Integrative Medicine on Exam Anxiety
Study Details
Study Description
Brief Summary
Introduction: Test anxiety, one of the forms of situational anxiety, is a crucial biopsychological factor negatively affecting the wellbeing and academic performance of students throughout their education. The study aims to determine the effects of music therapy and EFT (Emotional Freedom Technique) on situational anxiety and vital signs in nursing students before they take the OSCE (Objective Structured Clinical Exam).
The study was a randomized controlled experimental study and conducted with 90 volunteering students studying at the Faculty of Health Sciences, Department of Nursing at a university in Istanbul. A computer-based random number generator was used to randomly assign the students into three groups (Music, EFT, and control), each of which consisted of 30 students. Data collection was carried out using a Student Identification Form, the Situational Anxiety Scale, and the Vital Signs Form.
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
|
N/A |
Detailed Description
Anxiety - an important concept for describing human behaviors - is a condition in which a number of physiological responses are generated, accompanied by feelings of distress, anxiety, and depression in various scenarios where one feels threatened. Test anxiety experienced by nursing students around the world during their training is one of the most significant problems that hinder the acquisition of professional skills. Students in most nursing programs show poor exam performance due to anxiety caused by the OSCE exam. Studies on test anxiety also show a negative relationship between test anxiety and academic performance. When the literature is examined, it can be seen that stress reduction is very important in allowing students to maximize their learning of practical skills in the vocational education process. Techniques such as music therapy, cognitive therapy, emotional freedom technique (EFT), breathing techniques, mind cleansing, aromatherapy, and relaxation of muscles have been used to reduce the anxiety levels of nursing students . Based on prior research, the aim of the study to determine the effects of the music therapy and EFT (Emotional Freedom Technique), on situational anxiety and vital signs, before the OSCE (Objective Structured Clinical Exam) in nursing students.
This study was conducted with 90 volunteer students studying at the Nursing Department of the Health Sciences Faculty at a foundation university in Medipol University. The data was collected prior to the OSCE on May 31, 2017. Students included in the study were required to meet the eligibility criteria of (a) being 18 years old or above, (b) taking the theoretical course of Nursing Principles I and II, and (c) entering the OSCE on May 31 as part of the Nursing Principles course. All students taking the exam were included in the study without reverting to the method of sample size selection (n = 90). A randomly ordered class list was prepared with the student numbers in the classroom list using the random.org program. According to the newly created list, students were notified in writing one day before about what time to arrive before the exam. Students who arrived on the day of the exam were assigned to the music therapy and EFT groups, and the control group. Each group consisted of 30 students. The students were taken to a 90 m2 practice room. Each group was briefed for five minutes before obtaining their consent. The students had their vital signs measured by the investigators. They were asked to fill out the Student Identification Form and the Situational Anxiety Scale. Afterward, the methods (music and EFT) were applied for 15 minutes. The methods were applied by the investigators who are experts in their fields. After the methods were applied, the students had their vital signs remeasured by the investigators and were asked to fill out the Situational Anxiety Scale. For the control group, pre-measurements were taken, 15 minutes of free time was given, and then post-measurements were taken.
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| Experimental: Implementation of music therapy For the music therapy, lecturers specializing in music therapy were consulted and accordingly a "mahur maqam," an instrumental piece of traditional Turkish music played on the saz, was chosen. The mahur maqam has a descending scale, which has a relaxing impact as it moves along a 1-2 octave sound spectrum. It elicits feelings of joy and positivity, and immediately draws the attention of the listener, helping keep the mind clear. The mahur maqam belongs to the rast maqam family. Rast maqams are usually evocative of feelings of peacefulness, surrender, tranquility, trust, and mystical sentiments. |
Behavioral: Music Therapy
Music therapy was applied in the application room. Via a portable computer, students listened to the mahur maqam for 20 minutes under the supervision of the investigators using an MP3 player.
