Spiritual Therapy Approach toward People with Mental Disorder: Literature Review

Individuals who experience mental disorders certainly experience changes, both changes from the cognitive, affective, social, and spiritual dimensions. Spirituality is closely related to mental health, which affects psychological strength and well-being, so that it will increase acceptance of the problems faced. Spirituality therapy approaches must be carried out in managing care, which is integral to nursing services, including bio, psycho, socio, and spiritual. This review aims to collect and analyze articles related to therapy with a spiritual approach in dealing with mental health disorders, which is a spiritual treatment that is an essential aspect in the management of mental disorders, therefore it is necessary to conduct a study to determine the effect of spiritual therapy in the management of mental disorders. The research design used 6 (six) article databases as search results, such as Pub Med, Google Scholar, Crossref


INTRODUCTION
A person's health is influenced by the quality of liferelated to overall well-being, which consists of physical, psychological, social, and spiritual elements. Spirituality is the core element of the individual's mind that does not have certain boundaries built by the individual's choice (Hargreaves et al., 2021). Spirituality helps a person become a strong person and able to find meaning in life and find solutions to problems due to the inner conflict that is felt. Spiritual health is a condition in which a person can face everyday life by fulfilling all his potential, bringing meaning and concepts to his life, and feeling happy with himself. Spiritual health is characterized by continuity of life, serenity, a close relationship with God, and a purpose in life (Milner et al., 2020).
According to Riskesdas, 14.4 million people, or 6.4% of the population, suffer from mental-emotional disorders such as anxiety and depression. On the basis of data from the United Nations Office on Drugs and Crime, it is estimated that as many as 29.5 million people suffer from drug abuse and 190,000 people perish due to drug abuse (Muslih et al., 2021). In 2017, the number of drug consumers in Indonesia reached 4,1 million, or between 2.1 and 2.25 percent of the total population. The projected substance abuse numbers will rise from 4,1 million in 2015 to 5 million in 2020. Men are three times more likely than women to abuse drugs, and the working population contributes most to drug abuse (Grim & Grim, 2019).
Psychological factors are essential in the development of physical illness and in the response to physiological, physiological, emotional, and spiritual threats, which can lead to mental disorders such as anxiety, depression, drug abuse, and mental health in the elderly, resulting in a lack of personal control and consequently a decrease in life satisfaction (Heidari et al., 2019). Mental disorders are associated with functional changes in neuronal synapses where there is a decrease or increase in the neurotransmission of certain neurotransmitters. Datta and Nanda emphasized the discussion of spirituality (Kruyer et al., 2023). Therefore, professional nursing staff must give special attention to this dimension, specifically primary spiritual care, which is an integral part of the holistic nursing that nurses must provide. Spiritual care is a distinctive aspect of nursing care that cannot be replaced by other treatments such as psychological, social, and spiritual care that can provide answers to fundamental human concerns such as the meaning of life, pain, suffering, and death.

