Cognitive-behavioral Group Therapy to Reduce Anxiety in High

School Students Who Have Family Problems

Yudi Kurniawan

and Indahria Sulistyarini

Department of Psychology, Faculty of Psychology, Semarang University

Department of Psychology, Faculty of Psychology and Socio Culture Science, Islamic University of Indonesia

Keywords: Anxiety, Cognitive-Behavioral Group Therapy, Family Problem

Abstract: This study aims to examine the effectiveness of cognitive behavior group therapy for reducing anxiety in

high school students who experience anxiety due to family problems. Researchers want to change the

irrational belief of adolescents toward themselves and their families and teach effective coping techniques

of problems. This research is important because high school students are in the development phase of the

role of identity. If it fails to fulfill the task of development in this phase, then the individual will be confused

with his identity. Hypothesis in this research is there is difference of high school student anxiety level in

experiment group and control group after given cognitive-behavioral group therapy. Subjects in this study

were 16 high school students grade X and XI male and female female aged 15-16 years and have family

problems. Subjects were divided into experimental and control groups. The measurement tool used is Beck

Anxiety Inventory Research using quasi experiment with non-randomized pretest-posttest control group

design. Data were analyzed using independent sample t-test. The results showed that there was difference of

high school students' anxiety level in experimental group and control group after given cognitive-behavioral

group therapy with p = 0,001 (p <0,05). In conclusion, cognitive-behavioral group therapy is effective to

reduce anxiety in high school students who have family problems.

1 INTRODUCTION

Vocational High School X is one of the leading

secondary schools in Yogyakarta. The school has

several expertise programs offered to students,

including light vehicle engineering, catering

services, and computer and network engineering. In

addition to the expertise program, SMK X also

offers a variety of extracurricular activities and

counseling guidance to students. That is, this school

not only provides cognitive skills to students, but

also social skills and emotional management.

Emotional management skills are very important

because students are in the age range of 15-17 years,

meaning that they are in the teenage phase.

Psychologically, adolescence is the phase in which

individuals seek identity. If you fail to fulfill the

developmental tasks in this phase, then the

individual will be confused with his identity.

According to one of the career guidance and

counseling (BK) teachers, the behavioral and

emotional problems faced by students are very

diverse. There are students who come with problems

with the opposite sex (dating), problems with

classmates, problems with students who are often

sick and permission not to go to class, to the

problem of using addictive substances such as

cigarettes and liquor. BK teachers who numbered

three people were not enough to accommodate the

psychological needs of all students totaling around

800 people.

Based on observations by BK teachers, more

than 95 percent of students who came or were asked

for counseling came from families who had

problems. There are students who are not cared for

by parents, there are students who get violence from

parents, students who have parents but are ignored,

and various other family problems. That is, problems

that come from within the family and have not yet

been resolved can trigger negative emotions for

students. When facing an environment outside his

home, students are easily triggered by negative

emotions and become a source of problems in

interpersonal relationships.

The school together with Puskesmas X once

collaborated to prevent problems with student

Kurniawan, Y. and Sulistyarini, I.

Cognitive-behavioral Group Therapy to Reduce Anxiety in High School Students Who Have Family Problems.

DOI: 10.5220/0008585500720081

In Proceedings of the 3rd International Conference on Psychology in Health, Educational, Social, and Organizational Settings (ICP-HESOS 2018) - Improving Mental Health and Harmony in

Global Community, pages 72-81

ISBN: 978-989-758-435-0

behavior with peer cadre programs. However, the

program's follow-up has not been optimal because it

is constrained by the priority of the puskesmas and

the replacement of psychologists. The program is

expected to detect seeds of behavioral problems that

arise in school. In addition to peer cadre programs,

puskesmas also often hold student screenings that

cover reproductive and mental health material. The

screening results are used as an early detection tool

for students who experience physical or mental

problems. If there are students who experience

problems, the BK teacher will refer to the doctor or

psychologist at the community health center.

