Coping with test anxiety using imagery rescripting: A two-session randomized controlled trial.

BACKGROUND: Up to 55 % of students experience test anxiety (TA), which is characterized by intense physiological and psychological symptoms before or during exams, such as anxiety, fear of failure, sweating, or increased heart rate. Furthermore, TA increases graduation times and can result in discontinuance of the graduate program all together. Previous research demonstrated the beneficial effects of combining cognitive behavioral therapy with imagery rescripting, however, treatment programs are comparably long. Hence, they do not account for the students´ time-sensitive schedules. Therefore, the present study investigates a two-session short-intervention using imagery rescripting to treat TA. METHODS: 44 students and pupils were randomly assigned to either the two-session imagery rescripting intervention (22 participants) or the waitlist-control condition (22 participants). One week before the intervention clinical interviews were conducted and self-report questionnaires on TA, self-efficacy, symptoms of depression, and intrusive prospective images were completed (T1). The same questionnaires were completed one week (T2) and six months after the intervention (T3). RESULTS: Test anxiety significantly decreased from T1 to T2, as well as from T1 to T3 within the intervention group. Furthermore, there were medium to large within and between group effects for situational test anxiety, self-efficacy, symptoms of depression, as well as prospective intrusive images, showing significant improvements for the intervention group at six months follow-up. LIMITATIONS: The study is limited to the comparably small sample size, as well as the sole usage of self-report measurements. CONCLUSIONS: The presented short-intervention provides a feasible treatment technique, which can be easily applied within school and university counseling centers.

Psychobiotic Lactobacillus plantarum JYLP-326 relieves anxiety, depression, and insomnia symptoms in test anxious college via modulating the gut microbiota and its metabolism.

Introduction: Test anxiety is a common issue among college students, which can affect their physical and psychological health. However, effective interventions or therapeutic strategies are still lacking. This study aims to evaluate the potential effects of Lactobacillus plantarum JYLP-326 on test anxious college students. Methods: Sixty anxious students were enrolled and randomly allocated to the placebo group and the probiotic group. Both groups were instructed to take placebo and JYLP-326 products twice per day for three weeks, respectively. Thirty unanxious students with no treatments were assigned to a regular control group. The anxiety, depression, and insomnia questionnaires were used to measure students' mental states at the baseline and the end of this study. 16S rRNA sequencing and untargeted metabolomics were performed to analyze the changes in the gut microbiota and fecal metabolism. Results: The questionnaire results suggested that JYLP-326 administration could relieve the symptoms of anxiety, depression, and insomnia in test anxious students. The gut microbiomes of the placebo group showed a significantly greater diversity index than the control group (p < 0.05). An increased abundance of Bacteroides and Roseburia at the genus level was observed in the placebo group, and the relative abundance of Prevotella and Bifidobacterium decreased. Whereas, JYLP-326 administration could partly restore the disturbed gut microbiota. Additionally, test anxiety was correlated with disordered fecal metabolomics such as a higher Ethyl sulfate and a lower Cyclohexylamine, which could be reversed after taking JYLP-326. Furthermore, the changed microbiota and fecal metabolites were significantly associated with anxiety-related symptoms. Conclusion: The results indicate that the intervention of L. plantarum JYLP-326 could be an effective strategy to alleviate anxiety, depression, and insomnia in test anxious college students. The potential mechanism underlying this effect could be related to the regulation of gut microbiota and fecal metabolites.

Probiotic Supplement Preparation Relieves Test Anxiety by Regulating Intestinal Microbiota in College Students.

