Biofeedback-Assisted Relaxation Training to Decrease Test Anxiety in Nursing Students

By Prato, Catherine A.; Yucha, Carolyn B. | Nursing Education Perspectives, March/April 2013 | Go to article overview
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Biofeedback-Assisted Relaxation Training to Decrease Test Anxiety in Nursing Students


Prato, Catherine A., Yucha, Carolyn B., Nursing Education Perspectives


RESEARCH

ABSTRACT

Background. nursing students experiencing debilitating test anxiety may be unable to demonstrate their knowledge and have potential for poor academic performance.

Method. a biofeedback-assisted relaxation training program was created to reduce test anxiety. anxiety was measured using spielberger's test anxiety inventory and monitoring peripheral skin temperature, pulse, and respiration rates during the training. Participants were introduced to diaphragmatic breathing, progressive muscle relaxation, and autogenic training.

Results. statistically significant changes occurred in respiratory rates and skin temperatures during the diaphragmatic breathing session; respiratory rates and peripheral skin temperatures during progressive muscle relaxation session; respiratory and pulse rates, and peripheral skin temperatures during the autogenic sessions. no statistically significant difference was noted between the first and second tai. subjective test anxiety scores of the students did not decrease by the end of training.

Conclusion. autogenic training session was most effective in showing a statistically significant change in decreased respiratory and pulse rates and increased peripheral skin temperature.

Key Words test anxiety - Biofeedback - Diaphragmatic Breathing - Progressive Muscle relaxation - autogenics - nursing students

NURSING IS ONE OF THE MOST DEMANDING AND STRESSFUL MAJORS WITHIN A UNIVERSITY SETTING (DEARY, WATSON, & HOSTON, 2003; GIBBONS, DEMPSTER, & MOUTRAY, 2008; WATSON ET AL., 2008 ). It requires the integration of large amounts of knowledge and technical skills, coupled with the development of appropriate attitudes and responses to highly emotional settings. Thus, nurse faculty demand high performance on examinations, with students subjected to the stress of testing and high threshold standards. Many programs require that students achieve certain percentages on every examination in order to progress. As testing has high consequences, nursing students who experience debilitating test anxiety may be unable to demonstrate their knowledge and have the potential for poor academic performance.

Schools of nursing sh ould no t decrease the requirements for pr ogression within the ir programs and graduation. However, it is important to iden tify students who are struggli ng wit h te stanxiety and implement in terven tions aimed at decreasing anxiety a nd alleviating the negative conseq uences. A biofeedback-assisted responding to the world, which becomes stable over time (Zeidner, 2007). State anxiety is a transitory emotional condition that is characterized by subjective, consciously perceived feelings of tension, apprehension, nervousness, and worry (Spielberger). Spielberger defined test anxiety as an emotional state at a given moment in time and at a particular level of intensity that is characterized by "tension, apprehension, nervousness, and worry, and an activation of the autonomic nervous system" (p. 4).

Anxiety reactions are characterized by physical and autonomic changes with autonomic function a reflection of psychological state (Shinba et al., 2008). A relationship exists between respiration patterns and emotions (Homma & Masaoka, 2008); when a stressor is introduced, respiratory and pulse rates increase while peripheral skin temperatures decrease. Mental stress elicits the release of hormones such as epinephrine and norepinephrine, and the hormone release prepares the body for "fight or flight" (Webb et al., 2008). When an individual is anxious, there is an increased sensitivity to elevations in partial pressure of carbon dioxide (pCO2) levels that trigger the medullary suffocation alarm that stimulates breathing (Conrad et al., 2007). At the first response to anxiety, breathing is rapid and shallow; once the medulla is stimulated, the breathing rate and depth increase to expel the excess pCO2. Overactivity of the respiratory muscles contributes to feelings of dyspnea in anxious individuals because the shortening of the inspiratory muscles reduces efficiency of the lungs, thereby increasing the work of breathing (Ritz, Leupoldt, & Dahme, 2006).

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