One risk factor that results in an individual's

psychological vulnerability is a problem in the main

support group, or in this case a family problem

(Meisels and Shonkoff, 2000). There are causes of

multifactors that are a source of problems in

families. Some common situations are conflicts

between parents, parenting problems, conflicts

between children, and financial problems.

Individuals who have family problems tend to have

poor emotional control and face excessive stress,

even in situations that are normal when compared to

individuals from harmonious families. This risk is

greater in adolescence because, at this age, the

majority of individuals experience what G. Stanley

Hall calls storm and stress (Sarwono, 2011).

Adolescent age is the transitional phase between the

role as a child and the role of an adult, so that

teenagers are often confused with their social roles

and identities. When the nuclear family has a

problem, the teenager loses the role model that can

be used as a reference for ideal behavior.

One class X student named NS experienced

boredom in learning. NS also often feels dizzy,

difficult to concentrate, and has trouble sleeping for

some time. After conducting focus group discussions

(DKT), it turns out that the root of the problem is the

infidelity committed by the father, so that the

atmosphere at home becomes not conducive.

Father's behavior makes mothers lose emotional

control and often vent to their children. These events

make NS lose enthusiasm for learning and doing

activities in school. Whereas NS is a child of

achievement, as evidenced by obtaining the best

qori'ah award at the SMK level Musabaqah Tilawatil

level. Conflicts between parents make NS worry

about many things about his life. NS feels that there

are no more people who love him and worry about

his future after graduating from high school. NS also

often postpones doing work because it feels

uncomfortable when at home.

Another case happened to class X students with

the initials BR. He has insomnia, is easily nervous

when having to communicate with other people, and

often experiences headaches. After the assessment,

BR turned out to be in conflict with his mother and

sister. They often scold and demand that the BR

work independently, even though BR is still in

school. The condition of my father who was sickly

made their family's condition change. My mother

became angrier and often hit BR if she did not want

to find additional income by becoming a mechanic

in the garage. BR feels uncomfortable at home. He

also thought that there were no more people who

loved him. BR is also worried about the continuation

of education.

In the two examples of these cases, the

researchers observed that conflict in the family

triggered negative emotions and cognitive distortion

of the family. Teenagers with problem families need

help from professionals to recognize the emotions,

thoughts, and behaviors they do. Once the mind and

emotional barriers can be resolved, they can be

directed to develop potential. Otherwise, this

teenager's behavior will only lead to delinquency

(juvenile delinquency). The situation in the family

that is not conducive is the biggest risk factor that

causes juvenile delinquency (Santrock, 2014).

Parents become less skilled at coping with their

children's antisocial behavior. One reason is because

these parents have lost respect from their teenage

children.

Based on these data, researchers want to gather

several students with the same root problem (family

problems) in a group therapy session with the

Cognitive-Behavior approach. This therapy aims to

change false beliefs (distortion) in students and teach

new skills as a pattern of adaptive problem solving.

They can also share stories and provide

psychological support to reduce anxiety.

Anxiety is a state of mood (mood) which is

characterized by physical symptoms such as tension

and concern about something / condition that has not

happened (Durand and Barlow, 2012). In

individuals, manifestations of anxiety arise in the

form of subjective anxiety, feeling anxious for no

apparent reason, or in the form of physiological

responses that manifest in the form of discomfort in

certain organs.

Anxiety is a condition that results when a

transaction between an individual and the

environment causes the individual to feel a

discrepancy both real and not between the demands

of the situation and the sources of the biological,

psychological, and social systems in him. Anxiety is

Cognitive-behavioral Group Therapy to Reduce Anxiety in High School Students Who Have Family Problems

a disturbance of the mind and body in responding to

demands (Greene, Nevid and Rathus, 2005).

Early manifestations of anxiety are divided into

physiological and psychological symptoms.

Physiological symptoms include a heart that often

beats faster, the body feels hotter or colder, the body

muscles feel tense, cold sweat appears, headaches,

disturbed sleep, increased blood pressure, and

nausea. While psychological symptoms appear in the

form of feelings of excessive worry, feelings of

discomfort during activities, decreased life

satisfaction, decreased productivity in the school or

work environment, and negative emotions more

easily ignited (Durand and Barlow, 2012).