|
| Experimental: Implementation of EFT The EFT application protocol was explained to the students with the help of the image in the picture for 5 minutes. The method was applied through the investigator tapping on their bodies and the students repeating the steps for three sessions. Each of the treatment sessions was approximately three minutes, resulting in a nine-minute treatment for intervention. Each EFT session was performed by following the steps below. The content of each EFT session was as follows: Preparation Tapping Series The Nine Gamut Sequence and Eye Movements |
Behavioral: EFT
EFT includes taps, nine gamut sequences, and eye movements on the meridian system, focusing on the individual's inhibiting thoughts, disturbing emotions, or memories. EFT regulates the flow of energy in the meridian system of the individual, causing relaxation in the mind, body, and emotions.
|
| No Intervention: Control For the control group, 15 minutes of free time was given. |
Outcome Measures
Primary Outcome Measures
- The Situational-Continuous Anxiety Inventory [Immediately after intervention completion, an average of 1 hours]
The Situational Anxiety Scale was used for scoring anxiety. The Situational-Continuous Anxiety Inventory includes two separate scales with a total of 40 items. This study employed the Situational Anxiety Scale. The Situational Anxiety Scale consists of a total of 20 items. Its reliability coefficient varies between 0.83-0.96. The participants were expected to respond to the items according to their feelings and thoughts at that moment. In this study, the Cronbach's alpha value of the Situational Anxiety Scale was 0.92. The items of the Situational Anxiety Scale are scored on a scale of 1-4 depending on the level at which the mentioned emotions or behaviors were experienced. The total score obtained from the scale can vary between 20 and 80. Higher scores indicate higher levels of anxiety.
Eligibility Criteria
Criteria
Inclusion Criteria:
-
being 18 years old or above,
-
taking the theoretical course of Nursing Principles I and II,
-
entering the OSCE on May 31 as part of the Nursing Principles course.
Exclusion Criteria:
-
did not volunteer to participate in the study
-
arrived late or did not turn up
Contacts and Locations
Locations
| Site | City | State | Country | Postal Code | |
|---|---|---|---|---|---|
| 1 | Medipol Universtiy | Istanbul | Turkey | 34668 |
Sponsors and Collaborators
- Istanbul Saglik Bilimleri University
Investigators
- Principal Investigator: Demet İnangil, PhD, Sağlık Bilimleri University
Study Documents (Full-Text)
More Information
Publications
- Ince S, Çevik K. The effect of music listening on the anxiety of nursing students during their first blood draw experience. Nurse Educ Today. 2017 May;52:10-14. doi: 10.1016/j.nedt.2017.02.009. Epub 2017 Feb 14.
- Patterson SL. The effect of emotional freedom technique on stress and anxiety in nursing students: A pilot study. Nurse Educ Today. 2016 May;40:104-10. doi: 10.1016/j.nedt.2016.02.003. Epub 2016 Feb 7.
- Torabizadeh C, Bostani S, Yektatalab S. Comparison between the effects of muscle relaxation and support groups on the anxiety of nursing students: A randomized controlled trial. Complement Ther Clin Pract. 2016 Nov;25:106-113. doi: 10.1016/j.ctcp.2016.09.001. Epub 2016 Sep 7.