Spiritual Relaxation Therapy
The term psychotherapy comes from two words, namely psycho, which means psychology or mental, and therapy, which means healing. It can be concluded from the above understanding that psychotherapy is healing the soul. Psychotherapy is a form of mind treatment or treatment of psychological disorders and treatments through psychological methods. According to James P. Chaplin, in his book Complete Dictionary of Psychology, he divides the notion of psychotherapy into two perspectives, specifically, psychotherapy is defined as the application of special techniques to mental illness and daily adjustment difficulties (Gone, 2021). Meanwhile, in a broad sense, psychotherapy includes healing through religious beliefs through informal speakers or personal discussions with trusted people. From the above understanding, it can be concluded that psychotherapy is not just healing or treating the soul but can also be interpreted as maintaining and developing a healthy mind (Lloyd, 2021).
While relaxation is the absence of tension (tension), an atmosphere full of calm when all feelings related to the necessities of daily life can be kept away. Relaxation can be used for migraines, hypertension, insomnia, headaches, phobia of flying, and Raynadus disease. Relaxation procedures can also be applied to children to overcome symptoms and reduce chemotherapy's side effects for cancer patients (Bielinis et al., 2021).
Relaxation is an effort to relieve tension, first of all physical, relieving mental tension. The method can be respiratory by regulating breathing activities or muscles. Regularity in breathing, especially with the right rhythm, will cause the mental attitude and body to relax (Yu et al., 2021). From the explanation above, it can be concluded that relaxation is a state where individuals feel calm, comfortable, and peaceful. So that in everyday life, he can walk well and relax. Relaxation can also reduce anxiety, phobia of flying, insomnia, headaches, and hypertension and can be applied to children (Stevenson, 2021).
While spiritual understanding is the side of the soul that has divine characteristics (divinity) and has the power to attract and push other dimensions to manifest the attributes of the natural God himself. These potentials are very attached to the human psychic dimension and require actualization. In a broad sense, spirituality is related to the spirit (Martin, 2022). Something spiritual has eternal truths related to the purpose of human life, in which there may be beliefs that contain supernatural powers, as in religion, but emphasize the person. Individual self-awareness and awareness of origin, purpose, and destiny. Religion is the physical manifestation of the absolute truth on earth. Religion is a set of specific behavioural practises associated with beliefs articulated by specific intuitions and held by its adherents. A person may follow a particular religion but still have spirituality (Alizad & Sheikhloovand, 2022).
From the explanation above, it can be concluded that spirituality is a soul or spirit with an attractive divine nature that encourages dimensions to radiate its divine nature, which requires a growing achievement in each life. Spirituality is a belief whose existence resides in an eternal individual, as in embracing a religion. So, self-actualization is achieved through religion (Ruslan et al., 2022). On the basis of the preceding theoretical description, spiritual relaxation therapy aims to assist in the resolution of a person's psychological or spiritual issues by relaxing tense muscles in the body, accompanied by religiously-based suggestions. This therapy is a combination therapy consisting of pure relaxation therapy and spiritual suggestions. Therefore, a person attains both physical and spiritual tranquilly. Thus one is expected to experience more benefits from this spiritual relaxation therapy (Audate, 2022).
Relaxation can treat migraines and the phobia of flying and reduce chemotherapy's side effects for cancer patients and various other diseases. This therapeutic procedure can also be applied to children to overcome stress symptoms (Lacy et al., 2023). Burn describes several benefits of relaxation in terms of the studies that have been studied, namely: a) Relaxation will make individuals better able to avoid overreactions due to stress.
b) It can lower, reduce and treat hypertension, headaches, and insomnia. c) Reducing anxiety levels by relaxing individuals who have high anxiety can show positive physiological effects. d) Reducing distractions and controlling anticipatory anxiety before stressful situations, such as important meetings, interviews, etc. e) Relaxation can also reduce certain more common behaviors during stress, such as smoking too much, drinking alcohol, using drugs, and overeating. f) Improve work performance and social and physical skills. g) Relaxation can overcome fatigue and mental activity. h) Relaxation can also cause physiological stimulation so that one's self-awareness can increase. i) Relaxation is an aid in healing certain diseases and operations. Relaxation not only reduces anxiety but also facilitates the movement of the baby through the cervix. j) An essential physiological consequence of relaxation is that the individual's level of self-esteem and selfconfidence increases (Lantta et al., 2021).
Based on the description above, it can be concluded that relaxation therapy can treat various physical and psychological problems. Among them are overcoming hypertension, migraines, insomnia, anxiety, and phobia of flying, reducing the side effects of chemotherapy for cancer patients, and dealing with stress. In addition, relaxation can positively affect aspects of human life, namely feelings, thoughts, and behavior.

