Indonesia is located in the ring of fire, which stretches around the Pacific rim. This horseshoe-shaped region covers an area of ​​40,000 km. About 90% of earthquakes and 81% of the biggest earthquakes occur in this area. Recently, Indonesia has experienced severe natural disasters that have caused damage, loss, and changes in psychological dynamics of ordinary to serious and even emergency intensity. Conditions of psychological change are categorized as Post-Traumatic Stress Disorder (PTSD) [1].

Data from the Indonesian National Board of Disaster Management (BNPB) of 2017 to 2019 demonstrate that there were 8,305 natural disasters. More than 2700 people died and disappeared and more than 22,000 people were injured. and 14,690,228 people were suffering and evacuated. In 2018, there was an earthquake in Lombok. Based on data from the National Agency for Natural Disaster Management, 436 people died and disappeared, 2,036 injured, and 352,793 were suffering and evacuated.

The data were obtained only from a few samples of victims of natural disasters. It is believed that far more victims of natural disasters are not recorded or reported. Epidemiological studies worldwide have documented that natural disasters are very high events affecting Post-Traumatic Stress Disorder (PTSD) [2]. Study results [3] have even shown that emotional wounds that result from experiencing tragic and extraordinary events and that more women are at risk of experiencing Post-Traumatic Stress Disorder (PTSD).

PTSD is a psychiatric disorder that can occur following the experience or witnessing of life-threatening events such as military combats, natural disasters, terrorist incidents, serious accidents, or violent personal assaults [4]. Preadolescents who suffer from PTSD often relive the re-experienced events that are marked by the behavior of bringing up disturbing events (images, thoughts, or perceptions); recalling nightmares about an event (feelings reappear, illusions, hallucinations, and back to the dissociative past); symptoms of avoidance are marked by avoiding thoughts and feelings that can be reminiscent of traumatic events, reduced interest or real participation, feelings of alienation, inability to feel the tenderness of the heart, and symptoms of life disrupted that are marked distress in social functions or other important areas. These symptoms can be severe enough and last long to significantly impair a person’s daily life.

The importance of handling Post-Traumatic Stress Disorder (PTSD) was stated in a study [5-7], which revealed that “catastrophic stress” representing preadolescents who experienced an ordinary stressor or adjustment stressor and their potential ability to handle it because of differences in their capacity to confront the incident. The effects of PTSD on preadolescents are manifested in various disorders including physical, emotional, mental, behavioral, and spiritual fatigue [5, 8-11] (1) The mental fatigue symptoms include confusion, inability to concentrate and remember, and lack of decision-making ability; (2) the effects of PTSD emotional fatigue include irritation, moodiness, fear, exaggerated emotions, and loss of confidence; (3) fatigue behavior is manifested among others in sleeping difficulty, loss of appetite, overeating, excessive smoking, alcohol consumption, avoidance, irritability, self-confinement, excessive shame, fidgetting, agitation, and being suicidal; (4) symptoms of physical fatigue include tension, trembling, fatigue, tingling, nausea, digestive tract problems, rapid breathing, and even panic attacks; and (5) spiritual fatigue shows symptoms of discouragement, hopeless, blaming God, stopping worship, despair, doubting beliefs, and not being sincere.

The phenomenon of post-traumatic stress disorder is of serious concern as Indonesia has already had a set of the regulatory platform on disaster management. This is indicated by the issuance of Law on Republic of Indonesia Law Number 24 the Year 2007 concerning Disaster Management, including Disaster Management, Republic of Indonesia Government Regulation Number 21 concerning Disaster Management, Republic of Indonesia Government Regulation Number 23 the Year 2008 concerning Participation of International Institutions and Foreign Institutions Non-Government in Disaster Management, and Presidential Regulation Number 8 the Year 2008 concerning the National Disaster Management Agency.

Part Four of Government Regulation Number 22 of 2008 on Post-Disaster states that post-disaster management is focused on rehabilitation and reconstruction efforts, including environmental improvement of the disaster area, reconstruction of public facilities and infrastructure, providing assistance to rebuild community houses, psychological social recovery, health services, reconciliation and conflict resolution, socio-economic recovery, restoration of security and order, restoration of government functions, and restoration of public service functions. However, as with the existing legislation, more efforts seem to have been focused on managing disaster overall risks, which have not produced optimal results. Disaster management is a collective issue of the community in which education is expected to provide effective and reliable models and strategies and, at the same time, strengthen policy institutions and existing legislation.

This study is a follow-up research on traumatic counselling and various game applications to resolve the conflict in Ambon, Central Maluku, Buru Island, Ternate, Poso, Sampit, Madura, tsunami victims in Aceh, Nias, Ciamis, and Pangandaran, flood victims in Jember and Banjarnegara, and victims of Mount Merapi eruption in Yogyakarta. The findings show that traumatic counselling using game techniques can potentially be used effectively to handle post-traumatic stress disorder (PTSD) of victims of natural disasters. The games have psychologically encouraged the preadolescents to laugh, smile, cooperate, run, and embrace [12].

Guidance and counselling are an integral part of education. The handling of Post-Traumatic Stress Disorder (PTSD) representing individuals should be put in the perspective of facilitating the stages of physical, social, emotional, and spiritual development that can again develop in a constructive direction.

Based on the results of the latest literature studies and research, post-traumatic stress disorder (PTSD) can be reduced through cognitive-behavioral therapy that aims to change the emotions, thoughts, and behavior of individuals [13-15]; pharmacotherapy techniques that use drugs to reduce anxiety, depression, insomnia, distress and numbness; eye movement desensitization and reprocessing techniques that combine exposure and cognitive-behavioral therapies by putting parts of the body in motion [16-20]; group treatment techniques that give the individuals an opportunity to share empathy, cohesion, and security; and brief psychodynamic psychotherapy techniques that focus on emotional conflicts caused by trauma events, especially early in life.

