The Influence of Cognitive Therapy on Quality of Life of

People with Diabetes Melitus

Dwi Heppy Rochmawati

Faculty of Nursing, Sultan Agung Islamic University, Semarang, Central Java, Indonesia

Keywords: Cognitive Therapy, Diabetes Mellitus, Quality of Life.

Abstract: People with diabetes mellitus usually experienced disappointment and anxiety about the disease, causing the

quality of life to decline. The purpose of this study is to describe the results of cognitive therapy on the

quality of life of diabetes mellitus clients. Cognitive Therapy is a form of therapy that can train clients to

change negative ways of thinking due to disappointment and failure so that clients can be better and can be

productive again. Cognitive Therapy is carried out in the form of counseling and is oriented towards

changing negative thoughts into positive ones. This research uses quasi experiment with pre and post test

without control group method, it means that data collection is done before and after intervention with

cognitive therapy. Most of the aged 48-51 years (76%), education (44%) were junior high, female gender

was 13 respondents (52%) and duration> 3 years 10 respondents (40%). Quality of life before therapy

average score 103.96 with positive life quality of 17 respondents (68%). Quality of life after therapy

average score of 111.60 with positive life quality of 22 respondents (88%). There is influence of cognitive

therapy on improving quality of life of people with diabetes mellitus (p-value 0.035).

1 BACKGROUND

Diabetes Mellitus (DM) is one of the non-

communicable diseases whose prevalence is

increasing from year to year. DM is often referred to

as the great imitator, because this disease can affect

all the organs of the body and cause various

complaints. Symptoms vary greatly and can arise

slowly, so patients are not aware of any changes.

Results of basic health research (Riskesdas) in

2013 prevalence of diabetes mellitus in Indonesia

based on interview who was diagnosed with a doctor

by 1.5 percent. Diabetes Mellitus is diagnosed by a

doctor or a symptom of 2.1 percent. The highest

prevalence of diabetes diagnosed by doctors is in DI

Yogyakarta (2.6%), DKI Jakarta (2.5%), North

Sulawesi (2.4%) and East Kalimantan (2.3%). The

prevalence of diabetes diagnosed by doctors or

symptoms is highest in Central Sulawesi (3.7%),

North Sulawesi (3.6%), South Sulawesi (3.4%) and

Nusa Tenggara Timur 3.3%.

Diabetes Mellitus as a chronic illness has

psychological effects such as decreased quality of

life. Psychological conditions are negative if not

done because the treatment will aggravate the

condition of the illness and increase the risk of

death, it can be formulated research problem is to

develop Cognitive Therapy (CT) to improve the

quality of life of Diabetes Mellitus clients.

Cognitive Therapy (CT) is basically used to

change a person's thinking about a problem and this

helps people see the problem in a different and

positive perspective. CT is very popular and is

considered one of the best therapies for many mental

disorders such as obsessive compulsive disorder,

OCD, anxiety, phobia, depression, post traumatic

stress disorder, bulimia and schizophrenia. The

results of Gonzales (2010) study on DM patients

who received CT after treatment showed decreased

severity of depression and increased glycemic

control. Research on the effects of CBT on

depression: the role of problem-solving assessment

conducted by Chen, Jordan, and Thompson (2006)

suggests that CBT improves the ability to solve

problems and reduce depression levels.

2 METHODS

This research uses quasi-experiment with pre-test

and post-test one group method. Population and

648

Rochmawati, D.

The Inﬂuence of Cognitive Therapy on Quality of Life of People with Diabetes Melitus.