Mental Disorder
Today mental disorders are defined and treated as medical problems. According to the Ministry of Health of the Republic of Indonesia, mental disorders are alterations in mental function that result in mental function disturbances that cause individuals suffering and impede their ability to fulfil social roles. Mental disorders or mental illness are challenges that a person must confront because of his relationships with other people, his perception of life, and his attitude towards himself (Suartha et al., 2022).
Mental disorder is a manifestation of a form of behavioral deviation due to emotional distortion so that it is determined that the behavior is unreasonable. This happens because of the decline in all mental functions. Mental disorders are disorders that affect one or more mental functions. Mental disorders are brain disorders characterized by disturbed emotions, thought processes, behavior, and perceptions (sensory perception). This mental disorder causes stress and suffering for sufferers and their families (Wakefield, 2020).
Mental disorders are the same as other physical disorders, and it's just that mental disorders are more complex, ranging from mild ones, such as anxiety and fear, to more severe ones, such as mental illness or what we know more as crazy (Grover et al., 2020).
Mental disorders have various causes. The causes of mental disorders can come from unsatisfactory relationships with other people, such as being mistreated, being treated arbitrarily, losing loved ones, losing jobs, etc. In addition, there are also mental disorders caused by organic factors, neurological disorders, and brain disorders (Regmi et al., 2020). The main symptoms or symptoms that are most prominent in mental disorders are found in psychological elements, but the leading causes may be in the body (somatogenic), in the social environment (sociogenic), or psychological (psychogenic). Usually, there is no single cause, but several causes at once from the various elements that influence each other or coincidentally occur together, then physical or mental disorders arise (Lee et al., 2020).
According to Santrock, the causes of mental disorders can be divided into: a) Biological/Physical Factors 1) Descendants The exact role of a cause is not yet clear, and it may be limited in causing sensitivity to mental disorders, but unhealthy psychological and environmental factors greatly support this.
2) Physical Some researchers argue that a person's body shape is related to certain mental disorders. For example, those who are obese/endoform tend to suffer from manic-depressive psychosis, while those who are thin/ectoform tend to become schizophrenic.
3) Temperament People who are overly sensitive/sensitive usually have psychiatric problems and tensions that tend to experience mental disorders.

4) Illness and bodily injury
Certain diseases, such as heart disease, cancer, and others, may cause depression and sadness. Likewise, specific bodily injuries/disabilities can cause low self-esteem (Haanes et al., 2020).

b) Psychological Factors
Various experiences of frustration, failure, and success experienced will color the attitude, habits, and character. Giving parental love that is cold, indifferent, stiff, and complex will cause anxiety, pressure, and a resistant personality against the environment (Achotegui, 2019).

c) Socio-Cultural Factors
Culture is technically an idea or behavior that can be seen or not seen. Cultural factors are not a direct cause that can lead to mental disorders, usually limited to determining the "color" of symptoms. Besides influencing the growth and development of a person's personality, for example, through the customary rules that apply in that culture (Reupert et al., 2021). Some of these cultural factors, namely: 1) How to raise children How raise children who are rigid and authoritarian can cause the relationship between parents and children to become stiff and not warm. Adult children may be very aggressive or withdrawn and not sociable or overly obedient.
2) Value system Differences in moral and ethical values systems between one culture and another, between the past and present, often cause psychological problems. Likewise, moral differences are taught at home/school with those practiced in everyday society.
3) The imbalance between desire and reality Advertisements on radio, television, newspapers, films, and others cast dazzling images of modern life, which may be far from the reality of everyday life. As a result of the disappointment that arises, a person tries to overcome it by imagining or doing something detrimental to society. 4) Tension due to economic factors and technological progress In modern society, the need for competition is increasing and getting more challenging to improve the economy resulting from modern technology. Stimulating people to work harder to have it. Factors such as low wages, poor housing, limited time for rest, and company with family are some causes of abnormal personality development.

5) Transfer of family unit
Especially for children developing their personality, environmental changes (culture and social relations) are pretty influential.
6) The problem of minorities The pressure experienced by this group from the environment can result in a feeling of rebellion which will then appear in the form of indifference or taking actions that are detrimental to many people.

METHODS
The method used in this study is to analyze articles that have been selected and reviewed from several sources so that it becomes a new discussion. This journal will discuss the approach to spiritual healing in people with mental disorders. The author searched a journal using Google Scholar, Pubmed, Crossref, and Scopus references. The keywords in this article search "mental illness OR mental disorder AND spirituality OR spiritual therapies". The research begins with a review of the title and abstract, found several 2165 references, removed duplicates, and issued references that did not meet the criteria. The number of journals that meet the inclusion criteria for fulltex articles is 6.

