Application of Benson's Relaxation Therapy to Reducing Anxiety in Patients Hypertension: Case Study

Abstract


INTRODUCTION
The modern lifestyle that is currently embraced by humans tends to make humans like instant things. As a result, they tend to be lazy to do physical activities and like to eat instant food, which has a high sodium content. In addition, the modern style often makes people depressed with all their daily routines so it can cause stress, smoking habits, and excessive consumption of alcohol and caffeine. Unknowingly by humans, these things can trigger various diseases, including hypertension (Ratna & Aswad, 2019). Hypertension is a condition where blood pressure increases abnormally with systolic blood pressure greater than or equal to 140 mmHg while diastolic blood pressure equal to or greater than 90 mmHg and occurs continuously which is caused by one factor or several risk factors that do not work as well in maintaining normal blood pressure (Atmojo, J., Putra, M., Astriani, N. M., Dewi, P., & Bintoro, 2019).
Data shows that hypertension sufferers on the African continent are 5.2% and this prevalence is higher in urban areas, namely 53.3% -62%, while in rural areas it is 43.8% -52.3% (Kaze et al., 2017). Aged 45-75 years in the United States and China are at high risk of experiencing hypertension and the prevalence is increasing every year from 87.0 million in 1999-2000 to 108.2 million in 2015-2016 (Dorans et al., 2018). If currently, the population in Indonesia is around 252,124,458 people, then those who suffer from hypertension are 65,048,110 people. Conditions like this cause anxiety in people with hypertension (Atmojo, J., Putra, M., Astriani, N. M., Dewi, P., & Bintoro, 2019).
Chronic disease can have a health impact on the elderly in terms of mental health, namely anxiety (Setyawan, 2017). Anxiety experienced by people with hypertension will cause an increase in blood pressure, affect concentration and alertness, damage the function of the immune system and increase the risks of other health declines (Nurarif A & Kusuma H, 2015). Anxiety or anxiety is a feeling of worry and fear caused by anticipation of danger or a feeling of discomfort but still vague followed by an autonomous response (often the source is not specific or unknown to the patient) (Benson, Herbert and Klipper, 2000). When a person experiences anxiety, the body's nervous system will automatically work, especially the sympathetic nerves in response to stressful stimuli. Sympathetic nerves will work and activate the adrenal medulla in increasing the release of epinephrine, norepinephrine, cortisol and reducing nitric oxide. This will make changes to several body responses such as increased heart rate, respiration, blood pressure, increased blood flow to various organs and increased body metabolism. To suppress this, the sympathetic nerves must be inhibited by increasing the activation of the parasympathetic nerves so that they will cause feelings or relaxation responses. Therefore, anxiety in patients must get treated so that it does not worsen the patient's health condition.
Anxiety problems experienced by patients can be handled by pharmacological and nonpharmacological methods. To avoid the dangers of chemical drugs and increase the burden of costs for patients, non-pharmacological techniques can be used to deal with anxiety in patients such as the Benson relaxation technique (Kiani et al., 2017;Mahdavi et al., 2013;Poorolajal et al., 2017). Benson relaxation is a method developed by involving the patient's faith factor (with the patient focusing on certain expressions in the form of God's names, or words that have a soothing meaning for the patient himself) which is repeated regularly accompanied by an attitude of submission. thus, helping patients achieve higher states of health and well-being (Emilia & Beba, 2021;Herbert & William, 2010;. Benson relaxation will make a person relax. Many studies have revealed relaxation techniques that can be used to reduce anxiety, however, some of these techniques require money, training, and a lot of time and there is no key point to concentrate on (Mitchell M.D, 2013;Octavio et al., 2015;Rosemary & Marie, 2010). Meanwhile, Benson relaxation is cheaper, simpler, and safer to do with a relatively short duration of 10-20 minutes, and another advantage is the presence of a passive attitude and keywords that will accelerate the patient to reach the peak of relaxation (Emilia, Neng, et al., 2022;Kiani et al., 2017;Mahdavi et al., 2013;Rosemary & Marie, 2010;Troidle et al., 2003) so that it does not take up the time of the nurse to provide other nursing care. Based on the description above, the researcher is interested in conducting a case study by implementing benson relaxation therapy to reduce anxiety in hypertensive patients in Omu Village, Gumbasa District.

RESEARCH METHODOLOGY
Researchers used a descriptive case study design. A descriptive case study is a case study that is included to systematically and accurately describe a situation or area of a particular population that is actual. This case study is also to photograph certain individual phenomena regarding the problems that occur. The observed cases were limited by time and activity. The client criteria in this case study are clients who experience mild to moderate anxiety, clients who are >18 years old, and clients who do not experience concentration problems and are taking sedatives. This case study was conducted for 7 days with 1 therapy per day.