The World Health Organization (WHO) shows

that anxiety has a 10.1 percent prevalence of clinical

patients worldwide (Demyttenaere et al., 2004). This

prevalence includes general anxiety and anxiety that

leads to neurotic disorders. Anxiety disorders are

caused by distortion of thoughts about events that

have occurred, so that individuals have false beliefs

about situations that have not occurred. In mild

anxiety, manifestations of disorders are usually in

the form of physiological changes such as increased

heart rate or cold sweat in the not too distant future.

But in anxiety it is neurotic, manifestations of

disorder appear in the form of serious obstacles to

adapt to the functions of daily life, both in family,

work / education, and social environment (van

Boeijen et al., 2005).

There is a positive correlation between learning

procrastination and anxiety in 141 students at one

university in the United States (Lucchetti, Phipps

and Behnke, 2003). The anxiety experienced by the

subjects in the study came from family problems, so

they had difficulty concentrating while at university.

This situation makes the subject unable to complete

the lecture task within the allotted time. One

technique commonly used to eliminate or reduce

anxiety is with Cognitive-Behavior Therapy.

Cognitive Behavior Therapy is a therapeutic

approach that modifies the thoughts, assumptions,

and attitudes that exist in individuals (Spiegler,

2015). The therapeutic process can also be done in

groups and is called Cognitive Behavior Group

Therapy (Yalom and Leszcz, 2005). Cognitive

behavioral therapy basically believes that human

thought is formed through a process of stimulus,

cognitive, and respos, interrelated and forms a kind

of tissue in the human brain. Cognitive processes

will be a determining factor in explaining how

humans think, feel and act. Meichenbaum (Rutter et

al., 2018) developed this with self-instructional

training techniques, which are used to train

individuals to effectively adapt and solve problems

in difficult situations.

Cognitive behavior therapy is effective for

reducing overall anxiety symptoms in elderly people

who are handled by public health centers. The

elderly get education about the ability to manage

sleep and the ability to manage problems (Stanley et

al., 2009). Other studies in several cases of

adolescents show that cognitive behavior group

therapy is effective in the long term effective to

reduce anxiety problems related to peers (Davis et

al., 2014). Other studies in adults aged 25-35 years

showed that cognitive behavior group therapy was

effective in reducing social anxiety disorders and

was able to reduce negative thoughts arising from

the disorder (Hedman et al., 2011).

Teenagers are defined as the stages of age

between children and adults. This understanding is

too floating because a person's maturity is more

determined by psychological factors than age.

Therefore, the age limit for this transition period is

also somewhat vague. Most experts think that

adolescence is in the range of 12 to 20 years. There

are at least three important things that mark the

transition from children to adults. That is physical

change, search and consolidation of self-identity, as

well as preparation for the task and responsibility as

an independent human being (Mehroof and Griffiths,

2010).

When analyzed from the cognitive side,

adolescence has entered the stage of formal

operational thinking (Santrock, 2014). Teenagers are

no longer limited to actual concrete experience as a

rationale. Teenagers can begin to generate abstract

situations in their minds. In addition to abstract, teen

thoughts also begin to lead to idealism. Teenagers

start thinking about ideal characteristics for

themselves and others. In adolescence, thinking is

often a fantasy that leads to the future. Teenagers

usually become impatient with the ideal standards

that many adults make.

While socially emotional, adolescence is a phase

in which decision making increases (Santrock,

2014). Many teenagers make decisions about the

future, about the choice of majors in universities,

with whom they are friends, to what kind of social

relations they will live. How accurate this decision is

depending on the process carried out by adolescents

with adults around them, especially parents.

Therefore, problems in the family negatively affect

the decisions made by teenagers.