- 10840098-604.01.01-E.11892
Study Results
Participant Flow
| Recruitment Details | |
|---|---|
| Pre-assignment Detail |
| Arm/Group Title | Music Therapy | Emotional Freedom Technique | Control |
|---|---|---|---|
| Arm/Group Description | In the study, music therapy was applied in the application room. Via a portable computer, students listened to the mahur maqam for 15 minutes under the supervision of the investigators using an MP3 player. Music Therapy: Music therapy was applied in the application room. Via a portable computer, students listened to the mahur maqam for 20 minutes under the supervision of the investigators using an MP3 player. | The EFT application protocol was explained to the students with the help of the image in the picture. The method was applied through the investigators tapping on their bodies and the students repeating the steps. EFT: EFT includes taps, nine gamut sequences, and eye movements on the meridian system, focusing on the individual's inhibiting thoughts, disturbing emotions, or memories. EFT regulates the flow of energy in the meridian system of the individual, causing relaxation in the mind, body, and emotions. | For the control group, 15 minutes of free time was given. |
| Period Title: Overall Study | |||
| STARTED | 32 | 32 | 32 |
| COMPLETED | 30 | 30 | 30 |
| NOT COMPLETED | 2 | 2 | 2 |
Baseline Characteristics
| Arm/Group Title | Implementation of Music Therapy | Implementation of EFT | Control | Total |
|---|---|---|---|---|
| Arm/Group Description | For the music therapy, lecturers specializing in music therapy were consulted and accordingly a "mahur maqam," an instrumental piece of traditional Turkish music played on the saz, was chosen. The mahur maqam has a descending scale, which has a relaxing impact as it moves along a 1-2 octave sound spectrum. It elicits feelings of joy and positivity, and immediately draws the attention of the listener, helping keep the mind clear. The mahur maqam belongs to the rast maqam family. Rast maqams are usually evocative of feelings of peacefulness, surrender, tranquility, trust, and mystical sentiments. Music Therapy: Music therapy was applied in the application room. Via a portable computer, students listened to the mahur maqam for 20 minutes under the supervision of the investigators using an MP3 player. | The EFT application protocol was explained to the students with the help of the image in the picture for 5 minutes. The method was applied through the investigator tapping on their bodies and the students repeating the steps for three sessions. Each of the treatment sessions was approximately three minutes, resulting in a nine-minute treatment for intervention. Each EFT session was performed by following the steps below. The content of each EFT session was as follows: Preparation Tapping Series The Nine Gamut Sequence and Eye Movements EFT: EFT includes taps, nine gamut sequences, and eye movements on the meridian system, focusing on the individual's inhibiting thoughts, disturbing emotions, or memories. EFT regulates the flow of energy in the meridian system of the individual, causing relaxation in the mind, body, and emotions. | For the control group, 15 minutes of free time was given. | Total of all reporting groups |
| Overall Participants | 30 | 30 | 30 | 90 |
| Age (Count of Participants) | ||||
| <=18 years |
0
0%
|
0
0%
|
0
0%
|
0
0%
|
| Between 18 and 65 years |
30
100%
|
30
100%
|
30
100%
|
90
100%
|
| >=65 years |
0
0%
|
0
0%
|
0
0%
|
0
0%
|
| Age (years) [Mean (Standard Deviation) ] | ||||
| Mean (Standard Deviation) [years] |
18.96
(0.88)
|
19.1
(0.88)
|
19.53
(1.07)
|
19.27
(1.06)
|
| Sex: Female, Male (Count of Participants) | ||||
| Female |
27
90%
|
23
76.7%
|
24
80%
|
74
82.2%
|
| Male |
3
10%
|
7
23.3%
|
6
20%
|
16
17.8%
|
| Ethnicity (NIH/OMB) (Count of Participants) | ||||
| Hispanic or Latino |
0
0%
|
0
0%
|
0
0%
|
0
0%
|
| Not Hispanic or Latino |
30
100%
|
30
100%
|
30
100%
|
90
100%
|
| Unknown or Not Reported |
0
0%
|
0
0%
|
0
0%
|
0
0%
|
Outcome Measures
| Title | The Situational-Continuous Anxiety Inventory |
|---|---|
