The Effectiveness of Therapy Zikir in Reducing Anxiety Levels in Patients at RSU Lirboyo Kediri

People who are sick with certain diagnoses tend to experience anxiety disorders. Anxiety is a psychological problem that has a negative impact on the patient, one of which will affect the healing process. Anxiety cannot be observed and seen directly. Alternative actions that can support the healing process are by providing spiritual treatment. Treatment with spiritual aspects, one of which is the provision of Zikir therapy which has a relaxing effect that can reduce anxiety levels in patients. This study aims to determine the effectiveness of Zikir therapy to reduce anxiety levels in patients at RSU Lirboyo Kediri. This study used the Quasi-Experimental method, with data mining obtained based on filling out questionnaires, as well as interviews with inpatients, and also from observations at Lirboyo General Hospital. The subjects in the study were several hospitalized patients with different levels of anxiety. Measurement of anxiety levels using the Hamilton Anxiety Rating Scale (HARS) anxiety scale. From the results of the study showed, that by doing Zikir therapy for ±10-15 minutes there can be a decrease in anxiety levels in patients. This proves that Zikir therapy can effectively reduce anxiety levels in inpatients at Lirboyo Hospital. Zikir therapy can create a feeling of calm and tranquility in the soul. Zikir therapy is also a therapy for a person's anxiety when he gets problems, feels himself weak, has no support and help in the face of various pressures and dangers in life. This research is expected to be a source of information in order to improve health service efforts by implementing Zikir therapy, especially in patients who experience high levels of anxiety.


INTRODUCTION
Healthy and sick are unavoidable parts of a man's life as long as he is alive.But most humans think healthy alone has meaning.Instead, pain is only regarded as a burden and suffering.Many people do not understand why he must be sick, so he subconsciously considers the disease he suffered as a catastrophe or God's curse imposed on him.People who are sick, usually get medical advice from their doctor or nurse.However, rarely do these patients get religious advice from their families, nurses or doctors.Though someone who is sick in general not only complains of physical suffering, but also often accompanied by psychological disorders in the form of anxiety or fear related to the disease.Anxiety or anxiety in these sufferers, can cause psychological stress (tension) which will actually weaken the immunological response (immune system) and complicate the patient's self-healing process (Cahyono, 2013;Purba, Purba, Saragih, Megasari, Argaheni, Utami, and Darmawan, 2021).
Seeing the close influence between psychic and physical, it is important for a patient not only to get medical care, but also to be given spiritual care.One of them is by providing spiritual relaxation through Zikir therapy, namely by maximizing the potential of belief in religion and God so that it can increase the relaxation response more strongly than just relaxation techniques alone.The habit of a Muslim in remembering Allah such as reading prayer beads, tahmid, takbir, istighfar and so on can be an antidote for all types of mental illness, calm and calm a chaotic mind, so that it becomes healthy and in harmony with the surrounding nature.
A Muslim who seeks to draw closer to Allah, usually always feels the presence of Allah beside him and always feels in His protection and care (Shihab, 2008).Thus there will be a feeling of confidence in oneself, firm, calm, peaceful, and happy in a Muslim who always makes remembrance.Sufis also believe in a divine spark in every human being.This spark is always going to be part of it.Zikir is to reveal the knowledge, power and beauty of God's spark within man.One of the classic practices of Zikir includes the repetition of the phrase tawhid, la ilaha illa Allah.This phrase literally means "There is no god, only God" (Frager, 2014).Psychological Zikir will create a feeling of peace, calm, and an emotional mood overwhelmed by positive emotions.According to Wulff, Zikir if done with full concentration will cause alpha waves, which are brain waves that appear if the body condition is relaxed.Another effect of Zikir meditation is to cause a change in one's consciousness, from normal consciousness towards another consciousness often referred to as Altered States of Consciousness (ASC).According to Ludwig, changes that occur when individuals are in ASC conditions include changes in thoughts, changes in feelings about time, changes in selfcontrol, perception, body image, and feelings / experiences that are difficult to tell (Safari and Saputra, 2009).
Spiritual meaningfulness has been widely studied by experts in various parts of the world, and several studies confirm that there is a positive relationship between spiritual meaning and one's mental health.Mental health itself includes a condition that allows optimal physical, intellectual, emotional development and includes a harmonious state of all aspects of an individual's life in relation to others.WHO has also perfected the boundaries of healthy by adding one dimension, namely the spiritual dimension, so that individuals are said to be healthy if they are physically, psychologically, socially and spiritually healthy.This is what has come to be called bio-psycho-socio-spiritually healthy (Santoso, 2016).
Anxiety that greatly affects mental health is also experienced by inpatients at Lirboyo Hospital.However, Lirboyo Hospital, which incidentally is a hospital in the Islamic boarding school, certainly has its own methods to anticipate the anxiety of these patients, including optimizing spiritual activities of Zikir therapy.Therefore, this research is important to be carried out in order to examine more deeply the effectiveness of Zikir therapy as an effort to reduce anxiety levels in inpatients at Lirboyo Hospital.This Zikir therapy is considered to help a Muslim in facing the difficulties of his life, because with this Zikir he basically also makes total surrender to Allah which will then cause new hopefulness and optimism because he believes that Allah is certain give His help.From the Zikir activities carried out, Muslim individuals will get two benefits.First, it will get a reward from God.
Second, it will get positive benefits physically and psychologically such as the emergence of feelings of calm, comfortable and filled with positive emotions (Safari and Saputra, 2009).