These processes make adolescents who enter the

transition from child to adult experience behavioral

turbulence. According to the Great Indonesian

ICP-HESOS 2018 - International Conference on Psychology in Health, Educational, Social, and Organizational Settings

Language Dictionary (Setiawan, 2012), turbulence

is an irregular turbulent motion that is characteristic

of fluid (water and gas). Adolescence is analogous to

a phase filled with upheaval and consideration.

There is a term related to the concept of adolescence

which is called awareness restructuring. The term is

explained by Czikszentimihalyi and Larson

(Sarwono, 2011). Awareness restructuring is based

on a review of many experts who describe

adolescence as a time of improvement from

subsequent developments. Czikszentimihalyi &

Larson explained that the peak of mental

development is characterized by a process of change

from entropy to negentropy.

The term entropy is actually borrowed from the

concept of physics, namely the state in which there

is no particular system from an energy source so that

the source loses its energy. In the context of

psychology, entropy means a state of consciousness

that is still contradictory and mutually unrelated,

thereby reducing its work capacity. The result is

giving rise to experiences that are less pleasant for

people who experience. In layman's language,

entropy is seen as a period of searching for identity.

Often conflicts between ideas and thoughts with

adults occur at this stage.

Adolescence is a period when conflict with

parents increases beyond the level of conflict in

childhood. This situation will get worse if there are

conflicts within the family, such as infidelity,

parental violence against children, or other family

problems. This happens because adolescents are the

transition phase from childhood to adolescence, so

they always look for identities and compare the

character of parents and family situations with ideal

norms in society. If adolescents see a gap between

the ideal norm in society and the family situation,

they tend to develop feelings of anxiety and worry

about many things. For example about the future of

their education, about feeling owned and loved, or

about how their family will be. Therefore, teenagers

who have family problems need to get cognitive

restructuring and knowledge of new behaviors they

can do.

2 RESEARCH METHOD

This study uses quasi-experimental design with

nonrandomized pretest posttest control group design.

This design is used to measure the effectiveness of

an intervention by providing a measuring instrument

before and after being given an intervention

(Newcomer, Hatry and Wholey, 2015). This design

was chosen by researchers because of the limited

number of participants and researchers wanted to

compare the value of the dependent variable

between before and after the intervention was given.

The therapy participants who were recommended

by the BK teacher were initially sixteen students.

Four students had already received counseling with

BK teachers, with recurring pain problems, difficult

concentration, and learning motivation. Meanwhile

twelve students have never been counseled, but have

obstacles in learning motivation and work

assignments.

The researcher then made a questionnaire with

open questions with the aim of revealing the real

problems experienced by students. The

questionnaire consists of three items that contain

questions about family problems experienced by

students, the scale of feelings related to the problem,

and what has been done to solve the problem.

Based on the results of the questionnaire,

researchers carried out a preliminary Focus Group

DIscussion (FGD) to understand what problems

actually experienced by students. The table below is

the result of initial screening of problems

experienced by students. FGD participants were

sixteen students who had family problems. The FGD

was divided into two groups with each group

consisting of eight people. FGD facilitators are two

psychologists who are experienced in dealing with

problematic teen cases. The range of questions

submitted in the FGD is related to the experience of

each participant in the family and the problems they

experience with one family member.

Cognitive-behavioral Group Therapy to Reduce Anxiety in High School Students Who Have Family Problems

The researcher then gave Beck Anxiety

Inteventory (BAI) to find out the level of anxiety

experienced by students as well as pre-test before a

cognitive behavior-based group therapy session was

conducted. BAI validity 0,61 compared with

Hamilton Anxiety Scale. BAI reliability ranging

from 0,90 to 0,94 and has been tested for large

sample psychiatric patients, university students, and

community dwelling adults (Julian, 2011).

Table 2: Student Pratest Score

Name Age/Class BAI Score SUD

Score

NS 17/X 38 (high) 8

BG 18/XII 20

(

medium

)

EF 16/XII 24 (medium) 6

PP 16/XI 18

(

medium

)

BR 17/XI 28 (high) 7

UB 16/XI 16

(

medium

)

NA 17/XI 28 (high) 6

IA 15/X 25

(

)

AF 16/X 25 (high) 5

IP 15/X 25

(

)

AG 15/X 25 (high) 6

SY 15/X 24

(

)

FT 15/X 25 (high) 7

RN 15/X 25

(

)

ZN 15/X 25 (high) 7

BD 15/X 25

(

)

The sixteen students were divided into the control

group and the experimental group.