Article Used in This Research
Through the methods mentioned above, this study found six articles that match the criteria of the method. The following table below will explain the details of the articles used. These details include the author's name, the article's title, the research design, the study's object, the characteristics of the respondents, the type of therapeutic approach used, and the results found during the study. Following are the details of the six studies.

Spiritual education program
There is a significant statistically positive correlation between the total quality of life score and total score spirituality among studied patients pre, immediately, one month, and three months post-application of the program. There is a significant effect of SEFT therapy on drug consumers' anxiety levels, with a pvalue of < 0.001. SEFT intervention can reduce substance users' levels of anxiety.
The results of the literature review show that spiritual therapy is very influential in treating people with mental health disorders; namely, there is an influence on the level of anxiety and depression. The types of spiritual approaches will be discussed and analyzed in the literature review following the study of journal articles.

Spiritual Healing Approach with MACTH Guidelines
The spiritual treatment with MACTH Guidelines is given with the aim of reducing levels of anxiety and depression.
The MACTH Guide defined MACTH Guidelines with contain interventions in the from action as follows: a) M: Mercy For example, with the behavior of a vegetarian diet and define life as a start at fertilization. b) A: Austerity For example, by avoiding the use of narcotics and cigarettes c) T: Trustfulness For example, with the behavior of telling and telling the truth.

d) C: Clean
For example, by maintaining physical and mental hygiene, e) H: Holy Name For example, calling with the power of meditation with a holy voice The spiritual treatment mentioned above is carried out with the following principles: the following: firstly, there is discrimination of religion, gender, and or belief in God, the second accepts the broad general principle of all religions, the third principle namely caring through the environment, including healthy food, vegetarianism, spirituality, and emotional care.

Spiritual Healing Approach with Educational Program with Spiritual Practice
Spirituality is essential in helping with or recovering from mental health problems. The approach to spirituality in a holistic nursing approach has an essential role in helping people to cope with mental stress or mental illness and can help understand the conditions experienced and reduce negative effects.
Educational program with tome-consuming spiritual practice free time with meditation, listening to the scripture, praying privately or in groups according to the desired topic, and identifying the meaning of life through religious programs by watching videos. Therapeutic approach spiritual education program with spiritual practice positively affects the quality of life of hospitalized psychotic patients. Research Hafti supports these results. Implementing an exercise programme by integrating religion and religious spirituality into a mental health care setting revealed that more than 80% of respondents use religious beliefs or activities in overcoming the challenges of daily life, and that religious or spiritual coping is an essential component of religious coping behaviour.

Spiritual Healing Approach with Group Religious Intervention
Therapeutic approaches with faith-based interventions have a significant impact in relieving depression and improving the quality of life, the impact of research with religious spirituality intervention can affect the prevention and treatment of psychological disorders.
Religion-based intervention by conducting programs based on concepts such as hope, dependence on God's Power, and instilling patience and fortitude in the face of complex problems affect mental health. On the other hand, with religious programs, groups of patients experiencing anxiety can be helped with social activities by participating in the environment of religious activities and joint attendance community by increasing interactions that can improve spiritual well-being and mental health.

