheduled activities and obeyed taking medication and 3 people were able to rebuke hallucinations, carry out activities, have a conversation and obey taking medication. Almost all of them have attended Group Activity Therapy. Every meeting with therapy will focus on awareness and understanding yourself, improve interpersonal relationships and change behaviour. This is due to the feeling of togetherness that is felt, a sense of comfort and a sense of cohesiveness in hallucination patients. Based on this, the researcher is interested in conducting research on the effect of perceptual stimulation activity therapy on changes in hallucination symptoms in schizophrenia clients.

This study used a research design that is a Quasi-Experimental pre-post-test with group activity therapy intervention in schizophrenic clients. The population in this study were all Schizophrenia patients who experienced hallucinations at the Prof. Dr. Muhammad Ildrem Mental Hospital, totalling 323 people. Sampling in this study is to use simple random sampling. The sampling was 18 samples. Data analysis was carried out in two stages, namely univariate analysis to obtain a description of the distribution of research subjects and to describe the independent variables and bivariate analysis was used to determine the effect of perceptual stimulation group activity therapy on changes in hallucination symptoms using t-test dependent statistical test with α = 0.05.

Based on Table 1, it can be seen that the majority of respondents were <35 years old (50.0%), 9 people were male and female (50.0%), 13 respondents had high school education background (72.2%), the majority were self-employed as many as 7 respondents (38.9%) and most of the respondents were married as many as 8 respondents (44.4%).

Table 1: Characteristics of Respondents

Based on Table 2, it can be seen that the hallucination response before being given group activity therapy, with an average hallucination symptom in schizophrenia clients before group activity therapy includes a cognitive response of 9.50, an effective response of 9.83, a behavioural response of 9.44, social response of 9.06 and the composite value of 37.83.

Table 2: Analysis of the hallucination response of schizophrenic clients before being given perception stimulation group activity therapy

Based on Table 3, it can be seen that the hallucination response after being given group activity therapy, with an average hallucination symptom in schizophrenia clients before group activity therapy includes the cognitive response of 6.17, the affective response of 5.94, the behavioural response of 5.94 and social response of 6.39 and the composite value of 24.44.

Table 3: Analysis of the hallucination response of schizophrenic clients after being given perception stimulation group activity therapy

Based on Table 4, it can be seen that the difference in hallucinations in the cognitive response before being given a high Group Activity Therapy was 9.50 and after being given Group Activity Therapy had a change of 6.17 which indicated the effect of Group Activity Therapy. For the affective response before being given a high Group activity therapy was 9.83 and after being given a low Group activity therapy was 5.94. The behavioural response before being given a high Group Activity Therapy was 9.44 and after being given a low Group activity therapy 5.94. In the social response, there is also a difference before being given a high Group Activity Therapy of 9.06 and after being given a low Group Activity Therapy 6.39. The composite value shows a change in hallucination symptoms before being given a high Group Activity Therapy of 37.83 and after being given a low Group Activity Therapy of 24.44.

Table 4: Analysis of differences in the response of hallucinations in schizophrenia clients before and after being given perception stimulation group activity therapy

Based on Table 5, it can be seen that there is a significant influence between hallucination symptoms in respondents before being given group activity therapy and hallucination symptoms after being given group activity therapy from the Paired Sample Test results found p = 0.000 (p<0.05).
 

Table 5: Results of paired sample test of effect of perception stimulation group activity therapy on changes in hallucination response in schizophrenia clients

Analysis of Hallucination Responses Before Being Given Group Activity Therapy

The results showed that the average hallucination symptoms before group activity therapy were given, with the average hallucination symptoms in schizophrenia clients before group activity therapy including the cognitive response of 9.50, the affective response of 9.83, the behavioural response of 9.44, the social response of 9.06 and the composite value of 37.83.

The results of the research obtained showed that the ability to control hallucinations was mostly in the less category before the perception stimulation group activity therapy was carried out, this happened because all respondents had never received knowledge about the introduction of hallucinations experienced and how to control when hallucinations appeared perceptual stimulation group activity was or stimulating respondents through activities they like and discussing activities that have been carried out with the aim of helping members relate to other people and change destructive and maladaptive behaviour. The assumption of the researchers is that the observation results, the need for increased knowledge of clients in overcoming their hallucinations and the need for regular group activity therapy and support from health workers.

