Disertasi

Intervensi Pembelajaran Keterampilan Regulasi Diri dengan Perspektif Mindfulness pada Remaja dengan Gangguan Tingkah Laku di Sekolah Lanjutan Tingkat Pertama di Jakarta. = Intervention of Learning Self Regulation to Mindfulness Perspective in Adolescent with Conduct Disorder in Junior High School, Jakarta.

Latar belakang: Prevalens gangguan tingkah laku (GTL) remaja di Indonesia cukup besar, tercermin dengan banyaknya kasus bullying di sekolah (67 %, Plan International 2008) dan tawuran (136 kasus, 2012) di sekolah. Belum ada modul yang terstruktur untuk intervensi GTL yang dapat dilakukan oleh guru, sehingga perlu dikembangkan modul intervensi, yaitu "pembelajaran keterampilan regulasi diri dengan perspektif mindfulness". Pengembangan modul ini berdasarkan teori dan konsep latihan mindfulness, dengan cara terapi penerimaan dan komitmen diri yang bertujuan mengelola emosi dan kognitif remaja dengan GTL. GTL pada remaja disebabkan kurangnya kesadaran dan regulasi diri sehingga perilakunya tidak terkendali, kurang mampu memecahkan masalah secara terarah (fungsi eksekutif) dan mungkin terkait faktor hormonal. Tujuan penelitian adalah mengetahui keberhasilan "pembelajaran keterampilan regulasi diri dengan perspektif mindfulness" terhadap perubahan tingkah laku, kesadaran dan regulasi diri serta dampaknya terhadap kadar hormon kortisol dan testosteron. Untuk mendeteksi GTL di sekolah dibuat Model Penilaian - Gangguan Tingkah Laku Remaja (MP-GTLR). Metode: Uji diagnostik kesahihan dan keterandalan MP-GTLR terhadap 1060 subjek lelaki di sembilan SLTP di Jakarta. Uji kuasi eksperimental pada 103 subjek (53 intervensi, 50 treatment as usual) selama bulan April-Oktober 2012. Dilakukan randomisasi terhadap sekolah yang mendapat intervensi dan treatment as usual. Hasil: Telah dikembangkan alat deteksi MP-GTLR dan modul intervensi GTL "pembelajaran keterampilan regulasi diri dengan perspektif mindfulness ". Uji kesahihan MP-GTLR memperoleh nilai area di bawah kurva ROC sebesar 0,87 dengan titik potong 40 (sensitivitas 77,6 %, spesifisitas 88,8 %), sedangkan nilai prediksi positif 71,0 %, nilai prediksi negatif 91,8 %. Pada kelompok intervensi, terjadi penurunan skor MP-GTLR dan peningkatan skor DERS (Difficulties Emotional Regulation Scale )serta penurunan kadar kortisol serum yang bermakna (p < 0,00). Simpulan: Alat ukur MP-GTLR sahih dan konsisten, mempunyai nilai diagnostik baik, dapat digunakan oleh guru untuk mendeteksi GTL. Intervensi pembelajaran keterampilan regulasi diri dengan perspektif mindfulness berhasil menurunkan skor MP-GTLR dan meningkatkan kesadaran dan regulasi diri pada remaja laki- laki dengan GTL ringan dan sedang.
Kata kunci: deteksi - DERS - gangguan tingkah laku - keberhasilan - MP-GTLR - kortisol serum-pembelajaran keterampilan regulasi diri dengan perspektif mindfulnes.



Introduction: The prevalence of adolescent conduct disorder (CD) in Indonesia is quiet high, as can be seen in the high case of bullying at school (67 % Plan International 2008) and gang fight (136 cases 2012) at school. Up until now, there is no structured module for CD intervention that can be done by teacher, thus an intervention module need to be developed, that is "learning of self regulation to mindfulness". The development of this module is based on theory and concept of mindfulness learning, by using acceptance therapy and self commitment that aims to maintain the emotion and cognition of adolescent with CD. CD in adolescents is caused by lack of self consciousness and self regulation thus their behavior goes uncontrolled, lack of capability to solve problems with direction (executive function) and probably related to hormonal factors. The aim of this research is to identify the effectivity of "learning of self regulation to mindfulness" to behavioral changes, self consciousness, and self regulation and its effect to cortisol and testosterone hormone. To identify CD at school, diagnostic tool Teenage Conduct Disorder - Assessment Model (TCD-AM) is developed. Method: Diagnostic test for validity and reliability ofTCD-AM was done to 1060 subjects in 9 junior high school in Jakarta. Quasi experimental was done in 103 subjects (53 in intervention group, and 50 in treatment as usual group) from April - October 2012. Randomization was done to determine which school to intervene and which one treated as usual. Result: TCD-AM was developed and CD intervention module "learning of self regulation skill to mindfulness" was developed. Validity test of TCD-AM obtain the value of area under the curve ROC of 0.87 with cut-off point of 40 (sensitivity 77.6 % and specificity 99.8 %), while its positive predictive value is 71.0 % and negative predictive value 91.8 %. In intervention group, there is a statistically significant decrease in TCD-AM score and increasing DERS (Difficulties Emotional Regulation Scale) score as well as significant decrease in serum cortisol level (p < 0.001). Conclusion: The TCD-AM scoring system is valid and consistent, have good diagnostic value, and can be used by teachers to detect CD. Learning intervention of self regulation to mindfulness effective in decreasing the score of TCD-AM and increase self consciousness an self regulation in male adolescent with CD.
Key word: conduct disorder - detection - DERS - learning of self regulation to mindfulness - effectivity - TCD-AM - serum cortisol.