Therapy of Zikir
Zikir comes from Arabic, which is the origin of the words zakara, yazkuru, zikran, which means to mention and remember.According to the Quran and Sunnah, dhikr is defined as all kinds of forms of remembering Allah, mentioning the name of Allah, either by reading tahlil, tasbih, tahmid, taqdis, takbir, tasmiyah, hasbalah, asmaul husna, or reading ma'tsur prayers from the Prophet SAW.Thus dhikr is one of the efforts to get closer to the creator.While therapy is related to a series of efforts designed to help or help others.So, Zikir therapy is a series of efforts designed to help or help people by remembering Allah by mentioning His asthma.
Zikir means remembering Allah, but "remembering" is not just saying Allah's name verbally or in the mind and heart, but also remembering His substance, nature and deeds, and then surrendering life and death to Him.So that it is not afraid or afraid to face all kinds of dangers and trials (Purwanto, 2006).Zikir in the sense of remembering Allah can be done anytime and anywhere, both orally and silently (Chasani, 2022).Because in essence, dhikr (remember) is an act of the heart.This means that the activity of a servant must not forget God.Both in every breath and heartbeat.While dhikr in the sense of mentioning the name of Allah, is usually practiced routinely and is quite commonly known as wirid.Wirid is a string of words of Zikir that are ma'tsurat (there are examples and demands from the Prophet SAW) (El-Mubarok, 2014).
Zikir therapy is a series of efforts designed to help or help people by remembering Allah or mentioning the name of Allah.Zikir has a relaxing power that can reduce tension (anxiety) and bring peace of mind (Rajab, 2019).Each recitation of Zikir contains a very deep meaning that can prevent the onset of stress.The reading of la ilaha illallah means that no God deserves worship except Allah, there is a confession of lordship only to Allah in a belief.Individuals who have high spiritual abilities have a strong belief in their God.This belief gives rise to strong control, can interpret and accept every unpleasant event in a more positive direction and believes that there is something that governs every event that occurs in the universe.
That way individuals can reduce tension (anxiety), overcome health problems and increase mental strength quickly.While the reading of Allahu Akbar, means really the magnitude of God's power, the great wealth of God, the magnitude of God's creation, so that it causes an optimistic attitude.Optimism, a new source of energy in the spirit of life and removing a sense of hopelessness when someone faces circumstances or problems that disturb his soul, such as illness, failure, depression, and other psychological disorders (Anggraieni and Subandi, 2014;Muslih, & Subhi, 2022).
In dealing with patients' fears and anxieties, spiritual beliefs have an important role in lowering anxiety levels in patients in hospitals.Therefore, it is necessary to improve the provision of quality health services, especially in providing nursing care in the spiritual aspect.
One approach to spiritual belief given is in the form of giving therapy of zikir (Faradisi, 2012).
Physiologically, spiritual healing by Zikir or remembering Allah causes the right brain to work.When the brain gets stimulation from outside, the brain will produce chemicals that will provide a sense of comfort called endorphins.After the brain produces this, this substance will be absorbed by the body which then gives feedback in the form of calm or a sense of relaxation.If physically the body is relaxed, then the psychic condition also feels a feeling of calm so that it can reduce anxiety (Hannan, 2017).
Zikir is an intervention that nurses can use to meet basic human needs, especially in preand postoperative patients with anxiety problems, where by doing Zikir to Allah in a not too long period of time will provide calm in psychiatric (psychic) conditions (Hannan, 2017).Spiritual guidance in the form of prayer, remembrance, prayer, and reading the Quran causes the body to respond by secreting certain hormones that can cause confidence, optimism, bring calm, peace, and feel the presence of God so that it can help reduce stress and anxiety (Perdana, 2012).
For Sufis, healing with dhikr has been done since they entered the stage of bidayah (beginning), which is when they enter several stages of Sufism, namely takhalli (emptying the soul from everything that is destructive), tahalli (filling the soul with everything noble), and tajalli (finding what is sought and applying it in daily life).Then mujahadah and riyadhah, through maqamat and ahwal.
Then came nihayah (the end of the search).Sufis call this nihayah the last maqam which is wushul (attainment), ihsan (good deeds), or mortal' (impermanence).For ordinary people, there are also many paths that can be taken to do Sufistic healing.Among them by going through remembrance, prayer, reading shalawat, and listening to music.These methods have proven effective in overcoming various diseases.Of course, with certain methods or kaifiah or with the guidance of a teacher (Syukur, 2012).