Test anxiety creates barriers to learning and performance, which further affects students' social, behavioural, and emotional development. Currently, the medication to treat test anxiety has not been reported yet. Here, we enrolled 120 students to evaluate the effect of probiotic supplement preparation (PSP) on test anxiety from the aspect of the intestinal microbiota. We found that the intake of PSP alleviated the symptoms of depression and anxiety in students with test anxiety by evaluating their mental state using the Hamilton Depression Rating Scale and Hamilton Anxiety Scale. High-throughput sequencing results indicated that the consumption of PSP increased the abundance of Streptococcus and Akkermansia that was lowered by the anxiety state in the intestinal microbiota of students. Meanwhile, taking PSP reduced the level of intestinal pathogens of Fusobacterium and Clostridium as well. In conclusion, our work shows that PSP can reduce test anxiety and restore the disturbed microbiota to the standard level in Chinese college students, rendering the use of PSP a promising strategy for test anxiety.

Reducing Test Anxiety and Related Symptoms Using a Biofeedback Respiratory Practice Device: A Randomized Control Trial.

Test Anxiety is a widespread psychological phenomenon. With prevalence rates of 20-40 percent of university students, it impedes adaptive functioning and life quality. Many available treatments for Test Anxiety involve the intervention of clinicians and usually a few months are required before symptom reduction is reported. The present randomized controlled trial examined a simple behavioral intervention-the use of breathing tools-as an exclusive therapy for Test Anxiety. Specifically, the efficacy of a biofeedback respiratory practice device was examined. 34 students were assigned to 3 treatment groups during their exam period: Biofeedback device group, self-directed breathing exercise group, and psychoeducation group. Self-report measures of Test Anxiety were collected pre- and post-intervention. Participants also reported additional exploratory measures such as depression and anxiety, quality of life, and their perceived adaptive functioning post-intervention. The results reveal that only participants from the biofeedback device group reported a significant reduction in Test Anxiety symptoms (p's < 0.05). Participants from the biofeedback device group also reported a decrease in depression and anxiety symptoms and an increase in psychological wellbeing (p's < 0.05), a subscale of the quality of life questionnaire. Findings support the notion that using biofeedback respiratory devices may reduce students' Test Anxiety symptoms. Indications for further research are discussed.

Cognitive-behavioral intervention for test anxiety in adolescent students: do benefits extend to school-related wellbeing and clinical anxiety.

Background and objectives: Cognitive-behavioral interventions have been shown to be effective treatments for test anxiety. Studies on school-aged populations, however, are lacking. Design and methods: In the present study we evaluated a six-session cognitive-behavioral intervention for test anxiety in a sample of secondary school students aged 14-16 years preparing for high-stakes examinations. Furthermore, we extended outcomes to include school-related wellbeing and clinical anxiety. A screening procedure was used to identify highly test anxious persons who were randomly allocated to intervention or wait-list control groups. Results: Test anxiety showed a large reduction following intervention compared to control group participants who showed a moderate reduction. Clinical anxiety showed a small to moderate reduction following intervention compared to control group participants who showed a negligible reduction. The reduction in clinical anxiety was mediated by concurrent reductions in test anxiety. Conclusion: This supports an integrative network approach that deactivating core aspects of anxiety can deactivate associated networks of anxiety symptoms. The intervention showed no impact on school-related wellbeing which increased at a similar rate for both intervention and control group participants. This is likely because test anxiety is just one contributor of many to school-related wellbeing. Implications for school-based treatments are discussed.

Feasibility of Clinical Hypnosis for Test Anxiety in First-Year Medical Students.

The purpose of this pilot study was to characterize test anxiety among first-year medical students at the University of Erlangen-Nürnberg and to test clinical hypnosis as a possible intervention. The "Prüfungsangstfragebogen," a shortened and revised German version of the Test Anxiety Inventory, was used to estimate test anxiety. It was administered 3 times: at the commencement of winter term 2017/18 and 2 days prior to each of 2 mandatory oral anatomy exams. The test-anxiety categories emotionality, worry, interference, and lack of confidence were evaluated. The effect of clinical hypnosis on test anxiety was estimated. The global test anxiety and lack of confidence scores were reduced significantly over time in the group that underwent clinical hypnosis but not in the control group. Direct comparisons of hypnosis vs. control group yielded no statistically significant differences in the test anxiety scores.

