INTRODUCTION

Happiness can be affected by pregnancy, especially for mothers. When a woman finds out that she is pregnant for the first time, she often feels both excitement and anxiety (Yagmur & Oltuluoglu, 2021). In France, depression affects 11.8% of pregnant women and anxiety affects 13.2% of them. 7.9% of mothers who experienced anxiety were primigravida. Anxiety afflicts 373,000,000 pregnant women in Indonesia or 28.7% of all pregnant women (Viandika & Septiasari, 2021).

Depression is one type of mood condition that has an impact on a person's personality. It is also a term for emotions such as melancholy, depression, aggravation, dissatisfaction, and suffering. Meanwhile, postpartum depression is one disorder that can attack women after giving birth. No one expected to experience this because, in general, women who are pregnant, especially those who are pregnant for the first time, are certainly waiting for the birth of their child (Zaręba, Banasiewicz, Rozenek, Wójtowicz, & Jakiel, 2020).

Based on research conducted in East Java, 12.9% of pregnant women experience mild anxiety, 31.4% experience severe anxiety, and the rest are classified as normal (Zainiyah & Susanti, 2020). Data shows that pregnant women still experience significant levels of anxiety. Anxiety can be affected by age, gender, personality type, and physical health. Environmental and socio-cultural variables may play a role (Anggraini & Handayani, 2021). Age, education level, and family support level are just some of the factors that may contribute to pregnancy anxiety (Yu, Qiu, Liu, Cui, & Wu, 2020). In addition, the mother and fetus are also affected by this concern. According to (McNestry, Killeen, Crowley, & McAuliffe, 2023), .

The term "postpartum depression" is also used to refer to patients who experience various emotional disorders that develop after childbirth, specifically certain depressive disorders that affect 17.7% of all women worldwide and are experienced by 10-15% of women initially. year after childbirth (Hahn-Holbrook, Cornwell-Hinrichs, & Anaya, 2018). In Indonesia, between 50 and 70 percent of women experience this condition, which has a range of postpartum depression rates between 5 to more than 25 percent (Renata & Agus, 2021).

Previous research found a number of risk factors for postpartum depression, including prenatal depression, anxiety, stressful life events, and variables associated with postpartum depression within the first year of labor, such as economic disparities (Norhayati, Hazlina, Asrenee, & Emilin, 2015). According to (Wisner, Chambers, & Sit, 2006), postpartum depression is a serious public health problem. As a result, mothers may experience severe negative impacts, which will make it difficult for them to balance parenting, taking care of the house, and fulfilling their work obligations. In addition, postpartum depression in the mother can have a serious impact on the child's behavior as well as his physical, emotional, and cognitive growth (Manurung & Setyowati, 2021).

Because many still consider mental problems normal, such as maternal instincts and protective attitudes towards newborns, postpartum blues are considered an iceberg event that is difficult to uncover. Pay attention to the psychological signs experienced by pregnant women after giving birth. Because psychotherapy has no adverse effects on the mother or fetus and does not cause allergic reactions or medication, psychotherapy is essential for managing stress and anxiety. Supportive psychotherapy, re-education psychotherapy, reconstructive psychotherapy, cognitive psychotherapy, psychodynamic psychotherapy, behavioral psychotherapy, family psychotherapy, psycho-religious therapy, and relaxation techniques are some examples of psychotherapeutic techniques. Interventions, etc., will change based on the needs of the person and his or her family (Liu & Yang, 2021).

Energy psychology is a new subfield of psychology that includes SEFT. Using the body's energy system to change mental states, emotions, and behavior is the foundation of energy psychology. Various emotional illnesses, including sadness, stress, and anxiety, are affected by chemical imbalances in the body. The body's energy disorders may strongly influence the appearance of emotional disorders, and changes in the body's energy system can alter brain chemistry, which in turn can alter the emotional state. This is supported by a large amount of scientific research (Zainuddin, 2014).

Previous research has shown that nonpharmacological therapy can also help pregnant women feel more comfortable, calm, and relaxed while reducing anxiety levels (Susilowati, Pramana, & Muis, 2019). Pregnant women may also feel better and relax when touch freedom techniques are added. This is in line with previous research (Niko, 2018), which showed that recollection therapy can reduce stress levels. The results further showed that the use of Qur'anic murotal therapy helped relieve pregnancy-related anxiety, and such anxiety could be managed with the Spiritual Emotional Freedom Technique (Wisuda, bin Sansuwito, & Suraya, 2024).

