08/03/2020

TAHAPAN GRUP MMSSR

(RSJ Prof. Dr. Soerojo Magelang)

1. Pre-assesment: ukur level kecemasan (GAD-7)

2. VENTILASI
3. MINDFULNESS: konsep penerimaan diri-pikiran,
definisi & tujuan, latihan mindfulness formal
(mindful breathing)
4. Evaluasi peserta (pengalaman, kendala, saran);
anjuran latihan mandiri di rumah
5. Kontrak sesi grup lanjutan – evaluasi
 IDENTIFIKASI TAHAP PENERIMAAN DIRI
(SELF ACCEPTANCE) MENGHADAPI COVID-19
sedih

tidak senang
 MINDFULNESS
 Mindfulness = LATIHAN kesadaran mental (olah
rasa) dengan cara memusatkan penuh
perhatian, pengamatan tanpa menghakimi atau
menilai baik atau buruk suatu pengalaman, &
memusatkan kesadaran pada momen saat kini
(awareness on present moment) (van der Velden et al., 2015)
 Setting: Formal – Informal; Individual - Kelompok
 PRINSIP MINDFULNESS
1. Tidak menghakimi
2. Sabar
3. Pikiran pemula, selalu belajar
4. Percaya, yakin
5. Tidak ngotot, kudu, harus, pasti !
6. Menerima kenyataan (puas, syukur)
7. Melepas (amarah, pikiran negatif,
rasa bersalah, sesal, khawatir)

“ELING LAN WASPODO,

SABAR, NRIMO ING PANDUM,
LEGOWO, IKHLAS...”
 EFEKTIFITAS MINDFULNESS THERAPY
 Manfaat klinis: nyeri kronik, depresi inter-episodik-resisten
terapi, insomnia, panik, GAD, PTSD, bipolar, ggn makan,
kepribadian & substance abuse (Grecucci et al., 2014; Chiesa & Serretti, 2011).
 Teknik melabel stimulus afektif verbal (cth: ini kemarahan):
aktifasi VLPFC dekstra & mengurangi respon amygdala 
mengurangi afek depresif (Creswell et al.,2007)
 Mencegah relaps 34-40% depresi ≥ 3 episode (Piet & Hougaard, 2011)
• Sebanding antidepresan & CBT depresi fase aktif (Khoury et al., 2013).
• Rekomendasi: tambahan terapi lini ke-2 depresi akut (EBM
level 2); lini 1 fase pemeliharaan (level 1) (Malhi et al.,2015; Parikh et al., 2016)
TerapiMekanisme
Berbasis Mindfulness Contoh instruksi Area otak terkait
Pengaturan perhatian Mempertahankan perhatian pada objek Anterior cingulate cortex
(attention regulation) terpilih, saat terdistraksi mengembalikan
perhatian kepada objek

Kesadaran fisik Fokus pada objek sensasi internal: sensasi Insula, temporo-parietal
(body awareness) sensoris pernapasan, emosi & sensasi fisik junction

Regulasi emosi: Menilai reaksi emosional yang sedang Dorsal prefrontal cortex
penilaian kembali berlangsung dengan cara berbeda: tidak (PFC)
(reappraisal) menghakimi, penerimaan (acceptance,
nonjudgmentally)

Regulasi emosi: Mengekspos diri terhadap apapun yang ada Ventro-medial PFC,
paparan, lenyap & di bidang kesadaran; tidak membiarkan diri amygdala, hippocampus
rekonsolidasi dipengaruhi olehnya; menahan diri dari
reaktifitas internal

Perubahan Melepaskan diri dari identifikasi kondisi diri Medial PFC, posterior
perspektif diri (self) cingulate cortex, insula,
temporo-parietal
junction
Mekanisme aksi terapi berbasis mindfulness (Hölzel et al., 2011)
 PROTOKOL MINDFULNESS THERAPY

 Latihan dalam kelompok (8-15 orang); 8 sesi; 2-2,5

jam/sesi, dilanjutkan sesi individual di rumah
 KONTRAINDIKASI: kondisi akut berat, psikotik, mania,
skizofrenia, depersonalisasi, kejang, ggn kepribadian
schizoid, dalam pengaruh zat-alkohol (Lindahl et al., 2017)
 Latihan individual di rumah: praktik formal 45-60 menit
per hari & mencatat pengalaman harian (lampiran 1)
Contoh komponen keterampilan dalam sesi mindfulnes therapy (Didonna, 2009)
 Praktik mindfulness meliputi (Rebbeca, 2009):
1. Makan biskuit dgn penuh kesadaran & perhatian (raisin practice)
2. Latihan kesadaran napas (mindfulness of breathing) 10 menit

3. Gerakan berkesadaran melalui meditasi jalan (mindful movement).

4. Latihan mengenali kaitan pikiran & perasaan  memahami emosi
dampak interpretasi situasi
Praktik mindfulness

5. Latihan kesadaran peregangan & nafas (stretching & breathing) - yoga

6. Latihan kesadaran dengan memindai tubuh (body scan)

Skema praktik body scan (Kuyken & Evans, 2014)

Praktik mindfulness

7. Praktik kesadaran pernapasan ruang tiga menit (3 minute breathing space)

untuk keluar dari kendali pikiran otomatis

Skema praktik kesadaran pernapasan 3 menit (Kuyken & Evans, 2014)