3 RESULTS

Based on the results of different test statistical

analysis using independent sample t-test (pre and

post test scale difference test in two independent

groups) showed there were differences in anxiety

levels before and after the intervention in the control

and experimental groups, t = 7.746 (statistical

analysis in attachment), and significance p = 0,000

(p <0.01, meaning very significant). The mean value

before giving intervention was 24.57 (medium

category), while the mean value after

psychoeducation was 6.14 (low category).

4 DISCUSSION

Cognitive Behavior Group therapy is an intervention

carried out by including several people in a small

group who are accompanied by one or more

therapists who are trained in the group therapy

process (Brabender, Smolar and Fallon, 2004). This

therapeutic design can improve psychological

abilities and improve psychological problems by

means of cognitive and affective approaches that are

explored from interactions between group members

and therapists (Brabender, Smolar and Fallon, 2004).

The researcher began the intervention session by

offering participants to convey the problem. Initially

there were no participants who volunteered. Then

Table 1: Data of Student Problem

Name

Age/Class Problem SUD

Score

NS 17/X Family problems between father and mother (do not want to convey in detail) 8

BG 18/XII Family is not harmonious, conflict between father and mother Not sure about his

future

EF 16/XII Single parent mother, choosing love with your mother's sister hates he

PP 16/XI Parents are too restrained, the conflict between father and mother Feel worse than

frien

BR 17/XI Mother and sibling attacked physically and verbally, father passively believed he

would fail

UB 16/XI Mother is too restrained Not sure about her future 6

NA 17/XI Lack of affection from m

mother hates he

IA 15/X Problems with mother Feeling failed 5

AF 16/X Problems with mother Feeling faile

IP 15/X Problems with mother Feeling faile

AG 15/X Problems with father Not confident 6

SY 15/X Problems with brother Feelin

stu

FT 15/X Problems with siblin

s Feel stu

RN 15/X Problems with siblings Feel stupi

ZN 15/X The problem with my father hates himself 7

BD 15/X The problem with my father hates himself 6

ICP-HESOS 2018 - International Conference on Psychology in Health, Educational, Social, and Organizational Settings

BG raised his hand and began to tell the problem.

Initially BG conveyed the problems experienced in

the organization. Then the topic switches to the

feeling of anxiety and discomfort felt around the

past month. BG said about the arguments

experienced by his father and mother. As the eldest

child, BG must also maintain the feelings of his two

siblings. BG observed that actually the problems

experienced by his parents had long been occurring,

but exploded in recent times due to economic

problems. BG who is already in the XII class feels

pessimistic that he can continue his education to

college. His father and mother also never asked

about where his interest was after high school, so he

felt that his father and mother didn't really care about

his education.

Researchers provide opportunities for other

participants to respond to BG problems. NA said

that BG should not have to worry. As chairman of

the HDI, he believes that all teachers must care

about their future after high school. NA assured BG

to stay focused on learning, because that was the

only way to change his future destiny. While UB has

also experienced a parent conflict similar to BG.

What he feels is similar to BG, so UB feels the BG

problem represents what he has been worried about

all this time. While NS and EF said that BG must be

able to continue their education to higher education,

because so far BG is an outstanding student. They

also believe that the teachers will help BG.

Therapeutic factors are an important element in

group therapy which provides potential benefits for

each member in the group. Therapeutic factors are

expected to provide better changes to the problems

faced by each member in the group. The therapeutic

factors found in group therapy, among others

(Yalom, 2010) .

1) Support factors (Supportive Factors)

Support factors are one of the most important in

group therapy. Every member who enters group

therapy is always in an unpleasant condition and

in a state of helplessness about the situation they

face. Support factors relate to encouraging hope,

acceptance, mutual help, togetherness, and

mutual cooperation.