The purpose of this study was to evaluate how well spiritual emotional liberation strategies work in preventing postpartum blues in pregnant women.

The aim of this study was to equip pregnant women with a broader knowledge of the Spiritual Emotional Freedom Technique (EFT) as a tool that can help them experience the Postpartum Blues less often. This study intends to find out if Spiritual EFT could be a useful option for reducing symptoms of postpartum blues, a psychological illness that can impact a woman's emotional health after childbirth.

Results and Discussions

Spiritual Emotional Freedom Technique (EFT)

EFT therapy is a type of psychotherapy that combines psychology, spirituality, and prayer (Putranti, 2021). EFT is based on the idea that certain places in the body's twelve energy meridians, sometimes called energy channels, have a major impact on certain health disorders. A body that significantly affects our health. Five principles to follow when using EFT: assurance, sincerity, surrender, and gratitude. The five things we need to do in therapy are Set-up, Tune In, Tapping, and Reflect (Shava, 2023).

The psychological therapy approach that evolved from EFT is called SEFT. Energy psychology is the main theory that is the fundamental foundation of SEFT as a technique (Zainuddin, 2014). Theoretically, energy psychology is based on acupuncture theory but applies a needleless approach (Gallo, 2017). Energy psychology theory has the same assumption as acupuncture theory, namely that everyone has an energy system that controls all physical and psychological processes. The energy system consists of 365 meridian pathways of the body that function as a space for the flow of chi, chakras, or acupoints that function as centers for energy creation and supply energy to the cells of the human body, as well as life force, or commonly done by Chinese healers. Referred to as Chi (Gallo, 2017).

Based on various acupuncture studies, including (Church, De Asis, & Brooks, 2012) found that acupuncture points can send signals directly to the amygdala region of the limbic system and other brain regions that process fear. According to this theory, (Widodo, Silitonga, & Ali, 2020) found that acupuncture can deactivate the blood of the limbic system and neocortex in its investigation. Therefore, compared to psychotherapy and relaxation, (Church et al., 2012) found that EFT practices can lower cortisol levels significantly. This decrease in cortisol levels is strongly associated with decreased signs and symptoms of anxiety, depression, and other psychological illnesses. EFT has a significant impact on fear-related brain waves.

Postpartum Blues

According to (Olii et al., 2023), postpartum blues are episodes of low mood and moderate depressive symptoms that are temporary and limited. In affective domains such as feelings, behaviors, or thoughts, postpartum blues syndrome is defined as various changes (Manurung & Setyowati, 2021). Etiology Hormonal changes are one of the main causes of postpartum mood swings, while their pathogenesis remains largely unclear. After childbirth, estrogen, progesterone, and prolactin levels usually decrease dramatically (Olii et al., 2023).

One of the causes of postpartum blues, according to (Dowlati & Meyer, 2021), is:

1. When hormonal changes occur rapidly.

2. Unexpected discomfort, such as swollen breasts and pain during childbirth.

3. Concerns that arise after leaving the hospital or maternity clinic and returning home.

4. Breastfeed.

5. The way you sleep has changed.

Clinical signs and symptoms: Sadness, sobbing, fatigue, impatience, anxiety, lack of sleep, lack of focus, erratic mood, and changes in appetite are signs of postpartum depression. These symptoms often appear two to three days after delivery, peak in the following days, and disappear on their own two weeks after first appearing (Olii et al., 2023).

The Spiritual Connection of Emotional Freedom Techniques to Postpartum Blues Events

In order to reduce stress hormones, listening to the holy verse of the Qur'an can activate endorphins and trigger delta waves. This arrangement can make the listener feel comfortable and relaxed, which will have a positive impact on his mind and heart as well as his relaxed, serene, and serene physical state. By lowering blood pressure, respiratory rate, heart rate, and brainwave activity, listening to the Murottal Quran can reduce feelings of fear, anxiety, and stress and improve body biochemistry (Wisuda et al., 2024).

Dhikr has spiritual and religious components that can increase optimism and self-confidence while boosting immunity and inner strength. Dhikr also strengthens one's desire to achieve goals and inspires feelings of satisfaction (Fahrizal & Saputri, 2023). It also brings a person closer to God, makes them feel as if they are in His care, and cultivates serenity and peace in their soul.