Anxiety
Anxiety has three aspects, namely psychological, somatic, and physical aspects.Each aspect has indicators both visible and invisible.For example, excessive sweating, increased heart rate, indigestion such as nausea, diarrhea, excessive fear, difficulty concentrating.Anxiety or anxiety is a vague feeling of discomfort or worry accompanied by an autonomous response (the source is often nonspecific or unknown to the individual), a feeling of fear caused by anticipation of danger.This is a warning gesture that warn individuals of danger and enable individuals to act in the face of threats.
In Freud's opinion, anxiety is a reaction to threats from pain and the outside world that is not ready to be addressed and serves to warn individuals of danger.Insurmountable anxiety is called traumatic.When the ego is unable to overcome anxiety rationally, it will give

The Relationship of Zikir Therapy with Anxiety in Patients
Anxiety in patients has an impact on the recovery process itself, the level of anxiety can be lowered using several methods, one of which is Zikir therapy and relaxation.Zikir and relaxation emphasize the effort to rest and relax through tension or psychological distress.The experience of Zikir and relaxation will cause calm and be able to remind someone that the will of all things is Allah, so that Zikir and relaxation can suggest healing.The use of Zikir and relaxation to overcome anxiety in hospitalized patients shows that someone who follows Zikir and relaxation therapy experiences a decrease in anxiety because according to the Islamic view, Zikir and relaxation is one of the rituals that has therapeutic elements.The effect obtained from Zikir and relaxation is that it can reduce anxiety, anxiety, and anxiety in the heart.Emotional Zikir can bring up positive emotions, such as happiness, favor, providing calm and tranquility.And relaxation is to calm or relax.
Psychological dynamics through spiritual activities, such as praying, praying, or Zikir will create a state of relaxation or relaxation, calm, and peace.This situation affects parts of the human brain associated with emotional processes, especially in the hypothalamus.In meditative states through concentration on breathing, the pronunciation of Zikir sentences, prayers, prayers and the pronunciation of other autosuggestive sentences will cause stimulation of hypothalamic activity so as to inhibit the production of corticotropinrealising factor (CRF) hormone, which results in the anterior pituitary gland being inhibited from releasing adrenocorticotrophic hormone (ACTH) thus inhibiting the adrenal glands to secrete the hormone cortisol, adrenaline, and noradrenaline.This causes the thyroxine hormone released by the thyroid gland in the body is also inhibited.High thyroxine hormone will cause individuals to get tired easily, easily anxious, easily tense, and insomnia so that a meditative state full of calm and peaceful feelings will cause a more calm and relaxed psychic impact.The meditative state also affects and stimulates the autonomic nervous system which is divided into two, namely the sympathetic nervous system if the individual is in a state of tension or stress and the parasympathetic nervous system if the individual is in a relaxed state (Safari and Saputra, 2009).
In meditative conditions, it is the parasympathetic nervous system that works, causing a decrease in blood pressure and heart rate, the tension of the body's muscles decreases so that it relaxes, decreases glucose levels in the blood, and decreases energy consumption.The influence of this parasympathetic nerve on the psychological state of the individual such as causing feelings of relaxation, calm, peace, and increasing ability individual concentration.
According to the results of existing research, meditative states give rise to alpha waves in the brain that arise if the state of the individual is (Safari and Saputra, 2009).According to Witmer's notes, in several studies argued that the use of religious practices and spiritual beliefs as coping measures has a positive impact on overcoming anxiety.It can be concluded that one type of coping action that can be done when individuals experience difficulties is through a religious approach, in this case it can be done by praying, praying, reading the Quran, holy books, and dhikr (Safari and Saputra, 2009).
Prayer, remembrance, prayer, or praising the name of Allah swt.Can be used as preventive coping or combinative coping.As a preventive measure, dhikr strengthens the spiritual dimension of the individual, giving confidence in the help of Allah Almighty.With religious deepening the individual gains serenity, as well as peace of mind.As a combinative measure, Zikir can reduce the level of tension by causing a state of relaxation, optimism, developing healthy mental factors and eliciting a process of catharsis (Mustofa, 2021;Ridho and Hayati, 2022).