RESULTS AND DISCUSSION
This case study began with an assessment of a client who was 84 years old. Assessment is the initial stage of the nursing process by collecting data systematically to determine the client's health status. The assessment must be carried out comprehensively starting from biological, psychological, social and spiritual aspects of the client. Nursing assessment is not the same as medical assessment. The medical assessment is focused on pathological conditions, while the nursing assessment is aimed at the client's response to health problems related to meeting basic human needs (Wahyuni & Kep, 2015).
The data obtained from the results of the assessment on the client, namely the client says he feels anxious about his illness, often feel dizzy, often wakes up at night, the client also looks restless, tense and the results of vital signs: blood pressure 160/80 mmHg, temperature 36.1OC, pulse 81 x/minute and respiration 20 x/minute. For the results of the Hamilton anxiety assessment questionnaire, the rating scale for anxiety (HARS) is 24 (moderate anxiety). So that from the data obtained, the right nursing diagnoses to deal with client problems are based on the diagnoses from the PPNI SDKI (Tim Pokja SDKI DPP PPNI, 2017) (Tim Pokja SDKI DPP PPNI, 2017) (Tim Pokja SDKI DPP PPNI, 2017) (Tim Pokja SDKI DPP PPNI, 2017) is anxiety related to changes in health status, namely hypertension.
Anxiety is defined as an emotional response to a perceived threat with distressing symptoms, ongoing apprehension, worry, feelings of tension and an inability to relax (Nurarif A & Kusuma H, 2015). Anxiety experienced by people with hypertension which is a chronic disease can experience increased heart rate, breathing, blood pressure, increased blood flow to various organs and increased body metabolism (Setyawan, 2017).
Theoretically, planning is prepared based on the problems found in the client and priority problems that are life-threatening and require immediate treatment. The goals set are more general but in real practice, the goals of treatment are modified according to the client's condition. The goals set have a time limit and can be achieved, according to the patient's abilities (Simanjuntak, 2020).
In this case study the focus of the intervention provided was Benson relaxation therapy which was carried out every day for 7 days. Benson relaxation is a relaxation technique related to one's beliefs and will make the body more relaxed and calm as well can help improve health and well-being (Emilia & Beba, 2021;Herbert & William, 2010;). Benson's relaxation aims to train patients to be able to condition themselves to achieve a relaxed state, reduce anxiety, and anger, reduce muscle and bone tension, cardiac dysrhythmias, hypertension, insomnia, and pain, and reduce tension related to body physiology Day, 2000) During the administration of this therapy, the client is guided and supervised by the researcher, which is followed by an evaluation at each administration using the interview method and asking about the client's feelings after being given therapy. At first, it was difficult for the client to reach the relaxed stage as seen from the tense attitude and the client said he was still unable to concentrate but in the following days, the client was able to concentrate and said he felt more comfortable, relaxed and even wanted to sleep.
As the final stage of this case study process, an evaluation was carried out with the results of blood pressure which was initially 160/80mmHg to 140/90 mmHg, and the anxiety value (HARS examination) from 24 (moderate anxiety) to 16 (mild anxiety) which means there is a decrease the level of anxiety experienced by the client even a decrease in blood pressure on the client. And several studies also say that this Benson therapy not only reduces anxiety but can also reduce hypertension, pain after surgery, stress, and sleep disturbances (Baleegh et al., 2019;Emilia, Neng, et al., 2022;Juwariyah & Suciwati, 2019;Purwasih et al., 2017;Simandalahi et al., 2019). This case study has not been maximally carried out, one of the causes is the duration of administration, which is only 7 days, whereas according to several studies, the duration of administration of Benson relaxation therapy to reduce anxiety is carried out starting from 2 times a day morning and evening for 15-20 minutes for 4 weeks (1 month) (Gorji et al., 2014;Kiani et al., 2017;Mahdavi et al., 2013).

CONCLUSION
The application of Benson's relaxation therapy in this case study can reduce the anxiety level of clients who were originally anxious to become mild anxiety and not only decreased anxiety but also hypertension in patients. This proves that Benson therapy can be used in the application of nursing care to health workers as an alternative in treating patients who experience anxiety but still pay attention to the duration of administration, because the recovery process from anxiety in a person requires intensity and longer time, especially in the application of therapy. Benson relaxation. Future researchers are expected to be able to apply this therapy for more than 7 days or according to previous research so as to get maximum results and for health workers to make this Benson relaxation therapy intervention in providing nursing care.