Terapi Musik Klasik terhadap Penurunan Halusinasi Pendengaran pada Pasien Gangguan Jiwa Classical Music Therapy on Decreasing Auditory Hallucinations for Mental Disorder Patients

Auditory hallucinations are one of the symptoms of mental disorders in which individuals experience sensory-perceptual changes that need to get treatment as soon as possible. To overcome the problem of auditory hallucinations, this can be done through music therapy. The aim of the study was to determine the effect of classical music therapy on reducing auditory hallucinations in patients with mental disorders. The research method used a quasi-experimental pre-post test. The sample in this study were 30 people. The results of statistical analysis using the paired t-test showed a p-value of 0,000, which means that there was an effectiveness of classical music therapy in reducing signs and symptoms of auditory hallucinations. The conclusion is that there is an effect of the effectiveness of classical music therapy on the reduction of signs and symptoms in patients with auditory hallucinations at the Dadi Mental Hospital Makassar


INTRODUCTION
A common mental disorder is confusion that can make it difficult for a person to study or work normally. Common behavioral changes in people with delusions include self-destructive behavior lack of attention inability to make decisions and the inability to distinguish reality from real situations (Apriliani and Widiani, 2020).
From the results of a survey by the World Health Organization (WHO, 2022), about 379 million people worldwide suffer from mental disorders of which 20 million suffer from schizophrenia and psychosis. The results of the 2018 Basic Health Research (Riskesdas) show that the prevalence of severe mental disorders in the Indonesian population is 1,7 per mil and mental disorders is 6% ( Barus and Siregar (2019). The highest number of mental disorders occurred in Yogyakarta, Aceh, South Sulawesi, Bali and Central Java. Meanwhile, the proportion of households with severe mental disorders to be precise in rural areas was 14,3 nm (18,2%) and the lowest wealth quintile group (19,5%) (Kemenkes, 2018). According to the results of the 2022 annual report of Dadi Hospital in the province of South Sulawesi 5642 people were treated with mental disorders.
Auditory hallucinations are the most common hallucinations that people experience with mental disorders such as hearing loud sounds and seeing words or sentences. The person feels a voice directed at him so the patient often fights or talks with the voice he hears (Mulia et al., 2021). The severity of auditory hallucinations can be reduced through non-drug treatments one of which is relaxation techniques such as music therapy designed to help regulate mood and ease mental disturbances providing a sense of calm. Psychologists and psychiatrists utilize music therapy to treat a variety of mental disorders and mental disorders. According to Mutaqin et al. (2023) reported a reduction effect of auditory hallucinations after receiving classical music therapy.
Research conducted by Barus and Siregar (2020).states that music can function to increase individual physical vitality, relieve fatigue, relieve anxiety and tension, help increase concentration, strengthen relationships, strengthen friendships, trigger creativity, sensitivity, and can strengthen positive character and behavior. Music Angriani 1 et al. Vol. 5, No. 1, April 2023 therapy incorporates a crucial aspect of the interaction between the client and therapist through an evidence-based model (Raglio and Oasi, 2015). Based on the above researchers are interested in studying the effects of classical music on hearing loss in mentally ill patients.

METHODS
This research is quantitative research, using a Quasy Experiment approach. Quasiexperimental research is research that tests an intervention on a group of subjects with or without a comparison group. The research method uses a one group pre-test-post-test design approach, namely by way of initial observation (pretest) before the intervention, then given a post-test after the intervention. The researcher examined the signs and symptoms of auditory hallucinations, then provided music therapy and after that examined the signs and symptoms of auditory hallucinations again. Researchers managed research ethics before collecting data, as for the research ethics code number, which is 187/STIKES-NH/KEPK/XI/2021. Data collection techniques using observation sheets. The date of the research was January 17 to February 18, 2022. The researchers did ethical clearance which number Music therapy used classical music therapy. Data analysis used univariate analysis and bivariate analysis. Univariate analysis using the distribution and frequency characteristics of the subjects. Bivariate analysis using paired t-test, significant if p-value <0,05

RESULTS AND DISCUSSIONS
Based on the results of the study, the subjects were auditory hallucinatory patients at the Dadi Mental Hospital Makassar in getting (Table 1). Based on Table 1 shows that the age of most of the subjectsis less than 40 years as many as 22 (73,3%) subjects. Based on table 1 shows that the education level of the most subjectsis elementary school, namely 17 (56,7%) subjects. Based on Table 1 shows that the marital status of most subjectsis married, namely 18 (60,0%) subjects. Based on table 1 shows that the signs and symptoms of hallucinations before music therapy were carried out were 27 (90,0%) subjects. Based on Table 1 shows that there was a decrease in signs and symptoms of hallucinations after music therapy, namely 27 (90,0%) subjects.