METHODOLOGY Material Objects
Anxiety is something that afflicts almost every person at any given time in his life.Anxiety is a normal reaction to situations that are very stressful in a person's life, and therefore last not long.Most every person who is sick and has to undergo hospitalization in the hospital is always haunted by feelings of anxiety.Anxiety is a psychiatric condition full of worry and fear of what is happening, both related to limited problems and strange things (Bulechek, 1992).A patient's anxiety is usually characterized by the patient feeling fear, difficulty sleeping, reduced appetite, and others.

Data and Participants Used
This type of research uses Quantitative, with the results of questionnaire data as primary data and from interviews as secondary data.Interviews were conducted with inpatients at Lirboyo General Hospital.While the participants or respondents in this study amounted to 4 patients with different diagnoses.Patient 1 with a diagnosis of COPD, the 2nd and 3rd patients with an ILO diagnosis, and the 4th patient with a diagnosis of Penomonia.And with the criteria of patients who are able or can be communicated with.

1.
Fill in questionnaire data before therapy 2. Questionnaire suspended

3.
Providing therapy to patients

Fill in questionnaire data after therapy
The data collection used in this study was by conducting observations and interviews, and using scales to measure anxiety.The anxiety scale used is the Hamilton anxietas rating scale (HARS) which consists of 14 components (Perwataningrum, Prabandari, and Sulistyarini 2016).The assessment method is by scoring system, namely value 0 (no symptoms), value 1 (mild symptoms, ie one symptom from existing options), value 2 (moderate symptoms, ie half of the existing symptoms), value 3 (severe symptoms, ie more than half of the existing symptoms), and value 4 (severe symptoms, ie all symptoms exist).The results are then summed up by categorization as follows: a score of less than 14 means no anxiety; a score of 14 -20  Based on the analysis of the patient's anxiety level before being given Zikir therapy, it is known that most patients have moderate anxiety as many as 3 patients (75%), and those with mild anxiety levels as many as 1 patient (25%).Table 2 shows that based on the analysis of the patient's anxiety level after being given Zikir therapy, it is known that most of the anxiety patients in the mild category as many as 2 patients (50%), moderate anxiety 1 patient (25 %), and 1 patient (25%) do not experience anxiety.Table 3 shows that based on the analysis of the patient's anxiety level before and after Zikir therapy there was a significant difference, moderate anxiety level (75%) to mild (50%).This means that spiritual healing, namely recitation readings, is effective in reducing anxiety levels in patients.