The previous PTSD sub-study was more focused on the context of individual psychological dynamics that were very sustainable, but the existing approach tended to emphasize more on the task of adolescent and adult development, whereas the task of developing preadolescents deals more with spontaneous and natural emergent behavior. These considerations are the foundation for the follow-up.

Based on the phenomenon of Post-Traumatic Stress Disorder (PTSD) and findings as revealed in the previous sub, it is suspected that the failure of coping and adaptation to the traumatic experience that causes a wide, deep, and long-term snowball effect, may not be changeable (irreversible). In its extreme form, it will even result in social deprivation [11], [21].

Efforts to handle PTSD that are oriented towards long-term behavior; it requires ideas and innovations of a traumatic counselling approach that is packaged through responsive services with group play therapy. Play is considered as an educational medium that plays a role in increasing self-defence ability. The results of group play therapy studies have a connection to survival, provide a solid foundation for efforts to maintain the presence of games in human life, the ability to survive in their environment, and abilities, skills, and knowledge that are essential for survival. Play activities prevent boredom in the process of learning new skills and knowledge [21-24].

Empirical data were used to determine the effectiveness of group play therapy to resolve post-traumatic stress disorder.

T-test was used to test the effectiveness of group play therapy to resolve post-traumatic stress disorder on teachers and students of tsunami victims in Banten province. T-test was used with the aim of assisting the decision making in hypothesis testing. The following Table 2 describes data on empirical tests of group play therapy techniques to resolve post-traumatic stress disorder.

The following are the t-test data obtained from three provinces in Indonesia: In Lombok, West Nusa Tenggara province, the results of the calculation of the value μ₂ = 0.021. As the value of μ_1> 0.05, then Ho is not accepted. In Palu, Central Sulawesi Province, the results of the calculation of the value of μ₂ = 0.018. As the value of µ₁ > 0.05, then Ho is not accepted. In Anyer, Banten Province, the results of the calculation of the value of µ₂ = 0.011. As the value of µ₁ > 0.05, then Ho is not accepted. Therefore, traumatic counseling through the group play therapy technique gives the effect of reducing posttraumatic stress disorder in victims of the tsunami disasters in Lombok Province (West Nusa Tenggara Province), Palu (Central Sulawesi Province), and Anyer (Banten Province).

The empirical test results on the PTSD dimensions of IM1, IM2, IM4, IM5, and IM6 of the victims of natural disasters in Lombok showed that Ho was not accepted; however, the Ho of IM3 empirical dimension of PTSD was accepted.

Empirical test results on the PTSD dimension of group play therapy techniques to resolve posttraumatic stress disorder in victims of natural disasters in Palu (Central Sulawesi Province) showed that Ho was not accepted in the dimensions of IM2, IM4, IM5, and IM6, but was accepted in the IM1 and IM3 dimensions.

The results of the empirical test in Anyer (Banten Province) showed that Ho was not accepted in the dimensions of IM1, IM2, IM3, IM4, and IM6, but was accepted in IM5 dimension.

The study found that the highest average difference in Lombok (West Nusa Tenggara Province) was in the IM5 dimension with -2.15 and IM6 with -2.04, while the highest average difference in Palu (Central Sulawesi Province) was in the IM6 dimension with -4.57 and IM2 dimension with -4.32. The highest average difference in Anyer (Banten Province) was in the IM3 dimension with -2.70 and IM1 dimension with -2.33. In general, this means teaching and practising traumatic counselling techniques through group play therapy can help and make real changes to the victims of natural disasters suffering from PTSD.

The findings show that group play therapy has a significant overall effect on effective PTSD management. This is because playing is a natural expression of preadolescents where they can express their feelings and fantasies and channel the problems and conflicts they have. Accordingly, playing can be categorized as cathartic media [29, 30].

Preadolescents also use games as a language in communicating with the therapists. Games foster empathy on both sides and facilitate the process of more functional interpersonal relationships. Furthermore, preadolescents tend to be able to establish effective communication through play. In psychodynamic and client-centred therapy, effective communication is part of the therapeutic process [2, 31].

Play also acts as a vehicle that enhances understanding and facilitates the counselling process. The emotional resolution of conflict and trauma indicates the success of the therapy process. In the process of playing, preadolescents can experience and solve the traumatic problems faced in everyday life. This view is in line with [32, 33], Freud, and Klein, who agree that working through and mastery are important to change mechanisms as a result of the therapy process.

In practice, play involves various actions, namely pretence and the use of fantasy and symbolism. In line with this statement, [9, 34] it is explained that playing pretend is a symbolic behavior that considers “one thing to be treated pleasantly as if it were another.”

The following Table 3 presents a group play therapy model for the management of PTSD victims of natural disasters that are adjusted to the results of need assessment ranging from aspects and symptoms of PTSD, the goals of PTSD treatment and group play therapy.

The group play therapy technique is effective in reducing post-traumatic stress disorder of tsunami victims in Lombok (West Nusa Tenggara Province), Palu (Central Sulawesi Province) and Anyer (Banten Province). While empirical test results on the PTSD dimension show that Ho is not accepted in the dimensions of IM1, IM2, IM4, IM5, and IM6, the results of empirical tests on the PTSD dimension show that Ho is accepted in the IM3 dimension.

Group play therapy to resolve PTSD is an effort to express feelings and fantasies associated with problems and conflicts. In addition, preadolescents use play language as a tool to communicate with counsellors. Active labelling by therapists, empathy, and interpretation of games can help preadolescents to feel. Games provide opportunities for preadolescents to practice a variety of ideas, interpersonal behavior, and verbal expression.