Determine the effect before and after being given classical music therapy
Bivariate analysis aims to determine the effect before and after being given classical music therapy on the reduction of signs and symptoms of auditory hallucinations using the Paired Sample t-test (Table 2). A one-sample Shapiro-Wilk test produced significant values for both groups. Group before music treatment is 0,968 and group after music treatment is 1,068 (data > 0,05). So, we can conclude that the distribution of both data sets is normal. A hypothesis test that is used when it is known that the data distribution is normally distributed is the paired t-test. The result of the statistical test obtained at 0,000 (p-value<0,05) can conclude that there is a difference between the symptoms and signs of auditory hallucinations in patients with hearing impairment before and after classical music therapy or the effectiveness of classical music therapy to reduce it. Signs: Auditory symptoms in patients with auditory hallucinations.
Hallucinations can be treated with drugs and non-drugs. Non-drug therapies use physiological processes so they do not have the side effects of drugs and are safer. One of the effective non-drug treatments is listening to music. Music has the power to cure diseases and improve the mental capacity of people. When music is used as therapy it can improve restore and maintain physical mental emotional social and spiritual health. In modern times music therapy is widely used by psychologists and psychiatrists to treat various types of mental disorders mental disorders or psychological disorders. (Aldridge, 2019). Gold et al. (2021) conducted a study on the effectiveness of music therapy as an adjunct therapy in patients with hallucinations. The results of this study indicate that music therapy given as an adjunct to standard care can help demonstrate the distribution Angriani 1 et al. Vol. 5, No. 1, April 2023 110 of signs and symptoms of auditory hallucinations from 30 subjects prior to music therapy. Results after classical music therapy Signs and symptoms of auditory hallucinations were reduced after classical music therapy. According to Table 5 out of 30 subjectswho experienced auditory hallucinations 27 participants had signs and symptoms of hallucinations and 3 subjectsdid not experience signs and symptoms of auditory hallucinations. This is related to previous research from Candra et al. (2014) (regarding the effect of classical music therapy on changes in symptoms of aggressive behavior in schizophrenic patients with a sample of 15 people. The results of the study of aggressive behavior of patients with auditory hallucinations before being given music therapy were mostly 11 people (73,3%) in the moderate category. The aggressive behavior of schizophrenic patients after being given music therapy was mostly 12 people (80%) in the mild category.
Music therapy is easily received by the auditory organ and sent via the auditory nerve to the limbic system the part of the brain that processes emotions (Aldridge, 2019). In the limbic system of the brain there are neurotransmitters that regulate anxiety stress and some anxiety-related disorders (Purnama et al., 2016). Music can influence imagination intelligence and memory and can influence the pituitary gland in the brain to release endorphins (Rusdi and Isnawati, 2019).
A piece of classical music is generally considered to have a psychoactive effect that is relaxing and calming has a calming effect that stabilizes the heart rate and reduces stress. However, the use of this type of music requires consideration of the developmental age level and cultural background at the time of music performance as well as appropriate motor activities related to love and esthetics. The ideal time to listen to music therapy is 10 to 15 minutes (Mutaqin et al., 2023) Mozarts classical music is classical music that began 250 years ago. Compiled by Wolfgang Amadeus Mozart. Mozarts classical music provides calm increases spatial awareness and allows the patient to connect the mind to the heart. Mozarts classical music has rhythmic and high-frequency melodies that stimulate and strengthen the creative and motivating parts of the brain. Mozarts classical music has a different effect than other composers. Mozarts classical music has the power to liberate and heal (Sulahyuningsih, 2016).
From Table 2 it can be seen that the mean value of the score difference between before and after is 2,360 with a standard deviation of 2,180 and a significance value (p value) of 0,000 (p<0,05). The results of the statistical test before and after the treatment with classical music in patients with auditory hallucinations were obtained and may. The conclusion is that there is a change in the signs and symptoms of auditory hallucinations or that the effectiveness of classical music therapy is declining. Signs and symptoms of auditory hallucinations in patients with auditory hallucinations. This is in line with the results of previous research by Rafina et al. (2014) which stated that the experimental group obtained a significance value (p-value) of 0,00 or p-value <0,05. This means that there is a difference between pretest and posttest and there is a decrease in the average value of pretest and posttest given classical music therapy. From 3 to 2, it can be concluded that there is a decrease in the level of hallucinations in the experimental group that has been given classical music therapy. The test results in the control group that were not given classical music therapy obtained a significance value (p-value) of 0,414 or p-value>0,05. This means that there is no significant difference between the pretest and posttest in the control group.
Jurnal Ilmiah Kesehatan (JIKA) Vol. 5, No. 1, April 2023 Finding that the mean values of the pre-and post-tests in the control group did not change it can be concluded that the level of hallucinations in the control group was not reduced. Differences in posttest hallucination levels between experimental and control groups p-value 0,000 <0,05, which means (posttest) significant differences in hallucination levels after classical music treatment. Between the experimental group and the control group (Rafina et al., 2014). According to this theory classical music therapy is a form of wellness that uses classical music to enhance or enhance the physical emotional cognitive and social conditions of people of different ages. In this study classical music used in therapy is known to improve or enhance physical emotional cognition and social status which would help reduce the signs and symptoms of auditory hallucinations in participants (Ersida et al., 2016). Providing classical music therapy interventions can relax a person create a sense of safety and well-being release feelings of happiness and sadness relieve pain and reduce anxiety by reducing stress levels.

CONCLUSIONS
From this study it can be concluded that there is an effect between classical music therapy in reducing signs and symptoms in patients with auditory hallucinations in Dadi Makassar Mental Hospital. Recommendations for academic institutions to further advance knowledge of non-pharmacological treatment for the treatment of patients with auditory hallucinations so that patients can reduce the signs and symptoms of hallucinations. Nurses at Dadi Makassar Mental Hospital can apply classical music therapy once a week so that patients can reduce the signs and symptoms of hallucinations. It is hoped that this will improve knowledge and skills in treating patients with auditory hallucinations through the implementation and development of pre-existing music therapy. More research is needed to build on the research and investigate other non-drug therapies such as dangdut music therapy or fast beats used to reduce the signs and symptoms of auditory hallucinations. or other non-drug therapies such as play therapy.

ACKNOWLEDGMENTS
Thank you, Ministry of Health Makassar Polytechnic, for making a great contribution. In addition, the researcher turned to the research agency for recognition of the site.