Feasibility of a Virtual Reality Program in Managing Test Anxiety: A Pilot Study.

Test anxiety has been a growing problem in school-aged children, especially for students in East-Asian countries where the pressure for academic achievement is high. These students are more vulnerable to academic stress, which could further lead to anxiety disorders. For this reason, this study examined the feasibility of virtual reality (VR) test anxiety program in managing anxiety in students. A total of 22 typically developing children with varying levels of test anxiety and no history of psychiatric illnesses participated in the study (mean age = 11.6 and standard deviation [SD] = 1.84). A self-reported questionnaire measuring test anxiety, state-trait anxiety, and depression was administered. Heart rate (HR) variability and subjective anxiety were also measured to examine the changes during each of the anxiety-inducing (Exam 1 and Exam 2) and meditation (Med 1 and Med 2) sessions in the program. There was a significant difference in self-perceived anxiety during the program (p < 0.001), as well as a significant main effect of time on the standard deviation of R-R interval (p = 0.002). In addition, a significant relationship between changes in HR and perceived anxiety during Exam 1 (p = 0.003), Med 1 (p < 0.001), and Med 2 (p = 0.011) was found. In conclusion, this work demonstrates the feasibility of the virtual environment to induce different levels of anxiety and explores the potential use of VR program as a viable method to manage the negative emotion in students. This work shows the potential of technology-enhanced tools in addressing psychological problems in school-aged children. Further study is needed to validate the use of the program in clinical practice.

Evaluation of a brief cognitive behavioral group intervention to reduce depersonalization in students with high levels of trait test anxiety: a randomized controlled trial.

Background and objectives: Students with high levels of test anxiety frequently experience depersonalization during examinations. We investigated whether a brief cognitive behavioral group intervention reduces these symptoms.Design: Randomized controlled trial.Methods: Students with high levels of trait test anxiety and impairing depersonalization symptoms during their last oral examination were randomized. While the intervention group (n = 22) received a group training, a control group (n = 16) underwent an active waiting time protocol. Effects of the intervention on depersonalization severity and its appraisal, attention focus, emotion regulation, anxiety, heart rate, and heart rate variability within the Trier Social Stress Test for groups were examined. A follow-up assessment was conducted after a university oral examination. Registration number: DRKS00010190.Results: Depersonalization and its appraisal significantly changed within the intervention group, but not within the control group. The intervention group reported significantly less self-focused attention and fear and used the coping strategy reappraisal significantly more often. No significant Group × Time interaction was detected regarding heart rate and heart rate variability. Follow-up results give a first indication of the reduction of depersonalization through the intervention in a naturalistic setting.Conclusion: The intervention seems promising for treating depersonalization in students with high levels of trait test anxiety.

Effectiveness of mindfulness-based coloring for university students' test anxiety.

Objective: This study compared the effectiveness of mindfulness coloring (mandala), free drawing/coloring, and a noncoloring control activity for university students' test anxiety, and assessed the relationship of dispositional mindfulness and response to intervention on mindfulness and test anxiety states. Participants: University students (n = 167; 81.4% female; Mage = 21.29 years, SD = 4.46) were randomly assigned to a mandala (n = 57), free draw/coloring (n = 58), or noncoloring condition (n = 52). Methods: Participants completed standardized measures assessing test anxiety and state mindfulness pre-postactivity before completing a test, and two dispositional mindfulness measures. Results: Participants in both coloring conditions reported significant decreases in test anxiety and significant increases in state mindfulness pre-postintervention, and participants in the control condition reported significant increases in test anxiety. Reports of preintervention state mindfulness and test anxiety fully mediated relations between dispositional mindfulness and postintervention state mindfulness and test anxiety. Conclusions: Implications for research and practice on mindfulness coloring and test anxiety are discussed.