2) Self-Revelation Factors

In this factor it relates to self-disclosure and

catharsis. Openness is how a person opens

himself or herself in groups cognitively. While

catharsis is how someone opens himself in a

group affective and provides relief.

3) Learning from Others (Learning from Others)

One of the strengths of group therapy is that each

member can benefit from learning wisdom or

wisdom from other groups. This learning can

take the form of imitation (modeling) from the

experiences of other members can be as if

experienced directly (vicarious learning), each

member can directly receive feedback from

members as well as guidance, each member can

learn how to play a role in a group (education)

4) Psychological Work Factors

With regard to psychological factors there are

two things that are inseparable, namely: Learning

how to relate to others (interpersonal-learning)

and how to understand yourself (self-

understanding)

From the explanation above, it can be concluded

that the therapeutic factors are support factors,

opportunities to learn from others, self-disclosure,

and psychological factors.

There are three approaches that can be used in

group processes: (1), deductive approach, where the

therapist here acts as a health educator and group

members as patients who can ask the therapist (2),

an interactive approach, namely the therapist raises a

theme and then the theme is discussed more broadly

in groups and (3) an Inductive Approach where the

discussion process is more open to each group

member discussing what topics will be raised. In

group therapy that will be carried out using an

interactive approach, in which the discussion process

is based on a theme and then the theme is discussed

more broadly in the group (Brabender et al., 2004).

This support group intervention consists of a

group of people who have the courage to survive in

the problems faced such as people with cancer,

schizophrenia, or people who experience divorce.

Their courage to survive is based on the assumption

that the emphasis on survival is effective therapy for

some people (van den Heuvel et al., 2002). this

group without a formal leader or led by

professionals and combined or improvised from both

can be better. Members who join in this group have

the desire to reduce feelings of isolation and to learn

coping skills.

The therapist facilitates the implementation of

therapy in its entirety and unity, actively providing

encouragement among members. The therapist not

only encourages and gives advice, but also confronts

members with each other in the form of questions

about maladaptive coping methods when facing their

problems. The power of this therapy comes from

feedback given by all members to each other.

In accordance with the problems of the therapy

participants, this group therapy uses a cognitive

behavior approach (CBT), with the aim of changing

Cognitive-behavioral Group Therapy to Reduce Anxiety in High School Students Who Have Family Problems

cognitive distortion and teaching new behaviors that

are more adaptive. Therapists use group media to

deliver CBT techniques to a number of people at the

same time. The application of CBT in groups is

adjusted to the cohesiveness and needs of group

members. CBT in groups also emphasizes new

structure, focus, and skills taught to therapy

participants (Yalom & Leszcz, 2005).

Cognitive-behavioral therapy is directed towards

modifying the functions of thinking, feeling, and

acting by emphasizing the role of the brain in

analyzing, deciding, asking, acting, and deciding

something (Arch et al., 2012). This is due to the

belief that humans have the potential to absorb

rational and irrational thinking, where irrational

thinking will cause emotional and behavioral

disturbances. Therapy participants are expected to be

able to change their negative behavior to positive by

changing the status of thoughts and feelings.

The existence of rational and irrational thinking

that is closely related to making humans become

imperfect so that cognitive-behavioral therapy

emerges. In essence, cognitive-behavioral therapy

tries to help individuals to accept themselves as

creatures who will always make mistakes but at the

same time grow as people who can learn to live

peacefully with themselves. Cognitive-behavioral

therapy explicitly emphasizes that humans have the

ability to think and act simultaneously.

In cognitive-behavioral therapy, cognitive

therapy participants are modified in two ways:

directly through cognition intervention and

indirectly through visible behavioral interventions.

The process of changing our behavior with the

intention of changing what we think is an effective

strategy to save time in the process of changing

attitudes.