DOI: 10.5220/0008330306480652

In Proceedings of the 9th International Nursing Conference (INC 2018), pages 648-652

ISBN: 978-989-758-336-0

samples in this study were all patients with Diabetes

Mellitus which amounted to 54 people. Sampling

using total sampling method. Data collection using

questionnaires and giving intervention in the form of

cognitive therapy, which is a therapy to change the

negative auto mind into positive. The analysis using

a test dependent sample t-test

3 RESULTS

3.1 Respondents’ Characteristics

Based on Table 1, the largest age of respondents in

this study was age 48-51 years, amounting to 29

respondents (53.7%). While at least 40-43 years age

amounted to 10 respondents (18.5%). The most

respondents’ education in this study was graduated

from junior high school as many as 21 respondents

(38.9%) and not school or drop out as much as 6

respondents (11.1%). The most sex group is women

that is 34 respondents (63%). Meanwhile, the male

gender was 20 respondents (37%). Regarding the

duration of the disease, the most respondents

suffered more than 3 years of illness as many as 32

respondents (59.3%) and at least 1 to 2 years of

illness as many as 10 respondents (18.5%).

3.2 Univariate Analysis

3.2.1 Quality of Life

Table 2 shows that respondents who have positive

life quality are 29 respondents (53.7%) and negative

life quality of 25 respondents (46.3%). The table

also shows that respondents who have a positive

quality of life as much as 43 respondents (79.6%)

and negative life quality of 11 respondents (20.4%).

Based on Table 3, it can be concluded that

quality of life pre intervention average score is

103.96 with standard deviation 15.001. The lowest

score was 76 and the highest score was 134. With

95% confidence level, the mean pre life quality

score of pre intervention was between 97.77 and

110.15. While the concept of self-post intervention

average score was 111.60 with a standard deviation

of 12.196. The lowest score was 80 and the highest

score was 132. With a 95% confidence level, the

mean post intervention quality score was 106.57-

116.63.

3.3 Bivariate Analysis

Bivariate analysis will describe whether there is a

difference in quality of life before and after therapy

using a test dependent sample t-test. This bivariate

analysis is performed to prove the hypothesis that

has been formulated.

Table 1: Demographic Characteristics (n = 54).

Characteristic

Category

Frequency

Percentage

(%)

Pre-Test

Positive

53.7

Negative

46.3

Post-Test

Positive

79.6

Negative

20.4

The Inﬂuence of Cognitive Therapy on Quality of Life of People with Diabetes Melitus

649

From the results of the analysis using dependent

sample t-test showed that the average score of

quality of life before following the therapy was

103.96 and after following the therapy of 111.60

with a difference of -7.64 means that there is an

increase in quality of life after following therapy

with an average increase of 7.64. The result of

calculating the value of “t” is 2.231 with p-value

0.035 (2-way test) smaller than alpha (0.05) meaning

that there is statistically significant difference

between mean of quality of life score before and

after therapy (Table 4).

4 DISCUSSION

4.1 Age

The results showed that the largest age of

respondents in this study was age 48-51 years,

amounting to 29 respondents (53.7%). While at least

40-43 years age amounted to 10 respondents

(18.5%). Life expectancy from year to year has

increased, in 2010 life expectancy is 67.4 years and

2020 is estimated to be 70.2 years. Based on the

existing results that the increasing age has nothing to

do with quality of life. Negative quality of life that

existed in the respondents due to several factors that

did not participate researched in this study.

4.2 Education

The result of the research shows that most of

respondent's education in this study is graduated

from junior high school as much 21 respondents

(38.9%) and no school / drop out as much as 6

respondents (11.1%). The highest education of

diabetes mellitus is graduated from junior high

school. Patients with diabetes mellitus who

graduated from junior high school experience

confusion in assessing the ability that is in him

because of the limited knowledge received so that

the effect on taking action in the face of illness and

quality of life is also influenced by the ability of his

judgment.

4.3 Sex

The results showed that the largest proportion of

respondents were women. This is in line with the

prevalence that women are twice as likely to have

diabetes mellitus. While the sex does not have a

significant relationship to the quality of life.