Level of Anxiety Before Zikir Therapy in Patients
Anxiety can cause the health of body, mind and spirit to contract from complex interactions.Feelings of pressure and helplessness will arise when People are not prepared for threats.Before Zikir therapy, researchers measured anxiety levels using the HARS scale.The results of the study were obtained from 4 respondents, most respondents felt moderate anxiety as many as 3 respondents (75%), mild anxiety as many as 1 respondent (25%).(Haryanto, 2008).
Therefore, in dealing with patient fears and anxieties, there is pharmacological and nonpharmacological management.Pharmacological management is using drugs for antianxiety, especially benzodiazepines (Isaacs and (translator), 2005).While non-pharmacological management by means of distraction and relaxation.Relaxation is a technique of overcoming worries or anxiety through relaxing the muscles and nerves that occur sourced in certain objects.One effective relaxation to reduce anxiety is by providing spiritual support, namely reciting prayers or dhikr according to religion and belief.With good and correct Zikir therapy will cause peace of mind, free from anxiety, anxiety, and anxiety (Primadona, 2010).

Level of Anxiety After Zikir Therapy in Patients
Changes in anxiety after being given Zikir therapy are the psychological state of respondents felt after being given Zikir therapy.Zikir therapy is one of the complementary nonpharmacological therapies to help and reduce anxiety.Zikir given by patients in the study sample can reduce anxiety if given periodically because vision of an object or pleasant stimuli will make tolerance to reduced anxiety caused by the brain no longer focusing on the unpleasant thing and will automatically make a person feel calm and comfortable.The feeling of calm and comfort in patients is very influential on accelerating recovery more optimally because it is a positive stimulus from the brain which will always send a good message to problematic body parts and this positive response is one of the important indicators and supports various problems for the body (Tahir and Angreani, 2017).
The patient's response after doing Zikir therapy seemed calmer than before, his anxiety was reduced marked by the patient's face did not look pale, more relaxed, and did not appear shaky.Relaxation is achieved due to the combination of a person's physiological, psychological, cognitive, and social responses with relaxation techniques.Psychological responses may include anxiety, depression, insomnia, phobias, and hallucinations.Relaxation by including elements of belief can be done by anyone who believes in something and can be practiced by all religions (Kaplan, Sadock, & Grebb, 2010).Based on the results of measuring the level of anxiety after Zikir therapy during ±10-15 minutes were obtained from 4 respondents as many as 1 respondent no anxiety (25%), mild anxiety as many as 2 respondents (50%) and for moderate anxiety as many as 1 respondent (25%).This means that there is a decrease in anxiety levels after Zikir therapy for ±10-15 minutes.

Vol. 3 No. 1 May 2023
From the results of the study showed, that by doing Zikir therapy for ±10-15 minutes there can be a decrease in anxiety levels in patients.This proves that Zikir therapy can effectively reduce anxiety levels in hospitalized patients.Zikir therapy can cause a feeling of calm and tranquility in the soul, is a therapy for human anxiety when he gets problems, feels himself weak, has no support and helps face various pressures and dangers of life (Ahmad Husain Ali Salim 2006).Zikir or remembering Allah will give us a feeling of security and tranquility, this means that we will be free from anxiety, anxiety, and anxiety.To reduce anxiety levels by means of nonpharmacological treatment, namely by relaxation.One of the effective relaxations to reduce anxiety is by means of Zikir therapy.Zikir therapy is saying words of praise that remember the greatness of Allah SWT.

Differences in Anxiety Levels Before and After Zikir Therapy in Patients
Based on the results, there was a significant difference between the level of anxiety before and after Zikir therapy in hospitalized patients.This means that Zikir therapy can lower anxiety levels in patients in hospitals.From the results of the study showed, that before and after Zikir therapy for ±10-15 minutes there was a significant difference in the level of anxiety in patients.This proves that Zikir therapy can effectively reduce anxiety levels in hospitalized patients.The habit of doing Zikir properly and correctly will cause peace of mind, free from anxiety, anxiety, and anxiety.Zikir to Allah is a worship that brings tranquility and healing to the soul.slower breathing rate is very good at calming, emotional control, deeper thinking and a better metabolism.