CBT is a therapeutic approach that modifies the

thoughts, assumptions, and attitudes that exist in

individuals. Behavioral cognitive therapy basically

believes that human thought is formed through a

process of stimulus, cognitive, and respiration series,

interrelates and forms a kind of network in the

human brain (Rutter, Memorandum, Yusufov, &

Björgvinsson, 2018). The cognitive process will be a

determining factor in explaining how humans think,

feel and act. Meichenbaum developed this with self-

instructional training techniques, which are used to

train individuals to effectively adapt and solve

problems in difficult situations.

The researcher provided a worksheet and

explained to the participants the relationship

between participants' thoughts, feelings, and

behavior. Discomfort in the physical participants is a

systematic reaction that arises as a result of certain

emotional situations. The situation raises the

thoughts in the participants that emerge

automatically and cause a reaction to emotions

(moods, feelings) as well as an impact on the

physical participants. The existence of a situation

that causes the emergence of a mind response - the

mood - the physical participants can cause behavior

that is in harmony with the situation. Feelings of

discomfort in participants are the result of negative

(maladaptive) thoughts of participants who appear

automatically in response to certain situations. This

causes a physical reaction in the form of insomnia,

the heart beats fast or palpitations, cold sweats, and

body weakness.

The researcher explained to the participants that

the intervention that would be carried out was aimed

at reducing or eliminating negative thoughts on the

participants. In its implementation, the Researcher

and participants will work together to identify

negative and maladaptive feelings and thoughts and

then turn them into more positive-adaptive.

Cognitive behavioral therapy techniques are

divided into cognitive interventions and visible

behavioral interventions. The techniques used are as

follows (Rutter et al., 2018):

1. Thought Catching

This technique has the following basis:

a. That the relationship between thoughts,

feelings, and behavior can be demonstrated

by recording and raising thoughts

b. That recording and the appearance of the mind

has naturally helped break the bond between

the mind and feeling by making the mind

appear less realistic.

c. That with the recording and appearance of the

mind, the therapist and therapy participants

obtain data to formulate hypotheses that will

be used for testing reality.

The purpose of capturing the mind is to eliminate

maladaptive thoughts as a cause of anxiety

experienced by therapy participants. Catching the

mind is done by explaining to the therapy

participants about the close relationship between

thoughts, feelings, and behavior. Therapy

participants accompanied by researchers were asked

to capture the wrong thoughts that strengthened their

feelings of anxiety and caused unexpected reactions.

This is done to increase awareness of the therapy

participants about their wrong thoughts.

2. Reality Testing

The purpose of this technique is to find evidence

that supports or aborts the assumptions of the

maladaptive mind of the therapy participants.

ICP-HESOS 2018 - International Conference on Psychology in Health, Educational, Social, and Organizational Settings

Reality testing is done by identifying the thoughts or

statements made by the therapy participants,

negative, or related to disturbing feelings. The

researcher then asks the therapy participants about

their beliefs slowly looking for evidence that

supports or aborts the statements of the therapy

participants that are not in accordance with the

actual situation.

3. Generating Alternative Interpretations, namely

cognitive intervention techniques that restructure

the way of thinking with negative sentences into

more positive / adaptive sentences. The therapist

initially makes Generating Alternative

Interpretations in cases of anxiety or depression

and then the therapy participants repeat the

technique themselves.

4. Activity schedule, is a written plan / record related

to daily activities that must be carried out by

therapy participants. This technique is very

useful in therapy participants who have anxiety

and depression. Therapy participants and

therapists jointly design the daily activities of the

participants in a certain time span (for example

for two weeks). The activity plan provides space

for therapy participants to do something

productive. In therapy participants with cases of

depression, there are often major obstacles even

to just do simple activities. This activity plan

becomes a structure that helps therapy

participants to be actively involved and active

throughout the day.

5. Mastery and Pleasure Rating. In depression

therapy participants, what is needed is not just

activity, but also feeling competent and able to

do what they do. The Mastery and Pleasure

Technique provides space for therapy

participants to feel that they are able and able to

enjoy the activity in the form of a rating. Therapy

participants give a 0-5 rating on the activities

they do. 0 to illustrate the inability / not to enjoy

the activity, 5 illustrates being very capable /

very enjoying activities.