4.4 Duration of Illness

The results showed that most respondents suffered

more than 3 years of pain as many as 32 respondents

(59.3%) and at least 1 to 2 years of illness as many

as 10 respondents (18.5%). Long suffering pain

affects the ability of self in determining attitude

when facing suffering (Bastaman, 2007). A positive

quality of life is formed in the sufferer with the

longest illness through self-view and positive

experience. Thus, respondents can define attitudes

and change the idea that there is a wisdom behind

suffering.

4.5 Quality of Life

The results can be seen that most people with

diabetes mellitus have a positive quality of life.

Data obtained from 54 respondents, on the

measurement before the cognitive therapy

intervention, the result of positive quality of life was

29 respondents (53.7%) and the measurement after

the cognitive therapy intervention was found the

result of the positive life quality was 43 respondents

(79.6%).

Table 3: Results of quality analysis of pre life and post intervention (n = 54).

Variable

Mean

Median

Min-Max

95 % CI

Quality

of Life

103.96

105.00

15.001

76 – 134

97.77 – 110.15

Quality

of Life

111.60

111.00

12.196

80 – 132

106.57 – 116.63

Table 4: Average quality score distribution before and after following therapy.

Variable

Mean

p-value

Quality of Life

Pre Intervention

103.96

15.001

0.035

Quality of Life

Post Intervention

111.60

12.193

INC 2018 - The 9th International Nursing Conference: Nurses at The Forefront Transforming Care, Science and Research

650

Respondents who have a positive quality of life

can master new experiences and previous

experiences. Past experiences can affect a person's

quality of life. New experiences are gained when

individuals interact with their new surroundings

(Perry & Potter, 2009 and Alimul, 2006). Quality of

life is formed because there is a feeling of being

able to do something, personal and interpersonal

relationships, personal characteristics that affect

self-expectations and a stable self-realization can

lead to the purpose of adult development (Perry &

Potter, 2009).

4.6 Effect of Cognitive Therapy on the

Quality of Life of Diabetes Mellitus

Based on the results of the study, the analysis using

the dependent sample test showed that the average

self-concept score before following the therapy was

103.96 and after following the therapy of 111.60

with a difference of -7.64 means that there is

improvement of quality of life after following

therapy with average increase of 7.64. The result of

calculating the value of "t" is 2.231 with p-value

0.035 (2-way test) smaller than alpha (0.05)

meaning that there is statistically significant

difference between mean of quality of life score

before and after therapy.

According to the above calculation results,

statistically giving intervention has an effect on

quality of life. There is improved quality of life

before and after therapy. Quality of positive life

indicates the existence of self-acceptance where

individuals with a positive quality of life know

themselves well. Individuals who have a positive

quality of life can understand and accept a number

of facts about him so that the evaluation of yourself

to be positive and can accept themselves as they are.

Individuals who have a positive quality of life will

design goals that are in accordance with reality, that

is, goals that are likely to be achieved, able to face

the future life and assume that life is a process of

discovery.

5 CONCLUSIONS

This study concludes that cognitive therapy has

effect to the quality of life of people with diabetes

mellitus.

Regarding the recommendation, professional

nurse who has a particular scientific specialization

should be able to apply the knowledge and ability to

utilize the knowledge held in order to support the

successful development of the profession. The

giving of soul-nursing specialist therapies to be

more activated both in the area of healthy mental

nursing, nursing risk of mental problems and mental

nursing care area. The results of this study can be

used as basic data for researchers and further

research. For further research can develop some

methods and types of research on cognitive therapy

with different areas and respondents. For

educational institutions to provide more

opportunities to researchers in order to develop

science. Families and communities should be aware

that their role in assisting and caring for clients is

necessary. Continuous psychic and moral support

greatly determines the client's health and compliance

in medication and diet.

ACKNOWLEDGEMENTS

Rector of Sultan Agung Islamic University of

Semarang. Research Institute and Community

Service Islamic University of Sultan Agung

Semarang. Dean of the Faculty of Nursing

Universitas Islam Sultan Agung Semarang. All

Fellow Lecturers and Employees in S1 Nursing

Study Program Faculty of Nursing University of

Islamic University of Sultan Agung Semarang. The

whole family is especially parents, husband and

beloved children, who have provided motivation and

support throughout the process. All respondents,

families of respondents and related parties in taking

this research data. All parties involved in the

preparation of this research proposal, which cannot

authors mention one by one.