Analysis of Changes in Hallucination Response After Giving Group Activity Therapy

The results showed that the mean change in hallucination symptoms after being given group activity therapy, with an average hallucination symptom in schizophrenia clients before group activity therapy including the cognitive response of 6.17, the affective response of 5.94, the behavioural response of 5.94 and social response of 6.39 and the composite value of 24.44.

This study is supported by research conducted by Talilah [9], where there is an effect of perceptual stimulation group activity therapy on the ability to control hallucinations. The results of the study [10]. Perceptual stimulation activity group activity decreased the frequency of hallucinations. The similarity of the results of this study with the results of previous studies implies that perceptual stimulation group activity therapy can be used as an alternative therapy option for handling hallucinations in mental patients. This is supported by the theory that group activity therapy stimulates perceptual hallucinations to shape the client's ability to solve problems with stimuli. given to the patient. Based on the assumption of the researcher's observations, that the client is able to overcome hallucination symptoms after group activity therapy and knows how to handle it independently.

Analysis of Differences in Hallucination Response Before and After Group Activity Therapy

The results showed that the average change in hallucination symptoms of respondents who experienced hallucinations before the intervention which included cognitive response was 9.50, the affective response was 9.83, the behavioural response was 9.44, the social response was 9.06 and the composite value was 37, 83. Meanwhile, changes in hallucinations with schizophrenia experienced changes after participating in Group Activity Therapy including the cognitive response of 6.17, the affective response of 5.94, the behavioural response of 5.94 and social response of 6.39 and a composite score of 24.44. Hallucinations indicate that there are changes in hallucination symptoms in respondents before and after the intervention.

Group activity therapy that is given a stimulus to the client can control hallucinations in order that the client can explain the way that has been done to experience hallucinations. Clients can also understand the dynamics of hallucinations, how to tell hallucinations and can demonstrate how to tell hallucinations [11].

Therapeutic modalities that are appropriate for hallucination patients are sensory activity therapy, efforts to focus attention, physical fitness and express feelings. This therapy uses activities as stimuli and related experiences in life to be discussed in groups [8]. With perceptual stimulation group activity therapy, it will have a positive impact on prevention, treatment and health restoration, namely good behaviour. In perceptual stimulation group activity therapy here, the client is trained to perceive the stimulus provided or the stimulus the client has experienced. The client's perceptual ability is evaluated and improved at each session.

Based on the assumptions of the researchers' observations, this ability is due to the process of implementing continuous group activity therapy. In the group, there is a dynamic of interacting and influencing each other so that other respondents are stimulated to carry out what was taught and what other respondents have succeeded in doing. In addition, it also provides opportunities for clients to be able to receive feedback from others and be able to learn various ways to solve other people's problems.

Effect of Perceptual Stimulation Group Activity Therapy on Changes in Hallucination Response

Based on the results of research on the effect of group activity therapy on changes in the symptoms of hallucinations of respondents assessed using the Paired Sample Test statistical test, the calculated value of p = 0.000 (p <0.05) was obtained. Based on research conducted [12,13], with the title Effectiveness of Group Activity Therapy for the stimulation of perceptual hallucinations to decrease auditory hallucination client anxiety in the Sakura room of Banyumas Hospital for 30 hallucination patients, it was found that there were differences in anxiety levels before doing Group Activity Therapy and after doing group activity therapy. Another study conducted [14], entitled The Effect of Perceptual Stimulation Group Activity Therapy on the ability to control hallucinations in the Mental Hospital of Medan, North Sumatra Province, shows that there is a significant effect after the implementation of perceptual stimulation activity group therapy in controlling patient hallucinations. Another study conducted [15], entitled the effect of Group Activity Therapy socialization on the ability to cooperate in patients with social isolation problems at the Tampan Mental Hospital, Riau Province, shows the effect of socialization Group Activity Therapy on the ability to cooperate in patients with social isolation problems.

The assumption of researchers from the observations of researchers is that in handling mental disorders, medicine is not everything, but also counselling, psychotherapy and rehabilitation are needed. Various studies have shown that the factors that cause mental disorders are very complex, including physical, psychological and social factors. One other therapy besides drugs is group activity therapy.

There is a significant influence between hallucination symptoms in respondents before being given group activity therapy and hallucination symptoms after being given group activity therapy from the Paired Sample Test results found p = 0.000 (p<0.05).

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