A week after the psychological intervention

process, participants felt more excited in school and

learning. They also understand why negative

emotions arise and uncomfortable feelings when

there are problems. They are also more daring to

communicate with parents. Only BR did not do it

because they were still afraid of their mother. But by

doing relaxation, BR already feels more comfortable

while at home.

4.1 Therapy Evaluation

Researchers used group therapy with a cognitive-

behavior approach because they found cognitive

distortions caused by feelings of anxiety. These

characteristics appear in all therapy participants. The

interactive approach used during therapy makes the

researcher become a topic facilitator that will be

delivered by the therapy participants. Researchers do

not control the course of therapy, but only provide

direction and limits on the things discussed.

Researchers see high enthusiasm for each therapy

participant. They are teenagers who are active and

have a strong desire to improve themselves.

Therapy participants were also very open to

sharing their experiences and expressing their

coping strategies in dealing with problems that arise

during accompanying patients. Therapy participants

always pay attention to other therapy participants

when other therapy participants express their

experiences. Therapy participants asked each other

actively about other therapy participants if there was

information from other therapy participants who felt

less clear. The researcher as facilitator also gave

positive affirmations to each therapy participant who

expressed his opinions, experiences, and emotions

during the sharing process.

Based on the results of the pretest with BAI and

interviews, there were two therapy participants who

needed more individual treatment, namely NS and

BR. NS was troubled because his father was having

an affair, while BR had physical and verbal violence

from his mother and sister. Against these two cases,

the researcher, with the help of the psychologist at

the puskesmas, had done individual interventions

after the intervention of this group was completed.

Individual interventions were carried out about one

week after the group intervention ended.

The advantage of this therapy lies in the

cognitive-behavior approach. This technique allows

researchers as facilitators to map the problem

precisely and clearly, without the therapy

participants having to linger to submit their

complaints. This technique is suitable for therapy

participants because they have high enthusiasm and

have good insight. The therapy participants also

obeyed to do some advanced activities at home, such

as relaxation and cognitive rehearsal.

The number of sessions in this therapy is ideally

more than three, so that monitoring of behavioral

and emotional changes in therapy participants is

more optimal. This is the reason for the limitations

of therapy, because there are only two therapy

Cognitive-behavioral Group Therapy to Reduce Anxiety in High School Students Who Have Family Problems

sessions plus one follow-up education session in the

form of training.

5 CONCLUSIONS AND

RECOMMENDATIONS

5.1 Conclusion

Cognitive-behavior group therapy approach

effective to reduce the level of anxiety in

adolescents. This approach cannot be applied in all

cases, because it requires therapy participants who

have a strong desire for better and good insight. The

results obtained after therapy are in accordance with

the therapeutic target, which is to increase solidarity

between therapy participants, learn about patterns of

problem solving, and the most important is to reduce

anxiety levels.

5.2 Recommendations

The recommendation to the school is to immediately

implement regulations related to counseling and

psychology service policies for students. This is

important because the problems faced by students

are very diverse and affect their learning motivation.

The school is also expected to invite parents of the

seven students participating in the intervention

therapy. The aim is to provide education as well as

support for parents for the continuation of their

children's education. If this is difficult, the school

can invite all parents of students to the parent

meeting format. Through the meeting, schools can

provide education about the importance of parental

sensitivity to children's emotions and be careful

when there are family problems in the household.

The recommendation for the next psychologist is

to continue cognitive-behavior therapy with

additional sessions to monitor changes in behavior

and emotions and to see the impact of positive

activities on the problems experienced by therapy

participants.

The recommendation for parents is to increase

the intensity of the relationship with the school, so

that communication between the school, students,

and the elderly is better maintained. Parents often

feel their children are fine at school, without ever

confirming to school or students. Even though the

student is experiencing emotional problems and does

not know who to tell. The role of parents lies in the

ability to detect early emotional problems

experienced by children.

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