Untuk lebih memahami praktik mindfulness dalam MBCT dapat menelusuri:
www.guilford.com/MBCT_audio
 LATIHAN KESADARAN NAPAS
(Mindfulness of Breath)
1. Pejamkan mata & duduk tegak di kursi / posisi yang nyaman
2. Fokus & rasakan sensasi napas masuk & keluar hidung
3. Sadari munculnya suara, sensasi & ide-ide di pikiran.
4. Jika pikiran berkelana, secara pelan kembali fokus napas
5. Rangkul & sadari kemunculan pikiran / sensasi apapun yang
muncul tanpa menilai sebagai baik & buruk
6. Latihan selesai jika Anda diminta untuk membuka mata !
 Latihan awal 5-10 menit, 2 kali sehari (sebelum & bangun tidur)
 REFERENSI
• Chiesa, A., & Serretti, A. 2011. Mindfulness Based Cognitive Therapy for Psychiatric Disorders: A
Systematic Review and Meta-Analysis. Psychiatry Research, 187(3), 441–453.
https://doi.org/10.1016/j.psychres.2010.08.011
• Creswell, J. D., Way, B. M., Eisenberger, N. I., & Lieberman, M. D. 2007. Neural Correlates of Dispositional
Mindfulness During Affect Labeling. Psychosomatic Medicine, 69(6), 560–565.
https://doi.org/10.1097/PSY. 0b013e3180f6171f
• Grecucci, A., Pappaianni, E., Siugzdaite, R., Theuninck, A., & Job, R. 2015. Mindful Emotion Regulation :
Exploring the Neurocognitive Mechanisms behind Mindfulness. Hindawi Publishing Corporation BioMed
Research International Article, 9. https://doi.org/http://dx.doi.org/10.1155/2015/ 67072
• Didonna, F. 2009. Clinical Handbook of Mindfulness. Springer Science Publication.
https://doi.org/10.1007/978-0-387-09593-6
• Hölzel, B. K., Lazar, S. W., Gard, T., Schuman-Olivier, Z., Vago, D. R., & Ott, U. 2011. How Does Mindfulness
Meditation Work? Proposing Mechanisms of Action From a Conceptual and Neural Perspective.
Perspectives on Psychological Science, 6(6), 537–559. https://doi.org/10.1177/ 1745691611419671
• Khoury, B., Lecomte, T., Fortin, G., Masse, M., Therien, P., Bouchard, V., Hofmann, S. G. 2013. Mindfulness-
Based Therapy: A Comprehensive Meta-analysis. Clinical Psychology Review, 33(6), 763–771.
https://doi.org/ 10.1016/j.cpr.2013.05.005
• Kuyken, W., & Evans, A. 2014. Mindfulness-Based Cognitive Therapy for Recurrent Depression.
Mindfulness-Based Treatment Approaches Second Edition. Elsevier Inc. https://doi.org/10.1016/B978-0-
12-416031-6.00002-5
 REFERENSI
• Lindahl, J.R., Fisher, N.E., Cooper, D.J., Rosen, R.K., & Britton, W.B. (2017). The Varieties of Contemplative
Experience: A Mixed-Methods Study of Meditation-Related Challenges In Western Buddhists. PLoS ONE
(Vol. 12). https://doi.org/10.1371/journal.pone.0176239
• Malhi, G. S., Bassett, D., Boyce, P., Bryant, R., Fitzgerald, P. B., Fritz, K., Singh, A. B. 2015. Royal Australian
and New Zealand College of Psychiatrists Clinical Practice Guidelines for Mood Disorders. Australian and
New Zealand Journal of
• Piet, J., & Hougaard, E. 2011. The Effect of Mindfulness-Based Cognitive Therapy for Prevention of Relapse
in Recurrent Major Depressive Disorder: A Systematic Review and Meta-Analysis. Clinical Psychology
Review, 31(6), 1032–1040. https://doi.org/10.1016/j.cpr.2011.05.002
• Parikh, S.V., Quilty, L.C., Ravitz, P., Rosenbluth, M., Pavlova, B., Grigoriadis, S., Uher, R. 2016. Canadian
Network for Mood and Anxiety Treatments (CANMAT) 2016 Clinical Guidelines for the Management of
Adults with Major Depressive Disorder: Section 2. Psychological treatments. Canadian Journal of
Psychiatry, 61(9), 524–539. https://doi.org/10.1177/0706743 716659418
• Rebecca, C. 2009. Mindfulness-Based Cognitive Therapy, The CBT Distinctive Features.
https://doi.org/10.1007/978-3-319-29866-5
• Sean Mackey, Stanford. PLOS One. Journal of Neurosciences. Archives of Internal Medicine
• Segal, Zindel, V., Williams, J. Mark G., & Teasdale, John. R. 2013. Mindfulness Based Cognitive Therapy for
Depression second edition. The Guilford Press. London
• Van der Velden, A.M., Kuyken, W., Wattar, U., Crane, C., Pallesen, K.J., Dahlgaard, J., Piet, J. 2015. A
Systematic Review of Mechanisms of Change in Mindfulness-Based Cognitive Therapy in the Treatment of
Recurrent Major Depressive Disorder. Clinical Psychology Review, 37, 26–39.
https://doi.org/10.1016/j.cpr.2015.02.001