Spiritual Healing Approach with Spiritual Care
Spiritual care is critical in the stress and mental health of the elderly in a nursing home. Koenig suggests that spirituality and spiritual intervention create an integrated system in patients with Ktonis disease due to the aging process in old age that improve health and quality of life and enhances society and the economy. According to Bandad, spiritual care induces hope, and active listening can improve patient recovery from NAFZA abuse.
Spiritual care is a crucial factor in attaining personal integrity, as it enhances communication with oneself, the environment, and nature, as well as superior fortitude. It is believed that spiritual care is an indispensable resource for patients to overcome the suffering induced by illness. In the majority of studies related to health, religion, and spirituality, spiritual care has a direct and significant relationship with enhancing the health of the elderly, according to Hammond's review study.
Spiritual Healing Approach with Religious/Spiritual Group Psychotherapy New or HSC group psychotherapy (Happy Smile Clinic) HSC group psychotherapy includes the "Fourfold Paths" happiness principle taught at Japan's largest Happy Science religious institute. Okawa suggests that there are four principles in psychotherapy is the first principle is the principle of love. This principle contains that love is believing in others and recognizing that all humans are God's creation, so you must avoid dishonorable actions; otherwise, love is being kind to the people around you and trying to run life outside the individual, the environment, and the surrounding community.
The second principle is the principle of wisdom, which has a very deep meaning about knowledge of life and includes knowing spiritual and spiritual factors universal truth that can provide answers to the problems at hand and relieve the anxiety that arises. More specifically with-Wise words guiding others with the truth can understand that the problems that occur are valuable life experiences.
The third principle is the principle of self-reflection, when making mistakes in the past, now, and in the future is not just regret or contemplation but accepting the error and then making corrections and improvements for the error that occurred. The fourth principle is the principle of progress. When someone wants to solve problems that arise and achieve success successfully, they believe there are many ways to achieve it. With master love, wisdom, and selfreflection, we will find a way to achieve progress where the goal will give happiness, optimism, and hope, affecting a person's ability to progress in preventing and overcoming depression and improving physical health.
Religiosity/spirituality is closely related to complaints somatic by increasing social support. Aside from that associated with the rhythm of sympathetic nervous system activity and increased parasympathetic activity, which causes a decrease in blood pressure, and levels of inflammatory cytokines.
HSC psychotherapy is based on the Buddhist theory of MBCT intervention. Intervention MBCT is a cognitive therapy based on Buddhist mindfulness using meditation which can reduce depression recurrence.
Spiritual Healing Approach with Spiriyua; Emotional Freedom Technique (SEFT) Spiritual Emotional Freedom Technique (SEFT) therapy combines spiritual power and psychological energy to reduce stress's negative effects and promote relaxation. In this case, spirituality is associated with the mechanism in the positive and negative handling methods as well as exercise that has an impact on psychological well-being, This approach can provide cognitive stimuli related to social and recreational activities, resulting in more efficient brain networks. Religion is essential in providing therapy and rehabilitation programs for victims of NAFZA abuse. Implementation of drug abuse therapy, other than medical therapy, is also equipped with prayer therapy, namely remembering God like an activity prayer and dhikr.
Spirituality therapy will help individuals cope with a variety of illnesses, even in the face of various stressors; therefore, this spiritual healing will encourage an individual to increase positive emotions, such as well-being, happiness, hope, optimism, meaning, and purpose in life, thereby enhancing self-esteem and a sense of control over what is occurring. Positive energy is positive psychological energy, such as being kind, merciful, or forgiving, and it will be infused with gratitude. There is a significant influence (p < 0.001) in SEPT therapy with patient anxiety level NAFZA abuse at the Pelita Jiwa Insan Padang Foundation. This SEPT therapy is one of the most useful methods in treating drug abuse that is easy and cheap to carry out for worker's health, patients, and their families.

CONCLUSION
Based on the literature review, it was found that the Spiritual Therapy approach helps encourage others to increase positive emotions, improving mental health and reducing anxiety and depression in patients with mental disorders. Therefore, mental health in people with mental disorders can be improved by including a treatment program with a spiritual healing approach. Spiritual therapy has a crucial role in the treatment to maintain mental health. Approaching them with spiritual healing is also essential in achieving their therapeutic and treatment goals by knowing their spiritual needs and encouraging the use of spiritual interventions to implement holistic treatments. Expanding on the literature review, it was discovered that the Spiritual Therapy approach is crucial in promoting positive emotions and improving mental health for individuals with mental disorders. Integrating a spiritual healing approach into their treatment program can significantly enhance their mental health. Moreover, spiritual therapy holds a vital position in the treatment plan to maintain good mental health. It is imperative to understand the spiritual needs of these individuals and encourage the use of spiritual interventions as part of a holistic treatment approach to achieve their therapeutic goals effectively.