| Description | The Situational Anxiety Scale was used for scoring anxiety. The Situational-Continuous Anxiety Inventory includes two separate scales with a total of 40 items. This study employed the Situational Anxiety Scale. The Situational Anxiety Scale consists of a total of 20 items. Its reliability coefficient varies between 0.83-0.96. The participants were expected to respond to the items according to their feelings and thoughts at that moment. In this study, the Cronbach's alpha value of the Situational Anxiety Scale was 0.92. The items of the Situational Anxiety Scale are scored on a scale of 1-4 depending on the level at which the mentioned emotions or behaviors were experienced. The total score obtained from the scale can vary between 20 and 80. Higher scores indicate higher levels of anxiety. |
| Time Frame | Immediately after intervention completion, an average of 1 hours |
Outcome Measure Data
| Analysis Population Description |
|---|
| This study was conducted with 90 volunteering students studying at the Faculty of Health Sciences, Department of Nursing, at a foundation university in Medipol University. |
| Arm/Group Title | Music Therapy | Emotional Freedom Technique | Control |
|---|---|---|---|
| Arm/Group Description | In the study, music therapy was applied in the application room. Via a portable computer, students listened to the mahur maqam for 15 minutes under the supervision of the investigators using an MP3 player. Music Therapy: Music therapy was applied in the application room. Via a portable computer, students listened to the mahur maqam for 20 minutes under the supervision of the investigators using an MP3 player. | The EFT application protocol was explained to the students with the help of the image in the picture. The method was applied through the investigators tapping on their bodies and the students repeating the steps. EFT: EFT includes taps, nine gamut sequences, and eye movements on the meridian system, focusing on the individual's inhibiting thoughts, disturbing emotions, or memories. EFT regulates the flow of energy in the meridian system of the individual, causing relaxation in the mind, body, and emotions. | For the control group, 15 minutes of free time was given. |
| Measure Participants | 30 | 30 | 30 |
| Median (Inter-Quartile Range) [score on a scale] |
44
|
43
|
56
|
Adverse Events
| Time Frame | 1 day | |||||
|---|---|---|---|---|---|---|
| Adverse Event Reporting Description | There was no adverse event during and after interventions. | |||||
| Arm/Group Title | Music Therapy | Emotional Freedom Technique (EFT) | Control | |||
| Arm/Group Description | For the music therapy, lecturers specializing in music therapy were consulted and accordingly a "mahur maqam," an instrumental piece of traditional Turkish music played on the saz, was chosen. The students listened to this music for about 15 minutes. There was no adverse event during and after the intervention. | EFT was applied as follows: first, the researcher tapped on different parts of students' bodies and the students repeated the steps for three sessions. Each of the treatment sessions took approximately three minutes, nine minutes in total. There was no adverse event during and after the intervention. | For the control group, 15 minutes of free time was given. There was no adverse event during and after the intervention. | |||
All Cause Mortality |
||||||
| Music Therapy | Emotional Freedom Technique (EFT) | Control | ||||
| Affected / at Risk (%) | # Events | Affected / at Risk (%) | # Events | Affected / at Risk (%) | # Events | |
| Total | 0/30 (0%) | 0/30 (0%) | 0/30 (0%) | |||
Serious Adverse Events |
||||||
| Music Therapy | Emotional Freedom Technique (EFT) | Control | ||||
| Affected / at Risk (%) | # Events | Affected / at Risk (%) | # Events | Affected / at Risk (%) | # Events | |
| Total | 0/30 (0%) | 0/30 (0%) | 0/30 (0%) | |||
Other (Not Including Serious) Adverse Events |
||||||
| Music Therapy | Emotional Freedom Technique (EFT) | Control | ||||
| Affected / at Risk (%) | # Events | Affected / at Risk (%) | # Events | Affected / at Risk (%) | # Events | |
| Total | 0/30 (0%) | 0/30 (0%) | 0/30 (0%) | |||
Limitations/Caveats
More Information
Certain Agreements
Principal Investigators are NOT employed by the organization sponsoring the study.
There is NOT an agreement between Principal Investigators and the Sponsor (or its agents) that restricts the PI's rights to discuss or publish trial results after the trial is completed.
Results Point of Contact
| Name/Title | Dr. Demet İnangil |
|---|---|
| Organization | University of Health Science |
| Phone | +905303021160 |
| demet.inangil@sbu.edu.tr |
- 10840098-604.01.01-E.11892