Symptoms of postpartum blues, according to (Olii et al., 2023), include melancholy, crying, fatigue, impatience, anxiety, poor sleep quality, and erratic mood. Mothers will feel relaxed, calm, and serene after receiving murottaI AI-Qur'an and dhikr therapy, which will reduce postpartum blues symptoms in mothers.

Figure 1. The Spiritual Relationship of Emotional Freedom Technique to Postpartum Blues Events (Kumala, Kusprayogi and Nashori, 2017)

Systematic Review

A systematic review is a research technique for finding, assessing, and interpreting all research findings related to a particular research question, subject, or problematic event (Kitchenham, 2004). Primary research includes individual studies, and secondary research includes systematic reviews. A systematic review will be helpful in combining diverse, relevant research findings, resulting in more thorough and impartial
information provided to policymakers (Siswanto, 2010).

Figure 2. The Relationship between Research and Policy in the Perspective of Utilizing

A systematic review, as the name suggests, is a type of research methodology that presents more thorough and impartial information by condensing key research findings. Meta-analysis is one method that combines quantitative methodology. An additional method of synthesis of results is a qualitative approach. In other words, meta-analysis is the quantitative component of the systematic review procedure (Siswanto, 2010).

A. Method

Prosedur Systematic Review

This research strategy uses qualitative methods. The methods used include meta-analysis and literature review. A method called meta-analysis is used to compile research findings from previous studies related to the same research question. Using meta-analyses, researchers can evaluate all available data, identify emerging trends from the findings of this study, and reach stronger conclusions compared to a single study (Mohan et al., 2022).

In conducting a meta-analysis, there are several analysis processes that must be carried out, including:

1. Set criteria for research inclusion and disqualification. These scientists set criteria for selecting studies for analysis. This criterion takes into account the type of study, year of publication, language, and other elements.

2. These are the inclusion requirements for the study:

a. Use English or Indonesian;

b. Not limited to the year of study.

c. The purpose of this study is to determine the effectiveness of the spiritual, emotional freedom technique in reducing the incidence of postpartum blues in pregnant women.

The exclusion criteria for this study are as follows:

a. Research is conducted in languages other than Indonesian or English

b. Research that does not touch on the effectiveness of spiritual emotional freedom techniques in reducing the incidence of postpartum blues in pregnant women.

1. Literature search

Researchers use specific inclusion and exclusion criteria to guide their literature search. Electronic databases such as Pubmed, Google Scholar, and ProQuest can be used for searches. The initial search yielded journals using the search terms "Spiritual Emotional Freedom Technique (SEFT)," "Postpartum Blues," "Pregnant," and "Pregnancy."

2. Selection Study

The researchers conducted a study search using predetermined inclusion and exclusion criteria after assessing the literature. Studies that meet inclusion requirements are added to the analysis.

3. Data extraction

Researchers selected related data from each selected study. The data collected may consist of things like research findings, research factors, sample size, etc.

4. Data analysis

The results of the collected studies are now combined using statistical analysis by the researchers. The analysis to be carried out may include heterogeneity tests, publication bias tests, meta-analyses of random effects or fixed effects, etc.

5. Interpretation of results

Researchers hid the results of the combined study after data analysis. The correlation between the variables studied was then further inferred from these findings.

Systematic Review Analysis

The table presented showed that pregnant women who underwent SEFT therapy experienced a decrease in anxiety. First, research with a quasi-experimental approach conducted by (Shava, 2023) revealed that dhikr and SEFT treatment is effective in reducing anxiety in III-trimester pregnant women. With a relatively low p-value, the results of Wilcoxon and Mann-Whitney's statistical test show a significant difference. This suggests that both medications may be useful options for dealing with anxiety in pregnant women.

In addition, (Zukhruf & Itryah, 2023) research using observation, conversation, and question-and-answer techniques shows that many pregnant women do not know about postpartum blues and how to overcome these problems after giving birth. However, pregnant women understand this issue better after receiving Emotional Freedom Techniques (EFT) counseling and related knowledge. This underscores the need to educate expectant mothers about mental health issues during pregnancy and postpartum.