REFERENCES

Agustiani, D. H. (2009). Psikologi Perkembangan.

Bandung: Refika Aditama.

Badan Pusat Statistik. (2010). Profil Kriminalitas

Remaja.http://www.bps.go.id/hasil_publikasi/flip_201

1/4401003/files/search/searchtext.xml. dperoleh 14

Januari 2013.

Bastaman, H. D. (2007). Logoterapi : Psikologi untuk

Menemukan Makna Hidup dan Meraih Hidup

Bermakna. Jakarta: PT. Grafindo Persada.

Dahlan, M. S. (2011). Statistik untuk Kedokteran dan

Kesehatan : Deskriptif, Bivariat, dan Multivariat

dilengkapi Aplikasi dengan Menggunakan SPSS.

Jakarta: Salemba Medika.

Frankl, V. E. (1963). Man's Search for Meaning: An

Introduction to Logotherapy. New York: Washington

The Inﬂuence of Cognitive Therapy on Quality of Life of People with Diabetes Melitus

651

Square Press. (Earlier title, 1959: From Death-Camp

to Existentialism. Originally published in 1946 as Ein

Psycholog erlebt das Konzentrationslager), diperoleh

tanggal 8 Februari 2013.

Kartono, D. K. (2011). Patologi Sosial 2 : Kenakalan

Remaja. Jakarta: PT. Raja Grafindo Persada.

Keliat, B.A., & Yosep. (2010). Keperawatan Jiwa.

Bandung: Refika Aditama.

Kemenkes RI. (2010). Pedoman Umum Perlindungan

Kesehatan Anak Berkebutuhan Khusus.

http://kemenkes.go.id/2010/Pedoman-Umum-

Perlindungan-Kesehatan-Anak-Berkebutuhan-

Khusus/. Diperoleh 19 Januari 2013.

Mazaya, K.N. & Supradewi, R. (2011). Konsep Diri dan

Kebermaknaan Hidup Pada Remaja di Panti Asuhan.

Proyeksi, Vol. 6, 103-112

Ndoen, L.F. (2010). Jurnal Pengungkapan Pada Mantan

Narapidana. Fakultas Psikologi Universitas

Gunadarma.

Nisfulaili, Y. (2010). Hubungan Antara Konsep Diri dan

Kebermaknaan Hidup Kaum Waria di IWAMA (Ikatan

Waria Malang). http://lib.uin-

malang.ac.id/thesis/fullchapter/05410021-yulia-

nisfulaili.ps. Diperoleh 12 Februari 2013.

Sitohang, N. W. (2009). Makna Hidup Pada Remaja Putri

Pengguna NAPZA di Lembaga Pemasyarakatan II A

Palembang. Palembang : Fakultas Psikologi

Universitas Gunadarma

Tridhonanto, A. &. (2010). Meraih Sukses dengan

Kecerdasan Emosional. Jakarta: Elex Media

Komputindo.

Wong, D. L., & et.all. (2009). Buku Ajar Keperawatan

Pediatrik edisi 6 volume 1. Jakarta: EGC Penerbit

Buku Kedokteran.

Widianita, P. L., Mikarsa, L. H. & Hartiani, F. (2009).

Gambaran Makna Hidup Remaja Penderita Leukimia.

Indonesian Journal of Cancer. Jakarta : Fakultas

Psikologi Universitas Indonesia

Yulianti, S. A., & Widiasih, R. (2009). Gambaran

Orientasi Masa Depan Narapidana Remaja Sebelum

dan Setelah Pelatihan di Rumah Tahanan Negara

Kelas I Bandung. Volume 10, Nomor XXI, halaman

103. Diunduh 19 November 2012.

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