CONCLUSION
Based on the results of the research conducted, it was found that there was an effect of Zikir therapy on reducing anxiety levels, it was proven that there was a change or decrease in anxiety levels after Zikir therapy.It turns out that Zikir provides benefits, especially to neutralize the burden of thoughts or feelings that often come to us every day.It is highly recommended to respondents to Zikir as much as possible and done continuously, if you forget to remember again.Similarly, Zikir can be used to calm down in the face of problems such as patients wanting surgery.Zikir goes a long way in reducing unrest.The importance of Zikir therapy in respondents is to fulfill spiritual needs in the field of medicine not for the purpose of changing the patient's belief in his religion but to awaken spiritual strength in the face of suffering from illness or disruption to his health.This shows that spiritual or religious beliefs are closely related to the clinical field (medicine).
In Islam, explaining the existence of diseases or problems in the field of health is considered as a trial and test of one's faith.Therefore, people should be patient and should not despair, trying to treat it by always praying to Allah SWT.Also explained by Hammad, a person who is high in spirituality, then high alpha waves in his brain.This is what makes life calmer, even if the storm of anxiety, fear, and panic continues to hit without the need to take medicine or ask for help from a shaman, the movement of spirituality will be able to dampen it.
rise to the ego's defense mechanisms.According to Asmadi, factors that can occur trigger a person to feel anxious can come from oneself (internal factors) and factors from outside himself (external).Internal factors are age, temperament, previous medical actions.External factors are threats to integrity.And threats to self-estimation.The dynamics of anxiety, in terms of psychoanalysis theory, can be caused by the presence of bad pressure, past behavior, and mental disorders.Judging from the cogitive theory, anxiety occurs because of negative self-evaluation.Negative feelings about his abilities and negative self-orientation.Based on the view of humanistic theory, anxiety is a worry about the future, that is, worry about what is done.Blackburn and Davidson suggest that anxiety reactions can affect mood, thoughts, motivation, behavior, and biological movements(Safari and Saputra, 2009).According to Asmadi, factors that can trigger a person to feel anxious can come from oneself (internal factors) and factors from outside himself (external).Internal factors are age, temperament, previous medical actions.External factors are threats to integrity.And threats to self-estimation.Asmadi grouped anxiety triggers into two categories, namely threats to selfintegrity including physiological incompetence or impairment in carrying out daily activities in order to fulfill basic needs, and threats to the self-system the existence of something that Vol. 3 No. 1 May 2023 can threaten self-identity, self-esteem, loss of status or self-feeling, and interpersonal relationships.It can be concluded that anxiety is an individual emotional condition whose symptoms are almost the same as fear.Anxiety is an internal warning condition that is given a red flag.With the presence of anxious conditions, the body begins to give signs of danger that threatens the individual and requires the individual to be more aware and careful in dealing with what he considers a problem.

Vol. 3
No. 1 May 2023 The reason researchers chose Lirboyo Hospital as a place of research is because Lirboyo Hospital is one of the Islamic hospitals in Kediri City, and the majority of patients are also Muslims.Lirboyo General Hospital is one of the General Hospitals in Kediri City located on Jl.Dr. Sahardjo Kediri City.This hospital was founded by KH.Ahmad Idris Marzuqi in 2006.At the beginning of the establishment of Lirboyo Hospital named Santri Medical Center which then transformed into a type D General Hospital which was inaugurated by the Minister of Health Dr. dr.Hj.Siti Fadhilah Supari, Sp.JP(K) on July 14, 2006, with full support of sophisticated facilities and equipment infrastructure.The best service is proven by the recognition of the Intermediate Level Hospital Accreditation Committee which provide a full pass assessment.This proves that the services of RSU Lirboyo have met national service quality standards.

Vol. 3
No. 1 May 2023 means mild anxiety; a score of 21 -27 means moderate anxiety; a score of 28 -41 means severe anxiety; and a score of 42 -56 means severe anxiety.

Table 3 : differences in anxiety levels of patients before and after Zikir Therapy in patients No Patient Gender Age Score Category Before After Before After
(Haryanto 2008)h is a healing and mentioning humans is a disease (meaning moral disease)(Haryanto 2008).Zikir therapy can lower stressor hormones, activate natural endorphins, increase feelings of relaxation, and distract from Fear, anxiety and tension, improve the body's chemical system thereby lowering blood pressure and slowing breathing, heart rate, pulse rate, and brain wave activity.A deeper or Vol. 3 No. 1 May 2023