Furthermore, research by (Jalal, Roya, & Masoumeh, 2023) showed that the SMARTER intervention succeeded in reducing depression rates in pregnant women. The results of statistical analysis showed that the intervention group and the control group differed significantly. Based on these findings, additional treatment should be offered in obstetric services to help pregnant women who are depressed. This is especially true for midwives.

Remembrance psychoeducation, according to (Rofacky & Aini, 2015), can help reduce the incidence of postpartum depression. To combat postpartum depression, it is recommended that midwives incorporate remembrance readings into their standard treatment.

In addition, (Liang et al., 2021)) showed that the stress level of type II diabetes patients can be lowered with the use of dhikr treatment. The findings of this study suggest that, for some groups, dhikr relaxation may be an effective treatment alternative for managing stress.

According to (Ulya, Rahayu, & Sulistyono, 2023) research with quasi-experimental methodology, Qur'anic marital therapy is beneficial in reducing anxiety in third-trimester pregnant women. These findings suggest that Qur'anic murottal therapy may be a useful substitute for conventional treatment of pregnancy-related anxiety.

According to (Rizki, Masruroh, & Rahayu, 2023), every pregnant participant in her study knew how to use SEFT to reduce anxiety before giving birth and was able to do so. This suggests that pregnant women may perceive SEFT as an approach that is easy to understand and use.

A literature review conducted by (Susilowati et al., 2019) concluded that anxiety in pregnant women can be influenced by various variables and treated with various therapies, including relaxation, music therapy, and supportive group therapy. The findings of this analysis provide a complete picture of the various strategies available to cope with anxiety in pregnant women.

Overall, the study's findings highlight the importance of focusing on pregnant women's mental health and offering a range of therapies that can help address anxiety and depression issues. Because pregnant women undergo counseling to help them cope with their worries, the physiological effects of anxiety may go away on their own. But this takes much time because everyone's coping style might affect how quickly they adjust. Age may also contribute to decreased anxiety in pregnant women receiving SEFT therapy; As they get older, their thought processes become more mature.

As we get older, a person will be wiser in facing challenges, both those inside his own head and those outside his environment. Because immature thinking interferes with a person's ability to face or deal with difficulties, young individuals are more vulnerable to worry.

This is supported by research by (Shava, 2023) which found that the purpose of the series of SEFT procedures carried out is to ensure the body's energy flow is directed in the right direction through psychological neutralization or psychological resistance, which is assisted by prayer for submission. Se-tup performs two tasks. They first surrender themselves to God and willingly accept suffering. As a result, the spiritual component of SEFT treatment delivered through prayer sentences can improve one's mood. Chest compressions in the afternoon spot area are the second setup stage.

Adjusting to the discomfort you feel is the next stage of adjustment. Then concentrate on suffering while surrendering to God's will. Light tapping at 18 locations of the body is the last tapping technique. Tapping will stimulate the active electrical cells because it stimulates the active nuclei of the electrical cells. Transduction signals are generated when the interception site is stimulated by biological activity. Physiologically, tapping can trigger the release of endorphins from the pituitary gland. By calming and eliciting emotions of pleasure, this hormone helps reduce anxiety.

A person's conception of health will depend on his spiritual beliefs, specifically his adherence to religious doctrines. This will have an impact on the belief that everything that happens is the result of the will of God Almighty, which must be accepted and thanked in order to reduce feelings of hopelessness and insecurity and increase spiritual motivation ((Liu & Yang, 2021); (Rusner, Berg, & Begley, 2016)). Positive energy in the form of affirmations from the patient's personal touches will make the patient feel calmer and ready to face the situation faced after childbirth (Rofacky & Aini, 2015). This is done by providing therapy to patients to provide psychological energy by prioritizing or utilizing what is in the human body itself so that the strength in the patient will be more excited.

CONCLUSION

Based on the discussion above, it can be concluded that treatment based on religion and spiritual beliefs, including SEFT therapy and various spiritual remedies such as dhikr and Qur'an murottal, can help reduce anxiety and depression in pregnant women. Research findings show that the use of this therapy can significantly improve the mental health of pregnant women. In addition, a pregnant woman's level of anxiety and anguish may be influenced by things like age, personal coping mechanisms, and spiritual beliefs.

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Rahma Zakia Mubarok, Irma Finuria Mustikawati, Paramita Septianawati, Glorio Immanuel(2024)

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